The State Of Food Insecurity In The World 2004

The State of Food Insecurity in the World 2004 monitoring progress towards the World Food Summit and Millennium Development Goals

Acknowledgements This sixth edition of The State of Food The following FAO staff provided and undernourishment used in SOFI Insecurity in the World (SOFI) was technical contributions: Josef 2004 were produced by the Basic Data prepared as a collaborative effort within Schmidhuber, Global Perspectives Study Branch and the Statistical Analysis FAO led by the Economic and Social Unit (ES); Jennifer Nyberg, Ofﬁce of the Service of the FAO Statistics Division Department (ES). Assistant Director-General (ES); Cinzia respectively. Cerri, Haluk Kasnakoglu, Seevalingum Overall leadership was provided by Ramasawmy and Ricardo Sibrian, FAO extends special thanks to the team Hartwig de Haen, Assistant Director- Statistics Division (ES); Luca Alinovi, of Banson, Cambridge, UK, for design, General, ES, assisted by Kostas Sumiter Broca, Gero Carletto, Benjamin layout, editorial support and preparation Stamoulis, Chief of the Agricultural Davis, Margarita Flores, Amdetsion of graphic material. Sector in Economic Development Gebre-Michael, Guenter Hemrich, Service, who served as the chair of Naoko Horii, Madelon Meijer and Prabhu The Editorial Production and Design the core technical team. Valuable Pingali, Agricultural and Development Group of the Information Division, GI, conceptual and editorial assistance Economics Division (ES); Terri Ballard, was responsible for language editing was provided by Andrew Marx of Gina Kennedy and Guy Nantel, Nutrition services, editorial quality control KnowledgeView Ltd. Division (ES); Maarten Immink and and production. Translations were Jenny Riches, FIVIMS Coordination provided by the Translation Group of the Other members of the core technical Unit (ES); Concepción Calpe and Henri Conference, Council and Protocol Affairs team in the ES Department were: Jelle Josserand, Commodities and Trade Division, GI. Bruinsma, Global Perspectives Study Division (ES); Lavinia Gasperini and Unit; Randy Stringer, Agricultural and Ester Zulberti, Research, Extension Development Economics Division; and Training Division (SD); Andrew Ali Arslan Gurkan, Commodities and MacMillan, Field Operations Division Trade Division; Prakash Shetty, Food (TC). and Nutrition Division; Jorge Mernies, Statistics Division. The key estimates on food consumption Published in 2004 by the Food and Agriculture Organization of the United Nations Viale delle Terme di Caracalla, 00100 Rome, Italy The designations employed and the presentation of the material prohibited without written permission of the copyright holders. in this information product do not imply the expression of any opinion whatsoever on the part of the Food and Agriculture Applications for such permission should be addressed to the Organization of the United Nations concerning the legal or Chief, Publishing Management Service, Information Division, development status of any country, territory, city or area or of FAO, Viale delle Terme di Caracalla, 00100 Rome, Italy or by its boundaries, or concerning the delimitation of its frontiers or e-mail to copyright@fao.org. boundaries. © FAO 2004 The mention or omission of speciﬁc companies, their products or brand names does not imply any endorsement or judgement ISBN 92-5-105178-X by the Food and Agriculture Organization of the United Nations. Printed in Italy All rights reserved. Reproduction and dissemination of material in this information product for education or other non-commercial purposes are authorized without any prior Photographs written permission from the copyright holders provided the As cover (left to right): Thi ha Thein Nyan/UNEP/Topham; source is fully acknowledged. Reproduction of material in this Claudio Marcozzi/UNEP/Topham; Felix O Granmakou/UNEP/ information product for resale or other commercial purposes is Topham.

The State of Food Insecurity in the World 2004 monitoring progress towards the World Food Summit and Millennium Development Goals

About this report T he State of Food Insecurity in the the latest estimates of the number of The Towards the Summit commit- World 2004 reports on progress undernourished people along with pre- ments section presents examples of and setbacks in efforts to reach liminary calculations of the heavy eco- issues and actions that are essential to the goal set by the World Food Summit nomic burden imposed by hunger and fulfilling the commitments in the WFS (WFS) in 1996 – to halve the number of malnutrition. Plan of Action and related Millennium chronically hungry people in the world This year’s Special feature focuses on Development Goals. by the year 2015. the impact that the rapid growth of cities Tables provide detailed indicators of The first section of the report, Under- and incomes in developing countries has the status and progress of developing nourishment around the world, presents had on hunger and food security. countries and countries in transition. Food Insecurity and Vulnerability Information and Mapping Systems It hardly seems that a year has gone by since I sat down to IAWG-FIVIMS membership write the introduction for The State of Food Insecurity in the Bilateral aid and technical agencies World 2003. Time passes by so quickly for many of us. But for Australian Agency for International Development (AusAID) hundreds of millions of hungry people who must worry about Canadian International Development Agency (CIDA) where their next meal will come from, this has been another EuropeAid Co-operation Office (EuropeAid) long, painful year. In this publication we see that the number of German Agency for Technical Cooperation (GTZ) United Kingdom Department for International Development (DFID) hungry people remains intolerably high, progress in reaching United States Agency for International Development (USAID) them unconscionably slow and the costs in ruined lives and United States Department of Agriculture (USDA) wasted resources incalculably large. For those children and adults who were reached, we may have made a life-changing United Nations and Bretton Woods agencies Food and Agriculture Organization of the United Nations (FAO) difference. But the lives of far too many others continue to be International Fund for Agricultural Development (IFAD) plagued by hunger and poverty. International Labour Organization (ILO) In last year’s report, I mentioned the external assessment United Nations Department of Economic and Social Affairs (UNDESA) Office for the Coordination of Humanitarian Affairs (OCHA) of the Inter-Agency Working Group on FIVIMS (IAWG-FIVIMS) United Nations Development Programme (UNDP) that was under way at that time. The assessment pulled no United Nations Environment Programme (UNEP) punches. While noting some very positive initiatives and results, United Nations Children’s Fund (UNICEF) it concluded that FIVIMS had failed to live up to its true potential. United Nations Population Fund (UNFPA) World Bank (WB) Our membership pledged to find new ways of working together World Food Programme (WFP) to meet a need that remains even more urgent today than when World Health Organization (WHO) FIVIMS was created. At our annual meeting in April 2004, we World Meteorological Organization (WMO) United Nations System Standing Committee on Nutrition (SCN) agreed on a new organizational structure. We are currently defining our business plan for the future, and, in particular, International agricultural research organizations identifying high-priority areas of activity for the next two years. Consultative Group on International Agricultural Research (CGIAR) Our goal remains unchanged – to help countries establish International Food Policy Research Institute (IFPRI) International Service for National Agricultural Research (ISNAR) quality food insecurity information systems that will provide the International Center for Tropical Agriculture (CIAT) timely information needed both to formulate effective policies and programmes and to monitor progress in achieving global, International non-governmental organizations national and local goals. We need to go beyond making a world Helen Keller International (HKI) The Rockefeller Foundation of difference in the lives of a few hungry people to making a dif- Save the Children Fund UK (SCFUK) ferent world – a world where the scourge of hunger is confined World Resources Institute (WRI) to the annals of the past. Regional organizations Lynn R Brown (World Bank) Southern African Development Community (SADC) Chair, IAWG-FIVIMS Permanent Interstate Committee for Drought Control in the Sahel (CILSS) 2 The State of Food Insecurity in the World 2004

Contents 4 Foreword Towards the World Food Summit target: confronting the crippling costs of hunger 6 Undernourishment around the world 6 Counting the hungry: latest estimates 8 The human costs of hunger: millions of lives destroyed by death and disability 11 The economic costs of hunger: billions in lost productivity, earnings and consumption 14 Measuring hunger: improving estimates to target more effective action 16 Hunger hotspots 18 Special feature 18 Globalization, urbanization and changing food systems in developing countries 20 The impact of changing food systems on small farmers in developing countries 22 The changing proﬁle of hunger and malnutrition 24 Towards the Summit commitments 24 Acting to combat hunger 26 Factoring the resilience of food systems and communities into the response to protracted crises 28 Education for rural people and food security 30 Rice and food security 32 The way ahead: scaling up action to scale down hunger 34 Tables 40 Sources The State of Food Insecurity in the World 2004 3

Foreword Towards the World Food Summit target: confronting the crippling costs of hunger A s we approach the mid-term still, the number has actually increased more than 30 countries that are on track review of progress towards the over the most recent five years for which to reach the WFS goal, agricultural GDP World Food Summit (WFS) goal, numbers are available. In three of the increased at an average annual rate of FAO’s latest report on the state of food four developing regions, more people 3.2 percent, almost one full percent- insecurity in the world highlights three were undernourished in 2000–2002 than age point faster than for the developing irrefutable facts and three inescapable had been the case in 1995–1997. Only countries as a whole. conclusions: Latin America and the Caribbean regis- Several of these countries have Fact number one: to date, efforts to tered a modest reduction in the number also led the way in implementing a reduce chronic hunger in the developing of hungry people. twin-track strategy to attack hunger world have fallen far short of the pace – strengthening social safety nets to put required to cut the number of hungry We CAN do better food on the tables of those who need it people by half no later than the year most on the one hand, while attacking 2015 (see graph). We must do better. More than 30 countries, representing the root causes of hunger with initiatives Fact number two: despite slow and nearly half the population of the devel- to stimulate food production, increase faltering progress on a global scale, nu- oping world, have provided both proof employability and reduce poverty on merous countries in all regions of the that rapid progress is possible and the other. developing world have proven that suc- lessons in how that progress can be In certain cases, as Brazil’s Zero cess is possible. More than 30 countries, achieved. Hunger Programme has demonstrated with a total population of over 2.2 billion This successful group of countries is by buying food for school lunch pro- people, have reduced the prevalence of striking for several reasons. Every de- grammes and other food safety nets undernourishment by 25 percent and veloping region is represented, not only from local small and medium-sized have made significant progress towards those whose rapid economic growth farms, the two tracks can be brought reducing the number of hungry people by has been widely touted. Asia accounts together in a virtuous circle of better half by the year 2015. We can do better. for by far the largest drop in the number diets, increased food availability, rising Fact number three: the costs of not of hungry people. But sub-Saharan incomes and improved food security. taking immediate and strenuous action Africa boasts the most countries that to reduce hunger at comparable rates have brought the prevalence of hunger We cannot afford not to do better worldwide are staggering. This is the down by 25 percent or more, although central message I would like to convey often from very high levels at the outset. In moral terms, just stating the fact to readers of this report. Every year Among the African countries are that one child dies every five seconds that hunger continues at present levels several that demonstrate another key as a result of hunger and malnutrition costs more than 5 million children their lesson – that war and civil conflict must should be enough to prove that we can- lives and costs developing countries bil- be regarded as major causes not only not afford to allow the scourge of hun- lions of dollars in lost productivity and of short-term food emergencies but ger to continue. Case closed. earnings. The costs of interventions that of widespread chronic hunger. Several In economic terms the case is more could sharply reduce hunger are trivial countries that have recently emerged complex but no less cogent. Every child in comparison. We cannot afford not to from the nightmare of conflict figure whose physical and mental develop- do better. prominently among those that have ment is stunted by hunger and mal- registered steady progress since the nutrition stands to lose 5 to 10 percent We MUST do better WFS as well as those that have scored in lifetime earnings. On a global scale, rapid gains over the past five years. every year that hunger persists at cur- According to FAO’s latest estimates the Many of the countries that have rent levels causes deaths and disability number of hungry people in the develop- achieved rapid progress in reducing that will cost developing countries future ing world has declined by only 9 million hunger have something else in common productivity with a present discounted since the WFS baseline period, despite – significantly better than average ag- value of US$500 billion or more. commitments made. More alarming ricultural growth. Within the group of This crushing economic burden is 4 The State of Food Insecurity in the World 2004

borne by those who can afford it least, by people struggling to eke out a living Number of undernourished in the developing world: observed and on less than a dollar a day, by countries projected ranges compared with the World Food Summit target whose economies and development Millions Millions efforts are slowed or stalled by lack of 1 000 1 000 productivity and resources. Studies by the Academy for Educa- 900 900 tional Development cited in this report suggest that 15 countries in Africa and 800 800 Latin America could reduce protein- energy malnutrition by half between now and 2015 at a cost of just US$25 700 700 million per year. Over a ten-year period, Range around the point estimates that investment would pay for targeted 600 600 reported at the WFS interventions that would save the lives Range for the year of the WFS (1996) of almost 900 000 children and yield 500 500 On track long-term gains in productivity worth WFS target more than US$1 billion. 400 400 Point estimates prepared in 2004 FAO’s own estimates of the costs and beneﬁts of action to acceler- 300 300 ate progress towards the WFS goal 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 2020 suggest that US$24 billion a year in Source: FAO public investment, associated with additional private investment, would lead to a boost in annual GDP amounting to Profile of progress Payoff for progress US$120 billion as a result of longer and healthier lives. Number of undernourished in more than 30 Estimated costs and benefits of increased countries that have made significant progress public investment required to accelerate the Simply stated, the question is not towards the WFS target reduction of hunger and reach the WFS target, whether we can afford to take the urgent 2002–2015 Millions and immediate action needed to reach US$ billions 500 and surpass the WFS goal. The question 2 000 is whether we can afford not to. And the 450 answer is an emphatic, resounding no. 400 The hungry cannot wait. And neither 350 1 500 can the rest of the human family. 300 250 1 000 200 Range around estimates for 150 WFS baseline period 500 100 Range around 50% reduction from WFS baseline 50 Point estimates 0 0 Costs – increased Benefits – 1980 1990 2000 2010 2020 public investment increased GDP Jacques Diouf Source: FAO Source: FAO FAO Director-General The State of Food Insecurity in the World 2004 5

Undernourishment around the world Counting the hungry: latest estimates F AO estimates that 852 million people worldwide were under- Undernourishment in the countries in transition nourished in 2000–2002. This fig- The number of undernourished in the Undernourished in the countries in ure includes 815 million in developing countries in transition has risen from 23 transition countries, 28 million in the countries in million to 28 million since the break-up of transition and 9 million in the industri- CIS the former Soviet Union, Czechoslovakia alized countries. and Yugoslavia in 1991–1993. Most of the Baltic The number of undernourished peo- increase and the bulk of undernourished States ple in developing countries decreased 1993–1995 by only 9 million during the decade are in the countries of the Commonwealth Eastern 2000–2002 of Independent States (CIS), where the Europe following the World Food Summit base- proportion has increased from 7 percent to 0 2 4 6 8 10 line period of 1990–1992. During the % undernourished second half of the decade, the number 9 percent. Source: FAO of chronically hungry in developing countries increased at a rate of almost 4 million per year, wiping out two thirds world increased by 34 million. During ing countries other than China and India of the reduction of 27 million achieved the second half of the decade, however, essentially held steady during the sec- during the previous five years. progress slowed in China, where the ond half of the decade. And the propor- The reversal during the second half number of undernourished fell by only tion of people who were undernourished of the decade resulted mainly from 4 million. In India the number increased declined from 20 percent to 18 percent. changes in China and India. China had by 18 million. Encouragingly, the most pronounced registered dramatic progress during The news is not all bad, however. Just change in trends took place in sub- the first half of the decade, reducing the as gains in China and India outweighed Saharan Africa. Between 1995–1997 and number of undernourished by almost 50 setbacks elsewhere during the first 2000–2002, the rate of increase in the million. During the same period, India half of the decade, the slowdown in the number of undernourished slowed from pared the number of undernourished by two Asian giants masked significant 5 million per year to 1 million per year. 13 million. Gains in these two countries improvements in trends for the rest of And the proportion of undernourished drove the global totals down, despite the developing world. After climbing at in the region fell from 36 percent, where the fact that the number of under- a rate of almost 7 million per year, the it had hovered since 1990-1992, to 33 nourished in the rest of the developing number of undernourished in develop- percent. Proportions of undernourished in developing countries, 1990–1992 and 2000–2002 < 2.5% 2.5–4% 5–19% undernourished undernourished undernourished 80 60 40 20 0 Mexico Kuwait Algeria Indonesia Myanmar Gabon Mauritius Morocco Jordan Brazil Nigeria Jamaica Guyana Mauritania China El Salvador Suriname Trinidad and Tobago Lesotho Colombia Peru Ghana Paraguay Côte d’Ivoire Benin Nepal Venezuela Viet Nam Uganda Swaziland Burkina Faso Tunisia Libyan Arab Jamahiriya Rep. of Korea Argentina United Arab Emirates Malaysia Cuba Lebanon Turkey Costa Rica Chile Ecuador Uruguay Iran, Islamic Rep. of Saudi Arabia Egypt Syrian Arab Rep. % The graph does not show four countries for which there were insufficient data for the years 2000–2002: Afghanistan, Iraq, Papua New Guinea and Somalia 6 The State of Food Insecurity in the World 2004

