Hunger Food Security and Nutrition in the Post 2015 Development Agenda
Statement by Mark Suzman, Managing Director, International Policy, Programs & Advocacy
Bill & Melinda Gates Foundation
High Level Consultation on Hunger, Food Security and Nutrition in the Post-2015 Development Agenda
Madrid, Spain, April 4, 2013
The Millennium Development Goals (MDGs) have become a central framework to guide global development efforts. Endorsed by every UN member state, they have helped align actors and focus donors and developing countries on many of the basic ingredients needed to improve the lives of the poorest. The deadline associated with the goals, the specific targets attached to each goal to measure achievement, and the “compact” that both rich and poor nations have coordinated roles to play in achieving the MDGs, have led to a degree of public awareness and support, and a seriousness of effort on poverty reduction, that is unprecedented.
Given this success, the foundation is pleased to see such strong interest in the post-2015 agenda and the robust discussion about how to ensure that people are healthy and productive. The centrality of food insecurity, hunger and extreme poverty in the MDG framework was clearly recognized when they were placed first in the set of eight goals.
The triple challenges of hunger, malnutrition, and poverty remain central today, but the context for development has experienced significant changes since the Millennium Summit in 2000.
The financial context has changed. Many countries are successfully growing their economies, moving into or higher within middle income status, though still with large pockets of extreme poor. Domestic resource mobilization is increasing in most developing countries, though not always translating into pro-poor investments. New donors—public and private—have joined the landscape, while fiscal constraints in traditional donors pose big threats to a significant source of support for global development programs.
Some issues have risen to greater prominence. Resource constraints and environmental threats are an increased concern as global environmental negotiations have stalled and failed to catalyze significant changes in production and consumption patterns. This has particular relevance for food and agricultural systems, given their immediate proximity to the environment and the imperative of feeding a growing global population. The importance of political leadership and good governance is even more apparent as we learn both from good performers and those that are failing to turn their assets into productive investments for the well-being of all.
We need to find ways to better address these challenges. This means utilizing and re-animating the existing forums we have to address climate, biodiversity, trade, investment rules, and so on. This is challenging as the political context has also changed. The world is more multi-polar and long-standing models for forging political momentum (e.g. the G8) no longer hold as much sway. Global agreement will be more difficult to secure, particularly on issues that impose real costs. Governments will be paying keen attention to what they are endorsing.
How do we move forward?
Since the MDGs have garnered universal endorsement, there is a temptation to use the post-2015 discussion as the platform to move forward on these global concerns without critically examining: What is the purpose of agreeing to goals, and are time-bound, specific goals and targets the right tool to tackle all of these issues?
Addressing extreme poverty, hunger, malnutrition and the main factors that contribute to their reduction should be our first order of business, the global community’s top priority. The MDGs helped advance this agenda. The purpose of agreeing to successor goals after 2015 is to extend and finish this agenda, setting specific outcomes to significantly reduce extreme poverty, hunger, malnutrition and their contributing factors and manifestations (such as lack of agricultural productivity or higher stunting rates), particularly among the poorest and most vulnerable populations, that the global community collectively sets its will to achieve. The overall vision for what the goals themselves will contribute to can be laid out in an overall framework or vision statement. The Millennium Declaration in 2000 helped set the overall vision for the world we want, encompassing wider issues of peace, security, human rights, and good governance that set out the wider context in which the more concrete MDGs, which sought to measure progress in specific areas of development, were to be situated.
The resulting global goals are a time-bound, limited set of the most critical priorities that require (and can secure) global cooperation and for which concrete targets could be set and progress could be measured through clear indicators. Their simplicity and clarity have also resonated with the public, both making them an effective advocacy rallying cry and making it easier to track and push for governmental accountability for their achievement. We need to preserve these core principles for the next goals – as the Issues Paper rightfully recognizes – while also coming up with a system that allows countries, or groups of countries, to customize their own additional national or regional priorities, goals, and targets. Global goal-setting isn’t meant to preclude this, but rather to set shared global priorities that require action from many countries and actors, and for which these actors can be held accountable to deliver.
Post-2015: Poverty, Hunger, and Malnutrition
Today, three quarters of the world’s poorest people get their food and income by farming small plots of land. Despite considerable success in meeting the poverty reduction target ahead of 2015, nearly one billion people worldwide are still affected by poverty, severe hunger, and diets that do not provide for their minimum nutritional requirements, most of whom are in Sub-Saharan Africa and South Asia. If we are to help them on the pathway to prosperity and food and nutritional security, we must focus on helping family farms—most of whom are led by women—sustainably increase their productivity. When farmers grow more food and earn more income, they are better able to nourish their families, send their children to school, provide for their family’s health, and invest in their farms. The post-2015 agenda needs to take into consideration their needs and challenges.
