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targets related to stunting, wasting, overweight, and anaemia. Data on all the four indicators were available only for 99 countries. The report found that only one country of these (Colombia) was on course to meet all the four targets, and thirty-one countries were not on course to meet any of the four targets.
There are significant regional variations in malnutrition trends. East Asia has led all regions with a decline in the prevalence of underweight children to below 3 percent, followed by Central Asia, Latin America and the Caribbean, and West Asia. South Asia, with a 41 percent decline in the prevalence of underweight children, continues to be home to the largest number of underweight children. There were 52 million underweight preschool children in South Asia in 2012. Despite a 29 percent increase in the proportion of underweight children, Sub-Saharan Africa had 5 million more underweight children in 2012 than in 1990 (Table 1.2).
A quarter of the children in the world, and a third in developing countries, are stunted due to a range of factors including poor diet. Four out of five stunted children live in just twenty countries, including almost half of Indian children under the age of 5. Although the prevalence of stunting fell from an estimated 40 percent in 1990 to about 25 percent in 2012, an estimated 162 Uneven Progress 9 Table 1.3 Estimated prevalence and number of children under 5 years of age affected by stunting (moderate or severe), by region, 1990 and 2012
million children under 5 remain at risk of diminished cognitive and physical development associated with such chronic undernutrition (Table 1.3).
Nearly all regions of the world have experienced a decline in the number of children affected by stunting. The exception is Sub-Saharan Africa, where the number of stunted children increased by a third, from 44 million to 58 million, between 1990 and 2012 (Table 1.3). In Nigeria, over half of the poorest children are stunted, while children in poor rural counties in China are six times more likely to be stunted than urban children. In Indonesia, a sharp rise in wasting – or acute undernutrition – in the wake of the recent food crisis hit children from the poorest households hardest.
Figure 1.3 Prevalence of anaemia among pre-school children and women of reproductive age, by country, 1993–2005 (percent)
Consequences of malnutrition Micronutrient deficiencies impair cognitive and physical development, especially among young children, making people less able to learn and work, as well as more susceptible to disease and reduced life expectancy.⁵ A detailed review of studies and statistical evidence found that about 3.7 million child deaths were associated with maternal or child underweight status.
These deaths and increased morbidity among children, from pneumonia, diarrhoea and malaria associated with low weight-for-age, accounted for a loss of about 127 million disability-adjusted life years (DALYs) (Ezzati et al., 2004). Horton (2008) estimated excess mortality globally attributable to different types of malnutrition. She found 3.75 million deaths associated with being underweight; 0.84 million deaths due to iron deficiency; 0.78 million deaths because of vitamin A deficiency; 0.79 million deaths because of zinc deficiency; and 2.59 million deaths associated with being overweight.
Of the 8.75 million excess deaths on account of malnutrition, about 3 million were in Sub-Saharan Africa, and 2.
34 million in South and Southeast Asia (Horton, 2008).
Studies have noted that receiving the right nutrients in the earliest years of life is not only a matter of life and death, but also a major determinant of future life chances. The evidence summarized by Ezzati et al. (2004) shows that early child undernutrition is associated with impaired cognitive development and lasting intellectual deficits. Undernutrition among adults also results in diminished work capacity and lower productivity.
There have been some attempts at quantifying the economic consequences of malnutrition. Although such estimates have methodological limitations, it is clear that the economic consequences of malnutrition, particularly for the poorest and most vulnerable, are staggering. For example, using data from ten developing countries, Horton and Ross (2003) showed that the median value of per capita annual losses on account of reduced productivity and reduced cognitive abilities due to iron deficiency was about US$3.64 per year. For India, they estimated the value of losses on account of reduced productivity and cognitive abilities to be around US$4.8 per capita per year. The estimated costs of malnutrition would be much higher if the increased costs of health care due to malnutrition are taken into account. The present discounted value of the lifetime costs of malnutrition due to excess mortality, additional health-care costs, and loss of lifetime productivity and cognitive abilities have been estimated to be more than US$500 per capita (Alderman and Behrman, 2004; World Bank, 2006) and US$2.8–3.5 trillion globally (FAO, 2013b).
