As the COVID-19 pandemic continues to threaten health and food systems in Africa and around the world, the 2020 Global Nutrition Report urges governments, businesses and civil society to step up efforts to address malnutrition in all its forms. Excerpts from the report:
Today, one in every nine people in the world is hungry, and one in every three is overweight or obese. More and more countries experience the double burden of malnutrition, where undernutrition coexists with overweight, obesity and other diet-related non-communicable diseases (NCDs).
The trend is clear: progress is too slow to meet the global targets. Not one country is on course to meet all ten of the 2025 global nutrition targets and just 8 of 194 countries are on track to meet four targets.
Almost a quarter of all children under 5 years of age are stunted. At the same time, overweight and obesity are increasing rapidly in nearly every country in the world, with no signs of slowing.
Progress on malnutrition is not just too slow, it is also deeply unfair. New analysis shows that global and national patterns mask significant inequalities within countries and populations, with the most vulnerable groups being most affected. Nutrition outcomes also vary substantially across countries.
Underweight is a persisting issue for the poorest countries and can be ten times higher than in wealthier countries. Overweight and obesity prevail in wealthier countries at rates of up to five times higher than in poorer countries.
Within every country in the world, we see striking inequalities according to location, age, sex, education and wealth – while conflict and other forms of fragility compound the problem. This report finds a strong urban–rural divide, and even larger differences across communities. In children under 5 years of age, wasting can be up to nine times higher in certain communities within countries, four times higher for stunting and three times higher for overweight and obesity.
There is a clear link between infant and young child feeding practices and household characteristics. Continued breastfeeding up to 1 or 2 years of age is less common for children in wealthier households, urban areas or with a more educated mother. In contrast, rates of solid food introduction and minimum diet diversity are substantially lower for children in the poorest households, in rural areas or with a less educated mother. Although more granular high-quality nutrition data is needed, we have enough to act.
The COVID-19 pandemic has exposed the weakness of food and health systems, disproportionately impacting already vulnerable populations. As inequalities and malnutrition continue to sweep the world and Africa, the 2020 Global Nutrition Report stresses that the need to address malnutrition in all its forms by tackling injustices in food and health systems is now more urgent than ever.
The Report provides updated data and analysis on the state of malnutrition globally, including Africa, and highlights significant challenges faced by countries in the region, as well as progress made towards tackling them.
Double burden: Most countries in the world must now be equipped to fight both sides of malnutrition at the same time.
Some progress has been made both in Africa and globally, but this remains too slow. The region has made considerable effort to reduce the prevalence of stunting among children under 5 years of age. In Ethiopia, this has fallen significantly from 57.6% in 2000 to 38.4% in 2016. The same applies for Burundi that has managed to reduce stunting levels from 64.0% in 2000 to 55.9% in 2016.
However, Africa remains the region by far the hardest hit by overlapping forms of malnutrition. Of 37 countries that struggle with three forms of malnutrition – childhood stunting, anaemia in women of reproductive age and overweight among women – 27 were in Africa.
Obesity and overweight levels are also on the rise across the continent. The prevalence of overweight in adolescents is greater in girls (17.7%) than boys (11.2%). This trend continues into adulthood, where the overweight prevalence in adults is greater in women (41.1%) than men (25.8%).
Despite these figures, countries are often unprepared to face the global nutrition crisis.
Strong government nutrition coordination is often lacking; lower-income countries tend to deprioritise overweight, obesity, and other diet-related chronic diseases.
Financial commitments also don’t match the scale and nature of the issue: increases in domestic resources for nutrition have been marginal at best and nearly impossible in fragile states, while obesity and overweight have been largely ignored in aid allocations.
Jane Battersby-Lennard, Associate Professor at the University of Cape Town’s African Centre for Cities, said: “We have seen significant progress to tackle malnutrition in Africa, but the COVID-19 pandemic could reverse these gains. COVID-19 is expected to increase this disparity, which means that now is the time to scale up our efforts and support communities and people most affected.”
New perspective: redirecting resources to communities and people most affected is the right and the smartest thing to do.
Global and national patterns hide significant inequalities within countries and populations, with vulnerable groups being the most affected. The Report found clear links between levels of malnutrition and population characteristics like location, age, sex, education and wealth, while conflict and other forms of fragility compound the problem.
In Africa, differences between communities at the sub-national level are striking. Underweight is a persisting problem of the poorest countries, while overweight and obesity are prevailing in wealthier communities. In the Democratic Republic of Congo, the prevalence of overweight is 2.2% in poorer households and 9.7% in richer ones.
If no action is taken, the effects of the pandemic will only make it harder for vulnerable populations to protect themselves against malnutrition. Malnutrition affects our immune system, leaving us more susceptible to infection, and the socio-economic impact of the pandemic could, in turn, drive malnutrition globally.
Gaps in food systems: Poor diets are not simply a matter of personal food choices. The Report calls for a change in food systems.
According to the Report, existing agriculture systems still focus on staple grains like rice, wheat, and maize, rather than producing a broader range of more diverse and healthier foods, such as fruits, nuts, and vegetables.
Fresh or perishable foods are less accessible and affordable in many parts of the world compared to staple grains. In Burkina Faso, egg calories are 15 times more expensive than calories from staples, whereas they are 1.9 times more expensive in the United States.
Processed foods, especially ultra-processed food, are available, cheap and intensively marketed, with sales high and growing fast in many parts of the world. In sub-Saharan Africa, the growth of supermarket chains is diminishing the role of informal traders and has affected people’s food choices. These changes demand policy and planning resources to promote desirable nutrition outcomes.
Solutions have started to emerge in Africa and across the world: increased public investment for healthier food products, support for shorter supply chains for fresh-food delivery programs, use of fiscal instruments, limiting advertising of junk food, and food reformulation, or the use of front-of-pack labelling (FOPL) to inform consumers and influence industry behaviour adopted by Chile and the UK. However, much more remains to be done.
Venkatesh Mannar, Co-Chair of the Report and Special Adviser on Nutrition to the Tata Cornell Agriculture & Nutrition Initiative, said: “At a time when COVID-19 has further revealed the gaps in our food systems, we now have a unique opportunity to act in coordination to address them and ensure that healthy and sustainably produced food is the most accessible, affordable and desirable choice for all.”
Universal Health Coverage: an opportunity to make nutrition care universally available as a basic, live-saving and cost-effective health service.
Malnutrition in all its forms has become the leading cause of poor health and death, and the rapid rise of diet-related chronic diseases is putting an immense strain on health systems that are already fighting diseases like Covid-19, Ebola or Malaria.
But despite this assessment, nutrition actions only represent a minuscule portion of national health budgets although they can be highly cost-effective or even cost-saving solutions.
In most countries, health checks do not cover diet quality and national surveys rarely comprehensively assess diets and the nutritional status of populations. The distribution of trained nutrition professionals is inequitable, and these experts are not widely accessible. Globally, the median number of nutrition professionals stands at 2.3 per 100,000 people, 0.9 per 100,000 people in Africa, and some countries have none.
Renata Micha, Co-Chair of the Report and Research Associate Professor at the Friedman School of Nutrition Science and Policy at Tufts University, said: “Good nutrition is an essential defence strategy to protect populations against epidemics, release the burden on our health systems, deliver Universal Health Coverage and ultimately save lives. The findings of the 2020 Global Nutrition Report make clear that tackling malnutrition should be at the centre of our global health response.”
Processed food sales are still high in high-income countries and growing fast in upper-middle and lower-middle income countries, while sales are low in low-income countries.
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