21 Nov 2019

Learning from success: What’s working in the fight against malnutrition?

Dr Mariachiara Di Cesare Member of the Global Nutrition Report's Independent Expert Group, Senior Lecturer in Public Health, Middlesex University and Honorary Research Fellow, Imperial College London

Poor diets are now the leading cause of death worldwide, while improved nutrition is critical to achieving the Sustainable Development Goals. Each year, the Scaling Up Nutrition (SUN) Global Gathering provides a unique opportunity to celebrate success with the people who have made improvements in nutrition possible in their countries and communities. It’s a moment to take stock of achievements. And in doing this, we also discover where and how we can go further in the fight against malnutrition.

At the 2019 SUN Global Gathering in Nepal, the Global Nutrition Report (GNR) presented on the state of global nutrition to shine a spotlight on extraordinary achievements in improving nutrition at the national level. Such examples can be found in our Country Nutrition Profiles and Nutrition for Growth commitment tracking tool. Common to all the success stories shared at the event was a localised approach to nutrition and a focus on the people behind the data. The full presentation is available to download at the end of this article.

Progress so far: significant but inconsistent

Thanks to unprecedented commitments made by countries over the past two decades – with the aim of ending malnutrition in all its forms – we have seen promising developments. Data on levels of success and trends for achieving global nutrition targets clearly show that accelerated progress is possible with political will and dedication of resources. However, progress is inconsistent across targets, with significant improvement in some areas and no improvement, or even deterioration, in others.

In 2013, diverse sectors working on nutrition came together at the first Nutrition for Growth summit, where over 200 commitments were made to advance progress towards a set of global nutrition targets adopted the year before. These included the target of reducing the number of children under five who are stunted by 40% by 2025. Paraguay and Thailand are exceptional examples of progress in this area. In just four years, they have reduced stunting by 48% and 39%* respectively, showing that significant progress is possible in a short space of time. Similarly, Burkina Faso and India have already met the target of increasing exclusive breastfeeding in the first six months to at least 50%.

Nevertheless, despite a reduction in the number of stunted and wasted children and an increase in exclusive breastfeeding in the first six months, not a single country in the world is on course to meet targets for adult obesity or anaemia in women of reproductive age. For a long time, the attention has been focused on undernutrition in children, and rightly so. But this overlooks overweight and obesity and the nutritional status of adults in general. Globally, 15.1% of women and 11.1% of men are obese, and 32.8% of women of reproductive age have anaemia.

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Dr Mariachiara Di Cesare presenting on 'The state of global nutrition' during the SUN Global Gathering.

Unlocking local solutions

The global picture masks vast differences in nutrition-related outcomes between countries, and national averages often overshadow inconsistencies within countries. Disaggregated data available in the interactive Country Nutrition Profiles shows us that nutrition-related outcomes vary significantly for different groups of the population, based on where they live, their income, gender, education, age and other defining factors. For example, in Sudan there is a percentage gap of four points between girls and boys under five experiencing stunting: 40.3% of boys and 36.1% of girls were stunted in 2014. Further, while more boys than girls (aged 5-19) are underweight in Sudan, the reverse is true for overweight: 16.7% of girls were overweight in 2016, compared to 8% of boys.

What makes an intervention successful and what support is needed?

With the situation differing widely between and within countries, a context-specific approach is crucial to success. But what else makes an intervention successful? The 2018 Global Nutrition Report highlights several common factors, including a strong evidence base, political will and adequate resources. Comprehensive programmes, including multisectoral, multi-level and community-based actions have also proven impactful in improving nutrition at the national level. Food fortification, taxes on sugar-sweetened drinks and labelling systems are further shown to be effective in improving the diet of the population.

The examples of the Alive & Thrive initiative in Ethiopia to increase dietary diversity or the Amsterdam Healthy Weight Programme to reduce obesity among children remind us that progress is possible, and that the nutritional status of groups can be improved rapidly.

During the three days of the 2019 SUN Global Gathering, a clear call from countries for better data and accountability mechanisms emerged. The Global Nutrition Report already provides information on the status of commitments made to end malnutrition through the Nutrition for Growth commitment tracking tool. However, to guarantee that what we are doing is having the intended impact we need more data. We also need to ensure its relevance at the national and local level, so that numbers can be converted in actions.

Share your views

We celebrate progress on targets and the determination of countries to make progress, often in exceptionally challenging contexts. We also know that identifying common factors among interventions that have worked can help us to build on this success in the future.

We therefore invite you to share with us your views on nutrition in your country or region through this survey. This will help us to ensure that our resources are as relevant and useful as possible and support you in your area of work.

We have a responsibility to not drop our guard and keep working towards a common goal of a world free from malnutrition in all its forms. We already know much of what works to reduce malnutrition, and we know how to do it. Now we must work together to make our vision of a world free from malnutrition a reality.

Click here to download the 'The state of global nutrition' presentation slides.

*The percentage of reduction in stunting for Thailand has been changed since the original presentation in line with updated UN Population data.

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