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href="https://web.archive.org/web/20090724113127/http://blogs.cgdev.org/globalhealth/2009/03/hanging-in-the-balance-who-will-deal-with-child-malnutrition.php" rel="bookmark" title="Permanent Link to Hanging in the Balance: Who Will Deal with Child Malnutrition?">Hanging in the Balance: Who Will Deal with Child Malnutrition?</a></h3> <h4>By <a href="https://web.archive.org/web/20090724113127/http://blogs.cgdev.org/globalhealth/author/ruth-levine/" title="Posts by Ruth Levine">Ruth Levine</a> </h4> <p><p><img src="https://web.archive.org/web/20090724113127im_/http://www.cgdev.org/userfiles/image/balance.jpg" alt="Weighing an Infant" vspace="3" width="164" height="448" align="left">How can it be possible, in 2009, that almost half of all Indian children under three years old are underweight or severely underweight, and that child malnutrition accounts for more than one-fifth of the total burden of disease in that country? Something like three-quarters of all preschool children in India have iron-deficiency anemia, which impairs learning, and more than half have at least mild vitamin A deficiency. Given India’s place as one of the fastest growing economies in the world, the persistently high levels of malnutrition among children — close to double that of sub Saharan Africa — have to be cause for alarm and puzzlement. And the extraordinary vulnerability of Indian children, as manifested in these figures, holds in it a warning for what might happen as economic growth slows. Any claims of progress in child health have to be tempered by these sobering facts. A <a href="https://web.archive.org/web/20090724113127/http://www.nytimes.com/2009/03/13/world/asia/13malnutrition.html?hp" target="_new">feature in yesterday’s New York Times</a> focuses on the problem and describes it well, but leaves the questions — why and what can be done? — for others to answer.</p> <p>Who those “others” are in the field of nutrition is not at all clear, in India or elsewhere. Nutrition has long been a subject area that has fallen between the stools: related to health, yes, but never at the heart of what Ministries of Health consider their main mission. Moreover, a health-centric response to under-nutrition — which often boils down to providing medical care for severely malnourished children, promoting breastfeeding among new mothers, and distributing vitamin A capsules — usually fails to address the household food consumption patterns that are shaped by everything from women’s access to income to the way food is produced and distributed. It is everyone’s job, and no one’s.<br/> <span id="more-705"></span></p> <p>The responsibility and accountability problem is reproduced at the international level. A set of international institutions and bilateral agencies have traditionally focused some of their activities on nutrition, amidst many other, more prominent programs. UNICEF, the World Food Programme, the World Bank, USAID and CIDA are among the organizations that have made contributions in the field, but it’s well recognized that international nutrition is severely under-resourced, and has for years suffered from internecine squabbles and coordination problems. As the Lancet stated a year ago, “Leadership is absent, resources are too few, capacity is fragile, and emergency response systems are fragmentary.” (Also see the Lancet article, <a href="https://web.archive.org/web/20090724113127/http://www.cgdev.org/doc/Lancet.pdf" target="_new">Effective international action against under-nutrition: why has it proven so difficult and what can be done to accelerate progress?</a>) As the expert community has now started to come to a technical consensus about the menu of interventions that are needed to address child under-nutrition in high-burden countries (see <a href="https://web.archive.org/web/20090724113127/http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(07)61693-6/abstract">What works? Interventions for maternal and child under-nutrition and survival</a>) and the importance of addressing under-nutrition before age 2, the leadership and governance gap is looking more and more like the binding constraint to progress.