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THE GLOBAL ALLIANCE FOR IMPROVED NUTRITION

Nutrition: Everybody’s Problem but Nobody’s Business

September 6, 2011Kari Stoever, Senior Advisor

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The Global Nutrition Challenge

2 billion people affected by vitamin and mineral deficiencies

11% of the global disease burden

1 in 4 children underweight in developing countries

3.5 million deaths of children under five

2-3 percent loss of Gross Domestic Product (GDP) at national level

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Cost-Benefit Analysis

Copenhagen Consensus:

US$ 347 million investment in vitamins and minerals

US$ 5 billion in savings from avoided deaths, improved earnings and reduced healthcare spending

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• In 2002, Bill Gates and the U.S. Government founded GAIN because they believed two things:

• The world had the tools to end malnutrition but had not yet scaled investment to make it happen; and

• That because people buy their food (even the poorest and most rural people buy all or some), business is a key player in order to achieve lasting access for entire populations

• Thus, GAIN was created to stimulate business and government to take steps that would scale access to affordable and nutritious food.

• Formal creation in 2002 during UN Special Session on Children

• Evolved into a Swiss foundation in 2005, honored with receiving International Organization Status by Swiss Government in 2010

• Headquarters in Geneva, Switzerland

• Regional offices in Johannesburg (Africa), New Delhi (South Asia), Washington D.C. (Americas)

• Temporary presence in Cairo, new offices opened in Nairobi (Kenya), Dhaka (Bangladesh), Kabul (Afghanistan)

GAIN History

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GAIN is the World’s Major Nutrition Alliance

• GAIN taps the resources, experience and scale of business;

• Assists developing country governments with developing nutrition policies, legislation and oversight structures; and

• Taps relationships, networks and knowledge from donor governments and the UN.

With top engagement and access to all of the above, GAIN is the world’s proactive ‘broker’ to align all of the above for large scale and lasting impact.

Private sector

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Public sector

Nat

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Nutrition impact

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Foundations

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= 10M people

China

Cote d'Ivoire

Dominican RepublicEgypt

Georgia

Ghana

Kazakhstan

Mali

NigeriaNigeria

Pakistan

South Africa

Uganda

Uzbekistan

Vietnam

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Scale: Current GAIN partnerships reaching 400M people (1/2 women and children)

On track to 1 billion target

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400 million eating better

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14 percent reduction in micronutrient deficiencies in young children in Kenya

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30 percent reduction in neural tube defects in South Africa

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1/3 reduction in anemia

in China

11Source: Sun Framework slideshow / Nabarro, D. 2010 Scaling Up Nutrition

The SUN Framework calls to scale up efforts against rising undernutrition in a coordinated multi-stakeholder approach

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New Global Nutrition Movement

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14Source: USAID –Feed the Future slideshow / Adapted from UNICEF, Strategy for improved nutrition of children and women in developing countries, Policy Review Paper E/ICEF/1990/L.6 (New York, 1990)

Child nutrition

Food security Care resources

Health, water/

sanitation services

Food/nutrient intake Health

Institutions

Political & ideological framework

Economic structure

Resources environment, technology, people

BreastfeedingComplementary feedingVitamin A supplementationZinc supplementationHygiene & sanitationImmunizationSalt iodization

AgriculturePoverty reductionIncome generationEducationHealth systems strengtheningWomen’s empowerment

Immediate causes

Underlying causes at

household/family level

Basic causes at societal level

Interventions

Determinants of Child Nutrition and Recommended Interventions

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Children’s Health

• First 1000 days (pregnancy through 2 years of age) is the most critical development period

• A well nourished child is more likely to:

• Survive infancy • complete her education, • have a higher IQ• earn up to 46% more over

her lifetime.

• Attained height for age at two years is the single best predictor of human capital.

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Maternal Health

• Anemia is the most common micronutrient deficiency, and poses the greatest risk for maternal death

• Intergenerational cycle of growth

failure

• Height of a nation’s mothers can foretell the economic trend for that country

• Half of the growth failure accrued by two years of age occurs in the mother’s womb

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Malnutrition-Infection Complex

Malnutrition

Impaired child development

Infection

Energy loss

Disease

Compromised Immunity

Reduced productivity

Socioeconomic & political instability

Weak education and health systems

Poverty

Malnutrition-Infection Complex

Source: Schaible, U., Kaufmann, S., Malnutrition and Infection: Complex Mechanisms and Global Impact. PLoS Medicine. May 2007

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Malnutrition -Infection Complex

• The most prevalent public health problem in the world today1

• 54% of the 10.8 million deaths per year in children under five (U5s)2

• Greater risk for respiratory infections, infectious diarrhea, measles and malaria

• HIV/AIDS and TB exacerbate wasting and anemia

• 50% maternal deaths caused by anemia- trifecta of malnutrition, malaria and intestinal parasites

1ACC/SCN (1990) Report of 16th Session, para. 12; also in SCN News No. 6 (1990), p. 29 2Schaible, U., Kaufmann, S., Malnutrition and Infection: Complex Mechanisms and Global Impact. PLoS Medicine. May 2007

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HIV & Nutrition -- “Slim Disease”

Malnutrition:• Weakened immune system• Increased susceptibility to

opportunistic infections• Wasting & increased mortality • Poorer adherence & response to

treatment

HIV:• Loss of appetite• Increased nutrient

requirements• Impaired nutrient absorption• Altered nutrient metabolism

Entry Points:ANC/PMTCTClinical referralCommunity Referral

Assessment:AnthropometricBiochemicalClinicalDietaryFood Security

Counseling:AdherenceDietWASHInfant/child feedingReferral to Community Services

Clinical Mgmt & PMTCT Services:ARTOpportunistic InfectionsChronic disease management

Support:Food by Prescription: therapeutic & supplementary feedingMN supplementsLivelihood & food security referrals

Community Services:Nutrition surveillance & clinic referralsNutrition counseling & support within home-based careEconomic strengthening, livelihood & food security support

ClinicCommunity

Current Model

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Nutrition and Non-communicable Diseases (NCDs)

• Stunting and poor quality diets increase risks for diabetes, cancer and cardiovascular and metabolic disease (non-communicable diseases - NCDs)

• Decreases in worker productivity from NCDs will reach $35 trillion by 2030 - 7x the current level of global health spending

• Nearly 80% of deaths from these diseases were in the developing world, and 25% of deaths were of men and women under the age of 60

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“Take one world already being exhausted by 6 billion people. Find the ingredients to feed another 2 billion people. Add demand for more food, more animal feed and more fuel. Use only the same amount of water the planet has had since creation. And don’t forget to restore the environment that sustains us. Stir very carefully.”

Margaret Catley-CarlsonChair of World Economic Forum Global Agenda Council on Water Security