Undernourished 2000–2002 Changes in proportion of undernourished in developing subregions (millions) 1990–1992 to 1995–1997 (percentage points) 1995–1997 to 2000–2002 (percentage points) Countries in Industrialized China India transition 28 countries 9 Southeast Asia Reduction Near East/ West Africa North Africa 39 (progress) India South America 221 Southern Africa Latin America/ East Africa Increase Caribbean 53 North Africa (setback) Developing North America countries: 815 Other South Asia China Central America Sub-Saharan WORLD: 852 142 Africa 204 Caribbean Asia/Pacific* Near East 156 Other East Asia Central Africa * excl. China and India Source: FAO –5 0 5 10 15 20 -10 –5 0 5 Source: FAO Proportion undernourished by Changes in numbers of undernourished in developing subregions region 1990–1992 to 1995–1997 (millions) 1995–1997 to 2000–2002 (millions) Countries in China transition 1990–1992* India 2000–2002 Southeast Asia Reduction Near East/ South America (progress) North Africa West Africa Latin America/ North Africa Increase Caribbean North America (setback) Central America Asia/Pacific Caribbean Southern Africa Sub-Saharan Other East Asia Other South Asia Africa Near East 0 10 20 30 40 East Africa % undernourished Central Africa * 1993–1995 for countries in transition Source: FAO –50 –40 –30 –20 –10 0 10 20 –10 0 10 20 Source: FAO Grey bars: 1990–1992 Coloured bars: 2000–2002 Countries grouped by prevalence of undernourishment in 2000–2002 20–34% 35% undernourished undernourished 80 60 40 20 0 Thailand Pakistan India Bolivia Lao People’s Dem. Rep. Philippines Sri Lanka Namibia Honduras Guatemala Senegal Dominican Rep. Panama Cameroon Guinea Togo Sudan Gambia Mongolia Nicaragua Mali Bangladesh Botswana Cambodia Kenya Malawi Chad Niger Dem. People’s Rep. of Korea Yemen Rwanda Madagascar Congo Angola Central African Rep. United Rep. of Tanzania Zimbabwe Liberia Haiti Ethiopia* Mozambique Zambia Sierra Leone Burundi Dem. Rep. of the Congo Eritrea* % Source: FAO * Ethiopia and Eritrea were not separate entities in 1990–1992 The State of Food Insecurity in the World 2004 7

Undernourishment around the world The human costs of hunger: millions of lives destroyed by death and disability H unger and malnutrition inflict are tipped against them. LBW babies normal range for their age to signal heavy costs on individuals and face increased risk of dying in infancy, chronic undernutrition. Stunting, like households, communities and of stunted physical and cognitive growth LBW, has been linked to increased ill- nations. Undernourishment and defi- during childhood, of reduced working ness and death, to reduced cognitive ciencies in essential vitamins and min- capacity and earnings as adults and, if ability and school attendance in child- erals cost more than 5 million children female, of giving birth to LBW babies hood and to lower productivity and life- their lives every year, cost households themselves (see diagram). time earnings in adults. in the developing world more than 220 Compared with normal babies, the When stunting occurs during the million years of productive life from risk of neonatal death is four times first five years of life, the damage to family members whose lives are cut higher for infants who weigh less than physical and cognitive development is short or impaired by disabilities related 2.5 kilograms at birth and 18 times usually irreversible (see graph). The to malnutrition, and cost developing higher for those who weigh less than 2.0 costs in blighted health and opportu- countries billions of dollars in lost pro- kilograms. LBW babies also suffer sig- nities extend not only throughout the ductivity and consumption. nificantly higher rates of malnutrition victim’s lifetime but on to the next gen- and stunting later in childhood and as eration, as malnourished mothers give The vicious cycle of deprivation adults. A study in Guatemala found that birth to LBW babies. Maternal stunting by the time they reached adolescence is one of the strongest predictors for Every year, more than 20 million low LBW boys were 6.3 centimetres shorter giving birth to a low birthweight infant, birthweight (LBW) babies are born in and 3.8 kilograms lighter than normal, along with underweight and low weight the developing world. In some coun- while girls lost 3.8 centimetres in height gain during pregnancy. tries, including India and Bangladesh, and 5.6 kilograms in weight. Undernourishment and stunting fre- more than 30 percent of all children are Almost one third of all children in quently overlap with vitamin and min- born underweight. developing countries are stunted, with eral deficiencies that afflict nearly 2 From the moment of birth, the scales heights that fall far enough below the billion people worldwide. Even when Impact of hunger and malnutrition throughout the life cycle Persistence of stunting from Higher childhood into adulthood mortality rate Impaired mental Reduced capacity development Increased risk Stunting at age five to care for child of adult chronic Mild Moderate Severe disease 0 OLDER PEOPLE BABY malnourished low Untimely/inadequate Centimetres below normal at age 18 birthweight weaning -5 Frequent Inadequate infection Inadequate catch-up foetal growth Inadequate Inadequate food, health -10 nutrition food, health and care and care CHILD stunted WOMAN -15 Reduced malnourished Guatemala PREGNANCY mental Male low weight capacity Female gain ADOLESCENT -20 Inadequate stunted food, health India and care Male Female -25 Higher maternal Inadequate food, Reduced physical capacity mortality health and care and fat-free mass Source: Seres, ACC/SCN Source: Martorell, Khan and Schroeder 8 The State of Food Insecurity in the World 2004

mild, these micronutrient deficiencies weight (see graph). Micronutrient defi- and effective nutrition interventions, significantly increase the risk of death ciencies also increase the risk of death including breastfeeding, complemen- and severe illness. They can also cause from childhood diseases. A deficiency in tary feeding, vitamin A and zinc supple- irreversible cognitive deficits in children vitamin A, for example, increases the mentation, could reduce child mortality and productivity losses for adults. Iron risk of dying from diarrhoea, measles by 25 percent and save about 2.4 million deficiency, for example, has been linked and malaria by 20 to 24 percent. children’s lives each year. to increased maternal mortality in child- Overall, the World Health Organiza- birth, poor motor and cognitive devel- tion (WHO) estimates that more than The DALY costs of hunger opment in children and reduced pro- 3.7 million deaths in 2000 could be at- ductivity in adults. Iron deficiency af- tributed to underweight. Deficiencies in Malnourished people who survive child- flicts an estimated 1.7 billion people three key micronutrients – iron, vitamin hood often suffer from lifelong physical worldwide, half of whom suffer from A and zinc – each caused an additional and cognitive disabilities. One measure iron deficiency anaemia. 750 000 to 850 000 deaths. that has been used to quantify the A study of trends in malnutrition impact of malnutrition on both poor Undernutrition and child mortality and child mortality in 59 developing health and increased mortality is called countries between 1966 and 1996 found disability-adjusted life years or DALYs – More than three quarters of all child that reducing levels of underweight had the sum of years lost as a result both deaths are caused by neonatal disorders a significant effect on reducing child of premature death and of disabilities, and a handful of treatable infectious mortality, regardless of other socio- adjusted for severity. diseases, including diarrhoea, pneu- economic and policy changes. The Global Burden of Disease Study, monia, malaria and measles. And well Reductions of 60 percent in levels of sponsored by WHO and the World Bank, over half of these deaths can be traced underweight accounted for 16 percent calculates DALYs caused by a wide to the increased vulnerability of children of the decline in child mortality in Latin range of diseases and conditions and who are undernourished and under- America and 27 percent of the decline estimates the percentage that can be in Asia, the Near East and North Africa. attributed to various risk factors, in- In sub-Saharan Africa, immunizations, cluding childhood and maternal mal- Global child deaths by cause antibiotics and other improvements in nutrition. The latest Burden of Disease health care helped reduce child mortal- report ranks being underweight as the Neonatal ity despite the fact that levels of under- single most significant risk factor for disorders weight increased. But if underweight DALYs worldwide (see graph, next page) Diarrhoea had been reduced at the rate seen in and for both death and DALYs in “high- Pneumonia the other regions, child mortality in sub- mortality developing countries” – a Saharan Africa would have fallen much group that includes almost 70 countries Malaria more rapidly, by 60 percent instead of with a combined population of more 39 percent. Looking ahead, the study than 2.3 billion people. Other estimated that reducing the prevalence In all, six of the ten leading risk fac- AIDS of underweight by 5 percentage points tors for DALYs in these high-mortality could reduce child mortality by about countries are related to hunger and mal- Measles 30 percent. nutrition, including underweight, defi- Another recent study found that in- ciencies in zinc (ranked fifth), iron (sixth) Unknown terventions that are available today and and vitamin A (seventh), and unsafe wa- 0 5 10 15 20 25 30 35 are feasible for widespread use in dev- ter, sanitation and hygiene (third), which % of child deaths eloping countries could reduce child contributes to malnutrition by causing Proportion due to being underweight mortality by about two thirds. In the 42 infections that prevent digestion and ab- countries where more than 90 percent sorption of nutrients (see graph). Source: Black, Morris and Bryce of child deaths occur, a few affordable Around 50 percent of DALYs caused The State of Food Insecurity in the World 2004 9

Undernourishment around the world by diarrhoea, pneumonia and malaria in dominate the list of risk factors. Among overnutrition. A growing body of evi- high-mortality developing countries can low-mortality developing countries – a dence suggests, however, that low birth- be attributed to underweight. When the group that includes China, several other weight and undernutrition early in life impact of micronutrient deficiencies is countries in Asia and most of South increase the risk of obesity and diet- added, the proportion of DALYs from America – underweight and iron defi- related diseases in adulthood (see also these diseases attributable to malnutri- ciency remain among the top ten risk page 23). In China, more than 30 per- tion rises to between 60 and 80 percent factors. They are joined on the list by cent of diabetes and around 10 percent (see graph). overweight and a number of other diet- of both strokes and coronary heart As might be expected, underweight related risks that contribute to non- disease are estimated to be caused by and micronutrient deficiencies rank communicable chronic diseases such as childhood undernutrition (see graph). lower as risk factors for death and dis- ischaemic heart disease, high blood Overall, not including their contribu- ability in more advanced developing pressure and diabetes. tion to adult chronic diseases, child- countries with lower mortality rates. These chronic diseases are generally hood and maternal undernutrition are But nutrition-related conditions still associated not with hunger but with estimated to cost more than 220 million DALYs in developing countries. When other nutrition-related risk factors are Global DALYs attributed to nutrition-related risk factors, 2000 taken into account, the toll rises to almost 340 million DALYs, fully one half of Underweight (1, 1*) all DALYs in the developing world. Unsafe water/sanitation** (6, 3) That total represents a loss of productivity equivalent to having a disaster Iron deficiency (9, 6) kill or disable the entire population of a Overweight (10) Developing countries with high mortality Developing countries with low mortality country larger than the United States Zinc deficiency (11, 5) Developed countries of America. It also highlights the im- Low fruit/vegetable intake (12) measurable suffering that the ongoing * rank among risk factors worldwide and in Vitamin A deficiency (13, 7) developing countries with high mortality disaster of world hunger inflicts on ** includes inadequate hygiene Physical inactivity (14) millions of households and the crush- 0 30 60 90 120 150 ing economic burden it imposes on Attributable DALYs (millions) countries throughout the developing Source: WHO world. Nutritional risk factors for childhood and childbirth in developing countries Chronic diseases and childhood with high mortality rates, 2000 undernutrition, China and Sri Lanka Diarrhoeal diseases Coronary Lower respiratory infections China heart Sri Lanka disease Malaria Diabetes Underweight Measles Vitamin A deficiency Stroke Zinc deficiency Maternal mortality Iron deficiency 0 10 20 30 40 0 20 40 60 80 100 % of chronic disease due to % of DALYs attributable to malnutrition childhood undernutrition Source: WHO Source: Popkin, Horton and Kim 10 The State of Food Insecurity in the World 2004

The economic costs of hunger: billions in lost productivity, earnings and consumption E stimating the millions of human nutrition, suggests that these direct Lifetime costs of childhood hunger lives cut short or scarred by dis- costs add up to around US$30 billion ability leaves no doubt that hun- per year – over five times the amount Estimates of the indirect costs of hunger ger is morally unacceptable. Calcu- committed so far to the Global Fund to are generally based on studies that have lating the value of lost productivity in Fight AIDS, Tuberculosis and Malaria. measured the impact of specific forms dollars suggests that allowing hunger These direct costs are dwarfed by of malnutrition on physical and mental to persist is simply unaffordable, not the indirect costs of lost productivity development and have established cor- only to the victims themselves but to and income caused by premature death, relations with reduced productivity and the economic development and pros- disability, absenteeism and lower edu- earnings (see chart). These studies have perity of the nations in which they live. cational and occupational opportunities. shown, for example, that: The costs of hunger to society come Provisional estimates suggest that Stunted adults are less productive in several distinct forms. Perhaps the these indirect costs range into the hun- and earn lower wages in manual most obvious are the direct costs of dreds of billions of dollars. labour. Low birthweight (LBW) and dealing with the damage it causes. Both the direct and indirect costs protein-energy malnutrition (PEM) These include the medical costs of represent the price of complacency, cause stunting. treating both the problem pregnancies of allowing widespread hunger to Every year of missed schooling during and deliveries of anaemic, underweight persist. Both are unacceptably high, childhood cuts deeply into lifetime mothers and the severe and frequent not only in absolute terms but in com- earnings. LBW, stunting and micro- illnesses of children whose lives are parison with estimates of a third type nutrient deficiencies have all been threatened by malaria, pneumonia, di- of costs – the costs of interventions associated with reduced school atten- arrhoea or measles because their bod- that could be taken to prevent and dance. One study that closely moni- ies and immune systems have been eliminate hunger and malnutrition. tored children affected by a drought weakened by hunger. Numerous studies suggest that every in Zimbabwe found that malnutrition A very rough estimate, apportioning dollar invested in well-targeted inter- during critical months of development medical expenditures in developing ventions to reduce undernourishment cost children an average of 4.6 cen- countries based on the proportion of and micronutrient deficiencies can timetres in stature and almost a year disability-adjusted life years ( DALYs) yield from five times to over 20 times in the classroom. Those seemingly attributed to child and maternal under- as much in benefits. small losses in height and education translated into estimated losses of 12 percent in lifetime earnings. Impact of various forms of malnutrition on productivity and lifetime earnings Reduced cognitive ability, measurable in lower scores on IQ tests, leads Form of malnutrition Estimated loss of productivity or earnings (%) to reduced productivity and earnings. Low birthweight Iodine deficiency, which affects an (LBW) estimated 13 percent of the world’s Losses associated with Protein-energy with moderate impact on: population, has been associated with malnutrition (PEM) stunting productivity in manual losses of 10 to 15 points on IQ tests labour with severe cognitive development and 10 percent in productivity. stunting Combining these findings with available Iodine deficiency data on the prevalence of various forms of malnutrition in populations makes Iron deficiency heavy manual labour it possible to construct provisional esti- light manual labour mates of the costs of hunger on national and global scales. 0 5 10 15 20 A thorough review of the available Source: Alderman and Behrman; Horton and Ross; Horton evidence, for example, indicates that The State of Food Insecurity in the World 2004 11

