THE GLOBAL ALLIANCE FOR
IMPROVED NUTRITION
Nutrition: Everybody’s Problem but Nobody’s Business
September 6, 2011
Kari Stoever, Senior Advisor
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The Global Nutrition Challenge
2-3 percent loss of Gross Domestic Product
(GDP) at national level
3.5 million deaths of children under five
1 in 4 children underweight in developing
countries
11% of the global disease burden
2 billion people affected by vitamin and mineral
deficiencies
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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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GAIN History
• 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)
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GAIN is the World’s Major Nutrition Alliance
Foundations
Nutrition impact
National
National
International
Private sector
International
Public sector
• 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.
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Scale: Current GAIN partnerships reaching 400M people (1/2
women and children)
On track to 1 billion target
Uzbekistan
2,216,660
Georgia
1,512,637
Kazakhstan
7,534,247
China
62,883,235
33,411,790
Dominican Republic
4,590,666
45,210,774
Egypt
Mali
Cote d'Ivoire
12,743,203
Pakistan
7,259,534
107,191,811
12,034,787
16,140,852
Uganda
19,313,924
Vietnam
575,342
Ghana
Nigeria
50,445,360
South Africa
= 10M people
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6
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 China10
The SUN Framework calls to scale up efforts against rising
undernutrition in a coordinated multi-stakeholder approach
Source: Sun Framework slideshow / Nabarro, D. 2010 Scaling Up Nutrition
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New Global Nutrition Movement
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Determinants of Child Nutrition and Recommended Interventions
Interventions
Breastfeeding
Complementary feeding
Vitamin A supplementation
Zinc supplementation
Hygiene & sanitation
Immunization
Salt iodization
Agriculture
Poverty reduction
Income generation
Education
Health systems
strengthening
Women’s empowerment
Child nutrition
Food/nutrient intake
Food security
Care resources
Health
Immediate
causes
Health,
water/
sanitation
services
Underlying
causes at
household/
family level
Institutions
Political & ideological framework
Economic structure
Basic causes at
societal level
Resources environment, technology, people
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Source: 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)
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
Socioeconomic & political
Impaired child
Malnutrition-Infection
Complex
instability
development
Weak education and
health systems
Compromised Immunity
Infection
Poverty
Disease
Reduced productivity
Energy loss
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Source: Schaible, U., Kaufmann, S., Malnutrition and Infection: Complex Mechanisms and Global Impact. PLoS Medicine. May 2007
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”
HIV:
• Loss of appetite
• Increased nutrient requirements
• Impaired nutrient absorption
• Altered nutrient metabolism
Malnutrition:
• Weakened immune system
• Increased susceptibility to
opportunistic infections
• Wasting & increased mortality
• Poorer adherence & response to
treatment
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Current Model
Clinical Mgmt
& PMTCT
Services:
Assessment:
Anthropometric
Biochemical
Clinical
Dietary
Food Security
Entry Points:
ANC/PMTCT
Clinical referral
Community Referral
ART
Opportunistic
Infections
Chronic disease
management
Counseling:
Adherence
Diet
WASH
Infant/child
feeding
Referral to
Community
Services
Support:
Food by
Prescription:
therapeutic &
supplementary
feeding
MN supplements
Livelihood &
food security
referrals
Community
Services:
Nutrition surveillance &
clinic referrals
Nutrition counseling &
support within homebased care
Economic
strengthening,
livelihood & food
security support
Clinic
Community
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-Carlson
Chair of World Economic Forum Global Agenda Council on Water Security
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