The Global Nutrition Report (GNR) was envisaged following the first Nutrition for Growth Initiative Summit (N4G) in 2013. The first GNR was published in 2014.
The GNR 2021, released in November 2021, provides a concise data-focused update on the state of diets and nutrition around the world. In view of the fact that urgency of the nutrition crisis poses one of the biggest challenges today, the year 2021 has been declared as the Nutrition for Growth Year of Action. The Tokyo N4G Summit in December 2021 represented a landmark opportunity for stakeholders to accelerate efforts towards stronger nutrition action, spanning food, health, and social protection systems. The UN Food Systems Summit in September, 2021, highlighted the need to accelerate the transformation of food systems to enable better diets and improved nutrition. These two key events and their shared goal of ending malnutrition in all its forms calls for a collective action.
GNR is the world’s leading independent assessment of the state of global nutrition led by an Independent Expert Group. It is published every year and offers the world’s most comprehensive picture of the state of global nutrition. The commissioning and development of the report is done by the Global Nutrition Report Stakeholder Group. The group comprises members of government, donor organisations, civil society, multilateral organisations, and the business sector. The report is funded by Bill and Melinda Gates foundation; European Commission; Government of Canada; the US Agency for International Development (USAID); Federal Ministry of Economic Cooperation and Development, Germany; and Foreign, Commonwealth, and Development Office of UK. The main aim of GNR is to encourage governments, donors, civil society organisations, businesses, etc., to take immediate action to end malnutrition in all its forms.
The GNR 2021 sets out progress towards the global nutrition targets, evaluates the effects of poor diets on human health and on the planet. It also assesses the nutrition financing outlook. Its findings provide a complete data for leaders of nations to prioritise and invest in nutrition which would deliver healthy populations, prosperous economies, and sustainable planet.
Key Findings
Accelerated progress needed to achieve global nutrition targets In 2012, the World Health Assembly (decision making body of the World Health Organization) passed a comprehensive implementation plan on maternal, infant, and young children nutrition (MIYCN) targets. This MIYCN plan comprises a set of six WHO global nutrition targets to be achieved by 2025. Out of the six MIYCN targets, at present, we are off track to meet five of the stunting, wasting, low-birth weight, anaemia, and childhood overweight. Apart from these, the targets of all diet-related non-communicable diseases (NCD) targets on salt intake, raised blood pressure, adult obesity, and diabetes are also lagging behind.
Unacceptable levels of malnutrition persist as, worldwide 149.2 million children under the age of five are stunted, 45.4 million are wasted, and 38.9 million are overweight. Overall, around 40 per cent of all men and women, that is 2.2 billion people are now overweight and obese. Of the 194 countries that were assessed, 105 countries are on track to meet the target for tackling childhood overweight and over a quarter are on track to meet stunting and wasting targets. However, anaemia levels are worsening in 161 countries.
No country is on track to achieve the target on reducing salt intake or to halt the rise in adult obesity. No country was on course to meet any of the diet-related NCD targets in the African region. Only a few high-income western countries are on course to meet both raised blood pressure and diabetes targets.
According to the GNR 2021, all around the world, there are very few countries that are on the course of meeting the comprehensive implementation plan on MIYCN 2025 targets.
Maternal, infant, and young children nutrition targets 2025 The MIYCN targets 2025 include 40 per cent reduction in the number of children under the age of five who are stunted. Only 53 countries among the 194 surveyed are on course to meet the target. Target of 50 per cent reduction of anaemia in women of reproductive age by 2025, only one country is on course to meet the target. The target of reduction in low birth weight is 30 per cent, 15 countries are on the course to meet the target. It is expected that there should be no increase in the childhood overweight. Around 105 countries, which is more than half of the 194 countries surveyed, are on course of achieving the target by 2025. The goal is set for achieving an increase of at least 50 per cent of exclusive breast-feeding in the first six months. Only 35 countries are on course of achieving the target. The target for childhood wasting is to reduce and maintain childhood wasting at 5 per cent. About 57 countries are known to be on course.
