The Bill & Melinda Gates Foundation, in its eighth annual Goalkeepers report, has called on world leaders to prioritise global health spending where it is needed most to improve children’s health and nutrition, especially in the context of the global climate crisis.
Released today, the report, titled “A Race to Nourish a Warming World,” highlights the devastating impact climate change will have on child malnutrition without immediate global action.
The report projects that between 2024 and 2050, climate change could push an additional 40 million children into stunting and 28 million into wasting. Stunting, which prevents children from growing to their full mental and physical potential, and wasting, which weakens and emaciates children, leaving them at risk of developmental delays and death, are severe and often irreversible forms of malnutrition. The World Health Organisation (WHO) estimated in 2023 that 148 million children experienced stunting, while 45 million children were affected by wasting.
The Gates Foundation emphasised that scaling up solutions now can avoid these dire outcomes, while also building resilience to climate change and fostering economic growth. However, as global challenges like inflation, debt and wars intensify, foreign aid to Africa—where more than half of all child deaths occur—has decreased. In 2010, 40 per cent of foreign aid was directed to African countries, but by 2023, that number had dropped to just 25 per cent, the lowest percentage in two decades. This trend threatens to undo the progress made in global health across Africa between 2000 and 2020.
Co-chair of the Gates Foundation and author of the report, Bill Gates underscored the need for immediate action. “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,” Gates wrote. “I think we can give global health a second act—even in a world where competing challenges require governments to stretch their budgets.”
Gates identified malnutrition as “the world’s worst child health crisis,” exacerbated by climate change. He called for maintaining global health funding, addressing child malnutrition through targeted initiatives like the Child Nutrition Fund and fully funding established institutions that have a proven track record of saving lives. Key institutions such as Gavi, the Vaccine Alliance, and the Global Fund to Fight AIDS, Tuberculosis and Malaria are due for their next funding replenishments in 2025.
“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 wrote.
The report also highlighted the economic toll of malnutrition, which costs an estimated $3 trillion annually in productivity losses. In low-income countries, malnutrition can account for up to 16 per cent of gross domestic product (GDP) losses, akin to enduring a global recession at 2008 levels every year. Gates argued that the best way to combat 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.”
The report detailed several proven tools that are already helping to combat malnutrition, build resilience against climate change and reduce childhood deaths:
– New agricultural technologies: These innovations are producing two to three times more milk and safer milk, potentially preventing millions of cases of child stunting by 2050. In countries like India, Ethiopia, Kenya, Nigeria and Tanzania, these technologies could prevent 109 million cases of child stunting by mid-century.
– Fortifying staple foods: Scaling up efforts to fortify pantry staples such as salt and bouillon cubes can reduce anemia and prevent deaths caused by neural tube defects. For instance, fortifying salt with iodine and folic acid in Ethiopia could lead to a 4 per cent reduction in anemia and eliminate up to 75 per cent of deaths and stillbirths caused by neural tube defects. In Nigeria, fortifying bouillon cubes with iron, folic acid, zinc and vitamin B12 could prevent up to 16.6 million cases of anemia and avert 11,000 deaths from neural tube defects.
– Prenatal vitamins: Providing high-quality prenatal vitamins for pregnant women could save nearly half a million lives and improve birth outcomes for 25 million babies by 2040. The cost of providing multiple micronutrient supplements (MMS) for an entire pregnancy in low- and middle-income countries is as little as $2.60.
The report also underscored the promise of new research into the human microbiome, which could revolutionise how the world treats both malnutrition and over-nutrition. Improving gut health is key to ensuring children absorb the nutrients they need, develop strong immune systems and grow healthily. Gates suggests that a deeper understanding of gut health could transform not just the treatment of malnutrition in poorer countries but also over-nutrition in wealthier nations.
This year’s Goalkeepers report featured essays from farmers and experts on the frontlines of the malnutrition crisis. Sushama Das, a dairy farmer from Odisha, India, described how her participation in the Livestock Enhancement and Advancement Programme has transformed her family’s income. “Today, we have eight cows, and they are producing 60 liters of milk every day…Our monthly income is now five times as much as it used to be.”
In Kenya, dairy farmer Coletta Kemboi shared her experience with the MoreMilk programme. “Since I went through the training, the 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, highlights the country’s large-scale effort to fortify bouillon cubes, stressing the critical importance of access to essential nutrients for children under five. “Without access to the essential nutrients that children under five need to grow, thrive, and lead healthy lives, they are being robbed of their future,” she writes.
The report also featured insights from Rwanda’s Minister of Health, Dr. Sabin Nsanzimana who is working to ensure Rwandan women have access to pre-natal vitamins and UNICEF’s director of child nutrition and development, Dr. Víctor Aguayo who describes the Child Nutrition Fund as “a potential game-changer” in addressing the global malnutrition crisis.
The Gates Foundation’s report is a clarion call for action, urging governments and donors to step up investments in health and nutrition to save millions of lives and build a healthier, more resilient world.
