1

2 Overview – The Malnutrition Mapping Project

3 Fragmented and inaccessible data is undermining a collective response to the growing malnutrition crisis

4 Collaborating to develop the world’s first Malnutrition Map

6 Malnutrition Map partnership priorities

8 Partnership impacts

8 Partnership key success factors

Contents

Mapping the causes of malnutrition to enable more targeted and integrated solutions

Business partnership case study

2

Reducing the global burden of malnutrition in all its forms requires effective collaboration between sectors, which is why the Global Alliance for Improved Nutrition (GAIN) and Amway, a global business leader in the nutrition, beauty and home categories, have partnered through the Scaling Up Nutrition (SUN) Business Network to build the world’s first Malnutrition Map, which brings together a wide variety of nutrition and related data in one place.

Users of the map can make a holistic analysis of the causes and types of malnutrition and develop more effective and integrated solutions for it.

As a result of its partnership with GAIN, Amway has been able to use the Malnutrition Map to inform product development, build knowledge and capacity in its sales channel and strengthen its Nutrilite™Power of 5 Campaign, which targets child malnutrition.

The co-existence of undernutrition and rising overweight and obesity, increasingly referred to as the “multiple burdens” of malnutrition, represents a ticking time bomb in developed and developing countries alike, with potentially devastating consequences for people’s health and economies.

Planning and delivering more effective and co-ordinated action can often be held back by a lack of awareness and understanding among

businesses and policy-makers of the scale and interconnected nature of the malnutrition challenge. This barrier is exacerbated by the often fragmented and inaccessible nature of nutrition, health and wider socio-economic data, which organisations need to inform more integrated and targeted solutions.

About this case study series

The contribution of business and the need for collaboration are defining characteristics of today’s development landscape and underpin the Sustainable Development Goals.

Many types of business partnership models are emerging into the mainstream – bilateral, multi-sectoral, business to business. A variety of terminologies are used to describe them but they are all underpinned by a recognition of the need to pool resources and capabilities to address challenges that are too great and complex for any one sector to tackle alone.

Few challenges facing the global community today match the scale of malnutrition in all its forms, a condition that directly affects one in three people.

The Global Alliance for Improved Nutrition (GAIN) is at the heart of enabling collaborations between the private sector, governments and civil society to end malnutrition in all its forms. Effective partnership building, especially across sectors, requires new mindsets and skill sets on the part of individuals and new capabilities and incentives on the part of institutions.

This case study, and others in the series, share insights from GAIN’s experience building successful business partnerships, identifying different models, incentives, impacts and success factors.

The Malnutrition Mapping ProjectOverview

3

What do we mean by “multiple burdens” of malnutrition, and why does it matter to business?

In addition to undernutrition, which hampers physical growth and mental development, and contributes to premature death among young people, many low-, middle- and higher-income countries are also experiencing high rates of overweight and obesity, influenced by factors including income growth, urbanisation, demographic change and globalisation. The World Health Organisation (WHO) estimates that in 2014 more than 1.9 billion adults worldwide were overweight, while 462 million were underweight.

In the U.S., 3.1 percent of children are stunted, (low height for age), a key indicator of under nutrition. At the same time, the country has the highest prevalence of obese boys at 12.4 percent and obese girls at 13.4 percent.*

Guatemala exemplifies the “multiple burdens” of malnutrition, with stunting rates affecting nearly half (48 percent) of the population and over half (54.5 percent) of women categorised as overweight or obese.**

For businesses, which can be either be part of the problem or part of the solution to malnutrition, the implications are significant, impacting the sustainability of business models and supply chains, the spending habits of consumers, the health and welfare of employees and communities, and license to operate.

Fragmented and inaccessible data is undermining a collective response to the growing malnutrition crisis

According to the 2014 Global Nutrition Report (GNR), 45 percent of countries suffer from multiple preventable forms of malnutrition – both undernutrition and over-weight or obesity.

Malnutrition carries a substantial economic cost in addition to the distressing health impacts for individuals1. Undernutrition in Africa and Asia, for instance, is estimated to reduce gross domestic product by 11 percent per year. In the US alone, the healthcare bill for treating obesity is up to US$210 billion2. The 10% annual losses of gross domestic product (GDP) attributable to malnutrition are far greater than the annual percentage loss in world GDP resulting from the global financial crisis of 2008-2010.3

Despite the scale of the problem and the potential for more concerted action to address it, responses remain fragmented, siloed and uncoordinated between disciplines and sectors. This is often due to a lack of awareness and detailed understanding of the scale and interconnected causes of the “multiple burdens” of malnutrition, which can also include factors outside nutrition, such as poverty, infections, agriculture and climate change. This barrier is reinforced by the fragmented and inaccessible nature of nutrition and health related data, with many sectors limited to using data generated within their own sector.

