Child malnutrition and Covid-19 in Jamaica.

A blog post by Henrice Altink on behalf of the Caribbean Foodscapes team
Like many other low and middle-income countries, Jamaica experiences a double burden of malnutrition – the coexistence of undernutrition with overweight and obesity – which may be affected both positively and negatively by the current Covid-19 pandemic. In particular, school closures and increased unemployment directly impact on Jamaican children’s access to enough safe and nutritious food.

School programmes to tackle child malnutrition
In recent years, the number of overweight and obese school-aged children has rapidly increased. According to the Global School-Based Student Health Survey, in 2010, 21.7 per cent of 13-to-15 year olds were overweight and 6 per cent obese, rising to respectively 25.6 and 10.1 per cent in 2017. Childhood obesity poses a problem for the government of Jamaica because obese children run the risk of developing non-communicable diseases (NCDs) later in life, which in turn will place large burdens on the public health system, economy, and society. Yet there are also many underweight children in Jamaica. The Global School-Based Student Health Survey concluded that in 2010, 2.1 per cent of 13-to-15 year olds were underweight, rising to 3.6 per cent in 2017. Contrary to North America and Europe, it is mostly children from middle-income households that are overweight or obese. Undernutrition is largely linked to poverty: especially children who are on the Programme for Advancement through Health and Education (PATH), which provides cash transfers to poor families who have to comply with certain conditions, are underweight. Underweight children also pose a problem for the government because they are in a critical stage of growth and if they do not catch up, are more likely not to do well in school and hence can be trapped in a cycle of poverty

In recent years, the government of Jamaica has undertaken action to address rising childhood obesity levels. It has, amongst others, banned the sale of certain sugary drinks in and around schools; adopted the ‘Jamaica moves’ programme which encourages children and their parents to eat healthily and exercise; and recently drafted a nutritional policy for schools that will provide healthier food in school cafeterias. It is largely through its national school feeding programme that government has tried to reduce pockets of child undernutrition. Under this programme, which is operated by Nutrition Production Limited, some 300,000 children receive a baked good, a sachet of milk, and a bag of juice. Supplementing this effort to limit child undernutrition are a large number of school breakfast clubs and cooked lunch programmes that are run or sponsored by charities and major firms.

School closures due to Covid-19 and changes to the feeding programme
Jamaican schools closed on 13 March and will not re-open until at least 31 May. During the first stage of the lockdown, Nutrition Production Limited distributed snack packages consisting of baked goods, fruit juice, ready-made porridge, milk and water for the children on the national school feeding programme, which had to be collected from various points in local communities. Because of the effort and cost it took parents of children on PATH to get to the pick-up points, government decided to increase their cash transfer so that they can now cook breakfast and lunch for their children. Various charities have also started to donate care packages to vulnerable households to fill in the gap left by the breakfast clubs and cooked lunch programmes. In the immediate future, this provides essential support for underweight children and those at-risk of becoming underweight but if we look at the 2008-09 global financial crisis, we can expect that the number of underweight children in Jamaica will increase during and after the pandemic.

The global financial crisis and impacts on household food security
The 2008-09 crisis increased poverty levels in Jamaican and led to a hike in food prices, resulting in a greater prevalence of undernourishment across the population. According to FAO, in 2005-07, 7.3 per cent of the population was undernourished, rising to 8.6 in 2008-10 and increased further in the aftermath of the global financial crisis to 9.3 in 2012-14. The prevalence of undernourishment did not start to decline until 2016 but prior to the onset of the current pandemic it was still higher than before the 2008-09 global financial crisis. Especially the nutritional status of young children was affected by the 2008-09 financial crisis. The WHO calculated that in 2008, 2.4 per cent of children under five were underweight, rising to 3.4 per cent in 2010.

Disruption to food imports and price hikes due to Covid-19
The current pandemic and its aftermath will increase food insecurity in Jamaica. Many people will become unemployed or see a drastic reduction in income or revenue, and overseas remittances, upon which many vulnerable households rely, will decline. Alongside the price of food will increase. As many other Caribbean states, Jamaica is heavily reliant on imported food stuffs. The pandemic’s disruption of global supply chains will push up the price of imported food. Already before the pandemic the high import food bill put pressure on Jamaica through the need for foreign exchange to purchase imports. The decline in tourism, which is the main foreign exchange earner, during and after the pandemic will increase this pressure even further. It is essential, then, that government supports both the already food insecure households and those that will become so in coming months, by increasing its social protection programmes. In addition to putting families at risk of falling into poverty onto PATH and adopting other social protection programmes to help the most vulnerable, it could also consider a system of food subsidies. During the global economic crisis of the 1970s, for instance, the government of Jamaica controlled the price of a number of food items to protect low-income groups, which helped to reduce food insecurity.

Unintended consequences and possible opportunities
The 2008-09 global financial crisis increased child undernutrition but at the same also reduced childhood obesity. According to the WHO, between 2008 and 2010, the number of overweight Jamaican children under five declined from 7.7 to 4.1. per cent. The current pandemic could have a similar effect, particularly because it will lead to an increase in the price of imported food stuffs, most of which are processed foods high in fat and sugar. In addition, it may encourage people to cook more from scratch, using homegrown or locally-purchased ingredients. During the 1970s global economic crisis, the government encouraged the production and use of domestic food stuffs through its Growing and Reaping our Wealth scheme. The resulting increase in domestic food production was one of the main reasons why child malnutrition levels during that challenging decade did not drastically increase. The challenge for the Jamaican government today is to ensure that any reduction in childhood obesity levels during and after the pandemic becomes permanent. Food subsidies may again be a way forward. In addition to increasing the price of unhealthy foods, such as the adoption of a sugar tax which it has been considering for some time, the government of Jamaica could also subsidise, as is done in some other countries, healthy food items, making them cheaper to purchase. It could use the tax on sugar and other unhealthy foods to pay for these subsidies. A precedent for this already exists as Jamaica has been hypothecating 20 per cent of its tobacco excise taxes for tobacco control and other health promotion activities.