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About
The Nutrition International Cost of Inaction Tool is an online, evidence-based and user-friendly analytical tool built for country-level policymakers and advocates. It was created to rapidly generate estimates on the health, human capital and economic costs of inaction on stunting, low birthweight and anaemia (in women and children) for over 140+ countries. The tool was launched in 2024 by Nutrition International in partnership with Limestone Analytics, with funding from the Government of Canada. Evidence generated by the tool will support improved policymaking and investment decisions amongst government, industry and donors, by quantifying the health and human capital implications of the burden of low birthweight, stunting and anaemia in children and women.
The cost of inaction: a global tool to inform nutrition policy and investment decisions on global nutrition targets
Sakshi Jain, Sameen Ahsan, Zachary Robb, Brett Crowley, Dylan Walters
Health Policy and Planning, Volume 39, Issue 8, October 2024, Pages 819–830, https://doi.org/10.1093/heapol/czae056
Global findings from the Cost Of Inaction Tool
There are 17 million children (13%) born with low birthweight. 146 million children under five (23%) are stunted, and 245 million (41%) suffer from anaemia. Additionally, more than 586 million adolescent girls and women (15-49) (30%) are suffering from anaemia. Each year, this level of stunting, low birthweight, and anaemia result in an estimated:
- US $761 billion in economic costs (or 1% of global gross national income) due to cognitive and mortality losses
- 1.3 million child deaths
- 304 million IQ points lost
Nutrition International’s Cost of Inaction Tool methodology was developed in 2023 by Sakshi Jain, Sameen Ahsan and Dr. Dylan Walters in partnership with Limestone Analytics. The initial version of the tool was based on an economic model developed by Dr. Michelle Gaffey and Dr. Sue Horton for Nutrition International in 2017.
Why undernutrition?
In 2012, the World Health Assembly (WHA) established six targets to reduce the global double burden of malnutrition. The tool prioritizes the first three targets to motivate advocacy, policy and investment actions, as cost-effective interventions are readily available to address these issues. Refer to Nutrition International’s Cost of Not Breastfeeding Tool for more information on target #5. For more information on targets #4 and #6, refer to the WHA policy briefs on childhood overweight and wasting.
Undernutrition refers to deficiencies in nutrient intake, imbalance of essential nutrients or impaired nutrient utilization. It disproportionately impacts certain populations such as children under five, adolescent girls and pregnant women. For example, severely undernourished children are up to nine times more likely to die1 and anaemia is one of the leading causes of maternal mortality in adolescent girls and women.2 Undernutrition affects morbidity and cognitive development as well.
If good nutrition is not protected from the beginning, government budgets will increasingly be spent on costly health care treatments for diseases instead of being invested in prevention and in creating better health which will result in higher human capital and economic development outcomes.
Despite substantial evidence on the health and cognitive benefits of investing in nutrition interventions that address undernutrition, progress remains slow. At present, the world is off course to meet the WHA Global Nutrition Targets by 2025 for stunting, low birthweight and anaemia. Thus, efforts towards ending these forms of malnutrition need to be accelerated.
We’re interested in learning how you’ve used our tool in your work. Please complete this short form to share how you’ve applied the Cost of Inaction Tool.
For help with technical issues with the NI tools, please email healthecon@nutritionintl.org
Nutrition International’s Health Economics unit produces advanced modelling tools and robust data to bolster the organization’s impact in addressing malnutrition. The NI Cost of Inaction Tool equips stakeholders with essential evidence for informed decision-making. For further support, including additional analyses, tool demonstrations and technical assistance in conducting economic analyses and developing and operationalizing costed nutrition actions plans, please contact us at healthecon@nutritionintl.org.
2 Rahman MM. Abe SK. Rahman MS et al. Maternal anemia and risk of adverse birth and health outcomes in low- and middle-income countries: systematic review and meta-analysis. The America Journal of Clinical Nutrition. 2016; 103: 495-504.
Read our FAQ
- Why don’t the stunting, low birthweight, or anaemia prevalence rates on the cost of inaction tool match those reported in my country’s national survey or official reports?
The cost of inaction tool uses standardized estimates from global sources such as the WHO, UNICEF and the Joint Child Malnutrition Estimates (JME). Using standardized data allows for consistent comparison across countries and regions. If you are interested in a custom analysis using country-specific prevalence estimates from national surveys or other non-standardized sources, please contact us at healthecon@nutritionintl.org. - Where can I find more information on the data sources and methodology used in the tool?
The data sources and methodological approach are detailed in our peer-reviewed publication in Health Policy and Planning. - How often will the cost of inaction tool data be updated?The current version of the tool draws on the latest data available as of 2023. We plan to update the tool every two years, with the next update expected in 2026
- Why are there no modules on wasting, overweight, or other nutrition issues?
The current modules reflect Nutrition International’s programming focus and align with three WHA global nutrition targets: stunting, anaemia in women of reproductive age and low birthweight.The breastfeeding target is addressed through the complementary Cost of Not Breastfeeding Tool, developed in partnership with Alive and Thrive. We are exploring the addition of other modules. If you have suggestions or are interested in collaborating, please contact us at healthecon@nutritionintl.org.
- Does Nutrition International have other resources?
In addition to the Cost of Inaction Tool, Nutrition International offers other evidence-based resources, including the Cost of Not Breastfeeding Tool, which estimates the health, human capital and economic costs of promoting and supporting breastfeeding. Similarly, the MMS Cost-Benefit Tool assesses the cost and returns of transitioning from iron and folic acid supplementation (IFAS) to multiple micronutrient supplementation (MMS) in various countries.Nutrition International also designs tailored investment cases, costed plans and policy options that model the costs, impacts, and returns of interventions, making the strongest health, human capital and economic arguments for why nutrition should be an investment priority growth. For such custom analysis, please contact – healthecon@nutritionintl.org.