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Food and Nutrition Security (M4902-43)

Prof. Dr. M. Zeller, Prof. Dr. Heidhues,Dr. KeilRural Development Economics and Policy

Prof. Dr. med. H.K. Biesalski, Dr. ScherbaumBiological Chemistry and Nutrition

University of Hohenheim

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Syllabus

Part I: The World Food Situation1. A Global Perspective on Hunger and Food Insecurity

Part II: Concepts and Linkages2. Concepts of Hunger and Malnutrition3. The World Food Equation4. Multidimensionality of Hunger and Poverty5. Food Demand Analysis

Part III: Policies to Improve Food and Nutrition Security6. Food and Nutrition Policies7. Institutional Change8. Agricultural Commercialization and Innovation

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Course materials• Lecture notes can be downloaded from the course

website: http://www.uni-hohenheim.de/i490a/(link “teaching”)

• Textbook:Leathers, H.D., and P. Foster (2004). The World Food Problem: Tackling the Causes of Undernutrition in the Third World, 3rd Edition. Lynne Rienner Publishers, Boulder.

• Additional literature partly on course website• Literature list

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Part I: The World Food Situation

1. A Global Perspective on Hunger and Food Insecurity

1.1 Definition and Overview

1.2 The Economic Cost of Malnutrition

M5124 Food and Nutrition SecurityUniversity of Hohenheim

Zeller, Heidhues, Keil, Biesalski, Scherbaum

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1.1 Definition and Overview• What do you have in mind when you think about hunger

and food insecurity in the world?• Many think primarily of famine (temporary and localized

severe food shortage), caused by drought or conflict.• The reason is that famines get the spotlight: TV and

news specials, appeals for money by aid organizations etc.

• However, while acute famines are terrible, they are actually only a very small part of the world food problem.

• The bigger problem is chronic hunger.• While currently, an estimated 200,000 people starve to

death annually during famines, 6 million children die each year from hunger-related causes.

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DefinitionsHunger is a complex of severe sensations occurring when an individual is deprived of food energy for a longer period of time. The body starts to use its protein tissue (muscles) as the source of energy.Starvation is a severe reduction in food intake. An individual begins to starve when he/she has lost about a third of the normal body weight (>40% usually leads to death).Undernutrition is the underconsumption of food. A person suffering from undernutrition is short of the protein or energy needed for normal growth, health, and activity (= protein-energy malnutrition, PEM).Severe nutritional disorders associated with PEM are “Kwashiorkor” (lack of protein) and “Marasmus” (lack of energy) with similar symptoms, especially in children.

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Symptoms of severe PEM

• A good nutritional situation is crucial for the proper functioning of the body’s immune system.

• Undernourished people are often sick, because their resistance to disease is low.

• Infectious diseases (diarrhea, pneumonia, measles etc.) lead to high child mortality. In many cases, the underlying cause is undernutrition.

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Causes of child mortality

Source: Black et al. (2003). Neonatal: within first four weeks after birth.

0 5 10 15 20 25 30 35

Neonatal disorders

Diarrhoea

Pneumonia

Malaria

AIDS

Measles

Other

% of child deaths

Proportion due to undernutritionTotal

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Definitions and Concepts

Food Security Definition

• Quantity and quality• At all times• All members of society• Culturally acceptable

To lead a healthy and productive life

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Basic Views

• Food security as a basic human right• Food security as precondition for development• Food security as the result/symptom of poverty

All three are relevant; one does not exclude the other from being relevant

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Food security

• Global level• National level• Household level• Individual level

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What is required for food security ?

1.Food

Availability

2.Entitlement or

Accessto food

imports ownproduction

incomegeneratingactivities,employment

transfers

food contents/nutrition requirements

health linkages

3.Utilization

Knowledge/Proper use of food

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Food security – Definition (continued)

Food security – Definition (continued)

Food availabilityFood entitlementthrough employment/incomeor transfers

Knowledge about Nutrition requirementsAnd linkages to health

Requirements of culturally acceptable

imports reductionof lossesproduction

Com-mer-cial Food

aid Areaexpansion

Productivity increase

Public works (Private sector)Employment andIncome generation

Financial support

Food aid/Food for work

In adequate quantity and quality – at all times – for all members of society

By innovations (agr. Research),Institutions (rural financial markets,extension), infrastructure, education

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3. Food Security in Context:The Complexity of Food SecurityThe Food Security and Natural Resource Context

