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African Journal of Food, Agriculture, Nutrition and Development
Rural Outreach Program
ISSN: 1684-5358 EISSN: 1684-5374
Vol. 2, Num. 1, 2002
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African Journal of Food & Nutritional Sciences (now African Journal of Food, Agriculture, Nutrition and Development), Vol. 2, No. 1, March, 2002
BURYING NUTRITION MYTHS AND ACTIVATING CHOICES FOR OUR
CHILDREN'S DEVELOPMENT
Lawrence Haddad1
1International Food Policy Research
Institute (IFPRI), 2033 K Street, N.W., Washington, D.C. 20006-1002,
U.S.A., Email:
L.Haddad@cgiar.org
Code Number: nd02003
Child undernutrition will continue to be a major
development challenge in the 21st century. Accelerating its reduction will require concerted
action from various angles ranging from international development
assistance to community-based interventions; but efforts to mobilize
action at the national and international levels are often thwarted
by lack of fact-based information.
This lack of information and poor understanding of existing
information by policymakers has resulted in several myths about
child nutrition in developing countries.
Myths are seductive
but they crowd out facts. When the facts make a compelling case
for action, they tend to be buried by myths. In this paper I will
attempt to bury six myths that have made us complacent about undernutrition
and stifle our collective appetite for action- action to eliminate
undernutrition as a fate awaiting future generations. However, is achieving such a goal by the year
2020 truly possible? I
hope to convince you, the reader, that we are closer than you
may think.
It is clear that
undernutrition is not solely due to a lack of food.
If, for some monstrous reason one wanted to make an infant
undernourished, depriving it of food would certainly be effective.
The effects of depriving the infant of care from its mother, clean
water, good sanitary facilities, and effective health care would
be equally malignant. Food, care, and health-this, then, is the
holy trinity of good nutrition.
Unfortunately the
world is adept at creating undernourished infants.
Globally we estimate about 150-160 million of them. The good news is that their numbers are decreasing
steadily. The bad news is that this may be Myth 1. What
about the global estimates that say the numbers are going down? Well, they may be right. But we cannot be so sure. For a large number of countries, there are
no decent data and we have to rely on guesswork. Looking only
at countries for which there are good trend data, a decidedly
less rosy picture emerges. Undernutrition is going down in only 31 out
of the 58 developing countries that have good data over time.
The remaining 27 countries are witness to growing numbers of wasted
and stunted children. Overall, for these 58 countries, the number
of undernourished children has dropped from 137 million in the
1980s to 131 million in the 1990s.
At that rate, goals for halving the number of undernourished
children will only be accomplished by year 2094.
So, at best, the numbers
are not going down fast enough. They are even increasing in a
large number of countries, particularly in urban areas.
So what? If one
needs to answer that question at all, the most obvious response
is surely that the humanitarian costs are obscene and unnecessary.
Moreover, the rights of a billion family members to tend
to their infants' most basic needs are being violated day after
day.
Surely good nutrition
is about more than this. Without
it, other good things cannot happen.
Good nutrition is the bedrock upon which the present generation
secures a future for itself and for the next generation. Myth 2, then, is the claim that "nutrition has
little to do with my work in eradicating poverty and advancing
economic growth".
In response,
let me highlight recent estimates that suggest that the economic
costs of undernutrition may exceed 3.5% of GDP year in, year out
[1]. How big is this loss?
After 10 years in the absence of undernutrition, GDP would
be 41% higher than it would have been.
After 20 years it would double.
Over the 1990s these GDP losses are comparable to the losses
sustained by some Asian economies due to the financial crisis
of a few years ago.
We
also know that babies that are better nourished in the mother's
womb are more likely to survive birth and beyond, reducing one
strong incentive for parents to want larger families.
It is now established that underweight babies will grow
into adults more prone to diabetes, coronary heart disease, and
some forms of cancer [2]. There is research to show that undernutrition
hastens the progress of the AIDS virus once infection has occurred
and better nutrition possibly inhibits transmission of the virus
from mother to baby [3]. Undernourished
children enter school later and are less able to learn once they
get there. Education initiatives such as those proposed for Africa
at the Genoa summit will likely squander millions of dollars if
good nutrition is not seen as the first step on the road to a
secure livelihood [4]. Thus eliminating child undernutrition may
be one of the most fundamental economic activities for future
economic growth.
So, we want better
nutrition and for many reasons.
However, income growth-fuelled in the poorest countries
by agricultural productivity gains [5] will take care of things
on its own? This is
Myth 3. Income growth
is crucial, but not enough on its own.
Simulations based on survey data on what income growth
does to child undernutrition shatters this myth[6].
Of the 10 countries in the sample, only in Morocco will
have robust growth of 5% per year for the next 20 years halve
undernutrition. Such growth rates are fading gleams in the
eyes of those worried about a global recession.
Even if rapid income
growth rates were possible, the nutritional status of the majority
of today's children will be untouched by it.
If so, why don't parents in developing countries care enough
to invest more in their children's nutrition? This is Myth 4. Of course they care, but such an
investment is a tall order for people earning less than one dollar
a day. They are already
spending 70% or so of their money on food. One may ask: why can't they borrow for their children's nutrition? Can you imagine what they would say to a lender? "Could you lend me
enough money to purchase a decent diet, child care, and water,
sanitation and health care for my children for the next five years?
In 20-30 years they'll earn more than they would without
these fundamental things and be able to pay off the debt. Oh,
and by the way, I have no collateral."
This is a classic market failure and a strong justification
for public sector investment in child nutrition [7].
