Institute Insights: September 2020


The Humanitarian and Development Partnership Team in the Central African Republic (HDPTCAR)

From the Director

In the past couple of years, “resilience” has become something of a buzzword. The concept is certainly not new—people have always confronted circumstances beyond their control. “Bouncing back” from disasters and tragedies of all kinds is simply what people have to do.

The past several months have offered even more evidence than usual that resilience—and support for building it—are essential. The COVID-19 pandemic, a global economic crisis as a result of the pandemic, armed conflict, and natural disasters are just some of today’s urgent global problems.

With the nebulous quality of “resilience” in such high demand, individuals and organizations ranging from anti-hunger advocates to the governments of developing countries are now looking more closely at how to create it. What types of structures and systems can help boost resilience, now and in the near future?

This issue of Institute Insights offers some thoughts on strengthening systems for more resilient communities and nations. Topics include: the systems breakdowns now threatening the lives of millions of young children; progress on child survival over the longer term; changes needed in the food system to slow climate change; and “resilience in action” in Lebanon.

In the midst of all the heartbreak this year, the world got a significant piece of good news: Africa has eliminated wild polio. Africa was certified wild polio-free in August 2020 after all 47 countries in the WHO Africa region had gone four consecutive years without a case. Coordination and leadership from both national governments and global donors were cited as critical to success.

“Ending wild polio virus in Africa is one of the greatest public health achievements of our time,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “I thank and congratulate the governments, health workers, community volunteers, traditional and religious leaders, and parents across the region who have worked together to kick wild polio out of Africa.”

In addition to being welcome news of progress against a devastating illness, the polio effort is a timely and welcome reminder that people can accomplish a great deal in a short time. Before a vaccine became available, polio killed or caused lifelong disabilities in hundreds of thousands of U.S. children every year. By 1988, when a worldwide polio eradication initiative began, the disease was still causing paralysis in 1,000 children per day. Since then, more than 20 million volunteers have immunized more than 2.5 billion children. The number of cases of polio worldwide has dropped by 99 percent since 1988. Five of six WHO regions are now free of wild polio.

This public health victory reinforces the importance of strong social protection programs—such as the healthcare systems that made it possible to vaccinate 2.5 billion children. The responsibility of meeting the needs of people who cannot care for themselves is at the heart of what it means to live in a community. It would be hard to find anyone who openly disagrees with this sentiment, yet social protection is often not a top priority where it counts most—in national budgets.

Bread for the World continues to call for sufficient resources for social protection. Programs that meet basic needs—such as SNAP in the United States or treatment for Severe Acute Malnutrition in developing countries—are effective but simply do not have enough funding to serve all those in need in the wake of the COVID-19 pandemic.

As we mentioned in May, U.S. mothers of children under 12 reported shocking levels of hunger and food insecurity as COVID-19 spread nationwide. Many but not all children in need are now being reached because congressional pandemic relief bills that included resources to expand social protections have gone into effect. Some nutrition programs are new, such as SNAP-Pandemic, while others, such as school meals programs, have been adapted and scaled up.

Bread for the World remains alarmed about the millions of young children in countries with few resources whose lives are literally at stake. Researchers project a surge of deaths related to malnutrition over the next several months among children younger than 5. These deaths are an “unintended consequence” of lockdowns and other restrictions that are intended to slow transmission of the virus, but also disrupt vital nutrition and healthcare services for the most vulnerable people in society—pregnant women, babies, and toddlers.

There will always be emergencies, but the world is capable of planning ahead and avoiding much of the tragedy we have all seen this year.

Asma Lateef is director of Bread for the World Institute

Asma Lateef is director of Bread for the World Institute.

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Nutrition Rehabilitation Home in Dhangadhi, Nepal. Laura Elizabeth Pohl for Bread for the World

Malnutrition: All Systems Failed

By Jordan Teague

A malnourished child is a child that we, as the global community, have failed. In 2020, with all our medical and technological advancements, it is unconscionable that millions of children would still be unable to access the basic nutrients they need to live healthy lives. But it is their reality. Hundreds of millions of children – most of whom live in formerly colonized countries – face the effects of malnutrition. Humanity has failed in every way when children’s lives literally depend on where they were born.

Nutrition is deeply embedded in society, which means that many complex economic and social arrangements need to work together to prevent malnutrition. Inadequate healthcare services, lack of access to healthy diets, poverty, and gender inequity are among the most important symptoms of breakdown in “systems” such as the food system, the healthcare system, economic policy, and social protection programs.  The result is high rates of childhood malnutrition.

