Institute Insights: November 2019

Contents:

Myanmar displacement camps in Myanmarís Rakhine State. A mother and child at Thea Chaung camp on the outskirts of Sittwe, Rakhine State. UN Photo/OCHA/David Ohana

From the Director

“Big data” is a phrase we see frequently now. It certainly means just what it says—a lot of data. The results of data “crunching” can seem overwhelming—a vast collection of numbers, indicators, statistical correlations, and more.

Big data also carries implications for human decision-making that are far more extensive and sophisticated than data in the past, including decisions that can save lives and prevent malnutrition among women and children in the 1,000-day nutrition window between pregnancy and age 2.

The computers used in working with big data can handle many times the volume of information than older technologies, even those developed fairly recently. With so many inputs, big data can produce accurate forecasts of results or, failing that, narrow the options to those most likely to be successful.

In a piece published this October, "Big Data Can Improve the Health of the World's Most Vulnerable Mothers and Children," Naveen A. Rao, M.D., senior vice president of the Rockefeller Foundation’s Health Initiative, offered examples of how big data can help improve nutrition and health care for vulnerable mothers and  their young children in low-income rural communities. When big data is also applied to local circumstances such as weather forecasts or the state of repair of major roads, Rao noted, it can provide even more detailed information to community health workers, who serve in many communities as the first line of defense against preventable diseases and improve childbirth experiences and outcomes.

If a community midwife has a dozen patients nearing full term and cannot visit all of them in a given day or week, big data can enable her to make an informed decision as to which women may have serious risk factors or for other reasons need the closest monitoring she can provide. When poor road conditions and an approaching storm indicate that two villages may be cut off from the nearest hospital, with ambulances unable to reach patients experiencing health crises, big data may provide enough advance warning to enable personnel and supplies to reach patients, or patients to reach health centers, before travel becomes impossible.

However, Rao argues, a technology gap limits the improvements that community health workers are able to achieve. Farmers are increasingly able to access big data to make critical decisions such as when to plant specific crops or transport goods to market, thereby increasing food production and/or family income. Affordable phone connections are widely available in many countries, and as early as 2012, researchers found that more people in sub-Saharan Africa had access to a cell phone than to electricity. Yet as a new decade approaches, too many of the world’s 5 million community health workers lack access to the data tools that could enable them to save lives. 

“If you are looking for big data to have a big impact,” Rao said, “one of the greatest needs is helping community health workers prevent maternal and newborn deaths…. Last year, 2.5 million children died before they were one month old.” Most of these deaths could be averted with relatively straightforward, cost-effective interventions, but far too many newborns do not receive the right care at the right time.

The Rockefeller Foundation recently announced a new initiative to improve access to data science among community health workers. Plans call for an investment of $100 million for work in 10 countries, and the foundation projects that this strengthening of the power of big data in community health care could save 6 million lives over the next decade.

Asma Lateef is director of Bread for the World Institute

Asma Lateef is director of Bread for the World Institute.

P.S. For more on climate change and four other top-priority action areas for the anti-hunger movement, see the 2019 Hunger Report, Back to Basics: How to End Hunger by 2030.

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David Kpen opens cocoa pods on his farm in Wehplay, Liberia. He is the head of the farmers association. Before ACDI-VOCA all Liberian cocoa was considered low quality. David bought a motorcycle with the cocoa profits from last year. Now he can transport h

Peace Through Agriculture

By Jordan Teague

Peace Through Agriculture, the theme of this year’s Borlaug Dialogue , one of the World Food Prize events held October 16-18 in Des Moines, Iowa, was new to me. “How can agriculture make peace?” I thought to myself. Peace – real, lasting peace – is so elusive in our world today. And while I realize that peacemaking and conflict resolution are complex, requiring many different actors and steps, I had never considered that agriculture might be one of them.

But food and nutrition are integral to being human. As the Honorable Chanthol Sun, Cambodia’s Minister of Public Works and Transport, said during the conference, “First we eat, then we do everything else.” How can agriculture, food, and nutrition be integral to peace in our world? Here are three areas where they can:

  1. Conflict prevention
  2. Building local capacity
  3. Effective and equitable response

Prevention

Dina Esposito, Vice President of Technical Leadership at Mercy Corps, noted that in Syria, most people have coped with the war using two local resources: the support of family and friends, and access to markets. It is when those systems and institutions fail that the need for external assistance and humanitarian relief begins.

Countries and communities will be much better situated to prevent crises from spiraling into further cycles of disease, death, and destruction if national and local governments make and implement plans in advance to strengthen these key local resources. What is needed are strategies that help make communities as resilient to shocks as possible, whether those shocks are related to conflict, climate change, or another factor. Once a crisis is underway, agricultural production typically decreases—but the need for nutritious food only increases. As Ambassador William Brownfield, who has served as U.S. ambassador to Chile, Venezuela, and Columbia, wisely said, “It’s a lot easier to build a food security strategy before a country has fallen into conflict!”

