Breaking Nutrition out of the Echo Chamber

Breaking nutrition out of the echo chamber

Nutrition Narrative

Overarching story with a clear definition of what nutrition is, why it matters and how you take action

1. What is nutrition?

1. Why does nutrition matter?
2. Protection
3. Potential
4. Progress

1. How do we takeaction?

• Scale up what works
• Strong political leadership
• Improve accountability and track progress
• Guiding interventions

1. Core Narrative

1. Conversation Starter

1. Narrative Soundbites

1. What is nutrition?

1. What is nutrition?

Key messages

Good nutrition is:

• About ensuring mothers and children receive the vital ingredients they need to thrive, whether these come from a varied diet, breastfeeding, or supplementation.
• Not about how much food is available to consume, but rather about ensuring the right nutrients go into the body (e.g. breastfeeding), but also stay in (e.g. anti-diarrhoeal rehydration treatments).
• Put at risk by anything that prevents this process (e.g. infectious diseases like malaria can waste nutrients by hindering their absorption or diverting them to deal with high fevers).

1. Why does nutrition matter?

The narrative includes three supporting pillars that provide a clear, compelling starting point for conversations with our audiences on why this issue is important. These are building blocks that can be used flexibly – we may rely on one theme, or use a combination, differently for different audiences.

1. Why does nutrition matter?

Key messages

• Good nutrition enables the development of a healthy immune system, protecting children from the inside against illness, infection and disease, and ensuring better health outcomes throughout childhood and beyond.
• Breastfeeding babies and feeding our children foods with the right balance of nutrients provides them with the vital ingredients needed for a fully-functioning immune system that can protect them from illness, infection and disease.

Hope:

• If children are well nourished in the first 1,000 days from conception through to their second birthday, they can develop healthy, functioning immune systems and protect themselves from the threat of illness, infection and disease.

Jeopardy:

• Nearly half of all deaths in children under 5 are attributable to undernutrition. Children who are poorly nourished are more likely to get sick, and often die as a result. Without the right nourishment, their immune systems don’t develop properly and children are powerless to defend themselves against illness and infectious disease throughout their life.

Protection - Proof Points

• A child with severe acute malnutrition is nine times more likely to die from common infections (e.g. malaria, pneumonia, diarrhoea).[1]
• A severely stunted child faces a four times higher risk of dying, and a severely wasted child is at a nine times higher risk.[2]
• Nearly half of all deaths in children under five are attributable to undernutrition.[3]
• Breastfeeding within the first hour of life dramatically increases a baby’s chances of surviving infancy.[4] This first breast milk, or colostrum, contains vital antibodies to protect a baby against disease. It is rich in proteins, vitamin A and salt. It helps the development of the gut, reducing the incidence of diarrhoea.
• The scaling up of breastfeeding practices to almost universal levels is estimated to prevent 823,000 annual deaths, or 13.8 per cent of all deaths of children younger than 24 months in the 75 “Countdown to 2015” countries.[5]
• Approximately half of all diarrhoea episodes and a third of respiratory infections would be avoided by breastfeeding. Protection against hospital admissions due to these disorders is even greater: breastfeeding could prevent 72 per cent of admissions for diarrhoea and 57 per cent of those for respiratory infections.[6]
• Catch-up growth later in childhood is minimal – the damage caused is largely irreversible. Evidence from 54 low- and middle-income countries indicates that growth deficiencies begin during pregnancy and continue until about 24 months of age.[7]
• An estimated 20 per cent of stunting begins in the womb, when a mother is malnourished and is not getting enough of the nutrition she needs to support her baby’s growth and development during pregnancy.[8]
• Undernutrition puts children at far greater risk of death and severe illness due to common childhood infections, such as pneumonia, diarrhoea, malaria, HIV/AIDS and measles.[9]
• Globally, only 60 per cent of children aged six to eight months receive solid, semi-solid or soft foods, highlighting deficiencies in the timely introduction of complementary foods.[10]
• It is estimated that half of anaemia cases are due to iron deficiency.[11]

