The state of global nutrition
The Global Nutrition Report is the world’s leading independent assessment of the state of global nutrition. It is data-led and produced each year to cast a light on progress and challenges. The report aims to inspire governments, donors, civil society organisations, businesses and others to act to end malnutrition in all its forms. It also plays the important role of holding stakeholders to account on their commitments towards tackling poor diets and malnutrition in all its forms.
This year’s report sets out progress towards the global nutrition targets, evaluates the impact of poor diets on our health and our planet, assesses the nutrition financing landscape, and provides a comprehensive overview of reporting on past Nutrition for Growth (N4G) commitments.
It finds that, despite some progress, diets are not getting healthier and make increasing demands on the environment, while unacceptable levels of malnutrition persist. The high human, environmental and economic costs of continuing our current trajectory are so significant that we will pay a far higher price if we fail to act. While Covid-19 is exacerbating the problem, this report shows that it is just one part of a much bigger picture.
We can, however, remain hopeful. Healthy, sustainable diets that put an end to malnutrition, while preserving planetary health, are achievable. We have never been better equipped with the evidence and tools we need to improve accountability and drive better nutrition outcomes, and to mobilise far more financing than is currently invested in nutrition. We must immediately accelerate progress across all areas of nutrition, and reform the systems and structures that hold us back. This year is the N4G Year of Action – and the perfect time for stakeholders from global to local levels, across every sector and country, to commit to doing what is necessary for a well-nourished and thriving population and planet.
1. To meet global nutrition targets in most countries, we need greatly accelerated progress.
Globally, we are off track to meet five out of six global maternal, infant and young children nutrition (MIYCN) targets, on stunting, wasting, low birth weight, anaemia and childhood overweight. We are also off track for meeting all diet-related non-communicable disease (NCD) targets, on salt intake, raised blood pressure, adult obesity and diabetes.
Lack of progress means unacceptable levels of malnutrition persist. Worldwide, 149.2 million children under 5 years of age are stunted, 45.4 million are wasted and 38.9 million are overweight. Over 40% of all men and women (2.2 billion people) are now overweight or obese. There are countries showing some promising progress. For example, of the 194 countries assessed, 105 are on track to meet the target for tackling childhood overweight and over a quarter are on track to meet stunting and wasting targets. However, anaemia levels are showing no progress or worsening in 161 countries.
No country is on track to achieve the target on reducing salt intake or to halt the rise in adult obesity. In the Africa region, no country is on course to meet any of the diet-related NCD targets, and the only countries on course to meet both raised blood pressure and diabetes targets are a few high-income Western countries. There is a clear need for all stakeholders to step up efforts and take strong action to counter poor diets and malnutrition in all its forms.
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. 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. 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 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, 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.
Based on this report’s findings, there are clear areas for action. The change needed is significant but not impossible, and the stakes are so high that we must now do whatever it takes. We recommend three key areas for action.
1. There needs to be a step-change in efforts and financial investments to end poor diets and malnutrition, and gain the high social and economic returns we know are possible.
- There is an urgent need for all stakeholders to commit to strong, SMART actions in the N4G Year of Action, and to ensure that diet-related goals form part of their commitments.
- Far more financing is needed, or we will not achieve the change we need. Traditional forms of financing for nutrition – external and domestic – must be sustained and increased, while other sources of financing – particularly innovative and private – need to step up.
- Countries must be better supported to leverage new tools that drive efficiency and effectiveness of investments to maximise the impact of available financing.
2. Poor diets and malnutrition can and should be addressed holistically and sustainably to create a healthy future for all.
- Policy initiatives are urgently needed to transform food systems, increase intake of health-promoting foods, and reduce animal-based foods, to ensure diets are healthy and sustainable for people and the planet.
- Global nutrition monitoring must expand to key targets for improving diets and health that go beyond micronutrient deficiencies, hunger and excess weight.
- Stakeholders and commitment-makers must give special attention to nutrition action that supports equitable, healthy and sustainable diets for all.
3. Better data, greater accountability and systematic monitoring are key to identifying the progress needed and ensuring we stay on track.
- Better and more granular data is needed, including on financing, to fully understand the current state of nutrition, inform effective action, and ensure that impact can be measured and monitored.
- All stakeholders who can play a role in driving healthy, sustainable diets and good nutrition should ensure they benefit from support available and sign up to the Nutrition Accountability Framework to make SMART nutrition commitments and ensure their impact can be measured.
- Healthy diets that are also sustainable must be better integrated into global nutrition targets, and monitored, in recognition of their vital importance in tackling malnutrition and protecting our environment.
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According to the Global Dietary Database, 2021.
Recommended healthy and sustainable diets developed by the EAT-Lancet Commission on Healthy Diets from Sustainable Food Systems.
Nutrition for Growth (N4G) is a global effort that brings together all stakeholders, including country governments, donors, businesses and civil society organisations to accelerate progress on tackling poor diets and malnutrition in all its forms. The Global Nutrition Report was first conceived following the first N4G summit in 2013, as a mechanism for annually tracking the commitments made by 100 stakeholders spanning governments, aid donors, civil society, the UN and businesses, and assessing their translation to impact – and this role continues today.
SMART: Specific, Measurable, Achievable, Relevant and Time-bound