2020 Global

Nutrition Report
Action on equity to end malnutrition
Launch presentation - 12 May 2020
Why action on equity
to end malnutrition?
Nutrition inequity: our defining challenge
Injustices in food and health systems hold people back from healthy diets and lives

Social determinants are drivers of inequity… … that can lead to inequalities

in nutrition outcomes
Basic Underlying
determinants determinants
Globally, 1 in 9 Globally, 1 in 3
people is hungry adults is overweight
Socioeconomic and or undernourished or obese
Everyday
political context
circumstances
and norms

Human capital
or potential

Environments
Social position

Processes of unfairness, injustice and social exclusion

start at the basic level and extend to the underlying level
Nutrition equity: our defining opportunity
Everyone deserves access to healthy, affordable food and quality nutrition care

Poor diets are not simply a matter of personal Now is the time to act. Stakeholders must work
choices in coordination to overcome the barriers that are
holding back progress to end malnutrition
Food and health systems need to be transformed
Build Leverage key
equitable, moments to
Address inequities in food resilient and renew and
systems and make healthy, sustainable expand nutrition
sustainable food the most food and commitments
accessible and affordable health and strengthen
choice for all systems accountability

Fully integrate nutrition Focus on joint Invest in

in health systems and efforts – global nutrition,
make nutrition care, challenges especially in
preventive and curative, show how vital communities
universally available this is most affected

2020 Global Nutrition Report

Who is most affected?
The state of global nutrition
Progress towards the global nutrition targets is too slow and deeply unfair.
Global patterns hide significant inequalities between and within countries
Maternal, infant and young child nutrition targets

Anaemia Exclusive Low birth

In 2016, anaemia breastfeeding weight
affected 613.2 In 2018, 42.2% The latest estimate
million women of of infants 0–5 (2015) is that there
reproductive age, months were are around 20.5
35.3 million of whom exclusively million children with
OFF COURSE were pregnant. SOME SOME
PROGRESS breastfed. PROGRESS low birth weight.

Childhood Childhood Childhood

stunting wasting overweight
In 2018, 149.0 In 2018, 7.3% In 2018, 5.9%
million children of children were of children were
were stunted. wasted, equivalent overweight,
OFF COURSE OFF COURSE to 49.5 million OFF COURSE equivalent to 40.1
children. million children.

2020 Global Nutrition Report

The state of global nutrition
Progress towards the global nutrition targets is too slow and deeply unfair.
Global patterns hide significant inequalities between and within countries
Diet-related noncommunicable disease (NCD) targets

Salt Raised blood Adult Adult

intake
In 2017, the global
mean sodium intake
was 5.6g per day.
pressure obesity diabetes
In 2015, 597.4 million In 2016, 284.1 million men In 2014, 217.8 million
men and 529.2 million and 393.5 million women men and 204.4 million
women had raised blood were obese – 677.6 women were diabetic –
pressure – 1.13 billion million adults in total. 422.1 million adults
adults in total. in total.

OFF COURSE OFF COURSE OFF COURSE OFF COURSE

2020 Global Nutrition Report

 The double burden of malnutrition
Underweight still mostly affects children and adolescents,
while overweight and obesity are rising across all ages

Children and adolescents (5–19 years) Adults (18+ years)

Prevalence
Underweight Overweight Underweight Overweight
39.2%
37.0%
40%
31.6% 31.7%
38.5%
30%
19.2%
29.6% 29.7%
20% 25.9%
10.3% 11.5%
9.4%
17.5%

10% 11.1%
10.3%
8.6%

0%
2000 2004 2008 2012 2016 2000 2004 2008 2012 2016 2000 2004 2008 2012 2016 2000 2004 2008 2012 2016

2020 Global Nutrition Report Male Female

 Inequalities between countries
Underweight persists in poorer countries, while overweight and
obesity are more common in wealthier countries
Male
Low-income countries
Underweight
Children and Lower-middle-income countries
adolescents Overweight
(5–19 years) Upper-middle-income countries
Obesity
High-income countries

