Urgent action needed for what’s left of the ‘Nutrition Decade’

Most gains made during the first half of the UN’s Decade of Action on Nutrition have been wiped out in 2020, say nutrition experts, leaving little hope that the world can reach its nutrition targets within the 10-year programme. This has many nutrition experts worried.

The COVID-19 pandemic has interrupted global efforts to address the combined threats of undernutrition, obesity and micronutrient deficiencies. Pandemic-related disruptions to global health, food and economic systems mean the dual burdens of chronic undernutrition and unhealthy weight gain have increased dramatically. Greater investments in nutrition are needed now more than ever.

“Many effects of COVID-19 will be long term — a lot of nutrition will slide back,” says Zulfiqar Bhutta, an expert in paediatrics and nutrition from the University of Toronto, Canada and Aga Khan University, Pakistan.

But, not all nutrition shortfalls can be blamed on the pandemic. “It’s easy to find a scapegoat,” says Bhutta, “but for years we haven’t focused on reaching the poorest of the poor and that’s offset much of the progress on global efforts to end hunger, achieve food security, improve nutrition and promote sustainable agriculture.”

Now is the time to “build better,” says Patrizia Fracassi, a senior nutrition and food systems officer at the UN’s Food and Agriculture Organization (FAO). “From now until the end of the Decade of Action, we must make our food systems work for the most vulnerable communities.”

Taking action, tracking progress

The ‘Nutrition Decade’ was launched in 2016 as a framework for stakeholders to implement and build upon commitments made at the Second International Conference on Nutrition (ICN2) two years earlier. An FAO/WHO-run secretariat is tracking progress toward ending all forms of malnutrition.

Top priorities include making nutrition services integral to universal health care coverage; building sustainable and resilient food systems that promote healthy diets and ensure the livelihood of food producers; and addressing malnutrition through social protection programmes and food education.

Governments, businesses, donors, multilateral organizations and other development partners were encouraged to make data-driven, time-bound commitments in targeted action areas — and a handful of countries formally stepped up to the challenge.

Brazil, for example, pledged to tackle rising rates of adult obesity, to curb the consumption of sugar-sweetened beverages and to promote more servings of fruits and vegetables. Ecuador and Italy made similar commitments around healthy eating and childhood nutrition. These and other nations also joined loose coalitions, termed ‘action networks’, to focus on issues ranging from nutrition labelling and sustainable fisheries to healthy school meals and salt intake.

Then came the pandemic

One study from researchers at the UN World Food Programme and elsewhere concluded that the percentage of people living in low- and middle-income countries who could not afford even half the cost of a healthy diet had increased from 43% to 50% because of pandemic-related economic woes.

Another analysis from the Standing Together for Nutrition Consortium — a group that formed in 2020 to tackle the COVID-19–related nutrition crisis — anticipates a rapid escalation in numbers of children who are acutely malnourished, and thus at risk of death. By 2022, the group estimated, 13.6 million more youngsters in low- and middle-income nations will suffer from acute or chronic forms of malnutrition compared to pre-pandemic numbers.

Food insecurity due to the pandemic could also cause 283,000 additional child deaths, the study found, with millions more babies born to underweight women or mothers with anaemia — both health conditions that can negatively affect child development.

“These numbers are really staggering,” says study co-author Saskia Osendarp, executive director of the Micronutrient Forum in Washington.

Reporting in the July 2021 issue of Nature Food, Osendarp’s team estimated that an additional US$1.7 billion per year is needed to mitigate the effects of COVID-19 on undernutrition and child mortality. But, she says, in many countries, “the coffers are empty”. The funding landscape is “dire,” she says, although there are glimmers of hope.

Osendarp’s immediate priorities for investment begin with COVID-19 response and recovery plans for lower-and-middle-income countries that focus primarily on nutrition for women and children. Mid-term priorities should include cost-effective food supplementation and fortification. But in the longer term, she suggests, more structural investment is needed in food and health systems, which should include sector-wide commitments for direct investment in nutrition.

Recommitting to nutrition

The World Bank singled out food security as a top priority for its International Development Association replenishment drive last year. The African Development Bank has made food systems transformation integral to its pandemic recovery efforts. And, through the Nutrition for Growth (N4G) Year of Action launched in December 2020 by the governments of Canada and Bangladesh, several countries and aid organizations pledged nutrition-specific funding of their own.

Additional commitments are associated with two international events in 2021: the UN Food Systems Summit and the Tokyo N4G Summit. Many of those commitments might not formally fall under the banner of the Nutrition Decade but that matters little to the WHO’s Lina Mahy, a member of the Secretariat for the Nutrition Decade.

More consequential, she says, is that those commitments are made and nutrition is now on the global policy agenda. In her 30-plus-year career, “there has never been as high an alignment politically,” Mahy says. “Action is happening, impact is being realized.”

As long as commitments are made within the 10-year timeframe of the Nutrition Decade, Mahy and fellow secretariat members view those actions as contributing to a common cause. Any progress toward the effort’s objectives is included in a biannual report submitted to the UN General Assembly.

Mahy remains optimistic that the Nutrition Decade’s ambitious goals are within reach. If anything, COVID-19 has made plain the importance of healthy diets from resilient, sustainable food systems. Groups such as the Food Coalition, now led by FAO, aiming to address the pandemic’s adverse impacts on food systems and agriculture, help support these goals.

Such momentum is necessary to achieve the UN’s 17 Sustainable Development Goals (SDGs) by its deadline of 2030, notes Joel Spicer, president and chief executive of Nutrition International, a not-for-profit organization based in Canada. Whether directly or indirectly, improved nutrition underpins nearly all the SDGs and “there’s a lot to be done,” Spicer says.

“We’ve got to ring the global alarm,” he adds. The Nutrition Decade, or what’s left of it, should continue to do just that.