 The Global Nutrition Report is three things. It is global, it's about all countries. It's not just Africa and Asian countries, Latin America, it's all of them. 193, it's about nutrition in all its forms. So not just about stunting or micronutrient malnutrition, but it's about overweight and obesity and diabetes as well. And it is a report, we try to make it more than a report, try to make it an intervention as well. So we spend a lot of time putting it together and we spend a lot of time trying to get it into the hands of people who can use it and trying to get it into, trying to develop shareable content, easy to use content. The report itself, maybe not that easy to use, but there are a bunch of other products that are, we think hopefully stickier and snappier and more country tailored to countries and regions. So what you've got is the mothership there that the big document. It's, there are three co-chairs, my other co-chairs are Corinna Hawkes and I'm one of them, I'm Don Kessmally at Mahidol University in Thailand. And there's a group of 20 experts on the independent expert group that actually vouch for the independence and the quality of the report. And there's a group of stakeholders that set broad strategic directions which are countries, donors, the big four UN agencies. And who have I left out? Some academic and research institutions. And then there are over 70 authors who contribute to the report. Our job as co-chairs is to stitch all that together and come up with a storyline that's semi-coherent. So this is what I want to talk about a little bit about nutrition and the NDGs and progress on nutrition status, progress on actions, finance and capacity, climate, food systems, business and accountability data. And I only got sort of one or two slides on each of those. So it's very high level. Some of you may find that a bit frustrating. So apologies. You might also find it frustrating my ability to use this name. Nutrition driving the NDGs. So we're in the SDG area. So we spend a lot of time in the report saying why is nutrition important? It's not just a marker of development, it's a maker of development as well. It's not just an outcome, but it's an input. It's a crucial input. So we spend quite a bit of time in the report saying for people who don't even know about nutrition or who are under investing in nutrition, why should you invest? So obviously there are rights-based arguments, especially for children. We have the Convention on the Rights of the Child. It's very important if you care about health and mortality, 45% of all under five deaths are related in one way or another to malnutrition. So that's 45%. And so that's one of these iconic numbers that if I were to wake you up four in the morning, you'd be able to tell me that. That's our goal. I mean, I would never do that, don't worry. But if I were, that would be a number that we would want everyone to be able to recite. It's a very credible number it's published in the Lancet in 2013. Intergenerational equity, the Sustainable Development Goals, sustainability is all about really, what are we doing in this generation that affects the ability of the next generation to flourish and thrive and develop? We usually think about it in terms of climate and resource use, but it's also really relevant for nutrition because what we do for adolescent girls affects what birth outcomes they have when they eventually give birth. What we do for those kids that have just been given birth affects their ability to have healthy babies themselves later on. So it's an intergenerational cycle that we must break. So if you care about intergenerational equity, you care about nutrition and if you care about economic development, you care about nutrition. Here are some estimates from the literature from the last two or three years. It's a very fussy slide, but the bottom line is you've got lots of different countries, lots of different methodologies, lots of different data sources and they all sort of generally come out at the same kind of equivalent result which is malnutrition seems to be a drag of about 10% per year on GDP. That's a massive, massive drag when you add it all up, all the different forms. It's a massive drag. And in fact, the 2014 report tried to calculate what are the, so they've got this massive loss, but can we do anything about it? And the 2014 report estimated the benefit cost ratios of investing in nutrition interventions. And it said, it estimated some costs of how much it cost to scale them up. So 90% of the population that needs them gets them. And then it said, what are the benefits of scaling those up in terms of prevention of malnutrition? How do they pay off in terms of school attainment? And how does that pay off in terms of the labor market? So when you discount those benefit streams from 30 years down the road back to the present and then you compare them to the costs, you get ratios for 40 different countries and the median of the ratios is 16 to one. So half the countries are above 16 to one and half are below 16 to one. I was just in Philippines and Thailand last week and their ratios are in the 40s to one. So it's a fantastic investment. So those are the reasons to invest. Now how are we doing in terms of progress? So the report, again, it uses just UN data. It's