New York City September 22, 2015

Nutrition driving the SDGs Progress on nutrition status Progress on actions Financing and capacity Climate Food Systems Business Accountability & Data Calls to Action Outline

Nutrition driving the SDGs

Alive and thriving Intergenerational equity Human Rights Economic Benefits Why invest in improving nutrition?

40 low and middle income countries What are the returns to scaling up nutrition interventions? Benefit-Cost Ratio 16:1 IFPRI 2014 Brazil What happens when infants are breastfed > 12 months? Income increases by 33% Victora et al Malawi What is the cost of existing stunting? 10% of annual GDP AUC/WFP 2015 DRC, Mali, Nigeria, Togo What are the returns to scaling up nutrition specific interventions? Compound rates of return > 13% World Bank 2015 What % of healthcare expenses go to obesity treatment? Brazil: 2%, Europe: 2-4%, USA: 5-20% De Oliveira et al. 2015

Wordcloud of Draft SDG Outcome Document, 12 Aug, 2015 NUTRITION BARELY REGISTERS IN THE SDGs

Progress on Nutrition Status

Progress on stunting reduction Number of countries on course to meet global (WHA) targets #NutritionReport

Some progress on wasting reduction Number of countries on course to meet global (WHA) targets

Some progress on Under 5 overweight reduction Number of countries on course to meet global (WHA) targets

Exclusive Breastfeeding Rates Less progress. Not much data. Reversals even. Number of countries on course to meet global (WHA) targets Countries experiencing a reversal: Cuba, Egypt, Kyrgyzstan, Mongolia, Nepal and Turkey N=78

But… number of countries that have reduced adult obesity rates WHO:

39 Stunting children under 5 Wasting children under 5 Overweight children under 5 Anemia women aged years Exclusive Breastfeeding, 0-6 months Adult Overweight + Obesity (BMI≥ 25) Adult Obesity (BMI≥ 30) Adult Diabetes high blood sugar Global Target Missing data Off course, little/no progress Off course, some progress On course On course, at risk Number of countries at various stages of progress against global targets on nutrition 3

Progress on Nutrition Actions

Make SMART commitments Report on them Meet them S pecific M easurable A ssignable R ealistic T ime Bound

Percent of commitments The next set of N4G commitments must be “SMART”-er

Too many N4G signatories failed to report on commitments they made

Undernutrition interventions? We don’t know enough about scaling up No comparabl e national data exist Comparable national data exist Only proxy comparabl e national data exist 12 “Lancet interventions” Bhutta et al. 2013

How to create a healthy food environment? Labeling; Marketing; Economic Incentives; Public Settings; Position of healthier foods; Raise productivity of pulses, F&V

63 % High income Upper middle 27 % Lower middle 10 % Low income 0 % But few middle-to-low income countries have implemented policies to improve food environments Share of 67 countries that have implemented policies, by income level

Finance

Every country will need to increase its spending on nutrition policies & programs Domes

SUN member countries stepped up in 2015 Countries: How much of their budgets are allocated to nutrition? Bangladesh, Benin, Burundi, Burkina Faso, Cameroun, Chad, Comoros, Congo DRC, Costa Rica, Cote D’Ivoire, Ghana, Guatemala, Indonesia, Kenya, Lesotho, Madagascar, Maharashtra, Mauritania, Nepal, Pakistan, Peru, Philippines, South Sudan, Tajikistan, The Gambia, Togo, Uganda, Vietnam, Yemen, Zambia

Domestic Budget Allocations to Nutrition as % of total Government Budget Actual 1.3% Upper bound 4.1% % are medians 14 countries completed the exercise

Donor disbursements to nutrition in 2013 Total: $5bn Specific: $1bn Sensitive: $4bn Donors? 4% of spending to nutrition

but 13 of 29 OECD Donors spent less than $1 million on nutrition specific interventions in 2013

More resources are needed for nutrition to meet WHA undernutrition targets Spending on nutrition specific interventions, xx Governments R4D and World Bank estimates for stunting reduction

Climate Nutrition

JanFebMarApri l MayJun e JulyAugSep t OctNovDec Height-for-Age Z-Scores of children under 3 in India NFHS Data Lokshin and Radyakin 2012 Nutrition status is already shaped by seasons. What havoc will climate change cause? 0.2 is the median impact of complementary feeding interventions

Approx. per capita lifecycle greenhouse gas emissions; Kg of CO2-ceq/person/year Source: Adapted from Tilman and Clark 2014, Fig 4.1 Diet Choices Affect Efforts to Mitigate Climate Change

Food Systems Poor Diet is now the number 1 risk factor in the global burden of disease Lancet, September 10, 2015

Food Consumption Diversity Health and Nutrition Status Food Affordability Environ- mental Sustainability Dashboard for Food Systems (13 indicators) Food Systems How nutrition-friendly are yours?

Business

Trus t Engag e Which Comes First? Business and Nutrition

Transparency + Monitoring  Trust Register of PPPs Nutrition Transparenc y Initiative Enforcement Litigation Fund ATNI-type disclosures Public research Initiatives Opportunities to advance nutrition Mobile phones Health Logistics Food but…there is a massive dialogue gap

FAO, UNICEF, WHO and WFP, together with others, should establish an inclusive, time-bound Commission to develop a shared understanding of the roles and responsibilities of business in nutrition Once the WHO Framework for Engagement with Non-State Actors (FENSA) is completed in 2016…

Accountability and Data

Each of the 193 countries has a nutrition profile like this

WHA Data gaps are closing, but remain large

Calls to Action

1.Elevate nutrition across the SDGs 2.Strengthen national accountability on nutrition 3.Strengthen the Nutrition for Growth commitments 4.Implement actions to address malnutrition 5.Find more funding for nutrition action 6.Build alliances between nutrition & climate communities 7.Develop indicators for nutrition friendly food systems 8.Build a greater shared understanding of the roles and responsibilities of business in nutrition 9.Identify the data gaps that hinder action—and fill them

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