Institute Insights: July 2018


Pedro and Concepcion Granada and their children in front of their house in the highlands of Nicaragua. Photo by Richard Leonardi.

From the Director

If you're a regular reader of Institute Insights, the phrase "leave no one behind" may sound familiar. This key concept of the Sustainable Development Goals (SDGs) reminds the world that we cannot end hunger and all forms of malnutrition, or achieve any of the other SDGs, without reaching everyone. Between 1990 and 2015, hunger was cut almost in half. Hundreds of millions of people are now getting enough calories, are better nourished, and are less vulnerable to becoming hungry when a shock such as a natural disaster or a sudden spike in food prices occurs. The SDGs aim to finish the job.

This month, 47 countries, ranging from Uruguay to Qatar to Switzerland, will submit Voluntary National Reviews on their progress toward the SDGs. We look forward to learning how countries are planning to meet the imperative of leaving no one behind. How can the United States contribute to the success of low-income countries, and what can our country learn from other countries that are confronting the systemic problem of social exclusion?

Most often, as we explain in Bread for the World Institute's 2017 Hunger Report, Fragile Environments, Resilient Communities, the people not reached during the earlier Millennium Development Goals era live in areas where conflict or climate change has damaged or destroyed their livelihoods. In recent issues of Institute Insights, we have focused on the impact of current conflicts in South Sudan and the Republic of the Congo.

Hungry people who live outside these "fragile" contexts are generally hungry for the straightforward reason that they are poor and cannot produce or buy enough food. Among other underlying causes, people may be malnourished because they are geographically isolated, marginalized on the basis of race or religion, or considered lower status within their households.

The SDG framework, recognizing that some communities, families, and individuals are in immediate danger from hunger and malnutrition, also calls for "reaching the furthest behind first." In both emergency situations and poor communities with chronic malnutrition, it is young children who are most vulnerable to hunger. As we have often mentioned, the "1,000 Days" between a woman's pregnancy and her child's second birthday is the most critical human nutrition window. Missing essential nutrients during this time can cause lifelong damage. Recently, some researchers have argued that prenatal nutrition may be the most critical of all.

While children younger than 2 are the most vulnerable, children ages 2 to 5 are also at risk when they suffer even brief periods of hunger. Malnourished children are far less likely to survive infections and illnesses. This is why global statistics such as progress on child mortality define their population as children under 5.

The recent news on child nutrition is mixed. According to the most recent Joint Child Malnutrition Estimates, published by UNICEF, the World Health Organization, and the World Bank, many countries have made progress. Using proven strategies such as supporting exclusive breastfeeding has led to slow improvements in the rate of stunting, a devastating condition that is the result of early childhood malnutrition. It causes irreversible physical and cognitive damage as well as stunted growth. As of May 2018, the global rate of stunting was 22.2 percent, or about 151 million children.

As mentioned earlier, conflict causes a significant amount of the world’s remaining hunger. Families are trapped in war zones with little or no way to make a living, or they are forced to flee their homes and farms and depend on help from neighboring countries or the international community. Children in these families are at the highest risk of death from Severe Acute Malnutrition (SAM). Helping the millions of children with SAM is the most urgent task of reaching the furthest behind first.

Asma Lateef is director of Bread for the World Institute

Asma Lateef is director of Bread for the World Institute.

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A mother in Nepal receives nutritious foods and soap to improve the nutrition of her children. Photo: : Kesi Marcano-Collier / Bread for the World

Nepal: Enabling local governments to improve nutrition

By Jordan Teague

For many years, Bread for the World Institute has emphasized that strengthening local capacity for development is critical to the success of development efforts. Government and civil society structures that function well, in addition to country ownership of development efforts, are necessary elements of an enabling environment. An enabling environment is a set of conditions that make it possible to achieve development goals, including ending hunger and malnutrition.

One important support for countries working to improve maternal and child nutrition is the Scaling Up Nutrition Movement. Nepal joined early on, in 2011, and is now one of 60 member countries. SUN helps its members expand and replicate nutrition strategies that have been proven effective, leading to more progress.

Nepal is implementing phase two of its Multi-Sector Nutrition Plan (MSNP). The MSNP directs nutrition-related work in seven areas: education; health; agriculture; livestock; drinking water and sanitation; women, children, and social welfare; and local governance.

The development and launch of the MSNP is a great accomplishment. Putting a national nutrition plan in place demonstrates the political will needed to find and implement solutions to malnutrition. Next, it will take effort and attention to accomplish the plan’s goals.