• Almost half of children in low- and middle-income countries – 47 per cent of under-fives – are affected by anaemia, impairing cognitive and physical development.[12]
• Iodine deficiency is the greatest single cause of mental retardation.It can easily be prevented by adding iodine to salt.[13]
• Between 1990 and 2009, the number of households consuming iodized salt rose from 20 per cent to 70 per cent.[14],[15] Coincidently, the number of countries in which iodine-deficiency disorders were considered a public health concern reduced by 43 per cent between 1993 and 2007.[16]
• Vitamin A deficiency causes early childhood blindness and increases the severity of infections and anaemia.It affects an estimated 190 million pre-school aged children, and 19 million pregnant and breastfeeding women globally.[17]
• Zinc is essential for mothers during pregnancy, and for children’s health and physical growth. Zinc deficiency is estimated to cause four per cent of deaths in pre-school aged children in lower-income countries.[18]

Key messages

• Good nutrition provides children with the vital ingredients they need to develop their brains and their bodies, enabling them to reach their full potential.

Hope:

• Children who are well nourished in the first two years of life are more likely to do better at school and be more productive throughout their lifetime as adults.

Jeopardy:

• Children who are poorly nourished in their first two years can never reach their full potential, jeopardizing their education and future income for the rest of their lives.

Potential - Proof Points

• Children lose up to tenIQ points because they do not receive the right nutrients and care in their first 1,000 days of life.[19]
• Undernutrition leaves nearly four in ten children in Sub-Saharan Africa and South Asia with under-developed brains and bodies.[20] As adults, they are a third less likely to escape poverty.[21]
• Among undernourished children who survive, more than one quarter suffer from stunted growth, which can impair neurological development and learning.[22]
• Worldwide, more than 170 million children fail to reach their full potential due to poor nutrition and two billion people suffer the effects of nutritional deficiencies.[23]
• Recent studies from Brazil, Guatemala, India, the Philippines and South Africa confirmed the association between stunting and reduced school attendance and performance. The studies also found that stunting was a predictor of grade failure.[24]
• Reduced school attendance and diminished educational outcomes mean these children will earn less once they become adults. A 2007 study estimated an average 22 per cent loss of yearly income in adulthood.[25]
• Globally, nearly one in four children under age five (165 million or 26 per cent in 2011) are stunted. Stunting, or low height for age, is associated with impaired brain development, which is likely to have long-lasting negative consequences throughout a child’s life.[26]
• In urban Brazil, a prospective cohort study of more than 3,000 individuals tracked over a 30-year period found that infants who were breastfed longer than 12 months achieved an additional year of education and incomes about a third higher than those with less than one month of breastfeeding.[27]
  

Key messages

• Good nutrition lies at the heart of economic and social development and is the key to reducing inequality and eliminating poverty for everyone, everywhere.
• Improving nutrition during the first 1,000 days after conception is recognized as being one of the best and most cost-effective investments that can be made to achieve lasting progress in global health and development.
• There are proven solutions to address undernutrition that have already been successfully implemented in several countries worldwide, creating significant benefits.
• Investing in good nutrition now averts future spending on healthcare for households and for countries, since well-nourished children suffer from fewer episodes of sickness.

Hope:

• Eliminating undernutrition in children can increase productivity for an entire country and boost GDP by as much as 12%.

Jeopardy:

• The failure to provide children with adequate nutrition in the first 1,000 days after conception throws away human potential that can never be recovered, costing countries billions of dollars every year in lost productivity and holding back economic development that affects everyone.
• Undernourished mothers are more likely to have undernourished babies, perpetuating a cycle of poverty that is passed down across generations.
• While significant progress has been made in reducing undernutrition for the world’s children, improvements have been slow. The 2025 World Health Assembly targets and the SDG malnutrition target are at risk of not being met.

