Global Nutrition Report 2015: A clarion call for action

This writer was on his way to attend the launching ceremony of the Global Nutrition Report 2015. It was arranged by the International Food Policy Research Institute (IFPRI) on  November 04, 2015.  The car had to stop for a while near the Petrobangla head office (opposite the Sonargaon Pan Pacific Hotel) because of acute traffic jam. Looking through the window, a woman was found winnowing rice on the footpath which is meant to be used by the pedestrians. One would possibly assume that she might live in a slum nearby, collect food from different places, and her husband earns a pitifully low income. She looked very thin and quite old although she might not have crossed 30. She was wearing a torn and dirty saree. Obviously, she can be categorised as extreme poor.  She was surrounded by three of her children aged 1-5 years - one eating a piece of banana collected from the footpath, one munching a biscuit, and the other looking aimlessly. Bad smell was coming from the poor drainage system; people were spitting on the road. The mother and her kids appeared to be severely malnourished. Nutritionists argue that such malnourishment could be the cause of stunting, underweight, anemia, etc. The writer noticed a syndrome of malnutrition trap - malnourished mother giving birth to malnourished children - and thus causing intergenerational malnutrition to result in low productivity? low wage? low nutrition.
Meantime, the writer had reached Hotel Lakeshore where the Speaker of the Jatiya Sangshad, State Minister for Finance, Additional Secretary of the Ministry of Health and Family welfare, and IFPRI representative to Bangladesh gathered to unveil the Global Nutrition Report 2015.
The session kicked off with a key-note presentation by Dr Lawrence Haddad, Senior Research Fellow of IFPRI and Co-chair of the Global Nutrition Report. The signs of malnutrition cannot be concealed as they become visible through various ways - children growing improperly, adults growing too thin, people deficient in vitamins and minerals, and adults becoming overweight and obese, etc. Excepting the last one, all other indicators apparently corroborated the perception of malnutrition about the woman and her children as mentioned above.
"Whichever way you look at the world… malnutrition affects everyone", said Lawrence. The million-dollar question is: why should we invest to improve nutrition? First, about half of the children's death is due to malnutrition, and so it is a question of human right. Second, from the point of intergenerational equity, nutritional improvement matters. Third, the economics of investment in improving nutritional status is astoundingly appealing! If we invest $1.0 today on programmes related to nutritional improvement, we may reap home $16 as estimated for 30 year compound interest rate at 10 per cent.
Bangladesh's progress in nutritional indicators sometimes appears to be puzzling. Especially Amartya Sen's ranking of Bangladesh over India in a few social indicators has contributed to that puzzle. A closer look at the indicators targeted by the World Health Assembly (WHA), and presented by Lawrence, reveals that Bangladesh's performance is a mixed one. For example, incidence of stunting of Bangladesh's <5 children at 36 per cent in 2015 is lower than that of India and Pakistan. But the prevalence rate is much higher than that of Sri Lanka and the Maldives (15-26 per cent). The good news is that the prevalence rate has been on a wane: from 51 per cent in 2004 to 41 per cent in 2011 and 36 per cent now. But an eyebrow-raising information is that Maharashtra in India reduced stunting from 37 to 24 per cent (13 percentage points) in only seven years! This was possible with a frontal attack on malnutrition supported by increased budgetary allocation. By and large, out of the eight global nutritional targets, Bangladesh is on track to reach only two targets - stunting and overweight of <5 children. The country made little progress in terms of reduction of wasting of <5 children which stands at 14 per cent - far above the global target of 5 per cent. When stunting and wasting are combined, "a minority of Bangladesh under-5 children escape malnutrition." Besides these, progress seems to be very little in areas such as anemia of 15-49 aged women, adult diabetes and sugar, and promoting exclusive breastfeeding (0-6 months). Horrifyingly, about half of the women are anemic due to rice-centric consumption. The deficiency of vitamins and micronutrients have exacerbated the condition. Exclusive breast feeding has declined from 60 to 50 per cent possibly due to urbanisation and women's engagement in works.  On the other hand, there are some progress in adult overweight plus obesity (BMI> 25) and adult obesity (BMI>30).  By and large, Lawrence Haddad's assessment of the nutritional status of Bangladesh seems to leave some rooms for consolation but, at the same breath, rules out any room for complacency.
Anyway, after the discussion on the prevalence of malnutrition across the world, comes a clarion call for action. The eminent researcher from IFPRI, Lawrence emphasises on half a dozen 'C's: commitment or public pledge to the cause of malnutrition, expansion of coverage like mobile phone, coherence of polices, cash or investment - doubling by government and quadrupling by donors (nutrition-sensitive investment is only 0.2-1.32 per cent of budget in a few countries), community deliverance, and data counting.
Bangladesh is one of the 33 countries which are on course to meet one-fourths of the WHA Global Nutrition Targets by 2025. These targets are, for example, stunting, wasting, and overweight among children under age 5, anemia in women 15-49 years of age, and rates of exclusive breastfeeding. A country like Kenya tops the list with 5 targets on course and Columbia, Ghana, Vanuatu and Vietnam 4 on track.
It needs no mention that Bangladesh should perform much better given strong political commitment, improvement in women empowerment, improved food supply, greater access to improved health and sanitation facilities and improved performance of nutrition-specific interventions. The malnourished woman and her malnourished children - called a middle-income paradox -sorely need the fulfillment of the commitment right now.
The writer is Professor of Economics at Jahangirnagar University.
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