More comprehensive and accessible data about, for example, the nutritional status of consumers, particularly those who are vulnerable, risk factors, consequences of malnutrition and cost-effective interventions, would make it easier for businesses and policy-makers to undertake a more holistic analysis of the causes and types of malnutrition and identify more effective, targeted and coordinated responses.

For example, businesses, especially those not directly connected to the food, health and nutrition sectors, may lack awareness of the health and nutrition challenges in their operating contexts and fail to understand the business returns that investments in tackling malnutrition can deliver. Without this understanding, they are ill equipped to make the business case for action and to target resources most appropriately and effectively. Public health and nutrition policy-makers continue to develop siloed strategies to tackle malnutrition, which results in missed opportunities to develop more joined up and effective programmes.

Tackling the challenges of undernutrition and obesity together also creates opportunities for more effective outcomes as many of the approaches used to tackle undernutrition can also be used to address overweight and obesity – especially among children.

1. African Union Commission, NEPAD Planning and Coordinating Agency, UN Economic Commission for Africa and UN World Food Programme (2014). The Cost of Hunger in Africa: Social and Economic Impact of Child Undernutrition in Egypt, Ethiopia, Swaziland and Uganda. Addis Ababa, Ethiopia: UNECA.

2. Cawley, J. and Meyerhoefer, C. (2012). The medical care costs of obesity: An instrumental variables approach. Journal of Health Economics, 31(1), pp.219-230.

Finkelstein, E., Trogdon, J., Cohen, J. and Dietz, W. (2009). Annual Medical Spending Attributable To Obesity: Payer-And Service-Specific Estimates. Health Affairs, 28(5), pp.w822-w831.

3. Horton, S. and Steckel, R. (2013). Malnutrition: Global Economic Losses Attributable to Malnutrition 1900–2000 and Projections to 2050. In: B. Lomborg, ed., The Economics of Human Challenges. Cambridge, UK: Cambridge University Press, pp.247–272.

International Food Policy Research Institute (2015). Global Nutrition Report 2015: Actions and Accountability to Advance Nutrition and Sustainable Development. Washington, DC: IFPRI

*World Health Organization. (2017). UNICEF-WHO-The World Bank: Joint child malnutrition estimates - Levels and trends. [online] Available at: http://www.who.int/nutgrowthdb/estimates/en/ Accessed 17th July 2016.

**Ng, M., Fleming, T., Robinson, M., et al (2014). Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. The Lancet, 384(9945), pp.766-781.

4

What is in the Malnutrition Map?

The Malnutrition Map is an interactive analysis tool providing country-by-country statistics and insights on nutritional challenges in 30 low-, middle- and high-incomes countries.

The map includes over 45 indicators on demographics and rates of undernutrition, overweight/obesity and non-communicable disease. This data is important in describing “the double/multiple burden of malnutrition” — the co-existence of undernutrition and micronutrient deficiencies with rising overweight and obesity — at the population level as well as examples of its drivers and consequences.

The data is drawn from a range of international and national statistical sources, such as the Global Nutrition Report 2014, the World Health Organisation (WHO), the World Food Programme (WFP), UNICEF, the International Diabetes Foundation and national ministries of health.

Collaborating to develop the world’s first Malnutrition Map

Partnership background and goals

Building on an already well established relationship between the two organisations, Amway Corporation, the owner of Nutrilite™, the world’s number one selling brand of vitamins and dietary supplements, and the Global Alliance for Improved Nutrition (GAIN) conceived the idea of a Malnutrition Map in 2014 to inform the company’s product development strategy and educate Amway business owners (ABOs) about the multiple facets of malnutrition, the context driving them, and the consequences to communities where these entrepreneurs live and work.

The overarching objective of the Malnutrition Mapping Project (MMP) was to build a comprehensive compilation of malnutrition data from low-, middle- and high-income countries to demonstrate the full scale and breadth of malnutrition in all its forms and its impacts on societies and economies in an easy to use format. Armed with this data, users can undertake a more integrated analysis of indicators and optimise nutrition interventions.

GAIN and Amway’s aim is to make the tool widely available to other businesses and policy-makers.

