Stunted growth, both physical and mental. A higher chance of dying from infectious diseases. Diminished work productivity in adulthood. These are the consequences of hidden hunger, an urgent public health problem that affects two billion people worldwide and seriously hinders economic development.
Hidden hunger is a chronic lack of essential vitamins and minerals (micronutrients). In developing countries, multiple micronutrient deficiencies often occur at the same time, straining healthcare systems and hobbling economies. Iron deficiency anaemia, zinc and vitamin A deficiencies rank among the 15 leading causes of disease, costing $180 billion each year.
Fortunately, there are proven, low-cost, high-impact solutions that reduce hidden hunger, such as food fortification and micronutrient supplementation.
The new Lancet Series on Maternal and Child Nutrition, published in June, named 10 interventions that together have the ability to save nearly a million lives each year. Of the 10 interventions, half of them were micronutrient interventions. Since iron and calcium deficiencies contribute substantially to maternal deaths, the series called for maternal multiple micronutrient supplementation and calcium supplementation as key interventions that can save 102,000 lives per year as part of a package of interventions during pregnancy, which also includes universal salt iodisation. Another 145,000 lives could be saved through vitamin A and zinc supplementation for children.
The series also called for better data on micronutrient deficiencies. Where do they occur? Where should countries and partners prioritise interventions? Despite all our knowledge, we still need more data on micronutrient deficiency prevalence at the national and local levels in order for policymakers and partners to make evidence-based policy and programme decisions.
Recognising this need to expand the evidence base, Sight and Life, with the input of leading scientists, academics and decision-makers from a range of global institutions, developed the Hidden Hunger Index maps, which highlight global hidden hunger hot spots and provide a ranked index of affected countries. The maps show, for the first time, the combined prevalence in preschool children of multiple micronutrient deficiencies: vitamin A, zinc and iron, as well as iodine. The hidden hunger maps and indices are part of Vitamins in Motion, a Sight and Life effort to highlight the critical role vitamins play in overall nutrition and health and advocate for increased access to micronutrients.
The index found that hidden hunger hot spots exist in sub-Saharan Africa, India and Afghanistan and are severe in many countries in South-Central/South-East Asia. Most South American countries only had a mild-to-moderate degree of hidden hunger. In most of the 20 countries with the highest Hidden Hunger Index scores, 40 percent of preschool children were estimated to be stunted, more than 30 percent were anaemic due to iron deficiency and more than half were vitamin A deficient.
A high Hidden Hunger Index score was strongly correlated with a low Human Development Index score (a composite measure of three basic dimensions of human development: a long and healthy life, education and standard of living), and vice versa. This highlights the importance of addressing hidden hunger in order to accelerate development and give children a chance to develop to their full potential.
Our hope is that, for the global health and development community, the Hidden Hunger Index will provide the kind of evidence it needs to know where to focus national strategies and programmes, and on which micronutrients. For countries, donors and partners working to scale up nutrition, such as those involved in the Scaling Up Nutrition (SUN) Movement, the Hidden Hunger Index offers an opportunity to develop a unified approach targeting the alleviation of hidden hunger.
We’ve made tremendous progress in tackling hidden hunger. In 1999, only 16 percent of children were receiving the necessary two annual doses of vitamin A; by 2011, that figure had leapt to 75 percent – and it even exceeds 80 percent in many of the least developed countries. Scientific studies show that vitamin A capsule distribution on average results in a 24 percent reduction in under-five child deaths. Through universal salt iodisation, major progress has been made in combating iodine deficiency, the world’s leading cause of mental retardation and brain damage. Between 2003 and 2011, the number of countries with populations suffering mild to severe iodine deficiency fell from 54 to 32.
In these areas where we’ve made significant progress, we must continue to invest in scaling up these proven interventions – or we risk backsliding. And in areas where we have yet to see the impact we would like, such as in addressing iron-deficiency anaemia, we must re-double our efforts.
As the recent London Nutrition for Growth summit demonstrated – raising $4.15 billion to scale up nutrition – there is currently an unprecedented level of global political will to prioritise nutrition, now recognised as central to development. And yet, in order to translate these commitments into action and improve nutrition, governments and partners need tools that enable to make informed policy and programme decisions.
The Hidden Hunger Index is one of those tools. And I hope it’s a tool we put to use.
Klaus Kraemer, Ph.D. is the director of Sight and Life, a nutrition think-tank and humanitarian initiative of DSM, a global science-based company active in health, nutrition and materials. Sight and Life cares about the world’s most vulnerable populations and believes that the right mix of funding, knowledge, technology and policy will lead to better nutrition and health. As such, Sight and Life works through advocacy and thought leadership to address societal changes affecting nutrition. Sight and Life and DSM are currently leading Vitamins in Motion, an initiative to advance worldwide health and economic development through increased access to the essential vitamins all people need to be healthy and well-nourished.