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 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. The mention or omission of specific companies, their products or brand names does not imply any endorsement or judgement by the Food and Agriculture Organization of the United Nations. All rights reserved. Reproduction and dissemination of material in this information product for education or other non-commercial purposes are authorized without any prior written permission from the copyright holders provided the source is fully acknowledged. Reproduction of material in this information product for resale or other commercial purposes is prohibited without written permission of the copyright holders. Applications for such permission should be addressed to the Chief, Publishing Management Service, Information Division, FAO, Viale delle Terme di Caracalla , 00100 Rome , Italy or by e-mail to copyright@fao.org . © FAO 2004 ISBN 92-5-105178-X Printed in Italy Photographs As cover (left to right): Thi ha Thein Nyan/UNEP/Topham; Claudio Marcozzi/UNEP/Topham; Felix O Granmakou/UNEP/Topham.

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

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 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.

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

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. 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. 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. 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. 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. 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. 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. 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. 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. 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