The Journal of Nutrition
Supplement: The Impact of Climate Change, the Economic Crisis,
and the Increase in Food Prices on Malnutrition
How to Ensure Nutrition Security in the
Global Economic Crisis to Protect and
Enhance Development of Young Children
and Our Common Future1,2
Saskia de Pee,3,4* Henk-Jan Brinkman,5 Patrick Webb,4 Steve Godfrey,6,7 Ian Darnton-Hill,4
Harold Alderman,8 Richard D. Semba,9 Ellen Piwoz,10 and Martin W. Bloem3,4,11
3
World Food Programme, Rome 00148, Italy; 4Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02155;
World Food Programme, New York, NY 10017; 6Global Alliance for Improved Nutrition, Geneva 1202, Switzerland; 7The School
of Business at University of Cape Breton, Sydney, Nova Scotia, B1P 6L2, Canada; 8The World Bank, Washington, DC 20433;
9
Johns Hopkins University School of Medicine, Baltimore, MD 21205; 10Bill and Melinda Gates Foundation, Seattle, WA 98102;
and 11Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205
5
The global economic crisis, commodity price hikes, and climate change have worsened the position of the poorest and most
vulnerable people. These crises are compromising the diet and health of up to 80% of the population in most developing
countries and threaten the development of almost an entire generation of children (~250 million), because the period from
conception until 24 mo of age irreversibly shapes people’s health and intellectual ability. High food prices reduce diversity and
nutritional quality of the diet and for many also reduce food quantity. Poor households are hit hardest, because they already
spend 50–80% of expenditures on food, little on medicines, education, transport, or cooking fuel, and cannot afford to pay
more. Reduced public spending, declining incomes, increased food and fuel prices, and reduced remittance thus impede and
reverse progress made toward Millenium Development Goals 1, 4, and 5. Investments in nutrition are among the most costeffective development interventions because of very high benefit:cost ratios, for individuals and for sustainable growth of
countries, because they protect health, prevent disability, boost economic productivity, and save lives. To bridge the gap
between nutrient requirements, particularly for groups with high needs, and the realistic dietary intake under the prevailing
circumstances, the use of complementary food supplements to increase a meal’s nutrient content is recommended. This can
be in the form of, e.g., micronutrient powder or low-dose lipid-based nutrient supplements, which can be provided for free, in
return for vouchers, at subsidized, or at commercial prices. J. Nutr. 140: 138S–142S, 2010.
Introduction
At least 3.5 million preventable under-5 deaths per year are due
to undernutrition, which includes suboptimum breast-feeding,
Published in a supplement to The Journal of Nutrition. Presented at the
workshop “The Impact of Climate Change, the Economic Crisis, and the Increase
in Food Prices on Malnutrition,” held in Castel Gandolfo, Italy, January 25, 2009.
The workshop was organized by Martin W. Bloem, United Nations World Food
Programme, Rome, Italy; Klaus Kraemer, Sight and Life, Basel, Switzerland; and
Richard D. Semba, Johns Hopkins University School of Medicine, and with the
support of an educational grant from Sight and Life, Basel, Switzerland.
Supplement contents are solely the responsibility of the authors and do not
necessarily represent the official views of the organization that they are affiliated
with. Publication costs for this supplement were defrayed in part by the payment
of page charges. This publication must therefore be hereby marked "advertisement" in accordance with 18 USC section 1734 solely to indicate this fact.
Supplement Coordinator disclosures: Martin Bloem, Klaus Kraemer, and Richard
Semba have no relationships to disclose. Supplement Guest Editor disclosures: A.
Catharine Ross and Richard Semba have no relationships to disclose. The opinions
expressed in this publication are those of the authors and are not attributable to the
sponsors or the publisher, Editor, or Editorial Board of The Journal of Nutrition.
1
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especially nonexclusive breast-feeding in the first 6 mo of life,
intrauterine growth retardation (low birth weight), stunting,
severe wasting, and deficiencies of micronutrients such as
vitamin A and zinc (1). Almost all of these are directly linked
to the quality of dietary intake of children and mothers.
According to the WHO, undernutrition accounts for 11% of
the total global burden of disease.
At least 178 million children worldwide are affected by
chronic undernutrition or stunting (short stature) resulting from
poor fetal growth and reduced growth in the first 2 y of life. This
is due to inadequate nutrient intake, often exacerbated by
infection, and amounts to a “life sentence” because of irreversible damage manifested in later life (2). The damage associated
2
Author disclosures: S. de Pee, H-J. Brinkman, P. Webb, S. Godfrey, I.
Darnton-Hill, H. Alderman, R. D. Semba, E. Piwoz, and M. W. Bloem, no conflicts
of interest.
* To whom correspondence should be addressed. E-mail: saskia.depee@wfp.
org or depee.saskia@gmail.com.
