Africa: Fund Invests to Break 'Unrelenting' Cycle of Mother, Child Death

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The Children's Investment Fund Foundation (CIFF) will invest U.S.$787 million (£2.7 billion) to tackle undernutrition – which underlies over three million deaths of young children each year and causes lifelong intellectual and physical damage to another 165 million.

The philanthropy joined the governments of Brazil and the United Kingdom to host Saturday's Nutrition for Growth meeting in London, a convening of business leaders, scientists, governments and civil society. Participants pledged up to $4.15 billion in new commitments to address undernutrition between now and 2020 and an additional $19 billion for investments in agriculture and other "nutrition sensitive programmes". The day-long session followed last week's publication of a new Lancet series on maternal and child nutrition that details the human and economic costs of undernutrition and successful interventions to fight it.

CIFF co-founder Jamie Cooper-Hohn and trustee Joy Phumaphi talked to AllAfrica on the eve of the London summit.

Jamie Cooper-Hohn, tell us about the Children's Investment Fund Foundation.

We actively look for issues where we believe the evidence clearly says that if we were to work in these areas - in the right way - we would have a transformational impact on children. We have identified nutrition as one of those areas. We were very clear that health impacts were being under-appreciated and also strongly suspected that the economic implications of undernutrition were significant.

What we have learned is that health impacts are greater than we could have imagined - that undernutrition is an underlying cause of 45 percent of deaths and one-third of maternal deaths. We commissioned some of the best economists to look at the data, and that has been tremendously compelling. It looks like undernutrition means that Africa and Southeast Asia are forgoing as much as 11 percent annual GNP.

About 165 million children are "stunted", which means if they are not properly nourished in the first 1,000 days, they never reach their full growth potential and never get proper brain development. It means a 20-45 percent decrease in wages. If you are not stunted you are 28 percent more likely to work in a skilled job. You're one-third less likely to live in poverty as adults. So the economic implications are huge.

We very much want to work with leaders of emerging economies and developing countries towards success on the issues they care about. We are talking about emerging economic powerhouses that have around 40 percent stunting - Kenya, Nigeria, India. For them, this is a barrier to realizing their economic potential and sustaining their amazing economic growth.

Joy Phumaphi, what have you concluded about the role of nutrition in development, as someone who has been minister of health in Botswana, has headed the African Leaders Malaria Alliance and held many other high positions?

Being responsible for family and community health and women's and children's health at the World Health Organization and then going to the World Bank and being vice president for human development, I got to be very familiar with the challenges that developing countries face. What is absolutely clear is that nutrition is the single biggest check on reducing poverty. It is both vicious and unrelenting.

A mother who has very poor nutrition - if her child is not one of the 2.5 million children who die at birth or before birth, then she is going to have a stunted child. This child will have limited cognitive development and very poor learning outcomes at school. They are not going to be able to get a skill which can give them access to better employment so they can break out of the poverty trap.

Now you take this and you multiply it by millions and millions, so you have whole communities whose ability to develop is stunted. And it's not just the individual. It is the community's ability to pull itself out of poverty and the country's potential for economic growth and development. So this is the impact that it has in developing countries.

It is unrelenting. Until we break this vicious cycle by ensuring that one mother, then two, then millions of them get the right nutrition and are able to give their children the critical nutrition for cognitive development during the first 1,000 days, we are never going to break the poverty trap. This is the biggest impediment.

Children who are undernourished get sick easily; their resistance is compromised; their immunities are compromised. There is no resistance to disease. Most of the deaths from malaria in Africa are among children who are undernourished.

Look at the added costs. People are not strong enough when they are undernourished to be able to produce crops. You are trying to teach kids who are not able to learn. If you look at these costs, plus the opportunities that are lost, I would argue that there is no development challenge that can bring as good a return on investment as an investment in nutrition.

You're saying that there is increasing evidence to support these conclusions.

Jamie Cooper-Hohn: That's exactly right. We are absolutely committed to integrity and transparency. When we were going out talking to [government] ministers about nutrition, it was very important to us that we had the best economic data available. We commissioned entirely independent analysts - Lawrence Haddad [who heads the Institute of Development Studies] being one of those - who did the research to look at what they call the meta analysis, the best studies from various continents. Latin America has the best longitudinal data, but Asia and Africa had some very good long-term, peer-reviewed studies.

I think even the economists have been surprised at how robust and consistent the data is across countries - how clear it is. As Joy said, once you break the cycle of undernutrition you basically hit a tipping point, and it's sustainably solved!

Economic growth doesn't do it alone. You have to actively break the cycle, and once you do, the returns are enormous. They are as good as investments in power and roads and agricultural productivity. And because it does break the cycle, the maintenance cost, so to speak, is actually less than it would be for something like roads.

We are feeling very good and firm on this. It is clearly resonating with ministers in Africa and elsewhere. Because the data is so good, ministers are feeling ready to act on the data, and that's part of what's so exciting.

To what degree do you feel that African decision-makers are aware of this?

Joy Phumaphi: The evidence has been emerging gradually over time. The studies that Jamie was talking about took several decades to follow children who had participated in a nutrition program during pregnancy, the first two years of life, throughout their childhood development years, through school and up to the time that they develop skills and start earning. We were able to prove conclusively that these children are able to earn up to 40 percent more than the children who were not given access to good nutrition.

Evidence, for example, shows that iron deficiencies are associated with low birth weight in children and shows the importance of breastfeeding, particularly during the first six months of life. So every time you bring in this evidence and you give an analysis, as well, of the economic benefit, the argument becomes increasingly convincing.

We feel now that evidence effectively demonstrates that it does not make economic sense not to invest in nutrition.

Is there anything else you would like to say about this?

Jamie Cooper-Hohn: What I really hope is that we will move nutrition firmly into the heart of the agenda, instead of being an outlier issue. There have been lots of mobilizations before this moment to get us here - bringing together a large, important cohort of global leaders.

I'm convinced that we will see a big surge of momentum around evidence-based intervention to deal with severe acute malnutrition and stunting. And I'm quite sure that based on the enthusiasm and the resources that will be new and available, that is going to transpire. That's very, very exciting.

Joy Phumaphi: What I would say is that this is a very exciting time for talking about health – and for the global development community, not just the global health community. It is an opportunity for us to make sure that there are robust programs that in the developing world that are addressing not just food security but food and nutrition security.

As we address sustainable food production, the impact of climate change on our societies and the implications for agriculture production, we should lay proper emphasis on not just the production of staples but also on the production of nutritious foods that will not only protect the planet, but also protect the people.

I think it's a wonderful opportunity for us in the nutrition community and in the global development community to make these very important linkages between water, energy and air, and food production, agriculture, and nutrition, so that we can invest the limited resources that we have as a global community in the right way once and for all.