The project was developed as part of Amway’s commitment to the Scaling Up Nutrition (SUN) Initiative and the SUN Business Network4 [sunbusinessnetwork.org] specifically. Amway is one of more than 400 business partners (as of October 2017) meeting the required ethical standards to be involved in the network, which currently operates in 14 countries.

A team of GAIN researchers led the development of the Malnutrition Map, with financial and communications support provided by Amway. The team identified and aggregated a wide variety of data sources from around the world and incorporated them into an easy to use online digital map, which was launched in March 2015. GAIN also worked with Amway to develop 35 country profiles and advocacy and educational videos to share with the company’s Amway business owners in priority markets. The Malnutrition Map is hosted on the GAIN website here.

4. The SUN Business Network seeks to engage across government, civil and donor sectors while sensitising companies and other influential actors to the role that the private sector can play in scaling up national nutrition

5

Amway

Organisation profile: Amway is a leading US-based nutrition, beauty and home care company and one of the world’s largest direct selling businesses operating in over 100 countries. Its Nutrilite™ brand is the world’s number one selling brand of vitamins and dietary supplements.

Partnership incentive: The partnership has enabled Amway to access and leverage a unique and powerful database and insights on nutrition challenges across its core business, social investment and advocacy activities.

Partnership capabilities and contribution: Amway initially co-developed the idea and provided funding for the Malnutrition Map.

Amway has subsequently leveraged its Nutrilite™ business and its extensive global network of independent business owners (80 percent of whom are women) and used the map to widen and deepen understanding of local nutrition challenges and solutions.

GAIN

Organisation profile: The Global Alliance for Improved Nutrition (GAIN) is an international organisation that was launched at the UN in 2002 to tackle the human suffering caused by malnutrition.

Partnership incentive: The partnership has provided GAIN with resources to create a unique and valuable data tool, establish an influential advocacy platform to highlight the “multiple burden” issue and access Amway’s extensive business reach and influence to widen and deepen understanding and engagement with local nutrition organisations.

Partnership capabilities and contribution: GAIN initially helped design the Malnutrition Map concept and provided technical experts to identify, aggregate and validate nutrition and health data at the global and country level. It has also leveraged its mandate, status with UN membership bodies, global network and facilitation of the SUN Business Network to build the map’s overall positioning and credibility.

Partnership incentives and roles

Collaborating to develop the world’s first Malnutrition Map

6

“There has never been a comprehensive analysis that brings together all the pieces of research on malnutrition and puts them in one digital and easily accessible place. By pulling in all this research, this digital map provides a valuable insight into the global context of malnutrition today and the multiple burdens associated with it.” AMWAY

GAIN and Amway have harnessed the Malnutrition Map data and insights to ensure that Amway’s products continue to meet consumer and societal needs, and to build the knowledge and capacity of its ABOs, who are fighting childhood malnutrition.

Amway has leveraged the data from the Malnutrition Map across its core business, social investment and engagement priorities:

Supporting core business:

• Building the knowledge and capacity of ABOs: As a critical sales channel to reach millions of consumers, Amway places a significant emphasis on equipping ABOs with the tools they need to succeed. To support ABOs selling Amway’s Nutrilite™ vitamin and dietary supplements in key markets, Amway has drawn on insights from the Malnutrition Map to develop a series of country-specific profiles that provide heavily relevant, localised information on key nutrition issues and challenges. The profiles have helped mobilise individual Amway markets and helped ABOs build a comprehensive understanding of local nutrition challenges, engage local stakeholders, and ensure they are better prepared to provide products and services that help their customers live better lives.

• Informing commercial strategy: Data and insights from the Malnutrition Map have played a critical role in building greater internal understanding of nutrition and health trends, ensuring the business is well positioned to develop products and services to meet marketplace and societal needs.

For example, Amway’s Nutrilite™ Little Bits™ micronutrient powder complementary food supplement was originally designed to provide essential micronutrients to pre-school children at risk of micronutrient deficiencies in low-income countries. Data from the Malnutrition Map has helped Amway see the opportunity to make Nutrilite™ Little Bits™ available in higher-income countries, including China and the US, to help fill micronutrient gaps faced by children experiencing a poor diet. In addition, in more developed markets where overweight and obesity issues are becoming more prevalent, the Malnutrition Map is helping to inform the development of weight management products and services.

• Informing design of behaviour change strategies: Amway is also drawing on data and insights from the Malnutrition Map to inform its country-level behaviour change communication programmes, which aim to educate individuals and consumers on improving nutrition and diet, among other locally relevant topics.

