Gender inequality, the double burden of malnutrition, and global food systems were all discussed at this enlightening online panel event which took place on Thursday, 10th November, 2022. The event was organised in conjunction with Cambridge Reproduction and was chaired by Professor Alice Reid. Members of the panel were: Dr Akanksha Marphatia, Honorary Research Associate, UCL Great Ormond Street Institute of Child Health; Mduduzi NN Mbuya, Global Alliance for Improved Nutrition (GAIN); Dr Ann Prentice, Honorary Senior Visiting Fellow, MRC Epidemiology Unit, University of Cambridge and Rodrigo Rivera, Poverty and Food Security Analyst UNFAO.
To open the event, each panellist spoke briefly to outline their perspective on the state of global early childhood nutrition.
Dr Anne Prentice prefaced her presentation by stating that over the 40 years that she has been a nutrition scientist working both in the UK and abroad, the world’s children have become much healthier. Severe malnutrition has become less common and the world’s food supply has improved, that said, it seems that not only are old problems are re-emerging in new places, and the greatest nutrition-related challenge to child health is now obesity. However, she reminded the audience that diet is not the only factor in raising healthy children; activity and societal aspects of a child’s life are also very important.
Focussing on places where child mortality is still high, Mduduzi NN Mbuya pointed out that diet is still one of the main contributory factors to poor health in children. He talked about the need for a range of actions to orient food systems towards healthier diets.
Referring to the Food Systems Dashboard developed by his colleagues at GAIN, Johns Hopkins University and the UNFAO, he suggested that two types of policy action were particularly important: firstly, that which supports an enabling environment for business, making the production of safe, nutritious food worthwhile. Regulations on fortification and taxes on sugary drinks are good examples of this. Secondly, governments should commit to public food procurement policies that prioritise nutritious food and target vulnerable people. He warned that without coherent, data-driven policies it is extremely difficult for governments to be effective in these areas.
Dr Akanksha Marphatia’s research on gender inequality, maternal and infant undernutrition, has led her to understand that food systems and governments still do not address the interlinkage between key social and biological factors that keep children unhealthy. She has first-hand experience of the ways interventions can be fruitless because the social context is not considered. For example, school-based initiatives miss girls who don’t go to school, who are often in most need of improved nutrition. She pointed out that gender inequality is a better predictor of low birthweight than GDP. There is clearly a need for policies that include societal solutions.
In his work as an economist in the UNFAO’s Social Protection (SOCPRO) team, Rodrigo Rivera is well placed to consider these issues. He stated that the way the agrifood system works means that millions of people still lack access to safe nutritious food. In low to middle income countries, two in three children under five experience food poverty. But there is hope: social policies have been shown to play a part in transforming agri-food systems. For example, he said, new evidence highlights the role of behaviour change communication.
Following these brief presentations, Professor Reid invited audience questions.
Asked whether the global north and south are converging, in terms of differences in child nutrition, Dr Anne Prentice pointed out that dividing the world in this way is problematic and can lead to unhelpful stereotyping of regions. That said, obesity is becoming a big problem in all parts of the world. Rodrigo Rivera explained that, in Latin America, childhood obesity is associated with wealthier households, and malnutrition with poorer households. This ‘double burden of malnutrition’, of both obesity and malnurition, is an increasing problem throughout the world. Mduduzi NN Mbuya agreed that there is a global convergence in terms of this double burden. The difference between high- and low-income countries is now more likely to be the size of the burden, rather than the type.
Asked whether stunting is more prevalent in girls than boys, Akanksha Marphatia said that it was more prevalent in girls in Nepal, for societal reasons. Dr Anne Prentice gave examples from the Gambia, where girls don’t receive less food than boys, and in fact in early childhood boys are more vulnerable to malnutrition than girls for physiological reasons, because they have different nutritional needs.
Finally the panel was asked about the main challenges to implementing food policies favourable to children and families. Their answers were: curbing food prices and combatting climate change; addressing the interlinked nature of the factors of all magnitudes that cause malnutrition; getting governments to react rapidly to changing circumstances and, finally, the need for the diversification of food systems, foods, financing and processing for greater resilience and better nutrition for all.
The event began and ended with an audience poll. At the beginning of the event 75% said they thought they were in a position to keep their children healthy, whereas at the end this figure had reduced to 68%. In response to the question, which is the most important factor in maintaining child health; cost, access or education? At the start of the event, those who voted thought cost was the most important factor in maintaining child health, whereas at the end it was felt that access was more important.
Our panel:
Chair:
Professor Alice Reid, Director of the Cambridge Group for the History and Population and Social Structure, University of Cambridge.
Alice is a historical demographer, working on fertility, mortality and health in the late nineteenth and early twentieth centuries.
Speakers:
Dr Akanksha Marphatia, Honorary Research Associate, UCL Great Ormond Street Institute of Child Health
Akanksha's research focuses on how gender inequality, maternal and infant undernutrition shape educational attainment and girls' early marriage. She has recently applied this geographical perspective on a joint University of Cambridge and UCL project on women's early marriage in Nepal. She has two decades of experience working in international education and gender policy, most recently as Director of International Education at ActionAid International.
Mduduzi NN Mbuya, Global Alliance for Improved Nutrition (GAIN)
Mduduzi is Director, Knowledge Leadership with the Global Alliance for Improved Nutrition (GAIN). He has worked for over two decades on nutrition sensitive programs and policy in LMIC, and in his current role at GAIN he is responsible for research and evaluation. He works with GAIN teams and partners to generate and use evidence to guide improved design and implementation of food systems program and to fill critical gaps in the global evidence.
Dr Ann Prentice, Honorary Senior Visiting Fellow, MRC Epidemiology Unit, University of Cambridge
Ann is the former Director of the MRC Elsie Widdowson Laboratory (previously MRC Human Nutrition Research), Cambridge, and was Programme Leader of the MRC Nutrition and Bone Health Research Group, Cambridge, and Head of the Calcium, Vitamin D and Bone Health research team at MRC Unit The Gambia.
Rodrigo Rivera, Poverty and Food Security Analyst FAO
Rodrigo Rivera is an economist and the coordinator of the “Nutrition-sensitive social protection and food crisis” thematic area in the Social Protection (SOCPRO) team at FAO’s Division of Inclusive Rural Transformation and Gender Equality. Before joining SOCPRO in 2020, he worked for several years on poverty, food security and nutrition analysis and policy at FAO’s Regional Office for Latin America and the Caribbean.
Please find the event recording here.
