Institute Insights: August 2017

Contents:

Children at Lott Carey Mission School play outside during P.E. class. Photographer: Laura Elizabeth Pohl

From the Director

It’s August and, along with others across the country, many people in Washington, D.C., are on vacation or “staycation” (taking time off to relax at home, catch up with friends, and so forth). 

People who are malnourished or food insecure usually can’t go on vacation or staycation. Those who are smallholder farmers or work in the informal sector of developing countries can’t take days off since, as we sometimes say, “hunger doesn’t take a vacation.” Many low-income people in the United States also work six or seven days a week just to survive, at jobs that rarely offer paid vacation or sick days.

It’s not surprising that at Bread for the World Institute, we spend our time thinking about policies that will help end hunger. These can vary widely, everything from boosting nutrition for children in the 1,000 days between pregnancy and age 2, to tackling the racial and gender pay gaps in the United States — but they are larger policy issues. We are always mindful of the people behind the statistics; our everyday work is about easing their suffering, improving their health and nutrition, enabling them to afford necessities, and so forth.

But our top concern is not usually quality of life beyond the basics, because people need food, clean water, health care, and so forth — the tools that help equip them to build better lives — before they can think very much about anything else. A hungry person is primarily thinking about how to get food, period.

Yet while governments and analysts are counting and gathering data on low-income people, and the people themselves are working to support themselves and build a more prosperous future for their families, they are also living their lives. Human relationships are universally present, no matter how few material resources people have. Intangibles like faith, love, loyalty, hope, even a sense of humor are what shape a large part of a person’s quality of life.

One theme of this issue of Institute Insights is quality of life. We mention that the African Development Bank has named improving quality of life for Africans as one of its five main goals. We describe how teachers in U.S.-supported nutrition programs in Malawi are working to show parents how to prepare not just nutritious meals — vital as that is — but meals that children enjoy eating. We discuss recent proposals by the administration and Congress to slash funding for programs such as Medicaid. Any such cuts would take a heavy toll on not just the health and nutritional status of older Americans — again, vital as those are — but also on their quality of life as, more and more, they must “choose” between paying for food and paying for medical care.

Hungry people are not going on cruises or camping trips, or visiting tourist attractions. But they still have the intangibles that make their lives worth living — in fact, these factors have always been the mainstay of human civilization. One of the many reasons to end hunger is to better nurture them.  

Asma Lateef is director of Bread for the World Institute

Asma Lateef is director of Bread for the World Institute.

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Most Vulnerable, Least Visible in Medicare Debate: Older Americans. Photo: Bread for the World

Among Those Most Vulnerable and Least Visible in Medicaid Debate: Older Americans

By Derek Schwabe

At this writing, the administration and Republican Senate leaders continue to scramble to fulfill one of their key campaign promises: repeal the Affordable Care Act, better known as Obamacare.

The Congressional Budget Office “score,” or projection of a legislative proposal’s costs and impacts, indicates that at least 20 million people would lose their health insurance as a result. Many individuals likely to be harmed by any of the several versions of the Republican alternative plan have protested vigorously, confronting senators at town hall meetings, calling their offices, and denouncing the plans on social media. A few have even held sit-ins outside various offices on Capitol Hill, some risking arrest.

Combined with the mobilization of a diverse array of advocates from across a range of sectors — faith, health care, child welfare, nutrition, and anti-hunger groups such as Bread for the World — their efforts have so far managed to narrowly prevent passage of any of the proposals.

Bread for the World denounced the proposals. Bread president Rev. David Beckmann said that they would increase hunger and poverty in our country. Calling them “mean-spirited and cruel,” Beckmann said, “If senators truly care about the well-being of their most vulnerable constituents — the elderly, people with disabilities, and children — they will vote against this legislation.”

Elderly people are already more likely to be hungry or food insecure, more likely to have medical conditions and/or disabilities, and more likely to have low incomes. But older Americans are also less visible.

The Better Care Reconciliation Act (BCRA), the Senate plan that may have the most support, would force millions more people into the impossible “choice” of “treat of eat” — buying either the medications and health care treatments they need, or the food they need. There are several ways it would do this. First, it would allow insurers to charge older people five times as much as younger ones for health coverage; the limit currently is three times. With one-third of senior households either without funds or in debt after paying their basic monthly expenses, rising monthly premiums for health insurance will push many deeper into debt, poverty, and hunger.  

