A. A new World Bank report warns unless action is taken within the first two years of a child’s life to improve nutrition, children will suffer irreparable damage, ultimately adversely affecting the country’s economic growth. The report, Repositioning Nutrition as Central to Development, says malnutrition remains the world’s most serious health problem. Poor nutrition is implicated in more than half of all child deaths worldwide - a proportion unmatched by any infectious disease since the Black Death. ‘Malnutrition is among the most serious health problems in the world today that has not been tackled,’ says Meera Shekar, the report’s lead author. ‘Roughly 30% of children in the world are undernourished and in fact 60% of children for example who die of common diseases like malaria and diarrhea' would not have died had they not been malnourished in the first place.’

B. While criticizing the lack of large-scale action internationally and within countries to tackle malnutrition, the report says improving nutrition could add two to three per cent to the growth rates of poor countries. And contrary to popular belief, it reveals the rates of malnutrition in South Asia are almost double those in Sub-Saharan Africa. ‘We find the problem is much more severe in South Asia than in Sub-Saharan Africa. Roughly 50 per cent of children in South Asia are undernourished as compared to about 25 per cent in Sub-Saharan Africa. But we also find that the problem is not limited to those two regions alone. There are countries in other regions - Indonesia, Uzbekistan, Yemen, Guatemala and Peru - where the problem is acute as well.’

C. The report dispels the notion that malnutrition is simply a problem for the world's poor countries. ‘Poor nutrition also exists elsewhere, thus suggesting it's not simply a question of access to food,’ Shekar says. ‘India and Ethiopia have about the same levels of malnutrition. And 26 per cent of children in the highest income bracket in India are underweight and 65 per cent are anemic?. Anemic children perform less well in school, are more likely to drop out and have lower intellectual and physical productivity as adults. Everyone talks about how well India is doing in the IT industry

-              imagine how much better it could do if 65 per cent of the richest and 88 per cent of the poorest children were not anemic!’ As Shekar says, the developed world also faces the other side of malnutrition

-              obesity. 'In the developed world, there’s the other aspect of malnutrition that is coming up and that is the overweight agenda. And that links very closely to non-communicable disease like cardio-vascular heart disease, diabetes and cancers.’

D. Repositioning Nutrition as Central to Development also dispels the notion that simply putting more food into the mouths of children can overcome malnutrition. It says actions targeted to older children have little, if any, effect on improving nutrition. The emphasis of any programs3 to combat nutrition should therefore target pregnant women and children under two years of age. There is actually a very, very tight window of opportunity which is between conception through the first two years of life,’ Shekar says. 'If we miss this window, we miss a whole generation. This is the time when the damage that happens due to malnutrition is in fact essentially irreparable damage. So if we had only one dollar to invest in improving nutrition that is where we would like to focus our actions. Many people assume that feeding children later in life will improve nutrition. Well, it’s too little, too expensive and too late to improve nutrition or to improve future productivity.’

E. Shekar says it’s now time for the international community to re-think the importance it places on the value of nutrition. As the report says, ‘the unequivocal choice now is between continuing to fail, as the global community did with HIV/AIDS for more than a decade, or to finally put nutrition at the center4 of development so that a wide range of economic and social improvements that depend on nutrition can be realized.’

Shekar says in the past, the international community has thought of nutrition merely as a food consumption issue or a welfare issue. ‘But the case we are making in this report is that nutrition is an investment issue. It is something that can drive economic growth rather than ride on the coat-tails of economic growth, because children who are well-nourished have been shown to have much higher income potential as adults.’ The report makes the point that malnutrition is costing poor countries up to three per cent of their yearly GDP. And with the economies of many developing countries growing at a rate of two to three per cent annually, the report says improving nutrition could potentially double those rates.

F. ‘I think the biggest challenge now is getting the donor community to rally around this issue - to put resources, both technical and financial, behind this issue. And at the same time, there’s a need to build commitment among government partners as well - to invest not only in nutrition but invest in the right kinds of things for nutrition.’ The report calls on the donor community to co-finance a grant fund to jumpstart action in commitment-building and action research. Concurrently substantive funding is needed for developing countries through existing funding channels, to scale-up actions to prevent malnutrition.