Executive Summary Ending Malnutrition by 2020: an Agenda for Change in the Millennium Final Report to the ACC/SCN by the Commission on the Nutrition Challenges of the 21 st Century Members of the Commission Philip James, UK - Chairman Kaare R. Norum, Norway Suttilak Smitasiri, Thailand M.S. Swaminathan, India Julia Tagwireyi, Zimbabwe Ricardo Uauy, Chile Mahbub ul Haq, Pakistan (died 16 July 1998) February, 2000 We dedicate this report to the late Mahbub ul Haq, a member of our Commission who inspired us with his vision and reminded us that too often it is the lack of intellectual courage rather than the lack of wisdom which holds us back from reaching up to what the future could achieve i Ending Malnutrition by 2020: An Agenda for Change in the Millennium Richard Jolly, Chairman of the ACC/SCN played a pivotal role in supporting this initiative and substantial editorial help was provided by Sonya Rabeneck and her staff in the ACC/SCN Secretariat. Detailed research for the Commission was undertaken by Karen McColl, Ann Ralph and Nina Seres. Colette Backwell and Jean James provided additional help. This publication may be reproduced without prior permission of the Commission but please attribute to the Commission or to the ACC/SCN. The findings, interpretations and views expressed in this Report are entirely those of the Commission and do not imply endorsement, nor necessarily reflect official policy or positions of the member agencies of the United Nations ACC/SCN or its Secretariat. ii Executive Summary Ending Malnutrition by 2020: an Agenda for Change in the Millennium iii Ending Malnutrition by 2020: An Agenda for Change in the Millennium Executive Summary: Main Messages of the Commission Report To live a life without malnutrition is a fundamental human right. The persistence of malnutrition, especially among children and mothers, in this world of plenty is immoral. Nutrition improvement anywhere in the world is not a charity but a societal, household and individual right. It is the world community's responsibility to find effective ways and means to invest for better livelihood and to avoid future unnecessary social and economic burdens. With collective efforts at international, national and community levels, ending malnutrition is both a credible and achievable goal. The burden of malnutrition "This is completely unacceptable by any standards of human decency. We must do something right now to avoid this silent holocaust." (World Bank Vice-President, Ismail Serageldin, 1997) iv Executive Summary Elimination of undernutrition: a global deficit in policies and priorities Millions of underweight Prevalence (%) of preschool children underweight preschool children 200 30 Current IFPRI economic and 180 social policy projections based on existing mechanisms 160 140 20 120 100 Potential response on the basis of Thai World Food 80 experience Summit Goal 60 10 40 Opportunity Desired UN 20 lost with response with current policies amplified effort 0 0 1990 1995 2000 2005 2010 2015 2020 Note: If current trends continue, the International Food Policy Research Institute (IFPRI) predicts that the numbers of underweight (weight-for-age <-2SD) children less than six years will only drop to 150 million by 2020. The World Food Summit set a goal to halve the number of food insecure people in 1996 by 2015. In this diagram it is assumed that the number of underweight children should also be halved during the same time frame. If the World Food Summit goal were to be achieved, 84 million preschool children would still be underweight in 2015. Experience from Thailand shows what is potentially achievable with the benefit of political, social and organizational commitment. Thailand was able to reduce the prevalence of underweight from over 50% in 1982 to 10% in 1996. The diagram shows the same proportional change applied to the world’s underweight preschool children. The Commission suggests that with an amplified effort from governments and the UN system, eliminating underweight in preschool children by 2020 may be possible. The residual 2.5% reflects the accepted statistically derived lower cut-off point for normal growth in well-cared-for children from a reference population. VISION AND GOALS FOR THE FUTURE 1) lack of a locus within many countries for highly motivated academics and NGOs to interact with The Commission proposes a new paradigm of political leaders and decision makers and drive nutrition which incorporates the double burden of forward the nutrition agenda; undernutrition and diet-related adult disease. This double burden is amplified by the link between 2) frequent failure of health and agricultural maternal and fetal undernutrition and a sectors to combine forces to ensure coherent population’s susceptibility to adult diet-related plans of action; disease. This is displayed when food 3) within-country rivalries: these are often consumption and activity patterns change during amplified by the selective support of specific economic development. national programmes by NGOs, bilateral agencies The Commission’s vision requires an acceleration and UN organisations; in the development and implementation of national 4) the failure of some major financial institutions to and international strategies which will allow follow the World Bank initiatives which require societies and individuals to improve their life intersectoral measures to improve food security expectancy with minimum health handicaps from and human health when developing plans for these preventable disorders in middle and old age. economic reform and development; The International Conference on Nutrition and the 5) failure of political leadership in many countries World Food Summit embodied remarkable global to realise the possibilities of making rapid plans of action with new approaches to improvements by prioritizing nutrition when combatting undernutrition. Why has more not allocating national resources. been achieved? The Commission identified several factors: v Ending Malnutrition by 2020: An Agenda for Change in the Millennium The practical value and impact of existing goals In Thailand, a coherent national policy with explicit has already been shown. The main need is for actions and changes in governmental support for strong national action, often mobilised by the wide-ranging community-based improvements led catalytic efforts and support of one or more of the to remarkable declines in the prevalence of UN agencies and its field staff. Many of the preschool underweight. Maternal death rates also current goals relate to the year 2000; work is now fell by over 90%. This example shows that the needed to adapt and carry forward the goals into requirement for achieving rapid reductions in the 21 st century. undernutrition is purposeful action: a determined political commitment, clear goals, good strategic Until now the UN has considered nutritional and programme planning, sustained action, and deficiencies and “excesses” as separate. This is systematic monitoring within a physical and no longer sensible. The Commission recognises administrative infrastructure. To this must be that both dietary deficiency and adult chronic added a process of mobilizing the public at large. disease now affect developing countries as well as the developed world and Central and Eastern Costa Rica is another country which achieved Europe. The two sets of disorders are tremendous progress in a relatively short period of fundamentally linked through poor maternal time. This was brought about by a dramatic nutrition. increase in health services to cover a very large portion of the population, with emphasis on the Just as progress against malnutrition will require prevention of communicable diseases, on action in many sectors, supported by maternal and child health, water and sanitation, professionals from many disciplines, so most of and health education. These improvements were the main UN agencies must necessarily have a achieved rapidly within a democratic framework, role in reducing malnutrition on a global scale. A and serve as an inspiring challenge to other strengthened mechanism is needed at UN level to developing countries. ensure that its agencies can combine their best efforts. Table 1 summarises the recommendations The social and economic costs of poor nutrition of the Commission. are huge. Investing in nutrition makes good economic sense because it: reduces health care costs; reduces the burden of non-communicable RECENT PROGRESS AND SETBACKS diseases; improves productivity and economic growth; and promotes education, intellectual Over the last nine years, major international commitments have been made to reduce capacity and social development. undernutrition. These were articulated at the No economic analysis can fully encompass the World Summit for Children in 1990, the benefits of sustained mental and physical International Conference for Nutrition in 1992, and development from childhood into adult life. the World Food Summit in 1996. These Healthy adults with the physical capacity to Conferences emphasized the reduction of maintain high work outputs, and with intellectual undernutrition as part of a broader strategy to ability to flexibly adapt to new technologies, are a eliminate poverty. Each Conference also huge national asset. emphasized the vital role of the UN family, and Until 1997, many developing countries were goals were seen as a focus for collaboration benefiting from both reductions in poverty and an among the agencies and organisations involved in