On Universal Health Coverage Day, we must push to recognize nutrition as an essential part of public health.
Malnutrition currently affects 1 in 3 people across the globe, in ways both visible and invisible. Worldwide, 159 million children under the age of five are stunted and 50 million are underweight for their age; meanwhile, 2 billion adults and 41 million children worldwide are overweight or obese, putting them at greater risk for developing nutrition-related non-communicable diseases (NCDs) like diabetes. This double burden of malnutrition now affects 44% of countries around the world and comes with massive economic consequences - annual GDP losses from low weight, poor child growth, and micronutrient deficiencies average 11 percent in Africa and Asia, while a diagnosis of diabetes in China results in an annual 16.3 percent loss of income.
Nutrition is not a standalone issue: as the 2016 Global Nutrition Report shows, the fight against malnutrition is closely tied to advancements in other development areas, like social protection, education, and water, sanitation and hygiene. Twelve of the 17 UN Sustainable Development Goals contain indicators that are connected to nutrition; we are certainly not lacking in opportunities to encourage cohesion and efficiency in development planning through cross-sectoral collaboration.
As the global health community works to provide affordable, effective health care for all through universal health coverage, the nutrition community must draw attention to the role of universal coverage in fighting malnutrition.
Stopping malnutrition in its tracks
According to World Health Organization recommendations, universal health coverage plans should seek not only to treat sick individuals, but also to provide cost-effective preventive care and diagnostics to all who need them. This emphasis on prevention is important for preventing undernutrition in vulnerable populations, like pregnant women and young children. With regular care appointments, women can better understand the importance of proper nutrition during pregnancy to ensure a healthy pregnancy and birth. Similarly, post-partum follow-up appointments and regular check-ups for children can improve child health by promoting breastfeeding and appropriate nutrient intake, and by identifying potentially problematic micronutrient deficiencies in mothers and children alike. Universal health coverage plans can also help to identify warning signs of nutrition-related non-communicable diseases before they become dangerous for patient health—and provide treatment should the conditions become serious.
UHC and Nutrition: Missed opportunities
Though the potential for universal health coverage to fight malnutrition is clear, it is often not being realized. This is in large part due to the structure of many universal health coverage programmes, by which governments provide “essential services” to their populations for little or no cost. Therefore, if certain conditions, medicines, or procedures are not deemed “essential” by policymakers, they will not be covered by the plan—and many conditions will therefore remain undiagnosed or expensive to treat.
As the widespread funding gaps and lack of comprehensive nutrition policies have shown, fighting malnutrition often falls low a government’s list of priorities. With many developing countries struggling to eradicate infectious diseases like malaria and HIV/AIDS, chronic malnutrition and nutrition-related NCDs like for example, are not as obvious or pressing. They are therefore often not included in many “essential” packages—even though malnutrition can greatly increase the chances of illness and death from infectious diseases.
Many of the countries currently battling high rates of malnutrition are also in the early stages of implementing universal health coverage plans—and still others are in the process of revising their current lists of “essentials”. As countries seek to deliver on these promises, we must push for greater consideration of nutrition issues in the health sector. Monitoring vulnerable populations for signs of undernutrition needs to be a building block of universal coverage. In countries at risk of a “double burden”, NCD prevention, detection and treatment should be included in “essential” packages to prevent the growing double burden of malnutrition from going unnoticed. With returns of $16 for every $1 invested nutrition, the tremendous economic benefits of fighting malnutrition should be worked into health systems financing plans.
Universal access to care and access to adequate nutrients are inextricably linked—not only as factors affecting individual and societal health, but also as basic human rights. It’s time to start viewing nutrition as an essential part of public health.