BY YULIA BUYNOVA
Yulia Buynova is a first-year International Development student at Johns Hopkins SAIS and an Editor for SAIS Perspectives.
Dr. Maria Ruel,Director of the Poverty, Health, and Nutrition Division at the International Food Policy Research Institute (IFPRI) joined the SAIS community to discuss the impacts of the COVID-19 pandemic on global nutrition and food systems and the pathways forward. The current situation is a perfect storm for the nutrition systems: economic downturn, combined with the disruption of supply chains, contributed to the worsening of stunting, malnutrition, micronutrient deficiency, obesity and systemic inequalities.
Malnutrition is one of the most severe challenges the global community faces today, and COVID-19 provides additional constraints to achieving Sustainable Development Goal 2 "Zero Hunger" and its targets by 2030. In 2020, child wasting is expected to increase by 14.3 percent (compared to pre-COVID-19 projections); corresponding to 6.7 million more children with wasting, 80 percent of whom reside in Africa and Asia. Worse still, child mortality will rise by 128,605 deaths. The food systems are expected to stabilize in the next year, but the prospect of economic disruption in 2021 and 2022 threatens to erase the progress made in the nutrition system in the last decades.
COVID-19 has simultaneously disrupted several systems that help deliver proper nutrition – food, social protection, water, sanitation, and hygiene (WASH) as well as health and nutrition – creating a multidimensional challenge. Malnutrition today is associated with 45 percent of child deaths and can lead to long-term consequences in health, cognition, schooling, and economic productivity. The current situation exacerbates preexisting vulnerabilities and inequalities and highlights many of our society's problems.
More than 50 percent of countries worldwide have experienced disruptions in antenatal care, immunization, management of moderate acute and severe acute malnutrition. Both demand and supply shocks have affected the system: we observe stock-outs of essential drugs and supplements, while people frequent health clinics less due to fear of the pandemic, lack of transportation, and facilities closures. This trend could seriously harm efforts in behavior change communication, which is especially important for pregnancy and childbirth, and decrease immunization levels.
The current economic downturn is predicted to push 95 million more people into extreme poverty. A decrease in household incomes leads to a significant reduction in the consumption of fruit, vegetables, meat, fish, and dairy. The diet shifts to calorie-dense products, such as grains, staples, and oil, as households are pressured to decrease food expenditure. Supply chain disruptions and increased price volatility affected the supply of food, especially perishable items. As time passes, food systems adapt, stabilizing supply and prices, but decreased incomes will lead to long-term deterioration of diet quality and micronutrient deficiencies.
To address said challenges, 170 governments are adjusting their social protection systems to provide cash and food transfers for low-income households. 70 countries have implemented take-home school meals, but there are concerns about the quality, diversity, and micronutrient content of said meals. Current efforts nonetheless cannot satisfy the growing food demand, as more households experience income losses.
There are many ways in which the sector can protect nutrition and support systems. A recent blog by Derek Headey and Marie Ruel provides a framework for necessary interventions (summarized in the figure below).
Figure 1: Slide from Dr. Ruel's presentation at the SAIS Development Roundtable on October 22, 2020.
After the roundtable, Dr. Ruel sat down with SAIS Perspectives to continue discussing nutrition and food systems, the pandemic impacts, and the way forward. The interview has been edited for clarity and length.
Perspectives: How can governments prioritize different issues arising in relation to the current pandemic?
Dr. Ruel:It is a challenge for governments. Currently, medical issues became a priority for governments. At the same time, it is essential to make sure that children do not die from malnutrition and other problems associated with pandemic and economic turndown.
We cannot focus on just one thing. All systems together need to contribute to the solution. This is a multidimensional problem that requires a multisectoral approach. We need to prevent the collapse of basic routine maternal and child health services, which are already underutilized by many countries. We should promote service delivery innovations and outreach and prepare systems for the rise in wasting, stunting, and malnutrition. We should look for new modalities and implementation methods for social protection systems while keeping the agricultural sector functioning. Supporting homestead and local food systems can help increase access to nutrient-rich foods, even in the face of the disrupted transportation sector and supply chains.
