Investment Framework for Nutrition 2024: An Update to the Investment Framework for Nutrition

Investment Framework for Nutrition 2024

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Human Development Perspectives

Investment Framework for Nutrition 2024

Meera Shekar

Kyoko Shibata Okamura

Mireya Vilar-Compte

Chiara Dell’Aira

Editors

© 2024 International Bank for Reconstruction and Development / The World Bank

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Attribution—Please cite the work as follows: Shekar, Meera, Kyoko Shibata Okamura, Mireya Vilar-Compte, and Chiara Dell’Aira, eds. 2024. Investment Framework for Nutrition 2024. Human Development Perspectives. Washington, DC: World Bank. doi:10.1596/978-1-2162-2. License: Creative Commons Attribution CC BY 3.0 IGO

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ISBN (paper): 978-1-4648-2162-2

ISBN (electronic): 978-1-4648-2163-9

SKU: 212162

DOI: 10.1596/978-1-4648-2162-2

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Human Development Perspectives

The books in this series address main and emerging development issues of a global/regional nature through original research and findings in the areas of education, gender, health, nutrition, population, and social protection and jobs. The series is aimed at policy makers and area experts and is overseen by the Human Development Practice Group chief economist.

Previous titles in this series

Feng Zhao, Rialda Kovacevic, David Bishai, and Jeff Weintraub, eds. Strategic Investment for Health System Resilience: A Three-Layer Framework (2024).

Magdalena Bendini and Amanda E. Devercelli (eds.), Quality Early Learning: Nurturing Children’s Potential (2022).

Margaret Grosh, Phillippe Leite, Matthew Wai-Poi, and Emil Tesliuc (eds.), Revisiting Targeting in Social Assistance: A New Look at Old Dilemmas (2022).

Feng Zhao, Clemens Benedikt, and David Wilson (eds.), Tackling the World’s Fastest-Growing HIV Epidemic: More Efficient HIV Responses in Eastern Europe and Central Asia (2020).

Meera Shekar and Barry Popkin (eds.), Obesity: Health and Economic Consequences of an Impending Global Challenge (2020).

Truman Packard, Ugo Gentilini, Margaret Grosh, Philip O’Keefe, Robert Palacios, David Robalino, and Indhira Santos, Protecting All: Risk Sharing for a Diverse and Diversifying World of Work (2019).

Damien de Walque (ed.), Risking Your Health: Causes, Consequences, and Interventions to Prevent Risky Behaviors (2014).

Rita Almeida, Jere Behrman, and David Robalino (eds.), The Right Skills for the Job? Rethinking Training Policies for Workers (2012).

Barbara Bruns, Deon Filmer, and Harry Anthony Patrinos, Making Schools Work: New Evidence on Accountability Reforms (2011).

Harold Alderman (ed.), No Small Matter: The Impact of Poverty, Shocks, and Human Capital Investments in Early Childhood Development (2011).

All books in the Human Development Perspectives series are available at https://openknowledge.worldbank.org/handle/10986/2161.

Contents

Foreword

Acknowledgments

About the Editors and Contributors

Glossary

Executive Summary

Abbreviations

Chapter 1Objective and Scope of the 2024 Update

Introduction

What Worked Well in the 2017 Investment Framework—and What Did Not Work as Well

Note

References

Chapter 2Maternal and Child Nutrition Trends

Introduction: Progress toward SDG 2

Forms of Malnutrition and Target Groups

Maternal Malnutrition

Child Malnutrition

Nutrition among School-Age Children and Adolescents

Adult Overweight and Obesity

Double Burden of Malnutrition

Notes

References

Chapter 3Safeguarding Human Capital amid a Global Food and Nutrition Crisis

Human Capital

Human Capital Index

Nutrition as a Key Element of the HCI

References

Chapter 4Exploring the Intersection of Nutrition, Climate Change, and Gender: Shared Burdens, Shared Benefits

