Chapter 2 SUMMARY Much attention in 2013 was devoted to considering what should follow the Millennium Development Goals, which will come to an end in 2015. This chapter calls for prioritizing the elimination of hunger and undernutrition globally by 2025 and discusses what it will take to achieve that goal. Shenggen Fan is director general, International Food Policy Research Institute, Washington, DC. Paul Polman is chief executive officer, Unilever, London. AN AMBITIOUS DEVELOPMENT GOAL Ending Hunger and Undernutrition by 2025 Shenggen Fan and Paul Polman In 2000, the global community adopted the Millennium Development Goals, which called for halving both the proportion of people living in extreme poverty and the proportion of people suffer- ing from hunger. At a global scale, the poverty goal has been achieved, but progress toward halving hunger is not on track. Close to 850 million people worldwide still suffer from chronic hunger, according to recent estimates by the Food and Agriculture Organization of the United Nations (FAO).1 The 2015 deadline for achieving the Millennium Development Goals is fast approaching. As a result, deliberations on how to accelerate progress toward meeting the goals by 2015 and beyond have intensified. Now underway is a dis- cussion of a post-2015 development agenda that will advance what began with the Millennium Development Goals. The UN secretary-general appointed a High-Level Panel of Eminent Persons on the Post-2015 Development Agenda, which proposed potential new goals and targets that will guide the agenda and culminate in a set of sustainable development goals.2 Central to the discus- sions of the post-2015 agenda is the goal of eliminating extreme poverty by 2030. Though ambitious and laudable, this goal is not enough: we argue that it is equally important to eliminate hunger and undernutrition and that we should aim to do so by 2025. There are both economic and moral reasons for striving to end hunger and undernutrition. In countries where large numbers of people lack the food and nutrition security they need to lead healthy and productive lives, it is difficult to break out of poverty or sustain economic development.3 Research shows that undernutrition limits people’s educational achievements and produc- tivity, which in turn leads to large global economic losses.4 In addition to these economic considerations, ending hunger and undernutrition implies ending an important dimension of human suffering. It is thus a global ethical task that must be given top priority. The goal of ending hunger and undernutrition by 2025 is colossal, but not unattainable. To achieve this goal, governments and donors must allocate sufficient resources and pursue appropriate policies and investments. The experiences of countries such as Brazil, China, Thailand, and Vietnam in reducing hunger and undernutrition suggest that it is real- istic to strive for this goal if the pace of reduction is accelerated. Their achievements also offer les- sons for charting pathways to even greater success. Moreover, recent technological, policy, and institu- tional innovations put us in a better position to spur faster progress in reducing hunger and undernutri- tion. Such progress can be achieved when ideas are broadly disseminated, when countries learn from each other, and when cooperation in pursuit of ever better solutions sets in—in other words, when a snowball effect triggers avalanches in innovations. It is important to note, however, that achieving the goal may still leave 5–8 percent of the population suffering from residual hunger and undernutrition.5 The recent attention to food security and nutri- tion and the pledged increases in nutrition invest- ments are monumental. It is crucial to follow through on this momentum and develop a global and inclusive partnership for ending hunger and undernutrition that goes beyond rhetoric. WHY IT PAYS TO END HUNGER AND UNDERNUTRITION Hunger here means food intake that is insufficient to meet the dietary energy requirements of an active and healthy life.6 According to the FAO, the term hunger refers specifically to the consump- tion of fewer than about 1,800 kilocalories per day. Hunger can lead to undernutrition, which refers to the outcome of prolonged inadequate intake of macronutrients (such as calories, proteins, and fats) and micronutrients (such as vitamins and minerals).7 The World Health Organization esti- mates that more than 2 billion people suffer from micronutrient deficiencies, often referred to as hidden hunger.8 Deficiencies of vitamin A, iron, iodine, and zinc are the most common.9 Undernutrition typically takes the form of micronutrient deficiencies, child stunting (low height-for-age), child underweight (low weight- for-age), or child wasting (low weight-for-height). This chapter focuses on stunting, because this form of undernutrition has been recognized as the most critical.10 Stunting is associated with adverse outcomes related to slow physical and cognitive development.11 It results from inhibited skeletal growth and low accumulation of muscle mass and fat and is linked to negative neurological outcomes because of the damage it causes to the chemical processes associated with spatial navigation, mem- ory formation, and memory consolidation.12 This neurological damage leads to low cognitive devel- opment with both short- and long-term conse- quences, such as low school attainment and low lifetime earning potential.13 Worldwide, it is esti- mated that 25 percent of children under five years of age—162 million children—are stunted.14 In both Africa south of the Sahara and South Asia, the prevalence of stunting remains particularly high— approximately 38 percent in both regions. Poverty, hunger, and undernutrition are linked in a vicious cycle. To break this cycle, it is impor- tant to prioritize the elimination of hunger and undernutrition, which cause and perpetuate pov- erty, have detrimental effects on human health,15 