Making enough progress on climate change, and looking at COVID-19's effect on malnutrition

Naomi Oreskes joins us to talk about tackling climate change in time to avoid disaster, misinformation, and scientific messaging, then Saskia Osendarp and Shweta Khandelwal discuss how COVID-19 has exacerbated the world's malnutrition problem, with a specific focus on India.

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Transcript

This transcript was automatically generated using speech recognition technology and may differ from the original audio. In citing or otherwise referring to the contents of this podcast, please ensure that you are quoting the recorded audio rather than this transcript.

Gavin: Hello, welcome to another episode of The Lancet Voice. I'm Gavin Cleaver, and we're very pleased to have you on board for another look at the world of health and health care. Later on, we'll be talking to Dr. Saskia Ousendarp and Dr. Shweta Kandilwal about worldwide nutrition since the start of the COVID 19 pandemic, with a particular focus on India.

But first, we're going to talk a bit about climate change. Professor Naomi Oreskes is Professor of the History of Science and Affiliated Professor of Earth and Planetary Sciences at Harvard University. Her books on climate change and scientific consensus have defined much of the field and her 2010 work Merchants of Doubt on the tactics used by the industry to obfuscate the climate change debate was made into a documentary.

She spoke to us at an important moment for climate change action in the lead up to COP26 at the end of the year about shifting perspectives, effective messaging and tackling misinformation. Now I'm joined for this interview by Alistair Brown who's the editor in chief of our journal The Lancet Planetary Health.

You can read Alistair's Journal online every month for free now, the lines at.com if you wanna see the latest research on climate change and the health of the planet. Professor Naomi Quez. Thanks so much for joining me and Alistair on the podcast today. Let's cut right to it. There's a remarkable, very recent report from the IEA that essentially concludes that no one needs to take any more fossil fuels out of the ground to fulfill the Earth's energy needs.

Two things from that, first, is this good evidence of a kind of direction of travel overall? And second, is this as significant as it feels? Is it a kind of watershed moment? 

Naomi: Yes, on both counts. I do think it's a watershed moment, because as most people know, the IEA is a pretty conservative organization, has been For a long time very committed to the continued use of fossil fuels and has not generally been seen by Progressives or climate scientists as a leader in this space and moreover They have a track record in recent years of underestimating the performance And market share of renewable energy.

So for this organization to come around and say yes, this is a moment. This is a really severe problem and more important. We do not need More fossil fuel development. In fact, we positively should not have that. That's a watershed because one of the things that the fossil fuel industry has been consistently doing in recent years.

Is to say okay, we've come around. We get it that there is climate change, but you're still going to need us. You're still going to need fossil fuels. Renewables can't do the job. And anyone who says they can is being unrealistic. And therefore, justifying continued expiration for even more new development of fossil fuels.

And that's just completely inconsistent with fixing the climate problem. So I do think the IEA report is very important. I do think it's a watershed moment. And now I think, we're in this kind of wait and see moment to see whether governments and financiers and hedge funds and all banks and all the rest take this seriously and use the opportunity that this creates to say, yeah, the IEA is right.

And we really have to stop doing what we've been doing. 

Gavin: How did you feel about the direction of travel before the report, the last few months, obviously with the new administration in the U. S. of being a kind of sea change in approach, if you'll excuse the pun, 

Naomi: oh, yeah, we've seen a lot of promising steps in recent years in many quarters not necessarily in the United States under the former president, many good things have happened in recent years.

There was the Pope's encyclical on climate change a few years ago which I had the privilege of participating in one of the meetings that helped prepare for that. We have seen major investment funds. Like Blackwater say, we have to rethink investment in fossil fuels. We have seen major institutional investors, pension funds, foundations, religious organizations saying it is no longer justifiable either morally or financially.

to be continuing to invest in fossil fuels. So there have been a lot of steps in the right direction in recent years, and we've seen tremendous drop in the cost of renewable energy, but the problem has been for so long, it's just not enough. There are these small steps in the right direction, but the scale of these steps compared to the scale of the problem has been.

Small steps with a huge problem and so we have to find some way to, do, I don't know, call it a quantum leap or disruption or whatever metaphor you like best, I like the sort of electron model like, we need to leap to a different energy level to address this problem because the rate at which we're addressing it now is Utterly insufficient to fix it.

Gavin: I'm joined, as I mentioned, by Alistair Brown, editor in chief of the Lancet Planetary Health. Al, do you have any thoughts on this? 

