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often results in hidden hunger, whereby the signs and indicators for undernutrition are less visible and obvious. More data on micronutrient deficiencies are required, and, there is a lack of data on the state of micronutrient deficiencies in nutritionally vulnerable populations. Furthermore, the data that are available is not comforting. For example, anemia, which indicates broader micronutrient deficiencies, is one of the eight key nutrition indicators that are off track at the global level [1].
Micronutrient deficiencies have a range of negative and often lifelong consequences on individual health and can have downstream effects on productivity, negatively impacting the economy and the greater public health system. Micronutrient deficiencies are an urgent public health problem with high economic costs in virtually every country. They cause an estimated 1.1 million of the 3.1 million child deaths that occur each year because of undernutrition [2]. Nearly 18 million babies are born with brain damage due to iodine deficiency each year [3]. Severe anemia doubles the risk of death for women giving birth [3]. From an economic perspective, the toll is also huge. According to the World Bank, the combined economic costs of iron deficiency, iodine deficiency, and vitamin A deficiency alone in developing countries could waste as much as 5% of gross domestic product [4].
Suboptimal diets are a key driver of hidden hunger, as they lead to micronutrient deficiencies, especially in populations with low food intake. Diets based mostly on staple crops, such as maize, wheat, rice, and cassava, which provide a large share of energy, but relatively low amounts of essential vitamins and minerals, frequently result in hidden hunger. For example, countries where the average diet is rich in micronutrient-poor cereals tend to have higher levels of micronutrient deficiency [5].
The message in the 2018 Global Nutrition Report is loud and clear: diets are suboptimal in all parts of the world. This is true across all age groups, as it affects children, adolescents, adults, and the elderly. Changes in the food environment, from production-based to purchase-based, has resulted in a rise in the consumption of processed foods and availability of cheap, non-nutritious foods. The changes in the food environment highlight the essential need to have the private sector on board. Regardless of income or location, all age and population groups are not eating enough fruits or vegetables, whole grains or legumes, and are drinking too many sugar-sweetened beverages. In some regions, up to 33% (Latin America) of school-aged children eat no fruit daily and up to 59% (Latin America) drink soda [1].
To address the hidden hunger crisis, better connections must be made between what is being produced and what is being consumed, doing so in an environmentally sustainable manner. The world’s total supply of calories has never been greater; the Micronutrient Density Index has risen in most regions since the 1980s, and the estimated prevalence of inadequate micronutrient intakes globally has been greatly reduced. We need to produce more nutritious foods but also ensure that micronutrient-rich foods get to consumers and form part of a diversified quality diet.
A range of interventions are needed across food systems and a system-wide approach is essential. Food systems allow many entry points for interventions across the supply chain, within food environments, and related consumer behaviors. Solving the problem of micronutrient deficiency requires effort from a wide array of stakeholders, ranging from governments to business to civil society, and, therefore, a multi-stakeholder approach is fundamental. The private sector is a particularly critical key actor within our food system, and thus should play a pivotal role in tackling micronutrient deficiencies. Countries with a high estimated prevalence of inadequate micronutrient intakes may benefit from public-private partnerships aiming at increasing the nutrient density of the food supply through increased production, diversification, fortification, and biofortification, but also at improving access to and utilization of nutrient-dense foods.
The private sector has considerable potential to make food environments healthier and tackle different forms of malnutrition, including hidden hunger. The private sector can increase production of micronutrient-rich foods and work to make these more accessible to local populations. Additionally, the private sector can influence people’s attitudes, perceptions, and desires, as well as the affordability of key food items in local and global markets. The role of business is core to patterns of food availability, access, and consumer choice.
In tandem with private sector action, it is important for the public sector to set standards, signal appropriate practices, and enable business environments. In addition, the private sector must be incentivized to ensure that nutrient-rich, safe, and affordable foods and food products become accessible in all market settings.
In all cases, accountability and transparency of action must be greatly enhanced, and the role of healthy diets in addressing all forms of malnutrition needs to be more explicit in all public sector actions. It will also be important for both parties to look for “win-wins” which address the many competing agendas of the private sector; for example, relating to jobs, growth, environmental sustainability, and social responsibility. Identifying common ground will help to accelerate action and progress.
Two examples of the work the World Food Programme (WFP) is undertaking in partnerships with governments and the private sector to unlock hidden hunger include Vitamino micronutrient powders in Sudan and the Good Food Logo in Zambia. In Sudan, micronutrient deficiencies are widespread, the most common being iron, vitamin A, and iodine. Anemia rates are very high, estimated to affect 88% of preschool-aged children, 58% of pregnant women, and 43% of non-pregnant women. WFP Sudan entered a partnership with Moataman Maaz Medical Company (MMMC) to facilitate the retail of Vitamino, micronutrient powders packaged in small 1-g sachets which contain 15 micronutrients. Vitamino is available through accredited pharmacies and supermarkets for less than USD 1 per month, making it the most affordable nutritional product in Sudan. This partnership ensures a larger percentage of the population in need is reached with the product and, importantly, it builds a sustainable model that can, in the future, work without WFP’s support. MMMC manages the supply chain of Vitamino (purchase, import, and distribution to end users) and ensures product availability in locations where WFP does not have an operational presence. They use their capacity and knowledge on marketing and retailing of nutritious products to ensure the product is successful in the market. WFP complements their efforts by providing funds to support a comprehensive social and behavior change communication campaign on nutrition, aligned with the Ministry of Health’s messages. This support ensures that the price of Vitamino remains affordable. Additionally, the initiative is currently reaching 45,000 children aged under 5 years through 257 pharmacies and 33 supermarkets for less than USD 1 per child per month. Developed by the Scaling Up Nutrition (SUN) Business Network and the Zambia National Food and Nutrition Commission and Zambia Bureau of Standards, the Good Food Logo is a front-of-pack nutrition mark or seal for eligible products that meet predefined criteria and nutrition-related standards across the various food groups to help consumers identify nutritious foods in-store. The SUN Business Network is one of the multi-stakeholder networks in the SUN movement. The Network aims to reduce malnutrition in all its forms through mobilizing business to invest and innovate in responsible and sustainable actions. The SUN Business Network is convened globally by WFP and the Global Alliance for Improved Nutrition (GAIN). A total of 18 countries already have an established SUN Business Network and WFP is currently supporting the development of 6 additional networks. The nutrition brand logo aims to introduce a simple, positive mark to “help Zambian people make better food choices” in store with the objective of increasing the intake of micronutrients and reducing the consumption of ingredients that lead to overweight, obesity, and non-communicable diseases (NCDs). Furthermore, the Good Food Logo aims to reduce overweight, obesity, NCDs, micronutrient deficiencies, and encourage food companies to reformulate existing products and develop new ones with a healthier product composition. The goal of improving nutrition awareness and demand aligns with the SUN Business Network Zambia strategy,