A food system has two “jobs”: to provide an income to farmers and other workers in the food chain, and to provide access to affordable, healthy diets to all people. Malnutrition is a failure of the food system to make nutritious foods available at prices that all communities can afford.

It is encouraging that the global community has done a good job of taking the first step—ensuring that all people can get enough calories to survive. The food price crisis of 2008 was the motivation for some of the changes needed to make this happen. But there is a long way to go to ensure that farmers can produce healthy foods for a profit, the food supply chain can ensure their safe delivery to markets, and all families can afford those foods.  

Healthcare systems should be set up to deliver essential services that prevent malnutrition and to promptly treat people who develop it. One major barrier to accomplishing this is lack of physical access to health services.

Many people in rural communities must travel long distances to reach any doctor or clinic, and many communities lack transportation options and passable roads. Malnutrition means that the health system has failed to reach everyone with the powerful, effective, and cost-effective nutrition services that are available to part of the global population.

It is not surprising that in any country, children from lower-income families, especially those living in extreme poverty, are at far greater risk of acute malnutrition than children from the wealthiest families. Social protection or safety net programs should be available to all families that need them, and they should enable participants to afford essential health services and quality foods. Malnutrition is associated with poverty, and the global trend is one of rising inequality. Until recently, many countries did not have social protection programs in place, and thus far, global and national economic structures are not correcting for the vast inequalities between and within countries. Malnutrition is a failure of the economic system and social protection programs to ensure that all people have their basic needs met.

Because malnutrition is a result of inequitable and unjust structures and systems, ending it depends on identifying clearly and in detail how and why systems are failing. We must ask ourselves, why is it that the continents of Africa and Asia bear the highest burdens of malnutrition? Why is it that most malnourished children live in rural areas and/or live in extreme poverty?

Most importantly, of course, we must ask ourselves, what shall we do to bring about the needed improvements? Resources to strengthen failing systems are essential. The United States can help by leading the effort to fully fund essential global nutrition services and by contributing to initiatives aimed at ensuring that food, health, and social protection systems are set up to deliver good nutrition to everyone. But beyond this, humanity must find solutions to economic and social inequities, because malnutrition reflects such inequities and cannot be overcome while they persist.

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

Jorge Ibanez on Unsplash

The Milestone of Turning 5

By Michele Learner

Recently I came across an article from 2018 whose title caught my eye: "The world is much better. The world is awful. The world can be much better." The author, economist Max Roser, began by noting that all three statements are true. It all depends on frame of reference—in this case, whether one focuses mainly on the past, the present, or the present and near future.

This year has supplied far too much evidence for “the world is awful.” For the past several months, Bread for the World Institute has been drawing attention to the danger of a malnutrition pandemic as the result of the COVID-19 pandemic. Millions of young children are at risk of death or lifelong damage to their health and development because of malnutrition during the critical “1,000 Days” nutrition window between pregnancy and the second birthday. The numbers are far higher this year in part because nutrition and healthcare services have been disrupted by the lockdowns and other measures that were adopted seeking to contain the virus.

Taking a longer-term view, however, brings us to “the world is much better.” As recently as 1800, 43 percent of all children born, no matter where they lived, did not live to celebrate turning 5. If the world had not made immense progress over multiple generations, we would be seeing 60 million children die of preventable causes every year. The actual number, 5.4 million, is not something to be proud of, but it can fairly be described as “much better” than 60 million.

Lack of access to nutritious food and healthcare services—whether the reason is that travel to a clinic or market is forbidden, food and medicine are unaffordable because the economic crisis has destroyed a family’s livelihood, or a combination of these and other problems—can easily cost lives. A deadly disease that illustrates how this happens is measles.

The global progress against measles since 2000 is impressive. In the period 2000-2014 alone, deaths from measles fell by 79 percent. WHO estimated that 17.1 million lives were saved during this time period, solely because of expanded access to the vaccine against measles.

The flip side of this is, of course, that when children do not have access to vaccinations at the right time, as happens during a lockdown, they are at far higher risk of death from a common, highly infectious illness such as measles. Making the matter worse, children who are severely malnourished die from so-called childhood diseases at nine times the rate of well-nourished children. Shortages in the food supply have been caused by many facets of the pandemic—such as farmers forced to stay in their homes rather than work in their fields. The result is that for many families, nutritious foods are simply less available and less affordable.

