To ask Her Majesty’s Government what consideration they have given to formulating their pledge at the Tokyo Nutrition for Growth 2020 summit, and what they are doing to build commitments from other countries.
My Lords, I declare an interest as co-chair of the APPG on Nutrition for Growth. Nutrition is so foundational to human life that it intersects with almost all aspects of development policy and is therefore fundamental in delivering on the SDGs.
Unless a child has adequate nutrition, they will be unable to meet their potential in school and are more susceptible to disease. Malnutrition disproportionately affects women and girls, preventing many girls from attending school and hindering the potential of those who do. So, as welcome as it is, the Government’s objective to ensure 12 years of quality education for every girl will not be met unless we equally support nutrition. Nutrition has implications for a child’s employment prospects and therefore the economic success of their country. Good nutrition also relies on food and agriculture systems that deliver healthy diverse diets at a cost that people can afford. It is estimated that undernutrition in childhood reduces an individual’s earning potential by 10% and has the same impact on GDP rates, with a total global economic cost of $3.5 trillion.
I am sure that one area that many of the noble Lords who are speaking in this debate will focus on is climate change. Last year the UK committed £61 million to support drought-resistant crops that can withstand high temperatures, with the intention of preventing food insecurity because of climate change. While tackling food insecurity is important, unless the crops contribute to a diverse and nutritious diet, the Government will miss a gaping opportunity to really improve people’s health rather than simply keep them alive. Climate change adversely impacts food systems, but food systems also emit 20% to 30% of global greenhouse gas emissions. So how are we supporting the development of climate-smart as well as nutrition-sensitive food and agricultural systems?
The question tonight is about the Tokyo summit that will take place in December. The first summit in 2013, hosted by the UK, mobilised around £17 billion in new investments, and the UK contributed £1.25 billion. Since 2013 the number of children whose physical or cognitive growth is stunted by malnutrition has reduced by over 12 million. However, despite progress, nutrition remains one of the most pressing issues in global development. In 2018 5.3 million children under the age of five died, with undernutrition a key cause of nearly half those deaths. Some 149 million children under the age of five were stunted due to malnutrition, meaning that they will be more susceptible to illness throughout their life and unlikely to meet their educational and economic potential, as I have highlighted.
If progress is to continue, it is vital that the UK once again provides the lead at Tokyo by taking steps to better embed nutrition into UK aid’s portfolio and pledging funds at least to the same level as has been the case since 2013, or ideally making an uplift. I hope the Minister will be able to give us some positive news on the pledge, if not on the amount then at least on the timing of when a decision will be made. The springboard event in July that precedes the summit would be the ideal time to commit. A UK commitment of £800 million a year for 2021 to 2025 would represent a small increase reflecting inflation, the UK’s economic growth and the global shortfall in funding for nutrition. By taking such an early lead, we can encourage others to contribute. Other positive steps would be to ensure high-level ministerial attendance at the summit, drafting ambitious policy commitments, considering a match-funding scheme and co-financing and supporting the implementation of countries’ national nutrition plans. Is the Minster able to say tonight who will attend for the Government at both the July event and the December summit? It is vital that the Government take this seriously, since of course I know there are other commitments.
My Lords, I thank the noble Lord, Lord Collins, for securing this important debate this evening. I strongly suspect that there will be considerable agreement with what he just said from across the House. I certainly agree with him.
Malnutrition is the main driver of illness and poor human potential worldwide and the UK has been a leader in taking action against it. We have to admit that while asking for more, as we always do. Action on nutrition is one of the most cost-effective things we can do to help us achieve the sustainable development goals and to maximise the potential of the global population. Value for money is £16 for every £1 spent on nutrition. As it happens, such action is closely linked to the other global crisis, climate change: improve one and you beneficially affect the other. The scale of the problem is enormous, as we have heard, with over 20% of children stunted and unable to reach their education potential, and very susceptible to illness.
It is, of course, children who suffer most because of their vulnerability, but it is also girls and women who are particularly susceptible to anaemia and consequently give birth to underweight babies, thereby perpetuating the problem. We have long known that if you support a woman’s health, you benefit a family, and this is a cost-effective way of benefiting the economy of fragile countries. However, we must not forget malnutrition in older people who are more likely to lack the finance necessary to feed themselves properly and who often lack influence in their community, so get forgotten. I am told that one in three older people in hospital in this country is malnourished.
