1 THE GLOBAL ALLIANCE FOR IMPROVED NUTRITION Nutrition: Everybody’s Problem but Nobody’s Business September 6, 2011 Kari Stoever, Senior Advisor

2 The Global Nutrition Challenge 2 billion people affected by vitamin and mineral deficiencies 11% of the global disease burden 1 in 4 children underweight in developing countries 3.5 million deaths of children under five 2-3 percent loss of Gross Domestic Product (GDP) at national level

3 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

4 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) GAIN History 4

5 GAIN is the World’s Major Nutrition Alliance 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. Private sector International Public sector National International Nutrition impact National Foundations

6 = 10M people China Cote d'Ivoire Dominican Republic Egypt Georgia Ghana Kazakhstan Mali Nigeria Pakistan South Africa Uganda Uzbekistan Vietnam 6 Scale: Current GAIN partnerships reaching 400M people (1/2 women and children) On track to 1 billion target

7 400 million eating better

8 14 percent reduction in micronutrient deficiencies in young children in Kenya

9 30 percent reduction in neural tube defects in South Africa

10 1/3 reduction in anemia in China

11 Source: Sun Framework slideshow / Nabarro, D Scaling Up Nutrition The SUN Framework calls to scale up efforts against rising undernutrition in a coordinated multi-stakeholder approach

12 New Global Nutrition Movement

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14 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) Child nutrition Food securityCare resources Health, water/ sanitation services Food/nutrient intake Health Institutions Political & ideological framework Economic structure Resources environment, technology, people 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 Immediate causes Underlying causes at household/ family level Basic causes at societal level Interventions Determinants of Child Nutrition and Recommended Interventions

15 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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17 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

18 Malnutrition-Infection Complex Malnutrition Impaired child development Infection Energy loss Disease Compromised Immunity Reduced productivity Socioeconomic & political instability Weak education and health systems Poverty Malnutrition-Infection Complex Source: Schaible, U., Kaufmann, S., Malnutrition and Infection: Complex Mechanisms and Global Impact. PLoS Medicine. May 2007

19 Malnutrition -Infection Complex The most prevalent public health problem in the world today 1 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 1 ACC/SCN (1990) Report of 16th Session, para. 12; also in SCN News No. 6 (1990), p Schaible, U., Kaufmann, S., Malnutrition and Infection: Complex Mechanisms and Global Impact. PLoS Medicine. May 2007

20 HIV & Nutrition -- “Slim Disease” Malnutrition : Weakened immune system Increased susceptibility to opportunistic infections Wasting & increased mortality Poorer adherence & response to treatment HIV : Loss of appetite Increased nutrient requirements Impaired nutrient absorption Altered nutrient metabolism

Entry Points: ANC/PMTCT Clinical referral Community Referral Assessment: Anthropometric Biochemical Clinical Dietary Food Security Counseling: Adherence Diet WASH Infant/child feeding Referral to Community Services Clinical Mgmt & PMTCT Services: ART Opportunistic Infections Chronic disease management Support: Food by Prescription: therapeutic & supplementary feeding MN supplements Livelihood & food security referrals Community Services: Nutrition surveillance & clinic referrals Nutrition counseling & support within home- based care Economic strengthening, livelihood & food security support Clinic Community Current Model

22 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 x 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

23 “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