Second, the BCRA would gut Medicaid, the key federal program that serves older Americans who need but are unable to pay for longer-term services and supports, such as nursing home care or home health assistance. According to the AARP, nearly a third of older people are projected to deplete their life savings and turn to Medicaid for assistance as their ability to care for themselves declines. Medicaid pays the nursing home bills of the majority of residents, about 4.4 million people in 2011 and continuing to rise as the Baby Boomer generation enters old age. Of every 10 people now turning 65, seven will need long-term services at some point, for an average of three years.

Although federal law requires state Medicaid programs to cover nursing home care, states will not be able to make up for the proposed cut of $880 billion over 10 years in federal funding without either capping the amount of money the program spends per person, tightening eligibility requirements so that fewer people are allowed to participate, or both. The CBO estimates that Medicaid funding would fall 26 percent from its baseline. The bottom line is that states will face a significant funding gap in providing health care for a growing number of older Americans with less money saved for retirement.

Choosing either the treat or eat “option” worsens people’s health problems, food insecurity, and hunger. As explained in Bread for the World Institute’s 2016 Hunger Report, The Nourishing Effect, there is a bi-directional relationship between hunger and health outcomes. People who are hungry are more likely to end up in the hospital with costly health conditions, and those who cannot access healthcare are more likely to face  hunger. This may be most true for older Americans. Protecting Medicaid for them and others who need it makes sense economically, but it is also the right thing to do for one of the nation’s most vulnerable, least visible groups — a group all of us, if fortunate enough, will join eventually.

Derek Schwabe is a research associate in Bread for the World Institute.

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Malawi’s high rate of childhood stunting is an economic crisis. Approximately 37 percent of all children under 5 are stunted. Photo: Bread for the World

Advancing Life Expectations in Malawi

By Jordan Teague

Malawi’s high rate of childhood stunting is an economic crisis. Approximately 37 percent of all children under 5 are stunted, meaning that they have suffered irreversible lifelong damage to their health and development from early childhood malnutrition. Childhood stunting has clear links to stunted economic growth because of lower productivity and higher healthcare costs. Malawi is very poor, and stunting only makes the country’s struggle to build a stronger economy more difficult.

Stunting generally takes place before a child’s second birthday. Thus, it is especially alarming that young children are affected, along with the rest of the family, by the two main drivers of malnutrition — poverty, which prevents families from buying enough food, and heavy reliance on maize as the staple crop, which leads to very low dietary diversity. Only 8 percent of children under 2 receive what is called a minimum acceptable diet, a term that encompasses eating a variety of foods so as to get all essential nutrients.

The U.S. Agency for International Development (USAID), through its Food for Peace development program, is helping communities in southern Malawi build their own knowledge and capacity to adequately nourish themselves and their children. During my May 2017 trip to Malawi, I visited communities participating in the program United in Building and Advancing Life Expectations (UBALE), a USAID Food for Peace project. In the Nsanje district, I met a woman and her child participating in the Community-Led Complementary Feeding and Learning Sessions that UBALE conducts twice each year.

The little girl and her mother joined other caregivers and children in the community for 12 days of education and training. Caregivers learn about which foods are most nutritious and how to prepare them for the family, including their young children. The foods included are all locally available and locally grown. UBALE promotes six food groups — animal-source proteins, beans, vegetables, fruits, grains, and healthy fats and oils — and encourages women and children to eat from at least four of them every day. Many of the participants in these sessions also participate in UBALE’s Care Groups, which focus on building and cultivating home gardens to produce the vegetables used in UBALE’s recipes.

UBALE goes one step further in its educational efforts: every day of the session, staff demonstrate different ways to cook nutritious foods that are good for people of various ages to eat. The program even emphasizes making nutritious meals that children will enjoy eating! At each session, participants learn different recipes and cook them together. The entire group then eats the meal. 