Al: Sorry to jump in. Do you feel that you, do you have an idea about what you think is required for that leap? What are the real blocks? And what are the things that would carry us over into that new energy level?

Naomi: It's hard to say, I'm a historian of science, not a political scientist. But I think one thing that large scale social change shows, the history is that Everyone needs to be involved. You cannot just say, oh, this is a problem for climate scientists, or this is a problem for environmentalists.

This is a problem for all of us. Environmentalists and scientists have been on this issue for a long time. 30 years of history shows that they've been right. that scientists got this problem that environmentalists largely got this problem but other groups, the private sector, the banking industry, particularly finance and governments have really dragged their feet.

So again, this is one reason why I'm hopeful that the IEA report Could be important. It comes in the context of accelerating concern in the finance and business sectors. I think we desperately need more business leaders to step up to the plate, and I think we desperately need the business community to say the fossil fuel industry does not speak for us.

The fossil fuel industry is a dying industry. I like to say that coal is so 19th century and oil and gas are so 20th century, the future is not with fossil fuels. And we hear that say from the American Wind Energy Association, but they're small. Almost by definition the incumbents have a, have an advantage.

They have a political advantage, they have a social advantage, they have an economic advantage. And the fossil fuel industry has had a huge voice in this space, a voice that, in my opinion, they don't deserve and I think it's time for us to say we have to stop listening to them. I've done a lot of work on the history of tobacco and one of the things that public health officials came around to was realizing the tobacco industry could not be a partner in tobacco control.

The conflict of interest was just too existential and I think we've now seen that with fossil fuels as well. The fossil fuel industry has had 30 years. Arguably, actually more 40. When you think about what a company like ExxonMobil knew about this problem back in 1979, they have had 40 years to address it.

They've had 40 years to change their business model. They've had plenty of time to do it in an orderly way, but that's not what they've done. They've locked action, they've lobbied against meaningful policy. They've continued to spread half-truths and disinformation about the issue. So I think we really need to have a clean break.

with the fossil fuel industry, and that means government and the private sector have got to play a leading role. 

Al: Do you think that we're now winning the argument? The scientists, as you say, have been shown to be right, but not everyone in the public necessarily perceives that to be the case. 

Naomi: And one reason they don't perceive it to be the case is because of fossil fuel industry disinformation.

I have written about this, for years now. One of the key strategies the fossil fuel industry has used is to say that scientists are wrong, they don't really know or they don't have a consensus or they're just in it for the money. There's been huge misrepresentation by the fossil fuel industry of the state of science and the motivations of scientists.

So we face an uphill battle in large part because of the disinformation and half truths that have been propagated by people who really should know better. 

Al: And do you feel that the balance of influence is changing or is there something that our scientists Engaging more effectively now or are there things that that we could do to box cleverer?

Naomi: Yeah, I think both. I do think that the debate, the public conversation, particularly here in the United States has shifted in part because climate change has now become so obvious that ordinary people can see it. But we can see the climate changing around us. We can see spring coming earlier.

People in the Midwest can see that lakes that used to freeze don't freeze anymore. People in the southeast have seen, the recent spate of tornadoes in Tennessee and Mississippi. They've seen that hurricanes are getting worse, the extreme rainfall events, with, biblical levels of rain things that we didn't used to see in our childhoods.

And farmers are seeing it. They're seeing changes in how their crops and livestock are responding. So I think increasingly people get it that the climate is changing. And so that's where I think then scientists can come in and be helpful by saying, and we can explain why this isn't just natural variability.

And I do think scientists have done a better job now of finding ways to speak to people in their own terms in plain language. Not being condescending, not overwhelming people with technical jargon. The scientific community has worked really hard on this, I would say, in the last 10 years.

There's still obviously room for improvement, but I do think that the scientific messaging and the attitudes of scientists towards this problem has definitely improved. And the attitude piece is a big one, because when I was in graduate school long enough ago that I don't like to say how long it was considered, most scientists considered that spending time to speak to the public about science was not a good use of your time.

And that it wasn't their job. That was the job of, oh, I don't know, journalists or someone else to do that kind of work. And when someone did do that work, someone like Carl Sagan, they were often dismissed as a quote, popularizer. I used to always joke most scientists were not popular in high school, so they don't like popular people.

