According to new research published in The Lancet, early childhood nutrition has even more impact on an individual's lifetime health, education, and earning potential than previously thought. The journal published a series of five reports on the topic. They are available for free download. I recommend the executive summary, which is only 12 pages long and gives most of the key findings.
The fourth and fifth articles discuss the global and national systems for improving early childhood nutrition. They are worth reading, but don't expect to find anything earth shattering. The four recommendations to the international community are: 1) stewardship of national programs, 2) mobilization of financial resources, 3) direct provision of nutrition services when local organizations are unwilling or unable to do so, and 4) human and institutional resource strengthening. All of these things are already happening, and make up a large part of overall health sector development activities.
To be fair, The Lancet isn't claiming that these are original ideas, they are all apt suggestions, and it is reiteration of important points is often justified. Two things that struck me:
1) The journal argues that increased resources are due to nutrition. A particularly useful point made is that the world community spends approximately $250-300 million each year on nutrition, but $5.7 billion on HIV/AIDS, even though they are approximately equal in terms of Disability Adjusted Life Years (DALYs) lost. (A DALY is a public health statistic used to compare the relative severity of health problems.)
This argument isn't enough to justify equal emphasis of HIV and nutrition, but the disparity between the two funding amounts is staggering. As a small step towards correcting it, the Gates Foundation has donated $38 million to the Global Alliance for Improved Nutrition to increase public-private partnerships for nutrition.
2) The third recommendation (direct provision of nutrition services) is accompanied by a caveat that it is a distant second choice to national governments handling the problem with their own systems. I doubt they will get much disagreement there. But if the articles have a central argument I think it is that childhood nutrition deserves to be treated as a health emergency. That means vigorously addressing immediate problems while laying the groundwork for sustained activities.
Doing this will require a large scale service provision by the international community in many of the countries named in the report. If their systems were up to the challenge they would be doing better. Making this balance is a tricky thing and aid agencies are pretty bad at it. The decision to go ahead can be justified, but it isn't as simple a call as The Lancet makes it out to be.
