Interacting causes of hunger and health must be addressed if we are to meet MDGs, says new UN Report

20 November 2007 Earthscan

Under embargo until 28 November 2007 00:01 GMT

Interacting causes of hunger and health must be addressed if we are to meet MDGs
- Taking action on hunger and health a moral obligation to humankind
- New UN-WFP Report says hunger and poor health are solvable problems today

Rome – Overcoming hunger and poor health is at the centre of the Millennium Development Goals (MDGs). Yet at the half-way point to 2015, despite unprecedented resources to meet these challenges, the world is behind schedule in both of these core areas. It is well known that the cost of inaction is high, both in economic and moral terms. However, the cost of action is modest by comparison, according to a United Nations World Food Programme report co-published today with Earthscan.

“For the first time in history, we have the knowledge to end hunger. All we need now is the will and the action to eradicate hunger from humanity,” says Josette Sheeran, WFP Executive Director.

Examining the profound effect that hunger has on health, the World Hunger Series 2007 - Hunger and Health identifies critical junctures in the human life cycle when the benefits of reducing hunger and improving poor health have a particularly long-term impact on individual lives and on nations. The report demonstrates how the alignment of hunger and health interventions can assist those most in need, and contains compelling evidence which confirms that hunger and poor health are solvable problems today.

Hunger and Health: A Close Relationship

The World Hunger Series 2007 explores the multiple relationships between hunger and poor health and how they affect the growth of individuals, physiologically and psychologically, and constrain the development of nations both socially and economically.

Hunger and poor health are strongly related to political and economic choices, which in turn reflect the priorities attached to budget allocations, quality of social services and community values. People who suffer from hunger in any of its forms are not the decision-makers, nor are they necessarily well represented by them.

“Just as hunger and health are closely related, so are undernutrition and disease. Undernutrition leads to a state of poor health that puts the individual at risk of infectious and chronic disease. Hungry people are much less effective in fighting disease than well-fed people. An undernourished child tends to suffer more days of sickness than a well-nourished child as undernutrition contributes directly to disease.”

Infections, however mild, have adverse effects on a person’s nutritional status. Acute and chronic infections can trigger different reactions, including reduced appetite and impaired nutrient absorption. Even when nutrients are absorbed, they may still be lost as a result of the infection.

Progress on Eliminating Hunger

According to the report, there are improvements in reducing hunger in some regions, e.g. Asia Pacific, Latin America and the Caribbean – with the most significant progress in China and south-east Asia. But the number of chronically hungry people worldwide is growing by an average of 4 million per year at current trends – with the most dramatic increase in the Democratic Republic of Congo – where the number tripled from 12 million to 36 million in just a decade. Reaching the first Millennium Development Goal (MDG 1: Eradicate extreme poverty and hunger) is not on track. In some parts of the world, progress is being eroded by economic downturns, the spread of HIV/AIDS, population growth, conflict and natural disasters; sustainable solutions for the hungry are still far off. Progress towards meeting health-related MDGs, like those for hunger, is also uneven and well-off countries are improving their health at a faster rate than those that are worse-off.

“There are major differences between rich and poor countries. In the poorest, most food-insecure countries – low-income food-deficit countries – life expectancy for men and women remains less than 50 years as a result of prolonged food shortages, disease, conflict and unequal access to quality healthcare. Approximately half of all deaths in children under 5 are directly due to hunger,” the report says.

Solutions are Known and Cost-Effective

The World Hunger Series 2007 report, Hunger and Health sets out proven solutions which are available and affordable.

Despite the broad acceptance of the causal relationship between undernutrition and disease, resources have disproportionately been directed toward managing infectious diseases rather than preventing hunger and undernutrition. The report says: it is only by prioritizing the hungry – and especially women and children at all stages of the life cycle – and by supporting principles of inclusion, equality, ease of access and transparency that the hungry can benefit from the technological innovations that are transforming the world.

Reducing hunger increases productivity by improving work capacity, learning and cognitive development, and health by reducing the impact of disease and premature mortality. Hunger and poor health directly affect human and social capital formation and economic growth. These effects are long-lasting and inter-generational, with impacts impeding the achievement of other global social goals.

Essential Solutions

This World Hunger Series 2007 sets out a package of proven, practical and cost-effective solutions to address the interrelated causes of hunger and poor health. These solutions, combining food-based activities with basic healthcare and prevention activities, form “essential solutions” for hunger and poor-health reduction. These specifically aim to expand programmes aligned with two broad “windows of opportunity” – critical times in an individual’s life: early life, focusing on mothers, infants and young children, and adolescence, which includes school-age children.

The report argues that:

1) Food and non-food responses must be combined to enhance treatment.

