The global nutrition crisis we faced even before Covid-19^[1] has become far worse, with worrying trends across every form of malnutrition, from hunger to obesity. People affected by hunger leaped by 150 million since the Covid-19 outbreak, from 618 million in 2019 to 768 million in 2021, while those unable to afford a healthy diet^[2] rose by 112 million to 3.1 billion in 2020 alone.^[3] Almost a third (29.3%) of the world’s population, 2.3 billion people, were moderately or severely food insecure^[4] in 2021, up from 25.4% before the pandemic.^[5] At the same time, what we eat across the world continues to fall short of the minimum standards for healthy and sustainable diets^[6] with resulting obesity and diet-related non-communicable diseases (NCDs) on the rise and at epidemic levels – around 40% of all adults and 20% of all children are now overweight or obese.^[7] Policy interventions to date are failing to reverse these trends, while conflict around the world – including the recent war in Ukraine – and the impacts of climate change, which are key drivers of increases in malnutrition, continue unabated.^[8] It is countries faced with food and nutrition insecurity,^[9] and the most vulnerable populations, that are threatened the most.

These are complex and pervading issues that must be tackled by all, working together, if we are to achieve what is necessary to shift our current outlook for nutrition. It was in recognition of this that 2021 was named the Nutrition Year of Action, with a concerted effort to mobilise monumental action across the world. The year culminated in the Tokyo Nutrition for Growth (N4G) Summit where stakeholders stepped up to make an unprecedented level of commitments to improve global nutrition. As part of these efforts, the Global Nutrition Report (GNR) was endorsed by stakeholders to create the world’s first independent nutrition accountability framework (NAF) to ensure commitments – including and beyond N4G – can deliver transformative change. The NAF enables all actions to improve nutrition across the world to be captured as SMART^[10] commitments that can be consistently monitored and reported on publicly. By capturing commitments from anyone at any time, it has the potential to improve our understanding of nutrition action like never before. Such a step change in accountability will equip all actors with the vital data and evidence they need to deliver greater nutrition action.

The 2022 Global Nutrition Report: Stronger commitments for greater action therefore sets out the vital role of accountability and its ability to transform action to tackle this nutrition crisis that affects all. It analyses the hard work already underway through an unprecedented number of commitments made by governments, civil society organisations (CSOs), private sector businesses, donors and international organisations. It emphasises the unique and vital role of every stakeholder to demonstrate why collaboration and coordination is the only way we can deliver sustainable nutrition outcomes. And it highlights where greater effort both across the board and from specific actors is needed to ensure actions translate into impact.

Although the 2022 Global Nutrition Report analyses commitments made before the war in Ukraine, its emphasis on stronger commitments, accountability and action has a heightened significance in the face of the war’s impact on food and nutrition security globally. The need for stakeholders to step up and take action to mitigate these impacts and improve nutrition for all has never been more urgent.

The report finds much to celebrate with a remarkable number of commitments registered in the NAF and a concerted effort from stakeholders to make those commitments SMART. Low- and lower-middle-income countries stand out in particular, with all stakeholders stepping up to commit over US$42.6 billion. Overall, the goals that are set out in commitments show strong support to leadership and governance and for addressing undernutrition,^[11] and a significant proportion of commitments are aligned with key global nutrition targets on maternal, infant and young child nutrition. We do however identify gaps in some critical areas; few goals are focused on improving food and nutrition security, and a relatively low proportion of commitments focus on poor diets or obesity and diet-related NCDs. There is also the need for a more concerted effort across a far broader constituency of actors to take more and stronger action in light of the global nutrition crisis that is fuelled by Covid-19, climate shocks and conflicts around the world.

The 2022 Global Nutrition Report showcases the value of the NAF and the insights it can bring that have the potential to significantly improve nutrition action over time. It sets the baseline for monitoring nutrition actions and their impact over time. Crucially it serves as a powerful call to action for all stakeholders in the global fight against malnutrition. Every actor has a unique position, capacity and responsibility in this complex landscape, and all must step up in their role. It is only by having everyone’s contribution accounted for, monitored and reported on that we can deliver the change that people across the world need and deserve.

An unprecedented number of commitments to take action on nutrition worldwide have been made, including over US$ 42.6 billion in financial investments.

Governments have a fundamental responsibility and authority to safeguard their populations’ nutrition, resilience and wellbeing through wide-ranging enabling, policy and impact actions.

Low- and lower-middle-income countries made the vast majority of domestic commitments, allocating substantial financial resources to improve their populations’ nutrition.

