First Mondays: Final Thoughts – February 2016 Policy Salon

Thanks to all who attended our second member-facilitated First Mondays policy salon. Debi Spindelman asked us to think about how to engage business and policy leaders as we address the impact of stunting (a.k.a. chronic, early-life malnutrition).

Below, find our key distillations from the evening’s discussion and additional resources to explore the topic further. Mark your calendars for our next First Mondays salon on Monday, March 7th at 6:30 p.m., and look for an invitation to an upcoming special event.

Why the Richard Bransons, Ben Bernankes, and Bill Brattons of the world should care about stunting (a.k.a. chronic, early-life malnutrition)

Bransons, Bernankes, Brattons – you’re up! The nutrition folks have put together the right foods to reduce stunting. The humanitarian and development people have tried to get this food to where it’s needed. But these efforts are clearly not whole-problem solutions. We’re still living in a world that produces 159 million children so malnourished that their physical and cognitive development stops far short of their potential. This fact is a hit not only on our collective hearts, but on your respective sweet spots: the company bottom line, the country bottom line, and the CompStat report. As countries’ economies grow, leaders (like you) and operators (like us) across the business, policy, and security sectors can ensure that strategic investments are made not just in high-growth business sectors, but as well in poverty alleviation, nutrition security, maternal health, and early childhood development on the front-end and cognitive behavioral therapy and educational intervention for those affected by stunting on the back-end. These are long-term investments in the productivity of the global workforce and governance capacity in the most fragile corners of our world.

Stunting is a biomedical issue. It’s not only about quantity of food – the number of calories from fat, protein, and carbs, a.k.a. macronutrients; it’s also about quality of food – the vitamins and minerals, a.k.a. micronutrients, that make kale a better food choice than those fries you’re about to eat for lunch. Deprivation of micronutrients in the first 1000 days from conception (in utero) to 3 years of age impedes cognitive development, thereby influencing learning capabilities, IQ, judgement, and decision-making.

Reversible, or not reversible, that is the question. We queried whether cognitive impairment caused by stunting can be reversed to any degree across the lifespan of an individual. Most academics and practitioners have said, “No,” and put their efforts behind prevention. But Debi, who has spent substantial time in her career and throughout her life working with special-needs learners, contends that like other mild-to-moderate learning and behavior disorders, there may indeed be mitigation techniques for stunted individuals with a similar degree of cognitive impairment. These techniques could have a game-changing influence on economic productivity, law enforcement strategies, and public-private policy approaches in food-insecure areas with high stunting rates. Unlike the biomedically irreversible impairment caused by lead exposure, impairment from stunting may be partially reversible.

But, food is also a cultural issue. “Fixing” access to enough nutritious food is relatively straightforward, but changing how people engage with food is a stickier conundrum. Across South Asia and places with strong cultural gender biases combined with poverty, women, girls, and even expectant mothers (beginning the cycle of early-life malnutrition in utero) often eat last, after the most nutrient-rich foods have already been consumed. Further, nutrition is not simply sustenance; food also influences behavior and culture. Basic satiation leads to big changes in mood and behavior, as well as our ability to handle difficult decisions and learning processes. Thus there is a connection between nutrition, environmental health, and the social problems that often beset food-insecure communities, such as structural violence and higher enrollment in illegal activity. How do communities and countries change the path of food insecurity with behavior changes and cultural adjustments?

Nutrition is a money issue and money is a political issue. Poor communities are disproportionately affected and lack resources for remediation. Yet nutrition assistance is often a victim of partisanship in which social programs for the poor are framed as a moral hazard that incentivizes dependency. To pivot the conversation, we must recognize that poverty is not only a social issue; it is a primary driver of a biomedical problem that negatively affects children’s brains/cognitive development and their ability to be well-prepared, contributing adults of their communities, which, ironically, feeds the same vicious cycle.

Like the scourge of politics (#GetOutTheVote2016), cognitive impairment has broad implications for everyone. Whether cognitive impairment is due to stunting (caused by early malnutrition, neglect, or trauma), Zika-borne microcephaly, or lead poisoning, poor cognitive development is closely entwined with poverty and is a driver of reduced economic productivity. Conflict, disaster, and bleak livelihood options that stoke the fires of forced migration are tightly bound up with stunting rates (which are often double in conflict-impacted areas) and human capacity issues. Prevention efforts are great but attention needs to be paid to those living with this impairment to support them, their communities, and their countries
to fulfill their full participation in society.

For a deeper dive, Debi recommends:

Please feel free to share any additional thoughts or feedback by emailing us:
ideas (at) franklinstreetppolicygrp (dot) nyc.