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UNICEF’s latest report, The State of the World’s Children 2019

by Public Health Update

UNICEF’s latest report, The State of the World’s Children 2019

For the first time in 20 years, UNICEF’s flagship report examines the issue of children, food and nutrition, providing a fresh perspective on a rapidly evolving challenge.

This 2019 edition of The State of the World’s Children (SOWC) examines the issue of children, food and nutrition, providing a fresh perspective on a rapidly evolving challenge. Despite progress in the past two decades, one third of children under age 5 are malnourished – stunted, wasted or overweight – while two thirds are at risk of malnutrition and hidden hunger because of the poor quality of their diets. At the center of this challenge is a broken food system that fails to provide children with the diets they need to grow healthy. This report also provides new data and analyses of malnutrition in the 21st century and outlines recommendations to put children’s rights at the heart of food systems.

Key messages (Executive Summary Report)

At least 1 in 3 children under 5 is undernourished or overweight and 1 in 2 suffers from hidden hunger, undermining the capacity of millions of children to grow and develop to their full potential.

  • Globally, at least 1 in 3 children under 5 is not growing well due to malnutrition in its more visible forms: stunting, wasting and overweight.
  • Globally, at least 1 in 2 children under 5 suffers from hidden hunger due to deficiencies in vitamins and other essential nutrients.
  • Undernutrition continues to exert a heavy toll. In 2018, almost 200 million children under 5 suffered from stunting or wasting while at least 340 million suffered from hidden hunger.
  • Overweight and obesity continue to rise. From 2000–2016, the proportion of overweight children (5 to 19 years old) rose from 1 in 10 to almost 1 in 5.
  • The number of stunted children has declined in all continents, except in Africa while the number of overweight children has increased in all continents, including in Africa.
  • The triple burden of malnutrition – undernutrition, hidden hunger and overweight – threatens the survival, growth and development of children, young people, economies and nations.

The triple burden of malnutrition – undernutrition, hidden hunger and overweight – threatens the survival, growth and development of children, young people, economies and nations.

  • Stunting – a clear sign that children in a country are not developing well – is both a symptom of past deprivation and a predictor of future poverty.
  • Wasting can be lethal for children, particularly in its most severe forms. Contrary to common belief, most wasted children around the world live in Asia and not in emergency settings.
  • Hidden hunger harms children and women. Iron deficiency reduces children’s ability to learn and iron deficiency anaemia increases women’s risk of death during or shortly after childbirth.
  • Child overweight can lead to early onset of type-2 diabetes, stigmatization and depression, and is a strong predictor of adult obesity, with serious health and economic consequences.
  • The greatest burden of all forms of malnutrition is shouldered by children and young people from the poorest and most marginalized communities, perpetuating poverty across generations. Key Messages Children, food and nutrition | Growing well in a changing world A child sells snacks to other children outside a clinic in Gaza City, State of Palestine.

The triple burden of malnutrition is driven by the poor quality of children’s diets: 2 in 3 children are not fed the minimum recommended diverse diet for healthy growth and development.

  • Only 2 in 5 infants under six months of age are exclusively breastfed, as recommended. Breastfeeding could save the lives of 820,000 children annually worldwide.
  • Use of breastmilk substitutes is of concern. Sales of milk-based formula grew by 41 per cent globally and by 72 per cent in upper middle-income countries such as Brazil, China and Turkey from 2008–2013.
  • Poor diets drive malnutrition in early childhood: 44 per cent of children aged 6 to 23 months are not fed fruits or vegetables and 59 per cent are not fed eggs, dairy, fish or meat.
  • Only 1 in 5 children aged 6 to 23 months from the poorest households and rural areas is fed the minimum recommended diverse diet for healthy growth and brain development.
  • Many school-going adolescents consume highly processed foods: 42 per cent drink carbonated soft drinks at least once a day and 46 per cent eat fast food at least once a week.


Globalization, urbanization, inequities, humanitarian crises and climate shocks are driving unprecedented negative changes in the nutrition situation of children around the world.