So public sector involvement
is needed, but if the nutrition experts knew what to do, we would
not be in this situation. This is Myth 5.
We know what to do to end undernutrition. Of course there are some important gaps in knowledge-programs for
adolescent girls, for example-and some technological options that
we need to explore, such as conventional and transgenic breeding
for micronutrient-dense cereals. Of course the context matters-good
governance, the high status of women, control of HIV/AIDS and
an absence of conflict are of obvious importance. Yet we have
an extensive menu of cost-effective nutrition interventions to
order from. It includes
community-led programs to strengthen parents' behaviors about
the feeding, caring and health of their infants, and programs
to monitor child growth, distribute micronutrient capsules, fortify
foods such as salt and dry milk; improve access to clean water;
and improve the baby-friendliness of health clinics and hospitals
[8].
Crucially,
the missing items on the menu are financial resources and the
capacity to spend them wisely. Capacity is not simply about what
people know. It is also about whether they have incentives
to use their knowledge and to add to it. If salaries are low, accountability mechanisms absent, and little
priority is given to problem solving, capacity to spend effectively
will be weak. The nutrition
community has neglected capacity in this broadest sense. We need
to spend more effort on assessing capacity, understanding when
it is the key constraint to action, and developing it in ways
that further community goals.
Inadequate
resources, however, are a large part of the reason why malnutrition
persists. Is it incredibly
expensive to eradicate Third World undernutrition? This is Myth 6.
Estimates suggest that it would cost one to 6% of current
public expenditure on health to get every undernourished child
into a community nutrition program [7]. Are these numbers large
or small? There are certainly
difficulties in achieving these increases. However, there are
also opportunities to do so.
What can the more developed countries do?
If they would only choose to focus Overseas Development
Assistance more on the least developed countries, this would be
good for nutrition. Developing countries have opportunities too.
For example, public health expenditures are often skewed
away from the poor.
The
nutrition community does not get off the hook.
We must recognize and exploit resource opportunities within
the new financial arrangements.
For example, we should be thinking hard about how to build
nutrition concerns into the poverty reduction strategy processes
currently being prepared by over 20 of the poorest countries.
How,
then, do we generate increased pressure for nutrition-sensitive
resource allocation? Two
approaches are important: get deeper into the hothouse of policymaking
but also get further away from it.
Getting in deeper
means finding out why policymakers are not asked, "Are the
children growing?" as opposed to "Is the economy growing?"
Why do some countries decide to spend one percent of their
GNP on development assistance and some one tenth of that? Why do some provinces decide to spend 20 times more on their undernourished
children than others do? The research community has been too timid
in addressing such questions.
It will not be easy or comfortable but such efforts will
help to hold decision-makers accountable for their choices and
will lead to improved aid and budget choices.
At the same time getting
further away from the hothouse means that we need to engage the
public more directly. Systematically interacting with the general
public on our work might surprise us.
We hear about research that finds that Americans think
they spend 15 times more on foreign aid than they actually do
and that those who want to spend less on foreign aid are far more
vocal than the majority who want to spend more. We need more work
along these lines to bridge the reality gap between the public,
the media and the policymakers.
The civil society
activism witnessed at various international conferences and meetings
over the past three years has surprised many. The street violence
has become the story, giving politicians an easy ride and the
media an easy story. We need to eschew the violence and retain the energy, sustaining
it and channeling it with solid empirical evidence-evidence that
explodes myths and liberates action.
Evidence that tells
us that undernutrition is not decreasing as fast as we think it
is; that good nutrition underpins development; that income growth
alone will not deal with undernutrition quickly enough; that private
markets fail parents who want to invest in their kids' nutrition;
that we know how to eliminate undernutrition; that the resources
to deal a severe blow to undernutrition are relatively small;
and that there are plenty of opportunities to find these resources. To get the resources we need to become more
activist-with the policymakers and with the public-all the while
backed by rigorous research findings.
Unless consolidated action is taken towards elimination
of child undernutrition, the loss towards human capital and economic
development could be very high.
We need to do much better to address undernutrition in
the next few years to come. We can if we choose to.
REFERENCES
- Horton S Opportunities for
Investments in Nutrition in Low-income Asia. Asian Development
Review, 1999.
- Piwoz E and Preble E HIV/AIDS
and Nutrition: A Review of the Literature and Recommendations
for Nutritional Care and Support in Sub-Saharan Africa. SARA Project,
USAID, Washington, D.C, 2000.
- Popkin BM, Horton S and Kim
S The Nutrition Transition and Diet-related Chronic Diseases in
Asia: Implications for Prevention and Food Consumption, 2001.
- United Nations Administrative
Committee on Coordination/Sub-Committee on Nutrition). Fourth
report on the world nutrition situation. Geneva: ACC/SCN in
collaboration with IFPRI, 2000.
- Hazell P and. Haddad L Agricultural
Research and Poverty Reduction. 2020 Discussion Paper 34. IFPRI.
Washington, D.C, 2001.
- Alderman HS, Appleton L, Haddad
L, Song and Yohannes Y Reducing Child Under-nutrition: How far
does income growth take us? International Food Policy Research
Institute and the World Bank. Washington, D.C. Draft, 2001.
- Gillespie S and Haddad L. Attacking
the Double Burden of Malnutrition in Asia and the Pacific. Forthcoming,
Asian Development Bank in partnership with Sage Press, 2001.
- Allen LH and. Gillespie SR
Options for Interventions to Improve Human Nutrition: A Review
of Efficacy and Effectiveness. Forthcoming ACC/SCN State of the
Art Paper. ACC/SCN. Geneva, 2001.
Copyright 2002 - Rural Outreach Program
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