Preventing food systems from failing children
Of all child deaths under the age of 5, around 45% are linked to undernutrition. At the same time, we are also seeing rising rates of overweight and obesity in children from low- and middle-income countries. This is resulting in a concurrent ‘triple burden’ of malnutrition, where some children lack enough calories or micronutrients leading to stunting and chronic disease, while others suffer from overweight, obesity and the associated long term diet-related non-communicable diseases. More alarming, is that Type II Diabetes, once nearly exclusively an adult diet-related disease, is now occurring in children.
We have reached an important tipping point for our children’s health. Now, more than ever, we have a chance to shift the landscape and halt the burgeoning problem of childhood malnutrition in all its forms. The Sustainable Development Goals and United Nations Decade of Action on Nutrition have provided us with a renewed political commitment, and recent analytical reports, such as the Global Panel’s Foresight Report, provide us with the scientific evidence to support shifts in policy priorities.
Success, though, will require a fundamental change to our approach. We need to reposition our priorities from feeding children to nourishing them, and alter the way we think about malnutrition, to focus on diets rather than nutrients.
Likewise, we must break from our silos and connect policy makers across trade, infrastructure, agriculture, the environment and health sectors, bringing together coordinated action from governments, civil society academia and the private sector.
One area where we have seen co-ordinated action and multi sector successes is with school feeding programmes. Many in the field will be familiar with the lack of direct evidence linking school feeding programmes with reduced rates of stunting, but as detailed in the Global Panel’s brief Healthy meals in schools: policy innovations linking agriculture, food systems and nutrition, evidence on locally-sourced school meals reveals a multiple-win opportunity for policymakers in terms of important benefits for school achievement, employment and national economic growth.
When coupled with providing and promoting the intake of healthy nutritionally balanced meals, school feeding programmes can also increase the demand for local farm outputs, and support a more efficient local food procurement and delivery systems. In Kenya, the annual income of farmers has been shown to increase by US$50 per year, when schools purchase maize from them, rather than relying on national stocks or food aid.
Healthy, locally sourced school meals can also empower vulnerable groups, enrich the community and generate jobs. In India for example, nutritious fortified rice-lentil mixes for schools (Indiamix) are being produced by local women’s groups.
School meals can also provide an important buffer during food shortages, or food price spikes. During a severe drought in India, children participating in the School Midday Meals scheme did not suffer the declines in growth demonstrated by children who did not participate.
Better school attendance and improved dietary habits outside school hours are also seen in children consuming healthy school meals. These improved dietary habits are likely to extend into other members of the household. Studies across 32 African countries showed school enrolment by girls increased by 28% during the year after meals were made available.
Importantly, with an emerging ‘triple burden’ of malnutrition in many low and middle-income countries, healthy meals in schools, combined with nutrition education and physical activity has the potential to mitigate rising rates of overweight among children.
In India, we are seeing these transformational benefits. Almost 100 million children across 265,000 schools currently have free access to a balanced and nutritious midday meal. Likewise, in Ghana, 4,000 schools partake in a Government initiative where food is procured from local farmers, serving over 1.6 million children.
Whilst there have been past failures to demonstrate a link between school meals and stunting, this should not deter policymakers from considering the potential for schools to promote both nutrition and agriculture. This can be a multiple-win opportunity for policymakers, with important benefits not only for a child’s future, but for national socio-economic growth. Providing nutritionally balanced, locally sourced, school meals with complementary nutrition education and health measures can form one of the many multi-sector approaches needed to help reposition our food systems to focus on diet quality.
Let’s not allow our future food systems to fail our children.
By Professor Srinath Reddy, President of the Public Health Foundation of India and member of the Global Panel on Agriculture and Food Systems for Nutrition.