All Countries Are Malnourished—But They Don't Have To Be

Forbes

15-04-2025

It might seem that malnutrition is a problem only in poor countries. But 'all countries face at least one form of malnutrition,' according to the French Ministry for Europe and Foreign Affairs, which last month hosted a significant global conference on funding nutrition programs.
This conference in Paris, Nutrition for Growth (N4G), came at a challenging moment for international health funding. In recent months, the U.S., France, and other European countries have announced sweeping foreign aid cuts. The consequences for nutrition have included smaller food rations in refugee camps and paralysis of emergency food shipments.
Researchers have estimated that recently announced cuts in donor funding for severe acute malnutrition will affect 2.3 million children. In one year, 369,000 children are likely to die as a result. Each would be a preventable tragedy.
And beyond this, the shutdowns of research to improve farming practices, information systems to predict famines, and projects addressing child malnutrition will translate into less healthy lives and economies. A less stable food supply will also seed insecurity both overseas and in the U.S., for instance.
So it was some relief that the N4G summit led to pledges of over $27 billion for nutrition programs. Though this is about the same as what was raised at the last N4G summit four years ago, during this difficult time the amount surpassed most expectations.
However, it will remain important to scrutinize whether and how those pledges actually materialize. Following the first N4G summit in 2013, half of the pledging organizations failed to reach at least one of their targets, or did not respond to the Global Nutrition Report about their progress.
The commitments this time around came from a range of private, philanthropic, intergovernmental, and government agencies, though not from the U.S. and U.K. (despite recommendations). From school meals to prenatal vitamins, these funders are generally attempting to do more with less, by honing in on the core areas where they believe nutrition is most urgent. They're also hammering home the economic case for nutrition as a sound investment in productivity and prosperity.
But improving nutrition is not just an issue for over there. One of the Sustainable Development Goals most off-track is the ambitious SDG 2: 'End hunger, achieve food security and improved nutrition and promote sustainable agriculture.' This goal comes with several targets, including ending all forms of hunger and malnutrition by 2030, alongside doubling the income of small-scale food producers.
The United Nations continues to tinker with the indicators of progress, and recently introduced a new metric of minimum dietary diversity for infants and women of reproductive age. Thus, balanced diets are now explicitly factored in (although as with some of the other indicators, data is patchy). All told, zero hunger has proven one of the most challenging of goals to achieve worldwide.
'Basically nobody performs really well on this goal,' commented Guillaume Lafortune, vice president of the UN's Sustainable Development Solutions Network (SDSN). That is, just about every country faces issues related to undernourishment (such as anemic pregnant women), unhealthy diets (measured in terms of underweight and overweight children), or a combination of these. It's a universal challenge.
So sustained attention to nutrition is important to protect the gains that have been made. Hunger has fallen dramatically over the decades, but this progress has now slowed. Action in every part of the world will be needed to keep pushing malnutrition toward zero.
Here are three countries' snapshots of the work in progress.
There's perhaps no better sign of the incomplete progress made on nutrition than the resurgence of diseases of nutritional insufficiency that should be easy to eradicate. In wealthy countries, 'scurvy is coming back,' pointed out Brieuc Pont, the French diplomat who led the N4G summit. In France this is linked to poverty and inequality, leading to calls for strengthened food and social programs.
It's not only poverty that is leading to nutritional problems in France, whose government has said that its domestic SDG 2 challenge is more about enhanced nutrition than food security. In this, France isn't alone among its neighbors. As stated by a recent report that Lafortune coauthored for the European Economic and Social Committee, which advises the European Union, 'The average EU diet is not healthy and leads to high health and environmental costs.'
This research has identified that especially pressing challenges for the EU's food transition are the lack of financial incentives to consume healthy products; the marketing of foods high in saturated fat, sugar, and salt; and lack of financial support for farmers to ease the transition. Clearly, then, attention is needed to both the demand and supply sides of nutritious food. But demand has been overlooked. There are many political and social obstacles to addressing demand, which would involve, for instance, encouraging 'plant-forward diets.'
In some respects, France isn't doing badly on nutrition compared to other countries. For instance, its diabetes rate isn't in the high range for the EU. And Lafortune appreciates Nutri-Score, a labelling system that assigns color-coded grades based on the nutritional value of foods. This was devised in France, and has since rolled out to some other European countries. The Nutri-Score system is imperfect, and sometimes the grades are puzzling. But the fact that this nutritional guidance exists at all, despite much industry opposition in a country with a very protective food culture, offers hope to observers like Lafortune.
'Brazil is a case study' for school meals, Pont declared. The country's school feeding strategy has evolved since the mid-20th century, when it focused on cutting hunger. But as hunger became less common (though not eliminated), obesity became more common. A 2019 study found that 22% of Brazilian adolescents were prediabetic. These issues have led to more attention to not just the amount of food made accessible, but also the type and quality of food. Nutritionists prepare menus for public schools, which provide food for all students. Admittedly, the carefully balanced meals aren't always popular.
In some ways Brazil's public health system has shown boldness in taking on nutrition-harming industries. School meal programs have limited salt, sugar, and—in a world-leading move—ultra-processed foods. The basic food basket, an indicator of commonly consumed foods, also now excludes ultra-processed foods (though the links between nutrition and food processing aren't straightforward). Supporters say that these changes will bolster not only health, but also traditional culinary practices and local food industries.
However, the government has proven less willing to take on another food industry with consequences for human and environmental health: large-scale livestock farming. In general at the N4G summit, and in particular at a side event at the Brazilian embassy themed around food systems and climate change, discussions of climate change were timid about mentioning industrial livestock's role in land-use change. The Brazilian government has no plans at the national level to reconsider the amount of animal protein in school meals (and attempts to do so locally have proven controversial).
Helena Lettieri, a lawyer who volunteers with animal rights organizations in Brazil, was disappointed by the unwillingness to address Brazil's reliance on animal protein. Given how connected the Brazilian government is to agribusiness, she said, she didn't expect it to meaningfully address the impacts of beef at nutrition or climate conferences—including the upcoming COP to be held in the Amazon.
Nigerian nutrition programs have been hit hard by the withdrawal of USAID funds. In general, the effects of the sudden aid cuts on Nigeria's health sector have prompted much reflection about self-determination. When it comes to nutrition, self-sufficiency is broader than the source of the funds. It also extends to the source of the food.
For instance, Nigeria, like Brazil, has been a leader on school meals. The Home Grown School Feeding Programme provides a market for locally grown food, and has helped boost enrollment in primary school. According to Robert Akparibo, a global health and nutrition researcher at the University of Sheffield in the UK, Nigeria has reached 100% domestic production of school meals.
But when it comes to emergency feeding programs, it has not been so easy to source from home. Abdoulkader Yonli is the managing director of Nutri K, which manufactures the therapeutic food Plumpy'Nut (essentially a fortified peanut paste given to severely malnourished children). 60% of inputs into Plumpy'Nut are imported, Yonli said. Therapeutic foods require uniform ingredients, which can't yet be guaranteed in Nigerian peanut farming. As well, the fungal toxin aflatoxin continues to harm the domestic peanut supply. Agriculture in Northern Nigeria continues to be challenged by what Yonli identified as the two biggest threats: armed violence and climate change. These challenges will be very difficult to overcome.
Overall, it's sobering to realize that even the world's largest and wealthiest countries haven't achieved global nutrition goals. But as Pont said, that can't stop us from trying.