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Food Politics

Into the Mouths of Babes

Sure, the U.S. provides half of all global food aid. But while that food may be fine for adults, it does nearly nothing to alleviate childhood malnutrition.

Though you wouldn’t know it from the American press, a couple weeks ago a super-high-level food meeting convened in Madrid—a follow-up to the much-reported-on-and-mused-over “food summit” held in Rome last June. United Nations Secretary-General Ban Ki-moon flew in for the two-day gathering, put on by the U.N. and the government of Spain, as did Jacques Diouf, director of the U.N.’s Food and Agriculture Organization; Josette Sheeran, executive director of the World Food Programme; Ann Veneman, executive director of UNICEF; and Ngoze N. Okonjo-Iweala, managing director of the World Bank. Jeffrey Sachs gave a keynote before jetting off to Davos (which, in contrast to the food powwow, earned itself scores of inches in The New York Times) and Secretary of State Hillary Clinton sent a team of “senior officials” to represent her.

Given that most us have long since moved on to other things—debating whether a $500,000 cap will impose undue hardship on financial titans, for example; and whether a similar cut-off mechanism might be considered for women who’ve birthed 14 kids—it’s good to know that some folks are still focused on the nearly one billion people out there who continue to go hungry.

Particular kudos goes to Doctors Without Borders/Médecins Sans Frontières (MSF) and Spain’s ACF International, which in the past few months have been promoting a campaign to raise global awareness about the scourge that is childhood malnutrition. A few days before the Spain event, the two NGOs sent out a release warning that if the attendees didn’t come up with a “concrete implementation and funding plan” focused on the issue, some 55 million children under five would continue to face the potentially life-threatening condition. “ If Ban Ki-moon and [Spanish Prime Minister] José Luis Zapatero want this summit to rise above empty promises,” said Stéphane Doyon, nutrition team leader for MSF, “they must insist that food aid changes and that a new mechanism is created to support the 50 most affected countries to address childhood malnutrition.”

Key is that bit about food aid changing. The fact is, the stuff we’ve been sending overseas for decades—fortified flours and porridges made mostly from corn and soy—does nearly nothing to address the problem. While the traditional food aid is useful for filling adult stomachs in emergency situations, helping kids is a different story. In children, malnutrition is the result of a lack of nutrients, vitamins, and minerals present in the body at the crucial stages of development (birth to 24 months), and is far more an issue of the quality of food than of quantity. The fortified flours (including the corn-soy blend, or CSB, provided by the United States Agency for International Development, or USAID) that comprise the lion’s share of the world’s food aid don’t have anything close to the balance of nutrients necessary. (They also tend to have anti-nutrients—substances that inhibit the absorption of food—but that’s another story.) So while we can continue to boast that the U.S. is responsible for fully half of all global food aid, if we don’t start offering something other than our excess commodities, children across the developing world will continue to suffer the lifelong effects of physical and mental stunting and will fall prey to infections and diseases and often to early death.

What’s truly amazing is that the answer is already out there: At this point experts pretty much know what a body needs to develop normally in those first two years of life, and to therefore progress successfully to adulthood. Yes, things are slightly complicated by the fact that you can’t recommend a glass of milk or an egg salad sandwich (“animal-source” foods being key childhood dietary components) to people living in places where there are no refrigerators—much less cows and chickens available for the taking—but various non-perishable pastes and spreads (ready-to-use food, or RUF) have been developed and proven astonishingly successful in combating malnutrition. A study published just one month ago in the Journal of the American Medical Association showed that children in rural Niger who received RUF in addition to their normal diet were nearly 60 percent less likely to progress to the most life-threatening form of malnutrition than children whose diets were not supplemented.

So why is only one out of every ten affected children getting the U.N.-recommended treatment with RUF? The milk powder and other ingredients that go into effective RUF are expensive, as is the packaging, distribution, and manpower needed for educational initiatives to promote the products’ adoption. Still, when you consider the numbers—malnutrition is responsible for 11 percent of the global disease burden, more than HIV, TB, or malaria—“lack of funding” seems a particularly lame excuse. The fact that this new generation of nutritional therapies is out there, but that the international community (and, to be fair, many of the national governments themselves) isn’t using them recalls the days when AIDS patients were offered condoms and advice but denied antiretroviral drugs. “We cannot continue to provide food aid that we would not give to our own children,” said Olivier Longué, executive director of ACF Spain.

Part of the problem, said Buddhima Lokuge, U.S. manager for the MSF’s Campaign for Access to Essential Medicines, is that people still think about hunger only in the context of crisis settings. “It’s when CNN runs a story that says, there’s a famine in Angola, or there’s a famine in Ethiopia.” In fact, he said, “it’s happening each and every year in the high-burden malnutrition hotspots, and it’s happening without TV cameras, because it’s just so chronic and endemic and pervasive that people have become blind to it.”

With increased exposure, the hope is, will come increased funding. MSF, which last September co-sponsored a symposium on the importance of nutrition in food security strategies (“Starved for Attention: The Neglected Crisis of Childhood Malnutrition”) with Columbia University’s Institute of Human Nutrition, is on a mission to make that happen.

And there’s reason to be hopeful, said Lokuge. The new U.S. Farm Bill, for instance, stipulates that USAID reformulate its food aid to better meet the nutritional needs of targets. And if our country begins sending something other than CSB, others will likely follow. “The question,” said Lokuge, “is whether the interests—and there are many stakeholders, unfortunately, that are involved in food aid—would allow USAID to just look at the evidence and the science in program effectiveness” and change policy based on that.

At the close of the summit in Spain, the attendees released a Statement of the Madrid High-level Meeting on Food Security for All. In addition to calling for substantially increased financial resources (the Spanish government committed to 200 million euros and called on others to respond in kind), it announced the establishment of a Global Partnership for Agriculture, Food Security, and Nutrition, which at least suggests a greater focus on malnutrition moving forward. In the meantime, MSF and ACF intend to raise their voices any chance they get. “AIDS, TB, and malaria required activists to be out in the street,” said MSF’s Lokuge, “so that people were reminded there was a real sense of urgency. I think we need to do the same with this. Otherwise, it will just be words.”