1. Re-Positioning Nutrition HDNHE Nov 2005

2. Malnutrition Poverty Leads to a >10% potential reduction in lifetime earnings for each malnourished individual GDP losses 2-3% Malnutrition (stunting) in early years linked to a –4.6 cm loss of height in adolescence –0.7 grades loss of schooling –7 month delay in starting school Source: Alderman et al (2003) (Improved nutrition can be a driver of growth)

3. Source: Haddad et al (2003)

4. India: Income alone is insufficient to reach the nutrition MDG Data Source: World Bank (2005) 2059 2034 2020 MDG will be met in

5. Nutrition and poverty… Source: Gwatkin et al. 2003

6. MDG 1- Eradicate extreme poverty and hunger Targets: Halve between 1990 and 2015 –Proportion of people income is <1$/day (income poverty) –Proportion of people who suffer from hunger (non-income poverty) Indicators for hunger (non-income poverty) target: –Prevalence of under-weight children (<5 yrs) –Proportion of population below minimum level of dietary energy consumption Most reviews to-date have focused on income-poverty target – and the diagnosis is: poverty goal on track!!!

7. Progress on non-income poverty (nutrition MDG)

8. The Copenhagen Consensus ranks the provision of micronutrients as a top investment… Above trade liberalization, malaria, water/sanitation… Source: Bhagwati et al. (2004) …And the benefit:cost ratios for investing in direct nutrition interventions are very high.

9. Global trends in underweight (Children 0-4 Years) 1980-2005 Data Source: de Onis et al (2004)

10. Global trends in underweight (Children 0-4 Years) 1980-2005 Data Source: de Onis et al (2004)

15. Maternal Overweight Rates Data Source: Measure DHS com; Authors calculations Malnutrition affects both poor and rich countries…and Underweight children and overweight adults are often found in the same poor countries/households

16. The Window of Opportunity for Improving Nutrition is very small…pre-pregnancy until 18-24 months of age Source: Shrimpton et al (2001)

17. FOODHEALTH CARE

18. Malnutrition and Child Mortality Malnutrition is implicated in >55% under-5 deaths – a proportion unmatched by any disease other than the Black death.

19. Short and Long Routes to Improving Nutrition Long routes… income growth, womens education, agriculture and food production interventions, gender interventions Short routes: Exclusive breast-feeding, appropriate complementary feeding, ante-natal care for mothers,… (Knowledge, behavior change/demand side interventions); micronutrient supplementation/fortification Many success stories via a balance between long and short routes: Mexico, Bangladesh, Madagascar, Thailand, Honduras, Chile, Cuba…

20. Why Invest in nutrition? Malnutrition reduces intelligence & productivity; slows economic growth; constrains poverty reduction Benefit-cost ratios are high The Bank now has sufficient experience and evidence (though learning thru strong M&E must continue) The greatest challenge to scaling up is sustained country (and donor) commitment and capacity

21. The Bank is the largest investor in nutrition globally But, c urrent commitments to nutrition* are modest (April 2005) This is 3.8% of HD theme, 0.7% of Bank-wide lending; *Includes food security

22. Nutrition Not just a welfare issue Nor is it primarily a food or a consumption issue It is one of the drivers of economic growth

23. Summary recommendations... One size does not fit all! Focus on poor to address non-income poverty Focus investments on window of opportunity ( pre-pregnancy to 2 years) Balance between supply and demand-side, long and short route interventions Invest in micronutrients (where appropriate) Maximize potential to improve nutrition thru policies/progs in: –Health, ARD, gender, water/sanitation, education, CDD –Systematic PSIAs for Macroeconomic and sectoral policies

24. Next steps: Re-position nutrition A Bank-led re-positioning of nutrition timely Operational level (regions): Scale up undernutrition and micronutrient investments Reorient existing large-scale investments as needed Invest in strengthening commitment and capacity Support learning by doing: –Overweight/obesity/NCDs; Nutrition in HIV –Mainstream nutrition in to PRSPs/PRSCs/SWAps