The State Of Food Insecurity In The World 2004


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Published in 2004 by the
Food and Agriculture Organization of the United Nations
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The designations employed and the presentation of the material in this information product do not imply the expression of any opinion whatsoever on the part of the Food and Agriculture Organization of the United Nations concerning the legal or development status of any country, territory, city or area or of its boundaries, or concerning the delimitation of its frontiers or boundaries.

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ISBN 92-5-105178-X

Printed in Italy

As cover (left to right): Thi ha Thein Nyan/UNEP/Topham; Claudio Marcozzi/UNEP/Topham; Felix O Granmakou/UNEP/Topham.

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The State Of Food Insecurity In The World 2004

  1. 1. The State of Food Insecurity in the World 2004 monitoring progress towards the World Food Summit and Millennium Development Goals
  2. 2. 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 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.
  3. 3. The State of Food Insecurity in the World 2004 monitoring progress towards the World Food Summit and Millennium Development Goals
  4. 4. 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
  5. 5. 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
  6. 6. 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
  7. 7. 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 ad- ditional 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
  8. 8. 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
  9. 9. 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
  10. 10. 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
  11. 11. 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
  12. 12. 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 al- most 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 pro- ductivity 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
  13. 13. 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, measur- able 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