Children are the most visible victims of undernutrition. It is estimated that undernutrition—including stunting, wasting, deficiencies of vitamin A and zinc, and fetal growth restriction (when a baby does not grow to its normal weight before birth)—is a cause of 3·1 million child deaths annually or 45 percent of all child deaths in 2011 (UNICEF, World Health Organization [WHO], & The World Bank, 2018). Undernutrition magnifies the effect of every disease, including measles and malaria. The estimated proportions of deaths in which undernutrition is an underlying cause are roughly similar for diarrhea (61%), malaria (57%), pneumonia (52%), and measles (45%) (Black 2003, Bryce 2005). Undernutrition can also be caused by diseases, such as those that cause diarrhea, by reducing the body’s ability to convert food into usable nutrients.

From GAIN. https://www.gainhealth.org

Stunting

Globally 150 million under-five-year olds were estimated to be stunted in 2017. (UNICEF, WHO, & The World Bank, 2018).

The global trend in stunting prevalence and numbers affected is decreasing. Between 2000 and 2017 stunting prevalence declined from 33 percent to 22 percent and numbers declined from 198 million to 150 million (UNICEF, WHO, & The World Bank, 2018).

In 2017, about half of all stunted children under five years of age lived in Asia and over one-third in Africa (UNICEF, WHO, & The World Bank, 2018).

Wasting and severe wasting

Globally, 50.5 million under-five-year olds were wasted (or low weight for height) in 2017 (UNICEF, WHO, & The World Bank, 2018).

Globally, wasting prevalence in 2017 was estimated at almost 8 percent (UNICEF, WHO, & The World Bank, 2018).

Approximately two-thirds of all wasted children under five years old lived in Asia and over one-quarter in Africa, with similar proportions for severely wasted children (UNICEF, WHO, & The World Bank, 2018).

Take a three-question hunger quiz on this section

Micronutrients

Quite a few trace elements or micronutrients—vitamins and minerals—are important for health. Three very important micronutrient deficiencies in terms of health consequences for people in lower-middle-income countries are:

Iron

In many lower-middle-income countries, iron deficiency anemia is aggravated by worm infections, malaria and other infectious diseases such as HIV and tuberculosis.

The major health consequences include poor pregnancy outcome, impaired physical and cognitive development, increased risk of morbidity (illness) in children and reduced work productivity in adults. Anemia contributes to 20 percent of all maternal deaths (FAO, 2017).

Vitamin A

Vitamin A deficiency can cause night blindness and reduce the body’s resistance to disease. In children, vitamin A deficiency can also impair growth.

An estimated 250 million preschool children are vitamin A deficient. An estimated 250,000 to 500,000 vitamin A-deficient children become blind every year, half of them dying within 12 months of losing their sight (FAO, 2017).

Iodine

Iodine deficiency is one of the main cause of impaired cognitive development in children, especially in iodine-deficient areas of Africa and Asia. About 38 million babies are born with iodine deficiency (FAO, 2017).

Iodine deficiency has a simple solution: iodized salt. Thanks to this intervention, the number of countries where iodine deficiency is a public health problem has been halved over the past decade. However, 54 countries still have a serious iodine deficiency problem. (WHO)

Does the world produce enough food to feed everyone?

The world produces enough food to feed everyone. For the world as a whole, per capita caloric availability and food diversity (the variety of food groups in a diet) have increased between the 1960s and 2011 (FAO, 2017). This growth in food availability, along with improved access to food, helped reduce the percentage of chronically undernourished people in lower-middle-income countries from about 30 percent in the 1990-92 to about 13 percent two decades later (FAO, 2017). A principal problem is that many people in the world still do not have sufficient income to purchase (or land to grow) enough food or access nutritious food. This is an element of “food security”. The FAO defines four dimensions of food security, all of which must be fulfilled simultaneously, for food security to exist. The four dimensions are: 1) physical availability of food, 2) economic and physical access to food, 3) food utilization, and 4) the stability of those other dimensions over time.

What are the causes of hunger?

