Question for Short Debate
My Lords, I declare an interest as co-chair of the APPG on Nutrition for Growth. Nutrition is so foundational to human life that it intersects with almost all aspects of development policy and is therefore fundamental in delivering on the SDGs.
Unless a child has adequate nutrition, they will be unable to meet their potential in school and are more susceptible to disease. Malnutrition disproportionately affects women and girls, preventing many girls from attending school and hindering the potential of those who do. So, as welcome as it is, the Government’s objective to ensure 12 years of quality education for every girl will not be met unless we equally support nutrition. Nutrition has implications for a child’s employment prospects and therefore the economic success of their country. Good nutrition also relies on food and agriculture systems that deliver healthy diverse diets at a cost that people can afford. It is estimated that undernutrition in childhood reduces an individual’s earning potential by 10% and has the same impact on GDP rates, with a total global economic cost of $3.5 trillion.
I am sure that one area that many of the noble Lords who are speaking in this debate will focus on is climate change. Last year the UK committed £61 million to support drought-resistant crops that can withstand high temperatures, with the intention of preventing food insecurity because of climate change. While tackling food insecurity is important, unless the crops contribute to a diverse and nutritious diet, the Government will miss a gaping opportunity to really improve people’s health rather than simply keep them alive. Climate change adversely impacts food systems, but food systems also emit 20% to 30% of global greenhouse gas emissions. So how are we supporting the development of climate-smart as well as nutrition-sensitive food and agricultural systems?
The question tonight is about the Tokyo summit that will take place in December. The first summit in 2013, hosted by the UK, mobilised around £17 billion in new investments, and the UK contributed £1.25 billion. Since 2013 the number of children whose physical or cognitive growth is stunted by malnutrition has reduced by over 12 million. However, despite progress, nutrition remains one of the most pressing issues in global development. In 2018 5.3 million children under the age of five died, with undernutrition a key cause of nearly half those deaths. Some 149 million children under the age of five were stunted due to malnutrition, meaning that they will be more susceptible to illness throughout their life and unlikely to meet their educational and economic potential, as I have highlighted.
If progress is to continue, it is vital that the UK once again provides the lead at Tokyo by taking steps to better embed nutrition into UK aid’s portfolio and pledging funds at least to the same level as has been the case since 2013, or ideally making an uplift. I hope the Minister will be able to give us some positive news on the pledge, if not on the amount then at least on the timing of when a decision will be made. The springboard event in July that precedes the summit would be the ideal time to commit. A UK commitment of £800 million a year for 2021 to 2025 would represent a small increase reflecting inflation, the UK’s economic growth and the global shortfall in funding for nutrition. By taking such an early lead, we can encourage others to contribute. Other positive steps would be to ensure high-level ministerial attendance at the summit, drafting ambitious policy commitments, considering a match-funding scheme and co-financing and supporting the implementation of countries’ national nutrition plans. Is the Minster able to say tonight who will attend for the Government at both the July event and the December summit? It is vital that the Government take this seriously, since of course I know there are other commitments.
Nutrition-sensitive interventions have made up 84% of DfID’s past nutrition funding, and this should continue. Such programmes meet a number of objectives beyond nutrition—for example, economic empowerment schemes that help mothers to afford a healthy diet for their children. DfID can increase the impact of these interventions by ensuring that all teams within the department understand how nutrition affects their portfolio. I have previously raised the important issue that the implementation of the OECD policy marker for nutrition in its reporting systems would deliver on this by measuring the impact of nutrition-sensitive interventions. Two weeks ago the Minister indicated that the Government were exploring options to ensure that the policy marker was used to best effect in DfID. I hope that tonight she will be able to indicate the timescale for that assessment. It is certainly something that the Government have advocated, and they should not delay over it. Has the Minister assessed DfID’s historic nutrition programmes to determine which should be scaled up and which discontinued?
I am sure other noble Lords will mention this, but on nutrition-specific programmes we know that the promotion of exclusive breastfeeding for six months, continued until 11 months, is the single most effective way to reduce child mortality in countries with high burdens of malnutrition. What steps is DfID taking to promote uptake of exclusive breastfeeding? How are the Government working with partners to ensure better enforcement of the International Code of Marketing of Breast-milk Substitutes?
Having seen Scaling Up Nutrition programmes first hand in countries such as Zambia, I know the importance of civil society organisations in building the political will for nutrition in high-burden countries as well as holding the politicians to account. What support is the Minister’s department giving to such civil society organisations?
Finally, I know the Minister was heavily engaged in last year’s voluntary national review of the SDGs. It noted that challenges remain in the UK in measuring and addressing every aspect of household food security, highlighted of course by the 1 million people reliant on food banks. Is she confident that the UK will be able to announce progress on domestic nutrition before the summit? I beg to move.
My Lords, I thank the noble Lord, Lord Collins, for securing this important debate this evening. I strongly suspect that there will be considerable agreement with what he just said from across the House. I certainly agree with him.
Malnutrition is the main driver of illness and poor human potential worldwide and the UK has been a leader in taking action against it. We have to admit that while asking for more, as we always do. Action on nutrition is one of the most cost-effective things we can do to help us achieve the sustainable development goals and to maximise the potential of the global population. Value for money is £16 for every £1 spent on nutrition. As it happens, such action is closely linked to the other global crisis, climate change: improve one and you beneficially affect the other. The scale of the problem is enormous, as we have heard, with over 20% of children stunted and unable to reach their education potential, and very susceptible to illness.
It is, of course, children who suffer most because of their vulnerability, but it is also girls and women who are particularly susceptible to anaemia and consequently give birth to underweight babies, thereby perpetuating the problem. We have long known that if you support a woman’s health, you benefit a family, and this is a cost-effective way of benefiting the economy of fragile countries. However, we must not forget malnutrition in older people who are more likely to lack the finance necessary to feed themselves properly and who often lack influence in their community, so get forgotten. I am told that one in three older people in hospital in this country is malnourished.
It is tempting to think that malnutrition is something that happens somewhere else and is the responsibility only of the contributions of DfID. However, malnutrition includes undernutrition, shortage of micronutrients and obesity; one in three children globally suffers from one of these three, including here in the UK. Actually, I strongly suspect that it would be a good deal worse if it were not for the existence of food banks, the wonderful school breakfast initiative, the nutrient standards of school meals and the availability of free school meals. I congratulate those local authorities that ensure that children on FSM also get fed during the holidays. Although the main focus of this debate is the Government’s pledges at the Tokyo Nutrition for Growth summit, what action are they taking to address child and elder malnutrition, in all its forms, in the UK?