Nepal is in the midst of transitioning to a federalist government. Under this system, much of the decision-making power will be held by local governments rather than the national government.

The development and launch of the MSNP is a great accomplishment. Putting a national nutrition plan in place demonstrates the political will needed to find and implement solutions to malnutrition. Next, it will take effort and attention to accomplish the plan’s goals.

Nepal is in the midst of transitioning to a federalist government. Under this system, much of the decision-making power will be held by local governments rather than the national government. While many see this as a positive move, it will be important to ensure that local governments are aware of the MSNP II, understand its provisions, have the expertise to implement it, and can mobilize political will to establish the policies and budgets that will improve maternal and child nutrition.

This spring, I visited Nepal with two Bread colleagues to learn more about USAID nutrition-related programs. Suaahara II is USAID’s flagship nutrition and health investment in Nepal. A U.S. nonprofit, Helen Keller International, leads its implementation. Suaahara II equips Nepal’s government to do "nutrition governance"—for example, by supporting government officials as they lead the drafting and implementation of the MSNP II, organizing orientations to introduce the plan to newly-elected officials, and participating with local leaders to advocate for budget allocations for maternal and child nutrition services.

We saw an example of such a partnership in Dang District in Nepal’s mid-western region. A form of acute malnutrition known as wasting—weighing too little for one’s height—affects an estimated 8.8 percent of the region’s children. One local municipality partnered with Suaahara II to provide nutritious foods and soap to households where children had been identified as moderately malnourished. The local government provided the funds to purchase the supplies, while Suaahara II coordinated community meetings, nutrition education, and distribution.

This is but one example of how countries are investing in their population’s nutrition and implementing their own programs. Donors, including the U.S. government, will remain important stakeholders and investors, but local governments and civil society groups are in a far better position to ensure that programs are working as envisioned and that no one is being left behind. U.S. investments should help strengthen the capacity of national and local governments to reach the development goals that are most important to their citizens’ well-being.

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

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Mother and Child. Photo: Joe Molieri / Bread for the World

Leaving No Baby Behind

By Michele Learner

Poverty is a major cause of hunger and a host of other human problems. But rarely, if ever, is poverty as simple as “lack of enough money.” Social biases and their consequences, such as lack of educational opportunities or housing segregation, are frequently key components of poverty’s impact. One reason poverty and hunger are ancient problems resistant to change is their interrelationship with many other problems, such as racial, gender, and religious bias.

The Sustainable Development Goals (SDGs) have a steady drumbeat of “leave no one behind.” It is not possible to avoid leaving people behind when the solutions being tried overlook important factors in the creation of the situation we see today. It is undoubtedly more complex to identify and take into consideration the impact of key “outside” influences that appear separate from the problem at hand, but this is what is needed for lasting improvements.

In “Leaving No Mother Behind” in our May issue, we talked about the connections between maternal mortality and malnutrition, particularly iron-deficiency anemia. Deaths among newborns and infants share many of the causes of maternal mortality. The much-needed reduction in mortality among slightly older children, ages 1 to 5, has highlighted the problem of mortality among babies less than a year old. Infant mortality is a large and growing share of child mortality.

In developing countries and the United States alike, premature birth (before 37 weeks), low birthweight (less than 5.5 pounds), and their complications are responsible for many infant deaths. In any country, babies born to poor families are at much higher risk, as are their mothers.

UNICEF’s Every Child Alive initiative works in 10 countries that, together, account for half the world’s infant deaths: Bangladesh, Ethiopia, Guinea-Bissau, India, Indonesia, Malawi, Mali, Nigeria, Pakistan, and Tanzania. In addition to emphasizing the importance of skilled help during childbirth, discussed in greater detail in “Leaving No Mother Behind,” the Every Child Alive effort focuses on ensuring that health facilities have the necessities: clean water, soap, and electricity. A third priority is to ensure that each facility has the 10 supplies identified as most important for infant survival. Most of these are basic items, but all too often, they are in short supply. They include blankets, antibiotics, micronutrient supplements, thermometers, a broad-scale antiseptic, and tetanus vaccine.

In the United States, premature or low birthweight babies generally have access to sophisticated medical treatment. In this country, the greatest risk period is from 1 month to 12 months old. Babies who go home to families struggling with poverty and racial discrimination are at greater risk of death from such causes as infections, asthma, other conditions more common in poor neighborhoods, and Sudden Infant Death Syndrome (SIDS), whose cause or causes remain unknown.