With the global population set to increase by a billion people between now and 2030, it is estimated that the world will need to increase food production by at least a third to keep up with demand and changing dietary preferences. Adding to this complexity, farmers face increasing environmental degradation and constraints on land and water that pose serious challenges to gains in productivity. It is estimated that climate change could reduce agricultural productivity in Africa between 17% - 28% by 2080. With a dwindling amount of uncultivated land—much of what little remains is in Africa—farmers will have to grow more with less land, water, and other inputs while preserving natural resources for future generations.
The foundation recommends the inclusion of an agricultural productivity target in the post-2015 development framework, with a strong focus on small-holder farmers and sustainability. Tackling extreme poverty and hunger were placed at the top of the MDG list. However, agricultural productivity—one of the clearest pathways to reduce both poverty and hunger—was never an explicit target in the MDG framework. History has shown that growth in the agriculture sector is shown to reduce poverty two to three times faster than any other sector in the economy. Higher agricultural productivity results in greater food availability—the necessary condition to combat hunger—and when coupled with interventions to optimize diet and health care practices is key to reducing stunting and other forms of undernutrition.
Without agricultural productivity increases, led by small-holder farmers in South and East Asia during the ‘Green Revolution’, it is unlikely that we would have seen the Asian economic transformation. The Green Revolution doubled food production and saved hundreds of millions of lives, but also produced unintended consequences, notably to the environment and a rise in rural inequity. Sub-Saharan Africa, a region that missed the productivity gains of the Green Revolution, has seen higher rates of poverty, hunger, and malnutrition. In the last decade however, Africa’s agricultural output has helped fuel overall economic growth, which is a result of effective policy, investment and partnership with donors and private sector. An ambitious, but achievable, productivity target can help focus greater attention and resources to agriculture to sustain food production increases in the region.
Any post-2015 agricultural productivity target would need to be aimed toward small-holder farmers, who account for a large portion of global production as well as poverty. To achieve substantial reductions in poverty and promote inclusive growth, such a focus would be essential. Equally important, the environmental consequences of agricultural intensification need to be addressed proactively.
Addressing the Unfinished Nutrition Agenda
The face of malnutrition is changing. While significant progress in reducing underweight has been achieved in many regions of the world, this condition is still the leading cause of death and disability among children under five. Notably, since 1990, stunting has surpassed underweight as the most prevalent nutritional challenge, affecting 165 million children worldwide. Stunted physical growth goes hand in hand with stunted brain and cognitive development, hampering nations’ abilities to grow and transform economically.
The foundation recommends inclusion of a stunting reduction target in the post-2015 development framework, with consideration of other nutritional targets within health-specific development goals. Reducing malnutrition in all its forms will contribute to eliminating preventable maternal and child deaths and to building smart, strong and resilient individuals, families, communities, and populations. This unfinished agenda requires greater focus and attention in the successor framework to the MDGs.
Although global rates of stunting have declined by 36% over the last 25 years, the number of stunted children is rising in sub-Saharan Africa. In addition, today there are 52 million children suffering from wasting, with reduced numbers in Asia but increases in Africa, yielding little improvement globally since 1990. Low birth weight, sub-optimal breastfeeding, and anemia have remained relatively stagnant, while the number of overweight children has doubled since 1990, reaching 43 million in 2010.
It is now recognized that we do not live in two worlds, the wealthy suffering from overweight and the poor from undernutrition. Today, it is often the same households, families, and at times the same individuals who suffer from multiple forms of malnutrition. Exposed to poor and micronutrient-deficient diets, children stunted in early life are at heightened risk of becoming overweight, with subsequent increased risks for numerous non-communicable diseases later in life. Furthermore, evidence has emerged in the last decade firmly establishing that adequate nutrition in the 1000 days from conception through 2 years of age is a key driver of economic and social development and not solely one of its outcome measures.
The post-2015 development agenda also provides an opportunity to recognize linkages across the nutrition and agriculture sectors, and the potential of coordinated approaches that are highly effective in combating multiple development challenges. Nobel Prize-winning economists agreed in the 2012 Copenhagen Consensus, for the second time, that nutrition—bundled with agriculture interventions such as bio-fortification of crops and improving household consumption practices—was the top priority investment for policy-makers.  Thus addressing agricultural productivity, nutrition, and effectively exploiting the links between both can help further catalyze progress against extreme poverty, hunger, and malnutrition in the post-2015 development agenda.
What might agricultural productivity and nutrition targets / indicators look like?
Targets should be ambitious, but technically feasible, as with the current MDGs. While ambitious, to varying degrees the current targets were set within reach at the global level. This made the MDGs different: they are not pie-in-the-sky aspirational targets of the kind the UN was too often prone to embrace in the past with little hope of achievement, but are concrete and at the global level, largely achievable.
