LONDON (Thomson Reuters Foundation) - Sub-Saharan countries, India and Afghanistan top the list of 20 countries most affected by multiple micronutrient deficiencies, according to “Global Hidden Hunger Index”, a first-of-its-kind study published this month.
Hidden hunger is a chronic lack of micronutrients that accounts for about 7 percent of the global disease burden. It affects 2 billion people, mostly young children and women of reproductive age who live in developing countries.
Even mild to moderate deficiencies of essential vitamins and minerals, such as iron or vitamin A, lead to impaired development, poor physical growth and reduced work productivity in adult life.
Klaus Kraemer - director of the non-profit nutrition think tank Sight and Life and co-author of the study - spoke to Thomson Reuters Foundation by telephone about the importance of the index as a tool to target hidden hunger in order to achieve many of the Millennium Development Goals (MDGs).
Q: What are the key findings of the Global Hidden Hunger Index?
A: In this first approach to combine different indicators of micronutrient deficiency in one single index per country, we created a number of maps indicating the severity of hidden hunger and identified hidden hunger hotspots in sub-Saharan Africa and South Asia.
For me, the most striking finding was that countries with high hidden hunger scores had low human development index scores and vice versa. What it means is that in order to advance in development, countries have to tackle hidden hunger.
We also correlated undernourishment - which is the target of MDG 1 - with hidden hunger scores and found out that was far less correlated.
The conclusion from those two observations is that the quality of the diet is important for human capital development.
Micronutrients are very important, particularly in the first 1,000 days of a child’s development (from conception to two years) because in this period the child’s brain develops. Adequate nutrition during early development reduces stunting, which in turn relates to success at school, increased income, and - what is largely neglected - reduced risk of non-communicable diseases.
The foetus already in the womb of the mother is primed to develop chronic diseases in later life if it’s growing up in poor conditions where nutrition is not optimal.
Optimal nutrition and proper development depend not only on calorie intake, but also on whether the micronutrients in the diet are in sufficient quantities.
Q: What impact can this study have on Millennium Development Goals?
A: With this index and the country rankings we can highlight hidden hunger hotspots and bring that to the attention of the countries (and) governments.
The index can help to advocate with governments and other stakeholders, donors, to focus proven nutrition interventions like food fortification and micronutrient supplementation on those countries with the highest index, because in those nations there would be the highest return on the investment. As we know from the Copenhagen Consensus, investment in nutrition is very cost-effective and supports economic development.
Q: What do you hope will be the outcome of the study?
A: We hope the index can serve as an advocacy tool to inform strategies for unified efforts to eliminate hidden hunger.
We also hope that the index will become a benchmark to be used in the future as a baseline to monitor development progress.
To create the index, we used three hidden hunger indicators (zinc, iron and vitamin A) that have global databases, but these indicators are still not sufficient. We need more indicators for micronutrient deficiency. We also highlight that there is also more need for surveys that address micronutrient deficiency, nutrition and health in general that could be used in the future in these kinds of studies.
Q: Was there any particular country in the study that its rankings surprised you the most?
A: I was surprised that there were not more Asian countries alarmingly high, that the majority of the countries were from sub-Saharan Africa and also that the index didn’t highlight many countries in Latin America.
In China, where economic development has largely contributed to improved nutrition, in addition to providing enough calories, there was also focus on improving diet quality.
In India there are also enough food calories available, largely in the form of rice, but rice lacks micronutrients. So the national programmes of providing food assistance have been very successful, but they didn’t address nutrition. People don’t feel hungry, but they also don’t receive required nutrients like vitamin A and zinc, which are crucial for the immune system. As a result people are prone to infections, which in turn remove any remaining nutrients from the body.
The quality of the diet is very important, and the nutrients should be available in addition to calories. It may sound redundant to call for better dietary quality but we need to do it considering 2 billon people are suffering from hidden hunger. We have to raise this issue all the time and we need to do it with a scientific approach.