It is tempting to think that malnutrition is something that happens somewhere else and is the responsibility only of the contributions of DfID. However, malnutrition includes undernutrition, shortage of micronutrients and obesity; one in three children globally suffers from one of these three, including here in the UK. Actually, I strongly suspect that it would be a good deal worse if it were not for the existence of food banks, the wonderful school breakfast initiative, the nutrient standards of school meals and the availability of free school meals. I congratulate those local authorities that ensure that children on FSM also get fed during the holidays. Although the main focus of this debate is the Government’s pledges at the Tokyo Nutrition for Growth summit, what action are they taking to address child and elder malnutrition, in all its forms, in the UK?
My Lords, I thank the noble Lord, Lord Collins, for securing this timely and important debate. As the House is aware, we have spoken about nutrition on two recent occasions in this Chamber. The first was in the context of taking an integrated approach to UK foreign policy and development; the second was about weaving nutrition across DfID’s portfolio. I will continue on that theme, but it is the intersectional and foundational nature of nutrition that makes it so important.
I will start by talking about Gavi, the vaccine alliance, which is hosting its replenishment conference in London in June this year. Gavi aims to raise $7.4 billion from international donors to immunise an additional 300 million people between 2021 and 2025, saving up to 8 million lives. UK civil society organisations are calling for Her Majesty’s Government to retain or increase their share of Gavi funding, which is roughly 25%. I support that ask. Ensuring full coverage of all WHO-recommended vaccines will make the world a safer and more prosperous place.
However, if the UK is to spend such a large amount of money on vaccinations, it is only right that steps are taken to ensure that investment is as impactful as possible. It is well known that malnutrition reduces the efficacy of vaccines. While some vaccines may still work on a malnourished child, the timing, quality and duration of responses may be impaired. Likewise, malnutrition is often caused by vaccine-preventable diseases; additionally, malnourished people are far more likely to die from these. In short, vaccinations and nutrition are two sides of the same coin.
To accelerate action on ending preventable deaths and improving people’s health and economic prospects, the Government must invest ambitiously in Gavi, but also at N4G. In addition, they should take steps to align their objectives in both areas and across health more broadly. On that point, what steps is my noble friend the Minister taking to ensure that ready-to-use, therapeutic foods and other nutrition services are included in DfID’s wider efforts to build effective health systems? What consideration will her department’s N4G pledge give to the strategy of Gavi and other health multilaterals, in order to align objectives?
My Lords, I, too, welcome this timely debate. I thank the noble Lord, Lord Collins, and welcome the opportunity offered by the Tokyo Nutrition for Growth Summit.
It is moving to note, as other noble Lords have mentioned, that the number of people suffering from hunger has been increasing since 2015, albeit slowly. We know that behind the statistics lie terrible and moving stories of human suffering, disease and death, especially across Asia and sub-Saharan Africa. It is sobering to ponder on the one hand the challenge of providing a sustainable diet and preventing the lifelong consequences of malnutrition and, on the other, the striking rise in obesity across the world and consequent health problems.
Seven years ago, the UK Government exercised global leadership through the first Nutrition for Growth conference and have delivered on many of the pledges made there. I support strongly the calls made by other noble Lords in this debate for a renewal of that leadership at the Tokyo summit, for a strong United Kingdom delegation and for a generous pledge of £800 million per annum for nutrition between 2021 and 2025.
The Tokyo summit will take place just a few weeks after the key COP 26 in Glasgow, which the UK Government will host and chair. Short-term interventions to combat malnutrition are vital, but the world must also engage, as noble Lords have pointed out, with the long-term multiple linkages between poor nutrition and climate change.
Climate change is already having a negative impact on the four pillars of food security: availability, access, usage and stability. The climate emergency means that the world needs to increase spending on nutrition adaption and mitigation just to see the statistics stand still.
We see across the world the impact of extreme weather-related disasters, which have more than doubled in number since 1990. More than 70% of agriculture is rain-fed. This directly affects the ability of drought-affected countries to grow their own food, as we see currently in sub-Saharan Africa and elsewhere. Agricultural land will be lost to rising sea levels, fires and flooding.