Social and Economic Costs of Malnutrition and Climate Change

Bearing the Brunt: Women, Climate Change, and Nutrition

A Bidirectional Relationship through Food Systems

Ensuring Climate Actions Are Nutrition-Sensitive and Nutrition Actions Are Climate-Sensitive

Benefits of Investing in Both Nutrition and Climate Change Actions

Entry Points for Climate Change Adaptation and Mitigation Investments for Nutrition

References

Chapter 5Interventions That Address All Forms of Malnutrition

Framework for Achieving Optimum Nutrition

High-Impact Nutrition Interventions Delivered through the Health Sector

Nutrition Interventions Delivered through the Social Protection Sector

Nutrition Interventions Delivered through the Agriculture Sector

Nutrition Interventions Delivered through the Water Sector

Nutrition Interventions Delivered through the Education Sector

Multisectoral Delivery of Nutrition Interventions

Summary of the Evidence and Implications for Scale-Up

References

Chapter 6Policies and Fiscal Measures That Address All Forms of Malnutrition

Policy Nexus: Nutrition, Food Systems, and Climate

National Nutrition Policy Frameworks and Technical Guidelines

Legislative and Regulatory Policies

Fiscal Policies to Reorient Food Systems to Healthier and More Sustainable Diets

Policy Coherence

Policy Measures and Scale-Up Opportunities, by Income Group

Notes

References

Chapter 7Costs, Benefits, Effectiveness, and Efficiency of Nutrition Interventions

Analytic Approaches

Results

Anticipated Impacts of the Investments

Optimizing Investments for Maximum Impact

Costs and Benefits of Implementing Policies to Tackle Overweight and Obesity

Conclusion

Notes

References

Chapter 8Scaling Up Nutrition Actions: Operational Considerations

Introduction

Key Considerations in Scaling Nutrition Investment and Prioritizing Evidence-Based Interventions

Cross-Sectoral Actions to Improve Nutrition

Institutional Strengthening to Maximize and Sustain Nutrition Investment and Returns

Notes

References

Chapter 9Financing the Global Nutrition Targets: Progress to Date

Domestic Financing for Nutrition

Development Assistance for Nutrition

Projected Domestic and Development Assistance Financing for Nutrition

Nontraditional Sources of Nutrition Financing

Opportunities to Improve the Efficiency of Spending: More Nutrition for the Money

The Way Forward

Areas for Further Work and Research

Notes

References

Technical Chapter Annexes (available at https://openknowledge.worldbank.org/handle/10986/2161)

Annex 2A: The Double Burden of Malnutrition

Annex 4A: Estimating the Greenhouse Gas Emission Cost of Closing the Protein Gap in India

Annex 4B: Green Feeding Climate Action Tool

Annex 4C: Country Case Studies

Annex 5A: Systematic Review Map

Annex 5B: Evidence for Nutrition Interventions Delivered through the Health Sector

Annex 5C: Evidence for Interventions Delivered through the Other Sectors

Annex 7A: Overview of Optima Nutrition Model

Annex 7B: Details on Target Analysis Sample

Annex 7C: Costs of Nutrition Interventions by Target Condition

Annex 7D: Costs and Benefits by Target Condition

Annex 7E: Impact, Cost-Effectiveness, and Economic Benefits of Intervention Scale-Up

Annex 7F: Assumptions Underlying the Strategic Public Health Planning for Noncommunicable Diseases (NCDs) Model

Annex 8A: Tools to Support Operationalization

Annex 9A: Methodology Note on Estimating Domestic and Development Assistance Financing for Nutrition

Annex 9B: Technical and Policy Advisory Group Membership

Boxes

2.1Child Stunting in India

2.2Where Is the Greatest Decline in Child Stunting Seen?

2.3Where Is the Greatest Increase in Child Overweight and Obesity Seen?

2.4Where Is the Greatest Increase in Adult Obesity Seen?

