Scaling Up International Food Aid: Food Delivery Alone Cannot Solve the Malnutrition Crisis

Editorial I n January 2008, in an article entitled " The Starvelings, " The Economist made the case that childhood hunger and malnutrition have a far greater impact upon child health than was previously thought [1]. The most recent estimates are that stunting, severe wasting, and intrauterine growth restriction together are responsible for 21% of disability-adjusted life years and 2.2 million deaths in children under five years annually [2]. Those malnourished children who do survive are at heightened risk of long-term health, educational, and economic impairment [3]. Hunger is now arguably " the gravest single threat to the world's public health " [1]. There was therefore a tremendous sense of urgency among participants of the recent two-day international meeting in New York City on preventing and treating childhood malnutrition, organized by Columbia University's Institute of Human Nutrition and the humanitarian organization Médecins sans Frontières (MSF). Christophe Fournier, President of MSF's International Council, called childhood malnutrition an " invisible crisis " and asked: " Why are we witnessing countless deaths from a preventable cause? " There is no simple answer. UNICEF's framework on the determinants of nutritional status includes a complicated array of interconnected " basic determinants " —ecological, economic, and sociopolitical [4]. These basic determinants in turn give rise to three specific " underlying determinants " : the quality of health care services, caregiver resources such as maternal knowledge about child care, and food security (defined as secure access for all people at all times to sufficient quality and quantity of food in order to lead a healthy and active life [5]). An important challenge in preventing malnutrition is determining which of these three basic determinants should be the priority target. This is a highly contentious issue within the child nutrition community, and there does not seem to be a consensus. Some nutrition experts and health agencies, for example, believe that the focus should be on boosting caregiver resources—particularly educating mothers to feed their children the right foods [6,7]. The World Bank argues that most serious malnutrition is caused by bad sanitation and disease, leading to diarrhea, especially among young children, and that " women's status and women's education play big parts in improving nutrition " [7]. The child hunger crisis includes a knowledge crisis. In contrast, the Columbia University meeting focused on only one of the three determinants—food insecurity, particularly in crisis regions where many humanitarian agencies work. Several …