Richard Jolly

Poor nutrition is implicated in more than half of all child deaths worldwide – a proportion unmatched by any infectious disease since the Black Death. It is intimately linked with poor health and environmental factors. But planners, politicians and economists often fail to realize this. Serious misapprehensions include the following myths.

Myth No. 1: Malnutrition is primarily a matter of inadequate food intake. Not so. Food is of course important. But most serious malnutrition is caused by bad sanitation and disease, leading to diarrhoea, especially among young children. Women’s status and women’s education play a big part in improving nutrition. Improving care of young children is vital.

Myth No. 2: Improved nutrition is a by-product of other measures of poverty reduction and economic advance. It is not possible to jump-start the process. Again untrue. Improving nutrition requires focused action by parents and communities, backed by local and national action in health and public services, especially water and sanitation. Thailand has shown that moderate and severe malnutrition can be reduced by 75 per cent or more in a decade by such means.

Myth No 3: Given scarce resources, broad-based action on nutrition is hardly feasible on a mass scale, especially in poor countries. Wrong again. In spite of severe economic setbacks, many developing countries have made impressive progress. Over two thirds of the people of developing countries now eat iodized salt, combating the iodine deficiency and anaemia which affect about 3.5 billion people, especially women and children, in some 100 nations. Around 450 million children a year now receive vitamin A capsules, tackling the deficiency that causes blindness and increases child mortality. New ways have been found to promote and support breastfeeding, and breastfeeding rates are being maintained in many countries and increased in some. Mass immunization and promotion of oral rehydration to reduce deaths from diarrhoea have also done much to improve nutrition.

Partly as a result of such measures, the number and percentages of malnourished children have fallen in all regions of the world except sub-Saharan Africa. The United Nations’ fourth Report on the World Nutrition Situation shows that the number of underweight children under five fell from 175 million in 1980 to 150 million in 2000, with prevalence falling from 37 per cent to 27 per cent. Over the same period, the number of nutritionally stunted children fell from 220 to 182 million with the percentage down from 47 to 33 per cent. Even more impressive, this progress has been made in many countries where economic difficulties have been very severe.

Three important conclusions follow:

  • Accelerated nutritional progress is possible, even in poor countries and at difficult times.

  • Nutritional progress needs conscious strategy and action, embracing a broad range of initiatives tailored to each country.

  • National nutritional councils – as found in Norway and a dozen other countries – are needed to give a focus for action, to fine-tune the agenda to the specifics of each country and to act as watchdogs. They are needed in developed countries, where obesity is rising rapidly, just as much as in developing ones.

Poor nutrition has life-long consequences, especially when undernutrition among children is followed by obesity in middle age, as is increasingly common in South Asia. Research over the last decade has shown that heart disease and diabetes among people aged 60-70 is closely correlated with maternal malnutrition in the womb and during the first one or two years of life. A nutritional focus on women and on children, both in the womb and in the first year or two of life, is thus the starting point for what should be a lifecycle approach to ending malnutrition.

Putting an end to the extremes of malnutrition would lay the foundations for the improved health and well-being of the present generation and lead to benefits extending to future generations over the 21st century. Nutrition is the true foundation for sustainable poverty reduction. Yet it is still neglected.

It is time to spread a broader awareness of the worldwide challenges of nutrition – and its linkages with health and sustainable development – and of the new opportunities for making progress on a global scale

Sir Richard Jolly , formerly chair of the United Nations ACC/SCN Forum for Nutrition and Deputy Executive Director of UNICEF.

PHOTOGRAPH: Dev Nayak/UNEP/Still Pictures

This issue:
Contents | Editorial K. Toepfer | Answering poor health | Tackling water poverty | Everything connects | Up the gross natural product | Stopping AIDS | Whose city is it anyway? | Nutrition | At a glance: Poverty | Competition | World Bank Special: ‘Double burden’ | It’s not just, pollution | Smoke and fires | Breaking the cycle of poison | Pharmacies for life | Viewpoint: Change – or decay | The environment: why we must not give up | World Atlas of Coral Reefs | GTOS: An eyeglass on our planet

Complementary articles in other issues:
Issue on Food, 1996, including:
Jacques Diouf: Food for All: The World Food Summit
Nurul Islam: Securely sustainable
Robert L. Thompson, Merlinda Ingco and Lynn R. Brown: Liberal rations (Beyond 2000) 2000

AAAS Atlas of Population and Environment:
Natural resources and wastes