I think this has changed. And I used to always say to my colleagues, you have this all wrong. You should be kissing the ground that Carl Sagan walks on because he does so much good for the rest of us. He creates so much goodwill. towards science. And so I think it has changed. I think the scientific community understands now that the work of communicating to the lay public is a really important piece of what we do.

Gavin: It was just interesting to me that you mentioned misinformation, of course, and talking about developing consensus around factual information. Now, obviously, the last year has seen that kind of forefront of news in the West at least, these disinformation campaigns being waged against the development of consensus when it comes to thinking about COVID 19 and public safety messaging.

What's been your take on that back and forth over the last 12 months? 

Naomi: One of the main things I've said when I've been asked about COVID 19 and the involving scientific understanding is that this is an opportunity to remind people across a wide range of views that science is a process, right?

We use the word science rather loosely. And in a way we refer, use it to refer to two very different and in some ways actually opposite or at least intention things. So we use the word science. to describe what scientists do. It's a process of learning and discovery. And so by definition, if we're learning, then sometimes we will learn new things that make us rethink the old things.

And so particularly when something new emerges, like a novel virus that we don't yet know what it is, we don't understand it. In the early days, it's bound to be the case that some scientists first impressions or first conclusions will be revised in light of new evidence. And this is how science works.

So in a way, what happened this year was we saw, the messy sausage making process unfolding before our eyes. And this is actually an opportunity then for scientists and science communicators to say, yeah, this is actually how science works. We're trying to figure stuff out. And in the beginning, we definitely make mistakes.

But, we correct them, we keep on going, we try to figure out what's really happening. Now, the problem, though, I think, is that stands in tension with a different meaning of the word science. People also use the word science to refer to scientific knowledge, the body of information, of theories, facts, evidence that we take to be true, the things that are written in textbooks.

So that's science. Also, if you go to a museum or you go to a planetarium or an aquarium, you are presented with quote science. And that's presented typically as a body of facts or a body established theories and so there's a tension I think between our notion of science as a body of facts and our notion of science as a learning process that sometimes destabilizes those facts.

And so I think this year has been a good opportunity to explain that tension. I assume that's why I've had 7, 000 requests for interviews, because just by chance I published a book called Why Trust Science right before the COVID 19 epidemic hit. But it's tricky. it's a challenge. And then add to that challenge the fact that there are people out there deliberately spreading disinformation for largely political reasons.

It's a very challenging landscape. 

Gavin: Do you think that you've taken anything away from the past, from the last year in terms of what kind of health messaging is effective that might feed back into talking about climate change? 

Naomi: I think one thing that we have preliminary evidence on is the importance of diverse messengers.

It's a standard trope in communication theory, the idea of the trusted messenger, that people are more likely to accept a claim if it comes from someone they trust. And typically that means someone they either know already, like their own doctor, if they have a physician that they see regularly, or a nurse, or maybe a neighbor who's a nurse.

Or maybe a religious leader or a political leader, or it can also be someone who they feel they know. And that's where the political leaders and celebrities come in. It's always been a bit of a mystery to me why people would be influenced by what Beyonce, for example, says about public health.

But we know that one of the reasons people follow celebrities on Twitter and Instagram all the rest. It's because it makes them feel as if they have a relationship with that celebrity. And that relationship can put that celebrity into the role of the trusted messenger. So what I think this tells us, and I think we did see it this year, is we need a lot of different messengers.

It's not enough to just say, Oh, Carl Sagan's a great communicator. May he rest in peace now, but just to use that example, he's a great communicator. We should send him to as many towns and cities across America as we can. Yes, if you have someone who is, super effective and attractive and fun and get them out as much as possible, for sure, that's good.

But I think what we've also seen is that you need a lot more than that. You need people in their communities you need scientists going to their local schools, their children's schools, if they're a member of a religious organization or a civic organization, and get as many people out there speaking to the communities where they live or where they interact or where, for whatever reason, they have bonds of trust.

And that reinforces something that I, was suggesting a minute ago. We have to view this as not just the job of the communicators. I think we have to view this as broadly, I don't want to say all of our jobs, because as I've often said, some scientists really hate speaking in public.

Some scientists should not be allowed out in public. But in general, most of us should take at least a little bit of our time to think about, who do we know that we could be speaking to, and it might just be our local town meeting, or it might just be You know, church on Sunday, but I do think the evidence of this year shows that if more of us would do that in more diverse venues, it would probably have a salutary effect.

