online: Biesalski HK (ed): Hidden Hunger and the Transformation of Food Systems. How to Combat the Double Burden of Malnutrition? World Rev Nutr Diet. Basel, Karger, 2020, vol 121, pp 16–20 (DOI:10.1159/000507519)
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Unlocking the Hidden Hunger Crises: The Power of Public-Private Partnerships
Ilaria SchibbaKathryn OgdenMichael SmithEmily HeneghanFatiha TerkiBriony Stevens
United Nations World Food Programme, Rome, Italy
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Abstract
The global burden of malnutrition remains unacceptably high. Malnutrition is a universal issue restricting development and slowing progress. Malnutrition is responsible for more illness and ill-health than any other cause worldwide. Despite underlying determinants of undernutrition being well understood for decades, millions of children worldwide face multiple malnutrition burdens, and women face a higher burden than men when it comes to malnutrition due to higher nutrient needs. Despite these alarming statistics, significant strides are being made. Globally, stunting rates among children have declined and many countries are on their way to achieving at least one nutritional status target for 2025. However, a broader range of stakeholders must be more fully engaged if malnutrition is to be reduced in a sustainable manner, including increased engagement from the private sector. To support achievement of the 2030 Sustainable Development Goal of ending all forms of malnutrition (goal 2.2), there must be urgent and decisive actions by all stakeholders to address existing data gaps, present new food systems innovations, ensure nutritious diets for all, fully finance nutrition action, and adhere to global commitments.
© 2020 S. Karger AG, Basel
The 2030 Agenda commits the world to eradicating all forms of malnutrition by 2030, but the pace of progress is slow and we are still far from reaching the Sustainable Development Goal (SDG) nutrition targets detailed in SDG 2: End Hunger. Every country in the world is affected by malnutrition, irrespective of wealth, and 88% of countries experience more than one type of malnutrition [1]. Additionally, there are countries experiencing a “double burden” or even a “triple burden,” with different forms of malnutrition coexisting within countries, households, and even individuals.
Over 2 billion people around the world suffer from a chronic deficiency of micronutrients [2]. Micronutrient deficiencies are estimated to impact a significant number of people worldwide, but there remains a paucity of information on micronutrient status and deficiencies. Myriad estimates refer to a figure of 2 billion; however, this reference is dated and often considers only four nutrients, while current research argues that at least 19 nutrients are needed [1]. This lack of essential vitamins and minerals often results in hidden hunger, whereby the signs and indicators for undernutrition are less visible and obvious. More data on micronutrient deficiencies are required, and, there is a lack of data on the state of micronutrient deficiencies in nutritionally vulnerable populations. Furthermore, the data that are available is not comforting. For example, anemia, which indicates broader micronutrient deficiencies, is one of the eight key nutrition indicators that are off track at the global level [1].
Micronutrient deficiencies have a range of negative and often lifelong consequences on individual health and can have downstream effects on productivity, negatively impacting the economy and the greater public health system. Micronutrient deficiencies are an urgent public health problem with high economic costs in virtually every country. They cause an estimated 1.1 million of the 3.1 million child deaths that occur each year because of undernutrition [2]. Nearly 18 million babies are born with brain damage due to iodine deficiency each year [3]. Severe anemia doubles the risk of death for women giving birth [3]. From an economic perspective, the toll is also huge. According to the World Bank, the combined economic costs of iron deficiency, iodine deficiency, and vitamin A deficiency alone in developing countries could waste as much as 5% of gross domestic product [4].
Suboptimal diets are a key driver of hidden hunger, as they lead to micronutrient deficiencies, especially in populations with low food intake. Diets based mostly on staple crops, such as maize, wheat, rice, and cassava, which provide a large share of energy, but relatively low amounts of essential vitamins and minerals, frequently result in hidden hunger. For example, countries where the average diet is rich in micronutrient-poor cereals tend to have higher levels of micronutrient deficiency [5].
The message in the 2018 Global Nutrition Report is loud and clear: diets are suboptimal in all parts of the world. This is true across all age groups, as it affects children, adolescents, adults, and the elderly. Changes in the food environment, from production-based to purchase-based, has resulted in a rise in the consumption of processed foods and availability of cheap, non-nutritious foods. The changes in the food environment highlight the essential need to have the private sector on board. Regardless of income or location, all age and population groups are not eating enough fruits or vegetables, whole grains or legumes, and are drinking too many sugar-sweetened beverages. In some regions, up to 33% (Latin America) of school-aged children eat no fruit daily and up to 59% (Latin America) drink soda [1].
To address the hidden hunger crisis, better connections must be made between what is being produced and what is being consumed, doing so in an environmentally sustainable manner. The world’s total supply of calories has never been greater; the Micronutrient Density Index has risen in most regions since the 1980s, and the estimated prevalence of inadequate micronutrient intakes globally has been greatly reduced. We need to produce more nutritious foods but also ensure that micronutrient-rich foods get to consumers and form part of a diversified quality diet.
A range of interventions are needed across food systems and a system-wide approach is essential. Food systems allow many entry points for interventions across the supply chain, within food environments, and related consumer behaviors. Solving the problem of micronutrient deficiency requires effort from a wide array of stakeholders, ranging from governments to business to civil society, and, therefore, a multi-stakeholder approach is fundamental. The private sector is a particularly critical key actor within our food system, and thus should play a pivotal role in tackling micronutrient deficiencies. Countries with a high estimated prevalence of inadequate micronutrient intakes may benefit from public-private partnerships aiming at increasing the nutrient density of the food supply through increased production, diversification, fortification, and biofortification, but also at improving access to and utilization of nutrient-dense foods.
The private sector has considerable potential to make food environments healthier and tackle different forms of malnutrition, including hidden hunger. The private sector can increase production of micronutrient-rich foods and work to make these more accessible to local populations. Additionally, the private sector can influence people’s attitudes, perceptions, and desires, as well as the affordability of key food items in local and global markets. The role of business is core to patterns of food availability, access,
