A Development Investment for the Ages

 Bjørn Lomborg 

PRAGUE – Malnutrition receives less attention than most of the world’s other major challenges. Yet it is one area where a relatively small investment can have the most powerful impact.

An estimated two billion people do not receive the essential vitamins and minerals they need to grow and thrive – notably, iron, iodine, vitamin A, and zinc. Worse, malnutrition and undernutrition are part of a cruel cycle, in that they are both causes and effects of poverty.

This cycle disproportionately affects infants and young children, who suffer devastating consequences from malnutrition, including mental impairment, difficulty learning in school, and poor health generally. Even moderate nutritional deficiencies can hinder a child’s development. And because it is harder for that child to get a good job when he or she grows up, malnutrition shapes not just his or her life, but also the lives of the next generation.

Ideally, nutrients should come from a balanced, varied diet. But because this is not always possible, particularly in poor countries, governments and development organizations have a responsibility to help.

For more than a decade, my think tank, the Copenhagen Consensus, has studied and compared development options for governments and donor organizations operating at a global, regional, and national level. We work with the world’s top specialist economists, including Nobel laureates, to determine the best ways to fight humanity’s biggest challenges.

During this time, we have shined a spotlight on a wide range of important causes. For example, in 2004, our research made the case for stepping up the fight against HIV/AIDS, which then became a priority of the Danish government. And last year, Colombian President Juan Manuel Santos declared that our research into biodiversity was the reason for quadrupling the size of a marine reserve off his country’s coast.

Still, investments designed to fight “hidden hunger” or micronutrient deficiencies have consistently ranked near the top of our priority lists. The evidence clearly shows that breaking intergenerational cycles of poverty and undernutrition is one of the most powerful ways to improve lives anywhere on the planet.

In both 2008 and 2012, Copenhagen Consensus projects focusing on global development priorities concluded that policymakers and philanthropists should make fighting malnourishment a top priority. In each of these projects, experts wrote dozens of research papers examining how best to spend resources on a variety of issues, from armed conflict and biodiversity destruction to infectious disease and sanitation.

Even with dozens of compelling investments to choose from, Nobel laureate economists poring over the data found that measures to combat malnutrition were among the most powerful options. The 2012 study demonstrated that an investment of just $100 per child could pay for a bundle of interventions – including micronutrients, diet-quality improvements, and behavior-change programs – that would reduce chronic undernutrition in developing countries by 36%. In other words, each dollar spent reducing chronic undernutrition – even in very poor countries – would create returns to society worth $30.

The 2012 study had a tangible impact. The following year, a coalition of non-governmental organizations pledged more than $750 million for nutrition programs, based partly on our findings. Similarly, former British Prime Minister David Cameron cited the same research at a 2013 meeting on “Nutrition for Growth,” when G8 governments committed to spending $4.15 billion more on the fight against malnutrition.

What’s true at a global level is also true for many countries. The two most recent Copenhagen Consensus projects focused on Bangladesh and Haiti. In Bangladesh, 30,000 children die every year due to malnourishment. We called for more investments in targeted interventions that reach children in their first 1,000 days; and in a promising development, our research factored into Bangladesh’s Second National Plan of Action for Nutrition.

In Haiti, the government, with support from USAID, has just launched the country’s first food-fortification project. Fortification helps many people at once, because it involves adding nutrients to foods that are widely consumed – such as staples (wheat, rice, oils) or condiments (salt, soy sauce, sugar). It is just one weapon in the fight against malnutrition – the arsenal also includes education and targeted initiatives such as providing supplements to mothers and newborns – but a very important one.

Fortification isn’t a new idea. Most people living in rich countries benefit from it whether they realize it or not. In the early twentieth century, salt iodization began in Switzerland and has since been implemented across the world. Vitamin A-fortified margarine was first introduced in Denmark in 1918. And in the 1930s, vitamin A-fortified milk and flour enriched with iron and B vitamins were introduced in a number of developed countries. At this point, fortification is almost universal in the developed world, yet it is still absent in many low- and middle-income countries.

Haiti’s fortification project will focus on enriching wheat flour with iron and folic acid, vegetable oils with vitamin A, and salt with iodine. After we presented our findings to Haitian President Jovenel Moïse, he took steps to require that all wheat be fortified with vital micronutrients within one year. And during the launch of the new program, one US official cited Copenhagen Consensus research to show that fortification is “one of the most efficient investments in Haiti’s development.”

A research paper by Stephen Vosti of the University of California, Davis, and colleagues shows that 95% of Haiti’s wheat flour could be fortified for a decade with an investment of just $5.1 million in premixed micronutrients, equipment, and training. This relatively small investment would deliver extraordinary benefits, not least by preventing 140 neural-tube-defect deaths and more than 250,000 cases of anemia every year. In monetary terms, each dollar spent would accrue benefits to Haitian society worth $24.

There is no panacea for all of today’s development challenges. But policies to improve nutrition come closer than most. They have the potential to end a cruel cycle of poverty and malnourishment that can last for generations./ /project-syndicate