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

16:1IFPRI 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, TogoWhat 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

2014 2015

19 15

6660

24 39On course

Off course, some progress

Off course, no progress

Number of countries on course to meet global (WHA) targets

#NutritionReport

Some progress on wasting reduction

2014 2015

64 63

59 67

Off course

#REF!

Number of countries on course to meet global (WHA) targets

2014 2015

25 24

19 22

24 24

3139 On course, good

progressOn course, at riskOff course, some progressOff course, no progress

Some progress on Under 5 overweight reduction

Number of countries on course to meet global (WHA) targets

Exclusive Breastfeeding RatesLess progress. Not much data. Reversals

even. Number of countries on course to meet global (WHA) targets

32

10

30

6 on course

off course, some progress

off course, no progress

off course, reversal

Countries experiencing a reversal: Cuba, Egypt, Kyrgyzstan, Mongolia, Nepal and Turkey

N=78

But… number of countries that have reduced

adult obesity rates

WHO: 2010-2014

39Stunting children under 5

Wastingchildren under 5

Overweightchildren under 5

Anemiawomen aged 15-49 yearsExclusive Breastfeeding, 0-6 months

Adult Overweight + Obesity (BMI≥ 25)

Adult Obesity (BMI≥ 30)

Adult Diabeteshigh blood sugar

601579

63

84

8

115

67

39

5

32

63

242224

180

1036

190

193

185 53

Global Target

Missing data Off course, little/no progress Off course, some progress On courseOn 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

SpecificMeasurableAssignableRealisticTime Bound

30

70

Chart Title

SMART

not SMART

Percent of commitments

The next set of N4G commitments

must be “SMART”-er

2014 commitments

2015 commitments

42

44

9

10

40

25

10

21

met/on course off coursenot clear no response

Percent of commitments

Too many N4G signatories failed to report on

commitments they made

3

3

6Number of nutrition specific

interven-tions

Undernutrition interventions? We don’t know enough about scaling upNo compara

ble national

data exist

Comparable national data exist

Only proxy

comparable

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 BudgetActual 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 nutritionto meet WHA undernutrition targets

Spending on nutrition specific interventions, 2015-2025

x x

Governments Donors

R4D and World Bank estimates for stunting reduction

Climate Nutrition

2005-6

Jan Feb Mar April

May

June

July Aug

Sept

Oct Nov

Dec

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

Vegetarian

Pescetarian

Mediterranean

Global average diet

190

240

320

340

Approx. per capita lifecycle greenhouse gas emissions; Kg of CO2-ceq/person/yearSource: 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 factorin the global burden of disease

Lancet, September 10, 2015

Food Consumption

Diversity

Health and Nutrition

StatusFood

Affordability

Environ-mental

Sustainability

Dashboard for Food Systems(13 indicators)

Food SystemsHow nutrition-friendly are yours?

Business

Trust

Engage

Which Comes First?

Business and Nutrition

Transparency +

Monitoring Trust

•Register of PPPs

•Nutrition Transparency 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

2014 2015

65 58

9 1815 4

99 108

4 targets3 targets2 targets1 target0 targets

Number of countries that can track WHA targets for undernutri-tion

WHA Data gaps are closing, but remain large

Calls to Action

Calls to Action1. Elevate nutrition across the SDGs2. Strengthen national accountability on

nutrition3. Strengthen the Nutrition for Growth

commitments4. 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

systems8. 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

GN

R

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