This active feeding portion of the sessions gives UBALE staff an opportunity to help caregivers with problems such as children with poor appetite or inability to eat. The staff and participants problem-solve together to reach the shared goal of nourishing the children. Cooking and eating the meals can also be helpful for the adults, who may feel more comfortable cooking and serving these relatively unfamiliar foods  — especially if they begin to take the place of some of the maize dishes the family has always eaten.

During the 12-day session, children are evaluated for acute malnutrition on Days 1, 7, and 12. The little girl I met weighed 15 pounds on the first day, but by Day 7, when this photo was taken, she had gained 2 pounds!

This program helps treat acute malnutrition during the session by feeding children nutritious foods, but it also equips caregivers with knowledge of nutritious foods that are available where they live, and with recipes to make it easier for them to prepare and serve healthy meals. The children are not only at less risk of future episodes of acute malnutrition, but are also more likely to be well nourished in the longer term.

Investing in nutrition works. Investments in nutrition are investments in the health and well-being of children and, in addition, in a community’s and a country’s future generations. USAID, through Food for Peace and other programs, helps countries and communities strengthen nutrition policies, knowledge, and practices. In the end, this generation of children will then be able to grow up healthier, get an education, improve their own lives, and help make their country and the world better places.

Jordan Teague is international policy analyst with Bread for the World Institute.

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Despite having contributed little to cause climate change, the poorest developing countries are already experiencing the effects. Photo: UN / Evan Schneider

Climate Change Plus Conflict Equals Hunger

By Michele Learner

The Sahara Desert, which already occupies 3.5 million square miles in Africa, is expanding due to climate change. The Sahel, the region that stretches across the continent to the desert’s south, is becoming more desert-like every year.

The Sahel, which includes parts of nine countries, has always been a difficult place to live and earn a living. Traditionally, most of its population has been nomadic, moving from place to place, accompanied by camels as well as livestock such as sheep and goats. Some groups have prospered, however, and the region has also supported thriving economies based on crisscrossing trade routes.

According to the United Nations, ordinary conditions in today’s Sahel region include millions of people living in a permanent state of food insecurity. Every year children die of malnutrition-related causes at rates well above the global threshold for a hunger emergency. When the 2005 famine in Niger made international headlines, many food security workers in the country questioned whether conditions were indeed much worse that year than in previous years.

With an already challenging environment now affected by deeper and more frequent droughts, it is more and more difficult for people to eke out a living. Despite hard work, most families have few resources and options available to them as young children become lethargic from malnutrition, come down with illnesses that are dangerous given their weakened immune systems, and, all too often, die before their fifth birthdays.

Such profound economic vulnerability makes community-level development efforts far more difficult. It also makes younger people, in particular, more susceptible to the promises of extremist groups to provide their followers with a better life. As national governments continue to fight formal armed rebel groups, assorted jihadist groups have been contributing to the violence. Among these are ISIL and Al Qaeda in Mali, Boko Haram in Nigeria, and Al-Shabaab in Somalia.

Accounts such as this do not mince words: “Farmlands are invaded and looted by insurgents, farmers killed or kidnapped, markets bombed, farmers displaced as IDPs and refugees, animals seized, animal herding restricted, and farmland left uncultivated and not harvested.”

It’s not hard to see that armed conflict in an already hungry community further damages people’s hopes of keeping their children alive and well, much less working with others in their communities to build a stronger economy or find ways of adapting to climate change.

This is not to say that people in grim situations give up. They keep looking for solutions. Breaking the cycle could start with establishing social safety nets, particularly for women and children. This is one objective of the U.N. Integrated Strategy for the Sahel as it works toward enabling the people of the Sahel to build long-term resilience.

Food and nutritional security are at the center of the resilience strategy. Along with direct assistance for the most vulnerable, building this security could include, for example, improving irrigation and drainage, diversifying food sources, and finding better ways to store surplus food for the future.

But first, the fighting must stop.

Michele Learner is associate editor at Bread for the World Institute.

