The Global Alliance for Improved Nutrition (GAIN) set up its Ethiopia Country Office in 2012 and has since engaged in Large Scale Food Fortification such as salt iodization, in cooperation with UNICEF and Complementary Feeding projects. The organization is also working on new activities that are in their development stage are fortification of dairy products (yoghurt) and reducing food loss along selected value chains. Capital Spoke to GAIN’s Executive Director Dr. Lawrence Haddad who visited Ethiopia this week. He discussed the trend of nutrition worldwide and why governments don’t invest as much as they used in nutrition.
Capital: What kind of trends are you seeing globally when it comes to nutrition?
Dr Lawrence Haddad: There are different types of malnutrition; there is malnutrition from not having enough food to eat, there is malnutrition from not having the right kinds of food to eat and there is malnutrition from having too much of the wrong food to eat.
The under nutrition from not having enough food to eat that is going down; it is going down slowly but there is still progress. Globally I think about a little over 20 years ago there were 250 million kids worldwide who were stunted; too short for their age: you think they are 5 years old but really they are 9 years old. That number has gone down to 125 million in the last 25 years or so. It’s not rapped enough but it’s still good.
Micronutrient deficiencies; people who don’t get enough Iron, Zink or vitamin A or B and that kind of stuff, those numbers haven’t gone down that quickly; they are quite static. Women’s anemia rates globally, the target is to halve those rates by 2030 but we will miss that target by many years at the rate we are going.
On top of that you have got things like obesity, overweight diabetes which are all linked to poor diet skyrocketing in many countries. My country which is the UK a third of the population is obis, it’s not increasing, but it’s not going down. In countries like Ethiopia it is still very low but it is increasing rapidly.
It’s quite a mixed picture, we need to put our foot on the accelerator under nutrition, and a foot on the break to stop over nutrition and at the center of all of that is diet and the quality of what people eat.
Capital: One of the challenges for the nutrition issue is that there isn’t one specific body that is responsible for it. It is about health, education, agriculture and so on. Which body should be responsible for it?
Dr Haddad: When you look at countries that have done really well, for the last 10, 15 years what we find is that the responsibility for nutrition rests in the Prime Minister’s or the President’s or the vice prime minister’s office, or the ministry of planning which cuts across all sectors and its high up in government. So you need something that cuts across all the sectors.
Ministry of health is obviously very important but sometimes they are not considered a core economic development issue, or even if they are important, they only are part of solution; agriculture, education, water and sanitation, poverty they are all part of the issue, so you need a high level mechanism.
The government of India after a very long time of nagging and encouraging by people like me has created what’s called a national mission which is run out of the Prime Minister’s office which says, ending malnutrition or reducing malnutrition is a national priority and it is going to create a mechanism where all the ministries feed in and coordinate. So every country, to be successful, has to do the same.
Capital: In Ethiopia 80 percent of the population is in farming but we haven’t been able to produce enough food to feed everyone, we still import a large amount of wheat. So how can we focus on nutrition when there isn’t enough food to consume to begin with?
Dr Haddad: Malnutrition is caused by poor water, sanitation, poor education, poverty. Agriculture is really important because it generates food but it also generates income. It generates income for the farmers, it generates income for those people the farmer buys inputs; if the farmer is doing well then the farmer will buy machineries and other things so those people that provide that will do well and if those people are doing well they will buy stuff from the farmers. By having farmers who are more profitable, they will tend to produce more food and also produce it at a lower price.
Most people can buy enough of the stipple food, obviously there are some that can’t; but many more people can’t buy the right kinds of food, they rely on steeple food for 90 percent of their calories. Maybe they get 5 to 10 percent of their calories from fruits and vegetables, dairy and others. It’s these other kinds of food that are very rich in vitamins, minerals and proteins that are so important for a really good growth for children and adults.
What we can do in agriculture is try to make farmers more profitable and productive but not just in cereals but also in things that are really just don’t fill stomachs but also nourish as well.
Capital: Do you think culture plays a role in nutrition and what people prefer to eat as well?
