2018 Global Nutrition Report reveals malnutrition is unacceptably high and affects every country in the world, but there is also an unprecedented opportunity to end it

The world’s most comprehensive report on nutrition highlights the worrying prevalence and universality of malnutrition in all its forms.

In its fifth edition, the Global Nutrition Report provides a concrete overview of progress made and highlights solutions from around the globe calling on all stakeholders to act now to address malnutrition.

The burden of malnutrition is unacceptably high.

Malnutrition is a universal issue that no country in the world can afford to overlook. A third of reproductive-age women are anaemic, while 39% of the world’s adults are overweight or obese and each year around 20 million babies are born underweight.

Beyond health, slow progress on malnutrition is also impacting the social and economic development of countries. It is estimated that malnutrition in all its forms could cost society up to US$3.5 trillion per year, with overweight and obesity alone costing US$500 billion per year.

Corinna Hawkes, co-chair of the Report and Director of the Centre for Food Policy, said: “The figures call for immediate action. Malnutrition is responsible for more ill-health than any other cause. The health consequences of overweight and obesity contribute to an estimated four million deaths, while undernutrition explains around 45% of deaths among children under five. The uncomfortable question is not so much “why are things so bad?” but “why are things not better when we know so much more than before?”

Progress to date is simply not good enough.

Significant steps are being made to address malnutrition. Globally, stunting among children under five years of age has fallen from 32.6% in 2000 to 22.2% in 2017. There has been a slight decrease in underweight women since 2000, from 11.6% to 9.7% in 2016. Yet, while there has been progress, it has been slow and patchy.

The 2018 assessment of progress against nine targets reveals only 94 of 194 countries are on track for at least one of the nine nutrition targets assessed.

This means that most countries are significantly off-track on meeting all nine targets (see figure 2.5):

• No country is on course to meet all nine targets.
• Only five countries are on track to meet four of the nine targets – which is the most any country is on track for.
• No country is on track to achieve the adult obesity target for men or women, nor reach the anaemia target.
• Only 26 countries are on track to reach the target for women’s diabetes.

We are better equipped to end malnutrition.

The 2018 Global Nutrition Report highlights that solutions already exist but find effective ideas are not being adopted at scale:

• We now know more about what people eat, why it matters, and what needs to be done to improve diets. In Mexico, an evaluation of the sugar-sweetened beverage tax found that sales of targeted beverages fell by 9.7% across the population two years after the policy was implemented compared with expected sales if it had not been.
• New data is a game changer and can drive more effective action. Local-level data and action has been particularly effective. In 2012, Amsterdam faced an obesity crisis among young people. The city tracked childhood obesity in different districts and propelled the issue to the top of the agenda. In late 2012 ambitious targets were set. Actions are broken down by prevention (such as healthy urban design), cure (helping those already overweight) and facilitation (such as learning and research), and included: creating public drinking fountains, implementing restrictions on food advertising, and publishing guidance  for healthy snacks in schools. Today, overweight and obesity prevalence in the city is levelling off.
• We see examples of countries building multisectoral plans to deliver on their targets. In Tanzania a wide range of targets has been adopted – seven in all, including for stunting, anaemia and low birth weight. These targets form part of an ambitious five-year action plan to reduce multiple burdens of malnutrition. The plan was set up under the direct leadership of the Prime Minister’s office to reduce all forms of malnutrition associated with both deficiency and excess/imbalances. Its broad goal is to scale up high-impact interventions among the most vulnerable people, including children under five years of age, adolescent girls and pregnant and lactating women. It does this by calling for action across sectors, from social protection to education and food.
• Governments are showing commitment and stepping up to lead action. The government of China is facing the second-largest undernourished population, with overweight and obesity levels rising at alarming rates and diet-related non-communicable diseases (NCDs) such as diabetes on the up. To address this, it has developed two plans with the potential to transform malnutrition in China. Healthy China 2030 (2016), with the direct involvement of the President of China, underlines significant political will to enhance the health status of Chinese citizens. A year later the government released a new National Nutrition Plan (2017–2030), with a range of malnutrition targets including stunting, obesity, anaemia, breastfeeding and folic acid deficiency among vulnerable people. The emerging nutrition governance system deserves credit for the political and administrative commitment to food and nutrition security, demonstrating what institutional coordination can achieve.

The world is off track but the opportunity to end malnutrition has never been greater, nor has the duty to act.

To translate solutions into action, the report’s authors urge critical steps in the following areas:

• Breaking down existing silos to tackle malnutrition in all its forms;
• Prioritising and investing in data to identify key areas of action;
• Scaling up and diversifying funding for nutrition programmes;
• Immediately taking action on healthy diets by making healthy foods affordable across the globe;
• Implementing more ambitious commitments that are designed for impact through SMART targets.

