1. New York City September 22, 2015

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

3. Nutrition driving the SDGs

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

5. 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. 2015 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

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

7. Progress on Nutrition Status

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

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

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

11. 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

12. But… number of countries that have reduced adult obesity rates WHO: 2010-2014

13. 39 Stunting children under 5 Wasting children under 5 Overweight children under 5 Anemia women aged 15-49 years Exclusive Breastfeeding, 0-6 months Adult Overweight + Obesity (BMI≥ 25) Adult Obesity (BMI≥ 30) Adult Diabetes high blood sugar 60 15 79 63 84 8 115 67 39 5 32 63 24 22 24 180 10 36 190 193 185 5 3 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

14. Progress on Nutrition Actions

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

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

17. Too many N4G signatories failed to report on commitments they made

18. 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

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

20. 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

21. Finance

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

23. 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

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

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

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

27. More resources are needed for nutrition to meet WHA undernutrition targets Spending on nutrition specific interventions, 2015-2025 xx Governments R4D and World Bank estimates for stunting reduction

28. Climate Nutrition

29. 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

30. 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

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

32. 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?

33. Business

34. Trus t Engag e Which Comes First? Business and Nutrition

35. 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

36. 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…

37. Accountability and Data

38. Each of the 193 countries has a nutrition profile like this

39. WHA Data gaps are closing, but remain large

40. Calls to Action

41. 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

42. Want “Designer” Babies? Invest in Nutrition!

43. Thank You