My Lords, I too thank my noble friend Lord Collins for instigating this debate and for the invaluable work he and others are doing in the APPG. He and other speakers have made very important points in this debate and I fear that the Minister should prepare herself to hear us all singing from the same hymn sheet—perhaps she will be minded to join in. I am also grateful to Results for its excellent briefing and for the work it is doing in the coalition.
The juxtaposition in Japan of the Nutrition for Growth summit and the beginning of the Olympic Games can have escaped no one. On display in Japan will be thousands of the elite of the elite—Olympians who spend their lives working on strict nutritional regimes to ensure that they are in peak fitness. But these Games will take place when the world will be discussing truly appalling figures of malnutrition and obesity and when the effects of climate change are becoming ever more visible.
One in three children globally suffers from one or more forms of the triple burden of malnutrition, undernutrition and obesity. The effects on children under five will be a defining factor of how they live the rest of their lives. Not only will their health suffer but the effects on their future earning potential will be reduced, with consequences for themselves as well as the societies they live in. Income and wealth inequalities are closely associated with undernutrition, with more complex patterns associated with obesity.
I pay tribute to the work of DfID and the British Government, alongside Japan and Brazil, in appreciating the scale of the problem and mobilising support in 2013 from other countries to pledge money and action to deal with this issue. I am sure that the Minister shares this view, but it would be disastrous if DfID were absorbed into the Foreign Office or if there were not a dedicated Secretary of State sitting at the Cabinet table making the case for the important development role that Britain should play across the globe. DfID was created in 1997 by the incoming Labour Government to give a voice to the voiceless at the highest level, and that is as relevant today as it was then.
My Lords, I totally welcome the opportunity to speak in this important debate and thank the noble Lord, Lord Collins, for bringing it to the House.
When I was a DfID Minister I visited Zambia, and one day visited one of our projects where we had special practitioners talking to teenage girls about the challenges they faced, including lack of knowledge about their own bodies, contraception and sex—because their mothers never talked to them about such things—and violence against women. On leaving, I remarked to one of my private secretaries that I was rather surprised that such young children had been invited to the session—children aged six, seven and eight. She looked at me and said, “Minister, there was no one there under 12. Those girls are stunted.” That was my first experience of seeing the damage that nutritional deficit wreaks. Stunting affects brain development, making it difficult to learn or do well at school, which obviously has a knock-on effect on future life chances. In west and central Africa, the number of stunted children increased by 20% between 2000 and 2016.
The very first trip I made as a DfID Minister was to South Sudan, just after it had separated and things looked good—they have gone downhill ever since. I went to the refugee camps on the borders of Blue Nile and Kordofan, where I saw for the first time not just the sheer challenges of a refugee camp in the rainy season, but babies and toddlers being kept alive on Plumpy’nut. It was my introduction to a world where all the things we take for granted, such as food, clean water, shelter, health systems and successful agriculture just do not exist—and they do not exist in huge swathes of Africa and Asia.
DfID and governmental and NGO partners across the world were tackling—or trying to tackle—deprivation and poverty, in continents where disease, climate change, conflict, corruption and sheer poverty meant that none of these things was yet at a standard that could prevent child deaths. Lack of water, markets and a health system, and inaccessibility—there are so many factors to overcome. But the world can and must continue to fund this endeavour. International events such as the coming Tokyo Nutrition for Growth Summit are vital in so many ways: for funding, initiatives, pledges, and programmes to orientate all those involved in this endeavour to achieve the SDG targets.
My Lords, poor nutrition is a killer. Some 2.5 million children die from it every year. If it was a newly discovered virus from China, the world would be in a state of complete panic about it—but, sadly, we are inured to such devastation among our fellow human beings. Also, as has been said by numerous speakers, stunting, wasting and even obesity limit education and economic productivity, and drive ill health and costly treatments. Annually, the global economy loses $3.5 trillion from malnutrition. So, in spite of relatively good progress in recent decades —although not so much in recent years—the world in 2020 needs to focus on this continuing blot on our landscape.
In the short time on such a broad subject, I will focus on only three points. The first can loosely be described as home-grown nutrition. A community that lives on the foods it can produce itself is a healthy community. One that lives on imports of packaged foods is a dependent community that needs either an alternative source of income to pay for that food or continuous food aid, which of course is unsustainable. So an aid agenda that stimulates improved agriculture is vital for both nutrition and the local economy.