Underweight
Female
Adults
Overweight Low-income countries
(18+ years)
Lower-middle-income countries
Obesity

Upper-middle-income countries

0% 10% 20% 30% 40% 50% 60% 70% 0% 10% 20% 30% 40% 50% 60% 70% High-income countries
Prevalence

2020 Global Nutrition Report

 Inequalities between countries
Conflict and other forms of fragility compound the problem
100%
Percentage 7.4%
0.7%
of countries
with
overlapping 80% 46.5% 46.7%
38.2%
forms of
malnutrition
60%
3.7% 0.7% 4.7%
8.1% 9.3%
40% 4.4%
46.7%

20% 37.2%
36.8%

2.3% 6.7%
0%
136 Non-fragile countries 43 Fragile countries 15 Extremely fragile countries

Insufficient data Anaemia only Overweight and anaemia Anaemia and stunting

Overweight only Stunting only Overweight and stunting Overweight, anaemia and stunting

2020 Global Nutrition Report

Inequalities within countries
Subnational location matters, with large differences across communities

Stunting Wasting
prevalence (%) prevalence (%)
<10 20 30 40 ≥50 <5 10 15 20 ≥25

Overweight
prevalence (%)
0 8.75 17.5 26.25 ≥35

2020 Global Nutrition Report

 Vulnerable groups are often the most affected
Inequalities in infant and young child feeding practices
Continued breastfeeding (1 year) Introduction of solid, semi-solid or soft foods (6–8 months)

Urban Rural Rural Urban

74.8% 82.9% 64.1% 70.9%

Boys Girls Girls Boys

79.6% 80.0% 65.8% 66.2%

Richest Poorest Poorest Richest

71.0% 86.0% 60.1% 71.2%

Secondary or None or None or Secondary or

higher 76.8% primary 83.3% Primary 62.3% higher 70.4%

Continued breastfeeding (2 years) Minimum dietary diversity (6–23 months)

Urban Rural Rural Urban

48.9% 59.0% 27.4% 35.1%

Girls Boys Boys Girls

55.0% 56.1% 29.3% 30.4%

Richest Poorest Poorest Richest

43.6% 65.2% 22.9% 38.3%

Secondary or None or None or Secondary or

higher 49.8% primary 61.4% primary 24.4% higher 35.2%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

2020 Global Nutrition Report Prevalence Prevalence

How can we make our health
systems more equitable?
 Leadership and governance
Countries are not prepared to fight both sides of malnutrition at the same time
Percentage of countries
with actions related to
72.0%
global nutrition targets
70%
in health sector plans 66.7%

60.0%
60% 56.3% 55.6%
55.6%
53.8%
52.0%
50% 46.2% 46.2%
Low-income
43.8%
42.3%
40.7% Lower-middle-income
40% 37.0%
34.6%
31.3% Upper-middle-income
29.6%
30% 26.9%
25.0% High-income
18.8%
20%
12.0%
10% 6.3%
4.0% 4.0%

0%
Anaemia Exclusive Childhood Childhood Adolescent and adult Diabetes
breastfeeding stunting overweight overweight

2020 Global Nutrition Report

Challenges in health systems
Nutrition care – preventive and curative – is not equitably integrated
within health systems

Integration of nutrition
within health systems
Across each of the health system building blocks
Leadership Health Access to Health Health
Health
and systems essential services information
workforce
governance financing medicines delivery systems
Strong The number Spending on Important Nutrition Health records
government and distribution nutrition nutrition services are and national
coordination of trained represents a products and limited and surveys are
on nutrition is nutrition tiny portion of technologies focus most on not optimised
lacking professionals national health are not readily undernutrition to assess
is not equitable budgets available to all nutrition

2020 Global Nutrition Report

Opportunities in health systems
Universal health coverage is our chance to fully integrate nutrition
in health systems, save lives and reduce healthcare spending

