As the world’s leading report on the state of global nutrition, the Global Nutrition Report sheds light on where progress has been made and where challenges remain. New analysis shows that global and national patterns hide significant inequalities within countries and populations, with the most vulnerable groups being most affected. The 2020 Global Nutrition Report therefore examines the critical role of addressing inequity to end malnutrition in all its forms. Inequity is a cause of malnutrition – both undernutrition and overweight, obesity and other diet-related chronic diseases. Inequities in food and health systems exacerbate inequalities in nutrition outcomes that in turn can lead to more inequity, perpetuating a vicious cycle.
Although the 2020 Global Nutrition Report was written before the current coronavirus pandemic, its emphasis on nutritional well-being for all, particularly the most vulnerable, has a heightened significance in the face of this new global threat. The need for more equitable, resilient and sustainable food and health systems has never been more urgent.
Covid-19 does not treat us equally. Undernourished people have weaker immune systems, and may be at greater risk of severe illness due to the virus. At the same time, poor metabolic health, including obesity and diabetes, is strongly linked to worse Covid-19 outcomes, including risk of hospitalisation and death.
People who already suffer as a consequence of inequities – including the poor, women and children, those living in fragile or conflict-affected states, minorities, refugees and the unsheltered – are particularly affected by both the virus and the impact of containment measures. It is essential that they are protected, especially when responses are implemented.
Good nutrition is an essential part of an individual’s defence against Covid-19. Nutritional resilience is a key element of a society’s readiness to combat the threat. Focusing on nutritional well-being provides opportunities for establishing synergies between public health and equity, in line with the 2030 Agenda for Sustainable Development.
Covid-19 exposes the vulnerability and weaknesses of our already fragile food systems. Covid-19 has tested our food systems, already stressed by increasing climate extremes. Containing the virus has caused food and nutrition shortages and driven governments to reduce social services, such as school nutrition programmes, that the most marginalised rely upon. In the context of food and nutrition shortages, accessibility and affordability of healthy, sustainably produced food becomes even more challenging. Access to staple food distribution and local food markets is at risk. Millions of households in formerly food-secure regions of the world have fallen into severe food insecurity. Levels of hunger and malnutrition could double within the space of just a few weeks.
As measures to slow the spread of Covid-19 are enacted around the world, we must ensure that there is enough nutritious food, distributed fairly, to cover basic nutrition needs – especially for the most vulnerable. Quite simply, and as the 2020 Global Nutrition Report highlights, food systems everywhere must become equitable, nutritious, efficient and inclusive.
Covid-19 exposes deadly healthcare disparities. Transformed and strengthened health systems must focus on delivering preventive nutrition and health services and be ready to respond to crises. They should also be enhanced to address challenges faced by specific populations, especially older people and those with pre-existing conditions, such as weakened immune systems and poor metabolic health. They should specifically pay attention to women and children, especially to their nutritional well-being and healthcare. Yet even the strongest health systems are struggling with high healthcare costs and a shortage of medical personnel, equipment and facilities.
The 2020 Global Nutrition Report highlights the need to integrate nutrition into universal health coverage as an indispensable prerequisite for improving diets, saving lives and reducing healthcare spending, while ensuring that no one is left behind. Reversing the obesity epidemic would also lessen the burden on our healthcare systems, as obesity is not only one of the costliest health conditions but also a major risk of Covid-19 hospitalisations and complications.
The way forward: strengthened coordination, alignment, financing and accountability. We are only just beginning to feel the full range of disruptions to health service delivery, food supply chains, economies and livelihoods as a result of the virus. As Covid-19 spreads in lower-income countries across the world, people’s health, food, education and social protection systems are being tested. Contributions from all sectors of society are necessary to address our diverse challenges. National governments are leading the response, providing strategic direction and ensuring coordinated and aligned programming. Civil society organisations are also key. Yet additional resources will be needed to combat the virus at different levels of these vital systems; this should not come at the expense of essential public health and nutrition actions. Special attention should be paid to supporting women, as they play such a vital role in helping societies everywhere to become Covid-ready.
There is a real risk that, as nations strive to control the virus, the gains they have made in reducing hunger and malnutrition will be lost. These gains must be protected through increased and well-targeted official development assistance, as well as domestic resource allocations, focused on nutritional wellbeing. We must actively prevent the main drivers of malnutrition through more equitable, resilient, sustainable systems for food and health security, backed up by responsive social protection mechanisms.
We know that tackling malnutrition requires political commitment and simultaneous actions across multiple sectors, as well as considerable investment in data systems for implementation of programmes and tracking of progress. As the new Covid-19 reality emerges, it is important to avoid the wholesale displacement of the gains that have been made, while managing a new and ever-present threat. Looking beyond the present pandemic emergency, there is a need for well-functioning, well-funded and coordinated preventive public health strategies that pay attention to food, nutrition, health and social protection. We must learn from the challenges posed by Covid-19 and turn them into opportunities to accelerate actions needed to address inequities across malnutrition in all its forms, as called for by the 2020 Global Nutrition Report.
The Global Nutrition Report’s Independent Expert Group
Mariachiara Di Cesare
Special Envoy of the World Health Organization (WHO) Director-General on Covid-19, Co-Director of the Imperial College Institute of Global Health Innovation at the Imperial College London, and Strategic Director of 4SD
Dr David Nabarro