Malnutrition, a persistent global challenge, affects millions worldwide, with devastating consequences for health, economic productivity, and human development.
Despite the technological and agricultural advances of the 21st century, malnutrition continues to hinder the progress of nations, especially in the developing world. The ‘Triple C’ crisis – climate change, conflict, and the rising cost of living due to economic instability – exacerbates this issue, highlighting systemic inefficiencies in food distribution. As global attention shifts from food security to sustainable food systems, it is essential to understand the causes, consequences, and potential solutions for malnutrition, particularly in vulnerable countries like Pakistan.
Globally, approximately 150 million children under the age of five are malnourished, leading to stunted growth, impaired cognitive development, and diminished future economic potential. Stunting affects 22 per cent of the world’s children, and in some of the poorest countries, this figure rises dramatically. For instance, in Burundi and Libya, over half of children under five are stunted.
The lack of essential nutrients, particularly during the first 1,000 days from conception to a child’s second birthday, can have lifelong consequences, as brain development during this period is crucial. Children who experience malnutrition in these early years are likely to lose up to 15 IQ points and may face reduced productivity and earning potential later in life.
Recent advances in science have shifted the focus from simply providing calories to ensuring that diets are rich in micronutrients – vitamins and minerals crucial for proper growth and development. Innovative approaches, such as microbiome-directed complementary foods (MDCF), show promise in addressing malnutrition more holistically by improving gut health and enhancing nutrient absorption. However, these interventions are often slow to reach the regions that need them most.
The drivers of global malnutrition are complex and multifaceted. While poverty is a primary factor, it is not the only one. War and conflict displace millions, forcing people into food insecurity. In regions like sub-Saharan Africa and the Middle East, conflicts not only destroy food supplies but also disrupt agricultural cycles and food markets. Climate change compounds these issues by increasing the frequency and severity of droughts, floods, and other extreme weather events, further destabilizing food systems.
Another crucial factor is inequality in food distribution. Despite the world producing enough food to feed everyone, many still go hungry due to unequal access, poor infrastructure, and systemic inefficiencies. The global food system is skewed toward the production of calorie-dense but nutrient-poor foods, exacerbating the issue of ‘hidden hunger’, where people may have enough to eat but lack essential nutrients like iron, iodine, and vitamin A.
Rapid urbanization and changing dietary habits have also contributed to this shift, particularly in developing nations where processed foods high in sugars and fats are becoming more prevalent, leading to the paradox of obesity alongside malnutrition.
Pakistan provides a striking example of how these global dynamics play out at the national level. Malnutrition in Pakistan remains a critical challenge, affecting nearly half of the population. According to the 2023 State of Food Insecurity and Nutrition report by the FAO, 19 per cent of Pakistan’s population is undernourished, and 43 per cent face moderate or severe food insecurity. Even more alarming, 83 per cent of Pakistanis cannot afford a diet that meets basic nutritional requirements. This situation is aggravated by the fact that Pakistan’s food system remains heavily focused on staple crop production – particularly wheat, rice, and sugarcane – at the expense of more diverse and nutritious foods.
Pakistan’s agricultural sector has historically been production-centric, with little attention paid to nutritional outcomes. While the country is largely self-sufficient in cereal production, nearly 40 per cent of children under five are stunted due to poor dietary diversity. Cereals, which provide 50 per cent of daily caloric intake in Pakistan, lack essential nutrients, leading to widespread micronutrient deficiencies.
High post-harvest losses – estimated at around 26 per cent – and inadequate investment in agricultural research and development, which fell below 0.1 per cent of GDP in 2022-2023, have hampered efforts to improve food security.
Climate change is an increasingly significant factor in Pakistan’s food insecurity. Rising temperatures, erratic weather patterns, frequent floods, and water scarcity are already affecting agricultural yields. As temperatures rise beyond the global target of 2 C, the frequency of extreme weather events like floods and droughts will increase, further destabilizing food systems. For a country where agriculture employs a significant portion of the population, the impact of climate change on food production and rural livelihoods is dire.
These environmental challenges are compounded by the socio-economic issues facing many Pakistani families. Structural and policy reforms, including containing and reducing the energy circular debt, improving tax to-GDP ratio, and eliminating non-targeted subsidies, are steps in the direction to improve macroeconomic stability.
However, the cost of transition to such stability is disproportionally being borne by low and middle-income families in the shape of rising energy tariffs, increased taxes, and sudden exposure to the removal of GST exemptions in the absence of targeted subsidies. They are being forced to make difficult choices between essential expenses like electricity and food. As a result, many are unable to afford a balanced diet, leading to higher rates of malnutrition.
Tackling malnutrition requires a multifaceted approach that goes beyond increasing food production. A holistic food systems approach is needed, focusing on sustainable and climate-smart agricultural practices, dietary diversity, and enhanced social safety nets.
Pakistan’s Ministry of National Food Security and Research (MNFSR) must graduate from a production-focused model to one that considers sustained access to quality food. This will involve revising the country’s food security policy to prioritize nutrition-sensitive agricultural practices and improve socioeconomic access through improved coordination between federal and provincial governments.
One crucial area of focus should be the diversification of crops. While Pakistan has achieved self-sufficiency in staples like wheat, it must now invest in high-value crops such as fruits, vegetables, pulses, and animal products. These foods are essential for addressing the widespread micronutrient deficiencies that afflict millions of Pakistanis. By promoting a more diverse agricultural system and consumption of multigrain flour (such as wheat plus corn), Pakistan can improve both food security and nutrition.
Women play a critical role in agriculture, making up 40–50 per cent of the workforce in Pakistan’s agricultural sector. Their empowerment, particularly through access to resources, education, and decision-making power, will be crucial not only for improving food production and processing but also for behavioural change to use nutritional diet. Strengthening their role in the supply chain and integrating them into policy frameworks can have a transformative effect on national nutrition outcomes.
Additionally, the private sector can be leveraged to combat malnutrition through public-private partnerships that promote climate-smart agricultural practices, innovative agricultural technologies, food fortification, and the development of biofortified crops. Encouraging companies to produce healthier, fortified food products can address some of the root causes of malnutrition and food insecurity.
Pakistan can learn from global best practices in combating malnutrition. For instance, Bangladesh’s efforts to improve gut health through MDCF provide a model for addressing not just caloric intake but also nutrient absorption. Bangladesh’s success in reducing stunting from 63 per cent in 1990 to 24 per cent in 2022 demonstrates the power of targeted nutrition interventions, economic growth, and collaboration between governments and non-governmental organizations.
Furthermore, the global trend towards food fortification – adding essential vitamins and minerals to staple foods – offers a cost-effective solution to address widespread micronutrient deficiencies. Pakistan has already experimented with iodized salt. The success of that initiative should be expanded to staple food.
Malnutrition and food insecurity challenge not just food production but also equitable distribution, sustainable practices, and effective governance. The time to act is now. The global community, including Pakistan, must recognize that malnutrition is not only a health crisis but also a socio-economic and environmental one. Solving this issue will require coordinated efforts across sectors, and the benefits – healthier, smarter, and more productive populations with a bright future – will far outweigh the costs.
The writer heads the Sustainable Development
Policy Institute. He tweets/posts @abidsuleri
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