As we have heard, the current DfID funding for nutrition around the world ends this year. We all hope that the Minister will be able to go a little further when she replies than she did in answer to the Oral Question from the noble Lord, Lord Collins, earlier this month and say whether the Government will up their game a little and pledge £800 million a year for the next five years. Could the Minister also say what analysis has been made of the most effective nutrient-sensitive and nutrient-specific programmes so that we know that the money is being spent on what works best?
As a fellow of UNICEF, I have always been a great admirer of its child nutrition programmes. Part of that is the programme on breastfeeding which also takes place in the UK as the Baby Friendly Initiative. The wonderful thing about breastfeeding is that it helps to protect the mother from breast cancer as well as nourishing the child at minimal cost and risk. It also provides the child with valuable immunity from common diseases. Exclusive breastfeeding for six months and carrying on until 11 months could prevent over 800,000 child deaths and 20,000 maternal breast cancers. What are the Government doing both here and abroad to promote breastfeeding? To protect poor mothers from spending scarce resources on breast milk substitutes, are we providing education about the benefits of breastfeeding? I echo the plea from the noble Lord, Lord Collins, to make sure that we work with partners to ensure the enforcement of the International Code of Marketing of Breast-milk Substitutes.
Talking of working with partners, despite all we do, it is clear that the UK cannot solve malnutrition alone. However, we have already set an example and can do a lot to encourage others. Part of that would be to make the early pledge at the July event in Tokyo that the noble Lord, Lord Collins, asked for and show commitment at the top level by the presence of the Prime Minister.
What plans do the Government have to match fund or co-finance nutrition initiatives to support nutrition plans in the most fragile countries? Will the Minister commit to programmes which strengthen the resilience of food production in poor countries in the light of the effects of climate change? It is much healthier for populations to eat their own normal, fresh diet rather than have to rely on dried food brought in by aid organisations in response to famine, war or natural disasters.
Our track record on these matters is something we can be proud of, but there is much more to do. Therefore, we need the Minister’s assurance that the UK will continue to make a major contribution to tackling the scandal of child and elder malnutrition across the world and start this new decade with a major announcement in Japan in July.
My Lords, I thank the noble Lord, Lord Collins, for securing this timely and important debate. As the House is aware, we have spoken about nutrition on two recent occasions in this Chamber. The first was in the context of taking an integrated approach to UK foreign policy and development; the second was about weaving nutrition across DfID’s portfolio. I will continue on that theme, but it is the intersectional and foundational nature of nutrition that makes it so important.
I will start by talking about Gavi, the vaccine alliance, which is hosting its replenishment conference in London in June this year. Gavi aims to raise $7.4 billion from international donors to immunise an additional 300 million people between 2021 and 2025, saving up to 8 million lives. UK civil society organisations are calling for Her Majesty’s Government to retain or increase their share of Gavi funding, which is roughly 25%. I support that ask. Ensuring full coverage of all WHO-recommended vaccines will make the world a safer and more prosperous place.
However, if the UK is to spend such a large amount of money on vaccinations, it is only right that steps are taken to ensure that investment is as impactful as possible. It is well known that malnutrition reduces the efficacy of vaccines. While some vaccines may still work on a malnourished child, the timing, quality and duration of responses may be impaired. Likewise, malnutrition is often caused by vaccine-preventable diseases; additionally, malnourished people are far more likely to die from these. In short, vaccinations and nutrition are two sides of the same coin.
To accelerate action on ending preventable deaths and improving people’s health and economic prospects, the Government must invest ambitiously in Gavi, but also at N4G. In addition, they should take steps to align their objectives in both areas and across health more broadly. On that point, what steps is my noble friend the Minister taking to ensure that ready-to-use, therapeutic foods and other nutrition services are included in DfID’s wider efforts to build effective health systems? What consideration will her department’s N4G pledge give to the strategy of Gavi and other health multilaterals, in order to align objectives?
My second point covers aid and trade. Too often, a country’s ability to feed its population with a healthy diet is hindered because its fruit and vegetables are too expensive for most of the population, or are exported to wealthier nations. Conversely, companies from a range of countries, including the UK, are able to flood local markets with cheap, high-sugar foods. For example, it is worth noting that the CEO of Associated British Foods was present at the UK-Africa Investment Summit last week. ABF owns the largest sugar producer in Africa, which recently received a DfID grant to implement its land rights policies. While I am wholly supportive of that work, I urge that further DfID funding should improve employment and market conditions for locally owned companies, growing food that contributes to a healthy, diverse diet. What consideration will the Minister’s N4G pledge give to private sector engagement and international trading arrangements?
As the noble Lord, Lord Collins, and the noble Baroness, Lady Walmsley, have said, the promotion of exclusive breastfeeding for six months, continued until 11 months, is the single most effective way to reduce child mortality in countries with high burdens of malnutrition. Near-universal adoption of optimal breastfeeding could prevent 823,000 child deaths and 20,000 maternal breast cancer deaths per year. As well as being extremely high in impact, breastfeeding promotion is very low in cost. Will my noble friend the Minister ensure that the promotion of exclusive breast- feeding is made a priority in the Government’s N4G pledge? Specifically, will she commit, as has already been asked, to working with partners to ensure better enforcement of the International Code of Marketing of Breast-milk Substitutes?
As co-chair of the APPG on Nutrition for Growth, I look forward to a strong commitment from the Government. I appreciate that my noble friend he Minister is to meet APPG members to discuss this further, but what thought has she given to the International Coalition for Advocacy on Nutrition’s request that the Government commit £800 million per year to nutrition between 2021 and 2025? I look forward to hearing about a really ambitious pledge from the Government.
My Lords, I, too, welcome this timely debate. I thank the noble Lord, Lord Collins, and welcome the opportunity offered by the Tokyo Nutrition for Growth Summit.
It is moving to note, as other noble Lords have mentioned, that the number of people suffering from hunger has been increasing since 2015, albeit slowly. We know that behind the statistics lie terrible and moving stories of human suffering, disease and death, especially across Asia and sub-Saharan Africa. It is sobering to ponder on the one hand the challenge of providing a sustainable diet and preventing the lifelong consequences of malnutrition and, on the other, the striking rise in obesity across the world and consequent health problems.
