Children all over the world have the same potential for growth and cognitive development in early childhood. The nutrition necessary to realise this common potential is a birthright of every child. Unfortunately, we have far too much evidence that we are still denying millions of children this fundamental birthright. We are therefore undermining their chances to survive, and to thrive. We are undermining the futures of their families, their communities, and their nations.
What accounts for this state of affairs? One of the main reasons is invisibility: unfortunately, despite the immense damage it causes, malnutrition is largely a “hidden” problem. Often, in the public’s mind, “malnutrition” is the emaciated child needing treatment. This is only the tip of the iceberg. Many nutritional deficits are not visible. They are hidden by their ubiquitous nature—when many or most children are short for their age, families and communities assume this is the norm. And conditions such as anaemia, for example, do not have any tell-tale physical markers. And thus they remain hidden.
Addressing malnutrition requires concerted action on the part of many sectors. In addition to health, water, sanitation, social protection, and education, one of those sectors is agriculture. Malnutrition in the past was regarded primarily as an issue of not having enough food—a deficit of calories. The emphasis was on increasing yields to solve the problem. Yields across Africa and Asia have increased for many staple crops, and yet malnutrition persists. Perhaps the agricultural sector needs to re-consider how it measures success. Is it simply how much maize or how much millet has been produced? How do you capture the impact of agricultural development on household well-being, particularly of the most vulnerable? Perhaps agriculture can do more for nutrition beyond increasing yields.
In recent years there has been an increasing appreciation of the importance of dietary quality, not simply quantity. There has been a coalescence around a vision of agriculture and nutrition working together to create food systems which ensure year-round access to safe, affordable, nutritious diets. This is the new end game. Investments in the agricultural sector—and this is true in all countries—must prioritise increasing the productivity of non-staple, nutrient-dense foods to make them more affordable to low-income consumers. Among these are dairy, eggs, fish, legumes, fruits, vegetables—and we must include biofortified foods as well. Additional policy levers, such as price policy and trade policy, also convey important market signals which guide consumer preferences and can thus impact nutrition. Knowledge of what constitutes a healthy diet is important but not enough—we need a policy environment which promotes healthy food choices.
Even the term “food systems” is relatively new. When looking at food systems, we are concerned about more than just production on the farm, and need to consider inputs to that production as well as marketing, transport, storage, processing, retail, and finally, consumption. Food production and consumption clearly lie on a continuum, rather than existing in entirely separate spheres. At the Gates Foundation, we have recently created a new strategic initiative called Food Systems, a joint effort of our Agriculture and Nutrition teams. Through this initiative, we hope to support efforts in the following areas:
- increase the global evidence base on the potential impact of agricultural programs and policies on nutrition through strong impact evaluation and the development and use of better indicators and measurement tools
- invest in increasing the productivity of nutrient-dense crops and livestock to make them more affordable
- improve the safety of the food supply, including mycotoxin control and addressing food-borne pathogens in perishable foods
- reduce seasonal fluctuations in the accessibility of food to smooth consumption throughout the year
- increase demand for nutritious foods on the part of the consumer through behaviour change and nutrition education programs
- increase women’s empowerment to ensure that household resources are allocated to reach the most vulnerable; women as both food producers and caregivers in their families are truly at the nexus of agriculture and nutrition.
We hope to see these efforts being increasingly pursued by researchers, implementers and policy-makers based in Africa and Asia. We would like to see these conversations being led there. There are several projects under way where Africans and Asians are leading the way. They are bringing a multi-disciplinary approach to this issue; while developing expertise in a specific area is important, having some knowledge of the perspectives and methods of another discipline or sector can truly change how you come to a problem. You will necessarily bring a more holistic view—which is what we need to address malnutrition.