and impose huge social and economic costs. These costs and burdens can be felt at the individual, household, and societal levels. Growth failure in early life is likely to be passed to the next genera- tion. Women affected by stunting are more likely to have their first child at younger ages, have more children, and live in poor households as adults.16 Productivity losses and direct healthcare costs caused by hunger and undernutrition also have adverse economywide effects. According to the FAO, hunger and undernutrition reduce global gross domestic product (GDP) by 2–3 percent, equivalent to US$1.4–2.1 trillion a year.17 Another study estimates this loss to be 8 percent of world GDP over the 20th century and projects it to be 6 percent in the first half of the 21st century.18 Recent country-level cost estimates range from 16 Ending HungEr and undErnutrition by 2025 the box “Addressing Hunger Has High Returns on Investment” on page 20). It may be possible to cut the deaths of children younger than five years by 15 percent by adopting ten core nutrition 2 percent of GDP in Egypt and Panama to more than 10 percent in Ethiopia and Guatemala.19 The economic returns to eliminating hun- ger and undernutrition can be very high (see Concerted Action against Hunger and Malnutrition beyond 2015 DAVID NABARRO In 2013 the vision of ending hunger and malnutrition rose higher on the agenda of governments, development agencies, foundations, civil society groups, busi- nesses, and the research community, with increasing support for the Scaling Up Nutrition (SUN) Movement and the Zero Hunger Challenge. At the same time, the international community is looking beyond the 2015 deadline for the Millennium Development Goals to dis- cuss the post-2015 development agenda. In March 2013, the Open Working Group, established at the 2012 Rio+20 Conference, began deliberating how to formulate a set of sustainable develop- ment goals. At its third meeting in May 2013, the group discussed issues of food security and nutrition, sustainable agri- culture and desertification, and land degradation and drought.1 Meanwhile, the United Nations system and its partners have been engaged in an unprecedented process of country, regional, and global consultation as a contribution to this post- 2015 development agenda. This process included the High-level Consultation on Hunger, Food Security, and Nutrition hosted by Spain and Colombia in Madrid in April 2013.2 The promotion of food security, nutrition, and sustainable agri- culture in the post-2015 development agenda was also discussed at the 40th session of the Committee on World Food Security in Rome in October 2013.3 Many reports delivered to the UN sec- retary-general during this process put food security, nutrition, and sustainable agricultural and food systems high on the agenda. The High-Level Panel of Eminent Persons (appointed by the secretary- gen- eral) and the UN Global Compact propose a specific stand-alone goal for ending hunger and malnutrition.4 The Sustainable Development Solutions Network adds a specific goal of improving agricultural systems and raising rural prosperity to the overall goal of ending poverty and hunger.5 All the reports call for a focus on ending stunting (low height-for-age). The UN secretary-general’s report, A Life of Dignity for All,6 summarizes the vision emerging from these discussions: a universal and transformative post-2015 development agenda for eradicating pov- erty through sustainable development. Member states and other stakeholders concur that ending hunger and malnu- trition through inclusive and sustainable agricultural, rural, and food systems is an essential part of the overall post-2015 vision. In his report, the UN secretary- general included ending hunger and mal- nutrition in the set of transformative and mutually reinforcing actions that apply to all countries and that are required to bring the overall post-2015 vision to life. In his words, “Addressing hunger, malnutrition, stunting and food insecurity…will require a combination of stable and adequate incomes for all, improvements in agricul- tural productivity and sustainability, child and maternal care and strengthened social protection for vulnerable populations.”7 Taking action in a comprehensive way will bring multiple benefits, including stronger economic growth, social inclusion, and sustainable rural development. One of the most important determinants of success for the post-2015 development agenda will be its means of implementation, particu- larly adequate financing. In this respect, the funds pledged at the June 2013 Nutrition for Growth summit in London are an important first step.8 International stakeholders are sup- porting this discussion and developing proposals for global goals and rights. They recognize the importance of underpinning these goals and rights with incentives and policies that are kept coherent, and then legislated and implemented, at the coun- try level. This process requires the involve- ment, ownership, and accountability of all stakeholders. The United Nations system supports member states and partners as they advance this work in ways that take account of people’s voices. David Nabarro is special representative, United Nations Secretary-General for Food Security and Nutrition, and coordinator, Scaling Up Nutrition Movement, Geneva. an ambitious dEvElopmEnt goal 17 0 10 20 30 40 50 1990–1992 2011–2013 1990–1992 2011–2013 1990–1992 2011–2013 1990–1992 2011–2013 CHINA BRAZIL THAILANDVIETNAM CHINA BRAZIL THAILANDVIETNAM 0 10 20 30 40 50 60 70 1989 20071990 2010 1987 20061988 2010 UNDERNOURISHMENT CHILD STUNTING Agriculture-led strategies Social protection–led strategies + nutrition interventions Agriculture-led strategies + social protection–led strategies + targeted nutrition interventions FIGURE 1 PATHWAYS TO REDUCING UNDERNOURISHMENT AND CHILD STUNTING WHY WE ASPIRE TO END HUNGER AND UNDERNUTRITION BY 2025 The experiences of Brazil, China, Thailand, and