Poverty is the principal cause of hunger. The causes of poverty include lack of resources, unequal income distribution in the world and within specific countries, conflict and hunger itself. As of 2013, when the most recent comprehensive data on global poverty was collected, about 767 million people are living below the international poverty line of less than $1.90 per person per day (The World Bank, 2016). This was a decrease of about 1 billion people below the poverty line from 1990 (The World Bank, 2016). However, although the number of people living in extreme poverty globally has been declining, in lower-middle-income regions, such as sub-Saharan Africa, the number is actually growing (FAO, 2017).

Hunger is also a cause of poverty, and thus of hunger, in a cyclical relationship. By causing poor health, small body size, low levels of energy and reductions in mental functioning, hunger can lead to even greater poverty by reducing people’s ability to work and learn, thus leading to even greater hunger. See Victoria et al. 2008.

Conflict. More than half (489 million) of the 815 million hungry people in the world live in countries affected by conflict (FAO et al., 2017). Ranging from non-state and state-based violence to one-sided violence, some of the conflicts that result in internal or international displacement have occurred in Syria, Yemen, Somalia, the Democratic Republic of the Congo and Myanmar, among many other countries throughout the world. In addition, most of the 19 countries listed by FAO as countries in complex, prolonged conflict are located in Africa (FAO et al., 2017).

In 2016, the average prevalence of undernourishment in countries undergoing conflict was about four percentage points greater than the prevalence in non-conflict countries (FAO et al., 2017). About 75 percent of children in the world who are stunted live in conflict areas (FAO et al., 2017).

Conflict in rural areas interferes with food and agriculture production, when transportation or market infrastructure are affected, land is seized or resources are destroyed, or the violence forces displacement from home (FAO, 2017). In addition to impacting food systems, conflict can also impact the economy, driving up food prices and making it difficult to buy necessary foods (FAO et al., 2017). In areas of severe violence, it may be difficult to deliver humanitarian assistance to address undernutrition (FAO, World Food Programme [WFP], & European Union [EU], 2018).

Source: FAO, WFP, & EU, 2018

Political instability. In countries facing political instability, the resulting decline of the economy reduces the value of the country’s currency, leading to higher food prices and less nutritious food available for purchase (FAO, WFP, & EU, 2018). The loss of jobs in a declining economy also impacts people’s ability to afford food, as income declines as well (FAO, WFP, & EU, 2018). Countries like the Democratic Republic of Congo, South Sudan, Yemen and Venezuela are examples of countries in which political instability is currently affecting food security (FAO, WFP, & EU, 2018).

Food and agricultural policy. A lack of adoption of more productive technologies for agriculture in lower-middle-income countries contributes to large differences in amount of crops produced when compared with upper income countries (FAO, 2017). Within regions, the gap between potential crop yield and actual crop yield can be as large as 76 percent, as seen in Sub-Saharan Africa (FAO, 2017).

Also, past agricultural practices implemented to increase crop yield have unintended consequences in the form of land and soil degradation, and using up or polluting the available groundwater (FAO, 2017). This then affects future capacity for food production, as these resources have been permanently depleted (FAO, 2017). However, more countries are beginning to adopt “conservation agriculture,” where various strategies are used to prevent the rapid depletion of scarce natural resources (FAO, 2017).

Climate change. Throughout the previous 30 years, natural disasters have become increasingly common (FAO, 2017). Unstable weather patterns can lead to drought – in 2016, El Niño was responsible for conditions of severe food insecurity for 20 million people (FAO, WFP, & EU, 2018). On the other extreme, hurricane and cyclone seasons have produced more powerful storms, causing damage to livelihoods, agricultural production and local market prices, in countries in the Caribbean and Asia (FAO, 2017). In agricultural-driven areas, especially in parts of Africa (Somalia, southeastern Ethiopia, and countries in West Africa), drought has driven economic, food production and political stability crises (FAO, WFP, & EU, 2018). For countries facing prolonged conditions or yearly disasters, undernutrition worsens, as there is little time for recovery (FAO, 2017).

The ecological impacts of climate change can affect the emergence or re-emergence of diseases on a larger scale, especially those with vectors (like mosquitoes and fleas) that thrive in warm humid environments (FAO, 2017). Disease caused by these vectors can prolong the cycle of malnutrition (FAO, 2017).

Source: FAO, WFP, & EU, 2018

Revised May 25, 2018, with the assistance of Crystal Lam, George Washington University, MPH candidate

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