Why equity is critical to tackling malnutrition
Harpinder Collacott and Charlotte Martineau explore how equity in food and health systems is crucial to reducing inequalities in nutrition outcomes.
Yesterday, the launch of the 2020 Global Nutrition Report placed the importance of promoting equity within our health, food and financial systems at the centre of the debate on tackling malnutrition. This report could not come at a more critical juncture, as we face a global pandemic which seems to be affecting lower socioeconomic groups and minority populations at a disproportionately higher rate.
The Global Nutrition Report’s focus on equity
As the world’s leading independent assessment on the state of malnutrition, the Global Nutrition Report provides the best available data and in-depth analysis on who is most affected, where they are and what is holding them back. This year’s report focuses on equity, shining a light on the structural issues within societies which perpetuate inequalities in nutrition outcomes for specific groups. Examining data on sociodemographic characteristics such as geographic location, age, sex, education and wealth, the report confirms that access to healthy, affordable food, quality health and nutrition care is hindered by unjust systems and unfair processes which impact the everyday living conditions of all and disproportionately affect some of the poorest people in the world. As stated in its foreword:
“Inequity is a cause of malnutrition – both undernutrition and overweight, obesity and other diet-related chronic diseases. Inequities in food and health systems exacerbate inequalities in nutrition outcomes that in turn can lead to more inequity, perpetuating a vicious cycle”
Evidence of this vicious cycle and its devastating impact has never been more apparent. The report’s foreword also highlights how coronavirus disproportionally impacts already vulnerable populations and those who are malnourished: undernutrition affects the immune system, leaving people more susceptible to severe illnesses, while overweight and obesity put them in a high-risk category.
Slow and unfair progress to address malnutrition
Progress on addressing malnutrition in all its forms has been too slow and unevenly distributed. New analysis in this year’s Global Nutrition Report shows that global and national patterns mask significant inequalities within countries and populations, where progress varies significantly, with the most vulnerable groups most likely to be left behind from national level progress. For example, the data in the report’s second chapter clearly shows that stunting and wasting prevalence is higher among children in rural areas and with less educated mothers, whereas the reverse is seen for overweight. Nutrition outcomes also vary substantially across countries. Unfortunately, data gaps particularly on ethnicity and disability, which limit the analysis which could be conducted, prevent a deeper understanding of nutrition inequalities.
Addressing challenges within the health and food systems is critical for success
The coronavirus pandemic has further exposed the weakness of health and food systems which were already under tremendous strain due to global stresses such as climate change and population growth.
The global food system has had to adjust at speed in the last 50 years to the needs of a fast-growing global population. Now, four fifths of the world’s food is produced outside of the country in which it is consumed and food supply is predicted to need to increase by 50% over the next 30 years to meet demand.
As a result, food systems are being tested. The impact on food supply chains, economies and livelihoods are only just beginning to become apparent. What is clear is that the current food system does not enable people to make healthy food choices. The reasons behind this are complex and have as much to do with agricultural production as they do with food availability, affordability, increasing sales of ultra-processed food and marketing campaigns. As a result, hunger and undernourishment remains persistently high in Africa, West Asia and Latin America, while 113 million people across 53 countries experience acute hunger, due to conflict and food insecurity, climate shocks and economic turbulence, and at the same time overweight and obesity is increasing across the world.
Furthermore, the poor diets and increased levels of malnutrition in all its forms – the leading cause of ill-health and deaths – are placing a heightened demand on health services. Yet nutrition care services are often limited to undernutrition and are rarely delivered by skilled nutrition professionals. For example, as shown in the executive summary, in 2017 only about a quarter of the 16.6 million children aged under five with severe acute malnutrition received treatment. Health spending in some of the poorest countries also remains low; in 2019, 64 developing countries spent more on debt service than on health.
It is urgent to act now
Addressing the barriers identified by the Global Nutrition Report which hold back millions of people from accessing nutritious, healthy and desirable diets and nutrition care is critical to achieving SDG 2 and building the resilience of people everywhere. The report highlights a number of actions which can and should be taken, but the three that stand out for me are:
- When investing in nutrition needs, we need to invest in those who need it most; only by targeting resources will the inequity within the system be circumvented and positive results achieved.
- Tackling inequity in the food system is critical to improve access to and affordability of nutritious healthy and sustainable food for all; and this will require changes in the way food is produced to how it is marketed and made available.
- Only by fully integrating nutrition into the wider health system, to ensure prevention and cure as well as ensuring health and nutrition care universally accessible to all, can malnutrition be effectively tackled.
The 2020 Global Nutrition Report emphasises the need to act now. With only five years to reach the global nutrition targets set by the World Health Assembly, and less than ten years to achieve SDG2, coronavirus is a wake-up call: action is more urgent than ever. Solutions exist, we must all be prepared, ready to invest, coordinated and transparent about progress and held to account for commitments made.
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