The title of this blog may seem strange to some. The World Bank has made some very important intellectual and policy contributions to nutrition over the years, from Alan Berg to Judy McGuire, Harold Alderman, Meera Shekar and Leslie Elder. But it feels, to me at least, as if nutrition is not quite the priority it should be at present within the Bank.
If true, this lack of focus comes at a bad time. The SDGs are being set in quick drying concrete and there is only a month or so to affect the contours. The Spring meetings of the Bank/IMF might be the last throw of the dice to embed nutrition more firmly within the post 2015 framework.
So what am I basing this concern on? Admittedly as an outsider my evidence base is thin. I have to rely on the following pieces of “evidence”: (1) of 71 World Bank Press Releases in February 2015, only one was on nutrition, (2) out of 925 Topics in the Open Knowledge Repository of publications only 1 Topic heading is on nutrition (“Nutrition and Population”). Within the 232 publications in that Topic heading I could only find 23 that were actually on nutrition (under and overnutrition), and (3) the crudest of all measures, a Google search on “Jim Kim nutrition”, does not exactly turn up a treasure trove of statements (try it).
Words and publications are nice but surely, you say, money talks. Well, data provided by the Bank to the Global Nutrition Report shows that its commitments to direct nutrition programmes (“nutrition specific” interventions in the jargon) have increased dramatically between 2010 and 2012, from $55 million to $248 million. Commitments to indirect programmes (known as “nutrition sensitive” interventions, such as certain types of agriculture, cash transfer programmes and water and sanitation programmes) were estimated to be about $2 billion in 2010 and $1 billion in 2012 (the commitments are lumpy by nature, being large and multiyear). Nevertheless, in 2012 the World Bank was the second largest provider of ODA to nutrition, after the US Government.
So what am I complaining about? Well, the financial picture is far from clear—disbursement figures are lower than commitment figures and hard to interpret, for example. But my main plea is not about money, it is about ideas.
I want the Bank to become an intellectual leader in nutrition once again.
This is important because the Bank is the leading shaper of development thinking and nutrition is the quintessential post 2015 sustainable development issue. Consider the following 3 features of a post 2015 development issue: (a) it affects nearly all countries, (b) it affects intergenerational equity and (c) it is best addressed through collective action. Nutrition has all three features. On the first, the Global Nutrition Report finds that nearly every country has a serious public health problem with nutrition. On the second, we know that malnourished mothers are more likely to give birth to malnourished babies, and that they are more at risk of growing up to be malnourished adults and, if women, the cycle continues. Finally, because there are so many sectors involved in the production of good nutrition, all stakeholders have to work in harmony and sometimes collectively (as in the Scaling Up Nutrition movement). Even at the level of nations, international standards on healthy diets will do more to drive the food system towards good health for people (and for the planet) than national standards alone.
To this the Bank might say, hey, all we really care about is eliminating extreme poverty. Now extreme poverty is pretty sensitive to increases in GDP per capita. But stunting, the preferred measure of chronic malnutrition, is much less so. And yet it is hard to think of a more complete, if grisly, composite indicator of deprivation than the height of a child for its age. Every insult in the area of food, care, infection and neglect is captured and accumulated in a kind of negative rate of return, observed as height, which is a mere marker for the things we really care about: mortality and neurological and cognitive development. Society needs to make it easier for parents to make the right choices for their babies and infants. Stunting should be the indispensable complement to money metric poverty. If both of these can be eliminated we have conquered poverty today and tomorrow.
So nutrition needs the Bank to re-energise its interest in nutrition. The Bank is the premier development institution and nutrition is a key development issue. The Bank can help to make development decision-makers recognize that. But perhaps equally importantly, the Bank needs nutrition: to ensure that when poverty rates decline, they do so for this and for the next generation.