Conclusion: Critical steps to get nutrition on track

This year’s Global Nutrition Report shows advances in policy and actions, commitments and financing, and data collection and analysis, while also highlighting the immense challenge of tackling malnutrition in all its forms. The past five years have seen some gradual but welcome progress on nutrition. Through advances in data, we know more than ever about the burden of malnutrition but also which interventions are starting to be effective and where. Yet progress in translating that knowledge into coherent global progress is not as fast as it could be. For example, only 37 countries are on course to meet the global nutrition targets for wasting, 38 for childhood overweight and 24 for childhood stunting. While progress is being made in reducing childhood stunting, the decline is slow across the world, decreasing from 32.6% in 2000 to 22.2% in 2017.

Better data allows us to track where nutrition is improving and where progress is stagnating. More detailed and disaggregated data is transforming our understanding. We now know far more about how malnutrition affects different genders, ages and places. More data has revealed how important is it to invest in adolescent nutrition, particularly for girls and young women, and to consider all life stages when addressing malnutrition. Data on the coexistence of stunting and wasting in young children, and the different forms of malnutrition that exist in situations of protracted crisis, demonstrates the need to strengthen the humanitarian–development nexus.

New data shines a light on dietary intake and the impact diets have on disability and death. It shows how healthy diet policies, such as sugar-sweetened beverage taxes, are starting to work – and that an intensive, comprehensive approach can produce positive change in what infants and adults eat.

Early indications suggest that some governments in low and middle-income countries are increasing domestic spending on nutrition, and the importance of integrating humanitarian and development approaches to address malnutrition during crises is starting to be recognised. Innovative new approaches are being taken to involve young people in research and programmes designed to improve adolescent nutrition.

Donors have exceeded their collective commitment made at the 2013 Nutrition for Growth (N4G) summit of at least US$19.6 billion by 2020. Yet overall financing – particularly in the form of nutrition-related official development assistance (ODA) – remains inadequate. This is despite new financial and non-financial commitments made at the Milan Global Nutrition Summit in 2017.

While these advances are a positive sign, driving down malnutrition in all its forms is proving stubbornly difficult. While almost half of countries assessed are on course to meet at least one of the global targets on maternal and child nutrition, obesity and non-communicable diseases (NCDs), no country is on course to meet all and only five are on course to meet four. Nearly a quarter of children under five years of age, 150.8 million, are stunted, 50.5 million children under five are wasted and 20 million newborn babies are estimated to be of low birth weight. At the same time, 38.3 million children under the age of five are overweight. At least 124 of 141 countries struggle with overlapping burdens, while millions of children under the age of five suffer with coexisting forms of malnutrition. More than 2 billion adults are overweight or obese. Micronutrient deficiencies affect a significant number of people although data and information on micronutrient status remains weak. Malnutrition and diet-related NCDs are still the leading causes of disability and death globally. It is clear then that while we have seen progress in some areas, it is happening far too slowly and too inconsistently. Levels of malnutrition are still unacceptably high.

However, ending global malnutrition is within our reach. In fact, we have never been better placed to do it; we have more knowledge and more data than ever before, and stakeholders around the globe have shown the desire to see real progress. But we must act now if we are to prevent a reversal in the progress that has already been made, and this will require some critical steps to tackle the challenges we face.

The findings of the 2018 Global Nutrition Report indicate that five critical steps are needed if we are to take advantage of our knowledge and deliver concrete action on malnutrition before it is too late. These critical steps are not new ideas – but they are worth repeating year on year as the data continues to show just how important they are if we are to truly make things better.

1. Break down silos between malnutrition in all its forms.

Different forms coexist and need integrated approaches. All stakeholders must take a more holistic view of malnutrition.

The data shows that all stakeholders, governments, donors and nutrition and non-nutrition communities need to shift mindsets and embrace the need to address the full range of nutritional problems in local and national contexts if we are to meet the 2030 target of ending malnutrition in all its forms. Every government needs to prioritise and allocate resources based on a robust assessment of the different forms of malnutrition (including stunting, wasting, obesity and micronutrient deficiencies) and how these overlap and coexist. This must also involve systematic data collection by researchers and academia on how many people experience more than one form of malnutrition. Governments and the nutrition community should assess if existing actions targeted at one form of malnutrition could address other relevant forms too. Furthermore, they should identify ‘double duty’ actions that could reduce the risk of growing overweight and obesity while also tackling forms of undernutrition. Actions are needed that address the common causes of wasting and stunting among young children. The gap in understanding how micronutrient deficiencies overlap with all other forms of malnutrition must be filled. Siloed working cannot remain the norm – working across nutrition and non-nutrition communities is essential to addressing the inefficient use of scarce resources and unacceptable numbers of people at risk of multiple burdens of malnutrition.

