illustration for the drivers of inequality

Driver Category 5.2

Unequal access to good nutrition

This driver category covers all aspects of good nutrition – whether related to malnutrition and food security, or other nutrition issues related to poor diets, including obesity.

Guiding Questions

Malnutrition and undernutrition

  • Are maternal undernutrition and child malnutrition significant problems in your country?
  • Are trends improving or worsening and are gaps growing (e.g. in stunting rates) between children in wealthy and poor households?
  • Is there a comprehensive national nutrition policy and/or a malnutrition prevention programme?
  • Is there sufficient cross-sectoral coordination to implement policies effectively?
  • Are broader aspects such as a food security strategy and nutrition-sensitive agriculture and water and sanitation policies considered in an integrated fashion?
  • What programmes exist to improve the nutrition of pregnant and lactating women and child nutrition in the first two years of life?
  • Are there efforts to promote exclusive breastfeeding in the first six months and to support women to meet this goal (including health workers to support mothers, adequate paid maternity leave and the right to take nursing breaks while working)?
  • Are infant and child growth monitoring programmes in place?
  • Are there efforts to provide vitamins and other micronutrients and to support appropriate complementary feeding practices?
  • Are community health workers appropriately trained to deliver nutrition programmes?
  • Are children in ECD centres, community-based childcare centres, pre-primary classrooms or pre-schools provided with appropriate nutrition?
  • Are there any publicly funded feeding programmes to ensure access to appropriate nutrition in centres and in the early years of primary school?
  • Are programmes of sufficient coverage and quality, universal and/or properly targeted?

Obesity and poor diets

  • Is the incidence of obesity, including in children of different age groups, growing?
  • What is the prevalence of related conditions such as diabetes, heart disease and cancer?
  • Is there evidence of inequities in the prevalence of obesities?
  • In which geographical locations and which profile of households is the problem most notable?
  • What steps is the government taking to prevent obesity?
  • Is there analysis available of the typical nutritional content of cheap food?
  • Does food that is cheap in your country tend to have a higher sugar, salt and fat content?
  • What is known about the content of food provided through any food aid programmes and in relation to nutrition provided in schools, hospitals, prisons and any other public facilities?
  • Do publicly funded nutritional support programmes, and public facilities and institutions, have adequate standards regarding healthy food content?

Public budgets: nutrition

  • What is the level of public investment in nutrition?
  • What proportion of the most relevant programmes is the government financing and how much is reliant on donors?
  • What are the amounts spent on key aspects such as infant and child growth monitoring and vitamin and micronutrient supplement programmes?
  • Is there sufficient investment to ensure recruitment, training and supervision and support for the community-based health workers critical to delivering nutrition solutions?
  • Is there sufficient investment in nutrition education?
  • Is expenditure in key nutrition-related budget lines increasing or decreasing?

Regulation of the food industry

  • What legislation is in place related to the food industry’s manufacturing standards with the aim of tackling obesity?
  • What standards exist limiting the salt, saturated fats, artificial trans-fats and sugar in processed foods and soft drinks?
  • Are regulations in place regarding food labelling as part of efforts to tackle obesity?
  • Are food labelling systems voluntary or mandatory?
  • Are regulations in place regarding food pricing?
  • Are unhealthy foods and beverages subject to higher taxes or any price controls?
  • Are there any regulations in place that specifically seek to protect young people, such as in relation to fast-food advertising targeting children, the presence of vending machines inside schools, and/or zoning to restrict fast-food outlets near schools?
  • What response have food and drinks companies had to the policy debates and any new standards or regulations being put in place to prevent obesity?
  • Are companies lobbying the government or undertaking legal challenges to overturn new legislation?
  • Is there evidence of companies lobbying against unhealthy food or drink tax increases or helping draw up the rules for the sector?

Indicators

Potential indicators to monitor the drivers of inequalities in this main driver category

  • % of health budget spent on providing good nutrition and amount of budget spent on different nutrition interventions
  • % of health budget spent on addressing malnutrition
  • % of health budget spend on addressing obesity
  • Amount spent on infant and child growth monitoring
  • Ratio of community health workers to population (national and per region)

Candidate Policies

To see related Candidate Policies in this main driver category please click here.