4.1Greenhouse Gas Cost of Closing the Protein Gap in India

4.2Indonesia’s Climate-Sensitive Actions to Reduce Stunting

4.3Enhancing Climate and Nutrition Co-benefits in Madagascar

5.1Rwanda’s Nutrition-Sensitive Direct Support Program

5.2A Cash-Transfer Program in Niger

5.3Maternity Cash Transfers for Women Employed in the Informal Sector in the Philippines

5.4Water and Nutrition: New Monitoring Opportunities to Trigger Better Action

6.1Saudia Arabia: Moving from a Sugar-Sweetened Beverage Tax Policy to a Comprehensive, Multisectoral Health-Promoting Policy Package

6.2Design, Approval, and Implementation of Excise Taxes on Sugar-Sweetened Beverages and Ultraprocessed Foods in Colombia

7.1Cost Considerations for Implementing the Chilean Food Labeling and Marketing Law

8.1Embedding Evidence-Based Decision-Making Analyses into Budget Planning: Nigeria Optima Nutrition Case Study

8.2Scaling Up Small-Quantity Lipid-Based Nutrient Supplements to Vulnerable Populations Using Existing Health Platforms

8.3Implementation Research Supports Scale-Up of Multiple Micronutrient Supplements

8.4Poshan Tracker: India’s Innovative Mobile App to Transform Community-Based Nutrition Service Delivery and Monitoring

9.1Existing Innovative Financing Opportunities

Figures

ES.1Nutrition Services Can Be Delivered through Several Sectors

ES.2Effective and Coherent Policy Actions to Support Nutrition Investments

ES.3Additional Financing Needs by Region

ES.4Optimized Annual Spending Allocations: Potential Scenarios If 0 Percent, 25 Percent, or 50 Percent of Additional Financing Needs Are Met

ES.5More Money for Nutrition and More Nutrition for the Money

2.1Prevalence of Undernourishment and Number of People Undernourished, 2000–22

2.2Evolution of Global Moderate or Severe Food Insecurity, 2014–22

2.3Global Progress toward the SDG Nutrition Targets, 2000–22

2.4Nutrition Target Groups during the Life Course

2.5Prevalence of Anemia among Women of Reproductive Age, 2000–19

2.6Stunting Prevalence, Global and by Region, 2000–22

B2.1.1High Burden of Child Stunting in India

B2.2.1Top 10 Countries with Greatest Decline in Stunting Prevalence, 2012–22

2.7Wasting Prevalance, Global and by Region, 2022

2.8Low Birthweight Prevalence and Number, 2000–20

2.9Exclusive Breastfeeding Prevalence, Global and by Country Income Group, 2000 and 2019

2.10Anemia Prevalence among Children Ages 6–59 Months, Global and by Region, 2000–19

2.11Prevalence of Overweight and Obesity among Children Younger than Age Five Years, Global and by Region, 2000–22

B2.3.1Ten Countries with Greatest Absolute Increase in Prevalence of Child Overweight and Obesity, 2012–22

2.12Prevalence of Overweight and Obesity among Adult Women and Men, 2022

B2.4.1Ten Countries with the Greatest Absolute Increase in Obesity Prevalence among Adult Women, 2012–22

2.13Changes in the Proportion of Countries by Burden Level of Public Health Significance

3.1Nutrition Is a Key Component of the Human Capital Index

4.1Effects of Climate Change on Key Determinants of Nutrition and Nutrition Outcomes

4.2Interlinks among Climate Systems, Food Systems, and Natural Ecosystems

4.3Breaking Down the Food System’s Carbon Footprint

B4.1.1Modeled GHG Emission Estimates to Achieve the Recommended Protein Intake in India

4.4Determining Climate Investment Eligibility through the Climate Bonds Transition Framework

4.5Climate Change Mitigation and Adaptation Entry Points for Improved Nutrition Targeted to Women

5.1Multisectoral and System-Geared Framework for Nutrition

5.2Overview of Nutrition Interventions Delivered through the Health Sector in LMICs

5.3Overview of Nutrition Interventions Delivered through the Social Protection Sector in LMICs