Seven years ago, the UK Government exercised global leadership through the first Nutrition for Growth conference and have delivered on many of the pledges made there. I support strongly the calls made by other noble Lords in this debate for a renewal of that leadership at the Tokyo summit, for a strong United Kingdom delegation and for a generous pledge of £800 million per annum for nutrition between 2021 and 2025.
The Tokyo summit will take place just a few weeks after the key COP 26 in Glasgow, which the UK Government will host and chair. Short-term interventions to combat malnutrition are vital, but the world must also engage, as noble Lords have pointed out, with the long-term multiple linkages between poor nutrition and climate change.
Climate change is already having a negative impact on the four pillars of food security: availability, access, usage and stability. The climate emergency means that the world needs to increase spending on nutrition adaption and mitigation just to see the statistics stand still.
We see across the world the impact of extreme weather-related disasters, which have more than doubled in number since 1990. More than 70% of agriculture is rain-fed. This directly affects the ability of drought-affected countries to grow their own food, as we see currently in sub-Saharan Africa and elsewhere. Agricultural land will be lost to rising sea levels, fires and flooding.
Two years ago, I was privileged to visit one of our linked dioceses, Kimberley and Kuruman, in South Africa. It was excellent to hear reports of local feeding programmes to combat malnutrition, some supported directly by parishes in the Oxford diocese. However, those signs of hope were set against a background and a deeper narrative of concern about the climate and poor harvests.
There is increasing evidence that high ambient carbon dioxide in the atmosphere decreases the nutritional quality of important food crops, including wheat, rice and maize, affecting the entire world. The science suggests lower yields of micronutrients: protein, iron and zinc decrease as CO2 in the atmosphere increases. The changes in the climate affect agriculture. This in turn affects livelihoods, all too commonly leading to malnutrition and mass migration for a more sustainable future. There is a vicious circle here which can be broken only through a sustained global determination and action to address the climate emergency.
We have a moral imperative to love our neighbours as ourselves and to feed the hungry. We own now a moral imperative as the pioneers of the Industrial Revolution, who have gained most from fossil fuels, to lead on the fight against climate change. In this context, what consideration have the Government given to the linkage between our leadership of the COP 26 conference and the pledges we will make at the Tokyo summit in December? Will the Government continue to focus our interventions in the areas of most extreme poverty and climate change?
My Lords, I too thank my noble friend Lord Collins for instigating this debate and for the invaluable work he and others are doing in the APPG. He and other speakers have made very important points in this debate and I fear that the Minister should prepare herself to hear us all singing from the same hymn sheet—perhaps she will be minded to join in. I am also grateful to Results for its excellent briefing and for the work it is doing in the coalition.
The juxtaposition in Japan of the Nutrition for Growth summit and the beginning of the Olympic Games can have escaped no one. On display in Japan will be thousands of the elite of the elite—Olympians who spend their lives working on strict nutritional regimes to ensure that they are in peak fitness. But these Games will take place when the world will be discussing truly appalling figures of malnutrition and obesity and when the effects of climate change are becoming ever more visible.
One in three children globally suffers from one or more forms of the triple burden of malnutrition, undernutrition and obesity. The effects on children under five will be a defining factor of how they live the rest of their lives. Not only will their health suffer but the effects on their future earning potential will be reduced, with consequences for themselves as well as the societies they live in. Income and wealth inequalities are closely associated with undernutrition, with more complex patterns associated with obesity.
I pay tribute to the work of DfID and the British Government, alongside Japan and Brazil, in appreciating the scale of the problem and mobilising support in 2013 from other countries to pledge money and action to deal with this issue. I am sure that the Minister shares this view, but it would be disastrous if DfID were absorbed into the Foreign Office or if there were not a dedicated Secretary of State sitting at the Cabinet table making the case for the important development role that Britain should play across the globe. DfID was created in 1997 by the incoming Labour Government to give a voice to the voiceless at the highest level, and that is as relevant today as it was then.
The goal of eliminating malnutrition is not something one country—however good its programmes are—can solve in isolation. The money pledged at the 2013 conferences, as has been said, runs out at the end of the year and the concern of this House is that no further DfID money is currently earmarked for nutrition; momentum needs to be maintained if the goal of ending malnutrition in all its forms by 2030 is to be achieved. As noble Lords have said, nutrition underpins all the sustainable development goals, but the challenge is getting greater, with climate change impacting on world food production in vulnerable areas, especially in countries classified as drought-sensitive.
This highlights, as noble Lords have already said, how breastfeeding is crucial during the incredibly important first thousand days of a child’s life. It is one of the most cost-effective interventions for improving the health and survival of children. However, experience from NGOs such as Save the Children shows that during an emergency—such as El Niño—breastfeeding decreases at exactly the same time it is most needed. This can be due to factors such as inadequate food for the mother, lack of clean water or the sheer stress of the situation. Would the Minister take this opportunity, as other noble Lords have asked, to update the House on the steps the Government are taking to promote the uptake of exclusive breastfeeding?
It is also in emergencies that the promotion or donation of breast-milk substitutes can have a negative effect on breastfeeding rates. This is why it is so vital that nutrition objectives and sensitivity are included in all DfID programmes and investments. The code of marketing of breast-milk substitutes has had some success here in the UK. The Royal College of Paediatrics and Child Health has ceased to receive funding from BMS manufacturers, and the British Medical Journal no longer carries adverts from such companies. But bold action is required to eliminate all conflicts of interest and enforce the code. More work needs to be done to promote and support breastfeeding practices through DfID investments and to ensure that the code is enshrined in a greater number of countries. I would therefore be grateful if the Minister could say what steps the Government are taking with other donors and Governments to ensure better enforcement of the code. Perhaps she might also say whether breaches of the code still occur within the commissioning groups of the NHS.
There will be many reasons for Ministers and others to visit Japan in this Olympic year to support Team GB. However, I hope that we will send our strongest delegation to the July springboard Goalkeepers event to give a lead to other countries by pledging early support and, I hope, the £800 million a year as called for by the international coalition. We need to work with national Governments to develop, lead and finance national plans for nutrition. I look forward to hearing the Minister’s view on those points. While we will, quite rightly, fly the flag for Team GB, we should also fly the flag for the incredibly important role the British Government and DfID can play in moving the dial on achieving the SDG goal on nutrition, without which the other goals will never be achieved.