0022-3166/08 $8.00 ã 2010 American Society for Nutrition.
First published online November 25, 2009; doi:10.3945/jn.109.112151.
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Abstract
Deteriorating nutrition as a consequence of the global
economic crisis
The current global economic crisis represents the sharpest
economic downturn since the Second World War. Developing
countries face particularly difficult circumstances, reduced
foreign capital flows, declining export revenues, falling devel12
Estimated as follows: 555 million under-5 children in developing countries
(1) 3 (9+24=33 mo)/(0–59 mo) = 0.56 3 80% at-risk (see section, managing high
food prices: the household response) = 250 million.
13
Abbreviations used: CFA, Comprehensive Framework for Action; MDG,
Millennium Development Goal; WFP, World Food Program.
opment assistance, and sharp increases in unemployment (both
local and international, leading to reduced remittances from
migrants), which could amount to 50 million job losses
worldwide (6). As a result, incomes are declining and government budgets are under pressure, which could result in lower
expenditures on social protection and public services. Malnutrition is expected to rise through lower incomes, the twin effects
of lower subsidies or higher taxes on food and fuel, and reduced
spending in the health, water, and sanitation sectors (7).
The FAO food and cereal price indices declined by approximately one-third between June and December 2008 from the
prior peaks. Slower growth, alleviation of weather-related
supply constraints, easing of export restrictions, lower transport
costs, and a stronger dollar have contributed to lower food
prices. However, food prices are expected to remain relatively
high because of structural factors, such as low stocks, low
productivity growth, climate change, and demand for biofuels.
In May 2009, the FAO cereal price index was still 1.8 times the
2005 level and 2.2 times the 2000 level (8). Changes in global
prices do not always translate to a similar change in prices at the
national level. At the local level, FAO estimates that in 80% of the
countries with data, food prices are still higher than 12 mo ago (9).
The impact on millions of household budgets has been
dramatic. WFP regularly calculates changes in the costs of
typical household food baskets in 35 countries, based on a
weighted mean of price changes (10). Overall, the cost of the
food basket, using prices for the latest available quarter in 2008,
was 36% higher than for the same quarter in 2007 and 48%
more expensive compared with the previous 5 y (11).
This scenario of reduced public spending, declining incomes,
loss of jobs, high food prices, higher costs for milling and
cooking due to high fuel prices, reduced remittance income, and
consequences of climate change (12) is a toxic combination that
threatens the development of almost an entire generation of
children in developing countries.
Managing high food prices: the household response
The groups most vulnerable to a deterioration of their nutritional status are those who spend a large proportion of their
income on food (50–80% among the poor), buy more food than
they sell, have few coping strategies at their disposal, and may
face a further reduction or loss of cash income. This includes the
urban poor, rural landless, pastoralists, and many small-scale
farmers (typically ,20% produce enough surplus to be categorized as net-sellers) (11,13). These groups were already more
vulnerable because of a less diverse diet and greater risk of
infections and poor health.
But in many countries, even the middle class, those living on
US$6–10 per capita per day, are at risk, because food still
accounts for 35–65% of their expenditures. In many developing
countries, 80% of the population lives on ,US$10 per capita
per day (14). Thus, high food prices and the global economic
crisis affect the majority of the population in developing
countries.
Available evidence from the Asian economic crisis in the late
1990s as well as from Africa consistently shows that as prices
increase, households first reduce consumption of more expensive
food items, typically animal source foods (meat, poultry, eggs,
fish, and milk), and fruit and vegetables that are good sources of
high-quality nutrients. This is followed by a reduction of the size
and frequency of meals (15–19). WFP household-level food
security assessments conducted in 2008 found similar evidence
as well as reductions in health care visits or health expenditures,
increased school drop-outs, and sale of assets (20).
Nutrition security in global economic crisis
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with undernutrition accumulated during the first 2 y of life can
include increased susceptibility to infections; slowed cognitive
development and growth; reduced school performance, including later enrolment and earlier drop-out; increased susceptibility
to developing chronic diseases (diabetes, hypertension, and
coronary heart disease) among children who gain weight rapidly
in later childhood/adolescence; affected girls being at higher risk
themselves later in life of having low birth weight babies,
perpetuating the problem into another generation; and reduced
productivity and lifelong earning potential (3).
Thus, investment in early childhood nutrition protects health,
prevents disability, boosts economic productivity, and saves
lives. The long-term health and vitality of entire nations depends
on the wellbeing of its individual children. Today, ~250 million
infants and unborn children (29 to 24 mo of age) in developing
countries are at risk12 and an already unacceptably high level of
unnecessary, preventable child mortality and ill-health caused by
undernutrition is getting worse.
