Todayâs world is marked by a tragic injustice. Although the total amount of food produced can easily feed all people, hunger and malnutrition remain widespread. More than a billion people, mostly in the developing world, lack regular access to safe, sufficient, and nutritious food.1 Children are often the first to suffer. A quarter of the worldâs children are malnourished and thousands of children die each day simply because they do not have enough food to eat.
This book examines the global campaign to end hunger and malnutrition. Focus is placed on the work of the United Nations (UN) which has led international efforts to improve food security in the worldâs poorest countries. This includes both a long-term project to establish food as a universally recognized human right as well as the work of three affiliated agenciesâthe World Food Programme (WFP), Food and Agriculture Organization (FAO), and International Fund for Agricultural Development (IFAD)âin each region of the developing world.2
Hunger, Malnutrition, and Food Insecurity
The terms hunger, malnutrition, and food insecurity are referred to repeatedly throughout this volume and require careful definition. Hunger occurs when a personâs average daily caloric intake is less than their minimum dietary energy requirement (MDER).3 A continued and severe imbalance between caloric intake and energy expenditure will eventually lead to illness, organ failure, and mortality.4 In addition to total caloric intake, it is also important to consider the nutritional content of the food consumed.5 Malnutrition occurs when a person does not consume sufficient vitamins, minerals, proteins, carbohydrates, and other essential micronutrients to meet their basic nutritional needs.6 Because malnutrition weakens the bodyâs immune system, the risk of contracting communicable and parasitic diseases is heightened.7
Hunger and malnutrition are typically caused by food insecurity. FAO defines food insecurity as a â⊠lack of secure access to sufficient amounts of safe and nutritious food for normal human growth and development and an active and healthy life.â8 A distinction is also drawn between moderate and severe food insecurity. A person is considered moderately food insecure if they have been forced to reduce the quality and/or quantity of food they consume while a person is considered severely food insecure if they have completely exhausted their food supplies.9 Food insecurity is caused by one or more of the following four factors: a lack of food availability due to shortages in domestic production or imports; a lack of food access due to an inability to procure food; a lack of food utility due to poor nutritional content; and a lack of food stability due to recurrent shortages.10 Food insecurity can be transitory (occurring at a time of crisis), seasonal (occurring during certain times of the year), or chronic (occurring on a continuing basis).
Food insecurity is more common for women than men for a number of reasons discussed below. Women who are pregnant or nursing are especially susceptible to malnutrition. During these periods, women need to consume significantly more vitamins, minerals, and other micronutrients. Iron-Deficient Anaemia during pregnancy, for example, endangers a womanâs health and increases the risk of adverse maternal and neonatal outcomes.11 Anemia is extremely common among women of reproductive age in the developing world.12
Meeting the nutritional needs of women throughout pregnancy is also critical for the health of their babies.13 A lack of Folic Acid can lead to cerebral and spinal birth defects, a lack of Iodine can impair the babyâs nervous system, a lack of Calcium can impede development of the babyâs heart, muscles, and nerves, and a lack of Vitamin D can compromise growth of the babyâs bones. If a woman is malnourished during pregnancy, there is a greater likelihood of restricted intrauterine growth and low birth weight of the baby.14 The risk of death for an infant born at two-thirds of normal weight is ten times greater than for a infant born at normal weight. Low birth weight also slows the development of the babyâs immune system and thus heightens the risk of contracting illnesses.15
Malnutrition during childhood can be highly debilitating over the course of an entire lifetime.16 When children are poorly nourished, their growth, health, and cognitive skills are all compromised.17 Iron and Iodine deficiency impedes physical and cognitive development, Vitamin A deficiency can cause blindness, Vitamin D deficiency endangers bone health and increases the risk of diabetes, and Zinc deficiency impairs overall growth. When children do not consume sufficient protein, they risk developing Kwashiorkor (which causes a distended stomach and swollen feet) and Marasmus (which causes skin to be damaged and loosen). Because malnutrition weakens the immune system, children are far more susceptible to illness and infectious diseases. Nearly half of child mortality in the developing world is due to malnutrition or malnutrition-related diseases.18