When 80% of your population is dependent on agriculture for their living, as is the case in many African countries, transforming their output is the key to success. Although new roads, markets, finances, land tenure and water all matter to this agenda, the key is training: training in what to grow—such as, say, the highly nutritious and relatively new orange-fleshed sweet potato or other fortified or nutritious crops—and training in how best to grow and sell them to maximise yield and, above all, distribution.
My second point is that this training is also important in nutrition itself. I led a parliamentary group to Rwanda a few years back. The latest UN stats on stunting in Rwanda came out while we were there, showing an unnecessarily high figure for a country that is relatively productive in vegetables and good food. The President there immediately called a meeting of the leaders of the three key ministries—agriculture, education and health. The permanent secretary for agriculture told us that evening that the problem was that, although mothers were satisfactorily breastfeeding their babies, after weaning the tradition was to feed them maize milk, which is nothing more than ground-up maize and water and contained almost no nutrients at all. We asked what they were going to do about it, and he said that they would ask every village to choose their own most respected mother. They would put her on to a nutrition training course, and her role would then be to go back and teach her village about the importance of a mixed diet for young children, which in Rwanda with its varied agriculture should not be too difficult to achieve. This pyramid selling, or rather pyramid training, seemed to be a good idea and it would be interesting to return and see how it is working.
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Lord Rea (Lab)
My Lords, I am grateful to my noble friend Lord Collins, because he has chosen a subject on which I did some work 55-odd years ago, based in Lagos in Nigeria. The MD thesis that came out of that study was called Interactions of Nutrition and Infection, so it was very relevant to tonight’s Question. The study was modelled on the Newcastle Thousand Families longitudinal study, which observed a cohort of babies born successively in May and June 1947 and followed up for a number of years afterwards.
Lagos presented very different problems from Newcastle when randomly selecting which families to include in the study cohort. In the end, we were able to follow 420 randomly chosen infants in 250 families. All the children were seen every three months, when they would be weighed, measured and a note made of any illnesses that they had suffered. A visit to the child’s home was made if they did not attend the clinic. They were each allocated an illness score, depending on the severity and duration of the illness. It was possible to relate the illness score—equivalent to morbidity—to their nutritional state and growth over the previous three months, as well as to certain measures of social status such as the parents’ work, education, housing and so on. A weighted sample of well-off Nigerian professional families living a western lifestyle was included to act as a comparison with typical Lagos children. Their nutritional state and pattern of illnesses were very similar to those of typical western children of the same age, but the latter recovered much more quickly than the typical Lagos children from each episode of illness, which in their case was usually less severe.
It is not possible for me to describe the methods of study and analysis in any detail in a short speech, so I will not bore noble Lords with more research details. This type of study has been used in several other longitudinal studies in the UK and the US, and other developing countries.
The well-known signs of malnutrition, such as oedema and skin changes, were not overtly present in most of the children, but—apart from the chosen well-off group, of course—their mean weight and, less so, height was well below the norm, running at barely the 50th percentile of the better-off western norm. However, as I said, malnutrition was not overtly visible. If they were observed playing with other children, for instance, it was difficult to label them as malnourished.
Common childhood infections were present in children of all nutritional and social levels, but there was a tendency for them to be more serious and longer-lasting among those most underweight for their age, who more frequently developed pneumonia or diarrhoea as a complication. This pattern was shown most clearly in measles; the vaccine was then not yet available.
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Nutrition-sensitive interventions have made up 84% of DfID’s past nutrition funding, and this should continue. Such programmes meet a number of objectives beyond nutrition—for example, economic empowerment schemes that help mothers to afford a healthy diet for their children. DfID can increase the impact of these interventions by ensuring that all teams within the department understand how nutrition affects their portfolio. I have previously raised the important issue that the implementation of the OECD policy marker for nutrition in its reporting systems would deliver on this by measuring the impact of nutrition-sensitive interventions. Two weeks ago the Minister indicated that the Government were exploring options to ensure that the policy marker was used to best effect in DfID. I hope that tonight she will be able to indicate the timescale for that assessment. It is certainly something that the Government have advocated, and they should not delay over it. Has the Minister assessed DfID’s historic nutrition programmes to determine which should be scaled up and which discontinued?
