Researchers and donors are not giving nutrition the attention it deserves, says Priya Shetty.
When the world acts together to solve health problems the results can be formidable. We have produced powerful drugs against two of the planet's biggest killers, HIV and malaria, as well as treatments for countless other diseases.
But one simple way of fighting almost every disease affecting the poor is frequently overlooked: better nutrition.
Poor nutrition affects nearly all aspects of health, from susceptibility to disease to how the body responds to treatment. But nutrition research is severely underfunded — it seems that nutrition is everyone's problem, but no-one's priority.
This is partly because improving nutrition does not need complex technology, and advanced drugs or vaccines — most nutritional deficiencies are extremely basic. But addressing them does require social or behaviour changes for which other types of research are needed.
Research into the social determinants of health is as vital as biomedical science, and indeed is increasingly recognised as such. So why are we seeing obstacles to integrating social and scientific nutritional studies into mainstream research on reducing infectious and chronic diseases in developing countries?
Impact of malnutrition
The facts are clear enough. Six million children die each year from malnutrition, more than three times as many as tuberculosis (TB).
But malnutrition is not just devastating because millions go hungry every day. A lack of food and nutrients affects other aspects of health to a great degree.
Malnutrition can seriously weaken the immune system. This not only increases the risk of infection from diseases such as TB, it also further imperils the health of people with HIV/AIDS, for example. Children are especially vulnerable to malnutrition — half a million go blind every year from vitamin A deficiency (see The challenge of improving nutrition: facts and figures).
Dearth of funding
But despite the obvious need, donors rarely give nutrition the attention it deserves. According to research published in The Lancet, donors invested less than US$250 million in nutrition in developing countries from 2000 to 2005. This figure is dwarfed by the estimated US$1.5 billion given to fight malaria, or the US$10 billion for HIV/AIDS, in 2007.
A major problem is that many of the aid agencies that pour millions of dollars into global health programmes do not seem to fully appreciate the links between nutrition and disease.
Donors such as the Bill & Melinda Gates Foundation are investing heavily in research to develop crops with higher nutritional value, but there seems to be no direct links with the disease programmes they fund.
The Global Fund, which mobilises billions of dollars to fight HIV/AIDS, TB and malaria, acknowledges that nutrition is important for tackling these diseases, but relies on the countries it funds to specifically ask for help to implement nutrition programmes.
Responding to a challenge to prioritise nutrition in treating HIV/AIDS, the organisation said: "The Global Fund's key partners have specialised departments that deal with the issue of nutrition, health and development, traditional nutrition and pre-approval of lists of drugs." It names the WHO as one of these partners.
A cop-out by donors
For Ruth Levine and Danielle Kuczynski at the Center for Global Development, a think-tank based in Washington DC, this type of statement from major funders is a cop-out.
In a paper on funding for nutrition, Levine and Kuczynski call for greater coherence among funders.  They write: "Funders could collaborate to create a strong incentive for UN agencies, the World Bank, privately funded initiatives, and others to work together to fulﬁl key functions, including norm-setting, advocacy, scientiﬁc inquiry, programme and technical support, capacity-building and implementation at the national level."
While they acknowledge that giving donors more scope to intervene at national level could seem 'heavy-handed', they argue that it is necessary given the almost total lack of attention to this key issue within many developing countries.
The goals ahead
The issue of poor nutrition has now come to a head with the twin burdens of the food and financial crises, which are estimated to have added 100 million to the number of undernourished people in the world. There is also growing pressure on countries to start showing significant progress towards meeting the Millennium Development Goals — improving nutrition could go a long way to achieving them.
There is some hope in new initiatives such as the Global Alliance for Improved Nutrition, which is developing a programme to "increase vitamin and mineral intake in the diets of people in developing countries who are suffering from infectious diseases such as malaria, tuberculosis and HIV/AIDS".
Nutrition research must be better integrated into research targeted at major infectious diseases. Scientists must start to clarify the extent to which nutrition affects individual diseases — and how it could be used therapeutically. Until they do so, the research community could be overlooking one of the most important weapons in public health.