My Lords, I totally welcome the opportunity to speak in this important debate and thank the noble Lord, Lord Collins, for bringing it to the House.
When I was a DfID Minister I visited Zambia, and one day visited one of our projects where we had special practitioners talking to teenage girls about the challenges they faced, including lack of knowledge about their own bodies, contraception and sex—because their mothers never talked to them about such things—and violence against women. On leaving, I remarked to one of my private secretaries that I was rather surprised that such young children had been invited to the session—children aged six, seven and eight. She looked at me and said, “Minister, there was no one there under 12. Those girls are stunted.” That was my first experience of seeing the damage that nutritional deficit wreaks. Stunting affects brain development, making it difficult to learn or do well at school, which obviously has a knock-on effect on future life chances. In west and central Africa, the number of stunted children increased by 20% between 2000 and 2016.
The very first trip I made as a DfID Minister was to South Sudan, just after it had separated and things looked good—they have gone downhill ever since. I went to the refugee camps on the borders of Blue Nile and Kordofan, where I saw for the first time not just the sheer challenges of a refugee camp in the rainy season, but babies and toddlers being kept alive on Plumpy’nut. It was my introduction to a world where all the things we take for granted, such as food, clean water, shelter, health systems and successful agriculture just do not exist—and they do not exist in huge swathes of Africa and Asia.
DfID and governmental and NGO partners across the world were tackling—or trying to tackle—deprivation and poverty, in continents where disease, climate change, conflict, corruption and sheer poverty meant that none of these things was yet at a standard that could prevent child deaths. Lack of water, markets and a health system, and inaccessibility—there are so many factors to overcome. But the world can and must continue to fund this endeavour. International events such as the coming Tokyo Nutrition for Growth Summit are vital in so many ways: for funding, initiatives, pledges, and programmes to orientate all those involved in this endeavour to achieve the SDG targets.
Thank goodness, the UK is a world leader—an influencer. Quite frankly, the benefits to us in terms of status and soft power are immense, and we must remain so. The Nutrition for Growth commitment tracker shows that the UK has met all its commitments for 2013 to 2020. We have reached over 60 million children, girls and women. That is amazing, and we should be totally proud of our record. However, I worry when I hear rumblings from No. 10—aka Dominic Cummings—about collapsing DfID into the Foreign Office. It is already the case that, since the Lib Dems left the coalition, the DfID budget has become vulnerable to raids from other departments, which are now legitimised.
I worry even more when populist right-wing media means that the Government may try to take a wrecking ball to our aid commitments, because our international development programme is something we can and should be proud of. It sets a worldwide standard and ambition. We inspired a lead on FGM. We empower girls and women; and where women flourish, so do children and crops. We create routes to market. We support clean water provision. We empower local communities to know what to plant and how to irrigate.
In the most hostile climates and terrains, nutrition is possible. I have seen it. Cash transfers help the most vulnerable to survive the droughts and the floods that wipe away crops and livings. Our support for health systems is invaluable. How would local communities otherwise get the vaccinations they need, have safe births, treat those who need help and learn about breastfeeding, which many noble Lords have mentioned as the best start in life you can give?
I remember one particular visit to an agricultural market that we had set up to help smallholders to learn about agriculture, because bad sellers sold bad seeds that did not grow. This was an effort to educate people on how to do things. There were lessons on soil quality, how to keep water on the land, and which seeds were good and which would never flourish. Helping people to help themselves is the foundation on which a nation can survive and ultimately flourish.
One marketable product particularly sticks out in my memory. It was a product that meant you could get your cow to market in two and a half years instead of the normal seven, thus tripling the potential income of a family whose cow was its income. Lord knows what they put in the product, quite frankly, but imagine tripling your income. These are matters of life and death to the people living in these regions, so I very much hope that, at the Tokyo conference, we continue to commit to being one of the world’s leading contributors to development. As one of the wealthiest countries in the world, as we ourselves progress out of austerity, I trust we will continue to be generous, open-hearted and internationalist.
My Lords, poor nutrition is a killer. Some 2.5 million children die from it every year. If it was a newly discovered virus from China, the world would be in a state of complete panic about it—but, sadly, we are inured to such devastation among our fellow human beings. Also, as has been said by numerous speakers, stunting, wasting and even obesity limit education and economic productivity, and drive ill health and costly treatments. Annually, the global economy loses $3.5 trillion from malnutrition. So, in spite of relatively good progress in recent decades —although not so much in recent years—the world in 2020 needs to focus on this continuing blot on our landscape.
In the short time on such a broad subject, I will focus on only three points. The first can loosely be described as home-grown nutrition. A community that lives on the foods it can produce itself is a healthy community. One that lives on imports of packaged foods is a dependent community that needs either an alternative source of income to pay for that food or continuous food aid, which of course is unsustainable. So an aid agenda that stimulates improved agriculture is vital for both nutrition and the local economy.
When 80% of your population is dependent on agriculture for their living, as is the case in many African countries, transforming their output is the key to success. Although new roads, markets, finances, land tenure and water all matter to this agenda, the key is training: training in what to grow—such as, say, the highly nutritious and relatively new orange-fleshed sweet potato or other fortified or nutritious crops—and training in how best to grow and sell them to maximise yield and, above all, distribution.
My second point is that this training is also important in nutrition itself. I led a parliamentary group to Rwanda a few years back. The latest UN stats on stunting in Rwanda came out while we were there, showing an unnecessarily high figure for a country that is relatively productive in vegetables and good food. The President there immediately called a meeting of the leaders of the three key ministries—agriculture, education and health. The permanent secretary for agriculture told us that evening that the problem was that, although mothers were satisfactorily breastfeeding their babies, after weaning the tradition was to feed them maize milk, which is nothing more than ground-up maize and water and contained almost no nutrients at all. We asked what they were going to do about it, and he said that they would ask every village to choose their own most respected mother. They would put her on to a nutrition training course, and her role would then be to go back and teach her village about the importance of a mixed diet for young children, which in Rwanda with its varied agriculture should not be too difficult to achieve. This pyramid selling, or rather pyramid training, seemed to be a good idea and it would be interesting to return and see how it is working.