Vietnam suggest that we should aspire to end hun- ger and undernutrition on a global scale by 2025. The strategies implemented by these countries can be broadly classified as agriculture-led, social protection– and nutrition intervention–led, or a combination of both of these approaches (Figure 1). Successes in China and Vietnam, for example, may interventions at a cost of about $10 billion a year.20 This is less than 1 percent of the cost of hunger and undernutrition. Country-level evidence also shows large economic returns. Under conservative assumptions, every dollar spent on interventions to reduce stunting is estimated to generate about US$30 in economic returns, even in poor countries such as Ethiopia.21 Sources: Data on undernourishment are from the database underlying Food and Agriculture Organization of the United Nations, The State of Food Insecurity in the World 2013 (Rome: 2013). Data on child stunting are from World Bank, World Development Indicators 2013 databank (Washington, DC: 2013), http://databank.world- bank.org/data/views/variableSelection/selectvariables.aspx?source=world-development-indicators. Note: Data on undernourishment are reported as three-year averages, and data on child stunting are reported yearly. 18 Ending HungEr and undErnutrition by 2025 0 10 20 30 40 50 1990–1992 2011–2013 1990–1992 2011–2013 1990–1992 2011–2013 1990–1992 2011–2013 CHINA BRAZIL THAILANDVIETNAM CHINA BRAZIL THAILANDVIETNAM 0 10 20 30 40 50 60 70 1989 20071990 2010 1987 20061988 2010 UNDERNOURISHMENT CHILD STUNTING Agriculture-led strategies Social protection–led strategies + nutrition interventions Agriculture-led strategies + social protection–led strategies + targeted nutrition interventions FIGURE 1 PATHWAYS TO REDUCING UNDERNOURISHMENT AND CHILD STUNTING be seen as resulting mainly from an agriculture-led strategy. In Brazil, success has likely been primarily driven by social protection programs and targeted nutrition interventions for those most in need. Suc- cess in Thailand has likely been catalyzed by a com- bination of these strategies. By drawing on the experiences of these coun- tries, other developing countries have the oppor- tunity to design and implement successful context-specific strategies to address hunger and undernutrition. In this chapter we discuss trends of relevant indicators in countries that have had suc- cesses in reducing hunger and undernutrition. We also provide a brief overview of the main elements of the strategies employed. As an indicator of hun- ger, we use FAO data on the prevalence of under- nourishment (which occurs when a person’s daily food intake is less than his or her minimum energy requirement, typically around 1,800 kilocalories). As an indicator of undernutrition, we use World Bank figures on the prevalence of child stunting.22 Because a 5–8 percent rate of hunger or undernu- trition may be unavoidable, we use 8 percent as a cutoff below which we consider hunger and under- nutrition to be “eliminated.” Agriculture-Led Strategies: China and Vietnam If China continues its current rate of reduction, it can eliminate hunger and undernutrition by 2025.23 Between 1990 and 2013, China was able to halve the prevalence of undernourishment from roughly 23 to 11 percent. More impressively, between 1987 and 2010, China reduced the prev- alence of child stunting by more than two-thirds, from 32 to 9 percent. China’s agricultural and economic success was catalyzed through the decollectivization of agricul- ture (through the introduction of the Household Responsibility System for securing land rights), pro-market reforms and the dismantling of state planning and monopolies, and the implementation of policies that supported human capital devel- opment and rural nonfarm economic growth.24 These reforms, which began in the late 1970s, had a strong initial emphasis on agricultural growth— stimulated by improved incentives in smallholder agriculture—and rural development. These changes resulted in significantly higher incomes among rural residents, where levels of poverty and hunger were initially the highest, and in increased availability of food at affordable prices.25 In addi- tion, nutrition, health, and family-planning inter- ventions were implemented on a large scale.26 To complement these interventions, investments in education, clean water, and good sanitation were also expanded. Even though social protection policies have the potential to promote inclusive growth, such policies were not at the forefront of China’s strat- egies during the reform period. China could probably have achieved much greater progress if it had launched and scaled up well-targeted social protection programs earlier. Instead, it relied on social welfare benefits provided by individual firms to their employees, even when major eco- nomic transformation, including rising unemploy- ment and labor mobility, meant that this approach led to inequality in social welfare provision.27 In recent years, the government of China launched its main social protection program, the Minimum Livelihood Guarantee Scheme (widely known as Dibao).28 Overall, careful experimentation was vital to the design, sequencing, and implementation of successful reforms in China.29 A strong monitor- ing and evaluation system, including an effective data- collection strategy, facilitated the flow of information for policymaking. The reforms also profited from other factors, such as good initial conditions in rural infrastructure, agricultural research and extension services, and institutional capacity.30 Like China, Vietnam has the potential to elim- inate hunger by 2025 if it continues its current rate The experiences of Brazil, China, Thailand, and Vietnam suggest that we should aspire to end hunger and undernutrition on a global scale by 2025. an ambitious dEvElopmEnt goal 19 of reduction. Between 1990 and 2013, the preva- lence of undernourishment fell remarkably from about 48 to 8 percent. The prevalence