Undernourishment around the world switching one LBW infant to non-LBW probability that any given individual may like India, whose GDP in 2002 topped status could yield almost US$1 000 not survive or work throughout the nor- US$500 billion, the estimated present in benefits over a lifetime (see graph). mal span of working years. value of the cost of iron deficiency totals With about 20 million LBW children more than US$30 billion. born every year in developing coun- Estimating the losses of a lifetime These figures represent the dis- tries, the costs of doing nothing for counted present values of costs im- one more year add up to around US$20 The Academy for Educational Develop- posed over a lifetime by a specific form billion. ment (AED) has developed a methodol- of malnutrition. If the cost of anaemia to These benefits include estimates of ogy and software for quantifying both Bangladesh is estimated to be equiva- reductions both in the direct costs of the costs of various forms of malnu- lent to 8 percent of GDP, for example, neonatal care, illness and chronic dis- trition and the benefits of action to re- this does not mean that anaemia slash- eases and in the indirect costs of produce or eliminate it. FAO calculations es output by 8 percent every year. ductivity lost as a result of shortened based on data provided by AED show Rather it means that for every year that working lives and impaired physical and that the discounted present value of al- the prevalence of anaemia remains un- cognitive development. Since the bene- lowing current levels of iodine deficien- changed, the present value of costs fits are estimated as the current value of cy and PEM to persist for another ten spread over the lifetimes of the current increased productivity over the course of years range as high as 15 percent of one generation of five-year-olds amounts to a lifetime, a discount value must be ap- year’s GDP (see graph below and on- 8 percent of one year’s GDP. plied to account for inflation and the line technical note cited on page 40). None of these estimates present any- A similar exercise estimated the long- thing like a full accounting of the costs term costs incurred for every year that of hunger. Among other limitations, the Estimated benefits of shifting one iron deficiency remains at current levels calculations: infant from low birthweight status in a different set of ten countries. The take account only of market activities, present discounted value of costs asso- ignoring the value of work performed Discounted present value using 3% discount US$ ciated with iron deficiency anaemia inside the home; 1 000 ranged from about 2 percent of GDP in fail to take account of the fact that Intergenerational Honduras to 8 percent in Bangladesh wages are likely to grow over time; benefits 122.26 (see graph, next page). In a big country generally do not include the transmis- Lower costs of 800 chronic diseases 73.83 Costs of protein-energy malnutrition and iodine deficiency Discounted present value of estimated long-term costs of allowing protein-energy malnutrition and iodine defi- 600 Higher productivity ciency to persist at current levels for another ten years, as a percentage of one year’s GDP, selected countries. from higher ability 434.06 % of GDP 20 Protein-energy malnutrition (PEM) 400 Iodine deficiency 15 Higher productivity 10 from less stunting 180.17 200 5 Reduced illness 38.83 Less neonatal care 41.80 0 Lower infant n a na o a ire a a a o ria r i e l * da al ga ca ia ivi in al ne ny as th qu ni an M wa be Ivo an Ch em ne Be so as mortality 94.66 l Ke aF i bi Bo Gu 0 Ug Li ts nz am Le ag Se d’ at in Bo Ta Total: 985.61 te ad Gu rk oz Cô M Bu M Source: Alderman, Behrman and Hoddinott * United Rep. of Source: FAO from AED data 12 The State of Food Insecurity in the World 2004

sion of malnutrition from one genera- they dwarf the costs of action to reduce Based only on the increased life ex- tion to the next, as undernourished or eliminate malnutrition. For the 25 pectancy associated with higher levels mothers give birth to LBW babies; countries for which AED data were of food availability required to meet the depend on somewhat arbitrary dis- made available, the benefits of inter- WFS goal, the total discounted value count rates to calculate the present ventions to reduce PEM outweighed the over the years up to 2015 was estimated value of costs spread over a lifetime. costs by a factor of 7.7 to 1, on average. to be approximately US$3 trillion, which The choice of rates is difficult to de- For actions to reduce iron and iodine translates into an annuity benefit of termine and can make a big differ- deficiencies, the benefits averaged 9.8 US$120 billion per year. ence in the estimated benefits. and 22.7 times the costs respectively This calculation, too, almost cer- Yet even these partial and provisional (see graph). tainly underestimates the true costs of estimates make it clear that the costs of hunger. But like the AED estimates it hunger are extremely high. Take the low The costs of missing the WFS goal clearly demonstrates that the costs of end of the estimated range of lost pro- allowing widespread hunger to persist ductivity and earnings for each individu- Coming at the costs of hunger from are extremely high and far outweigh the al form of malnutrition. Adjust for the another direction, FAO conducted a costs of decisive action to eliminate it. likelihood that there may be consider- macroeconomic study to estimate the The FAO study estimated that an in- able overlap among them. Even with benefits of reducing undernourishment crease of just US$24 billion per year in these conservative assumptions, the by enough to meet the World Food public investment would make it possi- present discounted value of the com- Summit (WFS) target. The study esti- ble to attain the WFS goal and reap bined costs of PEM, LBW and micro- mated the value of increased produc- US$120 billion in annual benefits. nutrient deficiencies would add up to tion that would be unleashed by re- at least 5 to 10 percent of GDP in the ducing the number of undernourished developing world – roughly US$500 people in developing countries to Costs and benefits of billion to US$1 trillion. around 400 million by the year 2015, in- interventions to reduce hunger Losses of that magnitude clearly rep- stead of the approximately 600 million and malnutrition resent a significant drag on national projected by a standard FAO model in development efforts. AED’s estimates the absence of concerted action to re- Benefits as a multiple of costs (costs = 1)* at the country level demonstrate that duce hunger. 25 Costs Benefits Costs of iron deficiency anaemia 20 Discounted present value of estimated long-term costs of allowing iron deficiency anaemia to persist at current levels for another year, as a percentage of one year’s GDP, selected countries. 15 % of GDP 8 Impaired cognitive development in children 10 Impaired physical labour of adults 6 5 4 2 0 Iodine PEM** Iron 0 Form of malnutrition to be reduced nz p. sh an i t an ia as a ia a al yp gu Ta Re di liv an ur de M st Om Eg In ra Bo ki of d nd la * Averages for 25 countries from AED calculations ite ca Pa ng Ho ** Protein-energy malnutrition Ni Un Ba Source: Horton and Ross Source: FAO from AED data The State of Food Insecurity in the World 2004 13

Undernourishment around the world Measuring hunger: improving estimates to target more effective action F AO’s estimates of the number of for other non-food purposes, and divid- Other approaches and dimensions undernourished people in the ing the caloric equivalent of all the food world are the most closely fol- available for human consumption by the Many of the proposals to improve the lowed and widely cited element of The total population to come up with an av- FAO estimates put forward at the Sym- State of Food Insecurity in the World. erage daily food intake or dietary energy posium called for increased reliance on News reports invariably headline the supply (DES). data obtained from household budget latest figures as a gauge of progress Data from household surveys are surveys. Such surveys, which are avail- towards the targets set by the World used to derive a “coefficient of varia- able from an increasing number of de- Food Summit and the Millennium tion” to account for the degree of in- veloping countries, provide data that can Development Goals – to reduce hunger equality in access to food. Similarly, be used to calculate two of the parame- by half by the year 2015. since a large adult needs almost twice ters used in FAO’s estimates – daily food Given the attention focused on these as many calories as a three-year-old intake and the degree of inequality in annual estimates, it is not surprising child, the minimum requirement per access to food. They can also be used to that the methodology employed to cal- person for each country takes into ac- measure other dimensions of hunger culate them has been subject to close count its mix of age, gender and body and food insecurity, including poor diet scrutiny and debate. Experts within and sizes. FAO reports the proportion of the quality and vulnerability to food depriva- outside FAO have pointed out limita- population whose daily food consumption, and to monitor them over time tions in both the underlying data and tion falls below that minimum daily re- within different areas and population FAO’s methods of analysing them. quirement as undernourished. groups. In 2002, FAO hosted an International FAO’s method of estimating food Surveys also suffer from certain Scientific Symposium to review differ- deprivation offers several advantages. weaknesses. Data are not collected ent methods of measuring food depri- In particular, it relies on data that are regularly in all countries. Even where vation and undernutrition and identify available from most countries in more they are, the surveys are usually updat- ways to improve FAO’s estimates. Since or less the same form and can be up- ed only once every three to five years then, FAO has taken action both to dated regularly. This allows compari- and the results are often not compara- improve its own methodology and to sons across countries and over time. ble across countries or even from one validate alternative, complementary But the FAO methodology also suffers approaches. from several obvious limitations. For one thing, the estimates it produces Impact of mean food consumption Measuring food deprivation are only as reliable and accurate as the and inequality of access to food on data used to calculate the food balance estimates of undernourishment FAO’s estimates are essentially a mea- sheets, levels of inequality and daily % undernourished sure of food deprivation based on calcu- energy requirement cut-off points. For 70 lation of three key parameters for each many countries, the reliability of the 60 country: the average amount of food underlying food balance sheet data and 50 available per person, the level of in- measures of inequality is uncertain. A 40 equality in access to that food and the relatively small variation in just one of 30 minimum number of calories required these parameters can make a big dif- 20 for an average person. ference in a country’s estimated level of 10 Average food availability comes from hunger (see graph). 0 1 700 2 040 2 450 2 940 “food balance sheets” compiled by FAO Furthermore, estimates based on Mean food consumption (kcal/person/day) every year by tallying how much of each national production and trade figures Coefficient of variation for dietary energy food commodity the country produces, cannot be used to pinpoint where hun- consumption distribution imports and withdraws from stocks, ger has become increasingly concen- 0.20 0.24 0.29 0.35 higher number = greater inequality subtracting the amounts that were ex- trated in specific geographic areas and Source: FAO ported, wasted, fed to livestock or used socio-economic groups. 14 The State of Food Insecurity in the World 2004

survey to the next. This limits their val- Strengthening monitoring efforts within particular geographical areas, ue for monitoring national and global such as urban and rural residential trends annually. Since the Symposium, FAO has worked areas or ecological zones, or among Nutritional status can be impaired with more than 50 countries to improve socio-economic groups, defined by such not only by lack of food but by frequent their ability to apply FAO’s methodology things as the level of household income illness, poor sanitation and other condi- to measure food deprivation for specific or the main occupation and economic tions that prevent people from getting population groups. The mean of food activity (see graph). full nutritional benefit from their food. consumption that is one of the key FAO estimates have always relied on FAO’s estimates of undernourishment parameters in FAO’s estimates can be household budget survey data to derive measure only food deprivation. Other derived either from national food bal- a coefficient of variation for inequality in indicators, such as the proportion of ance sheets or from household budget access to food. But they have applied children who are stunted (short for their surveys. In calculating the estimates a single coefficient across the entire age) or underweight capture all the di- given in this report, FAO relies on food time series for each country, leading to mensions that affect nutritional status. balance sheets as the only way to obtain criticism that they fail to account for Most countries regularly collect such consistent global and regional coverage changes in equality over time. Since the anthropometric data, though only every on a regular basis. When it comes to Symposium, FAO has responded to this few years and only for children. targeting geographical areas or popula- by conducting a review of trends in in- Although the prevalence of stunting or tion groups within countries, however, equality in developing countries. Results underweight rarely matches the level of the FAO methodology can be applied show that inequality has decreased in undernourishment, the relative magni- using figures for both food consumption 28 of the 38 countries for which data tude and overall trends generally coin- and inequality of access taken from from at least two reliable and compara- cide (see graph). Anthropometric data household survey data. ble surveys were available. Once com- are extremely valuable for highlighting By taking this approach, countries parable trend data become more widely trends and evaluating interventions have been able to use data collected available they will be introduced into among particularly vulnerable groups, from household income and expenditure FAO’s estimates of undernourishment. such as children and pregnant women. surveys to estimate levels of hunger The emerging expert consensus is that no one indicator can capture all aspects of hunger and food insecurity. Regional trends in under- Undernourishment in urban and Instead, a variety of methods can pro- nourishment and underweight, rural China during the 1990s vide a suite of indicators that measure 1990–1992 to 2000–2002 the different dimensions of food insecu- % undernourished 30 rity, both at the global level and within % Undernourished Child underweight countries. 40 25 Considerable progress has been 20 made towards creating such a suite. 30 15 FAO and the World Bank have worked 10 together, for example, to build data sets 20 5 that integrate information on food depri- 0 Nationwide Urban Rural vation, income, food consumption and 10 anthropometry. As more such efforts 0 bear fruit, they will improve ability to 26% Urban 43% Urban 1990 2000 1990 2000 1990 2000 1990 2000 Rural 74% Rural 57% monitor progress towards achieving the Sub- Asia/ Latin Near Saharan Pacific America/ East/ World Food Summit target and Millen- Proportion of Distribution of Africa Caribbean North total population undernourished nium Development Goals and to tailor Africa and focus actions urgently needed to Source: FAO; UNICEF Source: FAO accelerate that progress. The State of Food Insecurity in the World 2004 15

Undernourishment around the world Hunger hotspots A s of July 2004, 35 countries faced In East Africa alone, the food security Trends in locations and causes food crises requiring emergency of over 13 million people was threatened assistance. Neither the number by a combination of erratic rains and the The number of food emergencies has of crises nor their locations differed impact of recent and ongoing conflicts. been rising over the past two decades, markedly from the situation reported Escalating civil conflict in the Darfur from an average of 15 per year during in The State of Food Insecurity in the region of the Sudan uprooted more the 1980s to more than 30 per year World 2003. Most of the crises were than a million people from their homes since the turn of the millennium. Most concentrated in Africa and were caused and fields, precipitating a major crisis. of this increase has taken place in by drought, conflict or a combination of Elsewhere in the subregion, recurrent Africa, where the average number of the two (see map). Almost all had per- drought caused crop failures and heavy food emergencies each year has almost sisted over a prolonged period, with an livestock losses in parts of Ethiopia, tripled (see graph). average duration of nine years. Eritrea, Somalia, Uganda and Kenya. The balance of causes of food emergencies has also shifted over time. Since 1992, the proportion of emergencies Food emergencies and their causes, 2003–2004 that can be attributed mainly to human causes, such as conflict or economic failures, has more than doubled, rising from around 15 percent to more than 35 percent (see graph). In many cases, natural and human- induced factors reinforce each other. Such complex crises tend to be the most severe and prolonged. Between 1986 and 2004, 18 countries were “in crisis” more than half of the time. War or economic and social disruptions caused or compounded the crises in all Mainly human-induced (22) Mainly natural (18) 18 (see graph, facing page). These coun- Conflict (13) Weather (mainly tries also offer evidence that frequent Past conflict (6) drought,18) and prolonged crises cause widespread Economic problems (2) Note: stripes indicate a chronic undernourishment. FAO’s lat- Refugees (1) combination of causes Source: FAO est estimates list 13 of the 18 countries among those where more than 35 percent of the population goes hungry. Food emergencies by region Primary causes of food crises Monitoring hunger “hotspots” 1986–1990 1986–1991 1991–1995 In order to identify and monitor potential 1996–2000 hunger “hotspots”, both the specifics of 1992–2004 2001–2004 locations and the complexities of causes 0 5 10 15 20 25 30 35 0 20 40 60 80 100 of food emergencies must be taken into Average number of food emergencies % of crises account. Tracking weather conditions Sub-Saharan Latin America/ Primary cause and crop prospects in regions regu- Africa Caribbean Human-induced (mainly conflict) Asia/Pacific Near East/ Natural (mainly drought) larly buffeted by monsoons, droughts Europe North Africa Mixed and other recurring weather patterns Source: FAO Source: FAO is relatively straightforward. The task 16 The State of Food Insecurity in the World 2004

of identifying potential human-induced differences among the continent’s sub- metres of rainfall in good years and is and complex emergencies is much regions. plagued with frequent droughts. more difficult, requiring an ongoing East Africa, for example, not only Sahel countries have been relatively assessment of many different environ- experienced several of the most severe free of conflict, however. And after a mental, economic, social and political crises during 2003–2004 but includes series of devastating droughts, they indicators. Once a food emergency has six countries that have been in crisis have integrated the unpredictability and been identified, monitoring can provide more than half the time since 1986. volatility of weather conditions into their the information needed to tailor effec- The subregion suffers from frequent agricultural and trade policies and farm- tive relief and rehabilitation measures. droughts and occasional torrential rains ing systems. As a result, these countries Many countries that are plagued and floods. But the East African coun- tend to fall into crisis less often than by unfavourable weather but enjoy tries that have suffered the most dev- countries elsewhere on the continent. relatively stable economies and govern- astating and persistent crises are those When crises do occur they tend to be ments have implemented crisis preven- that have been stricken by conflict. The less severe and far shorter. Since the tion and mitigation programmes and humanitarian crisis in Darfur, for exam- mid-1980s, the longest emergencies established effective channels for relief ple, engulfed an area that had generally in the Sahel lasted an average of one and rehabilitation efforts. But when a enjoyed good rains and crops. The crisis year. In East Africa, the average was country has also been battered by con- was triggered by conflict that drove an more than 11 years (see graph). flict or economic collapse, programmes estimated 1.2 million people from their Taking account of such differences and infrastructure for prevention, relief homes and prevented them from tend- in underlying causes of hunger and and rehabilitation are usually disrupted ing their fields and herds. poverty and in countries’ vulnerability to or destroyed. The Sudan and other East African natural disasters and human-induced As the continent with the highest countries are less vulnerable to weather crises is essential both for monitor- number and proportion of countries fac- conditions than the neighbouring Sahel, ing potential hunger hotspots and for ing food crises, Africa provides a good where the single annual growing season responding effectively when crises do illustration, especially if one analyses receives an average of only 575 milli- erupt. Frequency and primary causes of chronic food emergency, 1986–2004 Duration of longest crises in Countries in crisis more than 50% of the time Principal causes of food emergency African countries, 1986–2004 Angola Current or Subregional average (years) Ethiopia past conflict 12 Somalia Sudan Economic Mozambique problems 10 Afghanistan Haiti Weather Liberia (mainly 8 Sierra Leone drought) Iraq 6 Mongolia Dem. Rep. of the Congo Burundi 4 Eritrea Tajikistan 2 Rwanda Georgia Armenia 0 Sahel Central East Southern 0 50 60 70 80 90 100 Africa Africa Africa % of reporting periods “in crisis” Source: FAO Source: FAO The State of Food Insecurity in the World 2004 17

