6
INTERVENTIONS ADDRESSING THE UNDERLYING DETERMINANTS OF NUTRITION STATUS ARE IMPORTANT, BUT THEY NEED TO BE MORE NUTRITION SENSITIVE
S
IGNIFICANT AND SUSTAINED IMPROVEMENTS IN NUTRITION COME FROM COMBINA- TIONS OF NUTRITION-SPECIFIC AND NUTRITION-SENSITIVE ACTIONS AND ACTIONS that operate at the level of underlying determinants. This chapter focuses on nutrition-sensitive programs and on underlying drivers of improved nutrition status. These include food supply; water, sanitation, and hygiene; female secondary school enrollment; and availability of health care. The discussion here focuses heavily on undernutrition, and we aim to increase discussion of overweight and obesity in the 2015 Global Nutrition Report.1
First, this chapter describes trends in undernourishment and “overacquisition.”
We also report on access to improved water and sanitation facilities given the re- newed profile of these areas (for example, Spears et al. 2013).2
Second, we attempt
to highlight vulnerabilities in underlying determinants of nutrition status for different countries. Third, we review expenditure trends in sectors related to these underlying drivers. Finally, we summarize current thinking on how to make investments in the underlying drivers of nutrition more nutrition sensitive.
KEY POINTS
1. Investments in nutrition-sensitive programs and underlying determinants of malnutrition should be part of a portfolio of actions to improve nutrition status in a sustained manner.
2. With regard to food supply, as undernourishment declines, overacquisition of calories is rising. This means that the share of the population that has a healthy food supply—neither undernourished nor experiencing overacquisition—remains constant instead of increasing.
3. Access to improved water and sanitation services is steadily improving, but there are large coverage gaps in Eastern, Western, and Middle Africa for water and in Southern and South-Eastern Asia for sanitation. Girls’ secondary education enrollment is increasing steadily, exceeding 50 percent in Africa. Health worker population density remains very low in Africa and is half the rate of Asia.
4. Fifty-nine of the 100 countries that have data are relatively vulnerable (below the 25th percentile for all countries with data) on at least one of the underlying determinants. Thirty-five are relatively vul- nerable on three to five of these underlying determinants. Here there is a particular need to get the balance of investment right among nutrition-specific actions, nutrition-sensitive actions, and actions addressing more general underlying determinants.
5. Different countries have different vulnerabilities. Each underlying determinant is most important for a different set of countries.
6. Government expenditures on broad categories that can support improvements in nutrition status— agriculture, education, health, and social protection—vary between regions and within regions. Social protection spending is increasing rapidly in many African and Asian countries, providing an opportu- nity to incorporate nutrition into those programs.
7. The evidence base is getting stronger but is still weak on how to make interventions that address un- derlying determinants more nutrition sensitive. Drawing on the current evidence base, the report offers some ideas for agriculture, social protection, education, health, and water, sanitation, and hygiene.
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