5.4Overview of Nutrition Interventions Delivered through the Agriculture Sector in LMICs

5.5Overview of Nutrition Interventions Delivered through the Water Sector in LMICs

5.6Overview of Nutrition Interventions Delivered through the Education Sector in LMICs

6.1Policies and Fiscal Measures to Enable and Promote Better Nutrition

B6.1.1Saudi Arabia’s Front-of-Package Traffic Light Label

6.2Share of Global Agrifood Support, by Commodity, 2020–22

6.3Global Modeling Simulations Repurposing Agrifood Support to Improve Climate and Health Outcomes

6.4Sugar Consumption, SSB Taxes, and Support to Sugar Producers, Selected Countries

7.1Total Global Financing Needs, Undiscounted, for Full Scale-Up of Undernutrition Interventions

7.2Global Financing Needs to Scale Up Undernutrition Interventions, by World Bank Region, Country Income Level, and Intervention

7.3Optimized Budget Allocations: Potential Scenarios If 0 percent, 25 percent, or 50 Percent of Additional Financing Needs Are Met

7.4Annual Health Expenditures Associated with Overweight in Mexico, South Africa, and Bulgaria, 2020–50 Average

7.5Economic Costs of Overweight on Per Capita Labor Market Output in Bulgaria, Mexico, and South Africa and Average Annual Wages, 2020–50

7.6Costs of Implementing Selected Policies in Bulgaria, Mexico, and South Africa, Per Capita Annual Average, 2020–50

7.7Population-Standardized Effects of Selected Policies on Life Years Gained in Bulgaria, Mexico, and South Africa, 2020–50 Average

7.8Effects of Selected Policies on Health in Bulgaria, Mexico, and South Africa, by Labor Market Impact

9.1Trends in Domestic Expenditures for Health and Nutrition, 2015–21

9.2When Domestic Health Expenditures Increase, Domestic Nutrition Expenditures Do Not Increase Proportionately in the Majority of Low- and Middle-Income Countries, 2016–19

9.3Domestic Nutrition Expenditures Relative to Stunting Burden, by Country, 2019

9.4OECD-CRS Development Assistance Disbursements to Evidence-Based High-Impact Nutrition Interventions, 2015–22

9.5OECD-CRS Development Assistance Disbursements to Evidence-Based High-Impact Nutrition Interventions from the Top Six Providers as of 2022, Annualized Percent Change, 2015–22

9.6OECD-CRS Development Assistance Disbursements to Evidence-Based High-Impact Nutrition Interventions, by Funding Source, 2015–22

9.7OECD-CRS Development Assistance Disbursements to Evidence-Based High-Impact Nutrition Interventions, by Country Income Group, 2015–22

9.8Development Assistance Financing Disbursements to Priority Interventions, by World Health Assembly Target with Average Annual Change, 2015–22

9.9Projected Domestic Expenditures for and Development Assistance Disbursements to Nutrition, 2025–34

9.10Philanthropic Financing for Nutrition, by Intervention Area, US$, Millions, 2014–28

9.11Total Financing Needs and Gaps for Full Scale-Up of Nutrition Interventions, 2025–34

9.12The Way Forward: More Money for Nutrition, More Nutrition for the Money

Maps

6.1Front-of-Package Labels around the World

6.2Global Coverage of National-Level Taxes on SSBs, August 2023

6.3National-Level Unhealthy Food Taxes, January 2024

Tables

4.1Carbon and Water Footprints Associated with Consumption of CMFs among Infants Younger Than Six Months, Ghana and Mexico

5.1Summary of the Nutrition Interventions and Effect Sizes

B6.2.1Approved SSB Excise Tax Thresholds

6.1Typology of Policy Measures and Scale-Up Opportunities, by Country Income Classification and Epidemiological and Market Conditions

7.1Total Additional Financing Needs for Maternal Anemia, Low Birthweight, Breastfeeding, Child Stunting, Wasting, and Child Anemia, US$, Millions, 2025–34

