01 Aug 2012

Global Health Policy Forum

Distinguished Guests,

Ladies and Gentlemen,

Good afternoon.

It is an honor to join you and such distinguished speakers here at the Guildhall.  My thanks to the Imperial College and the Qatar Foundation for sponsoring this conference on global health policy.

In developed countries like the United Kingdom, we tend to think of health in terms of doctors, pharmaceuticals, and, sadly, bureaucracy. But for the developing world where annual government health care funding can be as little as a few pounds per person, what determines the health outlook for a child is very different indeed.  Health begins with the relationship between a mother and her child, especially in the first 1000 days and that relationship is first and foremost about food and nutrition. 

That is what I would like to talk you briefly about today.

I have a lovely 4 year-old daughter, Jalila, and a lively 8 month old boy, Zayed. They are healthy, protected and loved children, but in my time as a UN Messenger of Peace, I have encountered so many children who are not -- an infant who died of AIDS as I visited a hospital in Blantyre, Malawi, ragged little beggars in the Kibeira slum of Nairobi, and stunted children in rural Cambodia.

Perhaps the worst aspect of the problem is that it is becoming invisible and implausible in a world where the number of overweight people -- 1.6 billion -- now far exceeds the number of hungry.

Few people realize it, but hunger and malnutrition -- especially among mothers and young children -- are still the biggest threat to health in the world today.  

We hear a great deal about the threat of lifestyle diseases among the well off in both the developed and developing world -- diabetes, heart disease and even some cancers.  But we forget that hunger and related diseases claim more lives than AIDS, tuberculosis and malaria combined.   We think of food shortages as exceptional and the result of wars or natural catastrophes, but historically high food prices today have left 1 billion people chronically hungry.  The toll on health is staggering.

Who are these "hungry"?  

Well, most live a "hand to mouth" existence in the countryside of South Asia and Africa outside the market economies that have sprung up globally over the last few decades.

Who is most affected? 

Children are -- especially young girls. If you had to put a face on hunger, it would be young and female with a dark complexion -- and that goes a long way toward explaining why much of the world does not seem to care and aid often fails to reach them.

Government health spending is ultimately about politics - we decide what is worth our pounds, euros or dirhams.  The lack of focus on hunger as a health issue has to do with politics and who is hungry.  Your chances of being malnourished go up sharply if you are born Black, Asian or female.  A rapidly rising number of the malnourished are AIDS or TB victims and their families.  What you won't see as often among the hungry are faces that are white or male. 

It seems that hunger is both racist and sexist.

One way to look at malnutrition is as an inherited disease -- a sad legacy passed from mother to child.  Frail, poorly fed mothers give birth to malnourished babies who suffer from anemia and vitamin deficiencies.  They ultimately give birth to another generation of poorly nourished babies in a cycle of deprivation.  Some malnourished expectant mothers do not make it -- each year more than 60,000 women die in pregnancy and childbirth because of anemia.  More than 20 million babies are born with low birth weight because their mothers lacked adequate food, among them, millions have low brain weight lowering their eventual performance as much as 25 percent.  Hungry babies who survive often remain malnourished and suffer health problems and learning difficulties.  Anemia impairs the mental development of 40-60 percent of children in developing countries and is the most prevalent form of malnutrition, affecting roughly 2 billion people.

Sometimes, faced with donor fatigue, people in wealthier countries will ask: "Why can't the poor in Africa and Asia do a better job of helping themselves?"  They just got a part of the answer.  We like to see life as a free and clean competition -- an Olympic ideal perhaps.  It is not.  The odds are stacked against the hungry.

It really is in our collective interest to change that. 

Take iron deficiency.  It is the most prevalent form of malnutrition worldwide affecting 2 billion people.  For each $1 spent on iron fortification in aid projects, there is an $84 return in increased productivity and reduced disability (WFP).  The World Bank has said that ending malnutrition in developing countries can boost economic output by 2-3 percent a year and ending low birth weight is one of the best possible economic investments you can make in the health sector.

What should we do?

Well, we must recommit ourselves to reaching the Millennium Development Goals to reduce poverty and hunger in half by 2015.  Globally we will have made it to the goal on poverty despite uneven gains among countries. 

But on hunger we are falling behind.  There has been enough food on this planet to feed every man, woman and child for half a century.  Yet waste, overeating, food losses, poor trade and economic policies prevent that.  We need to help developing countries invest in agriculture - especially in women farmers -- if we are to offer a global opportunity to live in good health.  To address the most immediate problems, we also need to intensify support for "food as medicine" initiatives by MSF, UNICEF and the World Food Programme in which ready-to-eat therapeutic foods are used more widely to stamp out malnutrition among vulnerable children.  It is so important to reach these children BEFORE they show up on feeding tubes on the BBC.

So my global health message for you today is simple: let's remember food.