Special feature Globalization, urbanization and changing food systems in developing countries W ith more than 800 million peo- growth between 2000 and 2030 will Convergence in diets ple in developing countries still be concentrated in urban areas in de- suffering from chronic under- veloping countries. If present trends The combination of growing cities and nutrition, hunger and food security will continue, urban population will equal rising incomes has contributed to sig- remain the top priority for food policy rural population around 2017. By 2030, niﬁcant changes, not only in the aver- for many years to come. But profound almost 60 percent of the people in devel- age number of calories that people in demographic and economic changes oping countries will live in cities. developing countries consume, but in are rapidly transforming food systems As economic development fuels ur- the foods that make up their diet. and the scope and nature of nutritional ban growth it is also driving per capita As total caloric intake has increased, challenges. incomes higher. And the proportion of so has the proportion of those calories Although the pace of change var- people living in extreme poverty and derived from vegetable oils, meat, sugar ies considerably from region to re- hunger is slowly shrinking. The latest and wheat. To a large extent this reﬂects gion, common trends can be identi- projections by the World Bank show the preferences of consumers whose fied throughout the developing world. income per person in the developing rising incomes allow them to purchase Population is becoming increasingly countries growing at an annual rate of more expensive and more highly valued urban. Average incomes and calorie 3.4 percent for the period 2006–2015, foods. intake are rising. Commodity and food twice the 1.7 percent registered during Other contributing factors include the prices are falling. An increasingly in- the 1990s. steep decline in prices and rapid growth tegrated world trade environment and Over the same time period, the in imports of wheat and other commodi- improved transportation facilities are average daily caloric intake in develop- ties produced in temperate zones and spurring a greater concentration of ing countries is expected to increase exported mainly by the industrialized the food industry and a convergence of by nearly 200 kilocalories (see graph). countries. Net imports of these com- dietary patterns and preferences. The largest gains are projected in sub- modities by developing countries have Saharan Africa and South Asia, although increased by a factor of 13 over the past Rapid growth of cities and incomes the pace of progress in these regions 40 years, and are expected to grow by is still likely to fall below what would another 345 percent by the year 2030, According to the latest UN estimates, be needed to reach the World Food offering further evidence of changes in almost all of the world’s population Summit goal. food systems and dietary preferences. Urbanization in developing Changes in GDP per capita by Average daily caloric intake by countries, 1960–2030 region, 1980–2015 region, 1997–2030 Population (billions) GDP/capita, average annual change (%) Kcal/capita 1997–1999 2015 2030 4.5 8 3 500 Projected 1980s 4.0 1990s 3 000 6 3.5 2001–2005 2 500 Rural 2006–2015 3.0 4 2 000 2.5 1 500 Urban 2 2.0 1 000 0 1.5 500 1.0 -2 0 Sub- Near Latin South East Sub- Near Latin South East 0 Saharan East/ America/ Asia Asia Saharan East/ America/ Asia Asia 1960 1980 2000 2020 Africa North Caribbean Africa North Caribbean Source: UN Africa Source: World Bank Africa Source: FAO 18 The State of Food Insecurity in the World 2004

Nutrition experts identify two distinct rienced explosive growth both in invest- 1999 to 2001, the share of supermarkets trends fuelled by these changes: dietary ments by transnational food corpora- in sales of packaged and processed food convergence and dietary adaptation. tions and in the proportion of food sold in urban China increased by more than Dietary convergence refers to the in- through supermarkets. 50 percent. creasing similarity in diets worldwide. In the decade 1988–1997, foreign Transnational food companies played It is characterized by a greater reliance direct investment in the food industry a big part in this supermarket boom on a narrow base of staple grains (wheat increased from US$743 million to more as well. Between 1980 and 2001, each and rice), increased consumption of than US$2.1 billion in Asia and from of the five largest global supermarket meat, dairy products, edible oil, salt US$222 million to US$3.3 billion in Latin chains (all based in Europe or the United and sugar, and lower intake of dietary America, outstripping by far the level of States) expanded the number of coun- fibre (see graph). Dietary adaptation, on investments in agriculture (see graph). tries where it operated by at least 270 the other hand, reflects the rapid pace Over roughly the same period, the percent (see graph). The rapid growth and time pressures of urban lifestyles. share of food sales made through su- and increasing concentration of super- In households where both parents of- permarkets more than doubled both in markets are among the most visible ten commute long distances and work Latin America and in East and South- causes and consequences of the trans- long hours, consumers eat more meals east Asia (see graph, next page). In Latin formation and consolidation of global outside the home and purchase more America, supermarkets increased their food systems – the entire chain from brand-name processed foods. share of retail food sales by almost as agricultural production through trade, much in one decade as it took them processing, retail and consumption. Concentration of food processing and 50 years to do in the United States of These changes have profound implica- retail trade America. In the larger and wealthier tions for the food security and nutrition- countries that account for three quar- al well-being of people at both ends of The trends towards dietary convergence ters of the Latin American economy, the the chain, from farmers who must adapt and adaptation have also been fuelled by share of supermarkets increased from to the requirements and standards of the increasing concentration of food pro- about 15–20 percent in 1990 to 60 per- changing markets to urban consumers cessing and retail trade. Latin America cent in 2000. In Asia, the supermarket who depend increasingly on processed and Asia, the regions where these trends boom started later but took off even foods and meals purchased from street have been most pronounced, have expe- more quickly. In just two years, from vendors and fast food restaurants. Changing diets in developing Foreign investment in agriculture Global expansion of transnational countries, 1964–1966 to 2030 and the food industry, 1988–1997 supermarkets, 1980–2001 Kcal/capita/day US$ (millions) Number of countries where operating 3 000 3 500 35 Other Agriculture 1980 Pulses 3 000 Food, beverages and 30 2001 2 500 tobacco Roots/tubers Meat 2 500 25 2 000 Sugar 2 000 20 Vegetable oils 1 500 15 1 500 Other cereals 10 1 000 1 000 Rice 5 500 500 0 Wheat 0 t ur ld ro ar ) o sc ) 1988 1997 1988 1997 1988 1997 fo ) Aho s) et ) 0 re nce d M any alm SA Te (UK 1964–1966 1997–1999 2030 Sub-Saharan Asia/ Latin America/ ar ra an m W (U C (F rl er Africa Pacific Caribbean he (G et Source: FAO Source: FAO (N Source: UK Food Group The State of Food Insecurity in the World 2004 19

Special feature The impact of changing food systems on small farmers in developing countries C hanges in food markets, fuelled percent of supermarket sales in Latin poverty rate would decrease by approxi- by the rapid growth of cities and America (see graph). mately 25 percent (see graph). incomes, have major implica- But as the scale of Kenya’s exports tions for the food security of millions Opportunities and risks has grown, the share produced by of people who are neither urban nor smallholders has dwindled. Before the affluent – the small farmers and land- The increasing dominance of super- horticultural export boom in the 1990s, less labourers in rural areas who make markets has yielded greater consumer smallholders produced 70 percent of up the vast majority of the world’s choice, more convenience, lower prices vegetables and fruits shipped from chronically hungry population. For these and higher food quality and safety for Kenya. By the end of the 1990s, 40 per- households, the globalization of food urban consumers. It has also led to cent of the produce was grown on farms industries and the expansion of super- consolidated supply chains in which owned or leased directly by importers markets present both an opportunity to buyers for a handful of giant food pro- in the developed countries and another reach lucrative new markets and a sub- cessors and retailers wield increasing 42 percent on large commercial farms. stantial risk of increased marginaliza- power to set standards, prices and de- Smallholders produced just 18 percent. tion and even deeper poverty. livery schedules. The rise of supermarkets in develop- Over recent decades, a handful of The globalization of supermarket ing countries has created a domestic vertically integrated, transnational cor- procurement has created unprecedent- sector with centralized procurement porations have gained increasing con- ed opportunities for some farmers in and high-quality standards that has trol over the global trade, processing developing countries. In Kenya, for ex- quickly outgrown the export market in and sales of food. The 30 largest super- ample, exports of fresh fruits, vegeta- most countries. Latin American supermarket chains now account for about bles and cut ﬂowers for sale in European markets, for example, now buy 2.5 times one third of food sales worldwide. In supermarkets have soared to more than more fresh fruit and vegetables from South America and East Asia, the super- US$300 million per year. Smallholders local farmers than the region exports to market share of retail food sales has who grow for the export market enjoy the rest of the world. Like their counter- ballooned from less than 20 percent to signiﬁcantly higher incomes than non- parts in the industrialized countries, more than 50 percent over the past de- participating households. A recent study domestic supermarket chains are shift- cade (see graph). And the biggest found that if non-participating rural ing towards contracts with a limited chains, most of them owned by multi- households were able to take up grow- number of suppliers who can meet their national giants, now control 65 to 95 ing horticultural crops for export, their requirements (see graph, next page). Supermarket share of retail food Concentration of supermarket Horticultural exports and poverty sales sector in Latin America reduction, Kenya 1992 2002 Sales of 10 biggest chains as % of supermarket sales Non-participating household Central America 00 100 South America Southeast Asia 80 80 Simulation of switching to become a: East Asia* contract farm worker 60 60 Central Europe 40 40 participating smallholder South Africa Kenya 20 20 0 20 40 60 80 100 Household food poverty (%)* Zimbabwe 0 * Headcount of households for which food China (urban) ico a bi a il ile ex nt in az Ch expenditures are insufficient to meet the 0 0 10 20 20 30 40 40 50 60 60 e om Br M rg Col recommended daily food allowance A * excl. China Source: Reardon et al. Source: Faigenbaum Source: McCulloch and Ota 20 The State of Food Insecurity in the World 2004

Carrefour, the world’s largest super- for negotiating and managing contracts trade” and “environmentally friendly”. market chain, has set up its own, huge with small producers. Such products command a premium distribution centre in São Paulo, Brazil, price and bring higher returns to serving a market of more than 50 mil- Empowering small producers farmers. For small producers, organic lion consumers. Carrefour buys melons farming offers the added benefits of from just three growers in northeast Smallholders who have succeeded as reduced dependence on purchased in- Brazil to supply all its Brazilian stores suppliers for supermarkets have gener- puts like pesticides and fertilizer and and to ship to distribution centres in ally overcome these obstacles by forging increased use of low-cost labour. 21 countries. cooperatives or enrolling in outgrower The Del Cabo cooperative in Mexico, Small dairy farmers in Brazil have schemes. Often they have benefited for example, has thrived by supplying also borne the brunt of consolidation. initially from information, training and organic cherry tomatoes to supermar- Between 1997 and 2001, more than start-up funds provided by public and kets in the United States. Since it was 75 000 Brazilian dairy farmers were private sector development initiatives. founded in the mid-1980s, the coopera- “delisted” by the 12 largest milk proces- In Zambia, for example, a consortium tive has grown to include 250 family sors (see graph). Most presumably went of government and industry organiza- farms, many of them smaller than 2 out of business. Similar consolidation tions helped forge a partnership that hectares. Average income in the coop- has been taking place at an even more included government ministries, the erative has increased from US$3 000 to rapid rate in Asia. In less than five years, country’s largest supermarket chain, more than US$20 000. Thailand’s leading supermarket chain suppliers of farm inputs, and the poor Certified products generally compared its list of vegetable suppliers from farming community of Luangeni. The mand better market access in the in- 250 down to just 10. project enabled the farmers in Luangeni dustrialized countries. They may well Smallholders face many obstacles to to begin supplying high-quality vegeta- enjoy similar advantages in local super- joining the ranks of preferred suppliers bles for Shoprite. Participating farmers markets as consumers become more for supermarkets. Meeting standards reported both substantially higher in- demanding about food quality, safety for quality and reliability may require comes and improved nutrition. and sustainability. But the certification substantial investments in irrigation, A number of farmer cooperatives process itself is costly and may present greenhouses, trucks, cooling sheds and have broken into lucrative and dynamic a major obstacle to small producers, packing technology. Supermarket tran- niche markets by obtaining certification who often lack access to the credit, in- saction costs may be significantly higher for their produce as “organic”, “fair formation and training they would need to enter these niche markets. As supermarkets expand their mar- Sources of supplies for a Kenyan Number and size of suppliers to ket from the wealthy elite in the cities supermarket, 1997–2008 top 12 Brazilian milk processors out to middle and working class neigh- % of supplies bourhoods and towns throughout the 200 80 Number of suppliers (‘000) country, one Central American super- 1997 Litres/day/farmer market chain has estimated that only 2003 60 2008 150 17 percent of the population is beyond their reach. That 17 percent is charac- 40 100 terized as the poorest, rural segment of the population. Smallholders who 20 fail to gain a foothold in this globalized 50 marketplace risk finding themselves 0 consigned to a permanently margin- Small Medium/ Brokers Imports farmers large 0 alized minority, excluded from the food farmers 1997 1998 1999 2000 2001 system both as producers and as Source: Neven and Reardon Source: www.terraviva.com.br consumers. The State of Food Insecurity in the World 2004 21

