Why nutrition must feature prominently in the post-2015 Sustainable Development Goals

The establishment of new development goals in 2015 represents a massive opportunity for nutrition. Patrick Webb argues it is time nutrition becomes top policy priority.

During the coming months of 2015, important decisions will be made by governments around the world regarding the direction, the scale of ambition, and the milestones required to frame a new set of collective goals for development. The post-2015 Sustainable Development Goals (SDGs) will build on the unfinished business of the Millennium Development Goals (MDGs) and expand on that earlier agenda. By 2025, the new goals will serve as a roadmap to guide policy and budgetary resources towards commonly-agreed priorities designed to improve, but also sustain, human wellbeing. This represents a major opportunity for the international community to finally make good on its numerous unfulfilled commitments to securing good nutrition for all.

The influential Global Nutrition Report argued that, “improvements in nutrition status will be central to the sustainable development agenda.”[1] Poor nutrition doesn’t just represent a lack of nutritious and safe food; it derives from a host of interacting processes that link health care, education, sanitation and hygiene, access to resources, women’s empowerment and more. We know that good nutrition leads to higher individual earnings and mental acuity, which in turn support macroeconomic and societal growth. Malnutrition (which includes several forms of undernutrition as well as overweight and obesity) impairs individual productivity, which acts as a drag on national macroeconomic growth.[2] In this sense, poor nutrition represents an often invisible impediment to the successful achievement of all development targets. Conversely, good nutrition needs to be understood and positioned as both an input to, and an outcome of, the success of the SDGs as a whole.

But nutrition isn’t just one thing; it represents a set of overlapping processes and outcomes that manifest in different physiological, clinical, cognitive and developmental ways. Nutrition has been poorly served during the past 15 years by being represented in the Millennium Development Goals as a single metric intended to proxy for all forms of nutritional deficiencies. That one metric, the prevalence of children under 5 years of age who are underweight (low weight-for-age), is inadequate for identifying multiple underlying causes, and it leads to an inappropriate focus on increasing child weight as the main solution to malnutrition. Just as health isn’t defined as the absence of a single disease or medical condition, nutrition is about more than the absence of one or more nutrients in the diet or a single manifestation of nutritional compromise. It’s complicated. And in the past, that complexity has been a drawback to communication to donors and policymakers about nutrition problems and required actions.

Fortunately, things are changing. Accumulating empirical evidence of cost-effective actions in nutrition, acknowledgement that targeted, health-based interventions need to be supported by broader nutrition-sensitive actions in many sectors, and a political realisation that policy priorities can’t be addressed in isolation of others, is leading to acceptance that complexity can’t be ignored. It is nutrition’s complexity that underpins its multi-directional links with the SDGs, which demands less simplified messaging and less reliance on a single metric to represent all of nutrition.

This is now finally happening. In 2012, the World Health Assembly (WHA) endorsed a Comprehensive Implementation Plan on Maternal, Infant and Young Child Nutrition which included six targets highlighting critical public health concerns: child stunting, anaemia in women of reproductive age, low birth weight, childhood overweight, child wasting and exclusive breastfeeding for the first 6 months after birth.[3] Together, these 6 issues acknowledge the compounding effects of multiple burdens of malnutrition that manifest at different periods of the lifecycle.[4] The WHA’s message is that nutrition goals can’t be met piecemeal or in one-at-a time fashion; they are all important and must all be addressed immediately.

Since most governments track few of nutrition indicators on a regular or nationally representative basis, very few pay attention to this range of manifestations of malnutrition. As a result, nutrition policies and strategies are either blunt instruments -- poorly tailored to address the multiple forms of malnutrition found in most countries -- or too broadly cast to offer concrete guidance on programme levers that could be marshalled to tackle nutrition problems. A new paper in the journal Food Security, prepared as part of the evidence-building mandate of the Global Panel on Agriculture and Food Systems for Development, shows how countries such as Brazil and China can be doing very well in reducing stunting but still be faced with high levels of maternal anemia; or Belarus and Mongolia can have low wasting but high rates of child obesity; or Algeria and Djibouti can have low rates of low birth weight but also very low levels of exclusive breastfeeding.[5] Similarly, countries with large economies and vibrant agricultural sectors, including India and Nigeria, can have very high rates of stunting, maternal anemia and wasting.

Drawing on data from 89 low and middle income countries for which all six variables were available (that so few countries have the data available is a problem in itself), that paper underscores the fact that many countries can point to success in one or other domain of nutrition, but still face significant failure in at least one other domain. Thus, the WHA targets for improving nutrition by 2025 represent a major challenge to policymakers worldwide: governments are obliged to pay attention to the multiple manifestations of poor nutrition and to invest in interventions that promote gains in one or more areas while causing no unintended negative effects in others.

The widespread adoption of the six WHA targets has led to the proposal that they all be included within the SDGs. A wide consultation of experts and institutions concluded that the six WHA targets should be embedded within the proposed SDG2 (which focuses on ending hunger, achieving food security and improved nutrition, and sustainable agriculture), but coupled with two additional targets: one on achieving greater diet quality (a maternal diet diversity score), and another that tracks the percent of national budgets allocated to nutrition (Table 1).[6]

These eight targets should, indeed must, represent the core nutrition metrics for the SDGs. The establishment of new development goals in 2015 represents a massive opportunity for nutrition; it’s time to stop settling for being less than a top policy priority! Nutrition needs to emerge, pushed from behind if necessary, from the crowded space occupied by muscle-bound sectors that still occupy most of busy policymakers’ attention. The 21st century’s nutrition problems are many, and they need to be acknowledged as being multifaceted and complex. But, we’ve learned a lot in the period of the MDGs; we know how to do things better, faster, and more sustainably. We’ve also learned that things that are not measured are not prioritised. The nutrition, dietary and budget targets proposed are ambitious. Yet they can be achieved given wide support from a broad and vocal coalition of the willing. Now more than ever, it’s time to step up our game.

Patrick Webb
Policy and Evidence Adviser for the Global Panel