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Position Paper

A World Free from Hunger and Malnutrition

Food and Nutrition Security in the Post-2015 UN Development Agenda

The Global Alliance for Improved Nutrition (GAIN) is a global foundation which currently assists nearly 670m people facing malnutrition in over 30 countries. This short note sets out why and how we believe better nutrition should be integrated into global development priorities post 2015. Our major call is for Zero Stunting – eliminating the factors which blight the physical and mental development of children for ever - to be a new benchmark for global development success.

Severe food and nutrition insecurity continue to dominate the lives of a third of

humanity, and will become even more difficult to address due to the growing

complexity of global challenges, such as population growth, increasing consumer

demand from the growing middle class in developing countries, high and volatile

food prices, energy scarcity, urbanization, the new competition between food and

fuel, and climate change. The world faces an unprecedented challenge, which will

loom larger as the global population increases to 9 billion by 2050, and one, which

underpins the viability of all other development goals.

In parallel with food insecurity, global obesity rates are rising rapidly, including

among children under the age of 5,1 and will have significant cost implications for

health care systems and nations due to increased obesity related chronic diseases

and lost productivity. The prevalence of hunger and undernutrition, coupled with the

increasing incidence of obesity, known as malnutrition’s ‘double burden’, indicates

that systemic and structural challenges exist within our current global food and

health systems and will affect how we approach the prevention of malnutrition.

These challenges impact across every aspect of development. Addressing these

challenges will require smarter policy decisions in how we approach and finance

development’s priorities, and how we leverage markets to work better for the poor.

1 de Onis and Blossner. (2010) ‘Global prevalence and trends of overweight and obesity among

preschool children,’ American Journal of Clinical Nutrition, 2010, Sept 22.

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Scaled-up investments in science and technology, strengthened health systems

with better linkages to other sectors at the planning and community levels,

supported by international evidence-based technical guidance, and support for

improved country capacities are fundamental to accelerating progress and

achieving development objectives. Technological innovations such as

biotechnology, information and communication innovations, and biofortification, are

crucial to increasing agricultural productivity, building resilience to weather-related

shocks, enhancing the nutritional value of food crops, and ensuring food safety.

Innovative Partnerships to Deliver Impact

In response to the need to better integrate sectors in addressing malnutrition, the

Scaling Up Nutrition (SUN) Movement, a country-led, global effort to advance

health and development through improved nutrition, convened a diverse range of

public and private partners to drive the effort to reduce stunting and chronic

undernutrition. Innovative, country-led collaborations between governments, the

private sector, international organizations (including the United Nations), academia

and civil society are integral to the ‘Collective Impact’ approach to fighting hunger

and malnutrition that delivers sustainable impact at a scale that no single

organization can achieve alone.2

Equally important is working with a diverse set of partners on the ground – partners

who work all along the food value chain and understand the needs of the

community, who are embedded within the local or regional culture, and who can

leverage public and market-based channels for investment to ensure access to, and

consumption of, affordable and nutritionally adequate food. These efforts have the

potential to foster change on the ground, spurring innovation and entrepreneurship,

and create self-sustaining cycles of growth.

The post-2015 Development Agenda

A new global partnership should bring together a full range of stakeholders and

strike a balance between meaningful global commitments and the flexibility to

implement them at the global, regional, national and sub-national levels. Given the

changing development landscape, the post-2015 framework should emphasize the

interplay between prevention and treatment, while instituting a systems approach to

the development of solutions that build local capacity, integrate sectors where a

mandate for social impact is shared and roles in partnership are defined not by how

an organization is incorporated, but by opportunity and capacity tailored to context.

2 Hanleybrown, Kania, Kramer. (2012) ‘Channeling Change: Making Collective Impact Work’,

Stanford Social Innovation Review, 2012, Jan 26.

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Although progress has been made, two billion people in the world suffer from

various forms of malnutrition. Malnutrition is an underlying cause of death of 2.6

million children each year – a third of child deaths globally. 171 million children

around the world – 1 in 4, and 1 in 3 in developing nations – are chronically

malnourished, which leads to physical and mental stunting. If current trends

continue, this number could be as high as 450 million within the next fifteen years.

Undernutrition accounts for 11 per cent of the global burden of disease and is

considered the number one risk to health worldwide. Evidence also shows that

diets that provide inappropriate nutrition contribute to obesity and the slew of

attendant health problems, such as diabetes, heart disease, and cancer.

Poor and maternal and infant nutrition irreversibly damages not only the lifelong

mental and physical capacities of individuals, but also the growth of communities

and the economic performance of entire countries. Countries may lose two to three

percent of their Gross Domestic Product (GDP) as a result of iron, iodine, and zinc

deficiencies. Armed with this information, many governments and donor agencies

now agree that improving nutrition – particularly during the 1000-day period from

conception to a child’s second birthday when the impact is greatest – is the

pressing development issue of our time.

Recommendations: nutrition must be at the heart of the post-2015

development framework

As the post-2015 development agenda is shaped, it is clear that nutrition is

inextricably linked to health, livelihoods, and food security to deliver equity, capacity

development and economic growth. Nutrition is the foundation for development,

and addressing the challenges of its double burden of malnutrition is relevant to

poor and rich countries alike.

A focus on global improvement of nutrition will drive investment and prioritization for

the double burden of malnutrition that will have positive, far-reaching impact on

equity and economic development in all countries.

A broader, holistic approach is needed, as malnutrition is the ultimate expression of

systemic and cultural challenges in our global food and health systems. While a

health systems focus has allowed us to make significant gains, particularly in

reductions in some of the most severe consequences of malnutrition, it is too

narrow a mechanism to get us to significant reductions in malnutrition overall.

GAIN recommends that to have meaningful impact on the future of the international

development agenda and to guarantee food and nutrition security, improved

nutrition must become a specific focus in the post-2015 development framework,

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especially the nutritional status in the 1000 days window from conception to the age

of two, and tackling the scourge of stunting.

Zero stunting – a new and critical development goal

Because of the complex causal factors that determine good nutrition outcomes, it is

critical that a long-term approach is taken to streaming nutrition interventions across

broad development activities.

We therefore recommend that a post MDG framework identify a central, long-term

goal of eliminating stunting. Stunting is an indicator of chronic malnutrition, and is

important for understanding not only outcomes, but also the determinants of

maternal and child health. Furthermore, levels of stunting – both physical and

mental – strongly correlate with development, with stunting statistics a good

measure of success for development in general.

We propose this specific deliverable target of zero stunting as the best indicator of

whether the world’s children are getting the right start in life.

Measuring Progress for All

We also propose that the post-2015 framework also include a range of indicators

that have relevance, for both the agriculture and health fields and which can track

the rapidly changing trends toward the double burden of malnutrition, including

wasting, stunting, micronutrient deficiency rates, dietary diversity, and obesity rates.

Given nutrition’s multivariate nature, it is no longer useful to have only two

indicators for nutrition if we are to understand the implications of food insecurity and

poor eating practices.

The following indicators in addition to stunting should be measured for the

population as a whole:

Wasting, an indicator of acute malnutrition is needed to capture trends in

acute food insecurity situations such as war, drought and other emergency

situations.

Micronutrient deficiencies, both a nutrition and agriculture indicator is

needed to capture the measurable contribution of agriculture in addressing

malnutrition.

Childhood Obesity rates, a nutrition indicator, is useful to help to track the

growing trend of the double burden.

In addition, Dietary Diversity, a qualitative measure of food consumption,

reflects household access to a variety of foods and is also a proxy for

nutrient adequacy of the diet of individuals. It should be tracked as a

development indicator.