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seattle (september 17, 2024) – in its eighth annual goalkeepers report, released today, the bill & melinda gates foundation urged world leaders to increase global health spending where it’s needed most to improve children’s health and nutrition, which is especially critical as the world faces a climate crisis.

this year’s report, titled “the nutrition imperative in a warming world,” projects that climate change will cause an additional 40 million children to become stunted and 28 million to become wasted between 2024 and 2050. scaling up solutions now can avoid this outcome, while also building resilience to climate change and promoting much-needed economic growth.

cover of the gates foundation's 2024 goalkeepers report

according to a 2023 report by the world health organization, 148 million children worldwide are stunted, which prevents them from reaching their full physical and mental potential, and 45 million children are wasted, which means they are weak and small, facing a greater risk of stunting and death. these are the most serious manifestations of acute and chronic malnutrition, and they are irreversible.

yet, as global challenges intensify, the share of total foreign aid going to africa has fallen from 40% in 2010 to 25% today, the lowest level in 20 years. more than half of child deaths still occur in sub-saharan africa. a continued decline in aid to africa will put hundreds of millions of children at serious risk of death or preventable diseases, and threaten the unprecedented progress made in global health in africa between 2000 and 2020.

stagnant funding threatens decades of health gains. source: the gates foundation’s 2024 goalkeepers report

"the world faces more challenges today than at any time in my adult life: inflation, debt, new wars. unfortunately, aid is not keeping pace with these needs, especially in the places that need help most," wrote bill gates, co-chair of the gates foundation and author of the report. "i believe that even in a world full of challenges and governments having to tighten their budgets, we can still start a new round of global health boom."

gates believes that malnutrition is "the world's greatest child health crisis" and that climate change is making it worse. to address this crisis, gates called for maintaining investment in global health and immediately responding to the growing threat of child malnutrition by supporting the newly established child nutrition fund, a platform to coordinate nutrition donation funds. gates also called on governments to fully fund organizations that have been proven to effectively protect millions of lives each year, such as the global vaccine alliance and the global fund to fight aids, tuberculosis and malaria. both organizations will have their next round of fundraising in 2025.

"if we can do these three things well, we will not only usher in a new round of great prosperity in global health and save millions of lives, but we will also prove that mankind still has the ability and courage to face the most severe challenges," gates wrote.

the report also reveals the devastating economic costs of malnutrition and proposes solutions to help mitigate the damage. according to the world bank, malnutrition costs $3 trillion a year in lost productivity because people’s physical and cognitive abilities are weakened. in low-income countries, this loss ranges from 3% to 16% of gdp (or more), which is equivalent to a permanent global recession like the one in 2008, every year.

proven solutions

"the best solution to combating climate change is to invest in nutrition," gates wrote in the report. "malnutrition makes every step forward harder and more difficult. and vice versa. if we address malnutrition, we'll have an easier time addressing other issues. extreme poverty will be alleviated, vaccines will be more effective, and deadly diseases like malaria and pneumonia will become less deadly."

the report highlights several proven tools that can help address malnutrition, build resilience to the worst impacts of climate change, and further reduce child mortality. these tools include

new agricultural technologies could double or triple milk production and make it safer, preventing stunting in hundreds of millions of children by 2050.

modelling shows that improving dairy productivity and availability in just five countries – ethiopia, india, kenya, nigeria and tanzania – could prevent up to 109 million children from becoming stunted by 2050.

efforts to promote new ways to eat everyday foods, such as fortified salt and seasoning packets, could reduce millions of cases of anemia and prevent deaths from neural tube defects.

in ethiopia, a new process for adding iodine and folic acid to salt has reduced anemia rates by 4% and prevented nearly three quarters of deaths and stillbirths due to neural tube defects.

in nigeria, adding iron, folic acid, zinc and vitamin b12 to seasoning packets could avert 16.6 million cases of anaemia and more than 11,000 deaths from neural tube defects.

providing pregnant women with high-quality prenatal vitamins would save nearly half a million lives and improve the birth outcomes of 25 million newborns by 2040.

in low- and middle-income countries, multiple micronutrient supplementation throughout pregnancy can cost as little as us$ 2.60.

the report also presents new research on how the microbiome can improve human health, showing promising potential. studies show that improving gut health can help children absorb nutrients, develop strong immune systems and thrive. gates wrote,

a better understanding of gut health could change not only the way the world tackles malnutrition, but also the overnutrition that affects wealthy countries.

these new, proven tools can improve malnutrition at scale and save children’s lives. source: the gates foundation’s 2024 goalkeepers report

this year’s report also includes essays from farmers and experts on the front lines of the malnutrition crisis, providing their perspectives on how these tools are having an impact on their communities.

sushama das, a dairy farmer in astaranga, odisha, india, wrote of the livestock improvement and development program: “we now have eight cows that produce 60 litres of milk per day… the subsidies and training have helped my family earn more money and our monthly income is now five times what it used to be.”

coletta kemboi, a dairy farmer in melinini, kenya, who participated in the moremilk training, wrote: “before, they sometimes detected unclean milk, but since i received the training, they (inspectors) have come to the store about three times and the tests have proven that our milk is of good quality… the extra income we earn continues to be reinvested in the farm… we are able to pay for the school fees of our three children.”

“if children under five years of age are not given the basic nutrients they need to thrive and live healthy lives, they are being deprived of their future,” wrote ladidi bako-aiyegbusi, director of nutrition at nigeria’s ministry of health and social welfare, who is promoting a large-scale fortification program for seasoning packets.

historical levels and forecasts of stunting rates among children under five years old. source: 2024 goalkeepers report by the gates foundation

rwanda’s minister of health, dr. sabin nsanzimana, is leading an effort to ensure that pregnant women in the country have access to multiple micronutrient supplements. “prenatal vitamins save lives. that’s why you can find them on grocery store shelves in wealthy countries. they are even more important, yet harder to get, for women in low- and middle-income countries like rwanda,” he writes. so far, more than 50,000 rwandan women have received the supplements through a program in seven districts with the highest stunting rates.

“the child nutrition fund is a potentially game-changing initiative that has the potential to address the child malnutrition crisis and transform philanthropy in the area of ​​maternal and child nutrition,” wrote dr. víctor aguayo, unicef’s chief of child nutrition and development.