Gavin: So we've talked just to finish up, we've talked about momentum, of course, and looking to the very immediate future, it is COP26 in Glasgow at the end of this year, and it always feels a bit with climate change conferences and with meetings, it always feels a bit like each one could be a defining moment.

What do you hope to see at COP26? 

Naomi: It's good you said hope as opposed to expect, because I believe in persistence forecasting. The best predictor of tomorrow's weather is today's weather, and the best predictor of COP26 is COP25. No rational person can look at the COP process and really expect some kind of giant breakthrough in it.

However, that said, As we've been discussing this morning, there has been, there have been some pretty big significant changes in the last few years. And of course, one big significant change is what's happened in the White House here in the United States. One thing that people in America don't like to talk about is the way in which the United States has been truly obstructionist in this space.

The United States likes to present itself as a global leader, but the reality is, and if you speak to anyone who's been involved in this process or anyone who's sat in an IPCC summary for policy makers meeting, we know that the United States, Saudi Arabia and a couple of other countries have worked sedulously for a long time to keep these accords weak to prevent them from having real teeth.

To prevent them from ever agreeing to binding emissions controls. The U. S. has not been a leader in this space, and it's often been an obstructor. There is a possibility that will change now with Joe Biden in the White House, and especially with John Kerry back in the leadership position. Gina McCarthy at the EPA now.

Put a really good team around him of people who really do understand this issue and are really committed to meaningful change. Now, again, that said though, he still has to deal with Congress. So the other possible reason for optimism would be if other countries would begin to realize, they should have realized this a long time ago, but, with the sort of whiplash of American politics.

We can't wait, sit around waiting for the United States to do the right thing. You guys are British, you know the old Churchill slogan about you can always count on America to do the right thing after they've exhausted all possible alternatives. So maybe we're at that moment where we actually have exhausted all possible alternatives, including the alternative of a pathological president.

Who thought, who thought that climate change was a hoax, or at least that's what he said. Who knows what he really thought. So maybe there really is a moment now that finally we will do the right thing. But I also think that increasingly people are recognizing that change can come from a lot of quarters.

And again, this gets back to what I said a moment ago about the business community. I think if we started to see real leadership in the private sector, it would make what the U. S. does. less crucial. And it would also make it easier for the American president to move forward if he had really strong support for the private sector.

It would make it harder for Republicans to continue to be obstructionists in this space. So I think there are grounds for cautious optimism. My heart has been broken so many times over this issue that, I'm a little I'm a little toughened now, which is probably a good thing, but sometimes it feels a little sad.

Gavin: Thanks to Naomi and to Alistair there. A really interesting discussion. Now, as I mentioned, Alistair, who you heard interviewing Naomi with me there, is the editor in chief of the Lancet Planetary Health, and I just wanted to highlight that they have a new special issue out next week. It's open access and free to read, as all of their publications are.

And the papers in their special issue look at the latest figures in climate modelling. It's a collection of six papers. And the modelling forecasts in them look at areas like mosquito activity and sub optimal temperature effects. It's well worth looking up when they come out next week on July 7th, of course, at thelancet.

com. Now, I'm joined, as ever, by my co host, Jessamy Bagginall, who's a senior editor at The Lancet. Jessamy, it's interesting to think, isn't it, about this slow, incremental change. The danger, of course, with climate change is the domino effect, just like several consequences of climate change all cascading, to cause extremely quick and severe consequences for the planet.

Do you suppose maybe there's a chance that action itself, governmental action, policy action, systemic action, will cascade? Naomi sounds hopeful. What do you think? 

Jessamy: Climate change has been taking up all of my thoughts recently, really. And I feel both depressed and hopeful about it. In the sense that, we've got these SDGs, climate change is obviously a big part of that.

We've had a real lesson that the sort of anti fragility and Resilience type mode is really the only way to govern, we could have invested in pandemic preparedness and prevented catastrophic COVID 19, but we didn't, we could now invest seriously in climate change and prevent future generations having enormous issues, but we're not at the moment, but it does seem to be that we are potentially moving in that direction.

because one out of necessity, but also because I think there is increasing, regulations that will move the financial markets that they will also then have to start, putting more of a focus on this, but it still seems to be pretty slow. I think 

Gavin: following up with I do think maybe it's a little bit depressing, relying on kind of capitalist invisible market model of change to to tackle many of the problems with climate change.

