A report by the Bill & Melinda Gates Foundation reveals that fortifying bouillon cubes with iron, folic acid, zinc, and vitamin B12 in Nigeria could prevent up to 16.6 million cases of anemia and 11,000 deaths from neural tube defects in children by 2050.
The foundation’s eighth annual Goalkeepers report, released on Tuesday, emphasizes that prompt action in this area could significantly enhance health outcomes and drive economic growth.
The report also highlights new modeling projections indicating that climate change will exacerbate hunger, affecting an additional 40 million children by 2050.
The Bill & Melinda Gates Foundation is calling on world leaders to increase global health investments to improve child health and nutrition, particularly in the context of the climate crisis.
The Goalkeepers report, titled “A Race to Nourish a Warming World,” warns that without immediate global intervention, climate change will result in 40 million more children suffering from stunting and 28 million more experiencing wasting between 2024 and 2050. Addressing these issues now can mitigate these impacts, enhance resilience to climate change, and stimulate crucial economic growth.
The World Health Organization estimated in 2023 that 148 million children are affected by stunting and 45 million by wasting, both conditions that severely impact physical and mental development.
“These are the most severe and irreversible forms of chronic and acute malnutrition.”
At the same time, as global challenges intensify, the total share of foreign aid going to Africa has decreased.
In 2010, 40 per cent of foreign aid went to African countries. But that number is now down to just 25 per cent—the lowest percentage in 20 years—despite more than half of all child deaths occurring in sub-Saharan Africa.
This trend leaves hundreds of millions of children at serious risk of dying or suffering from preventable diseases and threatens the unprecedented progress the world made in global health across Africa between 2000 and 2020.
“Today, the world is contending with more challenges than at any point in my adult life: inflation, debt, new wars. Unfortunately, aid isn’t keeping pace with these needs, particularly in the places that need it the most,” writes report author Bill Gates, co-chair of the Bill & Melinda Gates Foundation.
“I think we can give global health a second act—even in a world where competing challenges require governments to stretch their budgets.”
According to Gates, malnutrition represents “the world’s worst child health crisis,” exacerbated by the impacts of climate change. In response to this urgent issue, Gates advocates for sustained global health funding and immediate action to combat rising child malnutrition. He supports the Child Nutrition Fund, a new initiative designed to coordinate donor financing for nutrition, and calls for governments to fully fund established institutions that have demonstrated success in safeguarding millions of lives annually.
These key institutions include Gavi, the Vaccine Alliance, which will conduct its next funding replenishment in 2025, and the Global Fund to Fight AIDS, Tuberculosis, and Malaria, which is also expected to hold its replenishment next year.
“If we do these three things, we won’t just usher in a new global health boom and save millions of lives—we’ll also prove that humanity can still rise to meet our greatest challenges,” Gates writes.
The report also emphasizes the severe economic impact of malnutrition and presents potential solutions to address it. According to the World Bank, undernutrition costs the global economy approximately $3 trillion annually in lost productivity due to its effects on physical and cognitive development. In low-income countries, this loss can range from 3% to 16% of GDP, equivalent to a sustained global recession at 2008 levels each year.
Proven Tools Exist Today
“The best way to fight the impacts of climate change is by investing in nutrition…Malnutrition makes every forward step our species wants to take heavier and harder,” Gates writes. “But the inverse is also true. If we solve malnutrition, we make it easier to solve every other problem. We solve extreme poverty. Vaccines are more effective. And deadly diseases like malaria and pneumonia become far less fatal.”
The report highlighted proven tools that are helping solve malnutrition, building people’s resilience to the worst impacts of climate change, and further driving down childhood deaths. They include:
* New agricultural technologies that are producing up to two to three times more milk and safer milk, which can prevent millions of cases of child stunting by 2050.
*Modeling shows that in India, Ethiopia, Kenya, Nigeria, and Tanzania, these technologies can prevent 109 million cases of child stunting by 2050.
* Efforts to scale up new ways of fortifying pantry staples, such as salt and bouillon cubes, can reduce millions of cases of anaemia and prevent deaths due to neural tube defects.
*In Ethiopia, a new process to fortify salt with iodine and folic acid could lead to a 4% reduction in anaemia and could eliminate up to 75% of all deaths and stillbirths due to neural tube defects.
* Efforts to provide a high-quality prenatal vitamin for pregnant women could save almost half a million lives and improve birth outcomes for 25 million babies by 2040.
*Adopting multiple micronutrient supplements (MMS) costs as little as $2.60 for an entire pregnancy in all low- and middle-income countries.
The report also highlighted how promising new research into the microbiome can improve people’s health. Studies indicate that better gut health can help children absorb nutrients, develop strong immune systems, and grow as they should to thrive. A deeper understanding of gut health, Gates writes, has the potential to change not just how the world treats malnutrition but also overnutrition, which impacts wealthy countries.
This year’s report also featured essays from farmers and experts on the frontlines of the malnutrition crisis, who explain the impacts these tools are making in their communities.
Sushama Das, a dairy farmer in Astaranga, in the Indian state of Odisha, wrote about the Livestock Enhancement and Advancement Programme: “Today, we have eight cows, and they are producing 60 litres of milk every day…The subsidies and training schemes have helped our family earn more money—our monthly income is now five times as much as it used to be.”
Coletta Kemboi, a dairy farmer in Maili Nne, Kenya, who participated in a training with MoreMilk, wrote, “Before, there were some traces of unclean milk, but since I went through the training, they [inspectors] have come to our shop around three times and their tests are proof that our milk is good…The extra money we are earning goes to the farm…We are able to pay my three children’s school fees.”
Ladidi Bako-Aiyegbusi, director of nutrition at the Nigerian Ministry of Health and Social Welfare and leader of a large-scale effort to fortify bouillon cubes, wrote, “Without access to the essential nutrients that children under 5 years need to grow, thrive, and lead healthy lives, they are being robbed of their future.”
Dr. Sabin Nsanzimana, Rwandan minister of health and leader of efforts to ensure all Rwandan women have access to MMS, wrote, “Prenatal vitamins save lives. That’s why you can find them on grocery store shelves in wealthy nations. But for women in low- and middle-income countries, like Rwanda, they are at once more essential and harder to find.” To date, more than 50,000 Rwandan women have received MMS through a program in seven districts with the highest rates of stunted growth.
Dr. Víctor Aguayo, director of child nutrition and development at UNICEF, wrote, “The Child Nutrition Fund could be a game changer. It holds the potential to address the child malnutrition crisis and transform philanthropy for maternal and child nutrition.”