Time for Hidden Hunger to Come Out of the Shadows

We always knew that vitamin and mineral deficiencies were prevalent. Ever since my university years in the early nineties, the field estimated that globally 2 billion people suffered from vitamin and mineral (micronutrients) deficiencies. A number so high that it was hard to imagine, particularly since the condition can be so invisible.

Unlike hunger or overweight, people with micronutrient deficiencies can look perfectly normal.  But these micronutrients, which our bodies need in only tiny amounts, are critical for proper growth, immune function and cognitive development.  Deficiencies in these nutrients have devastating, irreversible, and lifelong consequences for growth, health, and wellbeing – hence micronutrients are clearly Mighty Nutrients.

Remarkably, in all these years, no efforts have been undertaken to confirm if we have been successful in addressing this astronomical number. Not until today, that is. This week, research published in Lancet Global Health1 conducted by a group of micronutrient experts presents the first rigorous assessment of global levels of micronutrient deficiencies in women and children under the age of five.

The data are shocking: the prevalence of micronutrient deficiencies among women and children under five is even higher than we thought before.

Micronutrient Deficiencies Among Preschool-Aged Children and Women of Reproductive Age Worldwide

One out of two children and two out of three women of reproductive age suffer from micronutrient deficiencies. In some countries in Sub-Saharan Africa and South Asia this number is as high as 90%.  And the problem is not limited to low-income countries.  The authors report the prevalence of at least one micronutrient deficiency in high-income countries such as the United States and the United Kingdom reaching upwards of 30% and 50% of women, respectively.

Hidden Hunger, truly, is a global problem. 

The bad news is that all these numbers are based on surveys done before 2020. Since then, the world has faced an accumulation of crises that has further weakened global food and nutrition security.

The COVID-19 pandemic, climate change and conflicts have led to a surge in the number of people at risk of micronutrient deficiencies, simply because they cannot afford healthy diets with sufficient nutritious foods rich in micronutrients. New data suggest that climate change is further adding to the challenge: elevated CO2 levels impact the micronutrient content of food crops and reduce yield, further limiting  micronutrients for those that need it the most.

The implications for billions of women and children are dire. Micronutrient deficiencies in early life have irreversible, life-long, adverse effects on health and development that will affect the future of these women and children, their communities, and society as a whole.

And yet, we know what to do to prevent this. Unlike other persistent challenges in the fields of health or nutrition, we have strong and consistent evidence on a suite of highly cost-effective interventions: food fortification in populations that are nutrition-insecure, biofortification and micronutrient supplements and interventions.  In addition, clear opportunities exist that can improve the access and affordability of nutritious foods and can support the development of climate-resilient nutritious crops.  But it has proven difficult to translate this knowledge into effective policies, actions and progress. 

Why is this? Why is there so little discussion about the importance of investing in micronutrient security?  

  • First, investments have lagged and, thereby, micronutrient interventions have yet to be fully integrated into multi-sectoral approaches across food, health and social protection systems. 
  • Second, several successful micronutrient interventions may have become the victim of their success. In many low- and middle-income countries, salt iodization and vitamin A supplementation programs have successfully and significantly reduced the manifestations of goiter, iodine deficiency disorders, and vitamin A deficiency and related night blindness. This impressive achievement has led us to assume that investments in these interventions are no longer required: the prevention paradox. 
  • Finally, insufficient data on micronutrient status means that public health policymakers and planners often have to operate in the dark when trying to identify where to target interventions. Having more and better data, including national and subnational, segmented by audience, or having validated proxy indicators, would allow governments to target programs and monitor progress to ultimately increase impact and decrease costs.

We can and must turn the tide. One of the promising outcomes of the COVID-19 pandemic was the emergence of new and dynamic forms of collaboration to tackle the many complex challenges caused by the pandemic.

The Standing Together for Nutrition consortium, a multidisciplinary consortium of 35 nutrition, economics, food, and health system experts established by GAIN and the Micronutrient Forum and hosted by the Micronutrient Forum is one such example.

These consortia confirmed that together we can be so much more powerful and accelerate progress far more than alone. Fostering such collaborations is central to the mission of the Micronutrient Forum and is one of the many reasons why I love working for this organization.  Together, with our partners, we can achieve a future where Hidden Hunger is lifted from out of the shadows and help build stronger futures for billions of women and children around the world. 

By Saskia Osendarp, PhD
Executive Director, Micronutrient Forum 

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