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Nutrition in Universal Health Coverage WHO/NMH/NHD/19.24

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Nutrition in Universal Health Coverage WHO/NMH/NHD/19.24 Nutrition in Universal Health Coverage WHO/NMH/NHD/19.24 © World Health Organization 2019. Some rights reserved. Suggested citation: Nutrition in universal health coverage. Geneva: World Health Organization; 2019 (WHO/NMH/NHD/19.24). Licence: CC BY-NC-SA 3.0 IGO. Cover design and layout: Alberto March (Barcelona, Spain) Photo credits cover: ®Ingimage Printed in Switzerland 2 Nutrition in Universal Health Coverage Acknowledgements his brief was produced by the World Health Organization (WHO) Department of T Nutrition for Health and Development, under the leadership of Francesco Branca, with valuable inputs from (in alphabetical order): Evelyn Boy-Mena, Lenio Capsakis, Luz Maria De-Regil, Marie Durling, Kaia Engesveen, Dorit Kjaer Erichsen, Diana Estevez, Habtamu Fekadu, Jessica Chi Ying Ho, Emma Feutl Kent, Lawrence Grummer-Strawn, Nadeem Hasan, Penny Howes, Dan Irvine, Lina Mahy, Genevieve Moseley, Juan Pablo Peña-Rosas, Anne Peniston, Ellen Piwoz, Katherine Richards, Kuntal Saha, Karin Stenberg, Niisoja Torto. ®Ingimage ® Ingimage Nutrition in Universal Health Coverage 3 Key messages Good nutrition is a basic need, a human right and is fundamental to health and well-being. Universal health coverage cannot be achieved without ensuring everyone has access to quality nutrition services. Malnutrition in all its forms increases the risk of disease and death. More than half of deaths in children under 5 years of age, and one in five adult deaths worldwide can be attributed to dietary risk factors. The cost of addressing malnutrition and nutrition-related diseases is significant, but losses to the wider economy are even larger, amounting to almost US$ 3.5 trillion annually. Business as usual is no longer an option. Many nutrition interventions are highly cost-effective to prevent disease and reduce mortality and should be a central part of all comprehensive health systems. Essential nutrition actions benefit the poorest, most vulnerable and marginalized populations and are, therefore, critical to fulfilling the promise of the 17 Sustainable Development Goals, leaving no one behind. Primary health care is an important platform to achieve universal health coverage. However, essential nutrition actions are required at multiple levels of health service delivery, including secondary and tertiary care. Governments and partners are encouraged to make policy and financial commitments to more fully integrate nutrition interventions into national health systems, as an important component for achieving quality universal health coverage. Concrete measures are proposed to integrate nutrition-related actions into national health systems, to improve the coverage and quality of essential nutrition actions. Coherent multisectoral action is required to make meaningful progress towards achieving the nutrition- and health-related Sustainable Development Goals, especially to make universal health coverage a reality. 4 Nutrition in Universal Health Coverage Call to action © World © World Bank Nutrition in Universal Health Coverage 5 ® WHO ®Ingimage rti.org downs-syndrome.org.uk ® Dazzle Jam ® Dazzle Jam 6 Nutrition in Universal Health Coverage introductionIntroduction ood nutrition is fundamental for achieving the right to health, embodied in G article 25 in the Universal Declaration of Human Rights (1). No country can achieve universal health coverage (UHC) without investing in essential nutrition actions, and good nutrition for all cannot be achieved without UHC. UHC is achieved when all people receive the quality health services they need without suffering financial hardship. Out-of-pocket payments for health services push 100 million people into extreme poverty every year (2). Suboptimal diet is the single largest driver of morbidity and mortality in the world, more than tobacco smoking or high blood pressure (3). Malnutrition in all its forms significantly increases the risk of infectious diseases such as pneumonia, diarrhoea, measles and tuberculosis; noncommunicable diseases such as heart disease, cancer and diabetes; and Actors from every maternal and neonatal deaths (4). The cost of treating sector have a malnutrition and nutrition-related diseases is significant, but critical role to losses to the wider economy are even larger, amounting to play in supporting almost US$ 3.5 trillion annually (5). Thus, integrating essential governments to nutrition actions into health systems is foundational to deliver on UHC meeting people’s health needs and achieving UHC. plans Building on the 2019 High-Level Meeting on Universal Health Coverage, political leaders around the world will gather at the 2020 Global Nutrition Summit, to discuss new financial and policy