The case for investing in nutrition is clear. Poor nutrition during the fi rst

1,000 days—from pregnancy through a child’s second birthday—can

cause life-long and irreversible damage, with consequences at the

individual, community, and national level.

Multi-sectoralApproaches to Nutrition:

When a child is malnourished during the fi rst 1,000 days of life, it results in a weaker immune system and a higher risk of severe infectious diseases, including diarrhoea and pneumonia.1,2 As undernourished children become adults, they are more likely to suffer from chronic diseases, such as high blood pressure, diabetes, heart disease, and obesity.3,4 These health impacts have devastating consequences for social and economic outcomes. Poorly nourished children are more likely to complete fewer years of school and have lower productivity as adults, including 10 percent lower earnings over their lifetime.4,5

When multiplied across an entire nation, it is estimated that poor nutrition can reduce a nation’s economic advancement by at least 8 percent due to direct productivity losses, and losses due to reduced schooling and poorer cognition.6

By improving nutrition, we can build human capital and fuel economic growth for generations to come. However, nutrition’s full impact can only be unleashed when all sectors do their part—as shown in the UNICEF conceptual framework below.

UNICEF Conceptual Framework of Malnutrition (adapted)

Household food insecurity Inadequate foods, feeding, and care practices

House, environment and health services

Inadequate access to services

Inadequate � nancial and human resources

Sociocultural, economic and political context

Inadequate dietary intake Disease

Intergenerational Consequences

Short-Term Consequences

Mortality, morbidity, disability

Maternal and Child Undernutrition

Long-Term Consequences

Cognitive development, health, economic productivity

ImmediateCauses

UnderlyingCauses

BasicCauses

NUTRITION-SPECIFIC AND NUTRITION-SENSITIVE INTERVENTIONS TO ACCELERATE PROGRESS

Nutrition-specific

interventions address the immediate causes of undernutrition, like inadequate dietary intake and some of the underlying causes like feeding practices and access to food.

Nutrition-sensitive

interventions can address some of the underlying and basic causes of malnutrition by incorporating nutrition goals and actions from a wide range of sectors. They can also serve as delivery platforms for nutrition-specific interventions.

Achieving nutrition’s full impact on health and development outcomes requires a multi-sectoral approach

Nutrition-specific interventions are key to accelerating progress. However, it is also critical that other sectors—like agriculture, education, and social welfare—develop nutrition-sensitive interventions. A truly multi-sectoral approach will achieve optimal nutrition outcomes through greater coverage, while also helping other programmes achieve more powerful results and demonstrate their own potential for impact.

u Agriculture: Programmes that boost agricultural production, keep prices low, and increase incomes are critical—but they can still leave children vulnerable to the life-long effects of poor nutrition. Research shows that nutrition-sensitive programmes can enhance access to diverse diets in poor populations, foster women’s empowerment, and support livelihoods.7

u Education: When education programmes invest in nutrition, it improves academic achievement—with the potential for substantial gains in the cost, efficiency, and effectiveness of programmes.8 Keeping girls in school for longer is proven to delay the age of first marriage, and prepares young women to be more informed and empowered mothers.9 Deworming, micronutrient (including iron) supplementation, food fortification, and early childhood development programmes all show tremendous potential for impact.

u Social welfare: Efforts to lift poor families out of poverty are undermined unless good nutrition is part of the investment. When social protection programmes become nutrition-sensitive, they can improve diet quantity, quality, and diversity; decrease vulnerability to food insecurity; decrease child mortality; and help children reach their full potential.10,11,12,13

u Public health: Public health and nutrition are interdependent. Diarrhoea and pneumonia are the biggest killers of children in the Asia and Pacific region—deaths that are largely preventable through breastfeeding and adequate nutrition, hand washing with soap, safe drinking water and basic sanitation, and vaccination.14 Delivery of micronutrient supplements through antenatal care services can also reduce maternal death and low birthweight significantly.15

Key findings from The 2013 Lancet Series on Maternal and Child Nutrition show that nutrition-sensitive programmes in agriculture, social welfare, early child development, and schooling can be successful at addressing several underlying determinants of nutrition. Once there is consensus for a multi-sectoral approach, we can begin to tackle all the causes of malnutrition in a coordinated and synergistic way.

Criteria for nutrition-sensitive development1

Nutrition-sensitive development seeks to integrate and promote nutrition as a goal of multiple sector policies in order to accelerate national development. Agriculture, social protection, health, and education programmes all have specific and attainable actions they can make to improve their own outcomes by incorporating nutrition.

Nutrition-sensitive programmes can:

u Incorporate specific nutrition goals and actions in addition to their own goals.

u Directly address factors that influence undernutrition, like food security, access to health services, or ensuring safe and hygienic environments.

u Target key audiences for nutrition information, including the poor, who have the highest malnutrition rates.

u Deliver nutrition-specific interventions, like counseling on infant and young child feeding, care, and hygiene.