Local capacity

Bread for the World Institute has been advocating for stronger local capacity for several years. Strong and stable local institutions, systems that support good governance and the rule of law, and a vibrant civil society are critical to countries’ efforts to drive their own development. Strong local capacity is critical for conflict prevention, of course, but it may be even more important—and must not be forgotten—during crises or disasters. Even in situations where institutions and systems weaken or fail, it is vital to enable and equip locally-led efforts to fill essential leadership roles in ongoing work to respond to humanitarian needs and begin recovery.

Foreign assistance, while it saves many lives and can help prevent humanitarian disasters from mushrooming, is not a lasting solution for countries in conflict. Even foreigners with the best of intentions can easily misunderstand the nuances of local situations—around the world, all of these have their own histories, cultures, and languages. Foreign assistance has particularly limited capacities in recent years, when crises seem to multiply. A record number of people have been forcibly displaced (nearly 71 million, according to the latest data available).

A combination of local, national, and international actors and cooperative efforts is necessary to really make progress in many cases. Local and national actors are the ones who set the policies, sell and buy in the market, and work in the food and health systems. It is critical for local actors to be able to sustain these systems.

Effective and equitable response

Humanitarian organizations were built and designed to respond to rapid onset and rapidly resolved disasters. The world just doesn’t function that way anymore. As crises – both natural and manmade – drag on and on, seemingly turning into “permanent emergencies,” humanitarian actors find themselves unable to declare their jobs done and leave. This means that there must be a shift in approach to planning and implementing humanitarian responses.

Zemede Zewdie, Head of Programming for Catholic Relief Services in Ethiopia, explained, “We need to respond to emergencies in a sustainable way.” In a nutshell, humanitarian response should be planned with the goal of having long-term impact.  Therefore, it should support and build up markets, systems, and local actors. While saving lives is the first and foremost purpose of humanitarian aid, that is not where the responsibility ends.

As time goes on and countries at peace make more and more progress against hunger and undernutrition, the people still suffering from hunger are increasingly those living in fragile contexts.

How the global community responds to such situations must evolve if the world is to continue toward the goal of ending hunger by 2030. A renewed focus on prevention, local capacity, and effective and equitable responses is a start.

Jordan Teague is senior international policy advisor with Bread for the World Institute.

Yerzhan-Kazakhstan-Unicef.jpg (Some info about the photo) Yerzhan browses the snack section at a shop in Kazakhstan. He says his favorite sweets are the famous foreign brands. ©UNICEF/UNI209837/Karimova

UNICEF Revisits Food and Nutrition, Finding a World of Difference

By Todd Post

The State of the World’s Children is the annual publication of the United Nations Children’s Fund, better known as UNICEF. The 2019 report, released to complement World Food Day, October 16, focuses on food and nutrition. The last time UNICEF published The State of the World’s Children with this focus was 30 years ago. A lot has changed since then. 
 
What’s so different? Thirty years ago, it was insufficient calories— hunger—that dominated priorities and programs in the field of child nutrition. Micronutrient deficiencies, often called “hidden hunger,” and their impacts on children’s health and growth received little attention. Childhood obesity received no attention at all. 

In the years since the last UNICEF report on nutrition, there has been progress on hunger in terms of both calorie deficiencies and micronutrient deficiencies. But much more remains to be done. The global rate of stunting—the result of chronic malnutrition in early childhood that causes lifelong damage to survivors’ health and development—was still almost 22 percent in 2018. Wasting is an acute form of malnutrition that leaves children weighing far too little for their height and puts the lives of many in immediate danger. The State of the World’s Children reports that “at least one in three children under 5 is undernourished or overweight, and one in two suffers from hidden hunger.” 

As the Institute reported in the 2019 Hunger Report, Back to Basics: Ending Hunger by 2030, stunting and wasting combined are implicated in 2 million deaths of children under 5 every year. The world must make faster progress toward sharply reducing preventable child deaths and meeting the Sustainable Development Goal of ending hunger and all forms of malnutrition by 2030. 

Adding a new layer of complexity to the problems of undernutrition and hidden hunger, overweight and obesity are on the rise in children around the world. Hidden hunger and obesity can, and frequently do, affect the very same children. Between 2000 and 2016, the proportion of overweight children ages 5 to 19 increased from 1 in 10 to almost 1 in 5. The main reason is the mass introduction of ultra-processed food and sugar-sweetened beverages. There isn’t a country in the world, or any region of a country, where these foods aren’t to be found.

Another major change from 30 years ago is that research and experience have led to a much better understanding of nutrition.  The Lancet series in 2008 showed that good nutrition in early childhood, particularly during the 1,000-day window between pregnancy and age 2, is fundamentally important to living a healthy, productive life. The research also emphasized the importance of good nutrition for adolescent girls and young women as well as for pregnant women. 