Malnutrition can cause children to be too short for their age, a condition known as stunting, or too thin for their height, a condition known as wasting.19 Stunting impairs physical and cognitive development and can lead to immune system disorders that increase the risk of developing chronic diseases. The consequences of stunting are largely irreversible regardless of nutritional intake in later years. At present, approximately 150 million children, roughly a quarter of all children under five in the developing world, are stunted.20 Wasting causes delayed cognitive development, reduced muscular strength, and lower bone density.21 When children suffer from wasting much of their body energy is directed toward continually fighting off infections and disease. For girls, wasting is associated with adverse pregnancy outcomes later in life, including delivery complications, preterm birth, and low birth weight of their babies.22 At present, over fifty million children, approximately eight percent of all children under five in the developing world, are wasted.23 A third of these children are severely wasted.24
Food Insecurity Measurements
A number of measurements have been developed to assess the prevalence and severity of food insecurity. The Integrated Food Security Phase Classification (IPC), developed by FAO, is among the most commonly used measurements. IPC identifies the following five phases of food insecurity: IPC 1, Generally Food Secure, when more than eighty percent of households can meet their basic food needs without resorting to atypical coping strategies; IPC 2, Borderline Food Insecure, when food consumption is reduced for at least twenty percent of households but is minimally adequate; IPC 3, Acute Food and Livelihood Crisis, when at least twenty percent of households have significant food consumption gaps and levels of acute malnutrition are above normal; IPC 4, Humanitarian Emergency, when at least twenty percent of households face extreme food consumption gaps, resulting in high levels of acute malnutrition; and IPC 5, Famine/Humanitarian Catastrophe, when at least twenty percent of households face a complete lack of food, acute malnutrition exceeds thirty percent of the population, and starvation is evident.
FAO also employs a range of additional instruments to assess the level of food insecurity in a country. The Prevalence of Undernourishment (PoU) indicator estimates the proportion of the population whose habitual food consumption is insufficient to provide the dietary energy levels that are required to maintain an active and healthy life.25 The measurement is based on national estimates of dietary energy supply, minimum dietary energy requirements for an average individual, and the distribution of food within a country. While the PoU compares food availability to estimated needs, it does not identify which population groups are the most food insecure. The Depth of the Food Deficit (DFD) estimates the overall food shortage of a country. Researchers first determine the number of calories the average individual would need to meet their energy requirements. The difference between the average energy requirement and average caloric consumption is then calculated. This food deficit is then multiplied by the number of undernourished individuals and then divided by the total population of the country. The Dietary Energy Supply Adequacy (DESA) measurement also focuses on whether the dietary energy supply of a country is able to meet the dietary energy requirements of all people. A countryâs supply of calories is normalized by the average energy requirement estimated for its population. Like PoU and DFD, this measurement assesses whether undernourishment is primarily due to a lack of food availability. The Food Insecurity Experience Scale (FIES) estimates the percentage of people who have serious constraints on their ability to access nutritious food.26 This measurement relies on the responses of people at the individual and household level to a series of questions regarding their direct experiences of food insecurity. The questions focus on behaviors when respondents encounter difficulties meeting their basic food needs due to a lack of money or other resources.27 Because FIES disaggregates at sub-national levels and across different population groups, it identifies the geographic distribution of people who face serious constraints obtaining sufficient food. Similarly, the Food Insecurity and Vulnerability Information and Mapping Systems (FIVIMS) assembles information about food insecurity at both national and global levels. FIVIMS draws upon a range of data sources related to household food security and nutritional availability to assess where and why people are food insecure.
Three additional measurements have been developed to assess food insecurity. The WFPâs Comprehensive Food Security and Vulnerability Analysis (CFSVA) draws upon household interviews, feedback from focus groups, and secondary data to measure the nutritional status of various segments of a population. The Global Hunger Index (GHI) combines the following four indicators...