Dr Haddad: I think culture is very important in all countries. It is one of the most important things that determine what families buy and it certainly does in my family. Income and price matters and culture and taste matters, availability also matters.
I think we have been doing two things wrong. One is that we haven’t been creative enough in creating a demand for healthier foods. Most public sector government run campaigns for healthier foods are usually dull. People don’t buy food because they have more nutrients in them or fiber or because they are good for them. People tend to buy food because it tastes good and because it says something about them as a person.
So most behavior change programs that demand are not creative enough and don’t understand consumers enough. They treat people as recipient of program rather than agents who have choices. GAIN works to try and bring government scientists with marketers not from food companies but just people who know how to sell things. We bring them together to create emotional, funny, engaging messages.
The second thing to do differently is not necessarily relay on farmers or women to do backyard production of fruits and vegetables, it’s difficult to sustain. We really should be rewarding companies; small companies, midsize companies and even big companies who do produce fruits and vegetables, they need to be incentivized, let’s think about giving them lower tax rates, low utility rates.
We create business parks for those who produce for exports because government says it’s important for the economy, we should also create business parks for companies producing health foods.
Capital: Do you think governments are open to ideas of giving incentives to companies as a way of encouragement?
Dr Haddad: Governments are open to giving all kinds of incentives to business and consumers. I think the stumbling point of many governments in Africa, Asia and in my country too, they think it is all about consumer choice and consumers are irresponsible and buying the wrong food. There is an element of choice, but it’s really about the environment we face.
If I am faced with only cheep junk food and expensive food, I will the junk food because that is what I can afford. But if I find healthier and affordable options then maybe I will buy more of that. So it is about choice, but it is also about what space you have to exercise that choice in.
Capital: Can you give us an example of a country that has been successful when it comes to lowering or ending malnutrition?
Dr Haddad: First I want to say that Ethiopia has been quiet successful. It has reduced its stunting rate from 58 percent to almost 38 percent; in a period of 20 years and that is a good rate. Ghana has really done an amazing job in reducing its malnutrition rate; it has reduced it from 38 percent to about 19 percent, halving the stunting rate.
You have to look at reducing malnutrition as a chain; every link in the chain has to be strong. Ghana has had reasonable economic growth and that is important because it means families can afford better food, sanitation and so on.
Ghana has had also a commitment from the top to do something about hunger, not so much about nutrition, but hunger. It all starts with leadership; if I can talk to your Prime Minister I would say that I hope he is as interested in child growth as he is in economic growth.
I would say, Ethiopia stands a chance of being an industrial revolution powerhouse in 15 to 20 years if it invests in its kids today because those kids, if you don’t invest in their nutrition today, their brains won’t develop, their immune system won’t develop, they won’t do well in school, labor market, they are not going to be as innovative, they are less likely to be entrepreneurs and we have got really hard evidence to show this following kids who were well nourished verses kids that are malnourished.
You see what happens to them 20, 30 years down the road, they are more likely to live in poverty, less likely to have jobs, good wages. If you want a demographic dividend you better invest in kids now, if you don’t you are going to have a demographic nightmare.
Capital: The long term effect of malnutrition is devastating for a country’s growth and there is evidence for that. Then why does it continue to be a difficult decision for governments to invest in it?
Dr Haddad: I have had a lot of experience speaking to ministers of finance who say well it should be the responsibility of ministers of health. The economist who won the Nobel Prize a couple of years ago Angus Deaton, spent his life looking at the economic return of improved nutrition. Some of the estimates we have in top economic journals is that for every dollar invested in nutrition interventions, programs, you get 16 dollars back. I think for Ethiopia, that number is even higher.
The trick is that 16 dollars is not realized for about a 20 year period so it is difficult for politicians; they want results now and not in 16 years of time. The way you can appeal to politicians is to appeal to them on lives saved. 45 percent of all deaths under the age of three are related to malnutrition. You just have to figure out what your different politicians are triggered by; is it preventing child death, is it promoting economic growth, laying the foundation for next generations. Nutrition champions have to be really clever in how they approach.