</p> <p>Fostering leadership at the national and international levels is no mean feat, but tackling this huge and potentially growing problem demands it. When the food price crisis hit the headlines last year we heard some welcome messages from World Bank President Robert Zoellick and the Government of Japan (at least as hosts of the G-8). The Government of the UK has prepared an <a href="https://web.archive.org/web/20090724113127/http://blogs.cgdev.org/globalhealth/www.dfid.gov.uk/consultations/dfid-nutrition-task-team-action-plan.pdf" target="_new">action plan</a> and Irish Aid has convened a <a href="https://web.archive.org/web/20090724113127/http://www.irishaid.gov.ie/uploads/hunger_task_force.pdf" target="_new">Hunger Task Force</a>. But none of what international institutions or OECD donors have done has yet added up to anything resembling the focused attention and commitment that we’ve seen for childhood immunization, let alone for HIV/AIDS.</p> <p>Perhaps there’s another way. Maybe, just maybe, one or two of the members of the G-20 — Brazil’s President Lula and India’s Prime Minister Singh? — could state strongly that they understand the urgency of the problem, are committed toward progress in their own countries, and call upon international agencies to work intensively with high-burden countries on development and implementation of national action plans to address child malnutrition. There is an opportunity for countries whose citizens’ lives hang in the balance, and those who have the role of representing the developing world, to take the lead.</p> </p> <br/> </div> </div>  <div class="comments"><h3 id="comments">3 Responses to “Hanging in the Balance: Who Will Deal with Child Malnutrition?”</h3></div> <ol class="commentlist"> <li class="alt" id="comment-427"> <div class="gcomment"><cite><a href="https://web.archive.org/web/20090724113127/http://www.bread.org/" rel="external nofollow" class="url">Eric Munoz</a></cite> Says: <br/> <small class="commentmetadata"><a href="#comment-427" title="">March 17, 2009 at 12:17 pm</a> </small></div> <div class="ucomment"><p>You’re right to point out that nutrition has been a neglected area of focus, and its also worth stressing that malnutrition has dramatic impacts on long-term health and development. This is true for individual children who, when malnourished, suffer stunted growth and cognitive and motor impairment that can can impair their ability to learn and work. It’s also true of countries, particularly those with high-burdens of child hunger (there are 36 countries where stunting rates top 20 percent, 21 of which are in sub-Saharan Africa). When large segments of the population have suffered malnutrition in their childhoods, the result is a less capable, less productive work force (cf. “Effect of a nutrition intervention during early childhood on economic productivity in Guatemalan adults”). </p> <p>It seems to me that in order to drive political will to address this issue more education (among other things) is needed to reinforce the point that nutrition is crucial for development.</p> </div> </li> <li id="comment-428"> <div class="gcomment"><cite><a href="https://web.archive.org/web/20090724113127/http://www.institutenotes.org/2009/03/creating-political-will-to-address-malnutrition-1.html" rel="external nofollow" class="url">Institute Notes: A Dialogue on Overcoming Hunger and Poverty</a></cite> Says: <br/> <small class="commentmetadata"><a href="#comment-428" title="">March 17, 2009 at 1:06 pm</a> </small></div> <div class="ucomment"><p><strong>Creating Political Will to Address Malnutrition…</strong></p> <p>In a recent blog post, Ruth Levine at the Center for Global Development points out that malnutrition is an important issue that has not received……</p> </div> </li> <li class="alt" id="comment-498"> <div class="gcomment"><cite>Dr S.K CHATURVEDI</cite> Says: <br/> <small class="commentmetadata"><a href="#comment-498" title="">March 31, 2009 at 10:34 pm</a> </small></div> <div class="ucomment"><p>Its true that the Nutrition has long been a neglected subject and response to tackle malnutritions often boils down to providing medical care for severely malnourished children, promoting breastfeeding among new mothers, and distributing vitamin A capsules and usually fails to address the household food consumption patterns that are shaped by everything from women鈥檚 access to income to the way food is produced and distributed. It is everyone鈥檚 job, and no one鈥檚.