By Kristin Hall, Kerri Wazny
The coronavirus outbreak is overwhelming the capacity of health systems across Asia, Europe, and the Americas, despite many countries having robust health systems.
While many low- and middle-income countries have not yet reported high case numbers, rapid increases are expected, and the potential consequences are severe. The underreporting of positive cases in many parts of the world is assumed, due to limited testing capacity. While fragile health system infrastructure will certainly undermine the ability to meet medical needs, suggesting a potential health crisis is already underway.
Although the virus does not discriminate between wealth and poverty, the feasibility of mitigation strategies, which limit the spread of the virus, do.
Strict but necessary lockdowns have been enforced across Europe, Asia, and North America to ease the spread of the virus, yet is simultaneously paralyzing the world’s strongest economies. This will be drastically compounded in LMICs, where the majority of those living in poverty and the world’s hungriest will be forced to choose between sheltering and suffering from hunger or defying lockdown potentially risking death from the virus.
Other vulnerable communities, — such as refugees, migrants, and internally displaced people — live outside systems designed to protect populations. These groups are often subjected to overcrowded living conditions, without basic services and lacking access to direct government support.
And exacerbating the issue, a nutrition crisis is ominous. Before COVID-19, 57.7% of sub-Saharan Africa’s population and 34.3% of Southern Asia experienced moderate to severe food insecurity. This will increase.
Unsurprisingly, undernourishment increases during crises as people turn to cheaper, less nutritious foods to survive. Our challenge is therefore: how to help communities navigate this public health crisis while building resilient populations that can navigate nutritional needs. Doing so requires a multisystems approach.
The interconnectedness of health, social, and food systems
Newly launched this week, the 2020 Global Nutrition Report highlights the scale of nutrition inequities and the need for funding, renewed global commitments and strengthened accountability from all sectors.
COVID-19 only exacerbates this urgency — there is a pressing need to invest in the resilience and interconnectedness of health, social, and food systems: ensure accessibility, availability, and affordability of healthy foods; meet the immediate medical needs; and support livelihoods of vulnerable populations. All are imperative in COVID-19 responses to make sure the entire world emerges from this pandemic more resilient.
Today, over 62 million children under five in sub-Saharan Africa and South Asia suffer from stunting. Malnutrition compromises immune systems, putting children at increased risk of contracting infections. Based on previous crises, COVID-19 is likely to increase global malnutrition levels — such as when the 2007-2008 recession led to volatile food prices, which made it harder to purchase essential foods.
A robust and diverse food supply is an essential part of the health and nutrition response to COVID-19. This is noteworthy in LMICs, where agricultural policy has historically privileged the production of staple and cash-crops, undermining supplies of diverse and healthy foodstuffs necessary to ensure nutrition security within populations.
As the current locust crisis in East Africa demonstrates, domestic food production and sustainability will experience continued disruption from a natural disaster, compounded by the pressure COVID-19 places on domestic and international trade logistics. We need to shift toward investing in local functioning food systems and promote healthy proven diet that can be accessed and afforded close to home.
As a short-term measure, countries are investing in innovative ways to track, trace, and isolate the virus. This approach has proven effective in South Korea, New Zealand, and during the Ebola outbreaks in Africa. Expanding this tactic will not only slow the spread of the virus in communities but will also help identify regions disproportionately impacted by the disease and who require additional livelihood support. This means we can adapt supply chains and provide essential goods and services where they are needed most.
As a longer-term measure, experts argue for reinforcing nutrition as a pillar for universal health coverage. According to the World Health Organization, at least half of the world’s population does not have full coverage of essential health services. Quality UHC should be free at the point of service to protect people from being pushed into poverty from use.
UHC should also be framed in terms of essential nutrition actions through alignment of policies between nutrition and health system delivery. This is salient given COVID-19 as the virus is showing to severely impact those with underlying diet-related conditions such as diabetes, cardiovascular disease, and hypertension. Additionally, evidence is emerging that other underlying comorbidities that weaken the immune system — including infections and poor nutritional status — present a higher risk for severe disease.
Social protection systems
While many people in high-income countries are able to work from home and have the means to stock-pile food and other essentials, this is simply not a reality in LMICs where many need to attend work in-person, buy food in small quantities, have no reserves, and no recourse to financial support if they cannot work.
Compounding this problem is a rise in food prices while income suddenly decreases. Increasing financial resilience to promote food and nutrition security and livelihood recovery is therefore essential in times like these. The Ehsaas Emergency Cash income support instrument in Pakistan was developed as a comprehensive relief package to ensure lockdown compliance among the most vulnerable.
Togo provides another example, where a social protection scheme “Novissi” was designed to support informal workers whose incomes are interrupted by COVID-19, paying for basic daily necessities such as food, sanitation, and communication. Addressing the gender-specific impacts of COVID-19, women will receive the highest pay-outs.
A winning strategy to build back a more resilient society for all
COVID-19 has focused the attention of the global community, allowing for a moment of international coordination in the face of crisis.
While we need to acknowledge that LMICs and HICs must respond differently to the pandemic given the compounding fragilities LMICs face, it is also important that the global “we” promotes leadership from within LMICs, where experts have successfully steered like-responses such as those against Ebola.
Without multisystems coordination and investment grounded in nutrition at the local, regional, and global level we will not be able to turn the tide on this pandemic and respond more rapidly and effectively in the future.