EARLIER this year, when I was visiting women in a village in northeastern India, a casual conversation made my heart ache. We were chatting about our lives and families, sharing stories about our children. Then, I asked if anyone had lost a child.
Almost every woman raised her hand. Most of the children, it turned out, had died during the rainy season from cholera or other diarrhoeal diseases. One woman told me she had lost three children.
Those deaths could have been prevented — in 2015, diarrhoeal diseases don’t have to be fatal. And yet, they remain the second leading cause of child mortality, and malnutrition is often a critical factor. If kids don’t receive enough of the right kinds of nutrients, they become more susceptible to diarrhoea, which further weakens their young bodies.
It’s hard to think of another issue that wreaks as much havoc as malnutrition does, yet receives so little attention. Malnutrition plays a role in nearly half the deaths of children under 5. And, the hundreds of millions of malnourished kids who survive those first five years suffer lifelong effects. Across the globe, one in four children is stunted, which means the body and brain will never fully develop. A quarter of the people on this planet won’t reach their full potential simply because they aren’t getting the nutrients they need.
Why has the world allowed this to happen? One reason is that the symptoms of micronutrient deficiency are often invisible — you can’t always tell that children are malnourished just by looking at them. As a result, not enough governments, aid organisations and other donors have made preventing and treating malnutrition a top priority.
This is changing as awareness increases about the consequences of inaction. Governments in both wealthy and poor countries, and other donors, are leading efforts to increase funding and give this long-neglected issue the focus it deserves. And, they have the strong support of the Gates Foundation, which announced this month that it will more than double its investments in nutrition, committing US$776 million (RM2.9 billion) over the next six years.
Even more financial resources are needed. And for our collective efforts to have as big an impact as possible, it’s important that organisations and governments involved make deliberate, targeted choices about the types of interventions we invest in. Here are some key strategies that can help — the Gates Foundation adopted all of them recently.
We need to educate more women and girls about the solutions that we know will work. For example, we know that breastfeeding is the most important nutrition intervention for newborns, infants and young children — and spreading this message can save hundreds of thousands of lives each year.
As we carry out those education efforts, we should evaluate new methods that can have an even greater impact. Alive & Thrive, a programme partly funded by the Gates Foundation, was able to triple breastfeeding rates in targeted Vietnamese provinces in just five years. And in countries like Tanzania, we’ve seen that fortifying staple foods with essential nutrients can improve children’s health for just pennies a day. The challenge that follows is to bring successful initiatives to more families in more countries.
Meanwhile, researchers are working to understand exactly how our guts absorb nutrients, so that they can better help children survive extended periods of diarrhoea. Their work should be funded and supported.
Enlisting women and girls as allies in combating malnutrition is essential — especially, working with women before they become pregnant to increase the likelihood that they’ll have safe pregnancies and healthy, well-nourished babies. The 1,000-day window from the beginning of a woman’s pregnancy to her child’s second birthday is a crucial time. Kids who miss out on sufficient nutrition during those years never fully grow physically or mentally, which impacts their ability to learn in school and reduces their potential as adults.
We need to strengthen food systems to ensure that people everywhere have access to nutritious and affordable food year-round. That means partnering with farmers, and encouraging them to grow more diverse and more nutritious crops, such as orange-fleshed sweet potatoes that are rich in Vitamin A and beans that have been bred to be rich in iron. It also means working with local food companies — such as Grands Moulins de Dakar in Senegal, Brittania Industries in India and Ethio Chicken in Ethopia — to ensure that they’re investing in the health of their communities by marketing nourishing foods.
And finally, collecting better information about malnutrition will have a big impact, since many countries with high malnutrition rates lack reliable and timely data on the issue. We know, for example, that malnutrition is widespread in Nigeria, but we don’t know where the burden is highest, which interventions are working or whom we’re failing to reach. Having this data would help us develop more effective responses, and so the Gates Foundation is helping to lead this effort.
Based on our own experience, Bill and I can say one thing for sure about combating malnutrition: the more you learn about its terrible impact, the more you want to fight it. And the good news for families like the ones I met in India is that, working together, this is a fight we can win.
The writer is co-chair of the Bill & Melinda Gates Foundation