7.2Impact and Cost-Effectiveness of Interventions on Different Undernutrition Outcomes, US$

7.3Impact of Optimization Scenarios versus Baseline Outcomes and Full Scale-Up Scenario, 2025–34

7.4Economic Costs of Obesity, Estimated as Percentage Reduction in Gross Domestic Product by 2050, by Model

B7.1.1Systematized Listing of Actions That Need to Be Costed for Design, Implementation, and Monitoring of Food Labeling and Marketing Regulation Interventions

9.1Examples of Multilateral Climate Adaptation Funds for Nutrition

Foreword

With only six years remaining until the Sustainable Development Goals (SDGs) end line of 2030, the world stands at a critical juncture. Central to the World Bank Group’s commitment to eliminate extreme poverty on a livable planet is the recognition of the vital role nutrition plays in fostering sustainable development and building human capital. Despite significant progress on SDG 2.2 over the past decades, recent crises, compounded by climate change and conflicts, have exacerbated food insecurity, malnutrition, and poverty.

Child stunting, wasting, anemia, obesity, low birthweight, and maternal anemia persist at alarming rates, especially in lower- and middle-income countries in which more than 148 million children are still stunted and 1 in 3 women is anemic. These trends jeopardize future human capital and economic productivity and significantly increase the risk of poor learning outcomes, illness, death, and rising health care cost burdens.

Nutrition serves as both a maker and a marker of human capital, with both undernutrition and obesity significantly affecting it. The Human Capital Index paints a bleak picture of future economic productivity in the developing world, with scores below 0.40 in most African nations and hovering around 0.48 in South Asia, which means that children in Africa and South Asia will grow up to be only 40 or 48 percent as productive as they could be, respectively.

Unlike many other development investments, investments in nutrition are durable, inalienable, and portable. They are durable because investments made during the critical first 1,000 days of a child’s life last a lifetime. They are inalienable and portable because they belong to the child regardless of their location or circumstances. They are among the most effective tools for sustainable development, offering a return of $23 for every $1 invested.

Building on the 2017 Investment Framework for Nutrition, this report updates the latest evidence and serves as a comprehensive guide to the most effective interventions and policy measures to improve nutrition outcomes. It emphasizes the importance of multisectoral approaches and brings in interactions with gender and climate. Additionally, it complements previous financing estimates with important new approaches to innovative financing, such as repurposing agrifood subsidies for healthier and more sustainable options, thereby enhancing nutrition and climate co-benefits. The report serves as a key guide for domestic and official development assistance commitments in the lead-up to the global Nutrition for Growth summit to be hosted by the government of France in March 2025. It also informs the implementation of the World Bank Group’s new Food and Nutrition Security (FNS) Global Challenge Program, laying a robust foundation for addressing three interconnected issues: enhancing FNS crisis prevention, preparedness, and response mechanisms; promoting innovative, high-impact cross-sectoral solutions to improve nutrition outcomes; and scaling low-emissions, climate-resilient food systems. These action areas provide powerful, scalable solutions that can be implemented across countries, leveraging the World Bank Group’s unique capacity to mobilize public, private, and philanthropic financing for development.

Mamta Murthi

Vice President, Human Development

Acknowledgments

This publication was led by Meera Shekar, Kyoko Shibata Okamura, Mireya Vilar-Compte, and Chiara Dell’Aira. The report benefited from substantial inputs and support from the American Institutes for Research (AIR), Burnet Institute in Australia, Research Center for Equitable Development (EQUDE) at Universidad Iberoamericana, Results for Development (R4D) Institute, Stronger Foundations for Nutrition, Alive & Thrive, and Northwestern University. Financial support for this work was provided by the Bill and Melinda Gates Foundation (BMGF) and the government of Japan through the World Bank Nutrition Multi-Donor Trust Fund for Scaling Up Nutrition.