Every year in the United States, more than 23,000 infants die before reaching their first birthday. Black infants die at a rate more than twice that of white infants. In many cities, the disparity is even greater. In Ward 8 of Washington, DC, the poorest ward with a population that is 93 percent African American, the infant mortality rate is 10 times the rate in Ward 3, which is predominantly white and affluent.

It is worth repeating this shocking statement from a New York Times feature article, also included in “Leaving No Mother Behind”: “Recently there has been growing acceptance of what has largely been, for the medical establishment, a shocking idea: For black women in America, an inescapable atmosphere of societal and systemic racism can create a kind of toxic physiological stress, resulting in conditions — including hypertension and pre-eclampsia — that lead directly to higher rates of infant and maternal death.”

Of course, reducing and then ending racism and poverty are far harder tasks than supplying pregnant women with iron and folic acid. But as Dr. Nancy Krieger, a professor of social epidemiology at Harvard University, points out in "What's Killing America's Black Infants?," the fact that a problem is complex does not mean that it’s hopeless. Another way of seeing it is as something where progress can come from many different directions.

Programs such as Milwaukee’s Lifecourse Initiative are one of the approaches that drives progress. The initiative supports parents of infants in three poor districts on Milwaukee’s north side. One of its several components is a home visit program. A health educator or nurse visits new mothers who request the service, answering questions, explaining how to spot signs that their baby needs prompt medical attention, brainstorming possible solutions to the problems that parents face in neighborhoods of concentrated poverty, and providing support and encouragement. A nurse who has worked with 360 mothers over 12 years in her program Blankets of Love reports that so far, every baby has celebrated a first birthday.

Every Child Alive’s 2018 report sums up the most important ingredient in infant survival: “Political will to invest in strong health systems that prioritize newborns and reach the poorest and most marginalized is critical, and [it] can make a major difference, even where resources are constrained.”

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

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The Lower Ninth Ward sustained catastrophic flooding following Hurricane Katrina. Ten years later, the neighborhood has not fully recovered. In the background are houses being built in the area by actor Brad Pitt’s nonprofit foundation. Wikimedia Commons.

The Inequality of Storms

By Todd Post

The 2018 Atlantic hurricane season began in June and lasts through November. Most forecasters, including the National Oceanographic and Atmospheric Administration, are predicting above-average hurricane activity. If it is another season like 2017, I would expect climate change to emerge as a campaign issue in the midterm elections. 

In 2017, Hurricanes Irma and Maria developed into Category 5 storms. On the scale used to measure a hurricane’s catastrophic potential, 5 is the highest. If you’ve seen images of the destruction wrought by Irma and Maria, in Florida and Puerto Rico respectively, you will understand why Category 5 hurricanes call for the evacuation of all areas believed to be in the storm’s path. 

Also in 2017, Hurricane Harvey, a Category 4 storm, caused unprecedented flooding in Houston—27 trillion gallons of water in six days.

2017 was the first hurricane season on record that had three or more storms of Category 4 or higher.  According to climate scientists, however, the 2017 season may soon be the new normal.

It is sometimes said that natural disasters are an “equalizer,” as wealthy and poor people alike suffer their effects. But in reality, residents of low-income communities suffer far more than those with more resources and options. Far from making anything more “equal,” in fact, the differing impacts of the storm only widen over time. For example, 10 years after Hurricane Katrina, a survey of African Americans and whites who had lived in New Orleans at the time revealed sharply different opinions of the storm’s long-term effects. Most whites said they had “mostly recovered,” while most African Americans said they had “mostly not recovered.”

Why are people living in poverty or in low-income communities so much more vulnerable than wealthy people? One reason is that they are far more likely to live in vulnerable neighborhoods and vulnerable homes. New Orleans’ Lower Ninth Ward, the poorest neighborhood in the city, suffered the most severe damage. Houston is one of the most segregated cities in the United States, and African American residents live in the most flood-prone areas. In addition, the homes in poor neighborhoods may be old, not built to code, or both.

For all intents and purposes, Hurricane Maria destroyed the infrastructure of Puerto Rico. More than nine months after the storm, parts of the island still do not have electricity. By one estimate, 14 percent of the population has left, finding the slow recovery unbearable. As U.S. citizens, people in Puerto Rico are free to relocate to other parts of the country—but it is people with more money and other resources who are most likely to be able to move. Migration patterns tell the story of how disasters affect rich and poor people differently.

A recent study analyzed data for 90 years of natural disasters in the United States. Since wealthier people are more likely to move away in the aftermath of a disaster, we would expect to see increased poverty in the area, at least in the short term—and that is exactly what the researchers found.

