In a world preoccupied with the plight of starving children, the terrible truth is that more children are killed by their food than by the lack of it. Microbes, viruses, parasites, faecal matter and chemicals are a common part of the daily diet of millions of children in developing countries, and might kill more than 1,100 children under five each day. Every year 400,000 children die from consuming contaminated food and water. Millions more suffer from repeated bouts of diarrhoea which leaves them malnourished and stunts their growth and cognitive development. Half of all deaths caused by malnutrition are linked to repeated diarrhoea, and not to a lack of food. Growing up in Nepal, I saw first-hand the devastating effect that this has on people’s lives. Diarrhoea outbreaks remain the leading cause of under-five mortality in the region. In 2009, a single outbreak caused 371 deaths. It is why I have dedicated my career to public health, and now work for WaterAid to improve access to water, sanitation and hygiene in the most marginalised communities. The biggest single cause of poor food hygiene is a lack of clean water and sanitation – for families who cannot wash their hands before feeding their children, who are forced to feed their children from dirty plates with dirty spoons, or who must cook with dirty water. Poor sanitation facilities also attract flies which contaminate water and food. The hot climate and lack of public awareness of good hygiene practices further compound the problem. This is a reality for the 2.5 billion people in the world who do not have a proper place to go to the toilet, and the one in ten without safe, clean water. A lack of clean water and sanitation has a devasting impact on children. Diarrhoea outbreaks remain the leading cause of under-five mortality in Nepal. Photo: WaterAid/ Mani Karmacharya. The World Health Organization blames a lack of food safety for 200 of the world’s deadliest diseases. This World Health Day, the UN is shining a spotlight on the impact of poor food hygiene around the world. On behalf of those of us working in the field: it’s about time. We know poor food hygiene plays a major role in diarrhoeal diseases and malnutrition in infants and young children. The WHO estimates 70% of diarrhoeal episodes in developing countries are due to microbes spread through food. Yet very few interventions have been attempted on food hygiene; it remains a hidden killer, barely talked about. The full benefits of safe water and good sanitation can never be achieved without good hygiene practices. We provide children with health-care and medicines, but forget that prevention is always better than cure. It is cheaper, more effective, and better for children who suffer needlessly from disease. That is why I returned to my homeland last summer, to trial my ‘Safe Food, Healthy Child’ campaign with young mothers in Nepal – to make a real difference to children’s health by improving the safety of their food. Through five very simple hygiene measures – washing hands and serving utensils, proper food storage, thorough cooking and reheating, and boiling milk and water before use – we were able to reduce food contamination by 65%, drastically improving food safety and reducing the number of children suffering from diarrhoeal diseases. We need more such programmes across Asia and Africa. WaterAid has been campaigning for everyone, everywhere to have access to clean water, safe toilets and good hygiene by 2030. A dedicated goal on water and sanitation in the UN Sustainable Development Goals, now being negotiated by world leaders, will help achieve this aspiration, and the impact will be felt far and wide in health, education and economic benefits. But we must also learn from the mistakes of the past and ensure that hygiene is an integral component of any framework for ending poverty and inequality. The Millennium Development Goals which preceded the SDGs failed to include hygiene, and the developing world has paid the price in disease and unnecessary deaths. While the world has been focusing on those children without enough food to eat, it has ignored those with full bellies who are being poisoned with every mouthful. This can go on no longer. This article was original published in Thomson Reuters Foundation. Om Prasad Gautam is WaterAid’s Technical Support Manager for Hygiene. For global policy, practice and advocacy updates and discussion, follow @wateraid on Twitter.