At the Osu Maternity Home in Accra, Ghana, Rebecca Martey breastfeeds her newborn son Gerald. In the past, many women did not feed babies breast milk exclusively. Instead, a baby's diet was supplemented with water, sugar water, or other herbal concoctions, causing diarrhea and other problems. © Bill & Melinda Gates Foundation/Olivier Asselin

By Shawn Baker, Director, Nutrition, Bill & Melinda Gates Foundation

Nearly half.

That’s the data point the nutrition community has been rallying around for the past few years. Nearly half—or 45 percent—of all childhood deaths are linked to malnutrition.

Despite this daunting number, we have made great strides to tackle malnutrition. The rate of children under-five with stunted growth has dropped by more than 16 percent between 1990 and 2015—with countries like Peru, Vietnam and Brazil showing that rapid progress is possible with political leadership.

Yet the 45 percent statistic remains. As Bill and Melinda Gates point out in their Annual Letter, written as a note to foundation trustee Warren Buffet, “nutrition is the biggest missed opportunity in global health.” If we don’t tackle malnutrition, we will never meet our collective goals for improving women and children’s health globally.

After 30 years working in this field, I believe that greater, more rapid progress towards a malnutrition-free world is possible.

First, we know what works. We have a set of tools that, if scaled up globally, would have a huge impact on child survival and development. As Melinda says in the letter, this starts in the first hour after birth, with breastfeeding. New research last year found that babies who were not breastfed in their first hour had a 41 percent higher risk of dying in their first month. Many countries are struggling to increase their breastfeeding rates, but in just a few years Alive & Thrive helped triple the exclusive breastfeeding rate in Vietnam and reached more than 80 percent in program areas of Bangladesh and Ethiopia. The result? Improved infant and child feeding practices at scale.

A second proven tool Melinda points to is the fortification of staple foods and crops with essential nutrients. This is another area where we’ve seen tremendous gains in recent years—including a drop in iodine deficient countries from 53 in 2003 to 25 in 2014, thanks to a global campaign that brought together international agencies, governments, and salt producers. We’ve also seen great success in breeding crops so that they contain more nutrients. Between 2012 and 2014 HarvestPlus and USAID helped reduce vitamin A deficiency in Uganda by reaching 60 percent of households with orange-fleshed sweet potatoes.

But these tools alone won't solve that 45 percent statistic. As Bill says “nutrition is still one of the biggest mysteries in global health.” In fact, our estimates show that current tools and approaches will only address half of the malnutrition burden.

This brings me to the second reason I believe progress is possible—the development of promising new technology that will help unlock the mystery of nutrition. One of the biggest things we’re trying to understand right now is how and when malnutrition impacts children’s brain development. Our partner Global fNIRS is using brain imaging in Gambia and Bangladesh to look into this to learn more and ultimately, allow us to pinpoint the stages where we need to intervene. Another partner, the biomedical device company Body Surface Translations, is focused on better understanding physical growth, using iPads and iPhones to digitally position and calculate children’s body measurements—a technology that could dramatically change how we do measurements in the field.

These tools and others in the pipeline give me confidence that when it comes to nutrition, our biggest victories are still ahead of us. But when we reach them, as Bill notes, “the rise in children who achieve their potential will change the world.”

Finally, never before in my career have I witnessed the level of political will around nutrition than what we are seeing now. The heads of two major development banks—President Jim Kim at the World Bank and President Akin Adesina at the African Development Bank—have issued a call to action to Ministers of Finance to invest in their youngest citizens and the ‘gray matter infrastructure’ that will propel their economies forward: children’s brains. But to sustain this momentum, we all need to be held accountable. Many of our partners, including the Graça Machel Trust, are working with countries like Malawi, Mozambique and Tanzania to ensure that national leaders deliver on their promise to nourish the next generation. The Scaling Up Nutrition Movement, launched in 2010 as a platform for countries and their partners to accelerate action, now includes 58 countries working collaboratively to end malnutrition.

The United Nations’ Decade of Action on Nutrition and the Nutrition for Growth movement are aligning nutrition actions, including financial resources, toward a magical number: zero. Zero cases of malnutrition. Zero differences between the health of a poor child and everyone else. I can’t yet put an exact date on when we will reach this goal, but I believe Bill and Melinda when they say that, with continued determination, “the future will surprise the pessimists.”