That scheme brings me to my third point: the benefits of partnership, both nationally and internationally. Bringing together the departments of agriculture, education and health, which we saw in Rwanda, is also the key to the very effective World Food Programme school feeding programmes that I have seen in many countries—Ghana and Ethiopia to name but two. It is also the key to the Anganwadi village feeding centres that I came across in India in the state of Bihar, run by the Integrated Child Development Services programme, the key word there being “integrated.” Where they exist, the Anganwadis are very effective, but there are just not enough of them.
Of course, all these initiatives, of which there are many, depend on being pushed from the very top, like my example in Rwanda, where the President stepped in and pulled everyone together, or in Bihar, where it was the chief minister who was driving the Anganwadi programme. Players have to be forced to get out of their silos, preferably by their own leaders. But also, foreign aid money can exert considerable leverage in terms of driving an agenda of partnership and co-operation. If the world is determined to stamp out malnutrition, this leverage has got to be exercised, and that is the very least we should expect from Tokyo.
My Lords, I am grateful to my noble friend Lord Collins, because he has chosen a subject on which I did some work 55-odd years ago, based in Lagos in Nigeria. The MD thesis that came out of that study was called Interactions of Nutrition and Infection, so it was very relevant to tonight’s Question. The study was modelled on the Newcastle Thousand Families longitudinal study, which observed a cohort of babies born successively in May and June 1947 and followed up for a number of years afterwards.
Lagos presented very different problems from Newcastle when randomly selecting which families to include in the study cohort. In the end, we were able to follow 420 randomly chosen infants in 250 families. All the children were seen every three months, when they would be weighed, measured and a note made of any illnesses that they had suffered. A visit to the child’s home was made if they did not attend the clinic. They were each allocated an illness score, depending on the severity and duration of the illness. It was possible to relate the illness score—equivalent to morbidity—to their nutritional state and growth over the previous three months, as well as to certain measures of social status such as the parents’ work, education, housing and so on. A weighted sample of well-off Nigerian professional families living a western lifestyle was included to act as a comparison with typical Lagos children. Their nutritional state and pattern of illnesses were very similar to those of typical western children of the same age, but the latter recovered much more quickly than the typical Lagos children from each episode of illness, which in their case was usually less severe.
It is not possible for me to describe the methods of study and analysis in any detail in a short speech, so I will not bore noble Lords with more research details. This type of study has been used in several other longitudinal studies in the UK and the US, and other developing countries.
The well-known signs of malnutrition, such as oedema and skin changes, were not overtly present in most of the children, but—apart from the chosen well-off group, of course—their mean weight and, less so, height was well below the norm, running at barely the 50th percentile of the better-off western norm. However, as I said, malnutrition was not overtly visible. If they were observed playing with other children, for instance, it was difficult to label them as malnourished.
Common childhood infections were present in children of all nutritional and social levels, but there was a tendency for them to be more serious and longer-lasting among those most underweight for their age, who more frequently developed pneumonia or diarrhoea as a complication. This pattern was shown most clearly in measles; the vaccine was then not yet available.
Tropical diseases did not present a great problem in Lagos, apart from some helminth infestation that did not seem to do much harm. Malaria was rare, unusually for Nigeria, because all parents used Nivaquine—that is, Chloroquine—as soon as their child had a fever, so the malaria parasite was more or less drugged out of the city. Compared with this group, a group of children of the same age in a village 20 miles outside was absolutely saturated with pneumonia. They had 2 grams less per 100 millilitres of haemoglobin, too.
It was possible on fuller analysis to show that the illness scores were higher in the most underweight children. Statistically, the episodes lasted longer and more frequently developed into pneumonia or diarrhoea. This tendency has led clinicians to concentrate on treating acute infections, neglecting nutrition in busy clinics. Supplementary nutrition is in fact not acceptable to an acutely ill child, but appetite usually returns during the recovery period—though less so if the child is already undernourished or the illness episode was severe.
I see that I am running towards the end of my time. All noble Lords will have received emails from UNICEF asking us to ask DfID an enormous number of very apposite questions, which we have no time to do—but I am sure that the Minister and her department will have scrutinised them extremely carefully. The most important thing is that the funding for nutrition should continue and possibly be augmented. As I have already passed my time, I will call it a day.
My Lords, I declare my interests as president of both the Children First Alliance and Young Citizens. This is a valuable opportunity to put the issue of nutrition once again on the agenda and to press for more serious thinking, not to mention better implementation and better impact monitoring. I thank the noble Lord, Lord Collins, for this.
We continue as a nation to spend billions annually on overseas aid, and of this we should be extremely proud; we are an example to the world, although there is evidence that spending and monitoring need a great deal more attention. However, this evening, I want to bring up a domestic aspect of nutrition and children, and in so doing pose the question that, however great our goals as a donor nation are in our overseas development and humanitarian efforts, we might also pay attention to homegrown problems.
Today, I will speak about holiday hunger and the fact that many of our school-age children in socially and economically deprived areas go hungry during the long school vacations due to the lack of a daily meal, which in turn is due to poverty, ignorance and even sometimes religious reasons. Preliminary research for a pilot holiday activity and well-being programme, which the CFA intends to set up in three deprived areas of Tower Hamlets, north Bristol and Blackpool, indicates that 57% of local authorities do not provide a holiday meals scheme.
The statistics on hunger in our children are alarming. In 2019, 15.4% of all pupils in England and Wales were eligible for and claiming free school meals. It is reliably estimated that up to 3 million children are at risk of hunger during the school holidays—1 million of them as a result of extreme poverty, and a further 2 million excluded from free school meals due to one parent being in work. More than 4 million children in England and Wales live in relative poverty, with two-thirds of these children having one working parent.
These figures have disastrous consequences for the child. The effects of such poverty are multiple, severe and long-lasting, and include poor physical health, mental health issues, underachievement at school, and added risks of stigma and bullying. Again, these factors predispose children to antisocial behaviour. Furthermore, children on free school meals are more likely to be placed in lower sets, have access to less qualified teachers and have lower expectations from their schools.
