Only collective action will end undernutrition.

We are in a race against time to eradicate the global scourge of undernutrition. Undernutrition cripples global economic growth and development, and future global prosperity and security are intimately linked with our ability to respond adequately to this urgent challenge. The new Series in The Lancet shows that undernutrition contributes to the deaths of about 3 million children each year—45% of the total. Its results stunt the physical growth and life chances of millions of people, and for Africa and Asia estimates suggest that up to 11% of national economic productivity is lost to undernutrition. The evidence provided in this Series should act as a turning point to galvanise global action. The solution lies largely in the early years of life, when the foundations for human potential are laid—getting the right nutrients at the right time prevents undernutrition. The result is heightened educational attainment, adult wages, and economic productivity. Women and girls are at the heart of this message. As the bearers and carers of children, their health and economic potential is entwined with that of future generations. Unless girls grow well in early childhood and adolescence and enter into motherhood well nourished, are lent support during pregnancy, protected from heavy physical labour, and empowered to breastfeed and provide good food for their babies and toddlers, the intergenerational cycle of undernutrition will not be broken. This Series shows that poor maternal nutrition at conception and during pregnancy is a major contributor to undernutrition in childhood. Empowering women to make the right choices for their health, and that of their children, is crucial to solving this challenge. Why is this such an urgent issue? Important demographic changes are occurring in many countries with high levels of undernutrition. The ratio of the working age to non-working age population is rising and will peak in the next 20 years, and this increase in the available workforce has substantially boosted economic growth in many parts of the world. Any such demographic dividend will be even greater in wellnourished populations. Additionally, rapid urbanisation, increased sedentary behaviour, and a transition in dietary patterns has resulted in a fast rise of obesity in middle-income and even low-income countries. This Series emphasises that undernourished children are at increased risk of becoming overweight and developing non-communicable diseases such as diabetes in later life. Acting now brings a triple benefi t: it saves lives today, maximises economic opportunity, and helps to reduce obesity and chronic disease in the future. This Series shows that there are simple and proven interventions that can substantially reduce undernutrition and mortality in children. Many of these interventions deliver an excellent return on investment and should be delivered at scale without delay. However, making a lasting eff ect on the root causes of undernutrition will need more eff ort. Brazil’s remarkable experience during the past 20 years shows us that the right programmes need to be matched with strong political leadership and determination. Brazil’s success resulted from a wholegovernment response, a clear focus on groups at greatest risk, strong civil society engagement, and investments to track progress and use data to strengthen accountability and inform policy choices. In addition to strong national action on undernutrition, we need to take a hard look at our global agriculture and food system. As the global population rises, our food system needs to keep pace with the demand for both dietary energy and the essential vitamins and minerals needed for human health. Our agriculture and food system needs to be profi table for farmers and the wider food sector, environmentally sustainable, and directly supportive of the health and nutritional needs of populations. Published Online June 6, 2013 http://dx.doi.org/10.1016/ S0140-6736(13)61084-3