Integration of nutrition
within health systems
Across each of the health system building blocks
Leadership Health Access to Health Health
Health
and systems essential services information
workforce
governance financing medicines delivery systems
Full integration A greater Alignment of Inclusion of Integration of Inclusion of
of nutrition number of costed nutrition nutrition care nutrition into
care into equitably nutrition care products in in health health records
national health distributed plans with essential service delivery, and public
sector plans nutrition healthcare medicines lists regularly health
professionals financing and use of monitored surveillance
plans technologies systems

2020 Global Nutrition Report

How can we make our food
systems more equitable?
Food system framework
Food environments are the connecting link between supply and demand systems

Food environments Consumer behaviour

Food supply chain Individual-level filters
Food acquisition
Food production Food availability
Economic Preparation
systems and input supply
Meal practices
Food affordability Storage
Storage and distribution Cognitive

Processing and packaging Product properties Diets

Aspirational
Outcomes
Retail and marketing Vendor properties
Situational Health
Nutrition
Food messaging
Sociocultural
Economic
Environmental

Climate Globalisation Income growth Urbanisation Population growth Politics and Sociocultural
change and trade and distribution and migration leadership context

2020 Global Nutrition Report

External drivers
Challenges in food systems
Inequities in food systems restrict access to healthy and affordable diets

Existing Many processed foods

agriculture do not meet international
systems limit the recommendations on salt,
production of sugar and fat levels
diverse crops

Fresh food Ultra-processed foods

is often less are cheap and
accessible intensively marketed
and affordable to low-income groups

2020 Global Nutrition Report

Opportunities in food systems
Solutions already exist to make healthy, sustainable food the most accessible,
affordable and desirable choice

Implement Increase public

comprehensive investment for
regulatory and policy healthier food
frameworks to products
ensure availability
of healthy foods

Support shorter Work with the food

supply chains for industry to encourage
fresh-food delivery production and
programmes marketing of healthier
food products

2020 Global Nutrition Report

What investments are needed
to improve nutrition outcomes?
Challenges in equitable financing
Financial commitments don’t match the scale and nature of the issue

9.5 9.7
Additional 10 9.0 9.1 9.3
0.4 0.4
0.4 0.1
funds needed 0.4 0.1
0.4 0.1
0.1
0.1
to meet 2025 7.5 2.1
8
global nutrition 0.3 3.1
2.6
0.1
targets (US$ 3.5 Additional domestic
3.9
billions)
6 Additional donor
3.5

2.8
Additional household
4
7.1 Innovative sources
6.4
5.7
5.1
4.5
2 3.5
2.9
2.2
1.5

0
2020 2021 2022 2023 2024 2025
2020 Global Nutrition Report
Opportunities for equitable financing
Expanded financial commitments, strengthened data systems and evidence
of cost effectiveness

Increase resources
ODA Financing sources
Philanthropy
Domestic taxation/revenues
Voluntary contributions Innovative financing
Additional solidarity contributions mechanisms
Domestic investment mechanisms

Disaggregate data

Compile evidence

2020 Global Nutrition Report

What critical actions are needed
to achieve nutrition equity?
Critical actions
Transform systems and target resources for faster and fairer progress to end malnutrition

Nutrition care should be an integral

Build equitable, part of universal health coverage to
resilient and address nutrition inequities
sustainable food
and health An equity-sensitive approach to food
systems systems is key to ensuring healthy,
accessible and affordable food for all

Invest in nutrition, Well resourced, well coordinated

especially in and accountable. Resources should
communities be expanded and preferentially targeted
most affected to where the need is greatest

2020 Global Nutrition Report

Critical actions
Make nutrition equity a priority and a collective responsibility

Focus on joint Engage and mobilise all sectors to act

efforts – global now and target those most in need
challenges show
how vital this is
Renew and expand ambitious and
SMART commitments
Leverage key
moments to renew
and expand nutrition
commitments Establish an international system
and strengthen of governance and strengthen
accountability accountability

2020 Global Nutrition Report

Success is within reach

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For notes and sources,
please see the full report