UN data, which of course derives from the countries. The countries submit the data to the UN. The UN puts it through a sort of basic quality adjustment and quality thresholds. What passes those thresholds makes it into their databases and then we, with their help, use the UN data for our progress assessments. The assessments are based on the World Health Assembly targets, which are global targets. So the World Health Assembly, which is all the ministers of health in the world in 2011, they said we're going to reduce stunting from 160 million kids to 100 million kids by 2025. So we apply and they do that for a whole range of indicators, that kind of thing. So we apply those goals at the country level. Some countries have their own targets, but not many do, so to be comparable, we apply those global goals at the country level. And we say if a country's on course, if it's making rapid enough progress that it'll meet those goals in 2025, then we designate them as on course. And if they're not making rapid enough progress or they're stalling or going backwards, we say they're off course. So for stunting, and I'm assuming, I don't know if I need to explain stunting, stunting is a short height for age. It's sort of a chronic omnibus indicator of malnutrition. It combines chronic, but also acute, episodes. The kids don't look necessarily terribly malnourished. They look in proportion. Their heights and weights are usually in proportion, but you think they're five, but they're really eight or nine. They're just very short for their age. We don't really care about height per se, but we care about height because it's a marker for cognitive development, immune system development, all the things we really do care about. So in terms of stunting, if you look at 2014 and 2015, we go from 24 countries that are on course to 39 countries that are on course. Notice that not all 193 countries are here. That's because a lot of countries don't have data in the U.N. databases. A lot of those countries actually, middle income and high income countries who can't be bothered to put their data into the U.N. databases. But they're gonna have to now because we're in the SDG world. We're not in the MDG world anymore. So I don't know if Ireland doesn't have many, many data points in the U.N. systems. So Ireland will need to get its act together. Maybe not so much for stunting, but for women's anemia and other kinds of obesity, overweight, those kinds of things. You're gonna have to start getting your data into these systems. So the good news is that 39 countries are on course. 60 are making, 60 are off course, but they're making some progress, which is great. And only 15 countries are really off course and not making any progress in the red. That's good. There's, in terms of wasting, which is very thin for height, low weight for height, these kids really do look malnourished. They, again, a small majority of countries are on course. That's good. The trend is good. The absolute number is not very good, but the trend is good. For under five overweight, again, the number of green, the number of countries in the green is increasing. So, again, a good positive trend, but you can see there are plenty of countries that are off course or making no progress. These first three indicators that I've shown you are going to be in the SDGs. They're gonna be the SDG indicators for nutrition. So everyone's gonna have to take them very seriously every country, including the rich and the rich countries. So stunting and wasting may not be so relevant for Ireland and the UK, which is where I'm from, but under five overweight certainly will be. We talk about other ones, but I don't have time to go into all of them. I thought I'd show you exclusive breastfeeding rates because we didn't look at these in 2014 because we didn't have the rules for whether they're on course or off course. In 2015, we worked with UNICEF to develop the rules and you can see for 32 countries are on course, the target is 50% coverage. 50% of mothers are exclusively bred who are for kids in their first six months of life. 50% of them are exclusively breastfeeding. So no water, no sugar water, no honey, nothing. Just breast milk. 32 countries are on course. Quite a number of countries are off course and there are six countries where there is a massive reversal between the last two surveys. Massive reversal means a 10% decline in exclusive breastfeeding rates and the 10 are listed there. So that's the under nutrition size of things but in terms of obesity, we were really shocked to find that no countries are making progress in stabilizing adult obesity. In adult obesity, I think there are three countries where it's relatively stable and 190 countries where it's increasing. That's from WHO, that's between 2010 and 2014. So we look at these numbers a lot and we were shocked when we saw this. And so what we do in the report is develop a global scorecard. The numbers of countries, each of the rows is a different indicator that the World Health Assembly is set as an important. All the ministers of health have signed up to this. We want obviously not so much red and orange and lots of green. So that's kind of why we get up in the morning to try to support our champions within countries to get their countries into the