Interview by Katya Cengel, World Ark contributor
Goal No. 1 of the United Nations’ eight Millennium Development Goals (MDGs) is to eradicate extreme poverty and hunger. One of its targets is halving the 1990 proportion of people who suffer from hunger by 2015. A 2013 MDG report showed that the proportion of undernourished people in developing regions decreased from 23.2 percent in 1990-1992 to 14.9 percent in 2010-2012. But there’s still a good ways to go. Globally, nearly one in six children under age 5 are underweight and one in four are stunted, according to the 2013 report.
While progress has been made, its unevenness — China is doing well in regards to children under age 5, but most Southeast Asian countries will not reach the goal in the same age group — has caused concern. Because hunger and nutrition play a pivotal role in Goal Four — reducing child mortality — and Goal Five — improving maternal health — nutrition was a core issue at the 2014 Partnership for Maternal, Newborn & Child Health Partners’ Forum this summer in Johannesburg, South Africa.
UNICEF’s Chief of Health, Mickey Chopra, was there to talk about international child health and nutrition. A physician with a Masters in Public Health and a Ph.D. from the Faculty of Medicine, Uppsala University in Sweden, Chopra says one reason we are falling behind in eradicating hunger is because we have not paid enough attention to the little things.
WORLD ARK: Eradicating hunger is Goal One, what makes it so important in regards to achieving the other millennial goals? And what are the simple things we can do to continue to see progress?
MICKEY CHOPRA: Undernutrition underlies about 45 percent of deaths (among children). So even if they have pneumonia, if they’re undernourished, they are more likely to die than if they are well nourished. So it’s a really important part of the way forward.
It’s a tough one, because we have not made as much progress as we’ve made in child survival (Goal Four) in reducing say stunting, which is chronic malnutrition. Part of that is because we’ve not paid enough attention to the simple things that work, which are not very profitable or glamorous, such as emphasizing six months of exclusive breast-feeding for infants.
The other piece of this is getting better quality food, which means working with other sectors. But we also sometimes forget that infections and diarrhea are also a big cause of malnutrition in many countries, so working with water, sanitation, hygiene and vaccinations are also important interventions.
Another simple thing to remember is that the way in which we deliver services is connected. When you bring children in for vaccination, then we can also do the growth monitoring and nutrition education. And remind the mother about exclusive breast-feeding. Integration is a really important piece of the puzzle in terms of being more efficient at reducing malnutrition.
The challenge with nutrition is there is no one medicine, or no one bullet. It’s working across sectors, and that’s why it’s been challenging to get the impact we wanted.
Undernutrition affects so many of the goals, especially when it comes to children. Why has progress toward achieving this most basic goal been so irregular?
There are a number of challenges. One of them is how do we measure malnutrition? Traditionally we’ve measured it through severity — underweight — because that’s easy to measure. But what we’re recognizing is a child could be of normal weight, but still be malnourished because he or she is short in height, and they are short in height maybe because key nutrients are missing. So just weighing a child is not enough to tell you whether a child is malnourished or not. There are still huge numbers of children born around the world and growing up stunted, or short height for their age. And this is why we call it hidden hunger. The quality of their nutrition is not optimal.
What role can animal-source foods like meat, eggs, milk and cheese play in helping reach this goal?
We still have knowledge gaps, but we know pretty well the range of what we call macro- and micronutrients that are required for optimal growth. And many of those are found in animal products in quite concentrated form. But they’re also found in non-animal products, and we can also now, with fortification, make them more concentrated in non-animal foods as well. But the big advantage of animal-based foods is micronutrients are much denser or much more readily available for the body than they are in non-animal foods. In vegetables, it’s quite often locked up in the fibers of the vegetables and the fruit. But we are finding new ways of getting over that. So even those people who don’t eat meat, or meat products, there are alternative ways of making up for the lack of availability, or poor availability, of those essential nutrients.
Are you aware of any programs for farmers or animal holders that have achieved notable results toward Goal One?
We’ve had more success from a demand side. In other words, when you empower women with resources or knowledge, then they can go out and demand those kinds of foods, and the agriculture sector responds to that.
There have been successes, particularly from my experience in Europe and America, with the promotion of milk. Or the promotion of school feeding programs, for example, having nutritious foods in them, which can be a push mechanism to get better foods to kids as well.
What are the larger benefits and implications of a better fed population?
Evidence for return on investment from improving nutrition at a young age, in terms of better grade completion and educational performance, and then better economic returns, are well established. Nobel Prize-winning economists have agreed it’s a very sound investment. So those are pretty well established, but what we’re also finding now is the early programming of the body and that primes the body for later diseases as well.
So there’s growing evidence if you have a poor diet, even in the womb, and even before conception (in the mother’s diet), particularly if the baby is undernourished in the womb during pregnancy, that has implications for increasing risk that the child in adulthood will have some of the chronic diseases such as diabetes and non-communicable diseases.
Other experts at the forum weigh in on nutrition
Chris Elias, President, Global Development Program, Bill & Melinda Gates Foundation
If you look at stunting, it’s one of these stubborn things. It’s getting a bit better, but really not fast. In India, it’s over 40 percent of children are stunted to some degree, and it’s not moving that much. How do you understand that? We know that maternal nutrition is critical, but there’s also data now that suggests that many women go into pregnancy already behind the curve in iron, other micronutrients, folic acid etc. … So if you really want to optimize nutrition and address stunting, you really have to begin with the nutritional status of adolescent girls and young women, before they get pregnant.
Jay Naidoo, Chair, Global Alliance for Improved Nutrition (GAIN)
What we’ve got to say is why it’s important to link food and nutrition security. That you cannot talk about improving agricultural yields without improving human productivity. Therefore, we should measure the success of agriculture by using indicators like stunting. Because you’re producing food, it should be for health, it should produce healthy adults.
Katja Iversen, Chief Executive Officer, Women Deliver
Maternal nutrition is under reported, as if there is no tomorrow. It’s been very focused on the child, but evidence also shows that nutrition for pregnant women is absolutely key. … Bad nutrition is intergenerational.
Katya Cengel reported from South Africa and Mozambique as a press fellow with the International Center for Journalists and the UN Foundation.