Perspectives: How are urban diets changing in the time of COVID-19 in comparison to rural areas?
Dr. Ruel:Nutrition transition is happening in the world today as people move away from a traditional diet. Globalization made everything available, including ultra-processed and foods high in sugar, which are connected to increased risks of noncommunicable diseases.
We have a double duty today: undernutrition and obesity. This problem is especially evident in urban areas and requires both supply- and demand-side solutions. We need to improve the desirability and accessibility of nutritious foods by promoting healthy diets and investing in education. On the supply side, value chains should be leveraged to enhance the availability of macronutrient products. Biofortification is one way to improve the nutrient status of foods and improve diets for people across the world.
Convenience is vital for urban areas, and low-income households often do not have places to cook, making them rely on vendors. The most accessible, convenient, and cheap diets are always the unhealthiest ones, unfortunately.
Some coping mechanisms for supply chain disruptions are easier for rural areas, as urban residents often lack land access. We recommend that people engage in community and household gardening if they can access land under the current situation to absorb some systemic shocks.
Perspectives: How can the systems prepare for future risks? Do you see changes in approaches from the side of the government or international organization?
Dr. Ruel:Social protection systems need to adapt and expand. It is unlikely that current plans will meet the rising demand. Access to school feeding programs is essential and has decreased across the world with pandemic-related lockdowns. At the same time, school meals also lack in quality and diversity. Governments aim to keep calorie intake high but do not prioritize the variety of micronutrients. As people lose their jobs and incomes, families need to absorb additional members, decreasing food expenditure available per person. Unequal access to WASH services is another area requiring government intervention. Lack of basic sanitation and water services can lead to more infections, undermining already stressed healthcare systems.
Perspectives: Have any other crises in the last decade had a similar effect on food systems? For example, the 2008 economic crisis affected the global output, is the current challenge similar to the last one?
Dr. Ruel:2008 crisis and the 2020 crisis have affected food systems very differently. Today, disruption of transportation and lack of labor due to lockdowns and border closures are the main challenges, especially for the delivery of perishable foods. The government's measures to preserve global health put a significant toll on the value chains, but food production has not decreased. Moreover, suppliers are struggling with finding the market for their products.
In 2008, on the contrary, the main problem was the decreased supply of food to populations due to an economic shock, whereas value chains remained intact.
Perspectives: How long will it take for systems to restore?
Dr. Ruel:I cannot answer with certainty. We believe that the food systems can be restored by 2021, but with increasing unemployment and the closure of small businesses, the process to return to healthy diets and consumption of micronutrients might take a few years, given current pessimistic projections.
At the same time, there has been an incredible response from countries, and as soon as communities get better at decreasing the transmission of the virus, restoration of systems will come. We need to ensure that we learn from the crisis not only how to manage an emergency response but also how we can make systems more robust and resilient in general. Funding for sector restoration remains a serious concern as increasing demand for social protection puts additional strain on budgets. However, the world has adapted; we learned how to work from home, spending less money on traveling and office space, so systems can adapt as well and find new solutions for current challenges.
Perspectives: With a pretty gruesome situation in the world right now, is there anything that gives you hope?
Dr. Ruel:Yes, I am glad to see how some countries are coping with the pandemic. Africa's situation is not as bad as we anticipated at the beginning of the year; however, the virus might still hit the region later, so we must be prepared. There are several reasons for the current positive trajectory. The proportion of young to older people in Africa is higher than in many places worldwide, making the population less vulnerable. The recent response to the Ebola epidemic has prepared governments to some degree and made them take transmissions tracking more seriously than, for example, the U.S. has. The discipline of the population and readiness to follow governmental guidelines is another reason for success. In my opinion, if we are able to save Africa from a huge disaster - there is some hope there.
This pandemic is a wake-up call for everybody. The creation of new alliances and innovation in the sector could help us prepare our systems and make them more resilient in the long-term. Hopefully, we can learn from recent experience, and sectors will be able to document new and effective methods and institutionalize innovative approaches for the future.
You can watch the full talk here.
PHOTO CREDIT: “Wheat” by Shaun Dunmall licensed under CC BY-SA 2.0.