Why Ending Malnutrition Means Looking at Rapid Urbanization

Half of the world’s population lives in cities and half of the world suffers from malnutrition. Laurence Haddad, executive director of GAIN, explains that seeing how the two issues are linked will be key to meeting the SDGs on urbanization, hunger and nutrition.

Written by Christine Chung Published on November 15, 2016 Read time Approx. 4 minutes
As cities grow and poverty is increasingly concentrated within them, women take on more and more of the domestic duties. That puts them disproportionately at risk of substandard living conditions, including malnutrition. Photo by AP/Ben Curtis

Almost half of the world’s total population – around 3.5 billion people – are affected by malnutrition, be it undernutrition where they are not getting enough to eat, or micronutrient deficiency where they are not getting essential vitamins and minerals through their diet, or over-nutrition where they suffer from obesity, being overweight and other complications. The international community has acknowledged the importance of addressing these health concerns through Sustainable Development Goal (SDG) 2, which aims to end hunger, achieve food security and improved nutrition, and promote sustainable agriculture.

But the context in which people are suffering malnutrition is changing. Rapid urbanization poses new challenges. According to the U.N. Population Fund, as poverty is increasingly concentrated in cities, daily domestic activities, which fall mainly to women, take up more and more time and energy, which affects the types of jobs women are able to find. Gendered impacts of urban poverty mean that women will disproportionately suffer the hazards of substandard living conditions, including malnutrition. Today, half of the world’s population lives in cities and by 2030 another billion people are projected to join their urban ranks. SDG 11 aims to make cities and human settlements inclusive, safe, resilient and sustainable. But 30 percent of the urban population live in slum-like conditions – in sub-Saharan Africa, the proportion is 55 percent.

Laurence Haddad, the new executive director of the Global Alliance for Improved Nutrition (GAIN), was the founding co-chair of the recent Global Nutrition Report. He speaks to Women & Girls Hub about how to address malnutrition in an urbanizing world.

Women & Girls Hub: How are urbanization and malnutrition linked?

Laurence Haddad: We tend to think of urban populations as having lower levels of undernutrition. When you look at the numbers, like stunting of children under the age of 5, they are lower in urban areas than they are in rural areas, but they’re not much lower. When you break down the numbers, because there’s so much inequality within urban areas, you find that the depths of undernutrition in some urban contexts, slum areas, for example, are actually worse than in rural areas. There’s a lot of hidden undernutrition in urban areas.

The second thing is that there are other types of malnutrition that are now emerging, like overweight, obesity, Type 2 diabetes, hypertension, cancers. They’re growing much more rapidly in urban areas than in rural areas. Even when you hold income constant between the rural and urban areas, and you compare households at the same level of income, the urban households have much higher levels of high salt, high sugar, high fat, much higher levels of Type 2 diabetes, much higher levels of overweight and obesity. That’s because in the urban areas they’re consuming more highly processed foods.

Those are the reasons that these two things are linked. We haven’t gotten rid of undernutrition, some of the classic forms of malnutrition, very quickly. Then we’ve got this new wave of new types of malnutrition – the obesity, the overweight, Type 2 diabetes – crowding in. In the urban spaces, you find this double burden, the undernutrition and the overweight and obesity. That makes dealing with it very complex.

Women & Girls Hub: We have seen that women suffer disproportionately from the various forms of malnutrition. Do you see this phenomenon continuing in an urban setting?

Haddad: I think it still does persist. In fact, there are additional burdens on women. Often in an urban context, the kinship, the neighbor bonds, the bonds that tie groups together, are broken especially if you have a new migration into an area. There’s not much reciprocity. There’s not much help in neighbors, in communities, in childcare, for example. That’s really important because in urban areas women will be working outside of the home but not very far from the home. They need help with childcare, and often times they don’t have it. That doesn’t leave women with much time or resources to ensure their families’ nutritional needs.

Also, in urban areas, overweight and obesity are higher. Women’s rates of overweight and obesity are higher than men’s rates, quite a bit higher. We don’t have a good understanding of why that is, but the patterns are very clear. Those are two reasons why gender and women’s empowerment are even more important in urban areas.

Women & Girls Hub: You have just taken up the leadership of GAIN. What priorities do you foresee for the organization?

Haddad: GAIN’s mission is to reduce malnutrition through innovative partnerships and alliances. We’re further refining that, I think, to focus on diets and food. We’re doing this because food is a forgotten item when it comes to malnutrition. I know that sounds like a strange thing to say, but food falls between the health sector and the agriculture sector. I’m talking about food consumption. The health sector is not as focused on food consumption as it could be. It’s focused more on products and healthcare and breastfeeding, which are all important. The agriculture sector is more focused on food production and food distribution and processing but not really on food consumption – what are people eating?

Women & Girls Hub: Why is food consumption such an important issue?

Haddad: The most recent update of the global burden of disease adds up all mortality and morbidity throughout the world and asks, “What are the key risk factors for the burden of the disease?” The key risk factor, the biggest risk factor, is poor diets and poor food intake, much more important than unsafe sex, much more important than smoking, drug use, alcohol use, unsafe water and unsafe sanitation. What we eat is the key risk factor for the burden of disease.

We want to focus on food. That means we’ve got to focus on food systems, everything from production to processing, to transport, to marketing, to retailing, to creating the demand for healthy foods.