2. Prioritise and invest in the data needed and capacity to use it.

Designing actions that result in impact is impossible without adequate knowledge of who is affected by malnutrition and why.

Without good data, we’re just guessing. We need to scale up the collection and use of more data and through this learn about what is driving change. This will help us identify where action is most needed and what is contributing to progress. In particular, disaggregated data – by geography, socioeconomic status and gender – and increased use of and increased use of geospatial and disaggregated subnational data, mean we can better understand where the burden of malnutrition lies, how it has changed, why it exists and what this means for reaching nutrition targets. Governments and research, multilateral and academic institutions must increase capacity to carry out data collection and analysis, and improve coverage and frequency of the collection of disaggregated data. They also need to make it easy to use and interpret by policymakers, businesses and NGOs who are making decisions about what to do next. The gap in micronutrient data urgently needs to be filled, and more and better data is needed now to stimulate investment and action to address malnutrition in adolescence. Building on potentially innovative work with adolescents, there is scope to increase the collection and use of qualitative data from people who experience malnutrition to help design more effective action. We need to consolidate progress on reporting on nutrition financing to ensure spending is going to the right places and having the best impact.

Increasing the quantity and quality of data on financing requires ODA donors to use the new Creditor Reporting System (CRS) code and policy marker for nutrition spending to enable better tracking of funding, and national governments to open up data on domestic budget spending. The gap in data on funding of obesity and NCDs requires immediate action too.

3. Scale up financing for nutrition – diversify and innovate to build on past progress.

Ultimately we cannot make progress without adequate funds, and those who control resource flows need to prioritise nutrition.

Funding needs to be focused on ensuring nutrition plans are delivered in practice. This requires scaling up and expanding existing national and international investments to address all forms of malnutrition. Clear targets need to be set for domestic expenditure according to the burden of disease, and governments supported to increase spending against targets to drive progress. Although some aid donors have made nutrition a key focus, ODA funding is nowhere near enough to end malnutrition in all its forms – so investments for nutrition-specific and sensitive programmes need to strengthen. ODA donors also need to ensure humanitarian and development investments are providing continuity of nutrition support in the countries in crisis with some of the highest burdens of malnutrition. Nutrition finance needs to be delivered at scale to meet the challenges. Innovative mechanisms are urgently needed to supplement government finance.

4. Galvanise action on healthy diets – engage across countries to address this universal problem.

The poor quality of diets among infants, young children, adolescents and adults is unacceptable.

With malnutrition having such a universal and devastating impact, there is a role for all sectors in improving the quality of the world’s diets. Governments must step up to implement a comprehensive package of effective policies and programmes to enable and encourage everyone to adopt healthy diets. They must incentivise change by the private sector while guaranteeing transparency when conflicts of interests arise. The private sector must redouble its efforts to increase the availability of a wide array of foods that contribute to healthy diets and reduce foods high in fats, sugars and salt. Both governments and business must create food systems and environments that deliver affordable, accessible and desirable healthy diets for all. There are opportunities for the lead taken by communities, cities and city networks to be scaled up. International action to ensure shared learning and mutual support is vital to tackle this universal problem.

5. Make and deliver better commitments to end malnutrition in all its forms – an ambitious, transformative approach will be required to meet global nutrition targets.

Concerted efforts to tackle malnutrition will only continue if signatories consistently deliver against SMART (specific, measurable, achievable, relevant and time-bound) commitments.

The road to the N4G 2020 Summit in Tokyo, Japan, offers a chance to respond to the challenges and opportunities presented by the data in this year’s Global Nutrition Report. New commitments to improve the state of malnutrition have been made through the UN Decade of Action on Nutrition of 2016–2025, the Milan Global Nutrition Summit in 2017, and the 2018 UN High-Level Meeting on NCDs. The N4G 2020 offers the next opportune moment for renewed commitments to expedite action to end malnutrition. However, lessons must be learned from the N4G commitment process. With only two years to go to reach N4G commitments, reporting rates have declined alarmingly across all sectors – down from 90% in 2014 to just 45% in 2018. This trend threatens accountability. Furthermore, too many N4G commitments still lack targets for measuring progress – we need stakeholders to be empowered and accountable through specific, measurable, agreed on, realistic and time-bound targets. The commitments need to be relevant to where the burdens lie and based on the evidence we have about what forms of malnutrition need to be addressed, where, when and for whom.