Executive summary

All around the world, too few countries are on course to meet nutrition targets

There needs to be a step-change in action to end poor diets and malnutrition

Key global targets and systematic monitoring exclude diet, despite its health and environmental impacts. Current targets do not explicitly address poor diets and their quality (with the exception of salt levels) as the underlying cause of malnutrition in all its forms. Additionally, no global targets are set to address micronutrient deficiencies (with the exception of anaemia), despite their importance for health and development. There is also no specific target that captures malnutrition among children and adolescents. There is a clear gap to fill − for international bodies, countries and all key stakeholders − to improve recognition, targeting and tracking of poor diets.

The effects of the Covid-19 pandemic are knocking us further off course. An estimated additional 155 million people are being pushed into extreme poverty globally, as a result of the pandemic, and people who are obese or have other diet-related chronic diseases are more vulnerable to Covid-19. This certainly adds to the challenge of meeting global nutrition targets.

2. Our diets are increasingly harming our health and the planet.

Diets worldwide are far from being healthy and have not improved over the last decade.^[1] Fruit and vegetable intake is still about 50% below the recommended level of five servings per day that is considered healthy (60% and 40% respectively), and legume and nuts intakes are each more than two thirds below the recommended two servings per day.^[2] In contrast, red and processed meat intake is on the rise and almost five times the maximum level of one serving per week, while the consumption of sugary drinks, which are not recommended in any amount, is going up as well.

Despite some variation between regions, no region meets recommendations for healthy diets. Lower-income countries continue to have the lowest intakes of key health-promoting foods such as fruits and vegetables and the highest levels of underweight, while higher-income countries have the highest intakes of foods with high health and environmental impacts, including red meat, processed meat and dairy, and the highest levels of overweight and obesity.

No region meets recommendations for healthy diets

Poor diets and malnutrition need to be addressed sustainably to ensure a healthy future for people and planet

Diet-related disease and mortality rates are large and increasing in most regions. Deaths attributable to poor diets have grown by 15% since 2010 – more rapidly than population growth – and are now responsible for more than 12 million NCD deaths in adults. This is a quarter (26%) of all adult deaths each year. The proportion of premature deaths attributed to dietary risks is highest in Northern America and Europe (31% each), and lowest but also at notable levels in Africa (17%). No region is on track to meet the Sustainable Development Goal of reducing premature mortality from NCDs by 2030. Every region faces the immediate challenge of addressing dietary risk factors and reducing mortality from diet-related NCDs.

The harmful impacts of our diets on the planet are alarming and increasing. According to our new estimates, global food demand is now creating more than a third (35%) of all greenhouse emissions and using substantial and rising amounts of environmental resources. Compared to 2010, the environmental impacts of food demand increased by as much as 14%, with animal-source foods responsible for the majority of greenhouse gas emissions and land use. Northern American diets have the greatest environmental impact while African and Asian diets have the least. However, no region is on track to meet the set of Sustainable Development Goals aimed at limiting the health and environmental burdens related to diets and the food system. For example, all regions have diets that, if globally adopted, create impacts that are above sustainable levels if we want to limit global warming to less than 2oC. Every region needs large-scale dietary changes to achieve healthy and sustainable diets that tackle malnutrition in all its forms while preserving planetary health.

3. The financial costs of addressing poor diets and malnutrition have risen while resources are falling, but the costs of inaction are far greater.

The additional financing needed to meet nutrition targets has grown significantly, partly due to the impacts of Covid-19. Available data allows us to estimate nutrition-specific financing needs for global nutrition targets on only stunting, wasting, maternal anaemia and breastfeeding. We would need on average US$10.8 billion additional financing annually between 2022 and 2030 to meet these four targets by 2030, allowing for the impacts of Covid-19. Previous estimates (for 2016−2025) were an additional US$7 billion annually.

These additional costs would be much larger still if they also included nutrition-sensitive needs and meeting all global nutrition targets, including for obesity and diet-related NCDs. The cost of meeting the SDG 2 targets by 2030 would also be substantial: approximately US$39−50 billion annually to meet both nutrition-specific and nutrition-sensitive needs. At the same time, the total economic gains to society of investing in nutrition could reach US$5.7 trillion a year by 2030 and US$10.5 trillion a year by 2050.

The financial costs of addressing malnutrition are rising

But the total economic gains to society of investing in nutrition could reach US$5.7 trillion a year by 2030

Traditional sources of nutrition financing need to be protected, and innovative and private financing expanded. Projections for both official development assistance and domestic financing suggest a downward trend exacerbated by Covid-19, with recovery to pre-pandemic levels expected only towards the end of the decade.

There is a significant opportunity to leverage innovative forms of financing for nutrition. We can and should learn from other sectors like education, health and climate change, where there is notable progress on this. And the private sector is the most untapped financing source in nutrition. It can and must expand, and there are several ways in which this can happen that are climate-smart, sustainable and go beyond corporate social responsibility and actions from food companies.

Improving efficiency and effectiveness of existing nutrition investments can increase the impact of available resources on malnutrition. There are tools countries can use to optimise allocation of available financing to reduce more cases of malnutrition and save more lives with the same money.

4. Nutrition for Growth (N4G) tracking highlights challenges in delivering commitments and measuring progress.

While there is positive progress towards realising N4G^[3] commitments made in 2013 and 2017, countries are struggling to meet financial and impact goals. We find from the 2020 reporting that over two thirds of donors and civil society organisations reported having reached or being on track to reach their financial commitments. The majority of donor (63%) and civil society (76%) non-financial commitment goals were also on track or had been reached. Only 42% of country financial commitment goals had been reached or were on course, while 41% of country impact commitment goals were on course, with none reported to have been met. Covid-19 has exacerbated challenges, with reporting that progress on 43% of country commitment goals has been severely or highly affected by the pandemic, primarily due to diversion of resources. It is clear that efforts to meet commitments must be intensified, particularly those relating to financing and impact by country stakeholders.

In 2020, countries struggled to meet their financial nutrition commitments

In this Nutrition Year of Action, decision-makers must leverage Nutrition for Growth as a reset moment

Diets and diet-related NCDs have lacked attention in past N4G commitments. Of the 383 commitment goals made by stakeholders, 136 aligned with the global MIYCN nutrition targets. Only 17 commitment goals focused on improving food production or food quality, while diets and diet-related NCD targets were absent, largely due to their low priority at past summits. It is promising however that food and healthy diets are high on the agenda and a core commitment area of the Tokyo N4G Summit in December 2021.

There have been significant challenges in measuring progress, but the new Nutrition Accountability Framework provides the way forward. Only 29% of the past N4G commitments met the SMART criteria,^[4] making it challenging to assess delivery against them. Progress is self-reported by stakeholders, raising the potential for incomplete or biased reporting. Until now, we have been unable to gain a clear overall picture of progress or make comparisons over time. In September 2021 however, the Global Nutrition Report set up the Nutrition Accountability Framework to address these challenges and support the registration of new commitments made in the N4G Year of Action and beyond. This is the world’s first independent and comprehensive platform for making SMART nutrition commitments and monitoring nutrition action to help accelerate progress.