The vision of the Sustainable Development Goals (SDGs) is an integrated, indivisible system for development. In order to maximise the opportunity offered by this vision, it is critical that we transform our ways of working to ensure greater cooperation across the goals.
Improved nutrition is both a result and an enabler of achieving this vision. But we have not yet fully seized the opportunity of concerted actions to achieve change. Ending malnutrition in all its forms will catalyse improved outcomes and have powerful multiplier effects across the SDGs. It will reduce both the incidence and severity of disease and decrease the burden on the health system. Likewise, progress across the SDGs is essential to address the causes and consequences of malnutrition.
In the Global Nutrition Report in 2017, we showed that the SDGs encompass five broad areas that are critical to achieving positive nutrition outcomes:
- Sustainable food production is key to ensuring that our land and waters are resilient and can support the diversity, quality and availability of food needed to provide nutritious and healthy diets for all.
- Strong infrastructure systems are needed to deliver clean water, sanitation, energy and food essential for nutrition to urban, peri-urban and rural settings.
- Health systems are vital to provide preventative interventions and treatments for improved nutrition at scale; ensuring optimal nutrition early in life means better brain development for future generations that is essential to ensure economies can innovate and flourish.
- Equity and inclusion are essential to ensure efforts to address poverty, gender inequality, education and protections in the workplace deliver universal outcomes for nutrition; when vulnerable populations are better nourished, they become empowered to improve their status, reducing economic, gender and social inequities.
- Peace and stability are necessary preconditions to ending hunger and preventing conflict-related food insecurity; in an increasingly unstable world, addressing food and nutrition insecurity and famine can greatly alleviate the effects of conflict and support post-conflict recovery.
The environment–health–nutrition nexus
Integrating high-impact nutrition interventions into health services is vital to speed up progress. Such interventions include promoting infant and young child feeding, supplementation, prevention and treatment of malnutrition in all its forms, nutrition counselling and screening for dietrelated non-communicable diseases (NCDs) in patients. Yet we are not using the opportunity that the health system offers for delivering nutrition interventions where they are critically needed – for example, only 5% of children aged 0–59 months who need zinc receive it. The World Health Organization guidelines for NCDs include several nutritional interventions, but a significant number of countries have not implemented them. A focus on essential nutrition actions with substantive evidence within health systems will contribute to improvements in maternal, adolescent and child health and nutrition, whilst providing opportunities to achieve universal health coverage.
Sustainable food production is essential for a healthy planet and healthy people. The food chain is responsible for up to one-third of global greenhouse gas emissions, while agriculture is the second-largest cause of outdoor air pollution. The challenges of climate change and increased energy costs faced by agricultural systems today result in a depletion in the nutritive value of foods tomorrow. As global temperatures increase, higher levels of CO2 will reduce the micronutrient content of major crops, such as wheat, consumed by much of the world. Unsustainable fishing threatens 17% of the world’s protein and an essential source of micronutrients. The inclusion of comprehensive food system responses in climate change policies vastly increases the potential to adapt and mitigate the worst effects of climate change. For example, more resource-efficient agricultural practices can help farmers adapt to change, sustain their livelihoods and reduce greenhouse gas emissions from farm activities.
Across all the areas of the SDGs there are opportunities for ‘double-duty actions’, which tackle more than one form of malnutrition at once and can simultaneously address undernutrition, obesity and diet-related NCDs. Doubleduty actions increase the effectiveness and efficiency of investments in time, energy and resources to improve nutrition. For example, vertical programmes delivered through health systems often focus exclusively on undernutrition, yet opportunities exist to integrate obesity and diet-related NCD prevention into universal health care packages, such as nutritional counselling, treatment and monitoring.
Likewise, ‘triple-duty actions’ that tackle malnutrition and a host of other development challenges in parallel could yield multiple benefits across the SDGs. For example, diversification of food production landscapes can provide the basis for a nutritious and sustainable food supply essential to address malnutrition in all its forms. This same action can help reduce the incidence of diet-related diseases and empower women to become innovative food value chain entrepreneurs, while minimising their work and time burden. Scaling up access to efficient cooking stoves can improve households’ nutritional and respiratory health, save time, preserve forests and associated ecosystems, and reduce greenhouse gas emissions. Urban food policies and strategies can be designed to reduce greenhouse gas emissions, food waste, food insecurity and poor nutrition.
Co-benefits of integrating nutrition across the SDGs
Opportunities for achieving the SDGs through greater interaction and cooperation across the sectors are vast. Better integration of nutrition specific and nutrition-sensitive actions across the SDGs will speed up progress and increase our chances of achieving the SDGs. At the same time, sectoral priorities should not undermine the holistic and integrated vision of the 2030 Agenda and lead to business as usual. This requires us to map the connections across the SDGs, acknowledge where policies conflict, and transform our ways of working.
If you work in health systems, better nutrition means a lower burden on your health services. The health system needs to do a better job of providing a platform to deliver actions to reduce undernutrition. It can also provide services that help prevent and manage diet-related NCDs such as cardiovascular disease and diabetes.
If you work on climate change or protecting biodiversity, you will benefit if people eat diverse, nutritious diets. Such diets have lower environmental impact, decreasing the strain on natural resources and ecosystems essential for food production.
If you work in agriculture, better diets can increase markets for safe and nutritious foods while reducing the pressure on you to produce food using unsustainable methods.
If you work in education, better nutrition brings enormous improvements in the cognitive abilities and physical performances of children, contributing to their ability to do well in school. Improved school meal programmes can reduce undernutrition, ensure children are not unduly exposed to foods that increase the risk of obesity and provide income to farmers, while encouraging children to stay in school and continue to learn. Schools can also educate children on the importance of healthy diets to help them make healthier lifestyle choices.
If you work with governments, businesses and civil society, you should consider what the connections across the SDGs mean for the investments and commitments that you make and the actions that you take. Then, you can act by identifying one triple-duty action and make delivering it a priority.
Whoever you are, and whatever you work on, you can make a difference to achieving the SDGs and you can help to end malnutrition.