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Diet and Growth

KIGALI – There is no greater hindrance to a country’s long-term economic development than childhood undernourishment. When a growing body does not get enough essential vitamins and nutrients, the harmful effects last long into adulthood.

In low-income countries, diets consist primarily of starches, such as rice, and legumes, like peas, that contain very little protein. So even a child with a full belly does not necessarily get the right balance of nutritious food and vitamins required for healthy physical development.

This takes an enormous toll. Undernourished children are more susceptible to illness. According to UNICEF, children who suffer from severe under-nutrition are 9.5 times more likely to die from diarrhea and 6.4 times more likely to die from pneumonia. Fully one in three preventable deaths among young children worldwide – up to 2.5 million each year – are the result of inadequate nutrition.

Worldwide, one in four children under the age of five is stunted, meaning that chronic under-nutrition has caused serious and often irreversible physical and cognitive damage. There were 165 million stunted children in 2001, equivalent to half the population of the United States.

Stunted children often struggle to reach their potential in school and ultimately the workplace, diminishing economic productivity and development. A World Bank study found that under-nutrition can cost an individual up to 10% of his or her potential lifetime earnings, and as much as 3% of a country’s GDP.

To combat this problem, we need a multi-pronged approach that marshals all available resources to ensure good nutrition among children. That starts with strong leadership in countries where the challenge is acute. While my country, Rwanda, has reduced child mortality by 70% over the past decade, the rate of stunting remains high, with 44% of children under the age of five chronically malnourished.

Rwandan President Paul Kagame has initiated a national emergency plan to address the fundamental causes of malnutrition. This means not only increasing available food sources for children, but also educating families about the importance of nutritious diets.

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Between 2006 and 2011, for example, we doubled the agriculture budget, distributed more than 2,000 cows to low-income families, and expanded milk delivery and fruit and vegetable gardens across the country. Community health workers in each of Rwanda’s 15,000 villages, as well as nurses at health centers across the country, periodically measure the weight and height of each child under the age of five, referring for help those identified as malnourished or at risk.

At the same time, ensuring that these efforts translate into better health outcomes requires a revolution in the way families prepare their children’s food. Our government has started a massive educational campaign to broaden understanding of the importance of nutritious diets. Pamphlets have been distributed across the country detailing the kinds of foods that children need, how to cook them, and the need for proper hygiene and exclusive breastfeeding for children under the age of six months. In each village, a woman skilled in communication will teach families how to prepare balanced meals and ensure adequate nutrition for children.

Providing proper nutrition in a child’s first thousand days is particularly important. The British medical journal The Lancet has described a package of effective interventions to accomplish this. Recommended measures include providing essential vitamins and minerals through enriched foods and supplements; promoting breastfeeding and nutritious complementary feeding for weaning babies; and treating severely malnourished children with therapeutic foods such as specially fortified peanut butter.

There is an emerging consensus on the need to address under-nutrition worldwide. Last year, the Copenhagen Consensus – an esteemed panel of economists including several Nobel Laureates – ranked child nutrition as the top priority on its list of cost-effective investments that would improve global welfare.

In many low-income countries, making these investments will require forging partnerships with foreign governments – and we welcome the vital role that donor programs, aid agencies, and volunteer organizations can play by working within the framework of national plans. Regional collaboration will also be key to fulfilling our commitment to succeed in fighting malnutrition. For us, this means working closely with our neighbors in the East African Community.

On June 8, just ahead of the G-8 Summit, the United Kingdom will convene a summit on Nutrition for Growth. Leaders from rich and poor countries, foundations, non-governmental organizations, and private industry will gather to make specific commitments to invest in nutrition. I hope that they will increase their efforts – and that they think hard about how to ensure that all sectors of recipient countries’ economies benefit through local procurement.

Simply flooding markets with cheap high-calorie, low-nutrient grains will never solve chronic malnutrition. A change of mindset among development partners is required, along with long-term commitments to building sustainable, diversified, and equitably distributed systems of food production and distribution. The investments needed to make this happen represent a fraction of most donor assistance to low- and middle-income countries, but would have a massive global impact on human development in the long term.

All of these efforts – production of affordable and nutritious food, ensuring its availability everywhere, and education about how to prepare it – will be essential if Rwanda and other countries are to succeed in ensuring that children receive the nourishment they need to live healthy and productive lives. Our job will not be finished until every child is assured a healthy and balanced diet and the opportunity to reach his or her full potential.

Agnes Binagwaho, Minister of Health of Rwanda, is Senior Lecturer at Harvard Medical School, and Clinical Professor of Pediatrics at the Geisel School of Medicine at Dartmouth College.

Copyright: Project Syndicate, 2013.

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