How can we reduce the vulnerability of poor communities and speed their recovery in the wake of a disaster? I’ll be looking closely at potential solutions in upcoming editions of Institute Insights. It turns out that effective policy responses dovetail with several of the recommendations of Bread for the World Institute’s 2018 Hunger Report, The Jobs Challenge. Stay tuned.

Todd Post is senior researcher, writer, and editor with Bread for the World Institute.

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Dominic Duren spends a few moments with his son Dominc. Dominic is the director of the HELP Program in Cinncinati, Ohio. Joseph Molieri / Bread for the World

Honoring Father’s Day Every Day: Food Secure Families

Some of us celebrated Father’s Day with our fathers last month, while others have special memories of grandfathers, fathers, and father figures who enriched our lives in countless ways.

As a nation, we know that fathers are important. Public policies can help empower men to participate fully in their children’s lives. Unfortunately, policies can also undermine fathers’ efforts. We focus here on measures that help fathers, particularly by enabling them to support their children and ensure that they have sufficient nutritious food. Such policies honor Father’s Day year-round.

Children in the United States are at greater risk of hunger than adults, with a food insecurity rate of 17.5 percent, compared with 12.3 percent for the U.S. population. Children of color, children from female-headed households, and especially children who fall into both groups are by far the most vulnerable. Latino children have a one in three chance (32 percent) of being food insecure, while African American, Native American, and Alaskan Native children have an even higher rate, nearly 40 percent. That is more than twice the rate for all children, and more than three times the national rate.

Children are most often hungry because their parents are hungry. Discrimination on the job, in housing, and in the criminal justice system makes it far harder for parents of color to put food on the table. To reduce their families’ high risk of hunger, we support four policy changes that will help fathers:

  • Strengthen and expand the Earned Income Tax Credit (EITC). Single low-wage workers under age 25 are not eligible for the EITC, while noncustodial parents are eligible for very limited benefits. Noncustodial fathers with low-wage jobs need additional income to help support their children. Lowering the eligibility age and increasing current benefits would help young fathers and noncustodial fathers. Altogether, these changes would prevent 2.3 million African American and 1.7 million Latino workers from being taxed into poverty, effectively increasing their take-home income.
  • Strengthen and expand SNAP (the Supplemental Nutrition Assistance Program). Mass incarceration has had a devastating effect on African American men and their children. In 30 states, fathers who are returning from incarceration face partial or full bans on receiving SNAP benefits,  prolonging the high risk of hunger among these parents and their children even after the parent’s return. Eliminating policies that prohibit returning citizens from receiving SNAP would be a step in the right direction. Another step in the right direction would be to allow undocumented fathers who are income-eligible to participate in SNAP to help support their children.
  • Protect undocumented and mixed-status families through immigration policies. Fathers should not be separated from their children. Family separation contributes to hunger among Latinos and other immigrant groups. The country should adopt policies that protect working fathers from being deported and separated from their children. Current immigration law adds to hunger and poverty in immigrant communities.
  • Reform the criminal justice system to eliminate disproportionate arrests, prosecution, and incarceration of African Americans; end the practice of imprisoning people who have not been convicted of a crime solely because they cannot afford bail; and help people returning from incarceration integrate into society. To reduce hunger among African American fathers and children, the country needs an enabling environment that helps returning citizens reintegrate to society, ends discrimination in employment so that fathers can find work, and restores their eligibility for federal nutrition programs and other supports.

Marlysa D. Gamblin is domestic advisor, policy and programs for specific populations.

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from our Resource Library

For Education

For Faith

  • Unity Declaration on Racism and Poverty

    A diverse body of Christian leaders calls on the churches and Congress to focus on the integral connection.

    Dear Members of Congress,

    As the president and Congress are preparing their plans for this year, almost 100 church leaders—from all the families of U.S. Christianity—are...

  • In Times Like These … A Pan-African Christian Devotional for Public Policy Engagement

    This devotional guide invites deepened relationship with and among Pan-Af­rican people and elected leaders in the mission to end hunger and poverty.

  • Sermon by David Beckmann at Duke University Chapel

    Remarks delivered October 1, 2017 at Duke University Chapel in Chapel Hill in North Carolina.

    Thank you for inviting me to preach here at Duke University Chapel. And I especially want to thank the Bread for the World members who have come this morning.

    Bruce Puckett urged...

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Advocacy Summit

June 21, 2019


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