I am sure other noble Lords will mention this, but on nutrition-specific programmes we know that the promotion of exclusive breastfeeding for six months, continued until 11 months, is the single most effective way to reduce child mortality in countries with high burdens of malnutrition. What steps is DfID taking to promote uptake of exclusive breastfeeding? How are the Government working with partners to ensure better enforcement of the International Code of Marketing of Breast-milk Substitutes?
Having seen Scaling Up Nutrition programmes first hand in countries such as Zambia, I know the importance of civil society organisations in building the political will for nutrition in high-burden countries as well as holding the politicians to account. What support is the Minister’s department giving to such civil society organisations?
Finally, I know the Minister was heavily engaged in last year’s voluntary national review of the SDGs. It noted that challenges remain in the UK in measuring and addressing every aspect of household food security, highlighted of course by the 1 million people reliant on food banks. Is she confident that the UK will be able to announce progress on domestic nutrition before the summit? I beg to move.
As we have heard, the current DfID funding for nutrition around the world ends this year. We all hope that the Minister will be able to go a little further when she replies than she did in answer to the Oral Question from the noble Lord, Lord Collins, earlier this month and say whether the Government will up their game a little and pledge £800 million a year for the next five years. Could the Minister also say what analysis has been made of the most effective nutrient-sensitive and nutrient-specific programmes so that we know that the money is being spent on what works best?
As a fellow of UNICEF, I have always been a great admirer of its child nutrition programmes. Part of that is the programme on breastfeeding which also takes place in the UK as the Baby Friendly Initiative. The wonderful thing about breastfeeding is that it helps to protect the mother from breast cancer as well as nourishing the child at minimal cost and risk. It also provides the child with valuable immunity from common diseases. Exclusive breastfeeding for six months and carrying on until 11 months could prevent over 800,000 child deaths and 20,000 maternal breast cancers. What are the Government doing both here and abroad to promote breastfeeding? To protect poor mothers from spending scarce resources on breast milk substitutes, are we providing education about the benefits of breastfeeding? I echo the plea from the noble Lord, Lord Collins, to make sure that we work with partners to ensure the enforcement of the International Code of Marketing of Breast-milk Substitutes.
Talking of working with partners, despite all we do, it is clear that the UK cannot solve malnutrition alone. However, we have already set an example and can do a lot to encourage others. Part of that would be to make the early pledge at the July event in Tokyo that the noble Lord, Lord Collins, asked for and show commitment at the top level by the presence of the Prime Minister.
What plans do the Government have to match fund or co-finance nutrition initiatives to support nutrition plans in the most fragile countries? Will the Minister commit to programmes which strengthen the resilience of food production in poor countries in the light of the effects of climate change? It is much healthier for populations to eat their own normal, fresh diet rather than have to rely on dried food brought in by aid organisations in response to famine, war or natural disasters.
Our track record on these matters is something we can be proud of, but there is much more to do. Therefore, we need the Minister’s assurance that the UK will continue to make a major contribution to tackling the scandal of child and elder malnutrition across the world and start this new decade with a major announcement in Japan in July.
My second point covers aid and trade. Too often, a country’s ability to feed its population with a healthy diet is hindered because its fruit and vegetables are too expensive for most of the population, or are exported to wealthier nations. Conversely, companies from a range of countries, including the UK, are able to flood local markets with cheap, high-sugar foods. For example, it is worth noting that the CEO of Associated British Foods was present at the UK-Africa Investment Summit last week. ABF owns the largest sugar producer in Africa, which recently received a DfID grant to implement its land rights policies. While I am wholly supportive of that work, I urge that further DfID funding should improve employment and market conditions for locally owned companies, growing food that contributes to a healthy, diverse diet. What consideration will the Minister’s N4G pledge give to private sector engagement and international trading arrangements?
As the noble Lord, Lord Collins, and the noble Baroness, Lady Walmsley, have said, the promotion of exclusive breastfeeding for six months, continued until 11 months, is the single most effective way to reduce child mortality in countries with high burdens of malnutrition. Near-universal adoption of optimal breastfeeding could prevent 823,000 child deaths and 20,000 maternal breast cancer deaths per year. As well as being extremely high in impact, breastfeeding promotion is very low in cost. Will my noble friend the Minister ensure that the promotion of exclusive breast- feeding is made a priority in the Government’s N4G pledge? Specifically, will she commit, as has already been asked, to working with partners to ensure better enforcement of the International Code of Marketing of Breast-milk Substitutes?
