Klaus Kraemer, Ph.D. is the Director of Sight and Life, a non-profit humanitarian nutrition think tank of DSM, which cares about the world’s most vulnerable populations and exists to help improve their nutritional status. Acting as their advocates, Sight and Life guides original nutrition research, disseminates its findings and facilitates dialogue to bring about positive change. Sight and Life is currently celebrating their 100 Years of Vitamins campaign.
You have recently launched a campaign to celebrate 100 Years of Vitamins. How has our knowledge of vitamins and our approach to promoting nutrition changed in the past century?
Before the discovery of vitamins and their naming 100 years ago, people thought all food offered the same sustenance—that a pound of potatoes was the same as a pound of apples. Now we know that is not the case, and that there are 13 different vitamins essential for good health at every stage of the human lifecycle. Our bodies need these vitamins to grow, function, stay healthy and fight disease. Sadly, today one billion people suffer from hunger and do not get enough food, and at least two billion experience “hidden hunger”—they might get enough calories, but they do not get enough of the vitamins and minerals (micronutrients) their bodies need. The signs of vitamin deficiencies are not always visible (hence the name, “hidden hunger”); they include birth defects, anemia, blindness, impaired physical and mental growth, maternal and child death, brittle bones and increased susceptibility to disease. These affect not only health but an individual’s future potential. Vitamin deficiencies commonly occur when populations cannot afford or do not have access to enough diverse nutritious foods (such as meat, fish, eggs, dairy products, fruit and vegetables). As we connect the dots between optimal nutrition and health, our approach has shifted to promote a world where everyone not only has enough food, but enough of the right foods and sufficient essential vitamins—whether through diet, supplementation or fortification.
Why is it so
important to tackle micronutrient deficiencies to reduce global poverty?
Micronutrient deficiencies prevent children from reaching their full potential as adults; malnutrition, especially during the 1,000 days between pregnancy and a child’s second birthday, can lead to irreversible physical stunting and cognitive impairment. But children who are well nourished are able to grow, learn and prosper. They achieve more in school, are better able to survive illnesses and tend to earn more as adults. The 2012 Copenhagen Consensus panel of experts ranked providing micronutrients to preschoolers as the single smartest way to allocate global aid dollars, with every $1 spent generating $30 in benefits—an astounding return on investment. Investing in nutrition can also raise a country’s GDP by at least 2 – 3 percent. When children are properly nourished, they can grow up to be healthy and productive, helping to lift their communities—and their countries—out of poverty. The link is clear, and so tackling malnutrition and micronutrient deficiencies has to become a global focus if we are to address poverty.
What are some concrete examples of nutritional intervention programs that saved lives and reduced malnutrition?
A great example is vitamin A supplementation programs, now implemented in 103 countries. Vitamin A deficiency affects an estimated 190 million preschool children worldwide; one-quarter to half a million of these children become blind each year—and half of those die within 12 months of losing their sight. We’ve made tremendous progress addressing these cases of preventable blindness and death through twice-yearly distribution of vitamin A supplements to children under five. In 1999, only 16 percent of children were receiving the necessary doses of vitamin A; by 2007, that figure had more than quadrupled to 72 percent. Today, in some countries, 100 percent coverage has been achieved. These vitamin A supplementation programs have reduced under-five child deaths by 25 percent.
Food fortification is another low-cost, high-impact intervention that is improving nutrition and saving lives. Food fortification is the addition of essential micronutrients to the staple foods people normally eat (such as rice, wheat and maize flour, sugar, salt and cooking oil); the practice delivers vital missing nutrients to whole populations without requiring them to change their eating habits. Iodized salt is now found in 70 percent of developing-world households—up from 20 percent in 1990—preventing mental retardation and giving millions a better future. Folic acid fortification of flour is now required by 57 countries, reducing cases of brain and spine birth defects by up to 70 percent. These are amazing initiatives making a real difference in people’s lives, but now we need to scale these up and continue to develop innovative ways of improving the health and outcomes of the most vulnerable.
What has been the impact of the Scaling Up Nutrition (SUN) Movement in raising awareness of the prevalence of this “hidden hunger”?
The impact of SUN—a country-led Movement with more than 100 organizations and entities working to increase the effectiveness of existing programs by supporting national priorities, encouraging alignment of resources and fostering broad ownership and commitment to nutrition—has been that 31 countries to date have committed to address hidden hunger by scaling up nutrition programs and policies. These countries are home to more than 50 million children who have not reached the desired height for their age (who are stunted)—more than one quarter of all stunted children in the world. Stunting is an indicator of chronic malnutrition. With an emphasis on the 1,000 day window of opportunity between the start of pregnancy and a child’s second birthday, SUN countries and partners focus on implementing solutions that directly improve nutrition—such as support for exclusive breastfeeding for the first six months of life and continued breastfeeding until at least two years of age; and ensuring access to essential vitamins and minerals through a variety of interventions including supplementation, fortification and increasing dietary diversity—as well as efforts that have a broader influence on nutrition, such as empowering women, improving farming practices to increase the availability of nutrient-rich crops and improving access to health services.
Food security and nutrition are closely related. What actions are needed to increase the chances of the pathways linking agriculture and nutrition?
In the past there has been a tendency to only talk about the need for food security, but we now know that food security without nutrition security will do little to improve lives—the two have to go hand in hand. It is crucial that we break down the silos we have traditionally worked within. Nutritionists, agriculturists, public health workers, financiers and businesses need to come together to develop and implement innovative solutions and business models to reach all people—poor and rich, urban and rural—with affordable nutritious foods. Some examples of success include the promotion of orange-fleshed sweet potatoes (rich in vitamin A), fortification of staple foods with missing vitamins and minerals, and specialty products and delivery models for the most vulnerable.
We also need to break down silos within governments themselves. Per Pinstrup-Andersen, the only economist to win the World Food Prize, recently warned, “There are few incentives in government for multi-disciplinary problem solving. The economy is set up around silos and people are loyal to their silos. Agricultural and health sectors are largely disconnected in their priorities, policy and analysis.” Within government, we need to change incentives to encourage working across ministries. In this way, we can begin to pinpoint the health and nutrition-related factors driving food systems, and identify the best policies and programs to boost nutrition in crops and diets. Fortunately, the SUN Movement is providing a mechanism by which to coordinate our collective solutions.
What is Sight and Life doing to address malnutrition?
Sight and Life was established in 1986 to improve access to vitamin A, which prevents blindness and saves lives (hence our name, Sight and Life). Forming strategic partnerships with other organizations is one way in which we contribute to achieving better nutrition for all. One such partnership is with Vitamin Angels, a leading independent humanitarian organization dedicated to combating malnutrition by connecting at-risk populations in need with essential micronutrients. By partnering with Vitamin Angels, Sight and Life strengthens local supply and distribution capacity of vitamin A, mobilizes communities and governments to recognize and address vitamin A deficiency and fosters the creation of vital public-private partnerships to combat vitamin A deficiency, improving the lives of millions of children and women. Over the years, we have widened our focus to include other essential micronutrients as well as the eradication of hidden hunger as major areas of our work. With our new focus on a multiple micronutrient approach, Sight and Life’s activities now include a range of activities and innovations including in-home fortification programs. These provide micronutrient powder mixtures packaged individually in single-dose sachets. They can be added to meals in appropriate amounts during food preparation at home or at school, and fill the micronutrient gap of those most vulnerable to vitamin deficiencies. Sight and Life, as a non-profit nutrition think tank, has a triple focus: promoting research, sharing best practices and mobilizing support in order to improve the lives of the world’s people.