of child stunting was reduced from a high of 61 percent in 1988 to 23 percent in 2010. Although Vietnam is not likely to eliminate stunting by 2025, with the right policies and strategies in place it could come close to achieving this goal. As in China, initial progress in Vietnam was likely driven largely by growth in agriculture, supplemented by targeted nutrition and health programs.31 The Doi Moi reforms, introduced in the late 1980s by the Vietnamese government, Addressing Hunger Has High Returns on Investment ALEXANDER J. STEIN Estimates of the number of undernour- ished people have traditionally sought to shed light on the human and ethical dimensions of hunger. In 2013, however, a flurry of studies sought to do something different: to approximate the economic cost of hunger. Two studies tallied the global cost of undernourishment and micronutrient malnutrition. One linked estimates of the global burden of disease to undernutrition and tentatively converted them into dol- lar terms, suggesting that hunger in all its forms causes economic losses of US$0.8– 1.9 trillion a year.1 This estimate was similar to that offered by the Food and Agriculture Organization of the United Nations (FAO). Using a bottom-up approach to aggregate information on economic productivity losses due to undernutrition, FAO esti- mated a cost of US$1.4–2.1 trillion a year, the equivalent of 2–3 percent of global gross domestic product (GDP).2 Three other studies focused on coun- try-level costs—in Egypt, Ethiopia, and Uganda3—supplementing an earlier study of Central American countries.4 These country studies generated prelim- inary estimates based on healthcare and educational costs and on lower produc- tivity due to undernutrition. Their esti- mates of the cost of hunger ranged from 2 percent of GDP (in Egypt and Panama) to well over 10 percent (in Ethiopia and Guatemala), suggesting that the cost of hunger may be high even in relatively bet- ter-off countries, such as those in Central America. This is because as the share of nonmanual work increases in an economy, education often becomes a prerequisite for better-paying jobs, and by reducing educa- tional achievement, undernutrition threat- ens higher income-earning opportunities. Although reducing human suffering to a simple number is a limited approach to understanding hunger, it is a pragmatic one: it expresses the problem in monetary units, which are familiar and compara- ble. And although these figures are only rough estimates, their magnitude cannot be ignored. Such high sums send a strong signal: cost-effective programs that elimi- nate hunger should lead to large economic gains—globally and particularly in coun- tries where undernutrition is worst. Feasible solutions to eliminate under- nutrition in cost-effective ways do exist.5 With the annual cost of hunger perhaps in the trillion-dollar range—which is as much as the GDP of Indonesia or Mexico—the bill for addressing hun- ger may be only a fraction of that cost. For instance, reaching more than 80 percent of the world’s undernourished children with key nutrition interventions may require as little as $10 billion a year6—at most one-hundredth the cost of hunger. Alas, the commitments made so far by the international community are much lower. At the London Nutrition for Growth summit in June 2013, for instance, international donors made a commitment to spend about US$10 bil- lion on nutrition programs—an amount to be distributed over eight years, however, not one.7 This is unfortunate because, as has been suggested here, hunger is costly—not only for the indi- viduals concerned but also for society, given the productivity losses and public health burden it imposes on countries worldwide. Thus, in addition to meeting a moral obligation, eliminating hunger could offer high economic returns for humanity. Alexander J. Stein was research coordinator, Director General’s Office, International Food Policy Research Institute, Washington, DC, during the preparation of this report. He is now a policy officer, Directorate-General for Maritime Affairs and Fisheries, the European Commission, Brussels, Belgium. 20 Ending HungEr and undErnutrition by 2025 consisted of four main elements: (1) equitable land reform, (2) liberalization of agricultural markets and trade, (3) pragmatic and sequenced liberal- ization for attracting and benefiting from foreign direct investment, and (4) sustained investment in human development.32 The 1988 implementation of Resolution 10, which recognizes that the house- hold is the basic production unit of the rural econ- omy, drastically improved agricultural incentives. Both Resolution 10 and the 1993 Land Law played a critical role in spurring agricultural growth in the 1990s, enabling Vietnam to become one of the world’s major rice-exporting countries. Rapid agricultural growth contributed to higher rural incomes and the movement of labor into nonagri- cultural sectors.33 Vietnam also targeted significant public spend- ing toward improving nutrition and health out- comes. It implemented a comprehensive nutrition policy to improve dietary diversity and programs to increase micronutrient supplementation.34 Fur- thermore, Vietnam established child-health and family-planning programs, maintained national health coverage, and provided health subsidies to the poor. Notably, these reforms were implemented with a focus on promoting equity while improving living standards. In recent years, however, inequality has been rising—for example, between the North and the South and between urban and rural areas—as it has become more difficult to reach poor and vul- nerable groups.35 Given that a majority of Viet- nam’s poor earn 75 percent of their income from agriculture and related activities, this sector is likely to continue to play a critical role in stimu- lating more pro-poor growth.36 Measures such as improved access to markets, rural infrastructure, and basic services, as well as further