The importance of ensuring adequate nutrition, and especially combating micronutrient deficiencies, which has very high
benefit:cost ratios, was also emphasized by the Copenhagen
Consensus (4). The expert committee, which consisted of 8
economists, 5 of whom were Nobel laureates, declared in May
2008 that the world’s best investment from among 30 investments in any field is to provide vitamins and minerals for
undernourished children. Providing micronutrients for 80% of
the 140 million children who lack essential vitamins in the form
of vitamin A capsules plus a course of zinc supplements would
cost just $60 million/y while generating annual benefits worth
more than $1 billion. The third top priority of the economic
experts was micronutrient fortification involving the iodization
of salt and fortification of basic food items with iron. Each dollar
spent on this would result in benefits of more than $9.
A report by the World Food Program (WFP)13 and the
Economic Commission for Latin America and the Caribbean
highlights the high economic costs of inaction (5). Two methods
were used to estimate the economic impact of child undernutrition in Central America and the Dominican Republic. The
first, which was called the “incidental retrospective dimension,”
is a sum of the losses in a single given year due to child
undernutrition. The measure sums the health care costs for the
current under-5 cohort, the cost of repeated grades in schoolaged children previously impacted by undernutrition, and adult
productivity losses in the given year due to the impact of their
early childhood undernutrition on cognitive development or
premature death. In 2004 alone, this dimension cost 7 countries
nearly $7 billion. The second measure, the “prospective dimension,” projects future losses in health and education costs as well
as productivity for the cohort of children who are under-5 in a
given year. The 2004 under-5 cohort would accumulate nearly
$2.3 billion in costs due to malnutrition over 65 y.
Comprehensive response for the medium and long term
Because of the severe and long-lasting effects of the current crises
on nutrition and health, measures to mitigate this impact are
urgently required. Such measures should focus on nutrition,
especially during the window of opportunity from conception to
24 mo of age, and be immediately applied in the short term and
sustained over the medium and long term.
The Comprehensive Framework for Action (CFA) developed
by the UN Secretary General’s High Level Task Force on the
Global Food Security Crisis noted the urgent need to improve
food and nutrition security worldwide, systematically and
sustainably (32). Many necessary actions were identified, such
as the need to scale up productivity-enhancing safety nets and
promote agricultural investments focused on smallholder
farmers and rural development. It was also stated that increased
productivity must be accompanied by investment in local and
regional market development and adjustments of distorting
trade practices and that comprehensive, targeted social protection systems that achieve universal coverage of vulnerable
groups and link to other basic social services will build resilience
to future shocks. However, the CFA did not discuss details of
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Supplement
how to improve nutrition security. Based on the analyses in this
document, such recommendations are provided below for
inclusion in the CFA.
The CFA also noted that the financial implications related to
this crisis will be considerable, will exceed the response thus far,
and will require substantial political and financial commitments
from national governments first and foremost but also from the
private sector, civil society, and the international system. For
example, the World Bank just finalized an analysis of the
financing needs for scaling-up nutrition programming, which
estimates an annual requirement of US$10.3 billion (and an
additional US$1.5 billion from households) (33). The estimate of
the CFA for immediate food assistance, agricultural inputs, and
budgetary and balance of payment support is US$8–13 billion
per annum and an additional US$17–27 billion per annum for
building longer-term resilience and contributing to food and
nutritional security. The World Bank estimate includes less food
and no agricultural inputs. Therefore, the extent of overlap and
complementarity of the 2 estimates needs to be examined.
Commercially available products of good nutritional value
are potentially important tools for increasing dietary quality of
specific groups (in addition to other measures such as exclusive
breast-feeding for the first 6 mo of life and continued breastfeeding thereafter, good environmental hygiene, etc.) but are
generally not affordable for people in need. In that case, access
to such products can be provided in different ways, such as forfree distribution to specific vulnerable groups, either directly or
through distribution of vouchers, and by making them available
for sale using a variety of market channels.
The advantage of a voucher system is that it can harness
normal market mechanisms with sales at subsidized/low-profit/
commercial price to lower middle-class consumers, in which
case social marketing and information about the product could
be tailored to a larger target group, including buyers as well as
those exchanging vouchers. Eligibility for vouchers can be linked
to participation in other programs for the most vulnerable such
as receipt of food assistance (food-for-asset, supplementary
feeding, school feeding, etc.) or cash transfer programs. The
latter could be conditional upon the use of specific services such
as preventive health care or education, such as implemented in
Latin America (34), or based on vulnerability criteria such as age
(child-care grants or old-age pension) as, e.g., implemented in
certain countries in Africa and Asia (35). For a detailed review of
global experience on what does and does not work in safety nets,
see Grosh et al. (36).