Progress – Proof Points

• Leading scientists, economists, and health experts agree that improving nutrition during the critical 1,000 day window is one of the best and most cost-effective investments we can make to achieve lasting progress in global health and development.[28]
• Studies have found that malnutrition reduces gross domestic product by anywhere between three to sixteen per cent.[29] Malnutrition undermines economic growth and perpetuates poverty, and its human costs are enormous.[30]
• Eliminating undernutrition in young children can boost GNP by 11 per cent in Africa and Asia.[31]
• Undernutrition is estimated to account for a ten per cent reduction of lifetime earnings, placing a huge burden on household and national economies.[32]
• The right nutrition during the 1,000 day window can increase a country’s GDP by as much as 12 per cent.[33]
• Every dollar invested in improving nutrition in the first 1,000 days yields a return of $48 in better health and economic productivity.[34]
• Undernourished mothers have a greater chance of giving birth to low-birth-weight babies than adequately nourished mothers.[35]
• The cost of undernutrition is at least eight to eleven per cent of GNP.[36]Country specific data on the cost of undernutrition can be found at:
• The 2015 Copenhagen Consensus reported that scaling up nutrition-specific interventions to address undernutrition has a benefit-cost ratio of 60. This ratio, the median for a set of 17 countries, is at the high end of a set of estimates reported in the 2014 Global Nutrition Report.[37]
• The African Union Commission and the World Food Programme released a study estimating that malnutrition in Malawi reduced the country’s GDP by 10.3 per cent in 2012.[38]
• The costs of undernutrition and micronutrient deficiencies are estimated at 2–3 percent of global GDP, equivalent to US$1.4–2.1 trillion per year.[39]
• Globally, an annual investment of US$ 60 million in vitamin A and zinc supplementation combined would yield benefits of more than US$ 1 billion per year, with every dollar spent generating benefits of more than US$ 17. Every dollar spent on salt iodization and flour fortification would result in benefits of more than US$ 9.[40]
• Investing in ending malnutrition is one of the most cost-effective steps governments can take: every $1 invested in proven nutrition programs offers benefits worth $16.[41]
• For an illustrative set of 15 African countries, meeting the 2025 World Health Assembly target to reduce the number of children under-five who are stunted by 40 per cent, will add 83 billion dollars to national incomes.[42]
  

1. How do we take action?

1. How do we take action?

Scale up what works

Key messages

• We can reduce undernutrition if we scale up proven and costed interventions that have already benefitted women and children in many countries and communities around the world. To do this, it is crucial to close the financing gap that prevents governments from taking appropriate action.
• These interventions must address the direct causes of undernutrition like dietary and nutrient intake, feeding practices and access to food.
• Interventions must also address the underlying causes of nutrition in agriculture, social welfare, education, women's empowerment, water, sanitation and hygiene.
• We must focus on delivering interventions for women and children in the first 1,000 days from conception through to their second birthday to maximize impact.
• We must provide interventions targeting mothers before they are pregnant, in particular adolescent girls, to help them break the cycle of poverty that is passed down across generations.
• We must deliver interventions to women and children across a variety of channels including antenatal care, community-based services, markets and public campaigns to maximize coverage.
• We still have a lot to learn about the extent and implications of poor nutrition, which will be critical in our efforts to find new solutions to prevent it.

Strong political leadership

Key messages

• We need leaders and champions to take responsibility for tackling undernutrition and bring together all the key nutrition stakeholders from health, social welfare, agriculture and education. We must make undernutrition everyone’s responsibility.
• Tackling nutrition requires a multi-sectoral approach and coordination of efforts across Health, Education and Agriculture Ministries,among others, is critical.
• Nutrition budgets and investment in nutrition need to increase if we are going to have any chance of achieving global targets (2025 WHA) and commitments (SDG 2030).
• The choice to end undernutrition is a political one.

Improve accountability and track progress

Key messages

• We need credible, comprehensive and current data in order to track progress against targets set to reduce undernutrition and hold all nutrition stakeholders to account to commitments that they have made.
• We need to track both the resources committed to address undernutrition and the coverage and reach of interventions.
• We need to share and promote case studies and evidence that demonstrate the successful implementation of interventions that have reduced undernutrition and highlight the benefits to women, children and communities.

Guiding interventions

Eating a varied diet is key to good health but when varied options are limited, there are proven guiding interventions to ensure the right balance of nutrients go in, stay in and are absorbed by the body.