Gates Foundation Report Calls for Targeted Global Health Spending to Save Millions of Children from Malnutrition and Disease

In its eighth annual Goalkeepers report released today, the Bill & Melinda Gates Foundation urged world leaders to increase global health spending where it is needed most in order to boost children’s health and nutrition, especially in the face of the global climate crisis.

The Goalkeepers report, “A Race to Nourish a Warming World,” projects that without immediate global action, climate change will condemn an additional 40 million children to stunting and 28 million more to wasting between 2024 and 2050. Scaling up solutions now can avoid this outcome, while also building resilience to climate change and spurring much-needed economic growth.

In 2023, the World Health Organization estimated that 148 million children experienced stunting, a condition where children don’t grow to their full potential mentally or physically, and 45 million children experienced wasting, a condition where children become weak and emaciated, leaving them at much greater risk of developmental delays and death. These are the most severe and irreversible forms of chronic and acute malnutrition.

At the same time, as global challenges intensify, the total share of foreign aid going to Africa has decreased. In 2010, 40% of foreign aid went to African countries. But that number is now down to just 25%—the lowest percentage in 20 years—despite more than half of all child deaths occurring in sub-Saharan Africa. This trend leaves hundreds of millions of children at serious risk of dying or suffering from preventable diseases and threatens the unprecedented progress the world made in global health across Africa between 2000 and 2020.

“Today, the world is contending with more challenges than at any point in my adult life: inflation, debt, new wars. Unfortunately, aid isn’t keeping pace with these needs, particularly in the places that need it the most,” writes report author Bill Gates, co-chair of the Bill & Melinda Gates Foundation. “I think we can give global health a second act—even in a world where competing challenges require governments to stretch their budgets.”

According to Gates, malnutrition is “the world’s worst child health crisis,” and climate change is only making it worse. Amidst this crisis, Gates calls for maintaining global health funding; immediately addressing the growing threat of child malnutrition by supporting the Child Nutrition Fund, a new platform that coordinates donor financing for nutrition; and governments fully funding the established institutions that have proven effective at protecting millions of lives each year. These institutions include Gavi, the Vaccine Alliance, which is due to hold its next funding replenishment in 2025; and the Global Fund to Fight AIDS, Tuberculosis and Malaria, which is expected to also hold its replenishment next year.

“If we do these three things, we won’t just usher in a new global health boom and save millions of lives—we’ll also prove that humanity can still rise to meet our greatest challenges,” Gates writes.

The report also shines a light on the catastrophic economic costs of malnutrition and highlights solutions that can help mitigate them. According to the World Bank, the cost of undernutrition is US$3 trillion in productivity loss every year, because malnutrition stunts people’s physical and cognitive abilities. In low-income countries, that loss ranges from 3% to 16% (or more) of GDP, which amounts to a permanent 2008-level global recession every year.

Proven Tools Exist Today

“The best way to fight the impacts of climate change is by investing in nutrition…Malnutrition makes every forward step our species wants to take heavier and harder,” Gates writes. “But the inverse is also true. If we solve malnutrition, we make it easier to solve every other problem. We solve extreme poverty. Vaccines are more effective. And deadly diseases like malaria and pneumonia become far less fatal.”

The report highlights proven tools that are helping solve malnutrition, building people’s resilience to the worst impacts of climate change, and further driving down childhood deaths. They include:

• New agricultural technologies that are producing up to two to three times more milk and safer milk, which can prevent millions of cases of child stunting by 2050.
• Modeling shows that in India, Ethiopia, Kenya, Nigeria, and Tanzania, these technologies can prevent 109 million cases of child stunting by 2050.
• Efforts to scale up new ways of fortifying pantry staples, such as salt and bouillon cubes, can reduce millions of cases of anemia and prevent deaths due to neural tube defects.
• In Ethiopia, a new process to fortify salt with iodine and folic acid could lead to a 4% reduction in anemia and could eliminate up to 75% of all deaths and stillbirths due to neural tube defects.
• In Nigeria, fortifying bouillon cubes with iron, folic acid, zinc, and vitamin B12 could avert up to 16.6 million cases of anemia and up to 11,000 deaths from neural tube defects.
• Efforts to provide a high-quality prenatal vitamin for pregnant women could save almost half a million lives and improve birth outcomes for 25 million babies by 2040.
• Adopting multiple micronutrient supplements (MMS) costs as little as $2.60 for an entire pregnancy in all low- and middle-income countries.

The report also highlights how promising new research into the microbiome can improve people’s health. Studies indicate that better gut health can help children absorb nutrients, develop strong immune systems, and grow as they should to thrive. A deeper understanding of gut health, Gates writes, has the potential to change not just how the world treats malnutrition but also overnutrition, which impacts wealthy countries.

This year’s report also features essays from farmers and experts on the frontlines of the malnutrition crisis, who explain the impacts these tools are making in their communities.

Sushama Das, a dairy farmer in Astaranga, in the Indian state of Odisha, writes about the Livestock Enhancement and Advancement Programme: “Today, we have eight cows, and they are producing 60 liters of milk every day…The subsidies and training schemes have helped our family earn more money—our monthly income is now five times as much as it used to be.”

Coletta Kemboi, a dairy farmer in Maili Nne, Kenya, who participated in a training with MoreMilk, writes, “Before, there were some traces of unclean milk, but since I went through the training, they [inspectors] have come to our shop around three times and their tests are proof that our milk is good…The extra money we are earning goes to the farm…We are able to pay my three children’s school fees.”

Ladidi Bako-Aiyegbusi, director of nutrition at the Nigerian Ministry of Health and Social Welfare and leader of a large-scale effort to fortify bouillon cubes, writes, “Without access to the essential nutrients that children under 5 years need to grow, thrive, and lead healthy lives, they are being robbed of their future.”

Dr. Sabin Nsanzimana, Rwandan minister of health and leader of efforts to ensure all Rwandan women have access to MMS, writes, “Prenatal vitamins save lives. That’s why you can find them on grocery store shelves in wealthy nations. But for women in low- and middle-income countries, like Rwanda, they are at once more essential and harder to find.” To date, more than 50,000 Rwandan women have received MMS through a program in seven districts with the highest rates of stunted growth.

Dr. Víctor Aguayo, director of child nutrition and development at UNICEF, writes, “The Child Nutrition Fund could be a game changer. It holds the potential to address the child malnutrition crisis and transform philanthropy for maternal and child nutrition.”