Urban malnutrition: the solution must start with the cities’ poorest

"The degree of malnutrition amongst urban dwellers is frequently more severe than among their rural counterparts."

Almost 30 years have passed since the World Bank reflected on the urban nutrition picture and published this statement. Today, more than ever, these words hold true. The world’s cities have expanded as have the number of malnourished. But, the face of urban malnutrition remains the same.

The most vulnerable and marginalised people, those most affected, are the urban poor in particular women and infants. Different forms of malnutrition co-exist within the same urban poor communities, households and even individuals: high rates of child undernutrition occur alongside adult overweight and anaemia. Together they pose a significant challenge to cities committed to the New Urban Agenda, and countries, to the wider Sustainable Development Goals agenda.

Although the determinants of malnutrition are the same for urban and rural poor, both groups face a different set of constraints. Lack of purchasing power affects the urban poor’s ability to buy food, which in turn affects household dietary quality. Food purchases dominate their income. For those with small budgets, food prices matter. Vulnerable groups are particularly susceptible to food price fluctuations and often adopt several food and non-food coping strategies such as switching to cheaper and lower quality staples; reducing other expenditure such as child care, education or borrowing money. Mothers often protect their children by reducing their own food intake.

Solutions that aim to reduce malnutrition in the urban environment, must address barriers in the governance structure and the food and sanitation environment. Improving the supply of nutritious and affordable food is critical. However a focus solely on food supply does not translate into improved nutrition. Efforts must be made to understand why people eat what they do; what the existing food and care practices within the household are, and; what supports can be provided to promote better choices and habits? We must engage the poorer communities so that they can help shape the solution.

Thirty years have passed since James Austin wrote "the urgency of the urban problem requires immediate programmatic action."  For a long time, development efforts have focused on malnutrition in rural areas. Without displacing the rural focus, our efforts must also capture the urban picture. Explicit urban food policies and goals, improvements in the food and sanitation environment and community engagement are critical ingredients.

Our paper “The Urban Agenda - addressing food and nutrition security needs of the urban poor”, will explore what suite of intervention activities could be used to address the malnutrition issue in the urban context. The paper will be published in the coming days.