The exponential rise in the use of food banks is evidence of the increasing pressure families now face. In the last three years, there have been several reports indicating that parents in deprived areas report eating less or skipping meals in order to provide more for their children and that demand from food banks almost tripled at Christmas, when access to free school meals is cut off. Almost three-quarters of teacher respondents to an NUT survey said that holiday hunger was having a marked negative impact on children’s education.
Recent research by Citizens Advice demonstrates that investment in children at an early stage to eliminate severe poverty and holiday hunger is massively cost-effective. For example, for every £1 invested in Citizens Advice, the charity was able to generate £2.05 in savings to government and public services. This is achieved by helping prevent issues escalating and thus reducing pressure on public services such as health, housing or out-of-work benefits. Additionally, debt advice, an increasingly used service, resulted in social benefits savings of around £300 million to £570 million annually across the UK.
There is emerging evidence from bodies such as Sports England that activity, well-being and holiday meals schemes increase social cohesion and decrease both violence and gangs, as well as obesity. There are many admirable schemes afoot in specific areas, run by dedicated NGOs and often sponsored by major food companies. There are, too, some local authorities which, with extremely stretched budgets, continue to run breakfast and lunch clubs. Many teachers, acutely aware of hunger in their pupils, are sufficiently concerned to fund breakfast clubs themselves. But in this day and age, can we really accept that hunger in our children remains largely the responsibility of non-governmental bodies and a few local authorities and individuals? Is this not an issue that central government should be addressing nationwide?
The problem is clear and the remedy simple. All it requires is a bit of money. Again, preliminary figures suggest that a five days a week for five weeks’ activity and lunch programme, including welfare advice, costs between £10,000 and £25,000 per school, depending on free food provided by organisations such as FareShare or via local food companies and the amount of volunteer help.
If we are to nurture happy, healthy, empowered and resilient children, we need the political will to enable schools through local authorities to run these programmes on a regular and statutory basis. There are some temporary pilot schemes funded by government, but these are somewhat haphazardly located and a competition to win funds for a holiday meal scheme was won by a single school. What, one asks, about those that did not win? We need the political commitment to set up a countrywide system, bearing in mind devolved responsibilities. The fund of knowledge as how best to do this cost-effectively and how to engage the wider, especially corporate sectors is now abundant. It just needs doing.
My Lords, I congratulate the noble Lord, Lord Collins, on securing this debate and take the opportunity to welcome the noble Lord, Lord Rea, back to the Chamber after such a long illness.
We have heard from the Nutrition for Growth APPG that in 2018 it was estimated that 149 million children in the world were malnourished, and so became stunted in physical and mental growth and more susceptible to illness. Those features used to be seen among poor communities not so long ago—in Victorian times, in this country. Looking at that figure from the family and mother’s perspective, it is interesting that there are 220 million women in the world without any access to family planning services, who suffer ill health and poor nutrition themselves because they have large families with no means of feeding them properly. There must be some correlation there, surely. Malnutrition will never be solved while the world’s population goes on growing. This must be taken into account when nutrition is discussed at the Tokyo conference.
Our Government have a good record on family planning. Smaller families mean more food and better nutrition for everyone in the family, and that women must have access to family planning services. I make no apology for raising this over and again, because it is well accepted now by international bodies. The World Economic Forum in particular says, in my favourite quote, that there is a massive pay-off for promoting contraception for these women—voluntary contraception, I may add—at an estimated cost of $3.6 billion per annum. It would mean far fewer newborn and maternal deaths, and mothers more able to feed and educate the children in their smaller families, leading to economic benefit for their country estimated by the WEF at $288 billion per annum. In other words, $1 spent on family planning yields $120 in benefits. That is an awful lot of money to spend on food and good nutrition. I repeat that those are not my figures; they come from the World Economic Forum.
Someone implied during the debate that DfID has not paid enough attention to nutrition, but in my experience this is not strictly true. NGOs and DfID are constantly looking at what foods are available to a particular population and how best to supplement them. I was in South Sudan years ago during the famine in Bahr el-Ghazal, like the noble Baroness, Lady Featherstone. At that time, I saw reports from workers on the ground going back to DfID, not only saying what aid was being received but checking what nuts, berries and other natural foods were available in that area. The department has always been conscious of this problem.
It was interesting that so many Members promoted breastfeeding. It should be promoted—no woman doctor would not promote breastfeeding—but the problem is that if you are in an area where there is high malnutrition, mothers are often the most malnourished of the population. They feed the men and the children first; Mum comes last. In the time of rationing, when I was a little girl, my mother always ate less than we did. My father and the children always got the lion’s share. We must take that into account when we are promoting breastfeeding. Breastfeeding mothers need food.
Poor nutrition is often caused by conflict or the political actions of Governments. Briefs from NGOs say that 60% of Burundian children are irreversibly stunted, yet this is not so in neighbouring Rwanda, where they are tackling this problem, as we have heard from the noble Lord, Lord Cameron. Good governance means less malnutrition, and healthier and happier populations. The people of Gaza cannot afford food. They have been blockaded for 10 years and, apart from malnourishment and severe anaemia among the mothers, after 10 years of blockade, now 10% of the children there are stunted. We could do something about that. In Yemen and Syria, children are starving. All this is due to conflict, lack of action and poor foreign policy by our Government and their allies.
Finally, I endorse the calls for more attention and money to be spent on nutrition, but it must be in conjunction with other needs, such as family planning. All aid should be co-ordinated across the needs of a population, not confined to vertical delivery lines, as it has been in the past. I hope the Minister can assure us that these points will be raised at the Tokyo conference, especially family planning.
My Lords, I add my thanks to the noble Lord, Lord Collins, for bringing this important issue before your Lordships’ House today. As ever, the breadth and quality of contributions never ceases to amaze, such that by this stage in the debate there is very little to add. Maybe in summing up on behalf of these Benches I can add emphasis to some of the key points.
This issue is at the heart of successful delivery of the sustainable development goals, which owe their very existence in no small part to the leadership of development professionals within DfID. Let us face it: we can put a multitude of excellent questions to the Minister, to which she will no doubt give reassuring responses, but all good intentions pale into insignificance if the Prime Minister is determined to pursue his aim of abolishing DfID. I join my noble friend Lady Featherstone and the noble Baroness, Lady Nye, in stressing the importance of maintaining a fully functioning department for development, one that is already firing on all cylinders and which has the necessary structures, processes and global networks to pull together the threads that weave success on the global stage—something that the Prime Minister is so keen to achieve.
