This article, by Anthony Lake, UNICEF Executive Director, is reprinted from G8: The Camp David Summit – Route 2012: The Road to Recovery, courtesy of the G8 Research Group at the Munk School of Global Affairs, University of Toronto.
The condition known as stunting – the irreversible result of chronic nutritional deprivation during the most critical phase of child development – may be among the least understood and least prioritized development issues today. It represents a huge moral and practical challenge. It is also one of the greatest opportunities for G8 members to help developing countries – and their children – to reach their potential.
The news that hundreds of millions of children are at risk – of death, of a life shorter than that of their peers, of poorer cognitive capacity and thus less ability to learn in school and earn as adults – should command headlines and compel immediate action. And yet the condition that affects these children – stunting – is still relatively unknown among many development professionals, health and education ministers – even among medical practitioners.
Stunting is the irreversible outcome of chronic nutritional deficiency during the first thousand days of a child’s life, from conception through pregnancy to the age of two. The damage it causes to a child’s development is permanent – and the cumulative effect it can have on a country’s development is considerable. Stunted children are inches shorter than they could have been with proper nutrition. Their immune systems are weaker, leaving them more vulnerable to disease. A stunted child is up to five times more likely to die from diarrhoea – a condition which kills more than 3,000 children under five every day around the world.
The condition affects far more than the body. It also inalterably affects the development of the brain. If one compares the brain cells of a well-nourished child with those of a stunted child, the difference is apparent, even to an untrained eye.
These deficits in brain-cell size and connectivity translate to a loss of between two to three years of learning. Later, when such stunted children enter the workforce, their diminished physical and cognitive development can reduce their earning capacity by as much as 22 per cent.
In dozens of countries, up to 40 per cent of children suffer from stunting. In six countries, more than 50 per cent suffer from this condition. In Afghanistan, 59 per cent of children under five are stunted.
A condition that is easy to combat
The burden is not restricted to poor or food insecure countries. In India, a middle-income, food-secure country, nearly half of all children under five are stunted. Widespread in middle as well as lower-income countries, stunting is among the most glaring inequities in the world. It most affects the poorest children, who are three times as likely as the richest children to be stunted.
Stunting is so common that it is sometimes mistaken for genetic heritage. It is not. But, while not hereditary, stunted women are more likely to give birth to stunted children as a result of their own nutritional deprivation. This passes the tragedy of stunting from generation to generation – and helps to perpetuate the cycle of poverty.
Around the world 180 million children under five suffer from this terrible affliction. The full measure of this loss cannot be calculated, and the short- and long-term economic costs of this silent emergency cannot be ignored. The World Bank estimates that countries that are blighted by stunting and other consequences of under-nutrition lose at least three per cent of their gross domestic product, and billions of dollars in foregone productivity, as well as on avoidable healthcare spending.
The good news is that the solution to combating stunting is known – for example, by providing extra micronutrients such as vitamin A, zinc, iron and iodine. These are all easy to deliver and highly effective. They are also highly cost-effective. So, of course, is breastfeeding. In 2008, eight leading economists, including five Nobel Laureates, in the Copenhagen Consensus, recommended priorities for confronting the top 10 global challenges. They ranked providing young children with micronutrients as the most cost-effective way to advance global welfare. Delivered together with efforts to promote exclusive breastfeeding for a child’s first six months and to improve infant feeding practices, these interventions can change a child’s life.
These strategies are working. In the developing world, stunting prevalence fell from 40 per cent in 1990 to 29 per cent in 2008. This is encouraging, but by no means enough. It has not saved the 180 million children suffering from stunting today. And it will not prevent hundreds of millions of other children from suffering from the condition. More needs to be done. The time has come to recognise nutritional status as a marker of progress in development and also as a maker of progress – and a key to more sustainable development. Governments must invest in programmes to prevent stunting or risk diminishing the impact of other investments in education, health and child protection.
To accelerate global progress on nutrition, a movement is needed, driven by the countries that bear the greatest burden of stunting, supported by governments, international agencies, civil society, academia and the private sector, and made possible by communities themselves – a shared commitment to combat this terrible condition.
That movement now exists: the Scaling Up Nutrition (SUN) movement. SUN was established in 2010 to accelerate global progress on under-nutrition, especially stunting and acute malnutrition. It has already brought together more than 100 partners working to encourage, coordinate and improve the effectiveness of support for countries that have pledged to put nutrition at the centre of their national agendas.
‘Early risers’ in the SUN movement
Already, leaders in 26 developing countries have joined SUN. These ‘early risers’ are reviewing their policies and programmes through the lens of improving nutrition. Some are reviewing their budgets to increase allocations for nutrition programmes.
It is still too soon to see direct results, but the early signs are promising. The momentum is growing – and must built on. For a start, leading countries should allocate a larger percentage of their development budgets to support pro-nutrition programmes and interventions, paying special attention to the most disadvantaged.
These include expanding micronutrient delivery, promoting exclusive breastfeeding for the first six months and improving child-feeding practices. They also include community-based efforts to improve water, sanitation and hygiene and to treat common infectious diseases such as diarrhoea – the second largest cause of mortality in the under-fives. More than 80 per cent of all diarrhoeal diseases in children are caused by fecal contamination. Just as stunting increases a child’s risk of dying from diarrhoea, the disease inhibits the absorption of critical nutrients, which then increases the chance of stunting.
Together, governments, international agencies and non-governmental organisations should improve their collective ability to implement, as well as monitor, the results that these programmes are achieving, identify the barriers to progress and coordinate efforts to overcome them. This, in turn, maximises the effectiveness of aid dollars and budget allocations at a time when economic adversity makes every dollar count more than ever.
In addition, although the difference between food security and nutrition security must be recognised, the policy and programme linkages in efforts to achieve both must be strengthened.
The importance of agriculture
Supporting small-scale farming in developing countries is an important element of a food security policy. But governments can do more than enable small-scale farmers to buy seed and fertiliser. They can also advocate for greater diversity – more nutritious crops, more plentiful sources of protein and more production of staples such as vegetable oil.
Finally, more countries should join the growing SUN movement. Of the G8 countries, Canada, France, the United States and the United Kingdom are members. The G8 can send a strong signal about its commitment to sustainable development by making its membership unanimous – and, in doing so, encourage others to follow.
Together, we can make nutrition a global priority – and stunting a thing of the past. This is a cost-effective opportunity for a big global development win – an opportunity that nobody can afford to lose.