Malnutrition, obesity present global food challenges

Even as public health officials deal with the age-old problems of starvation and malnutrition, new nutritional maladies linked to Western diets and lifestyles are spreading around the world, complicating the global nutrition picture.

Experts say the expansion of obesity and diabetes around the world is presenting international health experts with a new agenda even as they struggle with the unfinished agenda of malnutrition, which remains a global health problem that underlies 54 percent of childhood deaths each year.

The abandonment of traditional diets filled with fruits, vegetables, and whole grains in favor of diets with processed foods and simple carbohydrates is taking hold even among the middle class of the world’s poorest nations, according to speakers at the Harvard School of Public Health (HSPH) on April 15.

The speakers were part of a symposium on global nutrition called “The Unfinished Agenda of Nutrition & Global Health: Challenges and Opportunities.” The event was sponsored by the Harvard Nutrition and Global Health Program at the Harvard Initiative for Global Health (HIGH).

Professor of Nutrition and Epidemiology Wafaie Fawzi said the Harvard Nutrition and Global Health Program is designed to draw on the expertise of Harvard’s various Schools and on that of local partners to understand the nutritional challenges around the world.

Speakers at the event came from as far away as India and Brazil and presented local views of the ongoing problems in their countries.

HSPH Dean Julio Frenk, who delivered opening remarks, said that some developing nations are not simply lagging behind Western nations on the path to development, but are instead off course. Such “mal-development,” as he termed it, is due to mismanagement and has some nations dealing with the problems of both malnutrition and obesity at the same time, coupled with the fight against infectious disease and new threats like the health effects of global warming.

“Many low- and middle-income countries are the victim of mal-development,” Frenk said. “The old and the new problems coexist in a complex present.”

Though the problems are challenging, Frenk said that modern science has given public health workers and administrators more knowledge and tools to address them than ever before.

The event’s keynote speaker, Jaime Sepulveda, director of the Bill and Melinda Gates Foundation’s Integrated Health Solutions Development Program and former director of Mexico’s National Institutes of Health, said slow progress against malnutrition is common around the world. Though the first United Nations Millennium Development Goal would halve the number of people living in extreme poverty and hunger by 2015, just a handful of nations are on track to achieve that goal, Sepulveda said. Some are even backsliding from where they were in 2000 when the goals were adopted.

Sepulveda outlined the progress that Mexico has made in recent decades, where the incidence of stunting — one measure of malnutrition — decreased dramatically in recent years. He credited Mexico’s “Progresa” program with focusing nutritional dollars where they’re needed most — in the rural south. One feature of the program is conditional cash transfers, which are payments to families of low socioeconomic status. The program is designed so that the payments go to women on the condition that their children are kept in school, vaccinated, and healthy. The program also provides fortified foods for pregnant women and children to improve health during the critical first months of a child’s life, up to age 2.

Despite the progress made under the program, Sepulveda said it will take Mexico 22 years at current rates of progress to attain the first Millennium Development Goal, so more needs to be done.

“Nutrition has no champion, no Global Fund,” Sepulveda said. “We need to raise the visibility of nutrition as a field and of undernutrition as a problem.”