• Governments, almost all from low- and lower-middle-income countries, have shown an outstanding level of engagement, representing the largest stakeholder group. Their domestic (non-donor) goals prioritised enabling (196, 42%) and impact (183, 39%) actions, rather than policy (91, 19%). Specifically, ‘nutrition care services’ (43, 47% of policy goals) and ‘food system policies’^[21] (37, 41%) received relatively equal attention, but were comparatively low overall.
• ‘Leadership and governance’ was the main focus for enabling actions committed by governments domestically. Key examples are the development of national laws, policies and nutrition plans and improving national coordination mechanisms. All financial goals are grouped as enabling actions, and governments pledged over US$13.3 billion as domestic nutrition-specific and/or nutrition-sensitive investments, including by increasing their national budget allocation to nutrition. Considering the constrained financial resources in lower-income settings, this is a notable achievement.
• Given the critical role governments have in improving the nutrition outcomes of their population, impact actions were also prioritised. ‘Undernutrition’ was the focus of such actions, mainly committing to directly decreasing stunting, wasting, anaemia and low birth weight. These findings show that low- and lower-middle-income countries are concentrating their malnutrition efforts on tackling undernutrition rather than obesity and diet-related NCDs. Of note, ‘food and nutrition security’ was largely not prioritised domestically.

CSOs have a vital role in advocating for nutrition, supporting governments to deliver effective nutrition action, and directly providing nutrition interventions.

Civil society organisations have stepped up through a range of commitments that showcase the diverse role they play in nutrition action.

• CSOs have a substantially stronger presence in 2021 compared to previous N4G summits. Their focus was on enabling actions (109 goals, 53%) followed by policy (62, 30%) and impact (36, 17%), going beyond advocating for and supporting nutrition action.
• CSOs’ advocacy role was largely reflected by their enabling goals. Supporting stronger ‘leadership and governance’ was fundamental, such as through cross-organisation and country partnerships and national nutrition plans. ‘Operational’ efforts, such as developing training and building capacity for food production and farming, were also high on the CSO agenda. Financial investments committed for nutrition interventions and plans were over US$567 million.
• Providing ‘nutrition care services’ was the focus of CSO policy actions (27, 44% of policy goals) such as wasting, stunting and anaemia treatment and vitamin supplementation programmes. Closely linked to that were impact actions to directly improve ‘undernutrition’ and ‘diet’ outcomes, such as stunting, low birth weight, as well as diet diversity and quality.

The private sector is an essential player, with the ability to help transform our food system and enable access to healthy, affordable and sustainably produced food.

Commitments from private sector businesses demonstrate the critical role they can play both for their workforces and improving the nutrition of the wider population.

• The private sector was represented by 23 food businesses and seven non-food businesses, mostly multinationals headquartered in high-income countries. They committed predominantly to policy actions (85, 79%) with global or multi-country reach targeting consumers and their workforce. Fewer actions were enabling (21, 20%) and just one was impact (1, 0.9%).
• There was a strong focus on adopting internal corporate policies. These aimed primarily at transforming the ‘food supply chain’ through food reformulation to improve the nutritional value of products, improvement of agricultural practices, increase of plant-based products and reduction of food loss and waste. The private sector further targeted the ‘food environment’ by expanding the healthy options for employees in cafeterias and providing workplace nutrition programmes.
• To create an enabling environment for nutrition within their companies, the private sector prioritised ‘operational’ actions, including training and educating their employees on how to prepare healthy meals and reduce food waste. Externally, businesses committed to ‘leadership and governance’ goals, such as joining global alliances. Their financial goals were about US$54 million.

Donors have a critical role to play in mobilising and providing financial investments required to achieve global nutrition targets and respond in periods of crisis.

Donors have committed more funding than ever before, with a third of this total to respond to the impacts of Covid-19, but there is a reliance on a relatively small number of actors.

• Donors were represented by donor governments (14), philanthropies (3), multilateral development banks (3) and international organisations (1). Their goals were mainly enabling (52, 85%), which encompasses financial investments. Only a few were policy (6, 10%) – focused on ‘food supply chain’ and ‘nutrition care services’ – and impact (3, 5%), focused on stunting and wasting.
• More than US$26.3 billion, the largest amount committed by donors across N4G summits, was pledged by nine donor governments and five donor organisations. Of this amount, more than US$8.2 billion was committed to address the impacts of the pandemic on food and health systems. All but one^[22] of these 14 donors were based in high-income countries in North America and Europe. Indicators used to track and report on financial spending varied, highlighting the lack of a standardised approach in monitoring finances for nutrition.
• Although financial investments are the primary focus for donors, their actions go beyond that. In fact, most of their enabling actions focus on leadership and governance, for example strengthening policy influence and partnerships in low and middle-income countries with the aim of advancing the implementation of nutrition-sensitive programmes.

International organisations are vital in setting agendas, promoting coordinated nutrition action across the globe, and championing action where it is needed most.

International organisations are demonstrating the important support and coordination role they play, focusing most on supporting governments to deliver effective nutrition actions.

• International organisations, comprising seven UN agencies, continue their key role in supporting governments in the global fight against malnutrition under the auspices of the UN Decade of Action on Nutrition. More than half (19, 56%) of their goals were enabling, just under a third (10, 29%) were policy and a few (5, 15%) were impact.
• UN enabling goals focused on strengthening ‘leadership and governance’ (15, 79%), with actions such as supporting the development of policies and programmes, enhancing public–private partnerships and developing environments that improve nutrition outcomes. Financial investments were made by one organisation and reached US$2.4 billion
• Of their policy actions, most (7, 70%) focused on enhancing ‘nutrition care services’. Examples of these efforts include improving the prevention and treatment services for undernutrition, such as wasting and micronutrient deficiencies, as well as supporting nutritional improvements among patients with NCDs. Less focus was given to impact actions aiming to address ‘undernutrition’, specifically stunting, wasting and anaemia.