⁵ See Alderman and Behrman (2004) for a review of studies on the effect of malnutrition on productivity and cognitive abilities.
Uneven Progress 13 As rightly pointed out in the Rome Declaration on Nutrition, “malnutrition, in all its forms, including undernutrition, micronutrient deficiencies, overweight and obesity, not only affects people’s health and well-being by impacting negatively on human physical and cognitive development, compromising the immune system, increasing susceptibility to communicable and noncommunicable diseases, restricting the attainment of human potential and reducing productivity, but also poses a high burden in the form of negative social and economic consequences to individuals, families, communities and States.” Transforming Food Systems to Provide Healthy Diets for All Improving food systems is key to fostering more balanced, diversified, and healthier diets. As shown by FAO’s 2013 report on The State of Food and Agriculture, food systems must be improved in ways that make such foods available and affordable (FAO, 2013b). Everyone should have access to a wide range of nutritious foods and be able to make healthy dietary choices. Consumers need help in making better informed dietary choices for improved nutrition with education, information, regulation, and other interventions. Improvements in post-harvest processing, storage, and marketing systems can reduce food losses and contribute to more sustainable resource use.
Regions and countries with the highest burden of micronutrient deficiencies also have a high prevalence of stunting and heavy disease burdens.
The problems are closely connected and thus require a systemic approach involving all relevant sectors if we are to make progress. The food system involves people, institutions, agricultural production, processing, storage, retailing, transportation, commerce, international trade, and consumption.
Improved nutrition involves and depends on every aspect of the food system.
This is why an integrated approach is needed to ensure that food consumed is adequate, nutritious, wholesome, acceptable, safe, and affordable, especially to the poorest and the most vulnerable.
Creating sustainable and healthy food systems is key to overcoming hunger and malnutrition around the world. But food systems often do not function in ways most conducive to ensuring that everyone has access to safe food and nutritionally adequate diets. Improving food systems requires a systemic approach to deal with problems of food availability, food access, food safety, and of sustainability. We have to increase our efforts to address these problems.
Transforming Food Systems 15
Food availability Globally, food production has more than tripled since 1961. The FAO’s index of net food production, which measures changes in food production over time, increased from 34 in 1961 to 123 in 2013. Over this period, average food production per person increased by about 50 percent, with the index of per capita net food production increasing from 73 in 1961 to 123 in 2013 (Figure 2.1).
While the world produces enough food to feed everyone, there are deficits in food availability in various parts of the world. Inadequate production capacity at the national level, poor storage facilities and other infrastructure, and trade barriers still result in localized shortages in food availability.
In addition, political conflicts and natural disasters result in localized shortages. Protracted crises disrupt livelihoods. Natural disasters, conflicts and wars adversely affect agricultural production, trade, food access, social protection, and food aid (FAO, 2010). As an illustration, Box 2.1 briefly discusses the impact of the 2010–11 drought on food insecurity in countries in the Sahel and the Horn of Africa. Cereal production dropped 30 percent in Niger, 17 percent in Burkina Faso, and 11 percent in Chad as a result of the 2009–10 drought in the Sahel region. The 2010–11 drought in the Horn of Africa resulted in a 70 percent drop in cereal production in Somalia. Box 2.2 describes the impact of the Ebola epidemic on food security in affected countries of West Africa. The epidemic resulted in a shortfall in domestic production, reduced capacity for importing food, and Figure 2.1 Index of net food production and net per capita food production, 1961–2012 (2004–06=100)
Box 2.1 Droughts and Food Insecurity in the Sahel and Horn of Africa The Sahel and the Horn of Africa are regions frequently hit by drought, poor harvests, and pasture deficits. About 20 million people are affected by food insecurity in the Sahel, and are likely to see their situation further deteriorate in 2015. Adversities on account of fragile ecological conditions have been compounded by conflicts in many countries in the region, which have resulted in large-scale displacement of people and disruption of livelihoods.