green space which is to be on course to meeting these targets. And when we do presentations in Philippines and Thailand, for example, we'll do a regional one of these. So we did one of these for ASEAN, the 10 ASEAN countries and we did one for Thailand and one for the Philippines. And it's quite, it's very simple visual, are you on course or off course? And they seem to be quite powerful. But we don't just measure outcomes, we also measure actions. We also, a commitment is we will do something by this time, by this, to this extent. So we, there are plenty of organizations that measure outcomes, but not many that measure actions as well. So we start off with the nutrition for growth commitments. This was this big summit that was held in London in 2013. I think somewhere like $15 billion was pledged. Additional money was pledged for nutrition at that event. There's going to be another nutrition for growth summit in Rio in August of this year. Who knows whether it's going to be a similar pledging event or not, I hope it is. But our starting point was what are these nutrition for growth commitments look like and who's delivering on them and who's not. So we did an analysis for the first time and said how many of these commitments are smart? You know, specific, measurable, assignable, realistic and time-bound, that's what you want. You don't want a commitment that says we will reduce malnutrition. What indicates over which period, by how much and how you're going to do it is what you want. So we did an analysis, we found that 30%, actually 29% of the, there's two or 300 commitments were made at that conference. And only about 30% of them are smart. So it means it's very hard to track the non-smart commitments. They're vague and fuzzy and vague and fuzzy commitments usually don't lead to actions that reduce malnutrition. So that's, so for the Rio event, we're really encouraging stakeholders to make their commitment smart. We're showing them in the 2016 report, which is coming out in June, how to do that. At least giving them some guidance on that. In terms of who's reporting and who's on course and who's off course, these are the, there are about, as I said, about 200 or 300 different commitments made by companies, countries, donors, UN agencies and research organizations. And about the same percentage are on course or have met their commitments, about 40% in both years, about green between 2014 and 2015. But we noticed this year that about 20% of the commitments were not even reported on, even though we chased people to the ends of the earth kind of thing. They were sick of us by the end of it. So if you're going to make a commitment, you need to report on it, whether you're on course or off course or whether it's unclear. We also look at interventions. So on the under nutrition side, there are 12 sort of Lancet approved under nutrition interventions that are very direct interventions, things like breastfeeding promotion, vitamin A supplementation, salt idolization, iron folate supplementation, those kinds of things. And we looked at how many indicators do we, who's tracking whether these programs are getting to the people they need to get to. That was the thing we started out with, but we found out it's really, actually really hard to answer that question because the data on coverage are not even being collected for six of the 12 interventions. So we're not even collecting the data. We talk about scaling up nutrition and some movement wants to do that and everyone wants to do that, but we're not tracking whether we're able to do it or not because the right data are not being collected by DHS surveys, by MIC surveys, by national surveys. Only for three of the 12 indicators, or three of the 12 interventions do we have comparable national data. So we need to do better on that. We also talk a lot about healthy food environments and food policies. And we say how many policymakers have lots of choices about things they can do to make food systems more nutrition friendly. But again, the best data we have show that there's a real implementation deficit. We went to the nourishing framework with a nourishing database and found that only 63% of high income... First of all, we found only 67 countries that have implemented any of these food policies designed to improve healthy diet. So only 67 countries. And of those 67 countries, most of them were high income countries. So very few or no low income countries are implementing these kinds of food system policies that are supposed to help improve diets. And only actually quite a small share of high income countries are doing so as well. So a big implementation gap. We also look at finance. And our bottom line conclusion is that every country is going to have to increase spending on nutritional policies and programs. Not just low income countries, not just donors who spend money from high income countries in low income countries, but high income countries for their high income populations. They're going to have to increase spending. In the 2014 report, we didn't actually have any data on how much do countries spend on nutrition. So it's really hard to calculate a gap. How much do we need to spend to meet these targets if we don't know how much you're already spending? So we only had data actually on three