development of the private sector (both within and outside of agriculture), will be important to promote more inclusive growth.37 The implementation of the Enterprise Law in 2000, for example, which streamlined the registration process for business, set in motion a move toward private-sector growth. Effective social protection policies will also be cru- cial as Vietnam continues to experience economic transformation.38 Social Protection–Led Strategies and Targeted Nutrition Interventions: Brazil Based on our cutoff point of 8 percent, Brazil has eliminated both hunger and undernutrition. Between 1990 and 2013, the prevalence of under- nourishment declined from 15 to 7 percent, and between 1989 and 2007, the prevalence of child stunting fell from about 19 to 7 percent. This success was arguably spurred by Brazil’s macroeconomic and trade policy reforms, intro- duced in the mid-1990s, accompanied by pro-poor social spending.39 Social protection reforms, which played an important role starting in the late 1990s, involved expanding and better targeting the coun- try’s social assistance and social security programs. Existing transfer programs were consolidated under Brazil’s flagship social program, popularly known as Bolsa Família.40 The program, which promotes improved education and healthcare for beneficiaries, is the largest conditional cash transfer program in the world to date. Key to the success of Bolsa Família is its integration with other social programs and social policies for food and nutrition security.41 To support these programs, the government put in place key social legislation and policies—in particular, the 1988 statutory right of every citizen to social security, the 2003 Zero Hunger strategy, and the 2004 basic income law.42 It also scaled up investments in education, healthcare, clean water, and sanitation.43 Despite these advances, Brazil began with a high initial level of inequality that, coupled with inequal- ity-promoting policy distortions, seems to have hampered progress.44 In more recent years, however, inequality has declined in the face of higher macro- economic stability and more progressive social poli- cies, creating room for accelerated progress. Agriculture-Led Strategies Plus Social Protection–Led Strategies and Targeted Nutrition Interventions: Thailand At the current rate of reduction, Thailand has already eliminated hunger based on our cutoff point of 8 percent prevalence. However, it will only come close to eliminating stunting by 2025. Between 1990 and 2013, the country dramatically an ambitious dEvElopmEnt goal 21 reduced the prevalence of undernourishment from about 43 to 6 percent. Child stunting has also fallen significantly, though more slowly, declining from about 25 to 16 percent between 1987 and 2006. If Thailand accelerates the implementation of appro- priate strategies, it could likely eliminate stunting. Agriculture was the driving force of pro-poor growth in Thailand in the 1960s and 1970s.45 Growth benefited from macroeconomic stability, more secure land rights, strong public spending on rural infrastructure, and a 1972–1974 world commodity boom. Fast-paced agricultural growth Measuring Hunger and Undernutrition Precisely and In Time TOLULOPE OLOFINBIYI AND SINAFIKEH GEMESSA In measuring progress toward ending hunger and undernutrition, no single indicator can capture all the dimensions of these two conditions. Therefore, it is important to use multiple indicators that together can capture the multidimensional nature of both phenomena. A compre- hensive assessment of hunger and under- nutrition needs to include indicators of both inputs to food and nutrition security (such as calories and dietary diversity) and outcomes (such as stunting, underweight, and wasting).1 It is also crucial to collect and report data for these indicators, as well as for the household and institutional factors that drive them, in a timely fash- ion. Data are already collected for many of these indicators, but not in a regular, comprehensive, and timely way. The prevalence of undernourishment— computed by the Food and Agriculture Organization of the United Nations (FAO)—is the most widely used measure of global and national hunger. For a coun- try, the prevalence of undernourishment is a function of food availability (dietary energy requirements and supply) and access (the likely distribution of these calories within the country). To estimate the distribution of calories, FAO does not make direct observations; instead, it sim- ulates the distribution using data from occasional household surveys. In 2012, FAO made some important revisions to the methodology and data it uses to construct the undernourishment indicator. Among other things, FAO revised its estimations of food losses and updated its parame- ters for dietary energy requirements and access to food.2 Although these are steps in the right direction, important infor- mation gaps remain. The indicator does not consider imbalances in people’s con- sumption of macro- and micronutrients, variation within countries, and short-term or within-year variations.3 Encouragingly, FAO’s 2013 State of Food Insecurity in the World report includes discussions of the different dimensions of hunger and under- nutrition, with a suite of proposed indica- tors to measure each of them.4 Research evidence suggests that indicators of dietary diversity are better measures of hunger, in a broad sense, than indicators of calorie deficiency.5 Dietary diversity indicators are sensi- tive to people’s nutrition intakes, shocks that affect their food consumption, and seasonal shortages. Household survey– based indicators, such as the World Food Programme’s Food Consumption Score and the US Agency for International Development’s Household Dietary Diversity Score, are examples of indica- tors that can be used to better assess nutrient adequacy.6 It should be noted, however, that dietary diversity indica- tors still require improvements to allow for