Institute of Development Studies

Undernutrition in Today’s World is an Unforgivable Crime

12 March 2010 - Lawrence Haddad

This year, the Millennium Development Goals (MDGs) will come under a huge amount of scrutiny. I think it is fair to say that progress against the first goal - to eradicate extreme poverty and hunger - is slow and mixed. One upward trend that is welcome is the rise in resources allocated to combat hunger and undernutrition. While shifting hundreds of billions to save the bank balance sheets of rich country citizens can be done quickly, finding resources to save the nutrition balance sheets of poor country citizens is much harder. We must make the most of the L'Aquila billions and other pledges. It would be a crime if these hard won resources were not used effectively.

So what would it take? For me the answer revolves around Motive, Means and Opportunity.

Motive

We have got to want to reduce the same thing. We need one focus, not many. The pursuit of multiple and often contradicting indicators (hunger, poverty, undernutrition) under the same goal dissipates energy and generates rivalries.

The one indicator should be child height for age (stunting) for chronic undernutrition and weight for height (thinness) for severe and acute conditions. It should be nutrition for two reasons. First, stunting represents what we are interested in: the sum of deprivations - food, care, water, sanitation, and health services highlighting the weak ability to claim rights and the weak capacity of duty bearers to respect, protect and fulfil them. It is also a herald of things to come in later life in terms of damaged learning, foregone productivity, compromised pregnancies, and susceptibility to middle aged chronic disease. All the technical tensions of aggregating indices across dimensions and over time are reconciled in two grisly indices.

Second, it is practical. It requires four measurements - weight, height, age and sex. Food consumption requires dozens. Income requires hundreds.

Opportunity

Every conception is an opportunity to reduce undernutrition. The stunting of children is like the descent of frost on a young bud, the broken bone whose setting keeps getting disrupted, or the baking cake whose rise is interrupted. Failure to prevent early childhood disruption is irreversible.

More generally, the list of opportunities to get food and nutrition back on the agenda is dizzying. L'Aquila, CGARD, USAID, DFID, Irish Aid, UN Secretary General's Special Adviser on Food and Nutrition, the high-level Task Force on the Global Food Security Crisis, the Global Partnership on Food and Nutrition etc. etc.

Within sectors there are plenty of opportunities too. Within agriculture, for example, its impact on nutrition could be enhanced by a greater focus on:

• changing power relations between men and women (which attributes, which crops, which risks, which constraints),
• focusing on micronutrients (e.g. orange flesh sweet potato),
• listening to smallholder farmers directly about what they regard as success, what is and is not working and what to do about it.

The windows of opportunity are there, but they are closing - we need leadership to wedge them open.

Means

If we need our measures of performance to be more focused, we have to expand the range of actors and actions that are mobilised to reduce stunting. We need a cross-government, cross-society effort.
Reducing undernutrition - like most other development goals - is complex. Reducing undernutrition requires coordination across sectors. It requires adaptive behaviour change. It is invisible until it is too late and therefore requires vigilance to hold people accountable. It is no-one's responsibility so there are specific leadership challenges. Coordination, Accountability, Adaptiveness, Leadership. This is the language of governance. Reducing undernutrition cannot be accomplished by any one sector. We cannot expect agriculture to do it all. Nor social protection. Nor targeted nutrition interventions. We need a strategic alliance of a range of talents.

Strategic alliances require proper governance and leadership. This means:

Institutional innovations to increase capability and incentives to build links, such as: developing new leadership roles and platforms, realigning organisational structures, creating new incentives for and from donors.

• Accountability mechanisms such as: sentinel sites for a global 'nutrition status watch' and the routine use of constituent feedback mechanisms and stakeholder audits.
• Responsiveness mechanisms such as: commitment indices, leadership training and a reworking of the archaic teaching and learning methods in nutrition - at all levels.

Conclusions

• The focus of the first MDG has to be on undernutrition - it is the practical indicator that most closely captures the things we say we value in society.
• We need to innovate to bring the whole of government and the whole might of society together to focus on undernutrition.
• We must seize the opportunities - they will not be there for long.
• This will require leadership of the kind we have seen in Brazil on the importance of focus and alliances and in the International Fund for Agricultural Development on putting people at the heart of the work.

We cannot afford to wait for leadership. We need leaders from political, trade union, business, religious, media, academic, social movement, and NGO groups to stand up and say ,'no - I will not be an accomplice to the crime of child undernutrition.'

This article is based on a speech given by Lawrence Haddad at Agenda 2010: the Turning Point on Poverty, the DFID conference on the Millennium Development Goals ahead of UN summit in September.

Image Giacomo Pirozzi/ Panos

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