Special feature The changing profile of hunger and malnutrition R ising incomes and falling levels tation facilities. Many also lack access accelerated, so have dietary changes. In of hunger and malnutrition have to adequate food, even though the urban China, the proportion of urban adults generally been associated with poor in many developing countries consuming high-fat diets, in which more the rapid growth of cities in the devel- spend 60 percent or more of their total than 30 percent of calories come from oping world. But although the propor- expenditures on food. In India 36 per- fat, shot up from 33 to 61 percent in just tion of people who go hungry usually cent of urban children are stunted and six years between 1991 and 1997. remains lower in cities, the numbers 38 percent are underweight. Changes in the composition of diets of poor and hungry city dwellers are A recent FAO study compared levels and increased consumption of pro- climbing rapidly along with the total of stunting in urban and rural areas in cessed foods have been spurred by urban population. Angola, the Central African Republic and changing lifestyles and the rapid growth A study by the International Food Senegal. Although overall prevalence of of fast food outlets and supermarket Policy Research Institute (IFPRI) anal- stunting was higher in rural areas, the chains. In 1987, Kentucky Fried Chicken ysed trends in urban poverty and mal- prevalence was essentially the same in (KFC) opened the first foreign-owned nutrition in 14 developing countries urban and rural areas when economic fast food restaurant in Beijing. Fifteen between 1985 and 1996. In a majority status was considered (see graph). years later, KFC boasts more than 600 of these countries the number of un- stores in China and total fast food sales derweight children living in urban areas Changing lifestyles, changing diets top US$24 billion a year. is rising, and at a more rapid rate than The urban poor may not be able to in rural areas. In 11 of the 14 countries, Urbanization and the globalization of afford fast food restaurants, but they do the share of urban children among food systems are redrawing not only the share in the lifestyle and dietary chang- underweight preschoolers nationwide map but the profile of hunger and mal- es brought on by urbanization. In cities also increased (see graph). nutrition in developing countries. from Bangkok to Bamako, poor people More than 40 percent of all urban For the developing world as a whole, often buy more than half their meals residents in developing countries live in per capita consumption of vegetable from street food vendors. A study in slums. That means around 950 million oils and of animal source foods such as Accra, Ghana, found that the poorest city people lack one or more of such basic meat, dairy, eggs and ﬁsh doubled be- residents spend 40 percent of their food services as access to sufficient living tween 1961 and 2000. Where the pace budget and 25 percent of their total ex- space, clean water and improved sani- of urban growth and rising incomes has penditures on street foods (see graph). Trends in urban malnutrition, Stunting by residence and wealth, Food and street food as shares of selected developing countries three African countries expenditure, Accra, Ghana Underweight children in urban % stunted Urban 0 % of total expenditure On food areas as % of total Rural On street food 50 100 0 70 60 Brazil 0 60 40 80 50 Philippines Mauritania 0 50 40 30 60 0 40 Peru Zambia 30 20 40 0 30 Egypt Nigeria Madagascar 0 20 20 Honduras 0 20 Bangladesh Tanzania* 0 10 10 Uganda China 0 0 0 Malawi Q1 Q2 Q3 Q4 Q5 Q1 Q2 Q3 Q4 Q5 0 Wealth index quintile Expenditure quintile 1985 1987 1989 1991 1993 1995 poorest wealthiest poorest wealthiest *United Rep. of Source: IFPRI Source: FAO Source: IFPRI 22 The State of Food Insecurity in the World 2004

Changing diets, mounting problems other ailments commonly associated tes may be caused by a combination of with too much food and too little physi- widespread hunger and urbanization. As people consume more oils, meat and cal activity. According to this theory, many of these dairy products and less dietary fibre, This has become known as the mothers were once low birthweight ba- more fast foods and fewer home-cooked “Barker hypothesis”, named after the bies themselves and therefore predis- meals, many developing countries now author of a study showing that adults posed to obesity and insulin resistance. face a double challenge – widespread who had been underweight at birth suf- When they move to cities, modify their hunger on the one hand and rapid fered higher rates of death from heart diets and become less physically ac- increases in diabetes, cardiovascular disease and strokes. It has been sug- tive, they are then more likely to be- diseases and other diet-related non- gested that this may be the result of come hyperglycaemic. Hyperglycaemia communicable diseases on the other. “foetal programming”, in which the body during pregnancy is known to be asso- An estimated 84 million adults in adapts to nutritional deprivation in ways ciated with giving birth to babies who developing countries suffer from dia- that help short-term survival but en- are short, fat and at increased risk of betes today. By 2025 that number is danger long-term health. Although the diabetes as adults, just like the babies expected to rise to 228 million, of whom hypothesis remains controversial, other observed during the Mysore study. 40 percent will live in the more popu- studies have demonstrated similar cor- Meeting the dual challenge of lous countries of India and China (see relations between low birthweight and chronic hunger and increasing non- graph). Levels of obesity, heart disease higher prevalence of insulin resistance communicable diseases highlights the and other diet-related ailments are also and type 2 diabetes (see graph). need for food and nutrition policies rising rapidly, not only in cities but in Studies carried out in Mysore in that target vulnerable groups among rural areas, influenced by the economic south India confirmed that men and the urban and rural poor. Ensuring that and social changes that have fuelled the women who were underweight at birth children and women of childbearing “nutrition transition”. had a higher risk of cardiovascular dis- age have access to adequate dietary A growing body of evidence suggests ease and insulin resistance. But it was energy and variety is essential to break that it is the poor who are most at risk the short, fat babies of heavier mothers the transmission of hunger and malnu- not only of hunger and micronutrient who faced the greatest risk of develop- trition from one generation to the next deficiencies but of diabetes, obesity and ing diabetes. These findings suggest and from infancy through a lifetime of hypertension. A recent study of nutri- that India’s looming epidemic of diabe- stunted opportunities. tion trends and underlying causes in Latin America found that obesity rates are higher and rising faster among the Prevalence of diabetes, selected Impaired glucose tolerance, poorest segments of the population. developing countries, 1995–2025 diabetes and low birthweight The study concluded that obesity and Prevalence of diabetes (%) % with impaired glucose related chronic diseases are likely to in- tolerance of diabetes 15 crease in countries where maternal and 1995 40 40 2025 child malnutrition coexists with urban- 12 35 ization and economic growth. 30 30 It has long been known that children 9 25 born to undernourished mothers are 20 20 6 likely to be underweight at birth and 15 that both their physical and cognitive 3 10 10 development may be impaired. Now, 5 0 0 0 there is growing evidence that low zil a a t ji a * < 2.5 a in bi yp Fi di ico nia land 2.5– 2.95– 3.41– 3.86– 4.31 Br Ch lom Eg In ex i birthweight and stunting in early child- M nza Tha 2.94 3.40 3.85 4.30 Co Ta Birthweight (kg) hood heighten the risks of growing up *United Rep. of Source: WHO Source: Barker to develop diabetes, heart disease and The State of Food Insecurity in the World 2004 23

Towards the Summit commitments Acting to combat hunger India’s “White Revolution” where many people are vegetarians and Although Operation Flood has come depend on dairy products for most of to an end, India’s dairy production is Continuing rapid growth in India’s the animal protein in their diets. expected to triple by the year 2020. With dairy sector has spurred such signi- Producing milk has boosted the in- government policies that facilitate rural ficant gains in alleviating poverty and comes of an estimated 80 to 100 million credit and provide essential support improving nutrition that it has been families. The vast majority are marginal services to promote milk production dubbed the “White Revolution”. Milk and small farmers, whose plots are of- by poor rural households, the White production in India has risen from less ten too small to support their families, Revolution will continue to play a sig- than 30 million tonnes in 1980 to around and landless labourers who depend on nificant role in reducing poverty and 87 million in 2003 (see graph). India now common grazing lands and forests for hunger in India. ranks as the world’s biggest milk pro- fodder. More than 70 percent of India’s ducer. Despite rapid population growth, milk is produced by households who Right to food gains support availability per person increased from own only one or two milk animals. less than 50 kilocalories per day in 1980 On average, dairy production pro- After more than a year of work, an to 80 kilocalories per day in 2000. vides around one quarter of the income Intergovernmental Working Group was The increased availability of milk of rural households. But it is far more expected to complete a set of voluntary represents an important improvement important than that for the poor and guidelines for the progressive realization in nutrition, particularly in a country for women, who carry out more than of the right to adequate food in time to 90 percent of activities related to care submit them to the September 2004 and management of dairy animals. In session of FAO’s Committee on World Milk production in India, landless households, dairy production Food Security. The guidelines will serve 1980–2003 accounts for more than half of house- as a practical tool in national efforts to Million tonnes hold income, compared with less than implement the right to food. 100 20 percent for large farmers. In the meantime, numerous coun- 80 The key to smallholder dairy pro- tries have pressed ahead with mea- duction and India’s White Revolution sures to transform the right to food 60 has been the growth of a nationwide from a statement of principle to an 40 network of dairy cooperatives. The co- enforceable right. 20 operative approach started successfully South Africa is the most advanced 0 as a local initiative in Anand, Gujarat, country in this regard. The right to food 1980 1985 1990 1995 2000 2003 Source: FAOSTAT half a century ago. Since 1970 it has is enshrined in the post-apartheid con- been replicated all across India through stitution adopted in 1996, which places a three-phase programme known as an obligation on the state to ensure that Operation Flood, backed by the Indian everyone has access to adequate food Growth of Indian dairy Government, the Anand Milk Union at all times. The South African Govern- cooperatives, 1970–2002 Limited, FAO and the World Bank. By ment has taken further steps towards 2002, more than 11.2 million house- clarifying and fulfilling this obligation by 12 Cooperatives (10 000s) holds were participating in 101 000 drafting comprehensive legislation on 10 Members (millions) village dairy cooperatives (see graph). food issues, in the form of the National 8 The importance of dairy products in Food Security Draft Bill. Both India and 6 Indian diets has grown along with milk Uganda have also recently upgraded 4 production and incomes. Between 1970 the right to food from a directive prin- 2 and 2000, the proportion of total food ciple to a legally “justiciable” right. 0 1970– 1980– 1990– 2000– expenditures spent on milk and dairy In India, non-governmental orga- 1971 1981 1991 2001 products in rural areas increased from nizations have succeeded in bringing Source: FAO 10 percent to 15 percent. violations of the right to food to court. 24 The State of Food Insecurity in the World 2004

The People’s Union for Civil Liberties, other diffuse and collective interests”. communities whose livelihoods depend for example, claimed that the public Since the 1988 Constitution broadened on herding, fishing or forest resources. food distribution system is not working the scope for these “public civil suits”, The remaining 20 percent live in cities in some districts and that no attempts public prosecutors have used them (see graph). have been made to prevent hunger- increasingly to press for rights such as Within these communities, hunger related deaths. Although the Supreme the right to food that might be derived disproportionately affects the most Court has not yet reached a final from the constitutional right to “edu- vulnerable groups, including children judgement on the case, it has issued cation, health, work, leisure, security, under the age of five, women of child- “interim orders” directing the govern- social welfare, maternity protection and bearing age and mothers of babies, ment to introduce midday meals for all childhood”. Indeed a survey of attitudes the sick and the infirm. The Task primary schools, provide 35 kilograms among public prosecutors found that Force has called for urgent, adequately of grain per month to 15 million desti- they believe the Public Ministry can con- funded programmes to improve peri- tute households and double the funding tribute more than any other institution natal health and nutrition services for India’s largest rural employment or sector to broadening and consolida- and to get food to the needy. It is programme. ting such “diffuse and collective rights” also emphasizing the need to renew Judicial processes can be slow and (see graph). and increase support for smallholder expensive. In some countries, quasi- farming, with special attention given to judicial mechanisms are being used Hunger Task Force promotes action improving soil fertility, water manage- to claim the right to food. In Brazil, ment, improved seeds and a complete for example, public prosecutors in the Both the UN’s Millennium Develop- restoration and overhaul of extension Ministério Público (Public Ministry) can ment Goals and the Rome Declaration services. All of the recommendations initiate civil suits against any person or approved by heads of state and gov- from the Hunger Task Force focus on entity, including government agencies, ernment at the World Food Summit investment in poor people and the in- “for the protection of public and social pledge to reduce hunger by half by frastructure and services they need to patrimony, of the environment and of the year 2015. The United Nations escape from the cycle of abject poverty Millennium Project has established a and hunger. Following early action in a special “Hunger Task Force” to promote number of countries in Africa, the Task Views of members of Public immediate action towards achiev- Force intends to put a price tag on the Ministry on contributions to ing that goal. The Task Force includes investments that are needed and to collective rights, Brazil experts on nutrition, agriculture, en- call upon the United Nations and its vironmental sustainability, research, member countries to make the nec- Bodies contributing to collective rights capacity building, business and com- essary funds available. Public Ministry munications, drawn from a wide range Society of public and private institutions. Other agencies The Task Force has carried out Who the hungry are Press research to identify more precisely Smallholder farmers 50% Lawyers who and where hungry people are. Judiciary branch A set of maps highlights the world’s Trade unions “hunger hotspots” and has been used Churches Legislative branch to help define general typologies of Urban Rural Executive branch hunger. Based on available informa- landless poor 20% 20% 0 20 40 60 80 100 tion, the Task Force has concluded that Proportion of public prosecutors who about half of the world’s hungry people believe that the contribution Pastoralists, fishers, is high or very high (%) are from smallholder farming commu- forest-dependent 10% nities, another 20 percent are rural Source: Arantes Source: Hunger Task Force landless and about 10 percent live in The State of Food Insecurity in the World 2004 25

Towards the Summit commitments Factoring the resilience of food systems and communities into the response to protracted crises M ore than 45 million people were in one Tamil village had been forced to and rehabilitation programmes have affected by the 21 most serious abandon traditional paddy cultivation achieved notable success by building on humanitarian crises in 2003. in the lowlands. But they succeeded in these foundations. Most of these crises have persisted for earning considerable cash by growing Strengthening diversity: communi- many years, often triggered by armed rainfed crops in the nearby hills and en- ties that cultivate a variety of crops, conflict and compounded by drought, gaging in wage labour. Similar evidence raise livestock and engage in other floods and the effects of the AIDS of both destruction and resilience has food- and income-generating activities pandemic (see map). Protracted crises been cited in reports from other coun- can often adjust and survive when food disrupt food production and undermine tries ravaged by war, natural disasters production and social institutions are food security as they drive people from and HIV/AIDS. disrupted. In the drought-prone west- their homes, strike at the foundations In recent years, recognition has ern Sudan, for example, communities of their livelihoods and erode the social grown that responses to chronic and traditionally devoted most of their land fabric of families, communities and protracted crises must go beyond the to crops and allocated only a small countries. repeated mobilization of emergency portion for grazing livestock. Food and Frequently, however, farmers and support when humanitarian conditions income from their herds helped them communities show remarkable resil- deteriorate. Relief and rehabilitation survive the increasingly frequent years ience in the face of such disasters. As efforts are far more effective if they when drought destroyed their crops. Angola neared the end of almost three build on the foundations of resilience To enhance their capacity to cope with decades of civil war, for example, a rather than relying exclusively on injec- recurring crises, a project was designed broad review of agricultural recovery tions of external inputs, technology and to build on this diversity by encouraging and development options reported that institutions. a significant shift of resources from in many areas traditional village institu- cropping to grazing. At the conclusion tions remained largely intact, demon- Resilience, relief and rehabilitation of the project, the proportion of land strating a sustained capacity to manage allocated for grazing had increased land allocation and small-scale irriga- Studies have identified several keys to from less than 30 percent to more than tion systems. In a war-torn area of Sri the resilience of farming systems and 80 percent (see graph, next page). The Lanka, a case study found that farmers communities. And emergency relief shift in land use was accompanied by a wide range of other activities, including rehabilitation of rangelands, improved Location and duration of protracted food emergencies, 2004 access to credit and improved vet- erinary services, all of which fostered greater diversity, increased resilience and improved food security. Supporting local institutions: during protracted crises, government and market institutions often collapse, leaving communities to fend for themselves. Their ability to do so often hinges on the strength and adaptability of traditional support networks and communities. Local seed markets have been recognized as responsive Consecutive years including 2004 institutions that can fuel both resilience during crises and rehabilitation 5–8 years 12–14 years 9–11 years > 15 years afterwards. Agencies engaged in Source: FAO emergency relief have found that 26 The State of Food Insecurity in the World 2004

