Main Messages:

• Undernourishment and undernutrition, including micronutrient deficiencies, have decreased in the last 20 years, but are still major challenges.
   
• Over-weight and obesity are increasing and are now prevalent in most countries, even those where undernutrition persists.
   
• Trends in the global food supply – namely heavy investment in cereals and underinvestment in non-staples – have created a situation where the cost of a healthy diet can be very high and the incentives to eat highly processed foods of minimal nutritional value are strong.
   
• These trends have contributed to the “perfect storm” for the double burden of malnutrition which is now common-place.
   
• Tackling these issues requires strengthening the links between agriculture, a healthy and affordable food supply, diet quality, and nutrition.
   
• A new focus on diet quality in high level political discourse is key to strengthening these links.
   
• Indicators of diet diversity are essential for assessing diet quality; as such they should be included in the SDG on food security and nutrition.

 

What does malnutrition look like in 2015?

While most of the world’s hungry people are still in South Asia, followed by East Asia and sub-Saharan Africa, Asia’s share in terms of absolute numbers has decreased markedly, while that  of Sub Saharan Africa’s has considerably increased. Overall, the prevalence of undernourishment in developing countries has declined since 1990; however the rate of decline has slowed in recent years.

In line with undernourishment or hunger² trends, undernutrition (stunting and wasting) is also declining, albeit too slowly. Stunting and underweight remain high in many countries, especially in Africa, as do micronutrient deficiencies, most notably in iodine, iron and vitamin A.^{3 4}

At the same time that these trends in undernutrition persist, overweight and obesity are rising so much so that in many countries, undernutrition, micronutrient deficiencies and overweight and obesity now co-exist and present within the same populations and in some countries, in the same households.

Nutrition transition and global shifts in diet quality

What is driving this “double burden of malnutrition”? Often referred to as the “nutrition transition”, the causes are complex and linked to rapid socioeconomic, demographic and technological changes, most of which are, themselves, linked to globalisation. These include changes in technology regarding how food is processed, marketed and prepared and changes in meal patterns. The end result is major shifts in diet patterns, characterised by increased total energy intake. While the latter includes increased intake of animal source foods and vegetable oils, as well as a small increase in global fruit and vegetable intake, most of the foods that people are eating more of are cereal-based.

Indeed between 1965 and 1999 in developing countries, growth in cereal production was over 100%, outpacing population growth; gains in pulse production during this same period remained relatively low, averaging well below 50%. The low production of pulses can be considered a rough indicator for all kinds of non-staple foods including fruits and vegetables, none of which have increased at anywhere near the rate of cereals, namely because agricultural research and other types of investment during this period was strongly biased towards cereal production.^{5 6}

Consequent declines in cereal prices have been followed by dramatic increases in the price of non-staple foods, effectively raising the “price” of diet quality and contributing to the afore-mentioned persistence of vitamin and mineral deficiencies. For example, in Bangladesh, prices for cereals, non-cereal plant foods and animal source foods were roughly equal in 1975. By 1996, cereal prices had decreased substantially while prices for non-staple foods had increased. The end result, especially for poorer families, was an increase in the percentage share of household food expenditures on non-staple foods, with a concomitant decrease in actual intake of those foods. The implication is that households will spend more of the food budget on non-staple foods, but these foods comprise only a modicum of total energy intake.⁷

Until the year 2000, cereal prices were in decline, assuring that at very least, the world’s poor were assured in terms of total energy intake. However in the last decade, cereal prices have themselves begun to rise, increasing food budget expenditures on staples at the expense of whatever small amounts of higher nutrient foods were being consumed. The end result is that in recent years, the “cost” of diet quality is higher than ever.

Revising conventional food security paradigms

As previously mentioned, today’s global food systems have been shaped by trends in agricultural research and investment over the past thirty years. These trends are in line with conventional food security paradigms which put the focus squarely on physical food availability at a national or sub-national level, usually assessed in terms of net food production and cereal stock levels. While national food availability is an obvious pre-requisite for total food security, it is not the whole story, as it does not necessarily reflect what foods households are growing and able to afford, let alone what individuals are actually eating. These dimensions of food security are typically referred to as “household food access” and “individual utilisation”.

Tackling malnutrition in all its forms requires revision of conventional food security paradigms to better include these dimensions. Doing so requires revisiting the cereal-centric support policies that have characterised the last three decades of agricultural policy in favour of an investment agenda that promotes production diversity. Figure 1 shows just how far we have to go in terms of achieving this goal. To date, there are over 250,000 globally identified, edible plant species; historically, 7,000 of these have been used for food by humans. Currently, three crops – rice, maize and wheat - provide over 50% of the world’s energy intake, and 12 (including five animal species) provide 75%.⁸ No wonder there is so little diversity in today’s diets.

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