For those in poor health, overcoming hunger is often a prerequisite for effective treatment and recovery. Nutritious food helps to speed recovery and guard against infection.

2) Hunger and health must be addressed together.

Hunger and Health shows that a combination of integrated food and health interventions is often more effective than a single disease approach.

3) Responses must address critical stages in the life cycle.

The report suggests that there are critical junctures when the benefits of reducing hunger and improving poor health have a particularly long-term impact. Improving the nutritional status of adolescent girls, pregnant women and mothers improves the chances that children will grow up well nourished.

4) There must be greater alignment of efforts to support national priorities.

The report points out that a greater alignment of efforts is crucial if we are to make faster progress in meeting the MDGs. One particular gap relates to the interaction between hunger and poor health.

Broadening Commitment

Despite the various cost-effective solutions for combating hunger and improving health, and the potential to direct national and international political commitments to address these related problems for the poorest people, efforts are still insufficient. There is a real risk that the MDGs, themselves relatively modest, may not be met. The World Hunger Series challenges leaders to build on past successes, combining current knowledge with a will to undertake practical and effective solutions to end hunger in the coming decades.

There are four strong motivations for prioritizing these hunger-health solutions:

- The cost of hunger and poor health is high.
- Solutions are affordable, cost-effective and sustainable.
- There is consensus on the human right to adequate food, nutrition and health for all.
- Well-fed and healthy populations contribute to economic growth more effectively.

In the end, commitment determines whether interventions are effective and sustainable. The elimination of hunger cannot be relegated as a subsidiary goal of other commitments. In view of the tremendous human, economic and social costs of hunger, its elimination must be a development priority and an integral part of national health goals.

To achieve optimal impact, appropriate resources are essential and their use must be maximized. The resources needed are not only financial: they include leadership, management and system support to make social services effective. To scale up activities, it is important to measure results and to know what works. Subsequently, resources can be allocated to projects that achieve impact:

- There is increasing evidence that nutrition and food support accompanying treatment for tuberculosis (TB), human immunodeficiency virus (HIV) and other infectious diseases increases adherence and improves outcomes, particularly for the poor. This support should become an integral part of treatment programmes. Research should be accelerated to improve the effectiveness of food and nutrition support aligned with treatment.

- The pervasive problem of micronutrient deficiencies shows that calories alone are not sufficient for good health. There is a need for increased awareness and understanding with regard to the value of micronutrients throughout the life cycle.

- Food fortification occurs in a number of countries, but more needs to be done. Multiple-micronutrient fortification of commonly consumed products and/or supplements may be a cost-effective strategy to address multiple deficiencies among school-age children, adolescents, refugees and internally displaced people (IDPs). Also, more consideration should be given to fortifying food in the household (home fortification) and ready-to-eat foods, particularly in emergency situations.

Making the Right Decisions

Urgent action is needed if hunger is to be eradicated in the coming decades. Government commitment to surpassing the MDGs, eradicating hunger and providing access to quality healthcare for hungry and marginalized people is the only option. The burden of hunger and poor health and its effect on national development can be only part of the rationale for acting. Action must address the human suffering caused by hunger and poor health and remove the divide between those who have access to sufficient quality food and healthcare, and those that miss these most essential ingredients for equitable human well-being.

“We need to mobilize our collective will to make the right choices. The cost of inaction is high – economically, politically and, most importantly, morally,” the report’s Overview concludes.

“Hunger and Health not only surveys current knowledge about the link between poor nutrition and health, but also details the mechanisms by which hunger saps health and destroys the promise of decent and meaningful lives. Any scholarly work should do at least this, but Hunger and Health offers much more, as it draws on decades of pragmatic experience alleviating ‘food emergencies’,” said Paul Farmer, MD, Harvard Medical School and Partners in Health.

Hard Facts

- 854 million people suffer from hunger with insufficient food intake to meet their basic energy needs.

- 2 billion people are affected by “Hidden Hunger” or micronutrient deficiencies - even when they consume adequate calories and protein.

- 90 percent of the world's hungry live with chronic hunger - a nagging hunger that does not go away.

- 178 million children under 5 are stunted or short in stature.

- 143 million children under 5 are underweight in developing countries - of whom 121 million live in low-income food-deficit countries.

- 53 percent of childhood deaths have undernutrition as a synergistic cause.

- Only 2.1 million people escape hunger each year far short of the MDG 1 target.

- 57 percent of malaria deaths are attributable to undernutrition.

- 1/3 of the 40 million people living with HIV are also infected with TB.

- 80 percent of chronic diseases occur in low-income and middle-income countries.

- Undernutrition, overnutrition and diet-related chronic diseases account for more than half of the world's diseases and hundreds of millions of USdollars in public expenditure.