When you read the words child malnutrition, you will most likely see a child with a hollow face and a swollen stomach in one of the world’s harshest or most dangerous environments. Sadly, this image is not obsolete. In conflict and emergency-stricken zones like Yemen and Mozambique, and countries like India and the Philippines, children continue to live on the brink of severe undernutrition, and UNICEF continues to work to save their lives.
But this picture is also far from complete. Today, the face of child malnutrition is more complex than it has ever been before. As UNICEF’s State of the World’s Children 2019 report shows, we now face a triple burden of child malnutrition, and it’s a burden that is borne by both the world’s poorest and wealthiest countries.
Almost 200 million children under five suffer from the first of these burdens: undernutrition. Conditions like stunting, which describes children who fail to grow and develop to their full potential, reflect a profound nutritional failure in the first 1,000 days, from conception to age two years. All too often, stunting has its roots in poverty; by limiting the child’s capacity to develop his or her full human capital potential, it also transmits poverty into the next generation.
The second burden is hidden hunger – or deficiencies of essential vitamins and other micronutrients, like vitamin A and iron. Hidden hunger is both ubiquitous and insidious: We estimate that at least one in two children under five suffer from it in some form. For most of these children, the impact on their health, growth and development may not be noticed until it is too late. As my former colleague at UNICEF, its former deputy executive director, Kul C. Gautam once said of hidden hunger, “You might not feel it in the belly, but it strikes at the core of your health and vitality.”
Finally, there is the burden of overweight and obesity, a rapidly emerging problem in even some of the world’s poorest countries. Children who are overweight face a much higher risk of developing conditions like type 2 diabetes and cardiovascular disease. The cost of childhood overweight will be borne by the child into adulthood; it will be borne, too, by our societies in the form of lowered productivity and higher healthcare costs.
How heavy is this triple burden of malnutrition? According to fresh analysis carried out for The State of the World’s Children, we estimate that at least one in three children under the age of five, are suffering either from undernutrition or are overweight. These are the children who are not growing well.
At the heart of all these forms of malnutrition is a common factor – poor diets. Too many children are eating too little of what they need and too much of what they don’t need. Almost everywhere, we see children eating diets that are lacking in diversity (not enough fruit, vegetables, milk, eggs, fish or poultry), especially in the crucial first two years of life, when physical growth and brain development should be exponential. And, almost everywhere, we see children eating more and more highly processed foods, which are high in calories, fats, sodium and sugar, and low in vitamins and minerals.
These poor diets reflect a basic failure everywhere of food systems – or all the actors and processes involved in bringing food “from farm to mouth”. To fix children’s diets, we need to fix food systems. That means creating more demand for nutritious, safe, affordable and sustainable food, and ensuring that supply puts children’s nutrition right to adequate nutrition at the heart of its business and meets this demand. It also means building food environments that support good nutrition for children – for example, by ensuring that school food environments are not obesogenic; that marketing and advertising practices do not target children; and that food labelling is not misleading and provides children, adolescents and caregivers with accurate and easy-to-understand information.
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There is no quick fix for food systems, but the time to act is now. Our response needs to involve governments, businesses, civil society, schools, communities, families and children and adolescents themselves. Failing to meet this challenge is unthinkable – we know much now of what is wrong with children’s nutrition and we also know how we can fix it. Now all we need is will, determination and a sense of outrage and urgency.