1. We need a far broader constituency of actors to step up worldwide and make commitments to improve nutrition that can be accounted for.

• Given the global nutrition crisis we face, every actor should step up with unprecedented effort to tackle it, and there are some stakeholders that are not yet well represented in commitment-making.
• Higher income governments should see themselves as more than just donors and follow the example set by lower income countries. Far more should register commitments for their own populations, where poor diets, obesity and diet-related NCDs in particular are a significant and growing problem.
• Greater diversity of actors within the donor group is needed to ensure that funding decisions and allocations are based on an inclusive agenda and to reduce the vulnerability of the funding base they provide.
• There is also a clear gap for greater representation from within the private sector among smaller and national-level businesses that are minimally represented in commitment-making and yet have a unique and important role to play.

2. We need commitments to reflect sustained and increased external and domestic public and private financing for nutrition that can be easily tracked.

• The immense effort to deliver funding for nutrition action is clear and evident in commitments. Yet, the scale of the challenge we face means we are far from closing the financing gap required to end malnutrition.^[23] Commitments should reflect the level and range of actions we need.
• Commitments from governments, donors, CSOs and international organisations should be sustained, increased, and made ever more inclusive, not least through diversifying the funding base externally and domestically. In addition, stakeholders that can provide or leverage new and innovative forms of finance, such as the private sector, should step up and commit to action in this area in recognition of the need to mobilise untapped resources.
• Mobilising more finance to build nutritional resilience and equip actors to respond decisively in times of crisis is crucial, reducing both the immediate and long-term financial and human costs of crises on nutrition.
• Critically, we need transparent and consistent reporting of funding commitments and spending, so we have a far better understanding of how money is being spent, where it is going, and the return on that investment. Building consensus across stakeholders providing funding about how their data is reported and tracked should be key in such efforts. This is the only way we can enhance the impact of funding increasingly over time.

3. We need far greater attention on food security that truly includes nutrition security in commitment-making.

• The lack of commitments focusing on food and nutrition security across all stakeholders is worrying. It is a significant problem in both low- and high-income countries, impacting all forms of malnutrition, and exacerbated by recent crises including Covid-19 and the war in Ukraine.
• There is a clear need for far more actions that aim to increase food and nutrition security and go beyond calories to put explicit emphasis on nutrition. This should be complemented by screening of diet quality when assessing food security interventions. This focus is vital to ensure people are accessing sufficient levels of food that also promote wellbeing and prevent illness and disease.
• In doing so, such actions will equitably address hunger and diet-related diseases – bringing together historically siloed areas of attention, both of which disproportionately affect the most vulnerable communities and compound existing inequities.
• Commitment-making in this area can and should come from every stakeholder group and be supported by guidance and policies that address the current neglect of nutrition in food and nutrition security efforts.

4. We need commitments that will bring transformative policies for our food system and deliver universal access to healthy, affordable and sustainably produced food.

• To transform the food system, significant effort from all stakeholders is needed to improve the food environment and food supply chain, yet commitments currently in this area come predominantly from the private sector.
• Governments in particular should ensure they are overseeing and coordinating any action that impacts the food system, since this determines whether their populations are able to access and afford healthy diets that are sustainably produced. This includes developing and setting standards for the private sector as necessary for this to be achieved.
• Such policies are far ranging and far reaching from production to consumption, with the ability to impact diets and multiple forms of malnutrition at once. They include crop diversification and improving the nutrient profile of products through reformulation and fortification, through to subsiding school meals and regulating labelling, marketing and advertising practices.
• It is clear everyone has a part to play, and commitments should now reflect this with coordination and collaboration at the heart of implementation to ensure efforts are mutually reinforcing and deliver improved nutrition outcomes.

5. We need commitments that promote universal access to nutrition care services that are integrated in the health system.

• Nutrition services that are built into healthcare services – whether public or private – are vital to achieving the significant mutual benefits to be gained by integrating health and nutrition.
• This recognition in fact led to the World Health Organization highlighting that Universal Health Coverage cannot be achieved without the integration of nutrition services. That was reflected in UN agencies committing most of their policies on improving such services, with a focus on undernutrition.
• While CSOs have committed notable policy actions to nutrition care services, as have country governments, few (9%) commitment goals overall focused on nutrition care services.
• There is a clear need for more commitments from all stakeholders, particularly governments, to ensure nutrition is built systematically into their health systems. Policy commitments should capture the breadth of malnutrition burdens from undernutrition to diet-related NCDs focused on preventing and treating disease, including nutrition supplementation programmes, breastfeeding support and nutrition counselling.