But there is reason for hope. There has been rapid progress in even the most difficult contexts, so it is not difficult to imagine the world moving rather quickly from an “awful” to a “much better” rate of preventable child death. The countries with the highest child mortality rates in 2017 were Somalia, Chad, and the Central African Republic (CAR). There is still a long way to go, but  each of these three countries had reduced its mortality rate by 27 percent since 2005.

The other good news in these statistics is that the goalposts have been moved: the highest mortality rate was 45 percent lower in 2017 than it was in 2000. That year Sierra Leone had the highest rate—an estimated 233 deaths per 1,000 live births. Somalia’s rate in 2017 was 127 deaths per 1,000 live births. As John McArthur and Krista Rasmussen with the Brookings Institution point out, these results translate to "a 3.5 percent average annual rate of improvement in the world’s worst-case situation for child mortality.” Also, in the meantime, Sierra Leone reduced its mortality rate from 233 to 111 deaths per 1,000 live births.

What would child mortality numbers be in an equitable world? The lowest national rates hover around  0.41 percent, or one child in 250, compared to today’s global average of 3.9 percent. If every child lived in a country doing as well as the best are doing now, there would be 577,000 deaths annually rather than 5.4 million. Put another way, global equity in life opportunities could save the lives of 4.8 million babies, toddlers, and preschool-age children every year. That would, without question, make the world “much better.”

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

Jed Owen on Unsplash

Climate Change: One Major Cause Is Food System Emissions

By Todd Post

In the 2020 Hunger Report, Bread for the World Institute focused on food systems. The report had much to say about climate change—an entire chapter—because food systems produce significant levels of greenhouse gas emissions. The report defines food systems to include not only growing food, but processing and packaging it, and disposing of food waste as well. This process, the essential task of supplying food to people, emits more of the gases that cause climate change than all of the vehicles in the transportation sector combined—cars, trucks, ships, and aircraft.

Transportation is evolving quickly to become less dependent on fossil fuels. By 2050, it’s conceivable that most of the world’s transportation systems will be powered by clean energy. But as long as food system emissions continue to rise, the world will continue to be headed toward catastrophic levels of climate change. By about that same point in the middle of the century, food systems are projected to produce half of all greenhouse gas emissions.

Carbon dioxide, methane, and nitrous oxide are the primary emissions produced in food systems. Based on estimated carbon dioxide levels by 2050, an additional 290 million people could face malnutrition, virtually all of them residents of low- and middle-income countries. We hear less about methane, produced by livestock, and nitrous oxide, produced by fertilizers and manure—but despite their relative obscurity, both methane and nitrous oxide have much higher global warming potential than carbon dioxide.

The United Nations Framework Convention on Climate Change (UNFCC) is the forum that produced the landmark 2015 Paris Climate Accord, which brings nearly every country together to work toward the goal of limiting global temperature rise to no more than 1.5° C above preindustrial levels. The UNFCC has mostly been silent on the topic of food system emissions. That is beginning to change, however, as high-profile international organizations such as the International Monetary Fund (IMF) call more attention to the need for food system reform.

Farmers are clearly important stakeholders and change agents in reducing emissions from the food system. U.S. farmers are pivotal, because the U.S. agricultural sector has a huge climate footprint. Setting aside for a moment the rest of the food system, agriculture alone is responsible for about 10 percent of total annual U.S. greenhouses gas emissions. I’ve heard that figure used in an attempt to dismiss concerns about emissions in the agricultural sector as exaggerated, but “just” 10 percent of U.S. emissions is an enormous amount—more than most countries produce in all sectors combined. Put another way, only a handful of other countries produce more emissions total than the U.S. agriculture sector does by itself.

The corn belt in the Midwest is ground zero for emissions in the agricultural sector. Iowa farmer Matt Russell, the executive director of Iowa Interfaith Power and Light, would at first seem to be an unlikely change agent. In a state where it is common for farmers to measure their acreage by the thousands, Russell and his husband farm just 110 acres, much of it dedicated to pasture, where they raise produce and grass-fed cattle. But Russell’s influence is not measured in acreage.

One sign of Russell’s gravitas is the fact that every Democratic presidential primary candidate who campaigned in Iowa asked to meet with him to discuss farming and climate change. That’s because in addition to his embrace of regenerative agriculture, and its potential to help slow climate change, he has a talent for bringing farmers together for frank discussions about the struggles they face in dealing with the effects of climate change.

