Tokyo Nutrition for Growth Summit

Question for Short Debate

Asked by

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.

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.