Editorial
A hunger for action
The basic nutritional needs of children are at grave risk.
Worldwide, more than 13·6 million children under 5
years have severe acute malnutrition, a serious wasting
condition associated with poverty and prolonged
insufficient access to food. Severe acute malnutrition
weakens children’s immunity, resulting in repeated
rounds of diarrhoea and other infections, such as measles
and malaria, and accounts for a fifth of deaths in this age
group. In an alert released on May 17, UNICEF warned
that over 10 million of these children do not have access
to ready-to-use therapeutic food (RUTF), considered the
most effective treatment for severe acute malnutrition.
UNICEF says that the price of RUTF is projected to
increase by up to 16% over the next 6 months due to
a rise in the cost of raw ingredients and delivery. An
additional 600 000 children will be left without access.
Against the backdrop of wider global food insecurity,
geopolitical tensions, and economic precariousness, it is
unclear who will act to protect them.
The Global Report on Food Crises 2022, published
on May 4, shows a worsening situation in 2021, with
almost 180 million people in food crisis in 39 countries
and territories, doubling from 94 million in 2016. The
report forecasts that the situation will persist or even
deteriorate in 2022. Food insecurity is exacerbated by
economic shocks reverberating from the COVID-19
pandemic, while climate change-associated weather
extremes further aggravate food shortages and
displace people. Conflict is also a driver. Ukraine, one
of the world’s top producers of corn, wheat, and barley,
has been forced to reduce its exports drastically after
the Russian invasion, with devastating effects on
wellbeing and health. UN Secretary-General António
Guterres has described millions of people in food
insecurity “followed by malnutrition, mass hunger
and famine, in a crisis that could last for years”. World
Bank president David Malpass has warned of a “human
catastrophe”. The effects will be felt worst in countries
that rely heavily on imported grain to support
their already fragile food systems, such as Somalia,
Ethiopia, Yemen, and Sudan. The Russian Government
is responsible not only for the atrocities in Ukraine, but
also these far-reaching harms.
Aside from one item focused on iodine deficiency
disorders, the agenda for the 75th World Health
www.thelancet.com Vol 399 May 28, 2022 1991
Assembly, on May 22–28, reflects a notable lack of
appreciation that a sufficient supply of nutritious
food is integral to sustaining health. Severe acute
malnutrition is a visible symptom of dysfunctional,
unequal societies. Food is a basic human right, yet
Hum Images/Alamy Stock Photo
we are at a dangerous juncture where any gains
made through increased research and nutritional
technology are being offset by a compounding cycle
of food crises. The result is a threat to the health of
millions of children. As pointed out in the Lancet
Series on Optimising Child and Adolescent Health
and Development, the 1000 days from conception
to 2 years of age are crucial for human flourishing
and the formation of future human capital. Not
just an individual’s economic potential, but their
health, wellbeing, knowledge, and interpersonal and
socioemotional skills needed to fulfil their individual
and societal potential. The negative impact of today’s
childhood malnutrition will be felt for decades to
come. The first three Sustainable Development
Goals: no poverty, zero hunger, and good health and
wellbeing, are intimately connected and must be
tackled together.
This might feel like an overwhelmingly complex task,
but for severe acute malnutrition, the immediate need
is simple—money, now. UNICEF calls for an additional
US$300 million in annual funding, so that every
child with severe acute malnutrition in the 22 Global
Action Plan for Child Wasting countries can be treated.
Financing for severe acute malnutrition treatment
relies heavily on donors’ official development assistance
(ODA), yet the proportion of aid spending on severe
acute malnutrition was only 0·2% of total ODA in
2019. Funding for humanitarian food assistance has
been falling since 2017, made worse because of global For the UNICEF alert on severe
economic decline and competing domestic priorities acute malnutrition see https://
www.unicef.org/child-alert/
in donor countries. Except for Germany, none of the severe-wasting
top donors to ODA (the USA, Japan, France, and the For the 2022 Global Report on
UK) meet the UN-recommended contribution level Food Crises see http://www.
fightfoodcrises.net/fileadmin/
of 0·7% gross national income. When the warnings user_upload/fightfoodcrises/
have been so clear, it will be a collective moral failure doc/resources/GRFC_2022_
FINAl_REPORT.pdf
if severe acute malnutrition is allowed to continue. In
For the Lancet Series on
the midst of an economic squeeze and a cost-of-living Optimising Child and
Adolescent Health and
crisis, countries must remember their international
Development see Series Lancet
obligations. n The Lancet 2022; 399: 1730–40