Reducing malnutrition, an imperative for ASEAN

Held every two years, the ASEAN Health Ministers meeting is an important opportunity to take stock on progress made across the region to improve the health of the 625 million people living in the ten Member States of this regional organisation.

When Health Ministers meet in Hanoi on 18 and 19 September, they will certainly see a mixed picture. On the positive side, child mortality has massively decreased in the region, with a 57% reduction of the under-five mortality since 1990. Yet, every year, 346,000 children die in Southeast Asia before reaching their fifth birthday. One of the main reasons for their death is poor nutrition, the underlying cause of nearly half (45%) of deaths in children under-five. Stunting remains widespread across most ASEAN countries. In Indonesia, 39% of under-five children are stunted and in the Philippines, 34%. Countries like Cambodia and Laos have even higher rates of stunting, with more than 40% of their children being stunted.  The consequences of stunting are very serious, and they are life-long. The body and brain of a stunted child will fail to develop properly. It is time for ASEAN countries to further scale up their efforts to reduce stunting. Vietnam has shown that it is feasible. In 2000, 43% of Vietnamese children under-five were stunted. A decade later, stunting prevalence has been reduced to 23%. It is still too high, but this marked reduction highlights that progress can be made. A first step is to make malnutrition visible. Chronic malnutrition is a hidden killer that is all too often ignored. Each ASEAN country should commit to ambitious targets for the reduction of stunting and should particularly invest in nutrition interventions targeting the first 1000 days of life, from the child’s conception to his or her second birthday. A recent Lancet series showed that, by scaling up ten proven nutrition interventions, we can save nearly 1 million children’s lives and protect 33 million from stunted growth. Investing in human resources for nutrition is critical. Doctors, nurses, midwives and community health workers have all an important role to play in delivering the direct interventions that can improve nutrition.

 One of these interventions is particularly worth highlighting: breastfeeding. An infant given breast milk within an hour of birth is up to three times more likely to survive than one breastfed a day later. Breastfeeding is one of the most effective ways to prevent the diseases and malnutrition that can cause child deaths. Yet, in most ASEAN countries, rates of exclusive breastfeeding during the first six months of life are low. In Vietnam, only 17% of infants are exclusively breastfed in their first six months of life and in Myanmar, less than a quarter. All ASEAN countries should make their health systems stronger to protect and promote breastfeeding. They should also more rigorously regulate the marketing and sale of baby milk formula. The aggressive marketing of these formula violate the International Code of Marketing of Breast-milk Substitutes. Amongst the most worrying violations is the targeting of health workers, encouraging them to promote baby formula to mothers of young infants. In many ASEAN countries, policies to prevent and stop these violations have been adopted; they are unfortunately poorly implemented. It is urgent for these policies to be properly enforced; they can go a long way in improving the health and nutrition of children.

 All these interventions point in one direction, the importance of having nation-wide nutrition-sensitive health systems. And it is here that the leadership of all ASEAN Health Ministers is critical. Six of the ten ASEAN Member States (Cambodia, Indonesia, Lao PDR, Myanmar, Philippines and Vietnam) have joined the Scaling Up Nutrition movement and committed to bringing together governments, business, civil society organisations, multi-lateral organisations and bi-lateral donors to scale up nutrition interventions. These stakeholders are supporting many programmes in collaboration with the Ministries of Health and other ministries in each of the six countries.

This approach to reduce malnutrition is not only a health imperative. It is also a very smart and cost-effective investment in the overall economic and social development of a country. National economic growth is negatively affected by malnutrition, which commonly leads to losses in GDP by developing nations of as much as 2 to 3% per year. Eliminating under nutrition in young children has multiple benefits for a country’s growth. It improves school achievement and leads to a more skilful workforce. In short, the costs of investing in better nutrition are far outweighed by the benefits. Yet, in many ASEAN countries, this investment is still limited and difficult to track. Mobilising financial resources to support at scale the implementation of nutrition policies and plans must remain a budget priority for all ASEAN countries with high rates of malnutrition.

 on Communicable Diseases are on the agenda of the ASEAN Health Ministers meeting in Hanoi. These diseases highlight one of the rising paradoxes in Southeast Asia. On the one hand, many countries are still dealing with issues of under-nutrition and persistent stunting. On the other hand, these same countries are also heading straight into an epidemic of non-communicable diseases related to over-nutrition. This situation is now being referred to as the “double burden of malnutrition”. In some countries in the region, overweight already affects between 5 to 15% of under-five children. We can see obese adults and stunted children in the same nuclear family. There is also the risk of seeing funding for expensive treatments for diseases like diabetes being diverted away from inexpensive measure to prevent stunting. Both are needed and call for increased attention and resources being committed to address under and over nutrition. Both require a strong focus on the first 1,000 days of life where critical interventions can make a difference between a healthy life and one plagued by disease.

 Nemat Hajeebhoy is the Programme Director of Alive & Thrive in Vietnam

Greg Duly is Save the Children Regional Director for Southeast and East Asia