Hoa Thi Mai Nguyen (World Bank), Nick Scott (Burnet Institute), and Michelle Mehta (World Bank) were lead authors on chapters 2, 7, and 8, respectively, and Jonathan Kweku Akuoku, Mia Blakstad, Lisa Shireen Saldanha, Kate Mandeville, Libby Hattersley, Felipe Dizon, Ali Winoto Subandoro, and Mary D’Alimonte (R4D) coauthored one or more of the chapters, laying the groundwork for this work’s broad scope and depth.

The following colleagues contributed to relevant chapters: Stephen Geoffrey Dorey, Loreta Rufo, and the Climate and Health team, as well as Anne Marie Provo, Chris Jackson, and Francis Addeah Darko of the World Bank (chapter 4); Claire Chase of the World Bank, Thomas de Hoop and the team at AIR, Sonia Hernandez-Cordero, Pablo Gaitán-Rossi and the EQUDE team at Universidad Iberoamericana, Sera Young of Northwestern University, and Roger Mathisen of the Alive & Thrive team (chapter 5); Reem Alsukait, Christopher Herbst, Ceren Ozer, Danielle Bloom, Norman Maldonado, Roberto Iunes, Yu Shibui, and Kajali Paintal Goswami of the World Bank, as well as Elisa Cadena at the Research Center on Health Economics and Social Protection, Universidad Icesi (chapter 6); Camila Corvalán and Marcela Reyes of the University of Chile, Fernando Mediano of the Catholic University of Chile, and Cristián Cofre of the Chilean Ministry of Health (chapter 7); Anne Marie Provo and Rogers Ayiko of the World Bank (chapter 8); and Abbe McCarter and Caroline Andridge from R4D, as well as Emily Custer at the Stronger Foundations for Nutrition (chapter 9).

The report greatly benefited from thoughtful comments provided by peer reviewers: Afshan Khan, coordinator of the Scaling Up Nutrition Movement; Rahul Rawat (BMGF); Abigail Perry (World Food Program); Saul Guerrero Oteyza (United Nations Children’s Fund [UNICEF]); and Jed Friedman (World Bank). Kathryn Dewey (University of California, Davis), Emanuela Galasso (World Bank), Helena Guarin (European Commission [EC]), Heather McBride (Canada), Lynette Neufeld (Food and Agriculture Organization of the United Nations [FAO]), and Purnima Menon (International Food Policy Research Institute [IFPRI]) provided additional valuable comments. The authors extend their deepest gratitude to the members of the Technical Advisory Group (TAG) and Policy Advisory Group (PAG) for their invaluable contributions to guiding this work. PAG members were Afshan Khan (Scaling Up Nutrition [SUN]), Helena Guarin (EC), Heather McBride (Global Affairs Canada); TAG members were Anna Hakobyan (Children’s Investment Fund Foundation [CIFF]), Augustin Flory (consultant), Avani Kapur (Center for Policy Research, India), Emanuela Galasso (World Bank), Felipe Dizon (World Bank), George Ouma (African Development Bank), Jed Friedman (World Bank), Kathryn Dewey (University of California, Davis), Lynnette Neufeld (FAO), Paddy Wilmott (Foreign, Commonwealth and Development Office), Purnima Menon (IFPRI), Rahul Rawat (BMGF), and Victor Aguayo (UNICEF). Emanuela Galasso, Kathryn Dewey, and Rahul Rawat went beyond the call of duty to support the team with a careful review of the evidence base.

Many thanks are due to Juan Pablo Uribe (director, Health, Nutrition and Population/Global Financing Facility, World Bank) for chairing the TAG/PAG meetings and the decision meeting and to Norbert Schady (chief economist, Human Development, World Bank) for his careful review and advice in finalizing the report.

The team thanks Michael R. Fisher for his incredibly skilled editing and David Lloyd for preparing the excellent graphics. Kathie Porta Baker was the copy editor. Jewel McFadden served as the acquisitions officer, Mary Fisk managed the production process, and Orlando Mota handled the printing and electronic file preparation.

Last, the team expresses their sincere appreciation to all those who have contributed to this report. Their insights and expertise have been crucial in enriching the content and depth of this report, and each of them is a co-owner of this report.