Russell is not trying to convince other farmers to give up raising corn and soybeans in favor of broccoli. For farmers everywhere, the common ground, so to speak, is soil health. Regenerative agriculture helps reverse climate change because, rather than plowing up soil and allowing carbon to escape into the atmosphere and trap heat as carbon dioxide, it allows carbon to be stored in the soils. But today’s U.S. farm policies don’t offer farmers much reward for soil conservation. More farmers would adopt regenerative practices, say Russell and others, if federal policies offered them more incentives.

Later this month, Bread for the World Institute will host its second in our webinar series on the 2020 Hunger Report. We’ll hear directly from Matt Russell, along with Dr. Jessica Fanzo, professor of global food and agricultural policy at Johns Hopkins, and Huguette Sepke, program director for Benin and Togo with CARE International. We’ll examine the relationship between hunger, nutrition, and climate change. It promises to be as engaging as our earlier webinar to launch the 2020 report, so you won’t want to miss it.

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

Scenes of destruction at the port area due to the massive explosion that tore through Beirut, Lebanon. ©UNICEF

Lebanon: The Concept of “Resilience” Is Put to the Test

By Rahma Sohail

The Lebanese people are resilient above all else. In the past 40 years, they have survived years of war, decades of Syrian occupation, Israeli invasions and bombings, a revolution, and several economic and financial crises. In the past year alone, the Lebanese currency has lost 80 percent of its value against the U.S. dollar, protests against corruption in government toppled a prime minister, a massive explosion at a warehouse in the capital city of Beirut leveled the port and destroyed much of the surrounding city, and the entire Lebanese cabinet, including the country’s second prime minister in 12 months, resigned after the August 4 explosions. While some people have simply had enough, many others are unwilling to give up on their country. According to the residents of Beirut, the true spirit of the Lebanese people can be seen in the wake of the concurrent crises—their resilience and their hope for a better future for themselves and their country.

The most recent catastrophe literally rocked the city. A Lebanese reporter said the two explosions at the Port of Beirut “felt like an earthquake and an air raid wrapped into one.” Almost 3,000 tons of ammonium nitrate had caught fire. The resulting explosions decimated whole neighborhoods and the country’s main port. According to the U.S. Agency for International Development (USAID), as of August 13 the blasts had caused 178 deaths, injured 6,000 people, left 300,000 people homeless, and caused between $10 billion and $15 billion in damage. The explosions at the port also destroyed a majority of the country’s wheat stores. Lebanon is a country whose middle class is slowly sliding into poverty, and the catastrophe has pushed people even closer to the edge.

In the wake of the blasts, however, it was not the Lebanese government that stepped up to help its citizens, but the residents of Beirut themselves who stepped up, or rather, out—out of their shattered homes to help their neighbors take stock and clean up. Thousands of volunteers, ranging in age from teenagers to people in their 30s, are putting Beirut’s neighborhoods back together and keeping the streets swept.

Even those who have lost hope that their country will free itself from a corrupt ruling elite and finally build a prosperous economy remain active. They rise day after day to help rebuild and to protest government inaction, corruption, and incompetence. Lebanese youth are leading recovery efforts for their city—crowdfunding for construction materials, volunteering their own skills (including construction) and time, and setting up sites to coordinate food donations and distributions to feed tens of thousands of people who have suddenly become destitute.

While the people of Lebanon work to rebuild their homes and their lives, the international community is also mobilizing to help the country begin to function more normally and to reduce the impact of the compounding crises on the most vulnerable members of society. The United Nations World Food Program (WFP) is on track to deliver more than 30,000 metric tons of wheat to Beirut and distribute 5,000 food packages to families most in need.

The WFP is also working to restore enough functionality to the Port of Beirut to be able to receive the food aid arriving in the country. Lebanon normally imports 85 percent of its food, much of it through this crucial port. While the U.S. government has announced $15.1 million in emergency aid to Beirut  through USAID, there is still much more to be done to aid a country struggling with an economy in free fall while many of its own people, as well as people from what is one of the largest refugee populations in the world, face a food crisis. Beirut is seeing a resurgence of coronavirus cases at a time where three major hospitals have suffered significant damage, and the explosions have also exacerbated other existing problems such as gender-based violence and lack of adequate care for pregnant women. Multiple UN agencies have issued funding appeals, including the U.N. High Commissioner for Refugees (UNHCR), the U.N. Population Fund (UNFPA), and WFP.

All available resources are urgently needed not only to meet survivors’ basic needs now, but to enable and equip Lebanon to establish or strengthen critical components of resilience, such as livelihoods that are viable in the current context as well as key elements of social protection, including health care and nutrition services.

Rahma Sohail is the 2020 Crook Fellow with Bread for the World Institute. 

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