The numbers are hard to ignore. Around the world, 48 million children experience stunted growth, 45 million suffer from wasting, and nearly half of all children who die every year die from malnutrition.
“Even for kids who survive [malnutrition], their ability to be physically and mentally at their full potential is such a big thing for their quality of life and that of the country they live in,” says Bill Gates, co-chair of the Bill & Melinda Gates Foundation. “Tragically, in Africa, 40% of kids never get to their full physical or mental development.”
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Each year, the Bill and Melinda Gates Foundation highlights an issue in its Goalkeepers Report with a large unmet need, and for which the organization provides proven, actionable solutions. This year, the group focused on childhood malnutrition, and the consequences it has throughout children’s lifetimes.Addressing nutrition in young children allows more kids to attend and remain in school, and if more of a country’s population is educated, it can then develop further economically, says Gates.
In the report, the Foundation highlights several ways to improve nutritional deficiencies around the world, some of which are more direct and others that involve boosting food production strategies in various countries.
One of the most straightforward interventions involves piggybacking nutrients onto existing food staples, such as salt, oil, and bouillon cubes, which many low-resource households rely on to flavor their foods. Fortifying bouillon cubes with iron, folic acid, zinc, and vitamin B12, for example, could prevent 16.6 million cases of anemia each year in Nigeria. Folic acid is already added to staples like wheat and other flours, but it could also be added to iodized salt to substantially reduce the risk of neural tube defects in newborns. The Ethiopian government is now exploring such an approach, which could avert 75% of deaths and stillbirths due to these defects, which generally occur in the first month of pregnancy and lead to nerve damage that contributes to learning disabilities, paralysis, and death.
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Another strategy is related to food fortification: boosting the distribution of multiple micronutrient supplements, a complete set of 15 prenatal vitamins and minerals established by the United Nations that are critical for early fetal development and maternal health. If current low-and middle-income countries provided these supplements to expectant mothers, the Foundation estimates that nearly half a million lives could be saved by 2040. The supplements can reduce the risk of babies being born at a low birthweight, which increases their risks of other health conditions, as well as their chance of developing anemia. They could also lower stillbirth and maternal mortality rates.
Even beyond providing nutrients directly to babies or pregnant women, the Foundation also encourages more long-term strategies for sustaining nutritious food supplies. Those include adopting agricultural practices and breeding animals used in developed countries to increase the eggs produced by chickens and the milk produced by cows. “Chickens [and cows] in the West produce four times more eggs and milk than those in Africa,” says Gates. “By blending that productivity with key tolerance and disease resistance in the African animals, we can create chickens and cows with higher egg and milk output. And as we see the cost of eggs go down, more children will have access to them.” About 80% of cows in Kenya produce only 2 liters of milk per day, but that’s been changing as farmers breed cows that are more productive, and rely on higher quality crop waste for feed. That’s led to some cows in the country producing six to 10 times more milk than they had before. By boosting dairy productivity in just five countries in Africa, the Foundation estimates 109 million cases of stunted growth could be prevented by 2050.
Gates says these interventions are intentionally ones that are both easy and inexpensive for countries to adopt. The prenatal supplements, for example, cost $2.60 to provide for a woman’s entire pregnancy. But overall reductions in aid over the past two decades mean that gains that were achieved in the 2000s are already slipping or in danger of disappearing completely. “I’d put the financial challenges they face in African countries in funding primary health care as the top thing,” says Gates of hurdles to implementing even these relatively simple solutions. “The research work [to find more interventions] I’m not as worried about; we’re not in a research crisis. [The crisis is in] the need for aid budgets that are affordable.”
Gates says that all it takes is 1% to 2% of the budgets of wealthier nations to spend about $1,000 per life saved in the poorest countries. “That should be doable, but we have to have a value system where voters say that it’s worth spending 1% to 2% to help people who are far away,” he says. “The visibility of success can help voters prioritize what to me feels like a moral imperative, but also has other benefits in terms of avoiding conflicts, pandemics, and building strong economic relationships. Having a thriving Africa is good for the world.”
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For that success, he points to countries in Asia that have been able to “graduate” from poverty and rely primarily on external aid to fund their own primary health care system. “We’ve seen it in Asia in Indonesia, Vietnam, and India; [they] are able through their own tax base to fund primary health care. We’d love to create those success stories in Africa.”
But shifting international priorities—paired with conflicts in many parts of the world, including in eastern Europe and the Middle East—have led to shrinking aid budgets, particularly for helping more African countries move out of poverty. “It’s a pretty acute situation right now,” he says of the health and nutrition needs of the continent. “We have to renew our ability to tell this story. When we have a war in Ukraine, and turmoil in the Middle East—I’m not downplaying those situations at all—but it’s a shame that Africa to some degree has gotten off the agenda, and we see that in the aid numbers. We can address 40% of the malnutrition in the world with the interventions we’ve got now.”