Elimination of hunger and malnutrition is good economics

Hunger and malnutrition are big global challenges that confront humanity. Nearly 850 million people across the globe are hungry. More than two billion people suffer from deficiencies in essential vitamins and minerals, and about the same number of people are overweight and obese.
The development of Sustainable Development Goals (SDGs) to anchor the post-2015 development agenda is now well underway. Elimination of extreme poverty is at the centre of the effort, but the agenda needs to give more attention to the elimination of hunger and malnutrition. Elimination of hunger and malnutrition should be equally central because poverty, hunger and malnutrition are linked in a vicious cycle. Hunger and malnutrition affect the capability of individuals to escape poverty by reducing their capacity for physical activity and impairing physical and cognitive development.
Improved nutrition and health are key priorities in international development. Better health and nutrition is an end in itself and a means to escape income poverty. Child malnutrition and ill health are of utmost concern since deprivation in early childhood often causes irreversible damage to physical and mental health, reduces learning at school, and leads to lower incomes as adult. It is therefore appropriate that several of the Millennium Development Goals adopted by the United Nations reflect on child malnutrition, including the goal to halve by 2015 the number of people living in hunger, and the goal to reduce child mortality by two-thirds.
Sustainable and inclusive economic growth is the most powerful driver of development. Economic growth has resulted in substantial improvements in wellbeing. We know that many factors have to happen to accelerate inclusive and sustainable growth. Macro policies have to keep inflation and interest rates under control. Fiscal policies need to get the balance right between revenue generation and entrepreneurial incentives that generate jobs. Social policies need to maximise opportunity and address deprivation through investments in human capital. Institutions need to support governance that is participatory, responsive and accountable. But what does nutrition have to do with economic growth? A lot.
Worldwide, malnutrition cuses 5.9 million child deaths each year, or more than one in three of all child deaths. While children living in poorer countries are more likely to be malnourished than those in wealthier countries, the proportion of children who are malnourished is not always associated with a country's economic status. Some countries that have become economic powerhouses have persistently high numbers of malnourished children, while other countries with low levels of national income have shown progress in combating malnutrition by investing in cost-effective, proven interventions that ensure children's access to proper nutrition.
Around seven million children suffer from stunting in Bangladesh and are vulnerable to dying at any given time due to malnutrition. The knock-on effects of malnutrition are huge. Socio-economic surveys show clear correlations between poverty and poor nutrition in early childhood with higher rates of stunting, susceptibility to infections and lower later life chances in education and employment.
During the first 1,000 days of life - from conception to age two - children need enough energy and nutrients to fulfill their growth potential. If not, both their bones and muscles grow slowly, leaving them short for their age, which is known as stunting. Poor nutrition in these early years not only affects physical growth but also the development of the brain.
Hunger and malnutrition impose huge social and economic costs, which can be felt at individual, household and societal levels. The International Food Policy Research Institute (IFPRI) research shows that growth failure in early childhood is likely passed to the next generation. Productivity losses and direct healthcare costs caused by hunger and malnutrition also have adverse economy-wide effects. For example, hunger and undernutrition cost the global economy USD$1.4 to $2.1 trillion per year-the equivalent of 2.0 to 3.0 per cent of global GDP (gross domestic product), according to the Food and Agriculture Organisation of the United Nations. As a result of being overweight or obese, the World Health Organisation estimates that about 3.4 million adults die each year, accounting for 3.9 per cent of years of life lost.
Bangladesh is a home of around 6.3 million stunted children as of 2010, according to UNICEF. Globally, malnutrition is responsible for 45 per cent of all child deaths and leaves 161 million children stunted in 2013, a joint survey of UNICEF, WHO and World Bank found.
Causes of malnutrition are multifaceted. Usually lack of food security and awareness, and rising inflation are behind the malnutrition problem in Bangladesh. Under-nutrition puts children at greater risk of dying from common infections and increases the frequency and severity of such infections. It is irreversible once it is occurred. Malnutrition has far-reaching human, social and economic consequences that last for generations. Malnutrition costs Bangladesh more than Tk70 billion ($1bn) in economic productivity each year, according to a joint survey of the Bangladesh government and the United States Agency for International Development (USAID).
