Ending global malnutrition: Opportunities for American leadership

By Shawn Baker

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While malnutrition is a distant memory for most Americans, it was not all that long ago that the population of the United States was plagued by diseases and disabilities caused by poor nutrition. A congressional investigation after World War II found that as many as 40 percent of draftees were rejected because of nutrition-related causes - and was one of the first studies to make the link between childhood malnutrition and physical deficiencies. As Roger Thurow notes in his new book, The First 1,000 Days, the results spurred President Harry S. Truman to action, proclaiming that, “No nation is any healthier than its children.”

Globally, malnutrition is still afflicting millions of families and communities. It is an underlying cause of nearly half of child deaths worldwide - meaning millions of children who are killed by preventable diseases such as pneumonia, diarrhoea and malaria would have survived if they had not been malnourished. Of the children who do survive, 160 million face stunted growth due to malnutrition, which can impair neurological development and prevent them from reaching their full physical, intellectual and economic potential over the course of their lives. Beyond the irreversible damage malnutrition does to individuals, its impact on a country's economy can be similarly devastating-estimates suggest that in low- and middle-income countries, the effects of malnutrition can decrease economic growth by between 2 and 11 percent.

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Luckily, research over the past decade-as well as lessons learned from successful interventions in the United States-have dramatically expanded our understanding of how to improve nutrition globally, particularly for women and children. For example, we now know that it is crucial to reach children within the “1,000-day” period between their mothers' pregnancy and their second birthday, as well to reach women and adolescent girls with the right nutrients before they become pregnant. We have also made great strides in ensuring agricultural programs are designed to improve family nutrition, including at a large-scale by naturally fortifying crops with essential vitamins and minerals.

One of the most cost-effective interventions being deployed globally is one that was piloted right here in the United States: the fortification of staple foods such as cereal flours, cooking oil, and salt.

After a number of prominent American health organizations in the 1920s presented findings that sodium iodide helped prevent goiter, state governments launched campaigns encouraging the iodization of table salt. The quick response of industry was so successful in reducing the incidence of goiter that most salt sold in the United States today is still fortified with iodine. Today, universal salt iodization is one of the greatest success in global nutrition; coordinated efforts resulted in 75 percent of the population consuming iodized salt by 2013.

The American agricultural sector later pushed for the enrichment of flour with thiamine, niacin, iron, riboflavin and later folic acid, as well as the fortification of milk with vitamin D, which combined helped to eliminate pellagra, beriberi and rickets - diseases that most Americans have never heard of.

The United States government has increasingly stepped up as a leader in fighting global malnutrition across both health and agriculture programs overseas, and is poised to do even more. American farmers, researchers, NGOs, and businesses also have a role to play in improving nutrition and food security.

The possibilities for private sector engagement in particular are potentially huge-from investing in smallholder farmers to funding research around nutrient-dense seed varietals and essential interventions in pregnancy to ensure that children can grow and develop healthily. Private sector expertise in strengthening farm-to-table distribution chains and developing low-cost, nutrient-rich crops will also be essential as we work to ensure families everywhere have access to a safe, affordable diet year round. Agricultural R&D, in particular, could be especially powerful in improving nutrition -and yields great returns on investment, averaging 43 percent a year in developing countries.

My work at the Gates Foundation is focused on securing a future where children everywhere have the opportunity to survive and thrive - same as so many children in the United States have been able to do thanks to investments in basic nutrition. Our foundation is working to cut the number of children under age 5 who die each year by 50% in the next 15 years. We know this goal can only be reached by making major strides in nutrition, which is why last year we announced a new strategy and that we are more than doubling our financial commitment to nutrition to reach $776 million by 2020.

By working with our partners in global development and drawing on historical successes in reducing malnutrition in the United States, we have the chance to ensure a more prosperous future for millions so that they, too, have an equal chance to survive and to thrive at school, at work, and in society.

Shawn Baker is the Director of the Nutrition team at the Bill & Melinda Gates Foundation. He leads the foundation's efforts to ensure that women and children receive the nutrition they need for healthy growth and development. Before joining the foundation in 2013, Shawn served as vice president and regional director for Africa for Helen Keller International. During his 30-year career, Shawn has served as co-promoter of the Niger Health Information System, coordinator of the Tulane University Center for International Health and Development, and coordinator of the Famine Early Warning System in Southern Africa. Earlier, he was a U.S. Peace Corps volunteer in Zaire (now the Democratic Republic of the Congo).



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