As co-chair of the APPG on Nutrition for Growth, I look forward to a strong commitment from the Government. I appreciate that my noble friend he Minister is to meet APPG members to discuss this further, but what thought has she given to the International Coalition for Advocacy on Nutrition’s request that the Government commit £800 million per year to nutrition between 2021 and 2025? I look forward to hearing about a really ambitious pledge from the Government.
Two years ago, I was privileged to visit one of our linked dioceses, Kimberley and Kuruman, in South Africa. It was excellent to hear reports of local feeding programmes to combat malnutrition, some supported directly by parishes in the Oxford diocese. However, those signs of hope were set against a background and a deeper narrative of concern about the climate and poor harvests.
There is increasing evidence that high ambient carbon dioxide in the atmosphere decreases the nutritional quality of important food crops, including wheat, rice and maize, affecting the entire world. The science suggests lower yields of micronutrients: protein, iron and zinc decrease as CO2 in the atmosphere increases. The changes in the climate affect agriculture. This in turn affects livelihoods, all too commonly leading to malnutrition and mass migration for a more sustainable future. There is a vicious circle here which can be broken only through a sustained global determination and action to address the climate emergency.
We have a moral imperative to love our neighbours as ourselves and to feed the hungry. We own now a moral imperative as the pioneers of the Industrial Revolution, who have gained most from fossil fuels, to lead on the fight against climate change. In this context, what consideration have the Government given to the linkage between our leadership of the COP 26 conference and the pledges we will make at the Tokyo summit in December? Will the Government continue to focus our interventions in the areas of most extreme poverty and climate change?
The goal of eliminating malnutrition is not something one country—however good its programmes are—can solve in isolation. The money pledged at the 2013 conferences, as has been said, runs out at the end of the year and the concern of this House is that no further DfID money is currently earmarked for nutrition; momentum needs to be maintained if the goal of ending malnutrition in all its forms by 2030 is to be achieved. As noble Lords have said, nutrition underpins all the sustainable development goals, but the challenge is getting greater, with climate change impacting on world food production in vulnerable areas, especially in countries classified as drought-sensitive.
This highlights, as noble Lords have already said, how breastfeeding is crucial during the incredibly important first thousand days of a child’s life. It is one of the most cost-effective interventions for improving the health and survival of children. However, experience from NGOs such as Save the Children shows that during an emergency—such as El Niño—breastfeeding decreases at exactly the same time it is most needed. This can be due to factors such as inadequate food for the mother, lack of clean water or the sheer stress of the situation. Would the Minister take this opportunity, as other noble Lords have asked, to update the House on the steps the Government are taking to promote the uptake of exclusive breastfeeding?
It is also in emergencies that the promotion or donation of breast-milk substitutes can have a negative effect on breastfeeding rates. This is why it is so vital that nutrition objectives and sensitivity are included in all DfID programmes and investments. The code of marketing of breast-milk substitutes has had some success here in the UK. The Royal College of Paediatrics and Child Health has ceased to receive funding from BMS manufacturers, and the British Medical Journal no longer carries adverts from such companies. But bold action is required to eliminate all conflicts of interest and enforce the code. More work needs to be done to promote and support breastfeeding practices through DfID investments and to ensure that the code is enshrined in a greater number of countries. I would therefore be grateful if the Minister could say what steps the Government are taking with other donors and Governments to ensure better enforcement of the code. Perhaps she might also say whether breaches of the code still occur within the commissioning groups of the NHS.
There will be many reasons for Ministers and others to visit Japan in this Olympic year to support Team GB. However, I hope that we will send our strongest delegation to the July springboard Goalkeepers event to give a lead to other countries by pledging early support and, I hope, the £800 million a year as called for by the international coalition. We need to work with national Governments to develop, lead and finance national plans for nutrition. I look forward to hearing the Minister’s view on those points. While we will, quite rightly, fly the flag for Team GB, we should also fly the flag for the incredibly important role the British Government and DfID can play in moving the dial on achieving the SDG goal on nutrition, without which the other goals will never be achieved.