Natural resourcescarcity

Socio-Culturalfactors

Population growthDegradation of Natural Resources

Natural disastersand wars

Institutions-Market-, Policy- failures

Food insecurity

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Development

Poverty Labor Productivity

Food security/Nutrition Health

Environment

reducesLess

poverty

improve

s

Better

nutrit

ion

enab

les hi

gher

Improved labor

productivity pushes

These interdependencies can work with in both ways, as a winning circle but also as a vicious circle

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4 Evolution of Thinking IFrom the glooming picture in 1950‘s

To industrialization (1950‘s) – food as the forgotten half of developmentTo agricultural science (1960‘s) based development: the green revolutionTo rural development (1970‘s)/basic needsTo structural adjustment (1980‘s)To comprehensive development (1999 )To priority for poverty reduction ( 2000)Back to agriculture (from neglect to respect)

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4 Evolution of Thinking IIFood as production problem – 1960‘s green revolution

Adding access – the 1980‘s contribution (Amartya Sen)

Adding knowledge / use of food 1990‘s

2000‘s food and waterfood and environmentfood in crises

2005 food versus fuel, the issue of bioenergy(again agriculture is in the forefront)

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Food and nutrition securityFood (and nutrition) security exists when all people, at all times, have access to sufficient (safe and nutritious) food to meet their dietary needs and food preferences for an active and healthy life. (FAO).The opposite is food insecurity (relationship with poverty?).

Often, hunger, undernutrition, starvation, and food insecurity are used interchangeably. While this is okay in general, we should know that there are slight differences.

The food security definition uses the term “access” to food.

Global and local food availability is a necessary but not a sufficient condition for food accessibility at the household level.

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Worldwide, 852 million people are chronically hungry (undernourished)

India, 221

China, 142

Sub-Saharan Africa, 204

NENA, 39

Transition countries, 28

Asia/Pacific, 156

Latin America, 52

Industrialized countries, 9

Source: FAO (2004).

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Proportion of undernourished

0 5 10 15 20 25 30 35

Transition countries

Near East/NorthAfrica

LatinAmerica/Caribbean

Asia/Pacific

Sub-Saharan Africa

% undernourishedSource: FAO (2004).

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Map: proportion of undernourished

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Countries worst affected by undernutrition (in 2000)

Proportion of undernourished Average calorie adequacy ratioCountry % Country %Congo, DR 73 Congo, DR 69.8Somalia 71 Burundi 72.5Afghanistan 70 Tajikistan 73.4Burundi 69 Afghanistan 74.0Tajikistan 64 Eritrea 75.7Eritrea 58 Somalia 76.1Mozambique 55 Armenia 83.2Haiti 50 Mongolia 83.6Angola 50 Zambia 84.5Zambia 50 Cambodia 86.2Tanzania 47 Sierra Leone 86.3Sierra Leone 47 Central African R 86.6

Source: FAO (2002).

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Targets for fighting hungerIn 1996, the World Food Summit (WFS) (organized by FAO) came up with a declaration to halve the number of undernourished people by 2015 (from 1990-92 levels). This became known as the WFS goal.

A similar goal was set in 2000 in the Millennium Development Goals (MDGs):

Goal 1 (target 2): Halve, between 1990 and 2015, the proportion of people who suffer from hunger.

Further MDGs are closely related to nutrition:

Goal 4: Reduce by two-thirds the under-5 mortality rate.

Goal 5: Reduce by three-quarters the maternal mortality ratio.

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Are we on the way of meeting the goals?

Source: FAO (2004).

500

600

700

800

900

1990-1992 1995-1997 2000-2002

Num

ber o

f und

erno

uris

hed

(milli

on)

Without China

21%18% 17%

All developing countries

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Changes in the proportion of undernourished

0 5 10 15 20 25 30 35 40

Transition countries

NENA

LatinAmerica/Caribbean

Asia/Pacific

Sub-Saharan Africa

% undernourished

2000-20021990-1992

Source: FAO (2004).

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Proportion of undernourished in transition countries

0 2 4 6 8 10

CIS

Baltic States

Eastern Europe

% undernourished

2000-20021993-1995

Source: FAO (2004).

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Changes in number of undernourished

-50 -40 -30 -20 -10 0 10 20 30

ChinaIndia

Southeast AsiaOther South Asia

Other East AsiaWest Africa

Southern AfricaEast Africa

North AfricaCentral Africa

Near EastSouth America

Change in million people

1995-97 to 2000-02

1990-92 to 1995-97

Source: FAO (2004).