Global non-communicable disease targets for 2025 The WHO Global Action Plan for the Prevention and Control of Non-Communicable Diseases (NCDS) 2013–2020 includes nine voluntary global targets to be attained by 2025. The target is 25 per cent relative reduction in the prevalence of raised blood pressure according to national circumstances. Twenty-three countries with regard to men and 45 countries with regard to women are on course to achieve the goal. For adult obesity, the target is to halt the rise in its prevalence by 2025. No country, according to the GNR 2021, is on course, both with regard to men and women, on this aspect. On adult diabetes, halting the rise in prevalence, is the target for 2025. Eight countries with regard to men and 19 countries with regard to women are on course of achieving the target. The target set for salt intake is set as 30 per cent relative reduction in mean population intake of salt (sodium). However, no country is known to be on course on this factor.
There is a need for a significant change in action to deal with the problem of poor diets and malnutrition. The key global targets and systematic monitoring exclude diet. The underlying causes of malnutrition include poor diets and their quality, apart from the exception of salt levels. However, these aspects are not explicitly addressed and no global targets are set to address micronutrient deficiencies, except for anaemia. Also, there is no specific target set for monitoring malnutrition among children and adolescents. These gaps need to be filled for recognition, targeting, and tracking of poor diets.
The challenges of meeting global nutrition targets have been adversely affected by the COVID-19 pandemic. Approximately, an additional 155 million people are being pushed into extreme poverty globally, as a result of the pandemic. People who are obese or have other diet-related chronic diseases are more vulnerable to COVID-19.
Our diets are increasingly harmful for our health and the planet. Over the last decade, diets worldwide are far from being healthy and have not improved. The intake of fruits and vegetables is still about 50 per cent below the recommended level of five servings per day. Intake of 60 per cent fruits and 40 per cent vegetables in a day is considered a healthy diet. Intake of two servings of legumes and nuts a day is recommended and considered healthy, however, in reality the intakes are more than two-thirds below the recommended level. In contrast, red and processed meat intake is on the rise and almost five times the maximum level of one serving per week. The consumption of sugary drinks which are not recommended in any amount is also on the rise.
Despite some variations between regions, no region fulfils the recommendations for healthy diets. Lower-income countries continue to have the lowest intakes of key health-promoting foods such as fruits and vegetables. They also account for the highest levels of underweight. On the contrary, higher-income countries have the highest intakes of foods with high health and environmental impacts, including red meat, processed meat, and dairy. They also account for highest levels of overweight and obesity. No region meets the recommendations for healthy diets.
Percentage deviation below recommended minimum intake With regard to whole grains, globally 61 per cent countries are below the recommended minimum intake for healthy diets. With 81 per cent non-compliance to the recommended minimum intake, North America is leading in this aspect. Globally, about 60 per cent of the countries are deviating below the recommended minimum intake of fruits, Asia being the leader with 65 per cent deviation. There is a 60 per cent deviation globally with regard to consumption of vegetables, of which, Africa contributes for 54 per cent of the deviation.
Percentage deviation above recommended maximum intake However, in case of consumption of red and processed meat there has been a maximum intake of 377 per cent globally and 740 per cent in Oceania, than the recommended maximum intake.
Poor diets and malnutrition are to be addressed sustainably to ensure a healthy future for people and planet.
Since 2010, deaths due to poor diets have grown by 15 per cent. It is responsible for more than 12 million NCD deaths (26 per cent) in adults. Deaths attributed to dietary risks is at its highest at 31 per cent, both in North America and Europe. It is lowest in Africa at 17 per cent. No region is on track to meet the SDG of reducing premature mortality from NCDs by 2030.
Compared to 2010, the environmental impacts of food demand have increased by as much as 14 per cent. Animal-source foods are responsible for the majority of greenhouse gas emissions and land use. Northern American diets have the greatest environmental impact while African and Asian diets have the least. However, no region is on track to meet the set of SDG 2030 aimed at limiting the health and environmental burdens related to diets and the food system.
Financial costs of addressing malnutrition on the rise On an average, an additional USD 10.8 billion is needed annually between 2022 and 2030 to meet the nutrition targets of childhood stunting, wasting, breastfeeding, and anaemia. But, the total economic gains to the society of investing in nutrition could reach USD 5.7 trillion a year by 2030, and USD 10.5 trillion a year by 2050. The cost of meeting the SDG2 targets by 2030 would be approximately USD 39–50 billion annually to meet both nutrition-specific and nutrition-sensitive needs. Improving efficiency and effectiveness of existing nutrition investments could increase the impact of available resources on malnutrition. Countries have to effectively use tools to optimise allocation of available financing to reduce cases of malnutrition and save more lives with the same money.