more frequent measurement and cross-country comparisons. On the outcome side, anthropometric indicators that measure consequences of undernutrition, such as stunting (low height-for-age), should also be tracked frequently. Stunting is increasingly rec- ognized as the most useful indicator of chronic undernutrition because of its greater specificity compared with other indicators such as underweight (low weight-for-age).7 However, frequent mea- surement of underweight and wasting (low weight-for-height) is still needed to capture relatively short-term impacts of undernutrition. When using anthropomet- ric indicators, researchers must control for other confounding factors, such as lack of access to safe drinking water and sanita- tion, which directly affect these undernu- trition outcomes.8 Dietary diversity indicators and anthropometric measures often rely on expensive surveys of households or indi- viduals that are challenging to update regularly. This problem is compounded by many developing countries’ lack of capacity to collect reliable and timely data due to shortages of statistical infra- structure and human capital. To design and implement evidence-based policies and programs, it is essential to invest in building developing countries’ capacity for data collection. Investments in inno- vative tools, such as information and communication technologies, should also be accelerated to reduce the cost and time needed to collect data and publish findings, as well as to improve the qual- ity of data collected.9 22 Ending HungEr and undErnutrition by 2025 agriculture.47 Thailand’s agricultural sector became characterized by a market-oriented approach with well-developed marketing chains and interaction between smallholders and private companies, as well as high diversification and specialization of products, as encouraged by public expenditures on in this period contributed to higher rural incomes and reduced poverty. Starting in the mid-1980s, pro-poor growth was led by the development of the nonfarm sector and a structural shift of household income from farm to nonfarm activity.46 In the 1990s, however, government policies refocused on Measuring Hunger and Undernutrition Precisely and In Time TOLULOPE OLOFINBIYI AND SINAFIKEH GEMESSA Proposed measures of global hunger and undernutrition Measure Description Source Proposed improvements Input-side indicators Prevalence of undernourishment The proportion of the population experiencing inadequate calorie intake lasting more than one year Food and Agriculture Organization of the United Nations • Increase use of representative household surveys • Regularly update distribution framework of calories Dietary diversity indicators (for example, Food Consump- tion Score) Frequency-weighted consumption of different food groups by a house- hold in the past 7 days before the survey World Food Programme • Compute at individual level and make comparable over time and space • Report yearly at national and subnational levels Outcome-side indicators Prevalence of stunting The proportion of children under 5 who are stunted (low height-for-age) World Health Organization Report yearly at national and sub- national levels Prevalence of underweight The proportion of children under 5 who are underweight (low weight-for-age) World Health Organization Increase frequency of data collec- tion, especially in hunger hotspot areas Prevalence of wasting The proportion of children under 5 who are wasted (low weight-for-height) World Health Organization Determine frequency of data collec- tion by extent of food crisis Source: Authors’ compilation. Note: Data for all the measures should be collected collaboratively by international organizations and national and regional governments. Tolulope Olofinbiyi is program manager and Sinafikeh Gemessa is senior research assistant, Director General’s Office, International Food Policy Research Institute, Washington, DC. an ambitious dEvElopmEnt goal 23 agricultural research and extension. This situation contributed to increased incentives for agricultural production, which enabled Thailand to become one of the largest global exporters of rice.48 Beginning in the early 1980s, Thailand adopted an integrated, community-based approach to improving nutrition and health outcomes.49 In the early to mid-1980s, Thailand’s Second National Health and Nutrition Policy focused on targeted nutrition interventions to tackle undernutrition.50 Nutrition programs, which were included in the National Economic and Social Development Plan, focused on underdeveloped areas, targeting mainly children and pregnant and lactating women. These nutrition programs were not implemented in isolation; rather, they had clear linkages with agriculture to help ensure that their impacts were sustainable.51 Intersectoral approaches and local participation continued to improve in the 1990s. In 2002, the government introduced the Universal Health Coverage Scheme.52 Fully financed by the government of Thailand, this scheme entitles every citizen to free basic healthcare. More recently, the government has extended social protection pro- grams that go beyond healthcare to cover, among other things, death and old-age benefits to workers in both the formal and informal sectors.53 WHAT WE CAN LEARN FROM THESE EXPERIENCES AND OTHERS In many countries, ending hunger and undernu- trition will require a mix of agricultural, social protection, and nutrition strategies. Agricultural growth contributes directly to reducing hunger and undernutrition by increasing farm households’ ability to produce and purchase more nutritious foods, lowering food prices for poor consumers, and raising demand for rural labor.54 Evidence from a study of multiple countries suggests that in food-insecure countries, agricultural growth is associated with reductions in underweight and stunting.55 The experiences of China and Vietnam show that in agriculture-based economies where smallholders predominate, growth