Governments feel accountable for achieving the MDGs. That is what has led to many developing countries actively allocating resources against “MDG priorities” in their budgets, adopting target acceleration frameworks to try to achieve the goals, and sometimes even adding their own additional goals. Purely visionary targets without a chance of achievement would have been much easier for governments to ignore – and indeed have routinely ignored over the decades. This is something we should keep in mind as we assess proposals for goals, targets and indicators for agriculture, nutrition, hunger, and food security.
For agriculture, an ambitious but achievable global target is a doubling of the rate of sustainable productivity growth by 2030. Such a target would help ensure enough food availability for a growing global population in the context of several constraining factors, such as the negative consequences of climate change on agriculture, limited arable land and the like. It would also help catalyze dramatic reductions in extreme poverty and hunger, under the right conditions.
The global productivity target would need to account for geographic variation at the regional and national levels. For Sub-Saharan Africa, the regional target would need to be a tripling of the rate of sustainable productivity growth by 2030, since nearly 60 percent of the global population increase will occur in that region, requiring substantially higher rates of food production. A specific set of indicators that are measurable, and if achieved, would track to higher agricultural productivity can be developed to ensure greater accountability and more effective monitoring. For instance, investments in agricultural research have consistently been shown to provide high rates of social and economic return.
There are several ways that nutrition could be addressed in the post-2015 framework. Although many may argue for a standalone hunger, nutrition and food security goal, we believe that the best approach is a ‘horizontal one’ that incorporates key nutrition indicators into health, hunger, and poverty reduction goals. This approach recognizes the foundational role that nutrition plays in human health and cognitive development, as well as the contribution other sectors to improved nutrition.
Among potential indicators of malnutrition, childhood stunting is the highest impact indicator, based on its power to capture inequity and chronic conditions of poor health, diet and caring practices during the crucial 1000 days from pregnancy through age 2 of a child’s life. An ambitious but achievable target would be a 40% reduction in the number of stunted children by 2030. This would require a nearly 4% reduction in stunting per year, a rate that has already been achieved by countries making significant investments in agriculture, health, sanitation, and nutrition. Country-specific annual rate of reduction targets will be required to meet this target and devising country-specific strategies has already begun through the Scaling up Nutrition (SUN) movement. Other important indicators could be considered such as those endorsed by the 2012 World Health Assembly, with targets that are achievable with scale up of proven interventions:
- 50% reduction of anemia in women of reproductive age
- 30% reduction of low birth weight
- No increase in childhood overweight
- Increase the rate of exclusive breastfeeding in the first 6 months up to at least 50%
- Reduce and maintain childhood wasting to less than 5%
As with stunting, country-specific plans are required to put nations on the pathway to achieving these targets, which if met would represent significant improvement in the lives of billions around the world.
Fine-tuning post-2015 goals: customization, disaggregation, and indicators
Customization: New global targets that aggregate progress at the regional and national levels are needed to rally the global community. However, learning from the current MDGs, where global targets were de facto applied to all regions and countries regardless of starting points, there should be more explicit customization and tailoring for regional and national contexts. This could be done through a transparent process at each level. The UN and other development actors could provide technical help and for example, work with countries and regional groupings to assess and learn from the high-performing countries that started from similar rates, or had similar income, spending, or capacity levels, to help fine-tune ambitious but realistic national targets. One such opportunity will arise next year when the African Union renews its Maputo pledges around the ‘Year of African Agriculture’. This will be a crucial moment for the UN system, led by the Rome Based Agencies, to work with the AU to endorse the regional productivity target and a robust results framework that can help achieve it.
The need to customize and move away from “one size fits all” targets also raises challenges with visionary absolute targets that call for the elimination of hunger and stunting that all countries would be expected to achieve. For worse-off countries, the targets are not realistic and if interpreted to apply to them, will set them up as failures, even if they make dramatic absolute or relative improvement from their starting point. Indeed, the top 20 best performers in terms of absolute progress on the MDGs include 10 sub-Saharan Africa countries, while just three make the top 20 relative performers list.
Disaggregation: As others have noted, MDG progress is based on averages, and much valuable research has shown that vulnerable and excluded groups (this includes rural communities, ethnic minorities, the poorest quintiles, farming families) have typically not experienced progress in the current MDG period. In the next development goals’ time frame, the global community needs to find ways of ensuring that the most vulnerable benefit. As most of the vulnerable and the poorest tend to live in rural communities, an agricultural productivity target that focuses on small-holder farmers, will help ensure greater equity and enhance the prospects of inclusive growth. That is the reason why the foundation would like to stress appropriate disaggregation of productivity growth among various food producers – from small-holder farmers to large-scale commercial farms.
