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AfricaJanuary 2 2018

Akinwumi A Adesina: Africa's nutrition challenge

Africa's most urgent problem is that of poor nutrition, which is responsible for stunting children's growth – and, ultimately, their future economic prospects. But the continent has the right tools to end malnutrition if its leaders exercise their combined will, writes the president of the African Development Bank.
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Akinwumi Adesina

The many negative impacts of poor diets and nutrition have long been underrated, and yet one in three people worldwide suffers from malnutrition. Poor diets now pose a bigger risk to mortality and morbidity than alcohol, unsafe sex and drug and tobacco use combined. Moreover, malnutrition comes in many different forms, from stunting growth, wasting and vitamin deficiency, to obesity and other diet-related diseases.

Many low- and middle-income countries are now experiencing a ‘triple burden’ of malnutrition, where undernutrition and micronutrient deficiencies co-exist with obesity and other diseases related to diets.

This triple burden is a particular challenge in urban areas dependent upon efficient food distribution systems and imports. About two-thirds of the world’s population will be living in urban areas by 2050, and there is no guarantee that food systems will be able to cope with the requirements of ensuring an adequate distribution of nutritious food, especially in the urban areas of less developed countries in Asia and Africa.

A cross-sector focus

As we concentrate on feeding people, we should increasingly focus on providing people with good-quality and nutritious food. This is no longer just about the delivery of calories. It is about developing and encompassing policies and programmes, not only in agriculture but also in trade, the environment, health and consumer affairs.

The evidence to support this thinking, together with relevant recommendations was presented in the Global Panel’s 2016 Foresight Report, 'Food systems and diets: facing the challenges of the 21st century'. High-quality diets eliminate hunger, are safe, reduce all forms of malnutrition and promote health. They need to be diverse and balanced as well as adequate, and they should be capable of sustaining the nutritious diets of future generations.

But very strong leadership is required for concrete action. This leadership must be determined, inclusive and committed, capable of maintaining focus on the effectiveness and timely delivery of the required action. We must transform our food systems in ways and means that promote greater diversity, availability and affordability, to secure improved nutrition, health and social and economic prosperity.

And in doing so, we should concentrate most of our efforts on those least able to provide for themselves: the children whose future health, education and livelihoods are conditional upon what we can do now.

Stunted children, unfulfilled potential

Poor nutrition is the single largest contributor to disease and bad health globally, and is the single largest contributor to child mortality. Nothing sums up more precisely the appalling tragedy of unfulfilled human potential than a stunted child.

Stunting is the impeded growth and development that children suffer from poor nutrition. Children are defined as stunted if their height-for-age is more than two standard deviations below the World Health Organization’s Child Growth Standards median.

Stunting in early life (particularly in the first 1000 days from conception until the age of two) has adverse and often lifelong, irreversible functional consequences on the child, beyond impaired physical growth. These consequences include poor cognition and educational performance and damage to language and sensory-motor capacities. More than 280 million people in Africa are malnourished and 58 million children are stunted. Stunting alone costs Africa $25bn a year.

Those involved in the gigantic task of encouraging economic development in Africa are well aware of the cardinal importance of social infrastructure such as transport hubs, power plants, dams, hospitals, schools and all the elements that help to maintain normal political, economic and social cohesion.

We can repair a bridge, we can rebuild a port, we can replace a railway line – but we don’t know how to fix brain cells once they have been destroyed. That’s why we need to change our approach to dealing with nutrition matters in Africa.

Brain power

If priority is given to the quality of social, community and family life, the most important infrastructure to build in Africa is 'grey matter infrastructure', the infrastructure that makes brains grow, and builds the healthy and productive workforces of the future. This grey matter infrastructure comes from healthy, balanced, nutritious diets, and the shortfall in grey matter infrastructure is estimated to reduce national gross domestic product in Africa by up to 11% annually.

Stunted children today lead to stunted economies tomorrow. For a typical African country, every dollar invested in reducing chronic undernutrition in children yields a return of $16. If 15 African countries attained the 2025 World Health Assembly target of a 40% reduction in chronic undernutrition – which forms part of the UN Sustainable Development Goals 2 – this could add $83bn to national incomes.

The African Development Bank supports 'African Leaders for Nutrition', which comprises global influencers and world leaders such as Bill Gates, Nigerian businessman Aliko Dangote of Dangote Group, president of Big Win Philanthropy Jamie Cooper, former UN secretary-general Kofi Annan, president of Madagascar Hery Rajaonarimampianina, and ex-president of Ghana John Kufuor.

The African Development Bank is also developing an Africa Nutrition Accountability Index, which will rate countries transparently and statistically on their progress in addressing malnutrition and building grey matter infrastructure.

For African leaders must stand up and be counted, and be held accountable for malnutrition. They must use the renewed energy generated by working to achieve global and national targets on nutrition – in particular, the second UN Sustainable Development Goal to “end hunger, achieve food security, and improve nutrition and promote sustainable agriculture” – by helping to direct global attention to malnutrition.

Targeting the most vulnerable

The African Development Bank is currently supporting a programme to build resilience in food and nutrition security in the Sahel region of Africa. The programme will initially target the most vulnerable households with special attention paid to women and young children, specifically those within the period of 1000 days from pregnancy to the age of 24 months. The nutrition actions cover 450,000 mothers and children. Overall, there will be more than 3 million direct and indirect beneficiaries.

The African Development Bank has a pipeline of operations identified in Burkina Faso, Nigeria, Tunisia, South Africa, Chad, the Republic of Congo, Sierra Leone, Madagascar, Gambia, Guinea, Ethiopia and Burundi, with 11 operations already validated for 2017 to 2019. The operations will specifically be designed to address malnutrition among the most vulnerable populations, and especially among women and children.

The bank has supported studies on food fortification in the west Africa region, and in collaboration with the West African Economic and Monetary Union, it supports capacity building in nutrition and the harmonisation of norms and standards in food fortification, including the elaboration of guidelines on iodised salt.

Keep the bar high

We must be forward looking and raise the bar high on our ambitions for Africa to address its challenges and unlock its opportunities. The African Leaders for Nutrition are doing so by pushing for greater political accountability and accelerated progress on nutrition to support countries’ efforts to reduce malnutrition and stunting.

More, probably, than at any period in history, we actually have the tools and the technologies we need to end malnutrition as well as hunger in the world. And they are very largely available. The man who saved a billion lives, Dr Norman Borlaug, was keen on repeating his advice to “take it to the farmers” on the basis that farmers knew better than most what to do. So what's needed now is to get these tools and technologies off the shelves and into the hands of millions of farmers, and especially women farmers.

The continent’s leaders must protect our greatest resource – our children – by committing to a high standard of nutrition to allow them to grow strong, wise and proud of their African heritage, as well as to fulfil their potential in a successful continental economy. I am optimistic about Africa’s future. Because when Africa’s leaders rise up, there is no challenge we cannot face together.

Dr Akinwumi A Adesina is president of the African Development Bank.

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