Do you think this is place of taking it outside of the market's hands or do you think maybe the There aren't enough governments around the world committed to that sort of action. 

Jessamy: I'm slightly swayed by this book I'm reading at the moment by Mark Carney, which is called Value and Values, and I've just finished reading the climate change section.

But he does make a good, I am not at all for the sort of markets will provide very neoliberal fundamental. The markets are everything and we can just leave it to them. I'm not of that view at all. And I don't think that, I don't think that there are that many people really that can be now after what we've experienced over the last two years.

There probably still are. I feel that given the right regulatory framework and governmental push that there is a sort of to be able to involve the private sector in there. the financial markets. It seems like the only way that we're going to get there. Otherwise I can't see how we're going to get there without involving them.

Do you know what I mean? 

Gavin: Yeah, I know exactly what you mean. It all has to, it all has to go together. It's not, it can't be the right approach to focus on one thing providing a solution. 

Jessamy: But again, it just comes back to this short termism for me, We have been operating in a world where we think about the next four years.

We don't think about future generations. We don't think about the next ten years. Anything that doesn't have an immediate impact is pushed to the side. And that's a culmination of both a sort of the political economy, which we now revolve around, the regulations that have then been, made and feed back into that the politicians, the finances.

everything else is a sort of downward spiral. We somehow have to start a position where we undo some of this and start being able to be in a position where regulations, measuring, and then financial remuneration slash, incentives are in a place. to be on a longer term field so that we can think about the future generations about our children's world and what that's going to be like.

Gavin: One consequence of the COVID 19 pandemic has been the disruption of established and vitally important food systems around the world. We originally spoke with Dr. Saskia Ossendarp, Executive Director of the Micronutrient Forum, in August last year, to discuss how bad the pandemic could be for malnutrition around the world.

Here, our Lancet Voice team member Liam Messin follows up with Saskia to chat about what the consequences of pandemic disruption actually have been. Liam and Saskia are also joined by Dr. Shweta Kandilwal, Head of Nutrition Research at the Public Health Foundation of India in Delhi. Shweta brings a focus on the specific malnutrition problems facing India as a result of the pandemic.

Liam: Hello Saskia. You 2020 about the impact COVID 19 must have on child and maternal nutrition. It's now 2021. So how are things going? 

Saskia: Yes, thank you Liam. So yeah, our first estimates done last year on the impact of the pandemic were based on assumptions on how COVID 19 would disrupt food systems affecting supplies and food prices, would disrupt the coverage of essential nutrition and health.

services and based on economic projections. And we are now in 2021. And unfortunately, the pandemic is far from over yet. And that's different than what we had anticipated last year. And we still don't have real time data on what happens to malnutrition. And that's because countries were unable. Due to COVID, or most countries at least, were unable to implement these household surveys that are required to collect these data.

However, we do have data now that demonstrate that our assumptions on how the COVID 19 pandemic would affect the underlying drives of child malnutrition They're correct, or maybe even too conservative. We know that an additional 150 million people have been pushed into extreme poverty and that the numbers of food insecurity and hunger are on the rise not just only because of COVID, but in combination with persistent conflicts and climate change.

We've seen reports at local levels on disruptions in the supply of perishable nutritious foods and declining consumption of these foods. And UNICEF reported an overall reduction of 30 percent in the coverage of essential nutrition services in 2020. And this includes school feeding programs, it includes micronutrient supplementation during pregnancy and antenatal care.

It includes the promotion of breastfeeding and the treatment and management of severe acute malnutrition. And in some regions, such as South Asia, we have seen reports that these disruptions in the delivery of services were more than 50 percent in 2020 and had not yet gone back to normal levels earlier this year.

And this was even before the second wave hit these countries in the region very hard. So yes, in 2021, the situation is very grim, and we know that these implications for child and maternal undernutrition will be severe and will have long lasting consequences, which we will And Shweta, 

Liam: COVID 19 has disrupted pretty much everything, but how does it affect nutrition?

Shweta: Let me give you an example from India in terms of the Poshan Abhiyan which is the government of India's flagship program on nutrition. Malnutrition among women and children was responsible for 15 percent of India's total disease burden prior to COVID. And now, unfortunately, COVID 19 has even exacerbated this.

With the disruption of Anganwadis or the child care centers that service as well as midday meal programs which provides food to the school going children, a large number of children actually have no longer got access to regular nutritious meals. In addition, the economic impact of the pandemic has also reduced the frequency and quality of meals consumed by these households.

