07 Jul 2020

Equity and the right to food: A systemic approach to tackling malnutrition

Dr Anna Lartey and Stineke Oenema Director of Nutrition at the UN Food and Agriculture Organization, and Coordinator of the UN Standing Committee on Nutrition

In order to tackle malnutrition, we must first address systemic inequities in food, health and social protection. However, Covid-19 is highlighting weaknesses in these systems and forcing us to rethink their structure.

One in three people suffers from one or more forms of malnutrition and around two billion people do not have access to a healthy diet. At the current pace of progress, we are unlikely to meet global nutrition targets by 2025 or even by 2030.

All countries are affected by malnutrition, but it does not affect all people equally. There are vast disparities between and within countries, which are particularly striking when viewed by gender, ethnicity, socioeconomic status and education. Income inequalities and power imbalances are two intersecting factors that determine unequal nutrition outcomes.

Addressing inequity is vital to ending malnutrition

“We will never end malnutrition unless everyone is treated fairly and according to need” said Renata Micha, Co-Chair of the Global Nutrition Report's Independent Expert Group, at the UNSCN–FAO event on the 2020 Global Nutrition Report (GNR). Addressing inequities in our food, health and social protection systems is a precursor to ending malnutrition and must go hand-in-hand with efforts to improve nutrition outcomes. Our promise to leave no one behind hinges on addressing these inequities.

Although there has been progress in reducing some forms of malnutrition, this is uneven and has left many behind. In many countries there are decreasing trends of chronic malnutrition among privileged groups. However this decrease is often slower, or even absent, for those in vulnerable groups (as in Burundi). In some cases, progress made in one group is offset by deterioration of nutrition outcomes in other groups (as in Nigeria).

The 2020 GNR highlights that “only by tackling injustices in food and health systems will we achieve the transformations needed to end malnutrition in all its forms”. UNSCN News 43 was dedicated to equity, equality and non-discrimination in food systems and drew links between unequal nutrition outcomes and other inequalities related to income, gender, ethnicity and geography.

COVID-19: From health crisis to food crisis

As stated in the 2020 GNR, “Most people cannot access or afford a healthy diet or quality nutrition care”. Covid-19 started as a health crisis but within weeks it became a food crisis, due to weaknesses in the food system that prevent it from supporting the most vulnerable.

Due to systemic inequities in the food system, families on low incomes cannot afford to protect themselves by having food delivered to their homes or buying healthy food. People on low incomes are more susceptible to undernutrition as well as obesity and diet-related non-communicable diseases, such as diabetes and heart disease, increasing their risk of severe ill-health and death from Covid-19.

Our global food system has long and fragile supply chains, especially for more nutritious foods such as nuts, pulses, and legumes. The system is also dependent on seasonal migration workers in low-paid and insecure jobs. As stated during the UNSCN–FAO event on the 2020 GNR, “We cannot talk about equity without looking at the working conditions of those who produce the nutritious food on our table.” Drivers of unequal nutrition outcomes are found in the daily living conditions of people, including access to water, sanitation and hygiene; education; health care; and household food security.

Tackling inequities in health, food and social protection

Malnutrition is a systemic problem, interwoven with the food, health and social protection systems (see the figure below). The Covid-19 pandemic forces us to rethink how these systems are organised in order to improve resilience, sustainability, inclusivity and nutrition outcomes.

Investments in social protection are important in ensuring access to food, nutrition and essential services, particularly for vulnerable groups in urban and rural settings, as set out in the UN Secretary-General’s recent food security statement.

UNICEF Systems Approach to Nutrition Graphic

Source: UNICEF, 2020

Investment in public research geared towards more diverse production schemes and in support of smallholder producers are examples of ways the food system could be improved. Research suggests that taxes, subsidies and food labelling support healthier food environments and make healthy choices more accessible and affordable for consumers.

Health systems have been under huge pressure during the pandemic and basic health care is under threat. In many countries essential nutrition services have been disrupted as a result of Covid-19. Investments in health care are needed to ensure universal health coverage that includes essential nutrition actions. Mainstreaming nutrition into health care would be a strong equaliser, as good health care is a direct determining factor of nutrition outcomes.

Breaking the cycle of inequity and malnutrition

A human rights-based approach to programming requires that solutions are developed in a participatory and inclusive way and puts governance and accountability at its centre. The UNSCN has called for a pro-equity and people-centred agenda, pointing out that inequalities are often locked into the system as a result of power imbalances and existing financial interests. Both the 2020 GNR and the UNSCN News 43 report outline actions to address inequity and inequality and eradicate all forms of malnutrition, leaving no one behind.

Joint and concerted action is required in the three systems:

  • Social protection schemes need to include nutrition at their heart to ensure access to healthy and sustainable diets.
  • Universal health coverage needs to include essential nutrition actions to save lives and reduce pressure on healthcare systems.
  • Food systems need to be transformed with people – and the planet that sustains us – at the centre.

Covid-19 has made us more aware of where our food comes from and has unlocked a desire for shorter supply chains and more diverse and nourishing food supply. This is the first step towards more just, sustainable and resilient systems that support the realisation of the universal right to food.

Image credit: FAO/Sergey Kozmin

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