A Special Alert issued by the FAO Global Information and Early Warning
System on Food and Agriculture (2010) described the conditions in Sahel thus:
In 2009, agricultural production has been seriously affected in parts of the Sahel following late onset of rains, prolonged dry spells and significant pest infestations. The eastern and central parts of the Subregion were most affected with cereal outputs estimated to have declined by 30 percent in Niger, 17 percent in Burkina Faso and 11 percent in Chad, compared to 2008. Although favourable growing conditions boosted cereal output in most of the western part, irregular rains led to a 24 percent drop in cereal production in Mauritania.
In addition to the decline in cereal production, pastures were seriously affected in the pastoral and agro-pastoral zones of Sahel. For instance, biomass production in pastoral areas of Niger in 2009 was estimated to be 62 percent below domestic requirements. This deficit is three times as severe as in the previous year. In Chad, a death rate of about 31 percent for cattle was reported in west–central areas, while in Mali, significant livestock deaths were reported in Timbuktu, Gao, Ségou and Kidal regions.
Significant shortfall (over 30 percent in many areas) in Deyr rains (October–December) in 2010 and poor performance of Gu rains (April–June) in 2011 caused an extreme drought across the Horn of Africa, affecting over 13 million people. The impact of drought was further compounded by high food prices, very low levels of resilience on account of prolonged ecological stress, political conflicts and underdevelopment, and inadequate and delayed humanitarian assistance. In Somalia, the country that was worst affected, cereal production fell by about 70 percent. In pastoral areas, rainfall deficit significantly affected pasture growth, resulted in a decline in the availability of crop-residue fodder and production of livestock. Despite well-functioning early warning systems, conflicts in the region and consequent restrictions imposed on humanitarian assistance resulted in a famine that caused 260,000 deaths in southern and central Somalia alone. A detailed study commissioned by FAO’s Food and Nutrition Security Analysis Unit for Somalia and USAID’s Famine Early Warning System Network (FEWS NET) estimated that between October 2010 and April 2012, the period of famine, more than 133,000 children under 5 years of age died in southern and central Somalia on account of famine. The highest famine-related mortality was in the Lower Shabelle region, where famine resulted in death of 9 percent of the population and about 18 percent of all children aged less than 5 years. (Checchi and Robinson, 2013) Transforming Food Systems 17 disruption of local markets, pushing about half a million people into severe food insecurity.
Disruption of rural livelihoods because of conflicts and disasters typically results in large-scale displacement and forces people to migrate, intensifying competition for scarce employment opportunities in nonagricultural activities, enhancing dependence on markets to obtain food, and increasing unsustainable exploitation of natural resources (FAO, 2010).
A more widespread problem on the supply side is the lack of adequate supply of different types of foods that should be part of a nutritionally adequate diet. Table 2.1 shows the average annual per capita supply of different types of food in different regions of the world. The table shows that Eastern and Southern Africa have the lowest average per capita supply
Box 2.2 Ebola Epidemic and Food Insecurity in West Africa
In 2014, the Ebola epidemic affected some of the most agriculturally advanced regions of Guinea, Liberia and Sierra Leone, with an adverse impact on agricultural production as well as household incomes from other activities.
Trade restrictions in the face of the epidemic further contributed to problems of food availability as all three countries are net importers of food.
Reports from FAO and WFP suggest that restrictions on trade, hunting, and other economic activities have resulted in a large number of people experiencing severe levels of food insecurity. It was estimated that Ebola pushed 230,000 people in Guinea to severe food insecurity. In Liberia, 170,000 people were estimated to be severely food insecure because of the impact of Ebola. In Sierra Leone, the Ebola epidemic accounted for the severe food insecurity faced by 120,000 people.