<br/> While knowledge exists : promotion of breastfeeding; strategies to promote complementary feeding, with or without provision of food supplements; micronutrient interventions; general supportive strategies to improve family and community nutrition; and reduction of disease burden (promotion of handwashing and appropriate strategies to reduce the burden of malaria in pregnancy, the strategies to reach out to the children in need are missing. This is coupled by lack of political motivation and commitment as well as lack of monitoring of the programmes related to nutrition.The international agencies have also miserably failed to suggest practical and viable solutions nor seriously adovacated the issues with the governments in question. The international agencies are quick to take credit when it comes to subjects like immunization etc but fail to share the responsibility for failure of their efforts to tackle malnutrition.</p> <p>DR. S.K CHATURVEDI MD</p> </div> </li> </ol> <br/> <div align="left"><a href="https://web.archive.org/web/20090724113127/http://blogs.cgdev.org/globalhealth/2009/03/public-delivery-of-aids-treatment-in-south-asia-a-timidly-heroic-assumption.php"><< Previous</a></div> <div align="right"><a href="https://web.archive.org/web/20090724113127/http://blogs.cgdev.org/globalhealth/2009/03/the-acronym-party-gavi%e2%80%99s-new-call-for-nominations-for-iac-members-for-the-amc-secretariat.php">Next >></a></div> <br/> <div class="comments"><h3>Leave a Reply</h3></div> <form action="https://web.archive.org/web/20090724113127/http://blogs.cgdev.org/globalhealth/wp-comments-post.php" method="post" id="commentform"> <p><input type="text" name="author" id="author" value="" size="22" tabindex="1"/> <label for="author"><small>Name (required)</small></label></p> <p><input type="text" name="email" id="email" value="" size="22" tabindex="2"/> <label for="email"><small>Mail (will not be published) (required)</small></label></p> <p><input type="text" name="url" id="url" value="" size="22" tabindex="3"/> <label for="url"><small>Website</small></label></p>  <p><textarea name="comment" id="comment" cols="60%" rows="10" tabindex="4"></textarea></p> <p><input name="submit" type="submit" id="submit" tabindex="5" value="Submit Comment"/> <input type="hidden" name="comment_post_ID" value="705"/> </p> <script type="text/javascript"> var RecaptchaOptions = { theme : 'white', lang : 'en' , tabindex : 3 }; </script><script type="text/javascript" src="https://web.archive.org/web/20090724113127js_/http://api.recaptcha.net/challenge?k=6LfzdwUAAAAAAOUHBPuigpQhA7deScWPg7HC9wc9"></script> <noscript> <iframe src="https://web.archive.org/web/20090724113127if_/http://api.recaptcha.net/noscript?k=6LfzdwUAAAAAAOUHBPuigpQhA7deScWPg7HC9wc9" height="300" width="500" frameborder="0"></iframe><br/> <textarea name="recaptcha_challenge_field" rows="3" cols="40"></textarea> <input type="hidden" name="recaptcha_response_field" value="manual_challenge"/> </noscript> <div id="recaptcha-submit-btn-area"></div> <script type="text/javascript"> var sub = document.getElementById('submit'); sub.parentNode.removeChild(sub); document.getElementById('recaptcha-submit-btn-area').appendChild (sub); document.getElementById('submit').tabIndex = 6; if ( typeof _recaptcha_wordpress_savedcomment != 'undefined') { document.getElementById('comment').value = _recaptcha_wordpress_savedcomment; } document.getElementById('recaptcha_table').style.direction = 'ltr'; </script> <noscript> <style type="text/css">#submit {display:none;}</style> <input name="submit" type="submit" id="submit-alt" tabindex="6" value="Submit Comment"/> </noscript> </form> <div class="navigation"><p></p></div>  </div> <div id="right"> <ul> <li id="text-377439231" class="widget widget_text"> <div class="textwidget"><p><a href="https://web.archive.org/web/20090724113127/http://blogs.cgdev.org/globalhealth/"><strong>Global Health Policy</strong></a> is a group blog discussing the issues facing the donor community on everything from HIV/AIDS financing to pharmaceutical R&D to broader health systems concerns. 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