strategies focused on these smallholders may do the most to reduce poverty and hunger. Within agricul- ture, investments should be directed toward the subsectors with heavy participation of poor and hungry people.56 Because growth alone is not sufficient to elimi- nate hunger and undernutrition, well-designed and well-implemented social protection strategies are also important. As Brazil’s success shows, social safety nets, such as conditional cash transfers, can contribute to more inclusive growth by helping people build assets and protecting these assets from shocks, reducing inequality, facilitating structural reform of the economy, and increasing the effective allocation of resources.57 Effective social safety nets should have a clear objective, a feasible means of targeting beneficiaries, a reliable mode of transfer- ring resources, a sound monitoring and evaluation system, and transparent operations.58 Accelerating progress in improving nutrition also demands well-targeted nutrition interventions that address both the immediate causes of under- nutrition (through nutrition-specific programs) and the underlying causes (through nutrition- sensitive programs in areas such as agriculture and early childhood development). Thailand’s expe- rience is instructive: Thailand was one of the few countries to prioritize nutrition in the early 1980s by targeting healthcare and nutritious food sup- plements to people affected by hunger and under- nutrition.59 The effectiveness, coverage, and scale of nutrition-specific interventions (such as micro- nutrient supplementation and optimum breastfeed- ing practices) can be improved immensely when nutrition-sensitive programs (such as agricultural and early childhood development programs) are leveraged as delivery platforms.60 The nutrition Accelerating progress in improving nutrition demands well-targeted nutrition interventions that address both the immediate cause of undernutrition and the underlying causes. 24 Ending HungEr and undErnutrition by 2025 sensitivity of programs can be increased by, for example, improving the targeting of interventions, using nutrition-related conditions, integrating nutrition goals and actions, and focusing on the empowerment of women. The relative importance of these strategies in different countries depends on the structure of the economy and where the vulnerable groups reside. In agriculture-based economies (mostly in Africa south of the Sahara), agriculture will play an important role in bringing about pro-poor growth and reducing hunger and undernutrition. In trans- forming economies (mostly in Asia, North Africa, and the Middle East), growth originates less from agriculture, but poverty, hunger, and undernutri- tion remain largely rural phenomena. In these econ- omies, growth in agriculture and the rural nonfarm economy is important for poverty reduction. In urbanized economies (mostly in Eastern Europe and Latin America), agriculture makes a smaller contribution to growth, and urban poverty is start- ing to exceed rural poverty. In these economies, agriculture functions much like other competi- tive sectors, such as manufacturing, even though it may predominate in some areas.61 Eliminating hunger and undernutrition in these urbanized countries will depend more heavily on targeted nutrition and social protection programs. In large countries such as India and Mexico, different states may exhibit different economic structures, fur- ther emphasizing the need for strategies tailored to local circumstances. HOW WE CAN MOVE FORWARD Concerted actions by all stakeholders, including national governments, donors, civil society, and the private sector, are needed to eliminate hunger and undernutrition by 2025. The positive experiences of successful countries suggest that we can aspire to achieve this goal if sufficient resources are allocated and appropriate policies and investments are pur- sued. The sustainable development goals that will eventually be agreed upon must be ambitious, prag- matic, and time-bound; have clear objectives; and be facilitated by a global and inclusive partnership. This partnership should be characterized by clearly defined roles and responsibilities in order to increase accountability and avoid duplication of effort. Approaches to accelerating the pace of hun- ger and undernutrition reduction include the following: X Country-led strategies and investments. As the country experiences show, national ownership of strategies and policies is important. Poli- cies aimed at ending hunger and undernutri- tion should be country led in order to be well adapted to the local context, highly effective, and sustainable, as shown by China’s par- tial and sequenced liberalization of markets. Beyond setting the direction of strategies for ending hunger and undernutrition, national governments must allocate adequate budgets to strategies that support more inclusive growth, including growth in viable smallholder agricul- ture; well-targeted social protection programs linked to improved food and nutrition out- comes; and specialized nutrition interventions. One global initiative that promotes country-led actions is the Scaling Up Nutrition Movement, which brings together governments, civil soci- ety, the United Nations, donors, businesses, and researchers to make improving nutrition a priority in countries’ policy actions. Countries that join the Scaling Up Nutrition Movement are expected to create a coherent policy and legal framework for nutrition policies, work in partnership with stakeholders, agree on com- mon objectives, and mobilize resources for scal- ing up nutrition. X Evidence-based policies and policy experiments. National strategies should be guided by evi- dence. Pilot projects and policy experiments The positive experiences of successful countries suggest that we can aspire to achieve this goal if sufficient resources are allocated and appropriate policies and investments are pursued. an ambitious dEvElopmEnt