Undernutrition is one of the world’s most serious but least addressed public health challenges. Its human and economic costs are enormous, falling hardest on the very poor and on women and children. Read More »
Undernutrition is one of the world’s most serious but least addressed public health challenges. Its human and economic costs are enormous, falling hardest on the very poor and on women and children. In developing countries, nearly one-third of children are underweight or stunted (low height for age). Undernutrition contributes to one-third of all child deaths and increased frequency, severity, and duration of infectious disease.
Globally, undernutrition is more common when household income is low, and is associated, within households, with chronic food shortage, diets lacking in diversity, high rates of infectious diseases and inappropriate infant feeding and care due to lack of knowledge. Recent global food and financial crises have worsened undernutrition in many regions.
Those who experience undernutrition between conception and 24 months of age have a higher risk of lifelong physical and mental disability, and are often not able to make a full contribution to the social and economic development of their households, communities and nations when they become adults. Thus, the economic costs of undernutrition, in terms of lost national productivity and economic growth, are significant—ranging from 2 to 3% of GDP in some countries.
The main elements of the framework for action are:
1. Start from the principle that what ultimately matters is what happens at the country level. Individual country nutrition strategies and programs, while drawing on international evidence of good practice, must be country-“owned” and built on the country’s specific needs and capacities.
2. Sharply scale up evidence-based cost-effective interventions to prevent and treat undernutrition, with highest priority to the minus 9 to 24-month “window of opportunity” where we get the highest returns from investments. A conservative global estimate of financing needs for these interventions is $10+ billion per year.
3. Take a multisectoral approach that includes integrating nutrition in related sectors and using indicators of impact on undernutrition as one of the key measures of overall progress in these sectors.The closest actionable links are to food security (including agriculture), social protection (including emergency relief) and health (including maternal and child health care, immunization and family planning). There are also important links to education, water supply and sanitation as well as to cross-cutting issues like gender equality, governance (including accountability and corruption), and state fragility.
4. Provide substantially scaled up domestic and external assistance for country-owned nutrition programs and capacity. Ensure that nutrition is explicitly supported in global as well as national initiatives for food security, social protection and health, and that external assistance follows the agreed principles of aid effectiveness of the Paris Declaration and the Accra Agenda for Action. Support major efforts at the national and global levels for strengthening the evidence base—through better data, monitoring and evaluation, and research—and, importantly, for advocacy.
International Development Association (IDA) commitments from 2003 to 2013 provided more than 117 million people with a basic package of health, nutrition, or reproductive health services.
Country-level results include the following:
In Senegal, the Bank supports an innovative nutrition health program that operates at the community level in collaboration with local governments, district health authorities, and civil society organizations. National underweight malnutrition rates dropped from 22% in 2005 to 17% in 2012, bringing Senegal--among very few countries globally--within reach of achieving the MDG to halve the rate of malnutrition.
In Peru, strong government commitment, in addition to Bank and partner efforts in advocacy, operations and non-lending technical assistance, led to a reduction in stunting of 8.3%, from 27.8% in 2007/8 to 19.5% in 2011 (using WHO 2006 growth reference standards). This is among the fastest rates of reduction seen for stunting globally.
The Bank has been instrumental in advocating for food fortification as a cost-effective approach to improve nutrition. In Tanzania, for example, Bank research showed that food fortification would have a benefit-cost ratio of 8.22:1, leading to a government decision to make Tanzania the first country in East Africa to institute mandatory fortification of wheat flour, maize flour and edible oil.
The World Bank is an active member of the Scaling Up Nutrition movement, through support to various SUN countries and active participation on the SUN Lead group.