countries in 2014. But in 2015, we had data on 30 countries. And that's largely because the Sun network worked with these 30 countries who stepped up. These are the countries. They really stepped up in 2015. What was the... What did we conclude? Well, 14 countries completed the exercise in full of the 30, the others are still ongoing. Working with Sun, we calculated what the domestic budget allocations to nutrition were as a percent of the overall government budget. So as a percent of what governments spend, what percent is that on nutrition? Not just on very specific nutrition programs, but a broader... There's quite a broad definition of what is nutrition. And the number is... The average for the 14 countries is 1.3%. So 1.3% of government budgets are spent on nutrition. Broadly speaking, so they would look at agriculture. They would look at education. They would look at water and sanitation. And say, of these 100 line items in the agriculture budget, we think these 10 are nutrition relevant. And we think this percentage of each of them should go to nutrition. And the countries themselves decided what that would be. So they're not crude estimates. They're quite... And you go through this document here. In those of you who know Zambia, that's the Zambia Revenue and Expenditure document for 2014. It's not... There's no PDF version of this. So the Sun CSO network in Zambia had to go through each one of those pages looking at all the budget line items and saying this budget line item looks like it's relevant to nutrition. What percent of that line item goes to nutrition? So it's not a high concept exercise, but it's a really laborious exercise. The upper bound was 4.1%. So they did what we really think it is and what we think it has the potential to be. So I think 1.3% seems low to me, but we don't have any benchmark, so who knows. But the good news is that the upper bound is 4.1%. So there's some room for nutrition champions to say, okay, on average it's 1.3%, but we can fight to make it 4% in the future. Donors spending 4% of their spending on nutrition. So that's good. They're spending one billion on nutrition-specific interventions. These are things that are explicitly designed to have an impact on nutrition. And that's really amazing because that's up from a quarter of a billion only 10 years ago. This is real dollars. So it's adjusted for inflation. So donor spending on nutrition is quadrupled in the last 10 years on nutrition-specific. But it's still only one billion and the envelope for overseas development assistance is about 130 billion. So it's one billion out of 130 billion. Other piece of good news is that nutrition-sensitive spending, this is stuff, this isn't all agriculture, but it's the bit of agriculture that we think has a big impact on nutrition. It's the bit of education that we think has a big impact on nutrition. You add all of that up and that's four billion. So five billion out of 130 billion is about 4%. So that's going up, so that's also good news. 13 of the 29 OECD donors don't spend, they spend hardly anything on nutrition. That includes some donors who spend a lot on ODA, but not much on nutrition. So it includes Denmark, Sweden, Norway, a couple other donors who spend a big percentage of their GDP, much more than 0.7% on development assistance, but hardly anything on nutrition. So an example of the report as an intervention, we wrote to NORAD in Norway and said, please let's have a launch and let's talk about some of the investment opportunities for NORAD and Norway in nutrition. So we're doing that next month, actually. There are some estimates about how much we need to spend to get to the World Health Assembly targets. The World Bank and a group called R4D in Washington have done this. Their conclusion is that governments are going to have to double spending on nutrition if we're going to reach these World Health Assembly targets by 2025. And the donors are going to have to quadruple their spending by 2025. The good news is that donors have quadrupled it over the last 10 years. Of course, it's more challenging to quadruple a bigger number over the next 10 years. But the donor stuff is a bit of a sideshow. It's really got to be governments that begin to invest in nutrition more. If governments don't invest, it doesn't really matter what donors do, it seems to me. The donor investments will be temporary and not sustainable. Governments have to really invest. And this is what we're trying hard in the 2016 report is to make it easier for them to do that, to give them some examples, success stories, tools, guidelines, to bring all of that together and make it accessible. We talk a bit about climate in the report. There's a nice chapter in there. We talk about climate because this is, I think, one of the agri-diet conclusions. I'm talking to the agri-diet team. You may not realize it, but we often say you're lucky if you're born in a certain country in terms of your nutrition outcomes. We're lucky we're born in Ireland and the UK, I guess, in terms of our nutrition outcomes. But in many countries, the luck is not, is which month you're born in. So here's some data from India. It's a bit old now, but it probably still holds. It held for the previous two surveys in India, and it probably holds for the one that's just