Thank goodness, the UK is a world leader—an influencer. Quite frankly, the benefits to us in terms of status and soft power are immense, and we must remain so. The Nutrition for Growth commitment tracker shows that the UK has met all its commitments for 2013 to 2020. We have reached over 60 million children, girls and women. That is amazing, and we should be totally proud of our record. However, I worry when I hear rumblings from No. 10—aka Dominic Cummings—about collapsing DfID into the Foreign Office. It is already the case that, since the Lib Dems left the coalition, the DfID budget has become vulnerable to raids from other departments, which are now legitimised.
I worry even more when populist right-wing media means that the Government may try to take a wrecking ball to our aid commitments, because our international development programme is something we can and should be proud of. It sets a worldwide standard and ambition. We inspired a lead on FGM. We empower girls and women; and where women flourish, so do children and crops. We create routes to market. We support clean water provision. We empower local communities to know what to plant and how to irrigate.
In the most hostile climates and terrains, nutrition is possible. I have seen it. Cash transfers help the most vulnerable to survive the droughts and the floods that wipe away crops and livings. Our support for health systems is invaluable. How would local communities otherwise get the vaccinations they need, have safe births, treat those who need help and learn about breastfeeding, which many noble Lords have mentioned as the best start in life you can give?
I remember one particular visit to an agricultural market that we had set up to help smallholders to learn about agriculture, because bad sellers sold bad seeds that did not grow. This was an effort to educate people on how to do things. There were lessons on soil quality, how to keep water on the land, and which seeds were good and which would never flourish. Helping people to help themselves is the foundation on which a nation can survive and ultimately flourish.
One marketable product particularly sticks out in my memory. It was a product that meant you could get your cow to market in two and a half years instead of the normal seven, thus tripling the potential income of a family whose cow was its income. Lord knows what they put in the product, quite frankly, but imagine tripling your income. These are matters of life and death to the people living in these regions, so I very much hope that, at the Tokyo conference, we continue to commit to being one of the world’s leading contributors to development. As one of the wealthiest countries in the world, as we ourselves progress out of austerity, I trust we will continue to be generous, open-hearted and internationalist.
That scheme brings me to my third point: the benefits of partnership, both nationally and internationally. Bringing together the departments of agriculture, education and health, which we saw in Rwanda, is also the key to the very effective World Food Programme school feeding programmes that I have seen in many countries—Ghana and Ethiopia to name but two. It is also the key to the Anganwadi village feeding centres that I came across in India in the state of Bihar, run by the Integrated Child Development Services programme, the key word there being “integrated.” Where they exist, the Anganwadis are very effective, but there are just not enough of them.
Of course, all these initiatives, of which there are many, depend on being pushed from the very top, like my example in Rwanda, where the President stepped in and pulled everyone together, or in Bihar, where it was the chief minister who was driving the Anganwadi programme. Players have to be forced to get out of their silos, preferably by their own leaders. But also, foreign aid money can exert considerable leverage in terms of driving an agenda of partnership and co-operation. If the world is determined to stamp out malnutrition, this leverage has got to be exercised, and that is the very least we should expect from Tokyo.
Tropical diseases did not present a great problem in Lagos, apart from some helminth infestation that did not seem to do much harm. Malaria was rare, unusually for Nigeria, because all parents used Nivaquine—that is, Chloroquine—as soon as their child had a fever, so the malaria parasite was more or less drugged out of the city. Compared with this group, a group of children of the same age in a village 20 miles outside was absolutely saturated with pneumonia. They had 2 grams less per 100 millilitres of haemoglobin, too.
It was possible on fuller analysis to show that the illness scores were higher in the most underweight children. Statistically, the episodes lasted longer and more frequently developed into pneumonia or diarrhoea. This tendency has led clinicians to concentrate on treating acute infections, neglecting nutrition in busy clinics. Supplementary nutrition is in fact not acceptable to an acutely ill child, but appetite usually returns during the recovery period—though less so if the child is already undernourished or the illness episode was severe.
I see that I am running towards the end of my time. All noble Lords will have received emails from UNICEF asking us to ask DfID an enormous number of very apposite questions, which we have no time to do—but I am sure that the Minister and her department will have scrutinised them extremely carefully. The most important thing is that the funding for nutrition should continue and possibly be augmented. As I have already passed my time, I will call it a day.