One thing that we know for sure is that there is a good reason why we have 17 SDGs, together with 169 targets and 232 indicators. It is because a transformative, interlinked agenda cannot be delivered without a holistic vision—one that leaves no one behind. But that vision needs to be informed and tempered by experience. Experience tells us very clearly that, to deliver our vision for better health, people need better jobs, and better jobs are dependent on better education. With better education, we can have better sanitation and hygiene, which completes the cycle back to better health. All development goals are interlinked and interdependent. It is a no-brainer that, in order to have healthy, educated people with good jobs, they must have good, nutritious food.
The Government have rightly identified the education of girls as being a crucial factor in successful delivery of the SDGs. We know that investing in girls’ education, enabling access to contraception and reproductive health care and giving women the power to decide when and how often to have a baby, will have the biggest possible impact, not least on the size of families, a point eloquently made by my noble friend—I hope I can call her my noble friend—Lady Tonge.
However, while the Government’s commitment to girls’ education is commendable, I hope they accept that a nutrient-rich diet which provides not only the calories but also the vitamins and minerals needed for healthy development is a necessary prerequisite.
We have heard some shocking statistics on the impact of malnutrition, but the one on stunting shocks me the most: 149 million children are malnourished enough to be classified as stunted. That is a shocking 21.9% of all children—more than one in five. What does it mean to be stunted? Stunting refers to children with a height considerably below the average for their age, as we heard from my noble friend Lady Featherstone, but modern neuroscience shows it also takes its toll on children’s brain development. Health and education outcomes for stunted children are poor and its consequences are irreversible. Without intervention we are building in inequality from birth—and sometimes before birth because stunting can occur in the womb of malnourished mothers-to-be.
We know that intervention works. For example, we know that encouraging breastfeeding is the single most effective way to reduce child mortality in countries with high burdens of malnutrition, and I hope the Minister will agree that bearing down on the marketing of breast-milk substitutes is essential. Hand in hand with that goes adequate nutrition for breastfeeding mothers.
Sometimes there is no alternative but to give micro- nutrient supplementation, fortification and biofortification —they work, as do ready-to-use therapeutic foods. We know they work because we have made it work before. The first Nutrition for Growth summit was hosted by the UK in 2013, mobilising $17 billion over seven years, as a result of which 12 million fewer children suffer from stunted growth and millions of lives have been saved. The next summit takes place this year in Tokyo in December, with a springboard event in July. DfID’s early leadership will encourage donors and high-burden countries to step up and pull in the same direction.
The International Coalition for Advocacy on Nutrition is asking for a pledge from Her Majesty’s Government of £800 million per year for 2021 to 2025. Is the Minister able to say whether that ask will be met in a timely manner for maximum impact?
My Lords, I thank the noble Lord, Lord Collins of Highbury, the co-chair of the APPG on Nutrition for Growth, for tabling this debate, and all noble Lords who have made such interesting contributions.
Noble Lords have expertly made the case for the importance of addressing nutrition in our development work. The right reverend Prelate also made it clear that behind these statistics lie real human tragedies, and we should never forget that. So, given the limited time available, I will not add my own arguments, but suffice to say, I agree that to achieve our development goals we must ensure that nutrition is at the front and centre of our minds.
I echo the point made by the noble Baroness, Lady Walmsley. As a believer in spending money efficiently and effectively—both for the British taxpayers, whose money we spend, and for the benefit of those we are trying to help—we must remember that investing in nutrition is not only the right thing to do but a development best buy. As the noble Baroness pointed out, every £1 we spend to address undernutrition yields a return of £16 in increased economic productivity.
Before I answer some of the specific questions, I shall take this opportunity to draw your Lordships’ attention to a revision to my department’s estimates on nutrition. This morning DfID published a correction to one of the nutrition estimates in its annual report to improve the quality of the data and to avoid any risk of double-counting. The number of women, adolescent girls and young children who have been reached by DfID nutrition-related services now stands at 50.6 million rather than the 60.3 million that the noble Baroness, Lady Featherstone, mentioned, and which I have previously stated at the Dispatch Box. That correction has now been issued. When publishing these headline estimates, we are committed to following the UK Statistics Authority code of practice, which means we update our estimates as and when we are able to do so. We still exceeded our 2015 target of reaching 50 million people, but the department and I are fully aware that more needs to be done.
Many noble Lords asked about the ICAN request for £800 million per year. Much as I would like to be, I am afraid I am not in a position tonight to talk about the specifics of our commitments to the Nutrition for Growth Summit. We are fully aware that the summit is an important opportunity to sustain progress on SDG 2 and to accelerate actions on nutrition after 2020, when our commitments run out. We are in the process of identifying the most appropriate and impactful commitment and are fully aware of the importance of doing so at the most opportune time, but I am not able to update your Lordships on how much or when, nor am I able to update on specific attendance for July or December. I use the defence that invitations have yet to be issued. However, we are fully aware of the importance of this. We played a leading role in 2013, and DfID continues to play that leading role.
Many noble Lords spoke of climate. The right reverend Prelate spoke about the vicious circle of climate change. We know that climate change will increase the risk of malnutrition and hunger by increasing the frequency of extreme weather events and disease outbreaks. We also know that most of the additional deaths that will come from climate change will be due to undernutrition. We are working carefully on quantity by ensuring that we are funding the development and delivery of new crop varieties that are more resilient to climate, disease and pests. The noble Lord, Lord Collins, highlighted the £61 million we announced last year. We are also looking at the quality and making sure that we have affordable and accessible healthy, nutritious diets for those who need them. We are looking at the vitamin A-enriched sweet potato which the noble Lord, Lord Cameron, mentioned, zinc-enriched maize and rice, and iron-enriched beans. We are also looking at testing new agricultural technology, such as digital weather and market price information systems for farmers and solar-powered cold storage solutions, as we know that that technology will be sorely needed.
The right reverend Prelate asked about COP 26. We want to use COP 26 to help ensure that people have access to the nutritious and sustainable diets that they need. We will be looking to boost climate resilience as well as to support good nutrition as we look carefully at the future of food systems.