Let me give you an example from the recent monitoring and evaluation report published by ID Insight and our think tank, Niti Aayog, which shows that take home rations, that means the food which people are about allowed to take home, the, that distribution in Rajasthan in one of our states here declined by almost eight percentage points between January and May, 2020.

And only about 26 percent of mothers actually reported having take home rations in the month of May of 2020 from an Anganwadi worker compared to the 34 percent pre lockdown. And most of our population, in fact, 50 percent or more is actually suffering from anemia. And due to disruptions in the supply chain for iron folic acid, anemia was also bound to exacerbate.

Only 10 percent as compared to the 22 percent of pregnant lactating women reported receiving. Iron folic acid. And of these also, only a quarter reported consuming this, while about 52 percent were reporting consuming this before lockdown. In addition, the food insecurity part has also become quite significant here in India.

Previously also, India accounted for about 22 percent of global burden for food insecurity. And some recent surveys report from UP, from Uttar Pradesh, one of our states here in India. that the household food insecurity increased sharply from 21 percent in December of 2019 to 80 percent in August of 2020 with 62 households actually changing their status from food secure to becoming food insecure and please bear in mind that these are households having less.

then two years of age child in their households. In addition, only 19%, to be precise children were found to be having minimum dietary diversity. What does, what do I mean by that? It means they were having less than four food groups in their diets. Very poor numbers here again.

Liam: What can be done to shift us from pessimistic towards optimistic? 

Saskia: Yeah, so what needs to be done in order to reverse these trends is a topic of discussion during a session on June the 8th that the Standing Together for Nutrition consortium with partners is organizing. As part of the World Health Organization's Food Systems Summit Dialogues Health Talks Week.

And we will be discussing the impact of the pandemic and the urgency to prioritize nutrition in COVID 19 recovery policies. And we are really calling on the international community, on donors, on country governments to respond forcefully now. To strengthen the deliveries of effective nutrition interventions and to include nutrition investments immediately in COVID 19 mitigation efforts.

And in addition, to also adopt longer term holistic approaches for resilience and building resilience and make sure that the world is meeting the targets that it has set itself for 2030 to reduce and eliminate hunger and all forms of malnutrition. And last year we summarized the actions that are needed in five key areas and these still hold and need to be implemented in an integrated way.

This includes actions to ens in food systems to ensure that more people have access to healthy diets and nutritious foods. It includes actions in health systems to make sure that the coverage of essential nutrition services, vitamin A supplementation, promotion of breast feeding, antenatal care services, and maternal nutrition interventions, that these are scaled up and can be delivered.

And it ensures the school feeding programs and programs for the management of acute malnutrition needs to be continued and stepped up. And finally, social protection programs. That have been increased in many countries, but that require more funding or more investments to step up and include nutrition into these programs so that more people and people of low income families have access and continue to have access to these nutritious foods and healthy diets.

Shweta: For India, I think I've summarized the solutions to be feasible, which is F E A S I B L E as an acronym here. F stands for financing. which means a sustained and an adequate aid to support uninterrupted public health nutrition activities and essentially having a universal coverage of the nutrition interventions.

The E stands for evidence generation. We all know that what gets measured gets done. And so high quality data evidence are prime, of a prime importance here. A stands for amplifying and augmenting the capacity to strengthen the local food environments and food systems. We all know this got hit in COVID 19 very badly.

And so our plea to Indian government is to be able to strengthen or invest their capacity in strengthening these local food environments. The S stands for systems approach. That means using COVID as an opportunity to rally for prioritizing nutrition sustainably across the health systems, the social protection systems, as well as the community systems.

I for me stands for investing in innovation, as well as scaling up. evidence based interventions. We all know that, bolstering capacity strengthening, building exercises, to deliver this on the ground is very important. The use of technology, for example, motivated workforce are critical to any program success.

And so this is also something which we may need to pay attention to. B for me stands for bringing together or building multidisciplinary talent or resource pools of global and regional experts for exchanging synergistic and symbiotic ideas. which actually should inform local solutions. The standing together for Nutrition Consortium, which Saskia mentioned, is also a very great example.

It has people from developing and developed countries, but it helps to bring together a multidisciplinary resource pool. L stands for leadership for me and it should be effective including the governance aspect. Because as we get up for this long battle with this pandemic, we must ensure that the nurturing and nourishment needs of people are met with this unwavering commitment to equity.