goal 25 are important to provide decisionmakers with information on what investments and processes work before they scale up successful policies and programs. Experimentation contributes to proper design, sequencing, and implementation of country strategies. X Knowledge sharing and transfer. Insights on pol- icy, institutional, and technological innovations carried out by successful countries can provide some guidance in designing national strategies to reduce hunger and undernutrition. Successful countries should engage in knowledge sharing with other developing countries. X Data revolution. Reliable and timely data on rel- evant indicators of hunger and undernutrition at the global, national, and subnational levels are Ending Hunger and Malnutrition: Holding Those in Charge Accountable LAWRENCE HADDAD Despite significant global progress in reducing the number of hungry and malnourished people,1 in Africa south of the Sahara and South Asia high levels of hunger and malnutrition remain a stubborn and tragic stain on the fabric of a thriving and vibrant world. The goal of eliminat- ing hunger and malnutrition sustainably by 2025 is an inspirational one because it stretches us, and yet, as several country experiences have shown—most notably in Brazil and China—we can get close to it. Meeting this ambitious goal will require the right policies and programs, the right investments, and a supporting legal frame- work. In addition, these commitments need to be monitored to guide action and to hold duty bearers to account. The world’s hungry and malnourished people cannot solve their plight on their own; they need support from their own governments and from the international community. Who can they count on, and how do they know whether those actors have deliv- ered? Who should they hold accountable, and how should they do this? Improving accountability will require measuring outcomes using credible data on hunger and malnutrition. Currently, the data on hunger are abundant, but their quality needs to improve. The data on malnutrition are more reliable but too infrequent. Yet it is not enough just to measure outcomes, because outcomes are determined by a range of more controlla- ble and less controllable factors. The ones that governments (and other key actors) can control should be made transparent and monitored carefully. The Hunger and Nutrition Commitment Index,2 from the Institute of Development Studies in the United Kingdom, is one way of comparing the commitment of different governments in terms of poli- cies, spending, and legislation designed to reduce hunger and malnutrition, and thereby of improving these governments’ accountability to their populations.3 The index ranks 45 countries that have high levels of hunger and malnutrition and for which data on commitments are available. It finds that the countries with the high- est burden of hunger and malnutrition are often, but not always, the ones with the highest commitment to doing some- thing about that burden. It also ranks donor countries and finds that some of the best donor performers (in terms of official development assistance as a share of gross national income) are some of the least committed to hunger and malnutri- tion reduction. It is important to collect data on these commitments as well as their outcomes. Equally important, accountability at the subnational level in countries affected by hunger and malnutrition needs to be improved—in this way, the relationship between the state and civil society around these issues can be strengthened. New methods and tools of accountability are being developed. These include real-time monitoring of program coverage using mobile technologies, subnational Hunger and Nutrition Commitment Index scores, social accountability mechanisms such as community scorecards, and better ways of diagnosing constraints on national strate- gies for reducing hunger and malnutrition to help clarify how programs should be sequenced and prioritized.4 We often hear the food and nutrition community lament that hunger and malnutrition are every- one’s business but no one’s responsibility. Through stronger accountability mecha- nisms we can promote everyone’s respon- sibility for ending these twin scourges. Lawrence Haddad is director, Institute of Development Studies, Brighton, United Kingdom. 26 Ending HungEr and undErnutrition by 2025 urgently needed for evidence-based policymak- ing. Providing these data should be a collabo- rative effort by international organizations and national and regional governments. To support this effort, data collection and analytical capac- ity in developing countries (particularly in terms of statistical infrastructure and human capital) need to be improved significantly. X Enhanced role of the private sector. The private sector has the potential to bring to bear sustain- able solutions to ending hunger and undernutri- tion, provided the right conditions and incentive structures exist. Recently, the private sector has stepped up its actions and commitments to improve food and nutrition security in a number of ways. Through the New Vision for Agriculture, the private sector is engaging in public-private partnership programs (such as the Grow Africa Initiative) in 11 countries. Clear monitoring and evaluation systems and regulatory mechanisms are needed to ensure that the private sector can take an even larger role in ending hunger and undernutrition. Ending hunger and undernutrition by 2025 should be a top priority in the post-2015 develop- ment agenda. This not only makes economic sense but should also be considered a global ethical duty. To achieve this goal, it is crucial to promote coun- try-driven strategies, build on evidence and past experiences, allow for the sharing of ideas, enhance and expand partnerships, and employ integrated approaches. ■ Ending hunger and undernutrition by 2025 should be a top priority in the post-2015 development agenda. an ambitious dEvElopmEnt goal 27