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DR. AKINWUMI AYODEJI ADESINA, the President of the African Development Bank (AfDB), will be recognized as the 2017 World Food Prize Laureate. Photo: Juliana Thomas / Clinton Global Initiative

“High-Five”: African Development Bank President Akinwumi Adesina Named 2017 World Food Prize Laureate

By Faustine Wabwire

On June 26, 2017, many of us in the Washington, DC, global development community gathered at U.S. Department of Agriculture (USDA) headquarters for the announcement of this year’s World Food Prize Laureate. The World Food Prize is the foremost international honor recognizing the achievements of individuals who have advanced human development by improving the quality, quantity, or availability of food in the world.

It was with great joy that I heard the U.S. Secretary of Agriculture announce that the 2017 World Food Prize Laureate is Dr. Akinwumi Adesina, president of the African Development Bank (AfDB).

Since becoming AfDB president in September 2015, Dr. Adesina has outlined a 10-year strategy for the bank. Its five themes are known as the High-Fives: Light Up and Power Africa, Feed Africa, Integrate Africa, Industrialize Africa, and Improve Quality of Life for the People of Africa.

There are three areas of special emphasis that cross all the themes:

Fragile states — tailor support to their diverse needs; take a continuum approach and a regional approach built around dialogue and local ownership
Agriculture and food security — invest in regional infrastructure; engage in policy dialogue to remove trade barriers to importing food; help restrict food price volatility and reduce food insecurity
Gender — focus on knowledge, skills development, and legal and property rights, especially land rights.

Adesina’s presidency of AfDB comes at a time when the continent has made great progress on some fronts while facing great challenges on others. Over the decade 2001-2010, six out of 10 of the world’s fastest-growing economies were in Africa. A range of countries, from Ghana in the west to Mozambique in the south, achieved consistent growth over this period.

African agriculture grew at 3.4 percent per year over this decade — the first decade when agricultural growth outpaced Africa’s population growth rate of 2.4 percent. This was no coincidence, since long before the 2007-2008 food price crisis, the governments of the African Union had been grappling with how best to refocus attention and resources on agricultural development.

Nonetheless, the encouraging growth rates did not necessarily mean that the continent made progress against hunger and extreme poverty. This is because growth was mainly concentrated in sectors such as banking and financial services, construction, and manufacturing. In many cases, these sectors were too far removed from the agriculture sector and the majority of hungry and malnourished people—who live in rural areas and depend on agriculture for their livelihoods — to benefit them.

And, although the world has made impressive progress against hunger, it is equally obvious from the current droughts and famine conditions that the problem is far from solved and that gains can be fleeting. 

The “High-Five” themes indicate key reforms needed to strengthen social, economic, and political resilience. In turn, greater resilience will make it possible for governments and communities to devote more resources to key sectors, particularly agriculture. The themes also provide a wide scope to boost investments in Africa’s human and economic capital — particularly youth employment and country-owned industrialization efforts.

For me, Adesina’s strategic plan and vision for the continent reflects the critical roadmap toward strengthening the capacity of national institutions and systems such as agriculture, markets, and infrastructure in an integrated way. It focuses on enhancing the knowledge and skills of individuals — particularly Africa’s large youth population. And it goes far beyond this to creating and sustaining incentives for effective local systems — both state and non-state — to achieve the ambitious Sustainable Development Goals (SDGs), which include Zero Hunger by 2030. We know now that nutrition in the 1,000-day window between pregnancy and age 2 is foundational — if we miss that window in a child’s life, the consequences are irreversible. Targeting mothers and young children with nutrition efforts is essential.

This is why I emphasized in my recent Congressional testimony that at a time of intense debate over budgets, and in the face of four famines, the United States should support multilateral and regional bodies such as the African Development Bank in unlocking the continent’s potential to achieve the SDGS. Development partners, including the United States, should commit to aligning their support with existing country and regional frameworks such as those of the African Development Bank and the Comprehensive Africa Agriculture Development Program (CAADP).

Awarding this year’s World Food Prize to Dr. Adesina is also recognition of the African Development Bank’s work, particularly its plan to focus on five themes and put a special emphasis on fragile states, agriculture, and gender. This work will help put Africa on track to achieve the SDGs, among them ending hunger and all forms of malnutrition.

Faustine Wabwire is senior foreign policy analyst in Bread for the World Institute.

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Conflict cost the global economy nearly $14 trillion in 2015. Graphic by Doug Puller / Bread for the World

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