An effective intervention with providing sufficient quality foods costs around $97 or Tk776 per child with much of the expense coming from the provision of fortified supplementary foods, according to the findings of the world's leading experts on nutrition and economics Professor Susan Horton at the University of Waterloo and Professor John Hoddinott at Cornell. On an average, implementing the effective direct nutrition interventions raises incomes by 11.3 per cent, the findings said.
If a Bangladeshi child is born in 2015, benefiting from effective intervention during conception and infancy and joining the work force at age 21, over his lifetime, he will earn the average per capita income of a Bangladeshi. If this person works until they are 50 years old and uses a conservative 5.0 per cent rate, switching this child from stunted to not stunted increases the present value of their lifetime by more than Tk 1,84,000. These income calculations are for different numbers of working years and different discount rates. If individuals work together, the present value of these monetary benefits gets larger.
There are other benefits of reductions in stunting. Nutrition interventions would reduce deaths by children under five by 15 per cent. Over the last decade, Bangladesh has made remarkable progress in fighting malnutrition. In 1997, the stunting rate was 58 per cent, which declined to 38 per cent in 2014, according to the Bangladesh Demographic Health Survey and other studies. The number of stunting cases among children below five years of age also came down to 31 per cent from 45 per cent in 2015, according to Food Security and Nutritional Surveillance Project.  National Micronutrient Survey 2011-12 says only 20 per cent of young children, aged between 6 and 23 months, receive the minimum acceptable diet. Rice dominates and its low nutrient density likely contributes to the high rates of zinc deficiency.
The good news is that investments in eliminating hunger and malnutrition have high economic benefits. For instance, in India and Bangladesh, research shows that every dollar spent on interventions to reduce stunting is estimated to generate about USD$34.1 and 18.4 in economic returns respectively.
According to under-nutrition map (The Under-nutrition Maps are developed jointly by the UN World Food Programme and the Bangladesh Bureau of Statistics ) unveiled in December last year, children under five suffered most from hunger in Sylhet division where 51.3 per cent of children suffered from stunting and 39.5 per cent were underweight.
Stunting rates are the highest in Bandarban district of Chittagong division, a hilly area, followed by Cox's Bazar district in the coastal belt of Chittagong division and Sunamganj district of Sylhet division which largely consists of haor (wetland) areas, the maps showed. As many as 55 districts are above the World Health Organisation critical threshold level for underweight which is 30 per cent. At the upazila level, 300 out of 544 upazilas have a stunting rate above 40 per cent while 440 upazilas have an underweight rate above 30 per cent.
Malnutrition costs the country over $1.0 billion in lost productivity a year. Ending it would not only improve the lives of millions but help break the cycles which perpetuate poverty into future generations. The annual costs of effective intervention to ensure a sufficient variety of quality foods to children in need have been shown to be perfectly manageable and to more than pay for themselves by reducing illness and raising future incomes.
Poverty is not the only problem, as rising rates of obesity among wealthier children are showing. It is ensuring awareness of good nutrition and access to a proper variety of foods which is key to preventing malnutrition. Better co-ordination is needed to improve the effectiveness of providing fortified supplementary foods and raising awareness among young mothers about the importance of ensuring balanced diets to both boys and girls.
Global development actors, including governments, development agencies, civil society, philanthropy organisations and the private sector, play a critical role in ensuring food security and nutrition. However, inefficient policies and practices that add to the burden of hunger and malnutrition-underinvestment in food security and nutrition, lack of social safety nets to protect the poorest, unsustainable use of natural resources in food production, trade restrictions and gender inequality in agriculture-must be eliminated.
We have the tools to decrease the number of malnourished children in Bangladesh. Investments in nutrition pay for themselves and can produce a lifetime of benefits for individuals, families, and nations. Key nutrition interventions should ensure:
n Mothers and children have access to-and are consuming-essential vitamins and minerals.
n Mothers and children have access to the right variety of foods and the right amount of foods.
n Parents and caregivers have access to the information and support they need to feed their children in the best ways possible.
These proven interventions can save the lives of thousands of children worldwide and help children reach their full potential by contributing to better school performance, higher lifetime earnings, and increased productivity in the labour force.
We must become better at fighting malnutrition to give all children the proper start in life they deserve. Elimination of hunger and malnutrition calls for efficient policies and practices from all stakeholders. It is good economics and also the right thing to do.

The writer is Assistant Inspector of Colleges, Bangladesh University of Professionals (BUP), Mirpur Cantonment.
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