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close this bookEnding Malnutrition by 2020: An Agenda for Change in the Millennium - Final report to the ACC/SCN by the commission on the nutrition challenges of the 21st century (ACC/SCN, 2000, 104 p.)
View the document(introduction...)
View the documentExecutive Summary: Main Messages of the Commission Report
close this folder1. Recent Progress
View the document1.1 International declarations for action in the 1990s
View the document1.2 Progress in accelerating improvements for nutrition
View the document1.3 The case for investing in nutrition
View the document1.4 Setbacks to progress: nutritional well-being during economic crisis
close this folder2. Global Nutrition Challenges: A Life-Cycle Approach
View the document(introduction...)
View the document2.1 Poor nutrition starts in utero
View the document2.2 Adult undernutrition
View the document2.3 Micronutrient deficiencies are major public health problems in nutrition
View the document2.4 Changing food consumption patterns
View the document2.5 Preventing premature adult death and disability
close this folder3. Societal Issues Underlying Malnutrition: Implications for Progress
View the document(introduction...)
View the document3.1 Conceptual framework
View the document3.2 Poverty and nutrition
View the document3.3 Women
View the document3.4 Care
View the document3.5 Education
View the document3.6 Key role of local communities
View the document3.7 The importance of non-governmental organisations (NGOs)
View the document3.8 The potential for public-private co-operation
View the document3.9 Purposeful action: the need for equity
close this folder4. Food, Agriculture and Environment: Future Challenges
View the document4.1 Food as an important determinant of nutritional status
View the document4.2 The constraints to meeting future demands
View the document4.3 Other forces affecting food security: trade, global finance and new technology
View the document4.4 Food production and food security: meeting the challenges
close this folder5. Food, Nutrition and Human Rights
View the document(introduction...)
View the document5.1 What difference does a rights-based approach make?
View the document5.2 The International Code of Conduct of the Human Right to Adequate Food
close this folder6. Vision and Goals for the Future
View the document(introduction...)
View the document6.1 A Vision
View the document6.2 Achieving rapid progress for the 21st century
View the document6.3 The need to review goals and options
View the document6.4 Integrating goals for diet-related diseases
View the document6.5 An integrated approach
close this folder7. Establishing a New Agenda for Change
View the document(introduction...)
View the document7.1 Developing regional and national policies
View the document7.2 Improving UN Mechanisms
View the document7.3 National-level developments
View the document7.4 Linking national policy developments and actions to international support
View the document7.5 Key international issues relating to nutrition
View the document7.6 Conclusions and priorities
View the documentAnnex 1: The Establishment and Membership of the Commission
View the documentAnnex 2: Existing Nutrition Goals which Should be Maintained, Developed or Refined
View the documentAnnex 3: Ending Undernutrition in India by 2020
View the documentAnnex 4: Issues to be Considered by Regional and National Meetings
View the documentReferences

1.3 The case for investing in nutrition

"Approximately half of the economic growth achieved by the United Kingdom and a number of Western European countries between 1790 and 1980, has been attributed to better nutrition and improved health and sanitation conditions, social investments made as much as a century earlier" (UNICEF, 1997a, p. 17).

The social and economic costs of poor nutrition are huge. Investing in nutrition makes good economic sense because:

it reduces health care costs. Preventing low birthweight and stunting reduces childhood mortality and morbidity and their substantial health costs. Pelletier et al. (1993) estimated that over half the child deaths in developing countries can be attributed to underweight and its effect on infectious disease. Children hospitalised for severe undernutrition experience a higher case-fatality rate and a longer duration of stay than children in hospital for other reasons (Atakouma et al., 1995).

it reduces the burden of non-communicable diseases. Diabetes, heart disease and cancers in adult life are very costly conditions to diagnose, manage and treat, and are already distorting the health budgets of the developing world. Preventing early undernutrition may reduce the risk of these conditions in later life (as reviewed by Scrimshaw, 1997). Public health programmes to reduce the dietary contribution to these diseases are also cost-effective.

it improves productivity and economic growth. Undernourished children become smaller adults with reduced physical capacity. Productivity of adults who are undernourished - even on a short-term, seasonal basis - is impaired. Better health leads to longer working lives, reduced absence due to illness and more productive days. Such differences at the individual level contribute to a country's economic growth (Spurr, 1987).

it promotes education, intellectual capacity and social development. Undernutrition during fetal life and infancy can damage a child's mental development and impair capacity to learn. Undernutrition is associated with delayed enrollment in school and with absences from school - and it can be difficult for a child to catch up, Healthier children are expected to live longer, healthier lives. They are therefore more likely to capitalise on the benefits of schooling (Pollitt, 1990). Education is the cornerstone of social development.

The cost-effectiveness of preventive programmes is well recognised as far exceeding those of therapy. Even in the USA (a country with low levels of undernutrition, but without universal access to antenatal care) the National Accounting Office concluded that providing the Women, Infants and Children (WIC) supplementation programme to pregnant women reduced first-year medical costs for US infants by $1.19 billion in 1992, offsetting the cost of the programme (Avruch and Cackley, 1995). Evidence from this Commission's Report implies far greater economic gains when undernourished mothers are assisted.

No economic analysis can fully encompass the benefits of sustained mental and physical development from childhood into adult life. Healthy adults with the physical capacity to maintain high work outputs, and with intellectual ability to flexibly adapt to new technologies, are a huge national asset. Figure 1.2 illustrates the links between improving nutrition and boosting economic growth.

Global financial institutions like the World Bank are now clear about the importance of investing in nutrition:

"... resources put into nutrition are an investment with significant returns, today and in the future." (World Bank, 1992, p. 1)