Hunger threatens to undo decades of global development, Bill Gates warns

Is the global health boom over? Decades of progress at a cross roads as malnutrition rages

Twenty years of progress in global health development is on the cusp of being undone by an unrelenting malnutrition crisis that is sweeping the globe, Bill Gates has warned.
In his annual assessment of the state of the world’s health, the philanthropist says the “global health boom is over” and warns that without further investment we may look back on the huge improvements made in the early part of the century as an aberration rather than a historic trend.
“The global health boom is over. But for how long? That’s the question I have been wrestling with for the past five years,” says Gates in the introduction to his foundation’s report on progress towards the UN’s Sustainable Development goals. 
“Will we look back on this period as the end of a golden era? Or is it just a brief intermission before another global health boom begins?”
Gates notes that between 2000 and 2020, the world witnessed a “global health boom.” Child mortality was cut by half, the impact of infectious disease began to fade and the poorest regions saw the greatest gains.
But the Covid-19 pandemic brought two decades of unprecedented progress to a “screeching halt” in 2020 and its economic and political fallout continues to dominate today. 
In particular, says Gates, a global food crisis is undermining the prospects for further future gains in global development. 
“Two thirds of the world’s children – more than 400 million kids – are not getting enough nutrients to grow and thrive, putting them at higher risk for malnutrition,” he writes.
“In 2023, the WHO estimated that 148 million children experienced stunting, and 45 million children experienced wasting – the most severe forms of chronic and acute malnutrition. It prevents them from growing to their full potential – and, in the worst cases, from growing up at all”. 
The report, ‘A Race to Nourish a Warming World,’ highlights that child malnutrition is not just a human tragedy, but an economic one as well. 
“The world’s worst child health crisis is malnutrition,” says Gates. “If we solve malnutrition, we make it easier to solve every other problem. We solve extreme poverty. Vaccines are more effective. And deadly diseases like malaria and pneumonia become far less fatal.
“Few economists think of the malnutrition rate as a critical economic data point – but they should start. Nutritional deficits quickly translate into financial deficits,” he says.
The World Bank agrees. It estimates undernutrition costs the world $3 trillion (£2.27 trillion) in productivity loss each year. In low-income countries, poor nutrition shaves between 3 and 16 per cent off gross domestic product (GDP), it says.
“Adequate nutrition is the missing link for sustainable growth. It is an integral input … yet progress in this area continues to be hampered by chronic underinvestment,” says a recent Chatham House report, ‘The business case for investment in Nutrition.’
“Success in tackling malnutrition in all its forms can have a multiplier effect at both household and economy level, improving health, boosting consumer incomes and stimulating economic development.”
Most associate malnutrition with famine and extreme hunger.  Images of starving children with swollen bellies were burnt into the memories of many by the Ethiopia famine in the 1980s.
But much more widespread and pernicious is what doctors call “hidden hunger,” or micronutrient deficiency; where infants and babies fail to get the nutrients they need to properly develop.
“With most serious childhood diseases, the kids who survive eventually grow up fine. But the kids who survive malnutrition never truly escape it,” writes Gates. 
“Kids can be eating enough calories and still not getting the right nutrients. When this happens to very young children, it interrupts the development of their bodies and brains. The effects are irreversible.”
Nearly half of all deaths in children under 5 have undernutrition as an underlying cause, according to Unicef. The development of those that survive is often “stunted”, dramatically hindering their life chances. 
In 2023, the World Health Organization (WHO) estimated that 148 million children experienced stunting.
Gates acknowledges that the pandemic and its fallout, together with conflicts in Europe, the Middle East and Africa have distracted political leaders and put a squeeze on budgets, but warns that investment in global health has stagnated.
“Today, the world is contending with more challenges than at any point in my adult life: inflation, debt, new wars. Unfortunately, aid isn’t keeping pace with these needs, particularly in the places that need it the most”, he says.
Ultimately, however, he says he’s “still an optimist”; “I think we can give global health a second act – even in a world where competing challenges require governments to stretch their budgets”.
To do this, he suggests a two-pronged approach. First, the world should “recommit” to the work that drove the progress in the early 2000s, especially investments in crucial vaccines and medicines. “They’re still saving millions of lives each year, and we can’t afford to backslide,” he says.
Secondly, he argues that science and technology are poised to provide many of the breakthroughs that are necessary. “The R&D pipeline  is brimming with powerful – and surprisingly cost effective – new breakthroughs. Now we just need to put them to work fighting the world’s most pervasive health crises. And it starts with good nutrition”.
Examples detailed in the report include expanding access to vitamins for pregnant mothers, fortifying basic kitchen staples, breeding more productive cows to increase milk yield and focussing funds into the new dedicated Child Nutrition Fund (see box below).
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