That should come from the leaders first and of course amongst all stakeholders. And last but not the least, E, E stands for strengthening an ecosystem for equitable access to food and nutrition security. Not only in times like this, but across the life course at all times. It should be not limited to the regular public health nutrition, national level programs and social safety nets, but they should be taught at of integration into different other programs as well.

So for me, India needs to gear up this, their response. to COVID 19 from a malnutrition point of view. And this is feasible, as I just said. 

Liam: Now, Sreeta, you just mentioned L for leadership. Is there the political willpower for these sort of proposals? 

Shweta: Thank you Liam for the question. And I think yes, malnutrition in India is a huge problem.

And there are several reasons for the government to actually pay attention to and try to tackle these multiple forms of malnutrition. Studies reveal that India loses up to 4 percent of its GDP and up to 8 percent of its productivity due to child malnutrition. And research on the other hand suggests that 1 invested on nutritional interventions in India could actually generate 34 to 38 in public economic returns, which is three times more than global average.

And these are figures which is pre COVID. So in COVID times, I'm quite certain that these numbers are going to be even better. For India. So yes, in short, my answer to your question is it's possible. The government intent is there, but we need to have concerted, convergent action, prioritizing public health nutrition across the life course, and it should be supported by development partners, as well as other stakeholders, including academicians, private bodies.

And so on and so forth. So yes, as 

Saskia: Svetlana said, I'm also optimistic and I believe there is a growing recognition among the international community as well that a nutrition crisis is looming and that we will lose decades of progress in nutrition with devastating lifelong and intergenerational consequences, basically losing an entire generation.

And also that we cannot get ourselves out of this pandemic. in regions with high levels of undernutrition if we don't tackle undernutrition simultaneously with COVID mitigation efforts. And this point has been made very clearly by leaders from the African Development Bank last month. Yes, there is this growing recognition that nutrition is essential and foundational for all other development goals and needs more investment.

But there's more work to do, of course, to convince decision makers and donors on the needs to prioritize nutrition over and above all these other development priorities that have now become urgent because of the COVID pandemic.

Gavin: Thanks so much to Liam, to Saskia and to Swita. I'm joined again. by Jessamy. Jessamy, it feels like every person we speak to about the consequences of the pandemic is talking in terms of decades of lost progress rather than years, aren't they? You wonder where the catch up impetus and the funds will come from for all of these areas, but nutrition is a particularly easy case, isn't it?

Of return on investment. 

Jessamy: Yeah, I think in that interview they were saying 44 billion lost in productivity from malnutrition and that's outside, that's just productivity, that's outside of the health consequences of malnutrition, people requiring extra healthcare as they get older or, all of those things that feed into each other, so it's an enormous burden.

Short 

Gavin: termism is a really deeply ingrained problem, isn't it? I think we've seen over the last 18 months in high income countries, the kind of extreme short termism of letting COVID run in places to save the economy, which became obviously this dichotomy that is completely false. We've learned further down the line, but we're also sitting on with this short termism of vaccinating everyone in your country without sharing vaccines around the world.

And of course, Here in the UK, as we often base our discussions on, just because the fact that you and I are both in the UK. We're seeing this Delta variant now, that's The case numbers are rising massively, and it's this kind of thing that's going to recur around the world, variants, if vaccines aren't shared properly, but instead we're just making sure that we get to herd immunity before sharing them anywhere.

And of course, these commitments were made at the G7, weren't they? But it's a drop in the ocean still, compared to what's required. It's such amazing short termism. 

Jessamy: It is the most obvious one, but as you say, it does require some long term planning, and that's, as we've seen, very difficult for governments to feed into their policy frameworks, it's not an immediate priority for many people, and as we have this sort of natural view from many nations to start looking inwards and to cut aid and everything else, it's.

It seems like quite a negative spiral and I like the question that I think Liam asked about turning it from pessimism to optimism. I think they came back with a very clever acronym about that, but it still seems quite difficult to get there.

Gavin: Thanks to all of our guests today. It's worth checking out those Lancet Planetary Health Papers on Climate Modelling, as I mentioned, they come out next week. And as for us we'll see you again here in two weeks time for more discussions from around the world of health. If you're not already subscribed, firstly, why not?

And secondly, you can easily rectify that at the podcast listening platform of your choice. I really look forward to seeing you back here soon. And thanks so much for listening to this episode of the Lancet voice.