About the Editors and Contributors

About the Editors

Chiara Dell’Aira is a nutrition specialist (Young Professional) in the Health, Nutrition, and Population Global Practice at the World Bank. She provides technical and analytical support to large-scale nutrition projects through research and global engagement activities and works with multidisciplinary teams on the intersections of nutrition with climate, agriculture, gender, and food security. Before working with the World Bank, she worked with the Pan American Health Organization, academia, and nongovernmental organizations. She holds an MSc in global health from the University of Copenhagen.

Kyoko Shibata Okamura is a senior nutrition specialist in the Health, Nutrition, and Population Global Practice at the World Bank. Building on her extensive experience in managing large-scale nutrition programs in countries such as Ethiopia and Nepal, she has more recently been working on nutrition financing, healthy diet, and food systems. She has a master’s degree in health sciences in human nutrition from the Johns Hopkins Bloomberg School of Public Health.

Meera Shekar is global lead for nutrition in the Health, Nutrition, and Population Global Practice at the World Bank. She has lived and worked across the globe and has extensive operational experience in Africa, East Asia, Latin America, the Middle East, and South Asia. Before joining the World Bank, she worked with UNICEF in Ethiopia, the Philippines, and Tanzania. She has a PhD in international nutrition, epidemiology, and population studies from Cornell University.

Mireya Vilar-Compte is a senior nutrition consultant in the Health, Nutrition, and Population Global Practice at the World Bank and an associate professor in public health (on leave) at Montclair State University. She specializes in global public health with an emphasis on maternal and child health and nutrition. She has led research grants and consultancies across the globe with national, international, and not-for-profit organizations. She has a PhD in health policy from New York University.

About the Chapter Authors

Jonathan Kweku Akuoku is a nutrition specialist in the Health, Nutrition, and Population Global Practice at the World Bank.

Mia Blakstad is a social protection specialist in the Social Protection and Jobs Global Practice at the World Bank.

Mary D’Alimonte is a program director at the Results for Development Institute.

Felipe Dizon is a senior economist in the Agriculture and Food Global Practice at the World Bank.

Libby Hattersley is a consultant in the Health, Nutrition, and Population Global Practice at the World Bank.

Kate Mandeville is a senior health specialist in the Health, Nutrition, and Population Global Practice at the World Bank.

Michelle Mehta is a nutrition specialist in the Health, Nutrition, and Population Global Practice at the World Bank.

Hoa Thi Mai Nguyen is a nutrition specialist consultant in the Health, Nutrition, and Population Global Practice at the World Bank.

Lisa Shareen Saldanha is a senior nutrition specialist in the Health, Nutrition, and Population Global Practice at the World Bank.

Nick Scott is the head of modeling and biostatistics at the Burnet Institute.

Ali Winoto Subandoro is a senior nutrition specialist in the Health, Nutrition, and Population Global Practice at the World Bank.

Glossary

Adult overweight and obesity

refers to an individual age 18 years or older with a body mass index (BMI) of 25 kilograms per square meter (kg/m²) or higher. Within this range, a BMI of 25 to less than 30 kg/m² is classified as overweight, and a BMI of 30 kg/m² or higher is considered obesity. Obesity severity is categorized into three classes: class 1 for a BMI of 30 to less than 35 kg/m², class 2 for a BMI of 35 to less than 40 kg/m², and class 3 for a BMI of 40 kg/m² or higher.

Anemia in pregnant women and children younger than age five years

is defined as a hemoglobin concentration less than 110 grams per liter (g/L) at sea level, and anemia in nonpregnant women is defined as a hemoglobin concentration less than 120 g/L. The current WHO thresholds for mild, moderate, and severe anemia are 110–119, 80–109, and less than 80 g/L, respectively, for nonpregnant women and 100–109, 70–99, and less than 70 g/L, respectively, for pregnant women. The hemoglobin concentration cutoff points may differ by age,