Implementing recommendations in the real world

The recommendations in this report are based on a strong and converging body of academic evidence. They reflect what is known to improve nutrition outcomes, build resilience and connect food systems with climate and equity goals. However, it is important to acknowledge the significant and evolving changes within the global context for implementing these recommendations.

Official development assistance from the Organisation for Economic Co-operation and Development’s Development Assistance Committee members declined by approximately 9% in 2024, with a further 9% to 17% reduction projected for 2025.^[1] The four largest donors, France, Germany, the United Kingdom and the United States, are cutting development budgets simultaneously for two consecutive years. Cuts equivalent to 44% of donor support for the World Health Assembly nutrition targets are projected to deprive 2.3 million severely malnourished children of treatment and cause an estimated 369,000 additional child deaths per year.^[2] The World Food Programme expects 40% less funding in 2025.^[3] As this report has emphasised throughout, nutrition programmes depend on simultaneous delivery across health, food, social protection and data systems. The integrated platforms critical for resilience to shocks (Chapter 2) are the most vulnerable to cross-sectoral defunding. Misaligned financing architectures and donor dependency, as analysed in Chapter 6, compound this vulnerability: when nutrition funding flows through fragmented, externally dependent channels rather than integrated domestic systems, cuts in any single funding stream can disrupt delivery across multiple sectors simultaneously.

The current situation supports the analysis presented in this report. When nutrition commitments rely primarily on externally funded, short-term projects, cuts in official development assistance translate directly into programme collapse. The current moment confirms that transformation cannot depend solely on expanding the range of donors; it must centre on strengthening national institutions, reallocating existing resources and deepening integration across sectors.

In times of fiscal constraint, the focus should shift from expansion to prioritisation. The systemic fragmentation (Chapter 6) and the gap between procedural and substantive accountability become starker when resources shrink. Procedural commitments, even if SMART and well documented, are insufficient unless embedded within stable financial and institutional frameworks. This requires identifying interventions that generate co-benefits across nutrition, climate adaptation and livelihoods. Redirecting even a fraction of the approximately US$540 billion in annual agricultural subsidies towards increasing the availability of nutrient-dense foods, embedding nutrition within routine primary healthcare and social protection systems and strengthening food environment regulations are more financially viable than creating entirely new programmes. Priority measures include taxes on unhealthy products, subsidies for healthier foods, reformulation of packaged foods, trans-fat elimination, front-of-pack labels and restrictions on marketing unhealthy foods to children.^[4]

Political resources are also scarce. Governments are managing inflation, debt, climate shocks and geopolitical instability. Nutrition risks are being treated as discretionary unless they are framed as essential to economic productivity, health system sustainability and climate resilience. Embedding nutrition commitments within medium-term expenditure frameworks, national climate strategies and social protection reforms increases their political durability and reduces the likelihood that nutrition is treated as an optional add-on vulnerable to cuts. Implementation may also need to be more incremental than ideal models suggest. More achievable pathways may include phased reform of subsidy structures, pilot programmes for integrated food, health, and climate action at the subnational level and stepwise strengthening of monitoring systems.

Where fiscal space is most constrained, sequencing should favour entry points that deliver the highest co-benefits at the lowest political and administrative cost. Integrating nutrition into existing primary healthcare platforms (e.g. through life-course counselling, micronutrient supplementation and growth monitoring within routine antenatal, postnatal and child health contacts) builds on infrastructure and workforce already in place and avoids the start-up costs of new programmes. Similarly, strengthening nutrition components within established social protection systems, such as adding dietary diversity criteria to school feeding or linking cash transfers to nutrition messaging, can improve dietary quality at marginal additional cost. Regulatory measures that reshape food environments, including front-of-pack labelling, restrictions on marketing unhealthy foods to children and trans fat elimination, require political commitment but relatively modest public expenditure and can generate fiscal returns through health taxes on sugar-sweetened beverages or other unhealthy products. These entry points contrast with more complex reforms, such as large-scale subsidy restructuring or the creation of new cross-ministerial governance bodies, which may yield greater systemic impact but require longer lead times, broader coalitions and sustained political capital. A practical sequencing strategy would therefore begin with integration into existing delivery platforms and low-cost regulatory action, use early gains to build political credibility and institutional capacity and phase in structural reforms as conditions allow.

A final reality check concerns the cost of inaction. Cutting nutrition funding does not eliminate risk but compounds it. Climate shocks, food price volatility and the rising prevalence of diet-related diseases generate substantial long-term economic costs. Withdrawing preventive and nutrition-sensitive programmes may ease budgets in the short term but will increase later expenditure on healthcare and lost productivity. For every dollar invested in addressing undernutrition, a return of US$23 is expected.^[5]

The current situation does not alter the strategic direction set out in this report. The recommendations remain valid, but their successful implementation requires sharper prioritisation, strong domestic policies and sequencing that is firmly grounded in political feasibility.

Within this context, the Food and Health for Equitable Nutrition (FHEN) Framework proposed in this report is intended to support the shift from diagnosis to implementation. It can be used to improve the design of N4G commitments by requiring clearer links between objectives, financing, delivery systems and accountability. It can also inform donor and development bank financing decisions by making cross-sector coordination, resilience provisions and equity measures part of funding conditions. However, better-designed commitments are a starting point, not an endpoint. The framework’s greater value lies in its application to national planning processes, including NAPs, NDCs, health strategies and social protection reforms, where it can help identify where responsibilities sit, which trade-offs need to be managed and which delivery systems need to be financed. Ultimately, the test of the framework is not whether it produces more integrated commitments, but whether it supports more integrated action: durable budget lines, functioning coordination across ministries, delivery platforms that reach those most at risk and systems that maintain essential services when shocks occur.