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Saturday, June 25, 2016
Jomo Kwame Sundaram was the Coordinator for Economic and Social Development at the Food and Agriculture Organization of the United Nations (FAO) and received the 2007 Wassily Leontief Prize for Advancing the Frontiers of Economic Thought.
- Nutrition is complex and multi-dimensional. Micronutrient deficiencies or ‘hidden hunger’ are much more widespread than chronic undernourishment or hunger, understood as inadequate dietary energy. Micronutrient deficiencies refer to the lack of essential vitamins, minerals and other substances required over the human life cycle by the body in small amounts. Micronutrient undernutrition has long-term effects on health, learning ability and productivity, leading to high social and public costs, reduced work capacity in populations due to high rates of illness and disability, and loss of human potential. Although the most severe problems of micronutrient malnutrition are found in developing countries, people of all population groups in all regions of the world are affected by some micronutrient deficiencies. More than two billion people in the world are deficient in key vitamins and minerals, particularly vitamin A, iodine, iron and zinc. This is a serious impediment to socio-economic development, exacerbating the vicious cycle of malnutrition, underdevelopment and poverty. Not surprisingly then, the economic gains to society of reducing micronutrient deficiencies are estimated to have a benefit-to-cost ratio of almost thirteen to one!
While there is no consensus on a plan to tackle all forms of malnutrition (undernourishment, micronutrient deficiencies, diet-related non-communicable diseases) across the world, the problems are better understood now, with options for addressing malnutrition increasingly known. Preferably, micronutrient requirements should be met through food intake.
Food-based strategies promote the consumption of foods naturally rich in micronutrients or enriched by ‘fortification’. Food-based approaches, which include food production, dietary diversification and food fortification, are sustainable strategies for improving the nutrition of populations. Increasing access to as well as the availability and consumption of a variety of micronutrient-rich foods improves nutrition in general.
However, progress in promoting and implementing food-based strategies to achieve sustainable improvements in micronutrient status has been slow. Much of the effort to control the three major deficiencies of public health concern – i.e. vitamin A, iron and iodine deficiencies – has focused on supplementation. Communities and households need to nourish themselves adequately with appropriate food-based interventions.
Where there are acute micronutrient deficiencies adversely impacting human nutrition, there is a clear, but temporary role for supplements for groups at high risk and during emergencies, until the food system is improved to ensure that it sustainably serves dietary needs over the human life-cycle.
An exclusive focus on supplementation also distracts from addressing the deeper causes of malnutrition. Focusing on supplements inadvertently promotes large commercial opportunities, which may have a vested interest in discouraging alternative long-term options for addressing malnutrition on a more affordable and sustainable basis.
It is important to approach interventions in a balanced and nuanced way, incorporating nutrition-sensitive food system and agricultural practices and knowledge as well as costed plans for nutrition supplementation. Food system-based nutrition interventions need to inform choices of appropriate strategies.
While supplement-based interventions are often viewed as short-term, and food-based interventions as longer-term, that is not necessarily the case. Food system interventions, such as providing school meals, can have an almost immediate impact besides longer term gains. The choice between supplement-based and food system-based strategies to end malnutrition is not always clear cut.
First, some supplements can be delivered through food systems. Mineral supplementation of soil, a key component of most agricultural systems, can help address dietary micronutrient deficiencies. In Turkey, for example, fertiliser has been enriched with zinc as zinc absorbent plant varieties help address widespread zinc deficiencies affecting Turkey’s soil, crops and people.
Second, micronutrient supplementation generally will not be very effective without adequate food. Micronutrient supplements without adequate food can even have negative effects. Third, the most effective way to address malnutrition varies with the type of micronutrient deficiency. Some micronutrients, such as iron and folic acid, are commonly delivered to pregnant women through supplements in rich and poor countries alike. Others, such as iodine added to table salt, are easily delivered through mineral fortification of foods. In most cases, however, micronutrients can be delivered effectively through nutrition-optimised food systems.
In recent years, a global movement has been gathering force to end hunger and malnutrition – reflected in the success of the Scaling Up Nutrition movement, calls for a single food security and nutrition goal for the post-2015 Sustainable Development Goals, the UN system’s mobilisation around the Zero Hunger Challenge and the November 2014 Second International Conference on Nutrition (ICN2).
Complementary national initiatives for global action – such as the UK and Brazilian governments’ ‘Nutrition for Growth’ initiatives since the 2012 London Olympics and the USAID’s Multi-sectoral Nutrition Strategy for 2014-2025 – have increased greater awareness of and action against malnutrition.
ICN2 clearly recognized the problem of hidden hunger, and that progress in addressing it has been weak. There is need for sustained and coordinated international support, including through ICN2 follow-up efforts, which offers a once in a generation opportunity to broaden and deepen political commitment and ensure appropriate, coherent and sustained efforts against malnutrition in all its forms.