Nutrition for growth (N4G) tracking The N4G tracking highlights the challenges in delivering commitments and measuring progress. Countries have been struggling to meet the financial and impact goals. Only 42 per cent of country financial commitment goals had been reached or were on course. Furthermore, about 41 per cent of the countries’ impact commitment goals were on the course, but none reported to have been met. COVID-19 has worsened the challenges, with reporting that progress on 43 per cent of country commitment goals have been severely or highly affected by the pandemic. This is primarily due to diversion of resources. There should be intensified efforts to meet commitments, especially those relating to financing and impact by country stakeholders.
It was asserted that decision-makers must leverage N4G as a reset moment. Of the 383 commitment goals made by stakeholders, 136 are aligned with the global MIYCN nutrition targets. Food and healthy diets are on a core commitment area of the Tokyo N4G Summit. Only 29 per cent of the past N4G commitments met the specific, measurable, achievable, realistic, and timely (SMART) criteria. There have been significant challenges in measuring progress, however, the Nutrition Accountability Framework presents the way forward. The Nutrition Accountability Framework was set up in September, 2021, by the GNR, to address the challenges and support the registration of new commitments made in the N4G Year of Action and beyond.
Areas for Action
Based on the GNR 2021 findings, following are clear areas for action to achieve healthy and sustainable diets to end malnutrition and preserve our planet.
To end poor diets and malnutrition, there should be a step-change in efforts and financial investments. This would provide high social and economic returns. All stakeholders must commit to strong, SMART actions in the N4G Year of Action. They should also ensure that diet-related goals form a part of their commitments.
Traditional forms of financing for nutrition, external and domestic, must be sustained and increased. Innovative and private financing for nutrition has to be set up.
Countries must be better supported to leverage new tools that would drive the efficiency and effectiveness of investments to maximise the impact of available financing.
Poor diets and malnutrition can and should be addressed holistically and sustainably to create a healthy future. Policies should be directed towards increasing intake of health-promoting foods and reduce animal-based foods to ensure diets are healthy and sustainable for both people and the planet.
Global nutrition monitoring must expand to key targets for improving diets and health that go beyond micronutrient deficiencies, hunger, and excess weight.
Special attention must be given to nutrition action that supports equitable, healthy, and sustainable diets for all.
Better data, greater accountability, and systematic monitoring are needed for identifying the progress. In order to fully understand the current state of nutrition, taking effective action, and ensuring its effect by measuring and monitoring, there is a need for better and more granular data.
All stakeholders who could play a role in driving healthy, sustainable diets, and good nutrition should ensure that they benefit from support available. They should sign up to the Nutrition Accountability Framework to make SMART nutrition commitments and ensure their impact could be measured.
Healthy diets that are also sustainable must be better integrated into global nutrition targets and monitored, considering they are of vital importance in tackling malnutrition and protecting our environment.
GNR 2021 on India
India is ‘on course’ to meet three targets for MIYCN. However, there is hardly any progress made towards achieving the target of reducing anaemia among women of reproductive age. About 53 per cent of women, between the age of 15 and 49, are anaemic. There is inadequate data to assess the progress of India towards achieving the ‘low birth weight’ target. India is ‘on course’ for the exclusive breastfeeding target, with 58 per cent of infants aged between zero and five months are exclusively breastfed. India is also ‘on course’ in meeting the target of ‘stunting’. But 34.7 per cent of children under the age of five years are still affected. This is higher than the average of the Asia region which stands at 21.8 per cent. With regard to the target for ‘wasting’, India has made ‘no progress’ with 17.3 per cent of the children under five years affected. This is higher than the average for the Asia region which is at 8.9 per cent. The prevalence of overweight children under five years is 1.6 per cent in India and the country is ‘on course’ to prevent the figure from increasing.
There is limited progress towards achieving the diet-related NCD targets by India. With an estimated 6.2 per cent of adult women over the age of 18 years and 3.5 per cent of adult men being obese. However, India’s obesity prevalence is lower than the regional average of 10.3 per cent for women and 7.5 per cent for men. Diabetes is estimated to affect 9 per cent of adult women and 10.2 per cent of adult men in India.
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