At the level of indicators, there is also fine tuning that can be done once the overall goal and target architecture is agreed. The foundation’s program teams look forward to helping inform that discussion when it moves forward. As an early input, some guiding parameters might include:
- Flexibility and customization. The tools and tactics we use to address agriculture and nutrition outcomes will change as we learn what works and as new tools become available. They may also be country-specific.
- Focus. Focus on those indicators for which we have and can get good data, and that best reflect the output and outcome we seek to achieve. Recognize that a long list of indicators can put enormous monitoring burdens on countries, so they should focus effort on the most illuminating indicators.
- Smart proxies. Include measurable indicators that are good proxies for sustainable productivity, such as partial measures like yields per input unit or adoption of high yielding varieties. These in turn also form one impact pathway toward the productivity target that can help achieve hunger and poverty goals. The same holds true for nutrition.
The MDGs succeeded in part because they did not pretend to be the “sum total” of development. They are a set of specific goals with bold targets that the global community set its mind and will to collectively address. They are deliberately ends rather than means, and as such are not the blueprint for development. Nor do they fully represent the set of issues critical for sustainable development. This distinction is critical as we look to agree on a successor framework to the MDGs. There is a danger that in trying to create the perfect framework that fully encapsulates global development challenges, we lose the power of the goals as a global collective agreement to address some of the most egregious contributions to and manifestations of extreme poverty in the world, including preventable disease and death.
I welcome this opportunity to offer these views on the post-2015 framework and the critical space for agriculture and nutrition within it. The foundation looks forward to working with all of you to ensure that development and health keeps its deserved space on the global agenda and to crafting goals and targets that will accelerate our momentum to ensure that all people can lead productive and healthy lives.
 This statement does not necessarily represent a policy position of the Bill & Melinda Gates Foundation. A similar statement was issued at the Global Thematic Consultation on Health in Botswana on March 5-6, 2013. Given our programmatic focus on agricultural development and nutrition, the focus of this statement is on those areas.
 FAO, WFP (2013): The Issues Paper on Hunger, Food Security and Nutrition in the Post- 2015 Development Agenda
 These requirements include energy, protein, essential fats, and critical vitamins and minerals needed to fuel healthy growth, development, immune function, and productive work.
 Melamed, C., Post-2015: The Road Ahead, ODI, October 2012. Melamed’s research reveals that farmer-headed households experience the greatest poverty as measured by education, health, and nutrition (MDGs 1, 2, 4, 5, 6). This indicates that progress in future MDGs—including beyond hunger and nutrition focused areas—is dependent upon greater focus on rural farm families.
 FAO and IFPRI estimates
 Cline, William. Global Warming and Agriculture: Impact Estimates by Country , Peterson Institute (2007)
 IFPRI (2007, 2010), ‘The Asian Green Revolution’ for IFPRI: Vision 2020 and Millions Fed: Proven Successes in Agricultural Development, IFPRI: Washington DC
 Lim et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 201. Lancet 2012; 380: 2224-60.
 Stevens G, Finucane M, Paciorek C, et al. Trends in mild, moderate, and severe stunting and underweight, and progress towards MDG 1 in 141 developing countries: a systematic analysis of population representative data. Lancet 2012; published online July 5.
 United Nations Children’s Fund, World Health Organization, The World Bank. UNICEF, WHO-World Bank Joint Child Malnutrition Estimates. (UNICEF, New York; WHO, Geneva; The World Bank, Washington, DC; 2012).
 See for example, Adair L, Fall C, Osborne C et al. Associations of linear growth and relative weight gain during early life with adult health and human capital in countries of low and middle income: findings from five birth cohort studies. Published Online March 28, 2013http://dx.doi.org/10.1016/l S0140-6736(13)60103-8.
 World Bank. Repositioning Nutrition as Central for Development: A strategy for large scale action. Washington DC: The World Bank, 2006. See also Black R, Allen L, Bhutta Z et al. Maternal and child undernutrition: global and regional exposures and health consequences Lancet. 2008 Jan 19;371(9608):243-60..
 Hoddinott, J., M. Rosegrant, M. Torero. Copenhagen Consensus 2012 Challenge Paper: Hunger and Malnutrition. 2012. Available at: http://www.copenhagenconsensus.com/projects/copenhagen-consensus-2012/outcome.
 This holds for MDG1, particularly the extreme poverty target. Maternal mortality was the one clear outlier that was further complicated by the extensive reliance on modeling for maternal mortality rates.
 World Development Report (2008), Agricultural For Development, World Bank, Washington DC
 Millennium Development Goals Report Card: Measuring Progress Across Countries, Overseas Development Institute, 2010. This work received support from the foundation.
 See earlier citation from Melamed. The table on page 7 shows the results of MDG progress disaggregated by income level, rural-urban, education level, occupation, ethnic minority. The poorest, least educated, more isolated, and minorities were health, education, and nutrition poor.