Cash transfer programs are consistently found to augment
household food consumption expenditures and dietary diversity
(35). However, impact on micronutrient status appears limited,
because households also spend some of the extra money they
have available on health care, education, and other valuable
investments (37,38), because micronutrient-rich foods or supplements are often expensive, availability may be limited, and
awareness of their health value not very high. Providing a
voucher would increase the likelihood that the commodity is
obtained by the target group and its value would be demonstrated by its availability in the consumer market.
Where markets are not functioning very well, or where
implementing a voucher system is not feasible, the special
nutritious commodities can be directly distributed to beneficiaries. However, this will require greater awareness raising about
the benefits of consuming the commodity, the risk of leakage of
the commodities may be greater, and when smaller quantities are
required, this could also be less interesting for the private sector
to produce.
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This reduction of the consumption of nutrient-rich foods
quickly increases the prevalence and severity of micronutrient
deficiencies as well as stunting, particularly among population
groups with high needs such as young children, pregnant and
lactating women, and the chronically ill (16,21–23). The
resulting increased susceptibility to infection further aggravates
the situation because of increased nutrient losses and reduced
appetite.
In addition to micronutrient deficiencies, people who also
have to reduce the size or number of meals will likely also suffer
deficiencies in macronutrients and energy, which leads to
thinness among adolescents and adults and weight loss and
increased risk of acute malnutrition (wasting) among young
children (24–28).
The current crisis is therefore undermining progress made
toward the Millennium Development Goal (MDG) 1 targets of
50% reduction of underweight and hunger between 1990 and
2015 and the MDG 4 target of reduction in under-5 child
mortality by two-thirds and making these and other MDG
targets (such as MDG 5 on maternal mortality) even more
difficult to achieve, especially in the poorest countries.
The impact of high food prices and global economic crisis
further compounded by climate shocks, even when of relatively
short duration, have long-term consequences, because undernutrition endured between conception and 24 mo of age, has lifelong consequences for the individual as well as, in the case of
girls, their offspring (2). Shocks to households’ current earnings
and purchasing power reduce their future livelihood capabilities
by degrading or destroying assets, resulting in reduced investment by the household in child nutrition, health, and education
(29). These consequences that erode human well-being and longterm capabilities through nutritional pathways also seed potential
future crises, whether of an economic, political, or environmental nature (30).
Furthermore, the current crises underscore the fact that large
segments of the world’s population face chronic food insecurity,
leaving them disproportionately more exposed to shocks.
Therefore, while addressing the nutritional needs of vulnerable
populations in response to the present crisis is urgent, these
populations should also be targeted with known nutritional
interventions at all other times to ameliorate the persistent
conditions that lead to increased mortality and morbidity (31).
The strategy should also support public-private partnerships
that link the private sector, governments, UN agencies, researchers, and not-for-profit organizations in the development
and distribution of new, affordable, and nutritious food
products. The recent Amsterdam Initiative on Malnutrition14
is an example of a replicable and innovative approach that will
deploy new financial and program instruments to strengthen the
role of business in helping the public sector tackle the nutrition
crisis.
Conclusion
There is overwhelming evidence of the negative impacts of the
current global economic crisis on nutrition and health, which
has immediate consequences as well as long-term effects on
individuals and societies, especially among children who are
now between conception and 24 mo of age. Tackling this
requires a variety of measures to increase dietary quality such
that the intake of nutrients essential for health, growth, and
development meets the needs of different target groups. Where
animal-source foods, fruit, and vegetables in adequate amounts
are beyond reach or cannot realistically meet the need for certain
nutrients (such as iron for children aged 6–23 mo), home
fortification using complementary food supplements (e.g. with
1 g/d micronutrient powder or 20 g/d lipid-based nutrient
supplements) or fortification of specific foods can be used (39).
Such commodities can be made available for purchase, in return
for vouchers, or through blanket for-free distribution.
Recommendations
Figure 1 lists measures that are urgently required for mitigating
the impact of the crises in such a way that nutritional quality of
the diet of vulnerable populations is improved. These measures,
which are for the short to medium term and go beyond food
security, can be linked to the CFA developed by the UN Secretary
General’s High Level Task Force on the Global Food Security
Crisis (32). Furthermore, effective surveillance systems to
monitor changes in the vulnerability and food and nutrition
security of populations as well as the coping strategies employed
in times of crisis need to be strengthened and expanded.
Acknowledgments
M.W.B. and S.d.P. conceptualized and designed the position
paper; S.d.P and S.G. wrote the paper; H-J.B., P.W., I.D-H.,
H.A., R.D.S., E.P., and M.W.B. thoroughly reviewed and made
suggestions for revisions of the paper. All authors read and
approved the final manuscript.
Other articles in this supplement include (40–44).
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2009, it aims to address the nutrition needs of 100 million people in 6 African
countries by 2015.
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