Economists have used the new nutrition knowledge to make a compelling case for ensuring that pregnant women, babies, and toddlers get the nutrients they need. The initial investment pays for itself many times over. The reverse is also true: some countries in sub-Saharan Africa and South Asia, the regions with the highest burden of child hunger and malnutrition, are sacrificing up to 11 percent of their gross domestic product to the effects of malnutrition. Government officials came to the realization that their countries could not afford not to tackle the problem.

Government leaders in countries with high burdens of malnutrition helped create the Scaling Up Nutrition (SUN) movement in 2010. SUN currently has 60 member countries, all of whom have high rates of malnutrition and are committed to bringing those rates down. The approach is for governments, the private sector, civil society organizations, families affected by malnutrition, donors, and multilateral organizations to come together in joint efforts to scale up proven strategies to improve nutrition. Bread for the World Institute has been an active supporter of civil society groups in their efforts to establish SUN’s civil society network. Institute director Asma Lateef serves on the SUN Executive Committee.

There is no magic overnight solution to global nutrition problems, but UNICEF emphasizes that food systems that deliver nutritious, safe, affordable, and sustainable diets for all children are the common responsibility of the adults in charge. Food systems need to be reshaped, from simply feeding people to nourishing people.

Todd Post is senior researcher, writer, and editor with Bread for the World Institute.

School lunch staff and students enjoy the new menu at the Yorkshire Elementary School in Manassas, VA., on Friday, September 7, 2012. USDA photo/Lance Cheung

New Opportunities for Better Student Nutrition

By Michele Learner

In the United States, the age group most at risk of living in poverty is children under 18. For many years, Bread for the World and Bread for the World Institute have urged decision makers to strengthen school meal programs, out-of-school programs such as the Summer Meal Program and extra summer EBT benefits for families with school-age children, and the linkages among the various nutrition programs for children and teenagers. 

On average, states require 180 days of school instruction annually, or not quite half the 365 calendar days. Most children who participate in free or reduced-price school meals receive lunch. Although the number eating breakfast at school is on the rise, far fewer students are reached. Summer, weekends, and holiday breaks present their own challenges for low-income families.

Still another issue, of course, is that children need to eat more than lunch, and more than breakfast and lunch. A decade ago, Bread members helped secure passage of the Healthy, Hunger-Free Kids Act of 2010. Its provisions included a step toward providing children with the nutritious food they need later in the day. For the first time, states were allowed to use federal funding to provide supper for children from food-insecure families.

After-school supper programs have grown significantly since then. An assessment of progress, After-School Suppers: A Snapshot of Participation, was published in October 2019 by the nonprofit Food Resource and Action Center (FRAC).  The report had some encouraging findings:  On an average day in October 2018, after-school nutrition programs provided suppers to 1.3 million children, a 10.4 percent increase from October 2017. Moreover, 34 states increased their rates of participation, of which 25 of these raised participation by more than 10 percent. North Dakota and Maine each more than doubled the number of students provided with supper by federal nutrition programs.

Still, the program has a long way to go to meet the needs.  For every 16 children who qualify for and receive free school lunch, only one receives after-school supper.

Kentucky is one of the states that has increased the number of suppers it serves. Some of the children who eat a meal after school would otherwise not eat until the next day, said Cindy Whitt, food service director of Kentucky’s Fairview school district. “One little boy said he is glad we have this food because there just isn’t that much food at his house,” she added. To boost the nutrients available to kids whose families can afford only foods that are less expensive but also less nutritious, the Fairview district always offers salads and bite-sized fresh fruit and vegetables .

The FRAC report identifies several strategies to help improve access to supper for children who receive free lunch. One is to increase the number of spots in after-school enrichment programs that are available and affordable for low-income families; there is currently a significant shortage. Another is to work with existing after-school programs that are eligible to be reimbursed for supper but do not yet offer the meals, providing information about the program and helping directors overcome any barriers to enrolling as participating sites. A third approach is to seek to expand the categories of programs that are allowed to serve supper and receive reimbursement from federal nutrition funds—for example, programs offered by the YMCA, YWCA, or Boys and Girls Clubs.

FRAC proposes a near-term goal for states: raising participation to 16 students eating supper for every 100 who are served free lunch. While meeting this threshold clearly will not close the gap between access to lunch and access to supper, the report argues that the goal requires significant progress while still being achievable. Only one jurisdiction, the District of Columbia, currently serves this proportion of students, with just over 22 children eating supper for every 100 who qualify for free lunch. The state that comes closest as of October 2018 is California, with almost 14 students eating supper for every 100 who eat lunch.

Michele Learner is associate editor with Bread for the World Institute.

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