COVID-19 and Malnutrition in the Asia-Pacific Region
In recent years, the Asia-Pacific region has been facing dire malnutrition and food insecurity issues. Even before the COVID-19 pandemic, approximately 1.9 billion people in the region were unable to afford nutritious diets. In 2019, the Asia-Pacific region accounted for about half of the global count of undernourished people. A press release published on UNICEF’s website reported that “across the region, an estimated 74.5 million children under 5 years of age were stunted (too short for their age) and 31.5 million suffered from wasting (too thin for height).” Children who are wasting, stunting, or obese may suffer later in life from reduced cognitive development and a laundry list of diet-related diseases such as cardiovascular disease, diabetes, and even cancer.
The pandemic has exacerbated these pre-existing malnutrition crises. Experts working for United Nations’ agencies noted that “while the extent of the impact of COVID-19 remains to be evaluated, estimates predict a 14.3 percent increase in the prevalence of moderate or severe wasting among children under 5 years of age…the number of people facing acute food insecurity will nearly double to 265 million by the end of 2020.” The avenues through which the pandemic has affected nutrition in the Asia-Pacific region may involve disruptions in domestic and international food supply chains. Important factors would include the health risks that have been associated with travel during the pandemic and the mobility restrictions enforced by governments as a part of lockdown measures. In India, for example, lockdowns closed markets and forced migrant farmers to leave cities and return to their villages. These changes could have reduced citizens’ access to fresh produce and other nutritious foods.
David Dawe, senior economist at the Asia-Pacific office of the Food and Agriculture Organization (FAO), argues that the pandemic has had a greater impact on the demand for food than the supply of it. “Overall, I think food supply chains have functioned pretty well,” Dawe notes. “Governments have put in place measures to allow people to travel around, and they’ve worked with the private sector to solve problems.” For example, many governments in the region have given the agriculture and food sectors the status of essential work to avoid hindering the production and delivery of food products.
Demand for food, however, is a different story. “By far, the most important channel [of COVID-19’s impact] is through job losses and associated income losses due to the lockdown measures but also due to people’s behavior,” Dawe remarks. “People might be staying home, they might be spending less money because they’re worried about the future, and those things will cause unemployment in some sectors of the economy.” Job and income loss can have detrimental effects on food consumption and choices. “When you have less income, your demand for food contracts…you can reduce your expenditure on everything, but there also will be a tendency to shift towards the cheaper sources of calories,” Dawe said. He notes that instead of bringing home meat, fruits, and vegetables, members of vulnerable households may increasingly rely on processed foods for calories. “Nutritious foods are more expensive, and so they will be the first ones to disappear from people’s plates, I think.”
United Nations agencies such as the FAO, UNICEF, WFP, and WHO have called for a series of diverse approaches to address both the impact of the pandemic on nutrition and the long-standing issue of malnutrition in the Asia-Pacific. A joint report published by these four agencies advocated for a multisystems approach to addressing malnutrition and food insecurity that considers the food, sanitation, health, social protection, and education systems. Improving the food system could broaden access to diverse, nutritious foods. Health systems promote healthy eating habits and provide treatment for malnutrition. Dawe points out that for people whose enduring low-income financial situation hinders their ability to afford micronutrient-rich foods, “health systems often deliver Vitamin A supplementation…and that’s a way to get around that income problem.” Sanitation systems create hygienic environments conducive to safe food preparation and storage, and education systems can help empower individuals and families to make informed choices about their diets. Dawe notes that in response to the COVID-19 pandemic, many countries have moved forward with various social protection measures, including cash transfer programs. Such programs have been shown to “improve household dietary diversity, increase food consumption and enhance productive capacity, with positive effects on the availability of more and higher quality food.” Ultimately, Dawe argues, “You really need all of these systems functioning. If you make progress in only one, that’s better than nothing. But you may not make much progress if you ignore the other systems.”
However, a multisystems approach can be difficult to implement, and not just due to the fact that it can be expensive to make interventions in all the systems at once. “It’s often difficult to get different people to talk to each other from different ministries, from different sectors,” Dawe notes. “The costs of coordination and collaboration are very real [because] they take people’s time.” In some instances, it might even be the case that some systems are holding up relatively well and are not in need of immediate intervention. Perhaps what is most crucial is for experts in specific systems to think both critically and objectively and to avoid thinking narrowly along their own specialization, Dawe argues.
He goes on to give an example. “If I go [into an area] and I’m part of the team, I shouldn’t just say, ‘Well, obviously food is the most important system because that’s what I know about, that’s my expertise.’ I have to have my mind open. And maybe food systems aren’t important in a particular [situation], maybe it’s education systems.” For Dawe, honesty and the willingness to take on the intellectual challenge of understanding other systems is key. “It’s important that we think in a systems manner so that our interventions can be appropriately targeted. Maybe the interventions won’t always be a holistic systems approach, but our thinking needs to be systems, that’s for sure.”
In the short term, when completely holistic interventions may not yet be feasible, there are still important measures that can be taken to mitigate the pandemic’s impact on nutrition in the Asia-Pacific region. “First of all, the most important step is getting the virus under control. I’m not an expert in health systems, but as long as this virus is circulating…it’s going to be difficult to restart economies and get them functioning at full strength.” Dawe’s office is located in Thailand, where tourism comprised an estimated 12.91 percent of the country’s GDP in the first quarter of 2020. The pandemic’s impact continues to be felt in the tourism industry due to the virus’ persistence globally. “My office, FAO’s office in Bangkok, is located near a tourist area,” Dawe shares. “And it’s just empty compared to what it used to be.” He shakes his head and adds, “So many restaurants are closed…it’s really a terrible thing.”
While countries slowly move back toward pre-COVID normalcy, action can be taken to bolster social protection systems. “Social protection systems need to be strengthened as long as economies are not operating at full strength,” Dawe argues. “And that’s really the most important one I would say, because it gets back to what the biggest impact on food security and nutrition is. It comes from lost jobs [and] lost income, so I think somehow restoring that income at least partially is the most important thing to do.” Additionally, Dawe proposes that governments’ efforts to work with the private sector to maintain the functioning of food supply chains should be ongoing.
The complexity and far-reaching consequences of the malnutrition issues in the Asia-Pacific region warrant extensive attention and analysis. Dawe kindly offered advice for current students who are concerned about the issue and want to contribute beyond offering time and money. “For students, I would say it’s important to learn about other disciplines. Try to think holistically…everybody, I think, even if we’re specialists in some areas, should make an effort to understand other disciplines at least a little bit so you can have a little bit more of this systems-typic thinking.” As the future generation of problem-solvers and policymakers, students have an important responsibility to create the possibility of multidisciplinary solutions by proactively challenging their minds and perspectives in the present.
April 25, 2021: The first paragraph of this article was updated for accuracy in regards to the effects of stunting, wasting, or obesity on children.