Breastfeeding, along with other interventions, such as hand washing and vaccinations, can help prevent diseases like diarrhoea and pneumonia — the biggest killers of children in the Asia and Pacific region.14

Other sectors can take practical steps to develop nutrition-sensitive programmes1

Programmes can become more nutrition-sensitive by:

u Strengthening their nutrition goals, design, and implementation. For example, health programmes can often deliver nutrition services through antenatal care services, routine immunisation, and family planning.

u Improving targeting, timing, and duration of exposure to interventions. For example, integrating nutrition into programmes that reach families with pregnant and lactating women and children between 0 and 24 months of age will optimise delivery of key services during the critical window of opportunity.

u Using conditions to stimulate demand for programme services, while ensuring good service quality. For example, cash transfer programmes can set conditions on payments that require families to utilise key nutrition services, enforce school enrolment and attendance, or require parent participation in health and life skills education.

ImprovedNutrition

Social Protection

Agriculture

Women’s Empowerment

Development & Poverty Reduction

Education

+Health

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Sources

1. The Lancet, (2008). Maternal and Child Undernutrition, Special Series, 371.2. The Lancet, (2003). Child Survival, Special Series, 361.3. Thomas, D., & Strauss, J., (1997). Health and wages: evidence on men and women in urban Brazil, Journal of Econometrics, 77, 159-85.4. Hunt, J. M., (2005). The potential impact of reducing global malnutrition on poverty reduction and economic development, Asia Pacific Journal of

Clinical Nutrition, 14, 10-38.5. Horton, S., (1999). Opportunities for investments in nutrition in low-income Asia, Asian Development Review, 17(1,2), 246–273.6. Horton, S., & Steckel, R. H., (2013). Global economic losses attributable to malnutrition 1990— 2000 and projections to 2050. In: Lomborg, B. How

much have global problems cost the world? A scorecard from 1900 to 2050, Cambridge University Press, Cambridge.7. Alderman, H., & Ruel, M., (2013). Nutrition-sensitive Interventions and Programmes: How Can They Help to Accelerate Progress in Improving Maternal

and Child Nutrition?, The Lancet, 382, 536-551.8. Bundy, D., et al., (2009). Rethinking School Feeding: Social Safety Nets, Child Development and the Education Sector, World Food Programme and the

World Bank.9. IOB, (2011). Lessons learnt: Synthesis of literature on the effectiveness of investment in education, Ministry of Foreign Affairs of the Netherland, IOB

Evaluation, The Hague, Netherlands, (355).10. DFID, (2009). The neglected crisis of undernutrition: Evidence for action, UKAID from the Department for International Development, London, U.K.11. Gilligan, D., et al., (2008). The Impact of Ethiopia’s Productive Safety Net Programme and its Linkages, IFPRI, Washington, D.C.12. Freeland, N., & Cherrier, C., (2012). Social Transfers in the Fight Against Hunger A Resource for Development Practitioners, Tools and Methods Series

Reference Document, European Commission.13. Rasella, D., et al., (2013). Effect of a conditional cash transfer programme on childhood mortality: a nationwide analysis of Brazilian municipalities, The

Lancet.14. UNICEF, (2012). Pneumonia and diarrhoea: tackling the deadliest diseases for the world’s poorest children, New York.15. Bhutta, Z., et al., (2013). Evidence based interventions for improving maternal and child nutrition: What can be done and at what cost?, The Lancet,

382, 452-477.16. The World Bank, (2013). Improving Nutrition through Multi-Sectoral Approaches, Washington, D.C.

This document has been produced with the financial assistance of the European Union, as part of the Maternal and Young Child Nutrition Security Initiative in Asia (MYCNSIA). The views expressed herein can in no way be taken to reflect the official opinion of the European Union.

For more information on this and other partnerships of UNICEF and the EU, please go to www.unicef.org/eu

By improving nutrition, we can build human capital and fuel economic growth for generations to come.

u Optimising focus on women’s nutrition and empowerment. For example, when programmes are designed from the outset to increase women’s decision-making power, it can increase investments in better nutrition for the whole family.

Nutrition-sensitive programmes can help enhance the scale of nutrition-specific interventions and create a stimulating environment in which young children can grow and develop to their full potential.

WE MUST ACT NOWPolicy-makers and programme implementers from across sectors can help ensure a brighter future by developing nutrition-sensitive interventions that help individuals and nations benefit from the full impact of optimal nutrition. By investing now, we can generate greater human capital, enable individuals to escape poverty, and help nations fuel economic development. Together, we can break the cycle of undernutrition for generations to come.

This is one brief in a five-part series on the importance of multi-sectoral approaches to nutrition. To read the other briefs, visit www.unicef.org/eu/devaid_nutrition.html.