providing vouchers that can be employed Farmer Field Schools (FFS). and promoting cassava production have redeemed at local seed markets is A project in Zimbabwe, for example, been emphasized in the reconstruction often far more effective than distribut- used participatory classes conducted campaign as keys to current progress ing seeds purchased on commercial by local farmers to teach AIDS widows and future resilience. markets. Seed fairs give farmers access how to produce organic cotton. Tradi- Reconstruction efforts have also to a much wider selection of crops and tionally, cotton had been considered a tapped local knowledge and enlisted varieties suited to local conditions. At “man’s crop”, and many of the women traditional village work groups to help seed fairs organized by Catholic Relief could not afford the expensive inputs identify, multiply and distribute cher- Services in five East African countries, required to grow conventional cotton. ished local seed varieties. FFS are be- for example, farmers were able to ex- Growing organic cotton reduced both ing extended to every rural household change their vouchers for an average input costs and labour requirements in the country as a way to spur innova- of seven different crops and around ten substantially. Although average yields tion and foster participatory, commu- varieties of each crop. In addition, since fell below those of conventional farm- nity institutions. project funds are not spent on seeds, 65 ers, saving an average of US$48 per A growing body of experience con- to 80 percent of the money remains in hectare spent on pesticides allowed firms the importance of strengthening the community. And much of it goes to the women to reap significantly higher the resilience of societies and food women. Half the seed sellers at fairs in profits (see graph). systems before crises erupt and of Kenya, the Sudan and Uganda and more Elements of resilience are serving factoring resilience into responses to than 80 percent in the United Republic as important building blocks in efforts protracted crises, based on: of Tanzania were women. to reconstruct Sierra Leone’s rural a dynamic understanding of commu- Enabling adaptation and building economy, shattered by over a decade of nity opportunities and capacities; on local knowledge: traditional insti- civil war, and to reach the nation’s goal a participatory approach to defining tutions and knowledge often provide of eliminating hunger by the year 2007. community priorities; a foundation for resilience. But crisis When availability of grains fell sharply strategies and policies that address conditions may also present unprece- during the war, for example, farmers communities’ specific long-term food dented challenges that call for creative fell back on crops that required fewer security concerns; and responses. As a way of reinforcing local inputs and did not depend on access mechanisms to ensure that food knowledge and building on farmers’ to distant markets. Production of cas- security assessments, programme capacity to adapt and reorganize, a sava and other tubers increased rapidly monitoring and impact evaluation number of projects have successfully (see graph). Maintaining this diversity take account of the resilience of food Change in land use increases Organic and conventional cotton, Availability of tubers and cereals resilience to drought, Sudan Lower Guruve, Zimbabwe during civil war in Sierra Leone Land use (%) Organic Conventional Per capita availability (kg/yr) 100 Cropland Average yield (kg/ha) Average profit (US$/ha) 100 Grazing land 1 000 120 Cereals 80 80 800 100 60 80 8 60 600 Tubers 40 60 6 40 400 40 4 20 20 200 20 2 0 0 0 0 0 Before project After project 1998 1999 2000 1998 1999 2000 1991 1992 1993 1994 1995 1996 1997 1998 Source: Zakieldin, AIACC Source: LEISA Source: FAO The State of Food Insecurity in the World 2004 27

Towards the Summit commitments Education for rural people and food security T he vast majority of the world’s lack of education are facets of extreme for rural girls averaged only 58 percent, 852 million chronically under- poverty. Hunger, malnutrition and food compared to 63 percent for rural boys nourished people live in rural insecurity erode cognitive abilities and and over 75 percent for urban children. areas in the developing world. So do reduce school attendance. Conversely, As a result, around two thirds of the most of the 860 million illiterate adults illiteracy and lack of education reduce illiterate people in the developing world (a majority of whom are women) and the earning capacity and contribute directly are women and the gender gap is sig- 130 million children (mainly girls) who to hunger and poverty. nificantly larger in rural areas. do not go to school. The fact that hun- School attendance and literacy rates Hunger and malnutrition deter chil- ger, illiteracy and lack of schooling af- are particularly low for women and dren from going to school and stunt fect many of the same areas and people girls in rural areas (see graph). In 50 their learning capacity when they do is no coincidence. Nor does it merely developing countries for which data are attend. A study in rural Pakistan found reflect the fact that both hunger and available, primary school attendance that a relatively minor improvement in nutrition would increase the likelihood of starting school by 4 percent Correspondence of high rates of illiteracy and undernourishment for boys and 19 percent for girls. Low birthweight, protein energy malnutrition, iron deficiency anaemia and iodine deficiency have all been linked to cognitive deficiencies that reduce children’s ability to learn. Iodine deﬁciency, for example, affects an estimated 1.6 billion people worldwide and has been associated with an average 13.5 point reduction in IQ for a population. Lack of education reduces productivity and earning capacity and increases vulnerability to hunger and extreme poverty. Research shows that a farmer Adult illiteracy > 30% Undernourishment > 20% with four years of elementary education Adult illiteracy > 30% and undernourishment > 20% is, on average, 8.7 percent more produc- Source: FAO tive than a farmer with no education. When complementary inputs such as fertilizers, new seeds or farm machinery Rural and urban literacy, 1990– Literacy and prevalence of rural are available, the productivity increase 1995 (22 countries) child undernutrition rises to 13 percent. % literacy % literacy Female Male 100 80 Improving education to feed both minds and bodies 80 60 60 40 Improving education can be one of the 40 most effective ways to reduce hunger 20 20 and malnutrition. Malnutrition rates 0 0–19% 20–34% 35% decline with increased literacy, espe- 0 Female Male Female Male Underweight rural children under cially female literacy. Higher rates of Urban Rural 5 years old literacy among rural women are also Source: USAID DHS Source: FAO associated with increased enrolment of 28 The State of Food Insecurity in the World 2004

girls in primary school and lower rates make it more accessible and relevant. an evaluation by the International Food of malnutrition (see graph). Almost half of the rural schools in Policy Research Institute found gains in Education is also the front line Colombia, for example, have adopted both education and nutrition. Primary against HIV/AIDS. A recent study in the Escuela Nueva (New School) model. school attendance had increased, es- Uganda found that people who ﬁn- These schools emphasize participatory pecially for girls. School absences and ished primary school were only half as learning and employ a curriculum that drop-out rates had declined. And calorie likely to contract HIV – and those with combines core national content with and protein consumption among parti- a secondary education only 15 percent local modules relevant to the culture cipating families had risen significantly. as likely – as those who received little and needs of rural people. Communities Mexico’s Programa de Educación, or no schooling. and parents are actively engaged in the Salud y Alimentación (PROGRESA) pro- The Indian state of Kerala is often schools. Drop-out rates are far lower vides cash transfers to more than 2.6 cited as a prime example of the virtuous and third-grade scores in Spanish and million poor, rural families as long as circle of benefits from investments in mathematics are significantly higher they send their children to school. education and nutrition. Since shortly than in traditional schools. Benefits are higher for older children after independence, successive govern- The Indian state of Madhya Pradesh and for girls, who are more likely to drop ments in Kerala have made education pledged to build a primary school out prior to secondary school. The pro- a top priority. Special attention has been building within 90 days for any rural gramme also provides nutritional sup- given to girls and women in rural areas. community that provided space and plements for infants and small children The investment has paid off. Although hired a qualiﬁed teacher. Today, all in participating families. Kerala is not one of India’s wealthier children of primary school age in the After its first three years in operation, states, it ranks first in female literacy state are enrolled in school. enrolment for the critical transition and school enrolment by a wide margin. Programmes that take direct aim year from primary to secondary school Kerala also boasts the lowest rate of simultaneously at lack of education increased by 20 percent for girls and malnutrition among children and an and malnutrition have achieved notable 10 percent for boys. Simulation of the infant mortality rate that is a fifth of that gains in several countries. impact over a longer period shows that, of the country as a whole (see graph). In Bangladesh’s Food for Education on average, children would complete A number of countries have recog- programme, families receive food if they 0.6 more grades in school and 19 nized the importance of education for send their children to school instead of percent more of them would attend rural people and adopted policies to putting them to work. After eight years, some secondary grades (see graph). Child undernutrition and rural Rural education and nutrition in PROGRESA impact on enrolment net enrolment for girls* Kerala and India as a whole Simulated distribution at age 14 Girls enrolled in school Rural areas Kerala India Proportion at With PROGRESA Without PROGRESA % Children underweight Female grade level (%) WithoutPROGRESA With PROGRESA 100 literacy 40 80 Female enrolment 30 60 Child 20 40 underweight 20 Infant 10 mortality* 0 < 50% 50–79% 80% 0 20 40 60 80 100 % 0 Rural female literacy Primary Grade Grade Grade Grade * 18 countries grouped by female literacy * Infant mortality = per 1000 live births only 7 8 9 10 Source: UNICEF; WHO; UNESCO; FAO Source: UNDP; Govt. of India Planning Commission Source: Behrman, Sengupta and Todd The State of Food Insecurity in the World 2004 29

Towards the Summit commitments Rice and food security R ice is central to food security in and a steep decline in prices. High- the 1960s and 1970s. Since then con- the world. It is the main source yielding varieties introduced during sumption of other foods has increased of calorie intake for about half of the Green Revolution gave a strong and the relative contribution of rice has the world’s population and the predo- boost to rice production. Between 1961 fallen. In parts of Africa, the Near East minant staple food for 34 countries in and 1990, global production more than and Latin America and the Caribbean, on Asia, Latin America and Africa (see doubled, from 216 million to 518 million the other hand, rice consumption has map). In several Asian countries, people tonnes. Yields increased from less than increased significantly, both in volume depend on rice for more than two thirds 1 900 kilograms per hectare to more and as a proportion of total calorie of the calories and 60 percent of the than 3 500. Real prices fell by more than intake (see graph). Rice is now the protein in their diets. 50 percent (see graph). most rapidly growing source of food in Growing and processing rice is also The increased availability and affor- Africa. the main source of employment and in- dability of rice contributed to a rapid come for an estimated 2 billion people. decline in the number of people suffer- Meeting the challenge About 90 percent of the world’s rice is ing from hunger in countries where rice produced and consumed by small- is the main staple food. In Asia, annual The International Rice Research scale farmers in developing nations. per capita rice consumption increased Institute estimates that by the year In many of the poorest countries in by more than 20 kilograms and the 2025 the number of people who depend Asia, 60 percent of the cropland is proportion of undernourished declined on rice as their main source of food devoted to growing rice and the poor- from almost 40 percent to 16 percent. will rise by more than 40 percent, est segments of the population spend from 2.7 billion to 3.9 billion. Meeting between 20 and 40 percent of their Changing consumption patterns this demand will require government income on rice. policies and agricultural practices to Over the past four decades, rice con- support sustainable increases in rice Higher yields, lower prices sumption patterns in different regions production. have evolved and converged. In Asia, Governments must calibrate farm Over the past 40 years, advances in where rice has been the mainstay of and trade policies to keep rice both technology and policy changes have diets for centuries, per capita consum- affordable for poor consumers and pro- fuelled rapid gains in rice production ption of rice increased rapidly during fitable for small farmers. In Indonesia, Contribution of rice to calorie intake, 1999–2001 World rice prices, 1950–1998 1997 US$ Trend 1950–1981, 1985–1998 2 000 1 600 1 200 800 400 Proportion of calorie intake (%) 0 1950 1958 1966 1974 1982 1990 1998 5–10 20–30 40–50 10–20 30–40 50 Source: FAO Source: IRRI/FOB Bangkok 30 The State of Food Insecurity in the World 2004

for example, the State Logistics Agency those achieved in farmers’ fields. FAO Empowering small farmers (Bulog) establishes a guaranteed floor estimates that yield gains of 1 percent price at which it will purchase rice from per year will be required to meet de- Technological advances can boost yields farmers and distributes more than mand without pushing prices higher. and government policies can help cre- 2 million tonnes of subsidized rice to Hybrid rice varieties offer one ate a favourable environment for pro- poor households through a targeted proven way to boost production. Such ducing and marketing rice. But long- social safety net programme. varieties typically yield about 15 to 20 term success in improving food security In West Africa, several governments percent more than even the best of the depends on the ability of millions of have taken steps to increase production. high-yielding varieties. Since breeding small farmers to benefit from these In Mali, the rice sector has grown the first successful hybrid in 1974, gains and increase rice production as rapidly over the past decade. Price China has increased production by part of sustainable, diversified agricul- liberalization has encouraged farmers almost 50 percent, even while the area tural systems. and merchants to invest resources planted to rice has shrunk by almost One approach that has proven suc- and expand production. Proliferation of one quarter. cessful at engaging and empowering small mills at the village level has Breakthroughs in rice breeding have small farmers has been the use of reduced processing costs significantly. also yielded major gains in West Africa. Farmer Field Schools (FFS). Between And the government has increased pub- The West Africa Rice Development 1990 and 2000, more than 2 million lic investments in infrastructure. Now Association succeeded in crossing Asian rice farmers participated in FFS. Mali, which boasts large areas suitable hardy African rice species with higher- They learned how to reduce their use for irrigated rice production, aims to yielding species imported from Asia, of pesticides and how to make better become “the rice basket of the Sahel” producing what has become known and more sustainable use of fertil- by increasing output from 735 000 as NERICA (New Rice for Africa). With izer and water. Their lessons translated tonnes to 4.5 million by the year 2010. a minimal increase in fertilizer, these into reduced costs, increased yields and new varieties can increase yields by higher incomes (see graph). Closing the yield gap as much as 150 percent in upland In Sri Lanka, for example, farmers areas and rainfed lowlands. Nigeria who participated in FFS reduced pest- With limited areas available to ex- has emphasized use of NERICA as a icide use by more than 80 percent while pand rice production, efforts to meet key element in its drive to increase increasing yields by over 20 percent. increased demand will depend on production from an average of 3 mil- With substantial savings on pesticides reducing the “yield gap” between yields lion tonnes in 2000–2002 to about 15 and higher yields, incomes from rice demonstrated at research stations and million in 2007. production more than doubled. Annual rice consumption per capita by region, 1961–2001 Farmer Field Schools reduce Kg/capita/year pesticide use and improve yields 100 FFS-trained farmers Yield 1961 1971 1981 1991 2001 vs control (%) Pesticide use 80 40 20 60 0 -20 40 -40 -60 20 -80 -100 0 ia h dia a Asia/Pacific Near East/ Sub-Saharan Latin America/ Low-income food- es es bo an k on lad m iL North Africa Africa Caribbean deficit countries Ind ng Ca Sr Source: FAO Ba Source: van den Berg The State of Food Insecurity in the World 2004 31