commitments for nutrition and UHC. As we are in the middle of the United Nations Decade of Action on Nutrition (2016–2025) (6), this is a historic opportunity to accelerate action on nutrition and transform health systems towards the integration of essential nutrition actions, delivering on the promise of people-centred health systems for UHC. We must seize this opportunity to ensure nutrition is part of the discussion on health policy and financing. The clock is ticking, and the time to deliver on the promises of the 2030 Agenda for Sustainable Development (7) is now. Nutrition in Universal Health Coverage 7 Malnutrition is real, is every where and has consequences alnutrition is a significant problem in every country. Nearly one in three people around M the world has at least one form of malnutrition (8). Despite continuous improvements in health outcomes and economic development, rates of malnutrition remain unacceptably high and progress towards reducing its burden is too slow. Part of the reason for this is that nutrition has not been systematically addressed in health systems. There are three key characteristics of malnutrition: 1 It can take many forms, namely 2 It is ubiquitous, as malnutrition undernutrition (including wasting, in all its forms can be found stunting and micronutrient everywhere and often coexist deficiencies) and overweight, within individuals, households, obesity or diet-related communities and countries. noncommunicable diseases (8). This is referred to as “the double burden of malnutrition” (see Fig. 1). 3 It has immediate, lifelong and intergenerational consequences, jeopardizing the development of people, communities and nations. A child with severe acute malnutrition is nine times more likely than a well-nourished child to die from common infections such as malaria, pneumonia or diarrhoea (13). Stunting before the age of 2 years is associated with poorer cognitive and educational outcomes in later childhood and adolescence. It has been estimated that adults who were stunted in childhood earn up to 20% less compared to their non-stunted counterparts (14). Rates of overweight and obesity worldwide have increased sharply in recent decades. From 1975 to 2016, there was a tenfold increase in overweight and obesity among children and adolescents (10). The prevalence of adult obesity has nearly tripled over the same period, with close to 2 billion adults now overweight or obese, contributing to 8 Nutrition in Universal Health Coverage Malnutrition is real, is every where and has consequences Good nutrition is 4 million deaths per year and the loss of 120 million healthy imperative for all. years of life across the globe (10, 15, 16). It protects from illness, shortens the Children who are overweight or obese are at a higher risk of recovery time and developing type 2 diabetes, high blood pressure, asthma and reduces the risk of other respiratory problems, sleep disorders and liver disease death. later in life (17). In any of its forms, malnutrition affects the health and well-being, physical and cognitive development, and productivity of people, impacting the overall economic development of countries. Fig. 1 illustrates the double burden of malnutrition worldwide. Fig. 1. The double burden of malnutrition Sources: Data for children under 5 years of age for 2018, from reference (9); other data for children aged 5–9 years, adolescents and adults for 2016, figures were calculated based on data in reference (10) and as featured in reference (11); and data on women with anaemia are from reference (12). Nutrition in Universal Health Coverage 9 Universal health coverage is essential to ensuring healthy lives and promoting well-being for all at all ages niversal health coverage means that all people can use the health services they need U – promotion, prevention, treatment, rehabilitation and palliation – services that are of sufficient quality to be effective and do not expose people to financial hardship (18). UHC embodies three related objectives: 1 2 3 equity in access to the quality of health people should be health services – services should be protected against everyone who needs good enough to financial risk, services should get improve the health ensuring that the cost them, not only those of those receiving of using services does who can pay for them; services; and not put them at risk of financial harm. UHC is the cornerstone to achieving the The concept of universal health health-related Sustainable Development coverage is rooted in the belief that Goals, including SDG2 and SDG3 (19). the highest attainable standard of Many national governments view progress physical and mental health towards UHC as a guiding principle for is a fundamental the development of health systems, and human right human development more broadly. 10 Nutrition in Universal Health Coverage
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