coming out now. And it says, how different is your height for age score, your standardized height for age score, by the month in which you're born in? It controls for income and education and location and all that sort of stuff. And it just isolates the month in which you're born. And these are extraordinary differences by the month in which you're born. And just to give you a sense of how big these changes are, that 0.2, that's the impact you'd expect from a really good complementary feeding program. And complementary feeding programs are when you improve the quality of the diet for kids between six months and two years of age. So if you have a very successful complementary feeding program, you would expect to get a 0.2 impact on height for age, said score. And yet, whether you're born in June or January, gives you a half a 0.5 height for age, Z score, twice the impact of a good complementary feeding program. So it's kind of a lottery which month you're born in. And this is why climate matters so much for nutrition because these seasonal cycles are going to be exacerbated in some cases. And in all cases, they're going to become less predictable. So nutrition folks have to climate-proof their work. You can't pretend that you're operating in a world where you don't have to climate-proof. But the reverse also holds true. Climate people have a lot to gain from linking more with nutrition and working with nutrition because diet choices affect greenhouse gas emissions. We know that certain types of foods result in greater greenhouse gas emissions either because they involve ruminants, large bowel ruminants, or because they use more energy. There's all sorts of reasons. But this is a paper that came out in Nature in late 2014, and it showed how different stylized diets, but based on real data, have different levels of greenhouse gas emissions. So you can see the global average was there, the Mediterranean is slightly lower, the pescetarian and the vegetarian. In other words, there seems to be a correlation. It's not perfect, but healthier diets for humans tend to be healthier diets for the planet. There's a lot of variation in that, but on average, that seems to be the case. We also talk a lot about food systems. Food systems are much more than just agriculture. They are about where do you buy the food? Is it processed, food marketing, food standards, food retailing, all that sort of stuff. Poor diet is the number one risk factor in the global burden of disease. It's a really important factor for under nutrition, as well as obesity, overweight, and diabetes. And yet, we don't really know much about how our food systems are affecting nutrition. Even if we ask the question, we don't really know how to assess how nutrition-friendly a food system is. So there's one chapter in the report that comes up with a dashboard for food systems. I think 13 indicators that any country could collect from existing data sets and begin to, it's not the last word, but it's a starting point for a conversation about how nutrition-friendly is our food system. We talk about business quite a lot, and we try to confront this issue of, some people say, we have to work with business because they're already involved in nutrition quite extensively through fortification, through processed foods, through drugs, through water, through mobile phones, all logistics, all kinds of things. Another group of people say, look, I can't trust business. I'm not gonna work with them. And another group that says, well, you can only build trust by working with them. So we're in this chicken and egg situation, I think, with nutrition and business. So we try to take it on by talking about mechanisms for promoting transparency, mechanisms for promoting monitoring, because we think those two things build trust, and we think trust is worth having because there are lots of opportunities for businesses to advance nutrition. There's lots of opportunities for them to set it back as well, but there are opportunities for it to advance. But in order to do that, transparency has to be high and monitoring has to be good. So we propose or recommend a register of public-private partnerships. If you have a public-private partnership between a government and a business sector, put the terms of that contract in a publicly available space, much as the people who are trying to get greater transparency in land, acquisition and land grabbing contracts, get them, if you put them up on a public available site, there's something called the Extractive Industries Transparency Initiative that's been quite successful in getting oil and mining companies and governments to make their dealings more transparent. Maybe we could do something like that in nutrition. ATME is the Access to Nutrition Index, which looks at large food companies and says are they, it ranks their governance, their disclosures, their lobbying activities, their labeling activities, it rates all of them, it promotes transparency. There's an enforcement litigation fund that the Gates Foundation and the Bloomberg Foundation have put into place that helps governments fight litigation from the tobacco companies because governments, whenever they try and enforce their anti-tobacco laws, the companies push back and governments have three lawyers and the