Towards the Summit commitments The way ahead: scaling up action to scale down hunger T he time that is left to reach the This means that within the twin-track beneﬁts throughout poor rural com- World Food Summit (WFS) goal framework we must give priority over munities. When small farmers have is getting short. The distance to the next ten years to actions that will more money to spend, they tend to be travelled remains long. It is time to have the most immediate impact on the spend it locally on labour-intensive step up the pace, to start acting aggres- food security of millions of vulnerable goods and services that come from sively on what we know can and must people. Where resources are scarce, the rural non-farm sector, boosting be done. we must focus on low-cost approaches the incomes of the rural population as Although progress has lagged so far, that empower small-scale farmers a whole, including landless labourers the WFS target is both attainable and to raise production in ways that will who make up a large proportion of the affordable. We have ample evidence that enhance food consumption for their hungry and poor in many countries. rapid progress can be made by applying families and communities. At the same a twin-track strategy that attacks both time, we must rapidly expand targeted Strengthen safety nets and transfer the causes and the consequences of safety nets. programmes extreme poverty and hunger (see diagram). Track one includes interventions Improve the productivity, nutrition and With the need so urgent and the time to improve food availability and incomes livelihoods of the poor so short, the quickest way to reduce for the poor by enhancing their produc- hunger may often be to provide direct tive activities. Track two features tar- The vast majority of the world’s hungry assistance to the neediest households geted programmes that give the most people live in rural areas and depend on to ensure that they can put food on needy families direct and immediate agriculture both for their incomes and their tables. In order to make a large access to food. their food. Even modest gains in output and enduring dent in hunger, we must To meet the WFS goal, we must by very large numbers of small farmers, scale up safety net and cash transfer now translate the twin-track approach when translated into improved diets, programmes and make sure that they into large-scale programmes that can would have a major impact in reducing target the most vulnerable groups, be adopted in countries where hunger rural hunger and poverty. including pregnant and nursing moth- is widespread and resources are ex- Improving the productivity of small ers, infants and small children, school tremely limited. farmers has a ripple effect that spreads children, unemployed urban youth and Accelerating a twin-track strategy to eliminate hunger Track 1 – strengthen productivity and incomes Linkages – maximizing synergy Track 2 – provide direct access to food Low-cost, simple technology Alliances against hunger Mother and infant feeding (water management, use of green manures, (including nutritional supplements) crop rotation, agroforestry) Local food procurement for safety nets School meals and school gardens Support to rural organizations Rural infrastructure (roads, electricity, etc.) Unemployment and pension benefits Primary health care, reproductive health Improved irrigation and soil fertility and HIV/AIDS prevention Food-for-work and food-for-education Natural resource management Asset redistribution (including land reform) (including forestry and fisheries) Targeted conditional cash transfers Education for rural people, especially women Market and private sector development Soup kitchens and factory canteens Clean drinking water Food safety and quality Food banks Legal reforms (including the Right to Food) Agricultural research, extension and training Emergency rations World Food Summit Goal Source: FAO 32 The State of Food Insecurity in the World 2004

the elderly, disabled and sick, including increase production and improve target- The Presidents of Chile, France and people living with HIV/AIDS. ing of social safety nets. Spain and UN Secretary-General Kofi Safety nets can also be woven with Sierra Leone has made FFS a key el- Annan have joined President Lula to strands that contribute to develop- ement in mobilizing a community-based forge the “Quintet against Hunger”, mental goals. Food banks and school drive to eradicate hunger within five which is considering a variety of alterna- feeding programmes can often be de- years. By September 2006, more than tive funding mechanisms. signed to boost incomes, improve food 200 000 of the country’s 450 000 farm- The United Kingdom has proposed security and stimulate development in ers are expected to have been enrolled one such mechanism – an Interna- vulnerable rural communities by buying in self-financing FFS focusing on food tional Finance Facility (IFF) designed food locally from small-scale farmers. security (see graph). “to ‘frontload’ aid to help meet the Mil- Similarly, programmes that provide food lennium Development Goals”. The IFF to people who attend education and Scale up funding and commitment would use bonds backed by long-term training programmes can improve both commitments from donor countries to their nutritional status and their em- Scaling up direct actions to reach the provide US$50 billion a year in develop- ployment prospects. WFS goal, while simultaneously increas- ment assistance to the world’s poorest ing long-term investments in sustainable countries up to 2015 (see diagram). Empower rural communities agriculture and rural development, will On 20 September 2004, more than also require scaling up resources and 100 countries participated in a one-day Rural communities themselves are of- political commitment. Fortunately sev- World Leaders Summit on Hunger held ten best able to diagnose the local root eral countries have taken the lead in at UN Headquarters in New York. At its causes of chronic hunger and to iden- mobilizing political will and pressing for conclusion, they endorsed a campaign tify solutions that will benefit the most innovative funding mechanisms. to raise an additional US$50 billion a community members with the least re- Calling hunger “the worst of all year to fight hunger and declared: liance on external resources. weapons of mass destruction”, Presi- “The greatest scandal is not that hun- Experience has shown that Farmer dent Luiz Inácio Lula da Silva of Brazil ger exists but that it persists even when Field Schools (FFS) and similar ap- has proposed taxes on the international we have the means to eliminate it. It is proaches to adult education and com- arms trade and on some financial trans- time to take action. munity empowerment can help farmers actions carried out in “fiscal paradises”. “Hunger cannot wait.” Scaling up Farmer Field Schools Structure of the International Finance Facility in Sierra Leone Number of farmers trained (thousands) Donor countries International capital markets 200 A B INTERNATIONAL Bonds 150 FINANCE FACILITY Donors C (IFF) 100 50 Approved disbursement Approved disbursement Approved disbursement mechanism mechanism mechanism 0 End July Sept. Sept. 2003* 2004 2004 2006 (projected) Recipient countries * < 100 trainers Source: FAO Source: HM Treasury/DFID The State of Food Insecurity in the World 2004 33

Tables Table 1. PREVALENCE OF UNDERNOURISHMENT in developing countries and countries in transition DEVELOPING WORLD Total population Number of people undernourished Proportion of undernourished Region/subregion/country in total population [undernourishment category] 1990–1992 1995–1997 2000–2002 1990–1992 1995–1997 2000–2002 1990–1992 1995–1997 2000–2002 millions millions % DEVELOPING WORLD 4 058.7 4 431.1 4 796.7 823.8 796.7 814.6 20 18 17 ASIA AND THE PACIFIC* 2 815.2 3 039.5 3 256.1 569.2 509.5 519.0 20 17 16 EAST ASIA 1 241.5 1 307.2 1 364.5 198.8 155.1 151.7 16 12 11 China [3] 1 175.7 1 237.8 1 292.5 193.5 145.6 142.1 16 12 11 Dem. People’s Rep. of Korea [5] 20.3 21.6 22.4 3.7 7.6 8.1 18 35 36 Mongolia [4] 2.3 2.4 2.5 0.8 1.1 0.7 34 46 28 Rep. of Korea [1] 43.3 45.4 47.1 0.8 0.8 0.7 — — — SOUTHEAST ASIA 444.2 484.7 522.8 78.4 66.3 65.5 18 14 13 Cambodia [4] 10.1 11.8 13.5 4.3 5.2 4.4 43 44 33 Indonesia [3] 185.2 200.1 214.3 16.4 11.2 12.6 9 6 6 Lao People’s Dem. Rep. [4] 4.2 4.8 5.4 1.2 1.3 1.2 29 28 22 Malaysia [1] 18.3 20.9 23.5 0.5 0.5 0.6 3 — — Myanmar [3] 41.2 44.8 48.2 4.0 3.2 2.8 10 7 6 Philippines [4] 62.5 69.9 77.1 16.2 16.3 17.2 26 23 22 Thailand [4] 55.1 58.5 61.6 15.2 12.0 12.2 28 20 20 Viet Nam [3] 67.5 74.0 79.2 20.6 16.7 14.7 31 23 19 SOUTH ASIA 1 125.3 1 242.7 1 363.3 291.3 287.3 301.1 26 23 22 Bangladesh [4] 112.1 126.3 140.9 39.2 50.4 42.5 35 40 30 India [4] 863.3 948.6 1 033.3 215.8 203.0 221.1 25 21 21 Nepal [3] 19.1 21.4 24.1 3.9 5.6 4.0 20 26 17 Pakistan [4] 113.7 128.4 146.3 27.7 23.8 29.3 24 19 20 Sri Lanka [4] 17.0 17.9 18.8 4.8 4.6 4.1 28 26 22 LATIN AMERICA AND THE CARIBBEAN 443.4 482.5 521.2 59.5 54.8 52.9 13 11 10 NORTH AMERICA 84.8 92.7 100.5 4.6 5.0 5.2 5 5 5 Mexico [3] 84.8 92.7 100.5 4.6 5.0 5.2 5 5 5 CENTRAL AMERICA 28.8 32.7 36.9 5.0 6.5 7.4 17 20 20 Costa Rica [2] 3.2 3.6 4.0 0.2 0.2 0.2 6 5 4 El Salvador [3] 5.2 5.8 6.3 0.6 0.8 0.7 12 14 11 Guatemala [4] 9.0 10.3 11.7 1.4 2.2 2.8 16 21 24 Honduras [4] 5.0 5.8 6.6 1.1 1.2 1.5 23 21 22 Nicaragua [4] 3.9 4.6 5.2 1.2 1.5 1.4 30 33 27 Panama [4] 2.5 2.7 3.0 0.5 0.6 0.8 21 23 26 THE CARIBBEAN 28.5 30.2 31.7 7.8 8.9 6.7 27 30 21 Cuba [2] 10.7 11.0 11.2 0.8 1.9 0.4 8 18 3 Dominican Rep. [4] 7.2 7.8 8.5 1.9 2.0 2.1 27 26 25 Haiti [5] 7.0 7.6 8.1 4.6 4.5 3.8 65 59 47 Jamaica [3] 2.4 2.5 2.6 0.3 0.3 0.3 14 11 10 Trinidad and Tobago [3] 1.2 1.3 1.3 0.2 0.2 0.2 13 15 12 SOUTH AMERICA 301.3 327.0 352.2 42.0 34.4 33.6 14 11 10 Argentina [1] 33.0 35.2 37.5 0.7 0.4 0.6 — — — Bolivia [4] 6.8 7.6 8.5 1.9 1.9 1.8 28 25 21 Brazil [3] 151.2 162.8 174.0 18.5 16.5 15.6 12 10 9 Chile [2] 13.3 14.4 15.4 1.1 0.7 0.6 8 5 4 Colombia [3] 35.7 39.3 42.8 6.1 5.1 5.7 17 13 13 Ecuador [2] 10.5 11.6 12.6 0.9 0.6 0.6 8 5 4 Guyana [3] 0.7 0.7 0.8 0.2 0.1 0.1 21 12 9 Paraguay [3] 4.3 5.0 5.6 0.8 0.7 0.8 18 13 14 Peru [3] 22.2 24.3 26.4 9.3 4.6 3.4 42 19 13 Suriname [3] 0.4 0.4 0.4 0.1 0.0 0.0 13 10 11 Uruguay [2] 3.1 3.2 3.4 0.2 0.1 0.1 6 4 4 Venezuela [3] 20.0 22.4 24.8 2.3 3.5 4.3 11 16 17 34 The State of Food Insecurity in the World 2004

Table 1 cont. PREVALENCE OF UNDERNOURISHMENT in developing countries and countries in transition DEVELOPING WORLD Total population Number of people undernourished Proportion of undernourished Region/subregion/country in total population [undernourishment category] 1990–1992 1995–1997 2000–2002 1990–1992 1995–1997 2000–2002 1990–1992 1995–1997 2000–2002 millions millions % NEAR EAST AND NORTH AFRICA* 322.8 362.6 399.4 24.8 34.9 39.2 8 10 10 NEAR EAST* 202.5 230.2 255.0 19.4 29.2 33.1 10 13 13 Iran, Islamic Rep. of [2] 58.0 63.3 67.3 2.1 2.1 2.7 4 3 4 Jordan [3] 3.4 4.4 5.2 0.1 0.3 0.4 4 7 7 Kuwait [3] 2.1 1.8 2.3 0.5 0.1 0.1 23 5 5 Lebanon [2] 2.8 3.2 3.5 0.1 0.1 0.1 — 3 3 Saudi Arabia [2] 17.1 19.5 22.8 0.7 0.8 0.8 4 4 3 Syrian Arab Rep. [2] 13.1 15.0 17.0 0.7 0.6 0.6 5 4 4 Turkey [2] 58.7 64.1 69.3 1.0 1.5 1.8 — — 3 United Arab Emirates [1] 2.1 2.6 2.9 0.1 0.1 0.1 4 — — Yemen [5] 12.5 15.7 18.7 4.2 5.7 6.7 34 36 36 NORTH AFRICA 120.4 132.4 144.4 5.4 5.7 6.1 4 4 4 Algeria [3] 25.6 28.4 30.8 1.3 1.7 1.7 5 6 5 Egypt [2] 57.0 62.8 69.1 2.5 2.2 2.4 4 3 3 Libyan Arab Jamahiriya [1] 4.4 4.8 5.3 0.0 0.0 0.0 — — — Morocco [3] 25.0 27.3 29.6 1.5 1.7 2.0 6 6 7 Tunisia [1] 8.4 9.1 9.6 0.1 0.1 0.1 — — — SUB-SAHARAN AFRICA* 477.3 546.4 620.0 170.4 197.4 203.5 36 36 33 CENTRAL AFRICA 63.4 73.6 82.0 22.7 38.8 45.2 36 53 55 Cameroon [4] 12.0 13.8 15.4 4.0 4.6 3.9 33 33 25 Central African Rep. [5] 3.0 3.4 3.8 1.5 1.7 1.6 50 51 43 Chad [4] 6.0 6.9 8.1 3.5 3.4 2.7 58 49 34 Congo [5] 2.6 3.0 3.5 1.4 1.8 1.3 54 59 37 Dem. Rep. of the Congo [5] 38.8 45.3 49.9 12.2 27.2 35.5 32 60 71 Gabon [3] 1.0 1.1 1.3 0.1 0.1 0.1 10 8 6 EAST AFRICA* 167.8 190.8 217.7 76.4 88.7 86.2 46 46 40 Burundi [5] 5.7 6.1 6.4 2.7 3.8 4.4 48 63 68 Eritrea [5]** na 3.3 3.9 na 2.2 2.8 na 68 73 Ethiopia [5]** na 59.0 67.3 na 35.8 31.3 na 61 46 Kenya [4] 24.4 28.1 31.1 10.7 10.8 10.3 44 38 33 Rwanda [5] 6.4 5.5 8.0 2.8 2.8 3.0 44 52 37 Sudan [4] 25.5 28.7 32.2 8.0 6.6 8.5 32 23 27 Uganda [3] 17.9 20.9 24.2 4.2 5.4 4.6 24 26 19 United Rep. of Tanzania [5] 27.0 31.7 35.6 9.9 15.8 15.6 37 50 44 SOUTHERN AFRICA 71.0 80.6 90.1 34.1 36.5 35.7 48 45 40 Angola [5] 9.6 11.2 12.8 5.6 5.4 5.1 58 49 40 Botswana [4] 1.4 1.6 1.7 0.3 0.4 0.6 23 27 32 Lesotho [3] 1.6 1.7 1.8 0.3 0.2 0.2 17 14 12 Madagascar [5] 12.3 14.2 16.4 4.3 5.7 6.0 35 40 37 Malawi [4] 9.6 10.3 11.6 4.8 4.1 3.8 50 40 33 Mauritius [3] 1.1 1.1 1.2 0.1 0.1 0.1 6 6 6 Mozambique [5] 13.9 16.4 18.2 9.2 9.5 8.5 66 58 47 Namibia [4] 1.5 1.7 1.9 0.5 0.6 0.4 35 36 22 Swaziland [3] 0.9 1.0 1.1 0.1 0.2 0.2 14 23 19 Zambia [5] 8.4 9.6 10.6 4.0 4.6 5.2 48 48 49 Zimbabwe [5] 10.7 11.9 12.7 4.9 5.6 5.6 45 47 44 WEST AFRICA 175.1 201.4 230.3 37.2 33.5 36.4 21 17 16 Benin [3] 4.8 5.6 6.4 1.0 0.9 0.9 20 17 15 Burkina Faso [3] 9.2 10.6 12.3 1.9 2.0 2.3 21 19 19 Côte d’Ivoire [3] 12.9 14.7 16.1 2.3 2.3 2.2 18 16 14 Gambia [4] 1.0 1.2 1.4 0.2 0.4 0.4 22 31 27 Ghana [3] 15.7 17.9 20.0 5.8 3.2 2.5 37 18 13 The State of Food Insecurity in the World 2004 35

