One of the great dilemmas of our time is how we will secure and provide plentiful, healthy and nutritious food for all, and to do so in an environmentally sustainable and safe manner while addressing the co-existing double burden of under- and over-nutrition, such as nutrition-related infectious and chronic non-communicable diseases. Issues such as disasters, shocks, fragility and conflict in households, communities, and within and among nations further challenge the global community to address this dilemma. Yet, we know that natural disasters and armed conflict have marked human existence throughout history and have always caused peaks in mortality and morbidity in the global population (Leaning and Guha-Sapir 2013). What is also clear is that disasters and displacement are also increasing. See the figures below from an NEJM 2013 paper by Leaning and Guha-Sapir.
We are witnessing multiple burdens of malnutrition, with some countries, communities and households suffering from undernutrition, overweight and obesity, and micronutrient deficiencies. Stunting, which reflects chronic undernutrition during the early stages of life, causes children to fail to grow to their full genetic potential, both mentally and physically. Although stunting in children under five years of age has declined from 40 to 26% since 1990, an estimated 162 million children remain moderately or severely stunted (Black et al. 2013). Wasting in children under five years of age has decreased 11% since 1990, but still, 52 million children suffer (Black et al. 2013). Deficiencies of essential vitamins and minerals (micronutrients) continue to be widespread and have significant adverse effects on child survival and development, as well as women’s health.
The risk and prevalence of malnutrition is high in fragile and conflict-affected countries as compared to more stable countries with the ability and capacity to absorb shocks – whether they are natural disaster related, economic, conflict and war, food shortages and price volatility. Regions such as Latin America and East Asia are making progress in addressing food and nutrition security, but sub-Saharan Africa, the Middle East and some countries of South Asia continue to see reversal of gains. Of the countries with the highest burdens of undernutrition, most are conflict or recently post-conflict countries. The UNICEF figure below clearly demonstrates this – Timor Leste, Burundi, Madagascar, Sierra Leone, Rwanda, Pakistan, the DRC…
Why does it matter? Inadequate nutrition has been described as “a scourge in our world” (DFID 2011). Not getting the right amount and type of food and nutrients can lead to people being undernourished or overweight—both of which have serious, deleterious effects on health, development, and productivity. Inadequate nutrition contributes to early deaths for mothers, infants and young children, and impaired and often irreversible physical and brain development in the young. This in turn can lead to poor health into adulthood, which affects not only individual well-being but also the social and economic development of nations.
Disruption of food production and supply, destruction of household assets and livelihoods, mass displacement of population, and degradation of vital services are associated with rapidly escalating levels of malnutrition. These disruptions are not isolated – and are linked to the recent global food, economic and fuel crises. Food insecurity and malnutrition are also associated with heightened risk of violent social unrest and conflict (Taylor 2013). As Devakumar and colleagues depict, conflict also has serious impacts on women and children’s health and nutritional status that can last generations as shown in the figure below. Despite this, there is little investment in long-term food security and nutrition resiliency and development.
Conflict aside, in an increasingly globalized world and interconnected food system, subjected to the pressures of growing populations, inequity, climate variability and food price volatility, no country or population is immune to the challenges that lay ahead. While unsettling, we now have more information, both in science and in practice, on how to improve the global food system and protect fragile and conflict states. The solutions are inherently trans-sectoral, engaging practitioners and experts across agriculture, rural development and public health.
Solutions should go beyond just food aid and assistance, which is vital to decreasing morbidity and mortality in some short-term emergency situations. Much effort will require advance preparedness that addresses both acute and chronic undernutrition, by incorporating interdependent interventions in health, food security and agriculture. Addressing underlying problems of food insecurity and undernutrition can have broader, longer-term benefits including education, poverty alleviation strategies, agricultural investments and subsidies, and land reform (Bhutta et al 2013).
The role of agriculture and food has a particular resonance in fragile and conflict states, where conflict results in often sharp rises in food insecurity, and where smallholder farming can, in the right circumstances, form the basis of peacebuilding and economic recovery (Taylor 2013). Improvements can be driven by resilient food system approaches to ensure better utilization of food and dietary diversity and quality. Interventions include social protection mechanisms through food safety nets, resilient food and nutrition sensitive approaches, mechanisms to protect natural resource assets, and management schemes to ensure better recovery and resilience against shocks. By taking a sustainable development approach to food and nutrition security, reconstructing livelihoods of conflict and disaster affected communities is possible.
Bhutta, Z. A., Das, J. K., Rizvi, A., Gaffey, M. F., Walker, N., Horton, S., … & Maternal and Child Nutrition Study Group. (2013) Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? The Lancet, 382(9890), 452-477.
Black, R. E., Victora, C. G., Walker, S. P., Bhutta, Z. A., Christian, P., De Onis, M., … & Maternal and Child Nutrition Study Group. (2013) Maternal and child undernutrition and overweight in low-income and middle-income countries. The Lancet, 382(9890), 427-451.
DFID (2011) Scaling Up Nutrition: The UK’s position paper on undernutrition. September 2011. London, UK.
Leaning, J., & Guha-Sapir, D. (2013) Natural disasters, armed conflict, and public health. New England journal of medicine, 369(19), 1836-1842.
Taylor S (2013) Fragile but not helpless: Scaling Up Nutrition in Fragile and Conflict-Affected States. World Vision, London UK.