Jessica Fanzo, PhD, co-chair of the Report and Bloomberg Distinguished Associate Professor at Johns Hopkins University, said:

“While malnutrition is holding back human development everywhere, costing billions of dollars a year, we are now in a position to fight it. From policies such as sugar taxes, to new data that enables us to understand what people are eating and how we can best target interventions, the global community now has the recipes that work.”

David Beasley, Executive Director, World Food Programme, added:

“The information in the Global Nutrition Report goes far beyond facts and figures. What is really behind these tables and graphs are stories of potential: the potential of more babies seeing their first birthdays, of children achieving their potential in school, and of adults leading healthy and productive lives – all on the foundation of good nutrition. The information collected, analysed and shared in the Global Nutrition Report is never an end in itself, but a means that allows us to save lives, change lives and ensure that nobody is left behind.”

Henrietta H Fore, Executive Director, UNICEF, said: “The 2018 Global Nutrition Report offers forward-looking steps to strengthen the ability of global and national food systems to deliver nutritious, safe, affordable and sustainable diets for children. This paradigm shift – food systems that contribute to prevent malnutrition in all its forms – will be critical for children’s growth and development, the growth of national economies, and the development of nations.”

Key themes of the report

Adolescence: a window of opportunity to fight malnutrition The world has woken up to the importance of adolescence as a critical life stage to address malnutrition and promote life-long good health. Regardless of wealth, diets of adolescents around the world is unbalanced.

A growing body of international evidence shows addressing nutritional problems and adopting healthy dietary habits during adolescence can be important for potential ‘catch up’ growth, improved cognition and reduced risk of NCDs later in life.

Adolescence therefore presents a ‘second window of opportunity’, not only to improve the health and nutritional status of adolescents themselves, but to break the cycle of intergenerational malnutrition and ill health.

Data from 195 countries shows both male and female adolescent obesity rates (10–19-year olds) are increasing annually, reaching 6.5% and 4.7% respectively, with adolescent girls being particularly vulnerable.

The political will exists to make a change, as demonstrated at the Milan Nutrition Summit, which called on the nutrition community to adopt a lifecycle approach that prioritises adolescents.

Successful approaches to adolescent malnutrition have been taken in Bangladesh (see pages 70 and 71), while a new call to action was published in April 2018 highlighting seven priority areas for improving female adolescents’ nutrition (see page 67).

To capitalise on this, we must invest in better data and targeted strategies, and bring adolescent voices into policy-making.

More and better data can be a game changer

Progress in tackling malnutrition can only be made through an evidence-based approach; yet many countries do not fully understand the nature of the burden of malnutrition, diet or indicators of progress within their own country.

At the same time, national statistics and data sets are no longer enough. Disaggregated geospatial data is game changing. Developments in disaggregated data show that while countries may be on track to end malnutrition, many localities are not.

We need improved data collection and analysis to make effective decisions, target interventions and end malnutrition. For example, India has by far the greatest number of under fives affected by stunting (an estimated 46.6 million), but it is important to understand how and why stunting prevalence differs across different areas. Researchers used mapping and descriptive analyses to understand spatial differences in the distribution of stunting across India’s 604 districts.

India’s national nutrition strategy – which is focused on addressing district-specific factors – draws on analyses such as these, along with district-specific nutrition profiles to enable diagnostic work. Ultimately, this information has directed policy action to reduce inequalities and childhood stunting.

Investments must be made in geospatial and disaggregated data analysis to further develop our understanding of the implications, causations and effective actions for malnutrition. We must act now to build capacity across governments, research and academic institutions to collect and use the data on diets that is fundamental to progress on malnutrition. Without data, we are flying blind.

Urgent actions needed to improve diets globally

Diet matters for nutrition and health outcomes at all stages of the life cycle, and today poor diet afflicts every continent. Fewer than one in five children (15.6%) aged six to 23 months eat a minimally acceptable diet, while 30.3% of young people do not eat fruit daily and 13.9% do not eat vegetables daily, and 7.5% of children do not eat fruits and vegetables daily.

Poor diet significantly influences morbidity and mortality across all ages and income brackets. Regardless of wealth, humans are not getting the right diet. Those with the highest incomes fail to eat enough of the right foods, while low-income countries eat too many starchy vegetables and legumes.

There is evidence that interventions to improve diets, such as fiscal measures and reformulation, can have positive outcomes.

In Burkina Faso the government has ensured maternity protection by implementing legislation requiring women be given 14 weeks of fully state-funded maternity leave, while laws on marketing of breast milk substitutes prohibit activities that would encourage women to substitute breastfeeding with formula. As a result of this legislative action breastfeeding rates in Burkina Faso have exponentially improved.

Governments are taking actions to encourage and enable populations to consume fewer packaged foods high in sugars, fats and salt.

We need concerted and integrated action to make healthy food accessible and affordable, but first we need all countries to collect data on diet to fully understand the nature and burden of malnutrition and build appropriate plans.

To download the report, click here