companies have 300 lawyers. So Gates and Bloomberg have set up this fund. Maybe there should be something similar in nutrition and there's very little research on the role of business in nutrition as well. I'm often on panels with folks who are from the business world and they say, we're doing great things for nutrition. And I say, well, where's the evidence? I say it politely, where's the evidence? And they say, look on the website. And I say, well, I'd like to see an independent assessment of that done by UCC or UCD or Ivory. And there's virtually none. There's quite a few in the fortification area, but outside of fortification, virtually no impact assessments done by independent research groups. There's no research program that's dedicated to understanding the positive and negative role of business in nutrition. So for research funders, we make a strong pitch to them, set up a research program and they're somewhere in the world. I'm nearly finished. One of the big recommendations coming out of this is we want the UN agencies together with others to establish some kind of time-bound commission to begin talking about roles, responsibilities, areas that the company should stay out of, areas that they should go into, under which conditions, for which age groups and which processes. There's no real dialogue at the moment, as far as I can tell. The Sun Business Network is promising, but I don't, and this is my, the only thing I'm not very happy about with Sun is that I think there's not enough dialogue going on within the Sun Business Network between, I think it's, I think it's people who all believe the same thing, talking to each other, and they should be expanding the circle of dialogue, not just intensifying it, which I think is what they're doing. Accountability and data, in addition to the reports, we produce 193 of these two-page documents, one for each country, that pulls together over 80 indicators of outcomes, but also spending, legislation, policies, underlying determinants, poverty, inequality, GDP, and they're all available, they're all available on the website, downloadable, I encourage you to look at them. We focus a lot on data gaps. There are 99 countries in 2014 that had enough data to be able to assess whether they were on course or off course for four of these indicators. If I showed you the graph for eight, you'd get really impressed, because there are very few countries that can track all eight indicators, so I'm just showing you the graph for four indicators. The good news is that that went up, so 99 countries in 2014, 108 in 2015, but still a lot of countries that don't have enough data to track their progress towards targets that all 193 Ministers of Health signed up to five years ago. That's pretty shocking. I think the SDGs will give an added impetus to data collection, and I very much hope they do. So finally, calls to action. I've basically talked about all of this already. We all need to do a better job of elevating nutrition as a development thing. It's not just a health thing, it's not just a food thing, it's a development investment. We need to do more accountability on nutrition. Very few countries have national targets. Very few. We need to strengthen the nutrition for growth. Nutrition for growth was great, 15 billion extra commitments. Also policy commitments, program commitments, lots of commitments, but not enough of them are smart, not enough of them are ambitious, so we can do better in 2016. We need to implement actions. Lots of people have pro-policies, but they're not implemented. Lots of countries are doing things, but they're not documented. We need to implement a document. We need more funding for nutrition action. That's, you know, we can do better with the existing funding we have, but there's no getting away from it. We need more. We need to build alliances with unusual suspects, climate and nutrition. We were, there were three, I think there were three nutrition events at the December COP conference, and two of those were GNR events. So, you know, three events out of thousands of events at the COP. Development indicators for nutrition-friendly food systems, or we're doing, a lot of people are doing work on that now. The Committee on Food Security in the UN is going to start doing work on that too. Build a greater understanding between nutrition and business, identify the data gaps, that hinder action, and fill them. That's my final slide. Tom's seen this before, maybe some of you have. It was something that came out in the Economist in the autumn of last year, and it was about designer babies. And it was talking about this rather dystopian future where we can perhaps select certain traits that we want in our future babies. And these are the traits they highlighted in the picture. I added the GNR, just for a bit of playfulness. So, you know, you look at these traits. High IQ, sprinter, so that's all about long limbs and strong muscle mass. 20-20 vision, low strokes. You know, this is, if you want design, people who want designer babies should forget about that, and just invest in nutrition. If you want to design a baby, invest in nutrition, you'll get babies with all of these things. It's too bad they can't do anything about baldness, but I'm willing to do that. So thank you very much, everyone.