Enhancing social impact

• Data from the Malnutrition Map has helped Amway make its Nutrilite™ Power of 5 Campaign more tangibly relevant. The initiative aims to fight childhood malnutrition through partnerships that make Amway’s Nutrilite™ Little Bits™ available to children between 6 months and 5 years old.

Malnutrition Map partnership priorities

7

• The Nutrilite™Power of 5 Campaign has created an important internal platform through which Amway can engage and strengthen relationships with ABOs, who value being part of a socially responsible business. ABOs are given the opportunity to donate to the campaign through the e-commerce platform and to date, 87 percent of Amway ABO leaders are supporting the Nutrilite™Power of 5 Campaign by raising awareness and funds to support the fight against childhood malnutrition. Tracking support growth for the campaign has become an important metric for Amway to assess the health of its relationships with ABOs.

Strengthening policy and advocacyData from the Malnutrition Map plays an important role in supporting Amway’s engagement in global and local partnership building with key health and nutrition stakeholders. For example, Amway has used the data in its work with the UN Committee on Food Security, which works through ministries of health to ensure that regulatory policy is fit for the purpose to positively impact nutrition. Amway also uses the research data in media relations programmes with resulting media coverage helping to increase public awareness and understanding of nutrition issues as well as Amway’s role in addressing them.

GAIN has also used the Malnutrition Map in support of its objectives:

Underpin advocacy Data and insights from the Malnutrition Map have provided evidence to underpin GAIN advocacy strategy to heighten awareness and understanding of the “multiple burden” issue and to encourage all sectors to rethink how malnutrition is conceptualised and tackled.

Facilitate engagement with business partnersThe tool has helped GAIN initiate and inform engagement with Amway, its ABOs and other business partners to encourage more responsible company practices, policies and business models. It also serves as a platform for engagement with multiple stakeholders interested in integrating and mapping their data with others.

Galvanise more research The existence of the Malnutrition Map has provided a focal point for disseminating research on the “multiple burden” issue and has provided an impetus for more investment into and greater use of research to ensure evidence-based programme design and action.

Partnership next steps Amway continues to support the Malnutrition Map as it remains a critical source of timely and easy-to-access nutrition data. GAIN is currently undertaking a technical information review of new data that will be used to continually update the map.

“From the start, the faith that Amway leadership showed in GAIN was fantastic. That helped us make great headway on developing the mapping tool. It also means we have been working on a basis of mutual trust from the start, which facilitated the kind of open and honest communication that marks all successful partnerships.”GAIN

8

Partnership impacts

The Malnutrition Map has successfully pulled together malnutrition data from multiple sources in a format that is unprecedented in terms of its accessibility and intelligibility. It has helped to:

Encourage a better understanding among Amway employees and ABOs of the malnutrition context in key markets. These increased insights and knowledge are feeding into the company’s local marketing and sales strategies. They are also critically informing Amway’s interactions with its business partners on a country-by-country basis.

Raise awareness of the issue of childhood malnutrition through the Nutrilite™ Power of 5 Campaign. Data from the MMP has enabled Amway to make its Nutrilite™Power of 5 Campaign more locally relevant and powerful. It has also enabled Amway to successfully engage ABOs in the campaign and, in the process, strengthen its relationship with this critical sales channel.

Increase understanding of Amway’s efforts to improve local and global society. Data from the MMP has been invaluable in informing engagement with key government, health and nutrition sector stakeholders.

“One of the main impacts of the MMP is its ability to bring the disparate sections of the malnutrition debate together – researchers and policymakers, as well as businesses, NGOs and donors - to kick start a global discussion about integrated solutions to undernutrition and obesity.”GAIN

Partnership key success factors

Building the internal business case and management support. From the beginning GAIN provided Amway’s corporate social responsibility team with evidence and support to strengthen the business case for investing in the Malnutrition Map and to build senior management support for the initiative.

A shared vision but flexibility on individual objectives. Having a common objective provided a vital guidepost for both Amway and GAIN in the early stages of the project. Subsequently, flexibility in how the data has been applied to support individual organisational objectives has meant that GAIN and Amway have achieved shared value.

Combining the different capacities and experiences of GAIN and Amway to achieve maximum effect. Building on a four-year relationship, GAIN and Amway have been able to leverage their core capabilities and resources for maximum shared benefit.

Case study methodology This case study was informed by in-depth interviews with members of the GAIN and Amway teams responsible for the development of the Malnutrition Map, and a review of background materials relating to the project.

Further reading

October 2017