According to the recently released Global Nutrition Report 2020 (GNR 2020), one in nine people are hungry or undernourished, while stunting still affects 149 million children under five, globally. Underweight is a persistent problem of the poorest countries (up to 10-times higher compared to richer countries), while overweight and obesity are prevailing in more affluent countries (at up to 5-times higher). Strikingly, one in three people globally are overweight or obese, with rising levels across all ages. Over 650 million adults suffer from obesity.
This then was the underlying state of the malnutrition situation that prevailed when the coronavirus pandemic struck. How are the two scourges – malnutrition and COVID-19 – connected? Medically, people who are undernourished tend to have less powerful immune systems; they may experience more severe cases of the virus than others who are well nourished. Good nutrition can be part of the arsenal against COVID-19. Malnutrition and its consequences at the other end of the spectrum – i.e., obesity and diabetes – are strongly linked to more negative COVID-19 outcomes, including higher risk of hospitalization and mortality.
New work brought forward by the GNR that echoes the COVID-19 pandemic experience is that global and national scales hide wide inequities within countries as well as across countries. Every country in the world shows patterns of vulnerability to malnutrition that vary with age, sex, education, and wealth. Conflict can exacerbate these vulnerabilities. The GNR finds that in the 110 countries that track stunting at sub-national scales, rural children have higher stunting rates (35.6 percent) than urban children (25.6 percent). Overweight children are more often found in richer households (5.7 percent) compared to those living in poor households (3.6 percent).
Thus, malnutrition in all its forms is a ‘threat multiplier’ for COVID-19. The poor, minorities, and refugees are particularly affected by the virus. They are more likely to suffer from the response measures as well, with job loss, lack of social safety nets, and crowded living conditions, and food deficits a likely factor in their heightened vulnerability. Dedication to improving the nutritional status of all citizens needs to be part of national pandemic risk management.
Beyond these multiplying threats, COVID-19 is causing disruption to all parts of the food system, which is already under stress from manifestations of ongoing climate change, including increasing frequency of extreme weather events such as heat waves, droughts, and floods.
On the production side, the farm labor force has been unable to work due to illness and unable to travel due to restrictions. In supply chains, there have been breakdowns and trade restrictions. On the consumption side, accessibility has been diminished. Increased prices lead to increased malnutrition, as low-income people are forced to eat cheaper, less nutritious food.
Additionally, school nutrition programs that marginalized families depend on have been canceled. Food insecurity is massively on the rise – levels of hunger and malnutrition continue to build as the weeks now turn to months that the virus has been with us throughout the world.
In the longer term, we need to transform the food system with a focus on ensuring healthy food for all, and a healthy planet as well. There are many calls now to endow our food system with respectful interactions among natural resources and the ecosystems on which it depends. Transforming the food system is also inextricably linked to climate change, since it is already affecting food production, with likely negative effects on the quality and quantity of food available to consumers in the future. At the same time, dietary choices influence greenhouse gas emissions, the root cause of climate change (Figure 1).
The figure from the GNR 2020 illustrates that animal-sourced foods cause significant amounts of greenhouse gases and that these emissions are projected to grow. Cropland and water use needed for food production are also projected to increase, as well as nitrogen and phosphorus applications exacerbating environmental stresses.
The GNR 2020 states:
Production and consumption practices affect many people living in low-income countries who do not have the resources to adapt fast enough to environmental changes and are limited in their options for accessing healthy food. Between demand and supply, a well-regulated food environment – with specific attention to environmental impact, ecosystems management, and effect on climate change – is an opportunity to ensure more equitable availability and accessibility of food for all, and to reduce inequality of nutrition outcomes.
Reducing consumption of red meat and other processed foods and increasing consumption of diets with higher proportions of vegetables, nuts, and fruits can lead to reduction of greenhouse gas emissions from ruminant cattle and free land for carbon storage in forests and/or growing of second-generation biofuels. Reduced health costs of diseases linked to malnutrition will result in a ‘win-win’ for health, climate, and sustainability of the planet.
However, how land-use transitions would proceed from one production to another and the effects they would have on farmers is a subject now of intense research. How to ensure that these are ‘Just Transitions’ is critical for sustainable food system transformation.
Policy solutions must not leave out nutrition in COVID-19 recovery plans. There are many ways that these solutions can be entrained through standards and regulations, markets, institutions, and governance. Public procurement, health insurance incentives, school lunches, and education campaigns can all help to address both undernutrition and overweight issues – the double-burden of malnutrition.
Another area for effective action is reduction of food loss and waste. About one-third of all food produced is either lost or wasted, at an estimated cost of about $1 trillion per year. Food security and nutrition are part of the food loss and waste story – not just the economic costs. By reducing the availability of food, increasing prices, and decreasing farmers’ incomes, food loss and waste significantly impacts food security. It affects future food production since it engenders an ever-expanding use of natural resources. And food loss and waste increases greenhouse gas emissions. It is estimated that Global food loss and waste equaled 8–10 percent of total GHG emissions from 2010-2016.
In developing countries, lack of efficient storage and refrigeration cause a large proportion of food loss and waste. In developed countries, food waste is often caused by behavior such as over-buying and inattentive food preparation. Technical options for reduction of food loss and waste include investments in more efficient infrastructure and packaging.
The COVID-19 and climate emergencies make it crucial to transform food systems at the global, national, and local scales. Healthy food that is sustainably produced needs to be continuously available, accessible, and affordable to everyone on the planet. No one should be left either hungry or overweight.
The GNR recommends four action items, all equally germane to both COVID-19 and climate change:
- Build equitable, resilient, and sustainable food and health systems.
- Invest in nutrition, especially in the communities most affected.
- Focus on joint efforts to solve global and local challenges.
- Leverage key moments to renew and expand nutrition commitments and strengthen accountability.
Let us seize this moment to design the food system and the public nutrition/health system that we need going forward. Without the inclusion of nutrition in COVID-19 responses, the potential for health will not be realized and food security will be jeopardized. Just as our immune systems are compromised when nutrition is not fully integrated into healthy diets for all, without attention to climate change, our long-term future is compromised and our planetary health will continue to suffer.