Tables Table 1 cont. PREVALENCE OF UNDERNOURISHMENT in developing countries and countries in transition DEVELOPING WORLD Total population Number of people undernourished Proportion of undernourished Region/subregion/country in total population [undernourishment category] 1990–1992 1995–1997 2000–2002 1990–1992 1995–1997 2000–2002 1990–1992 1995–1997 2000–2002 millions millions % Guinea [4] 6.4 7.5 8.2 2.5 2.3 2.1 39 31 26 Liberia [5] 2.1 2.3 3.1 0.7 1.0 1.4 34 42 46 Mali [4] 9.3 10.6 12.3 2.7 3.4 3.6 29 32 29 Mauritania [3] 2.1 2.4 2.7 0.3 0.3 0.3 15 11 10 Niger [4] 7.9 9.4 11.1 3.2 3.9 3.8 41 42 34 Nigeria [3] 88.7 102.7 117.8 11.8 8.9 11.0 13 9 9 Senegal [4] 7.5 8.5 9.6 1.8 2.2 2.3 23 25 24 Sierra Leone [5] 4.1 4.1 4.6 1.9 1.8 2.3 46 44 50 Togo [4] 3.5 4.0 4.7 1.2 1.0 1.2 33 25 26 COUNTRIES IN TRANSITION Total population Number of people undernourished Proportion of undernourished Region/subregion/country in total population [undernourishment category] 1993–1995 2000–2002 1993–1995 2000–2002 1993–1995 2000–2002 millions millions % COUNTRIES IN TRANSITION 413.6 409.8 23.3 28.3 6 7 COMMONWEALTH OF INDEPENDENT STATES 284.5 281.7 19.0 24.1 7 9 Armenia [4] 3.4 3.1 1.8 1.1 52 34 Azerbaijan [3] 7.7 8.2 2.6 1.2 34 15 Belarus [1] 10.3 10.0 0.1 0.2 — — Georgia [4] 5.4 5.2 2.1 1.4 39 27 Kazakhstan [3] 16.7 15.5 0.2 2.0 — 13 Kyrgyzstan [3] 4.5 5.0 0.9 0.3 21 6 Rep. of Moldova [3] 4.4 4.3 0.2 0.5 5 11 Russian Fed. [2] 148.4 144.9 6.4 5.2 4 4 Tajikistan [5] 5.7 6.1 1.2 3.7 21 61 Turkmenistan [3] 4.1 4.7 0.5 0.4 13 9 Ukraine [2] 51.7 49.3 1.2 1.5 — 3 Uzbekistan [4] 22.3 25.3 1.7 6.6 8 26 BALTIC STATES 7.6 7.2 0.4 0.2 5 2 Estonia [3] 1.5 1.4 0.1 0.1 9 5 Latvia [2] 2.5 2.4 0.1 0.1 3 4 Lithuania [1] 3.6 3.5 0.2 0.0 4 — EASTERN EUROPE 121.4 120.9 3.9 4.0 3 3 Albania [3] 3.2 3.1 0.2 0.2 5 6 Bosnia and Herzegovina [3] 3.6 4.1 0.3 0.3 9 8 Bulgaria [3] 8.5 8.0 0.7 0.8 8 11 Croatia [3] 4.5 4.4 0.7 0.3 16 7 Czech Rep. [1] 10.3 10.3 0.2 0.2 — — Hungary [1] 10.2 10.0 0.1 0.0 — — TFYR Macedonia [3] 2.0 2.0 0.3 0.2 15 11 Poland [1] 38.5 38.6 0.3 0.3 — — Romania [1] 22.8 22.4 0.4 0.2 — — Serbia and Montenegro [3] 10.5 10.5 0.5 1.1 5 11 Slovakia [3] 5.3 5.4 0.2 0.3 4 5 Slovenia [1] 2.0 2.0 0.1 0.0 3 — For notes on Table 1, please see page 39. 36 The State of Food Insecurity in the World 2004

Table 2. FOOD AVAILABILITY, DIET DIVERSIFICATION, CHILD MORTALITY, CHILD NUTRITIONAL STATUS, EDUCATION AND URBANIZATION in developing countries, classified by category of prevalence of undernourishment CATEGORY OF PREVALENCE Food Diet Child Child nutritional Education Urbanization OF UNDERNOURISHMENT availability diversification mortality status in total population 2000–2002 Dietary energy Share of non-starchy Under-five Under-five Literacy Urban share in Country supply (DES) food in total DES mortality rate underweight rate total population 1990–1992 2000–2002 1979–1981 2000–2002 1990 2002 1990 2000 1990 2003 1990 2000 kcal/day/person % per 1 000 live births % % % LESS THAN 2.5% UNDERNOURISHED Argentina 2 990 3 070 67 65 28 19 2 5 98 99 87 89 Libyan Arab Jamahiriya 3 280 3 320 54 51 42 19 na 5 91 97 80 85 Malaysia 2 820 2 890 48 53 21 8 25 20 95 98 50 62 Rep. of Korea 3 000 3 060 32 51 9 5 na na 100 100 74 80 Tunisia 3 150 3 270 42 47 52 26 10 4 84 95 58 63 United Arab Emirates 2 930 3 200 70 62 14 9 na na 85 92 83 85 2.5 TO 4% UNDERNOURISHED Chile 2 610 2 850 51 56 19 12 2 1 98 99 83 86 Costa Rica 2 710 2 860 62 65 17 11 3 na 97 99 54 59 Cuba 2 720 3 000 58 63 13 9 na 4 99 100 74 75 Ecuador 2 510 2 740 65 66 57 29 17 14 96 98 55 60 Egypt 3 200 3 340 36 35 104 39 10 11 61 72 43 42 Iran, Islamic Rep. of 2 980 3 070 39 38 72 41 na 11 86 95 56 64 Lebanon 3 160 3 160 58 62 37 32 na 3 92 96 83 87 Saudi Arabia 2 770 2 840 52 50 44 28 na na 85 94 78 86 Syrian Arab Rep. 2 830 3 040 51 54 44 28 12 7 80 89 49 50 Turkey 3 490 3 360 45 47 78 41 10 8 93 97 59 65 Uruguay 2 660 2 830 62 59 24 15 4 na 99 99 89 92 5 TO 19% UNDERNOURISHED Algeria 2 920 2 990 41 41 69 49 9 6 77 91 51 57 Benin 2 340 2 520 30 27 185 156 na 23 40 57 34 42 Brazil 2 810 3 010 57 66 60 37 7 6 92 96 75 81 Burkina Faso 2 350 2 410 26 25 210 207 33 34 25 38 14 17 China 2 710 2 960 20 42 49 38 17 10 95 98 27 36 Colombia 2 440 2 580 59 59 36 23 10 7 95 97 69 75 Côte d’Ivoire 2 470 2 620 34 35 157 191 12 21 53 64 40 44 El Salvador 2 490 2 550 44 48 60 39 15 10 84 89 49 58 Gabon 2 450 2 610 58 51 92 91 na 12 na na 68 81 Ghana 2 080 2 620 35 28 125 97 30 25 82 93 36 44 Guyana 2 350 2 710 50 50 90 72 18 14 100 100 33 36 Indonesia 2 700 2 910 25 30 91 43 38 25 95 98 31 42 Jamaica 2 500 2 670 58 60 20 20 7 4 91 95 51 52 Jordan 2 820 2 670 48 48 43 33 6 4 97 100 72 79 Kuwait 2 370 3 050 62 58 16 10 11 2 88 93 95 96 Lesotho 2 450 2 620 26 19 120 87 16 18 87 91 17 18 Mauritania 2 560 2 780 50 49 183 183 48 32 46 50 44 58 Mauritius 2 890 2 960 49 53 25 19 24 15 91 95 41 43 Mexico 3 100 3 160 52 53 46 29 14 8 95 97 72 75 Morocco 3 030 3 040 35 36 85 43 10 9 55 71 48 55 Myanmar 2 630 2 880 20 27 130 108 32 35 88 92 25 28 Nepal 2 350 2 440 19 23 145 87 na 48 47 64 9 14 Nigeria 2 540 2 700 45 35 235 201 35 31 74 89 35 44 Paraguay 2 400 2 560 56 59 37 30 4 na 96 97 49 55 Peru 1 960 2 550 46 46 80 39 11 7 95 97 69 73 Suriname 2 530 2 630 52 56 48 40 na 13 na na 65 74 The State of Food Insecurity in the World 2004 37

Tables Table 2 cont. FOOD AVAILABILITY, DIET DIVERSIFICATION, CHILD MORTALITY, CHILD NUTRITIONAL STATUS, EDUCATION AND URBANIZATION in developing countries, classified by category of prevalence of undernourishment CATEGORY OF PREVALENCE Food Diet Child Child nutritional Education Urbanization OF UNDERNOURISHMENT availability diversification mortality status in total population 2000–2002 Dietary energy Share of non-starchy Under-five Under-five Literacy Urban share in Country supply (DES) food in total DES mortality rate underweight rate total population 1990–1992 2000–2002 1979–1981 2000–2002 1990 2002 1990 2000 1990 2003 1990 2000 kcal/day/person % per 1 000 live births % % % Swaziland 2 460 2 360 45 53 110 149 na 10 85 92 23 23 Trinidad and Tobago 2 640 2 730 59 62 24 20 7 6 100 100 69 74 Uganda 2 270 2 360 52 55 160 141 23 23 70 81 11 12 Venezuela 2 460 2 350 63 60 27 22 8 4 96 98 84 87 Viet Nam 2 180 2 530 16 28 53 26 41 34 94 96 20 24 20 TO 34% UNDERNOURISHED Bangladesh 2 070 2 190 15 16 144 73 66 48 42 50 20 23 Bolivia 2 110 2 250 52 50 120 71 11 8 93 97 56 62 Botswana 2 260 2 160 45 51 58 110 na 13 83 90 42 50 Cambodia 1 870 2 060 12 22 115 138 na 45 74 81 13 17 Cameroon 2 110 2 260 45 43 139 166 15 23 81 92 40 49 Chad 1 780 2 150 34 42 203 200 na 28 48 71 21 24 Dominican Rep. 2 260 2 320 65 67 65 38 10 5 88 92 55 58 Gambia 2 370 2 270 36 47 154 126 na 17 42 62 25 26 Guatemala 2 350 2 190 40 48 82 49 33 24 73 81 41 45 Guinea 2 110 2 380 40 40 240 165 24 23 na na 25 33 Honduras 2 310 2 350 46 54 59 42 18 17 80 86 40 44 India 2 370 2 420 32 39 123 90 56 47 64 75 26 28 Kenya 1 920 2 110 36 46 97 122 23 21 90 96 25 36 Lao People’s Dem. Rep. 2 110 2 290 14 23 163 100 44 40 70 80 15 19 Malawi 1 880 2 150 29 24 241 182 28 25 63 73 12 15 Mali 2 220 2 200 30 28 250 222 31 33 28 39 24 30 Mongolia 2 070 2 240 52 53 104 71 12 13 99 99 57 57 Namibia 2 060 2 270 42 40 84 67 26 na 87 93 27 31 Nicaragua 2 220 2 280 52 49 68 41 11 10 68 73 53 56 Niger 2 020 2 130 28 26 320 264 43 40 17 25 16 21 Pakistan 2 300 2 430 42 47 130 104 40 38 47 60 31 33 Panama 2 320 2 240 61 61 34 25 na 8 95 97 54 56 Philippines 2 260 2 380 41 44 63 37 34 32 97 99 49 59 Senegal 2 280 2 280 34 39 148 138 22 23 40 54 40 47 Sri Lanka 2 230 2 390 42 45 23 19 37 33 95 97 21 21 Sudan 2 160 2 260 50 47 120 94 34 41 65 80 27 36 Thailand 2 250 2 450 33 50 40 28 25 18 98 99 29 31 Togo 2 150 2 300 22 23 152 141 25 25 64 78 29 33 35% OR MORE UNDERNOURISHED Angola 1 780 2 040 40 32 260 260 na 31 na na 26 33 Burundi 1 900 1 640 56 48 190 190 38 45 52 67 6 9 Central African Rep. 1 870 1 980 34 43 180 180 27 24 52 71 37 41 Congo 1 860 2 090 34 37 110 108 24 na 93 98 48 52 Dem. People’s Rep. of Korea 2 450 2 140 34 36 55 55 na 28 na na 58 60 Dem. Rep. of the Congo 2 170 1 630 28 24 205 205 na 31 69 85 28 30 Eritrea na 1 520 na 25 147 89 41 40 61 73 16 19 Ethiopia na 1 840 na 20 204 171 46 47 43 59 13 15 Haiti 1 780 2 080 49 45 150 123 27 17 55 67 29 36 Liberia 2 210 1 990 27 36 235 235 na 27 57 72 42 45 38 The State of Food Insecurity in the World 2004

Table 2 cont. FOOD AVAILABILITY, DIET DIVERSIFICATION, CHILD MORTALITY, CHILD NUTRITIONAL STATUS, EDUCATION AND URBANIZATION in developing countries, classified by category of prevalence of undernourishment CATEGORY OF PREVALENCE Food Diet Child Child nutritional Education Urbanization OF UNDERNOURISHMENT availability diversification mortality status in total population 2000–2002 Dietary energy Share of non-starchy Under-five Under-five Literacy Urban share in Country supply (DES) food in total DES mortality rate underweight rate total population 1990–1992 2000–2002 1979–1981 2000–2002 1990 2002 1990 2000 1990 2003 1990 2000 kcal/day/person % per 1 000 live births % % % Madagascar 2 080 2 060 27 23 168 135 41 40 72 82 24 26 Mozambique 1 740 2 030 25 25 240 205 na 26 49 64 21 32 Rwanda 1 950 2 050 50 44 173 203 29 24 73 86 5 14 Sierra Leone 1 990 1 930 40 36 302 284 29 27 na na 30 37 United Rep. of Tanzania 2 050 1 960 31 29 163 165 29 29 83 92 22 32 Yemen 2 040 2 040 34 34 142 114 30 46 50 69 21 25 Zambia 1 930 1 900 23 23 180 182 21 28 81 90 39 35 Zimbabwe 1 970 2 020 34 44 80 123 12 13 94 98 29 34 NOTES TO TABLE 1 * Although not listed separately, provisional estimates for Afghanistan, Iraq, Countries revise their ofﬁcial statistics regularly for the past as well as Papua New Guinea and Somalia have been included in the relevant regional the present. The same holds for population data of the UN. Whenever aggregates. this happens, FAO revises its estimates of undernourishment accordingly. ** Eritrea and Ethiopia were not separate entities in 1990–1992 but estimates Therefore users are advised to refer to changes of estimates over time only of the number and proportion of undernourished in the former Ethiopia PDR within the same SOFI publication and refrain from comparing data published are included in regional and subregional aggregates for that period. in editions for different years. Figures following country name refer to the prevalence categories KEY (proportion of the population undernourished in 2000–2002): — proportion less than 2.5% undernourished [1] < 2.5% undernourished na data not available [2] 2.5–4% undernourished 0.0 zero or less than half the unit shown [3] 5–19% undernourished [4] 20–34% undernourished SOURCES [5] 35% undernourished Total population: UN Population Prospects, 2002 revision Table does not list countries for which there were insufﬁcient data. Undernourishment: FAO estimates NOTES TO TABLE 2 KEY Non-starchy food: all food sources for DES, except cereals and roots and na data not available tubers. Under-five mortality rate: probability that a newborn baby will die before SOURCES reaching age five, if subject to current age-specific mortality rates. The Category of undernourishment, food availability and diet diversification: FAO probability is expressed as a rate per 1 000 live births. Child mortality: UNICEF Under-five underweight: proportion of children under the age of five whose Child nutritional status: WHO weight falls below the mean weight-for-age by two standard deviations or Education: UNESCO more. Dates of the surveys vary. For each country, data were included for Urbanization: UN Population Division: UN Population Prospects, 2003 the year closest to 1990 from the decade 1985–1994 and for the most recent revision year from the decade 1995–2004. Literacy rate: The percentage of persons aged between 15 and 24 who can, with understanding, both read and write a short simple statement on everyday life. Urbanization: Percentage of population at mid-year residing in urban areas. The State of Food Insecurity in the World 2004 39

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The State of Food Insecurity in the World The sixth edition of The State of Food Insecurity in the World reports that the number of chronically hungry people in the developing world has fallen by only 9 million since the World Food Summit baseline period of 1990–1992. The conclusion is inescapable – we must do better. Looking at the impressive progress that more than 30 countries in all developing regions have made in reducing hunger, the report highlights another clear and compelling lesson – we can do better. And for the ﬁrst time, The State of Food Insecurity in the World 2004 presents provisional estimates of the staggering costs that hunger inﬂicts on households and nations – the millions of lives ravaged by premature death and disability, the billions of dollars in lost productivity and earnings. On both moral and pragmatic grounds, these estimates lead to one more unavoidable conclusion – we cannot afford not to do better. The report also includes a special feature examining the impact that the rapid growth of cities and incomes in developing countries and the globalization of the food industry have had on hunger, food security and nutrition. The State of Food Insecurity in the World 2004 concludes with an urgent appeal to scale up action, resources and commitment in order to achieve the World Food Summit goal. That goal of cutting the number of hungry people in half by the year 2015 can still be reached if we just focus our efforts over the next ten years on simple, low-cost, targeted actions that will improve food security quickly for very large numbers of people. Hunger cannot wait. ISBN 92-5-105178-X 9 7 8 9 2 5 1 0 5 1 7 8 8 TC/M/Y5650E/1/11.04/6000

The State Of Food Insecurity In The World 2004

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