The noble Lord, Lord Collins, mentioned our approach to nutrition and our assessment of our historic nutrition programmes, and the noble Baroness, Lady Walmsley, said that it is important that we spend our money as effectively as possible. The noble Lord, Lord Rea, highlighted the importance of evidence and research in everything we do. The study he pointed to in Lagos was 55 years ago, but it is still relevant today. That framework of work he highlighted underpins our decisions on our nutrition-specific and nutrition-sensitive approaches. We review all our programmes on an annual basis to make sure that we are looking carefully at the evaluation of all our work. That information, as well as evidence generated by others, is used to look at the types of approaches we should take in the future.
The noble Baroness, Lady Walmsley, correctly said that poor breastfeeding practices result in 800,000 child deaths annually. Alongside saving lives, increasing breastfeeding strengthens the economy. It could save up to £300 billion per year and has the health benefits for women that many noble Lords mentioned. To reassure noble Lords who mentioned this, DfID includes support for exclusive breastfeeding in its health and nutrition programmes at country levels. We are very clear on that. We have had some really good programmes in northern Nigeria and in Bangladesh, where we are supporting health workers to bring groups of mothers together to discuss and solve problems and—not forgetting the men—we are making sure that we are working with fathers’ groups so that they understand the importance of breastfeeding and are better prepared to support their wives and ensure that they have the food they need.
DfID clearly supports the implementation of the International Code of Marketing of Breast-milk Substitutes. In countries where we work, we know that the inappropriate marketing of breast-milk substitutes undermines breastfeeding and that infants in developing countries who are not breastfed are more likely to get sick and die. We remain concerned that manufacturers of breast-milk substitutes continue to contravene the code. Our position is that we do not partner with companies that are not compliant with the code. We are also funding the Access to Nutrition Index, which monitors performance and progress by those companies. Enforcement is more challenging. That is done at country level and is dependent on Governments’ legislation. However, we are supporting Governments to put better nutrition policies in place, using the wording of the code. For example, in Yemen we work closely with Save the Children and are working to translate that monitoring into future enforcement.
My noble friend Lady Manzoor asked what consideration we give to nutrition when we look at our pledge to Gavi. That is another pledge that we are not able to talk about—the announcement or the target—but it is being carefully considered. We very much look forward to hosting the Gavi summit in June. As hosts, it is a great opportunity to continue to champion efforts to bring all health services, including vaccination and nutrition services, together under the single umbrella of universal health. We pushed for that at the UHC summit this year, held by UNGA, and we will continue to so. That includes ensuring that all our investments in health systems are strengthened through Gavi and that other health multilateral organisations take this integrated approach, as noble Lords have advocated.
My noble friend Lady Manzoor also asked about ready-to-use therapeutic foods. As we invest in health system strengthening and service delivery, we ensure that integrated nutrition is available in countries such as Bangladesh and the Democratic Republic of the Congo as part of our efforts to achieve universal health coverage. That includes ensuring that more predictable financing is available to cover ready-to-use therapeutic foods to treat child wasting.
My noble friend also asked about the private sector. I agree that it plays a very important role in creating jobs and enabling people to improve their income so that they have the money to spend on more nutritious foods. We want more businesses to step forward and make commitments, and we will be working on that at the Nutrition for Growth summit. However, we want to avoid some of the poor practices that we have seen in the private sector and ensure that any investments that it makes have positive impacts.
I have already spoken about what we are doing to ensure that we do not work with companies that violate the International Code of Marketing of Breast-milk Substitutes. We have also worked with CDC, our development bank, to ensure that the investments do not support ultra-processed and other damaging foods.
I take this opportunity to thank the noble Lord, Lord Cameron, for his continued engagement with the department on nutrition and agriculture. I entirely agree about the need to invest in advancing people’s knowledge of and practice in agriculture to improve nutrition. We have to ensure that we support farmers to diversify what they grow.
On the point about weaning foods and nutrition education, we know that we have to give families access to the right information on what to feed their children. Just this morning, one of the nutrition team showed me a bowl that we use as part of our training. It shows very clearly the kinds of foods that will give children a nutritious diet. However, we also need to be clear that nutritious diets remain unaffordable for the poorest and that the cost often exceeds the entire average income of poor households. Because of the economic barriers to good nutrition, we need to invest more in improving the affordability of nutritious foods and the economic security of the poorest. I also agree with the noble Lord on the importance of having integrated services so that families can access nutrition and health services at the same time.
The noble Lord, Lord Collins, asked about the importance of civil society support. Since 2012, we have been a clear supporter of Scaling Up Nutrition—the SUN civil society network. That includes funding through the SUN pooled fund to ensure that we properly support advocacy efforts in countries with a high burden of malnutrition. We are also working closely with the Government of Japan to make sure that civil society is properly acknowledged at the summit.
On gender, one of my favourite topics, which was raised by the noble Baronesses, Lady Featherstone and Lady Tonge, we know that family planning interventions have a positive impact on nutrition. The evidence is clear: without family planning, we can contribute to high levels of child malnutrition as well as child mortality. That is why the WHO recommends gaps of 18 to 24 months between pregnancies and why it is so important that we continue our support for voluntary family planning. I am proud of the work that DfID does in giving women a choice on their family size. We estimate that, every year, our investment will support nearly 20 million users of contraception in total, preventing 6 million unintended pregnancies. I make no apology for repeating those figures.
We know that girls and women are particularly vulnerable to undernutrition, sometimes because they prioritise other family members over themselves. We need to get better at making sure that our investments in health, nutrition and other sectors meet their needs.
I am running out of time. I wanted to talk about obesity, the other side of the malnutrition coin; we will maintain our focus on tackling undernutrition, but we need to make sure that we are looking at the double burden as we move forward. On domestic obesity and malnutrition, I am afraid that I do not have any details of the holiday meals scheme, but I will come back to the noble Baroness, Lady D’Souza, on that.
I am out of time. There was quite a lot to get through in 12 minutes. I have done my best, and I will follow up in writing. I thank noble Lords for their contributions to tonight’s important debate. I look forward to briefing the APPG team on our preparations for the summit, which will be a pivotal moment. We need to make sure that Governments, the UN, civil society and businesses—everyone—step up to do more. I take the opportunity to reassure noble Lords that we remain fully committed to nutrition. We know that preventing malnutrition delivers enormous benefits for child survival, health and future prosperity. We will continue to play a leading role globally to make sure that more actors take action to help end malnutrition entirely.
House adjourned at 9.36 pm.