  • Globalization is shaping food options and choices: 77 per cent of processed food sales worldwide are controlled by just 100 large firms.
  • In cities, many poor children live in ‘food deserts’, facing an absence of healthy food options, or in ‘food swamps’, confronted with an abundance of high-calorie, low-nutrient, processed foods.
  • Poor families tend to select low-quality food that costs less. Because of poverty and exclusion, the most disadvantaged children face the greatest risk of all forms of malnutrition.
  • Climate shocks, loss of biodiversity, and damage to water, air and soil are worsening the nutritional prospects of millions of children and young people, especially among the poor.
  • UNICEF and its partners treated more than 3.4 million children with severe malnutrition in humanitarian settings in 2018, from Afghanistan and Yemen to Nigeria and South Sudan.


Improving children’s nutrition requires food systems to deliver nutritious, safe, affordable and sustainable diets for all children.

  • Millions of children are eating too little of what they need, and millions are eating too much of what they don’t need: poor diets are now the main risk factor for the global burden of disease.
  • National food systems must put children’s nutrition at the heart of their work because their nutritional needs are unique and meeting them is critical for sustainable development.
  • Financial incentives should be used to reward actors who increase the availability of healthy and affordable foods in markets and other points of sale especially in low-income communities.
  • Financial disincentives on unhealthy foods can improve children’s diets. For example, taxes on sugary foods and beverages can reduce their consumption by children and adolescents.
  • Fortification of complementary foods and staple foods with micronutrients can be a cost-effective intervention to combat hidden hunger in children, young people and women.


Food environments are crucial. When healthy options are affordable, convenient and desirable, children and families make better food choices.

  • Children, adolescents, young people, parents and families need support to demand nutritious foods, but food environments need to promote and support healthy diets.
  • Innovative, fun, memorable and engaging communication strategies to promote healthy eating can leverage the cultural and social aspirations of children, adolescents and families.
  • Legislation plays a key role in promoting good diets for children, such as by regulating the marketing of breastmilk substitutes to mothers and families, and of unhealthy food to children.
  • The marketing of unhealthy foods and sugar sweetened beverages is directly linked to growing overweight and obesity in children.
  • Front of package labelling – visible, accurate and easy to understand – helps children, young people and families make healthier food choices and incentivizes suppliers to deliver healthy food.
  • Governments need to promote healthy food environments in schools, including healthy meals and limiting the sale and advertising of ‘junk food’ in proximity to schools and playgrounds.
  • The health, water and sanitation, education and social protection systems also have crucial roles to play in promoting and supporting good nutrition for children, adolescents and women. Investing in nutrition for children and young people is a cornerstone investment if the world is to achieve the Sustainable Development Goals by 2030.


Investing in child nutrition is key to human capital formation because nutrition is central to children’s growth, cognitive development, school performance and future productivity.

  • A large and young labour force – with a great creativity and productivity potential – is emerging in Africa and Asia. However, malnutrition risks limiting this demographic dividend.
  • Returns from investment in nutrition are high. For example, every dollar invested in reducing stunting generates an economic return equivalent to about US$18 in high-burden countries.


One word must be at the heart of our response to children’s malnutrition – action. We need action that reflects the core role of food systems, that strengthens the supply of – and demand for – better food, that improves children’s food environments, and leverages the role of key supportive systems. With action comes another imperative: accountability. Progress must be measured, shared, acted on and celebrated. Sound nutrition is fundamental to children’s well-being and the achievement of the Sustainable Development Goals. It needs to be put at the heart of government policy and supported by key stakeholders, including civil society and the private sector.

The State of the World’s Children 2019 report concludes with the following Agenda to Put Children’s Nutrition Rights First:

  1. Empower families, children and young people to demand nutritious food.
  2. Drive food suppliers to do the right thing for children.
  3. Build healthy food environments for all children.
  4. Mobilize supportive systems – health, water and sanitation, education and social protection – to scale up nutrition results for all children.
  5. Collect, analyse and use good-quality data and evidence regularly to guide action and track progress.


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