As Pandemic Rattles Global Food System, Report Deems Mass Malnutrition World's Top Killer

As the coronavirus pandemic continues to expose and exacerbate enduring issues and inequities in the global food and health systems, a United Nations-backed report released Tuesday declares the double burden of malnutrition--undernourishment and obesity--the leading cause of death worldwide.

The foreword of the 2020 Global Nutrition Report puts the assessment in the context of Covid-19, which has not only killed over 287,000 and infected over 4.2 million people around the world but also revealed "the vulnerability and weaknesses of our already fragile food systems" that are "stressed by increasing climate extremes."

Although the report was written before the current public health crisis, "its emphasis on nutritional well-being for all, particularly the most vulnerable, has a heightened significance in the face of this new global threat," the foreword says. "The need for more equitable, resilient, and sustainable food and health systems has never been more urgent."

The foreword continues:

Covid-19 does not treat us equally. Undernourished people have weaker immune systems, and may be at greater risk of severe illness due to the virus. At the same time, poor metabolic health, including obesity and diabetes, is strongly linked to worse Covid-19 outcomes, including risk of hospitalization and death.

People who already suffer as a consequence of inequities--including the poor, women and children, those living in fragile or conflict-affected states, minorities, refugees, and the unsheltered--are particularly affected by both the virus and the impact of containment measures. It is essential that they are protected, especially when responses are implemented.

In a statement Tuesday, report co-chair and Tufts University professor Renata Micha echoed the foreword's call for learning from the pandemic and pursuing "well-functioning, well-funded, and coordinated preventive public health strategies that pay attention to food, nutrition, health, and social protection."

"Good nutrition is an essential defense strategy to protect populations against epidemics, relieve the burden on our health systems, and ultimately save lives," Micha said. "The findings of the 2020 Global Nutrition Report make clear that tackling malnutrition should be at the center of our global health response."

According to the report, one in three people worldwide are overweight or obese, one in nine are hungry, and almost a quarter of all children under age five are stunted. Although obesity is "increasing rapidly" in nearly every nation, people in poorer countries more commonly are underweight while those in wealthier countries are more often overweight.

Resolving the global problems of poor diets and resulting malnutrition requires addressing inequities across the entirety of the world's food systems, which currently "do not enable people to make healthy food choices," the report says. "The vast majority of people today simply cannot access or afford a healthy diet."

The report details the necessity of reducing the production of highly processed foods and staple grains such as maize, rice, and wheat while increasing the availability of affordable and locally produced fruits, vegetables, nuts, and whole grains.

"Natural resources, ecosystems, and climate change affect food production, and in turn the quality and quantity of food available to consumers," says the report. "At the same time, consumer choices and demand influence the type of food produced and therefore potentially increase pressure on ecosystems and can contribute to climate change."

The assessment points out that "nitrogen and phosphorus fertilizer applications can affect the quality of food" while animal-sourced foods have a significant impact on greenhouse gases. As the Guardianreported Tuesday:

The report's conclusions echo calls by climate scientists for a transformation of food and land management, after a report by the Intergovernmental Panel on Climate Change (IPPC) last year concluded that poor land use is responsible for a quarter of greenhouse gas emissions.

Cynthia Rosenzweig, a climate expert at the NASA Goddard Institute for Space Studies, and the author of the food security chapter in the IPCC's report on land and climate change, said: "It is really a call to action for countries and international organizations, NGOs, and the whole system, to create a transformation in the food system."

"Malnutrition is a threat multiplier. I think it has been ignored that people who are malnourished are likely to have lower immune systems."

The assessment also emphasizes the importance of addressing nutrition inequities in the world's health systems, noting that "strikingly, worldwide, only 4.4 million of the 16.6 million children under five years of age with severe acute malnutrition currently have access to treatment."

"Global commitment to universal health coverage is an opportunity to integrate nutrition care fully into health systems," the report says. "Essential nutrition services--preventive and curative--should be universally available to all, with a focus on those who need it most."

The report calls for reforming how healthcare is provided globally, stating that a focus on "the medical, drug-treatment-based model of disease that ignores fundamental causes such as diet and lifestyle" has led to a "malnutrition epidemic that is sweeping the world."

U.N. Assistant Secretary-General Gerda Verburg, coordinator of the Scaling Up Nutrition Movement and a member of the new report's stakeholder group, warned Tuesday that "2020 must represent a turning point for nutrition."

"As we look to reinforce our resilience to global stresses, nutrition must become a key component of any emergency or long-term response," Verburg said. "Investing in nutrition, renewing and expanding commitments, and strengthening accountability has now become urgent if we want to prepare our systems for future shocks, and avoid a reversal of gain."