• Child Health
• Health Policy
• Developing Countries
• Growth

As we write, thousands of children suffer from hunger and starvation, especially in areas ravaged by military aggression such as Gaza and Ukraine and civil and political strife such as Afghanistan and Somalia. Also, while subjective hunger might be assuaged for others living in relative peace, over 150 million children continue to live on food that is simply not up to par with global nutritional standards. Some of these children may not be hungry but they remain ‘food poor’. It is important to underscore that the world has not just transitioned from one category to another; hunger has not been eliminated and lives on in pockets across the world. Hunger has served as an important rallying cry for human rights advocates for decades, and it continues to deserve immediate attention.

Yet, the UNICEF report1 ‘Child Food Poverty, 2024’ is a welcome reinforcement of the need to acknowledge but move beyond merely speaking of filling hungry stomachs and set our sights firmly upon also achieving decent food quality for all children.1 UNICEF highlights an important metric, ‘food poverty’, defined as a child’s inability to access and consume a nutritious and diverse diet. Food poverty is measured using the WHO/UNICEF dietary recall instrument, which defines a diverse diet as consuming at least five of eight core food groups daily. This report’s focus on child food poverty should not signify as much a shift away from a focus on hunger, as highlighted in the report using the Early Childhood Food Insecurity Experience Scale, but a welcome addition.

The findings of the report show over 183 million children living in severe food poverty, primarily in Africa and South Asia. Child food poverty, expectedly, is concentrated among the poor and is associated with other factors that also contribute to poverty, including stunting and rural habitation. The report courageously identifies key drivers as ‘growing inequities, conflict and climate crises, combined with rising food prices, the overabundance of unhealthy foods, harmful food marketing strategies and poor child feeding practices’. There is a welcome shift away from placing responsibility on individuals and families, with an emphasis on failures of food, health and social security systems. Rapid assessment data emphasise caregivers’ concerns about food affordability and accessibility. Furthermore, the report provides a spotlight on Gaza and Ukraine in several sections and calls out ‘historic patterns of inequity, discrimination and disempowerment and underlying systemic issues as root causes.

Additionally, the report provides a significant perspective on the intrusion of processed foods. As high as 54%of children living in severe child food poverty belong to the middle and upper wealth quintiles due to the consumption of unhealthy foods and beverages. This phenomenon is not, however, restricted to the higher income quintiles. In Nepal, for instance,42% of children living in severe child food poverty consume processed foods and 17% consume sweet beverages. Here too, systemic issues of harmful marketing by food companies are stated upfront. The report is quite explicit that the marketing of ultra-processed foods is ‘driven by profit at the expense of children’s needs and rights’ (p 44). It also points to an underemphasised factor: constraints upon women’s time and energy in the absence of societal support for childcare promote the consumption of cheaper, unhealthy foods. ‘Ultra-processed foods permeate small kiosks, shops and supermarkets…including in the remotest corners of the world. In the absence of national policies, laws and standards…these unhealthy ultra-processed foods are often aggressively promoted and carry misleading nutrition and health claims that falsely reassure parents and families’ (p 44).

Globally, inequities in child food poverty have not diminished, even as absolute gains have been made. The report highlights wide subnational variations in severe child food poverty, though the methods used do not allow very reliable data. While there are no gender differences between children of different sex, maternal characteristics clearly continue to demonstrate the intergenerational effect of gender discrimination.

Since we must believe that change is possible, several case studies are included to elaborate upon strategies used to achieve positive outcomes. Looking at positives from Burkina Faso, Nepal, Peru, Rwanda and Kenya, common facilitators emerge, such as nutrition governance at the highest levels, social protection, including but not limited to cash transfers, the use of local fresh and diverse foods through intense supplementation programmes, ring-fenced funding, effective food business regulation, good use of data and the promotion of nutrition-sensitive agriculture.

The report ends with comprehensive and strong recommendations for governments as well as civil society that flow logically from its substantial analysis. However, the report does lay itself open to some critique and also provokes the need for deeper analysis.

First, the absence of a detailed methods section, considering a multitude of methods with a host of limitations and assumptions used, feels like a major gap. Some limitations are mentioned in the smallest of prints under graphics. The concern here is that important conclusions are apt to be rubbished by governments living in denial. In our contested world of policymaking, research methods acquire a political dimension as arenas of contestation and hence must be seen as rigorous.2

As another methodological issue of political importance, the frequent use of the term ‘predictor’ in the report is incautious and liable to misinterpretation. For example, ‘Severe child food poverty predicts child stunting and wasting’ simply means a multivariable regression model showed an association. This does not necessarily imply direct causality. Indeed, in our own work, we have repeatedly observed that gains in diet quality do not always readily translate to changes in growth outcomes.3 Child growth dynamics are complex, multifactorial and intergenerational. It is important to craft clear policy messages while also encouraging stakeholders to recognise that there are no ‘magic bullets.’4 Change will require sustained, multisectoral interventions for generations.

Next, while ‘harmful social and cultural and norms’ find due space (p 44), religious dietary beliefs are not mentioned, although the report notes animal-source foods as the densest source of nutrients, with less than 5% of children in severe child food poverty consuming them. Agriculture barely makes it to the analysis as a significant domain of crisis resulting from climate change and economic policy. While calling upon governments to limit conflicts of interest, the Scaling Up of Nutrition programme founded by the Bill and Melinda Gates Foundation and the European Union is upheld uncritically, even as this programme has been widely critiqued as a ‘multistakeholder programme’ that includes food business companies.5

Thus, there is a ‘stopping short’ in the report that leads us to systems, but not far enough to structures. If the main drivers of hunger and food poverty are climate change, conflict and economic crisis, is there not a common root? The report notes that the Ukraine war has increased child food poverty. The interpretation is strange: ‘the need for shock-responsive social protection programmes that are able to anticipate and respond swiftly to shocks’. There is neither questioning of the essential root cause nor a demand to end the war, or all wars.

We live in a world that is deeply divided between massive concentrations of wealth among a few at the cost of the economic exploitation of a vast majority situated, not coincidentally, in the same geographies as child food poverty. While a focus on low- and middle-income countries is appropriate, it is well worth noting that the poor in the ‘developed’ world are not spared either since the root causes remain the same. In the USA alone, for instance, food insecurity in households with children (17%) has increased by 40% between 2021 and 2022.6 Similarly, 12% of households with children in the UK will suffer from food poverty in 2021, as per a report placed in the House of Commons Library.7

The paradox of a political economy that thrives on ever-escalating material consumption, driving the climate crisis, while even basic needs for children are not met, should not be lost on us. Geopolitical struggles for power facilitate conflicts in which more children might die from a single airstrike than the entire number of child deaths in peacetime. Corporates that make profits out of climate shocks, conflict and economic crises influence decision-making through ‘multistakeholder’ platforms. Without challenging the dominant socioeconomic paradigm itself, we may not be doing more than lip service to the elimination of child food poverty. We must go beyond concepts of resilience to staunchly demand freedom, equality and peace.

Let us make no mistake: we are living in times of escalating global crises fuelled by our lack of vision beyond neoliberalism. Food-poor children are but canaries in a collapsing coal mine with nowhere else to be rescued. They cannot be saved till the coalmine itself is questioned.