The statistics are alarming. Worldwide, 48 million children face stunted growth, 45 million suffer from wasting, and nearly half of all child deaths are attributed to malnutrition.
“Even for children who survive [malnutrition], their ability to reach their full physical and mental potential is significantly impacted, affecting their quality of life and the development of their country,” says Bill Gates, co-chair of the Bill & Melinda Gates Foundation. “Sadly, in Africa, 40% of children never achieve their full physical or mental development.”
Each year, the Bill and Melinda Gates Foundation highlights a critical issue in its Goalkeepers Report, one with a significant unmet need and for which the organization offers proven, actionable solutions. This year, the focus is on childhood malnutrition and its lifelong consequences. Addressing nutritional deficiencies in young children enables more children to attend and remain in school. A more educated population drives economic progress, explains Gates.
The report outlines several strategies to combat nutritional deficiencies globally, ranging from direct interventions to boosting food production methods in various countries.
One of the most straightforward approaches involves fortifying existing food staples, such as salt, oil, and bouillon cubes, commonly used in low-resource households to enhance flavor. Fortifying bouillon cubes with iron, folic acid, zinc, and vitamin B12, for example, could prevent 16.6 million cases of anemia annually in Nigeria. Folic acid is already incorporated into staples like wheat and other flours, but adding it to iodized salt could significantly reduce the risk of neural tube defects in newborns. The Ethiopian government is exploring such an approach, which could prevent 75% of deaths and stillbirths caused by these defects. These defects typically occur in the first month of pregnancy and result in nerve damage that contributes to learning disabilities, paralysis, and death.
Another strategy centers around food fortification: expanding the distribution of , a complete set of 15 prenatal vitamins and minerals established by the United Nations that are crucial for early fetal development and maternal health. If current low- and middle-income countries provided these supplements to expectant mothers, the Foundation estimates that nearly half a million lives could be saved by 2040. These supplements can reduce the risk of low birthweight babies, increasing their vulnerability to other health conditions and the likelihood of developing anemia. They could also lower stillbirth and maternal mortality rates.
Beyond directly providing nutrients to infants or pregnant women, the Foundation also advocates for long-term strategies to sustain nutritious food supplies. These include adopting agricultural practices and breeding animals commonly used in developed countries to enhance egg production in chickens and milk production in cows. “Chickens [and cows] in the West produce four times more eggs and milk than those in Africa,” says Gates. “By combining this productivity with key tolerance and disease resistance in African animals, we can create chickens and cows with higher egg and milk output. As the cost of eggs decreases, more children will have access to them.” Approximately 80% of cows in Kenya produce only 2 liters of milk per day, but this is changing as farmers breed more productive cows and utilize higher-quality crop waste for feed. This has led to some Kenyan cows producing six to 10 times more milk than before. By boosting dairy productivity in just five African countries, the Foundation estimates that 109 million cases of stunted growth could be prevented by 2050.
Gates emphasizes that these interventions are deliberately easy and affordable for countries to adopt. Prenatal supplements, for instance, cost $2.60 to provide for a woman’s entire pregnancy. However, overall aid reductions over the past two decades mean that progress made in the 2000s is being reversed or threatened. “I would say that the financial challenges African countries face in funding primary health care are the most significant obstacle,” says Gates regarding the hurdles to implementing even these relatively simple solutions. “I’m not as concerned about research efforts [to discover more interventions]; we’re not in a research crisis. The crisis lies in the need for affordable aid budgets.”
Gates asserts that a mere 1% to 2% of the budgets of wealthier nations could be allocated to save around $1,000 per life in the poorest countries. “This should be achievable, but we must have a value system where voters prioritize spending 1% to 2% to help people in distant lands,” he says. “Demonstrating success can encourage voters to prioritize what I believe is a moral imperative, but it also offers other benefits like preventing conflicts, pandemics, and fostering strong economic relationships. A thriving Africa is beneficial for the entire world.”
He points to Asian countries that have successfully transitioned out of poverty and now primarily rely on internal resources to fund their primary health care systems. “We’ve witnessed this in Asia, particularly in Indonesia, Vietnam, and India, where they are able to fund primary health care through their own tax base. We aspire to create similar success stories in Africa.”
However, shifting global priorities, coupled with conflicts in various parts of the world, including eastern Europe and the Middle East, have resulted in shrinking aid budgets, especially for initiatives aimed at lifting African countries out of poverty. “The situation is quite dire right now,” he states regarding the continent’s health and nutrition needs. “We must renew our ability to tell this story. While we acknowledge the significance of the war in Ukraine and turmoil in the Middle East—I’m not downplaying those situations at all—it’s unfortunate that Africa has, to some extent, fallen off the agenda, and this is reflected in aid figures. We have the capacity to address 40% of global malnutrition with the existing interventions.”