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The number of food crises is risingA food crisis is defined as a temporary situation, which requires emergency assistance. A famine is an extreme form of a food crisis.

0 5 10 15 20 25 30 35

1986 - 1990

1991 - 1995

1996 - 2000

2001 - 2004

Average number of food crises

Sub-Saharan Africa Asia/Pacific Europe Latin America NENA

Source: FAO (2004).

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Countries in food crisis more than 50% of the time (1986-2004)

Source: FAO (2004).

50 60 70 80 90 100

AngolaEthiopiaSomalia

SudanMozambiqueAfghanistan

HaitiLiberia

Sierra LeoneIraq

MongoliaCongo, DR

BurundiEritrea

TajikistanRwandaGeorgiaArmenia

% of reporting periods "in crisis"

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Primary causes of food crises

0% 20% 40% 60% 80% 100%

1986 - 1991

1992 - 2004

of crises

Human-induced (mainly conflict) Natural (mainly drought) Mixed

Source: FAO (2004).

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Measuring hunger• The FAO statistics on the number of undernourished

are the most quoted figures on hunger and on progress towards the WFS and MDG goals.

• The FAO statistics are calculated based on three key parameters for each country (FAO method):

1. Average dietary energy supply (DES) in a country, derived from FAO’s “food balance sheets”.

2. Minimum average calorie requirements in a country, taking into account the demographic composition.

3. A coefficient of variation (CV) for dietary energy consumption distribution to account for the degree of inequality in access to food. This is derived from limited available household surveys.

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Food balance sheet for India, 2001Produc-

tionImports-Exports

Stock changes

Total supply

Non-food uses

Food uses

Per capita supply

Daily per capita

(Million metric tons) (kg) Kcal.

Cereals 196,843 -5,333 -6,160 185,350 19,016 166,346 162.27 1,487

Starchy roots 30,242 -23 0 30,219 6,306 23,917 23.33 47

Sugar & sweetener 327,832 -1,524 -864 325,443 286,159 39,290 38.32 255

Pulses & oils 48,552 6,238 110 54,899 26,445 28,481 27.78 375

Fruit & vegetable 135,193 -1,263 0 133,930 14,495 119,442 116.51 129

Meat 8,647 -249 0 8,398 179 8,220 8.02 76

Milk & eggs 86,026 -375 0 85,651 17,277 68,718 67.03 111

Fish 5,352 -335 1 5,017 473 4,545 4.44 8

Total vegetal 2,292

Total animal 195

Total 2,487

Source: FAO (2004), http://faostat.fao.org/

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Impact of mean DES and inequality of access to food on estimates of undernourishment

0

10

20

30

40

50

60

70

1700 2040 2450 2940Mean DES (kcal/capita/day)

% u

nder

nour

ishe

d

0.20 0.24 0.29 0.35

Coefficient of variation

Source: FAO (2004).

(CV)

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Assessment of FAO’s methodAdvantages• It relies on data that are available from most countries

and can be updated on a regular basis (except for CV).• It allows comparisons across countries over time.

Disadvantages• The estimates can only be as good as the underlying

data, which can be of varying quality across countries.• A small variation in one of the parameters can make a

big difference.• Due to lack of updated household surveys, the CV

(inequality parameter) is assumed to be constant.• Hunger mapping within countries is not possible.

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Methods based on standard health indicators Since health and nutrition are closely linked, health indicators from available statistics are often used to proxy nutrition status:• Under-five mortality rate (U5M) provides a proxy for

nutritional status of infants and children.• Low birth weight (LBW) provides a proxy for nutritional

status of girls and pregnant women.

Since these indicators are recorded in standard health statistics, they can be updated on a regular basis. Yet,• they only capture certain population groups,• there can be factors other than nutrition

influencing them,• hunger mapping within countries is not possible.

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Country ranking based on health indicatorsUnder-5 child mortality (U5M) Low birth weight (LBW)

Country Per thousand Country % of birthsSierra Leone 180 Bangladesh 30.0Angola 172 Haiti 28.3Afghanistan 165 Yemen 25.7Niger 159 India 25.5Liberia 157 Chad 23.5Mali 142 Iraq 23.1Somalia 133 Sierra Leone 22.0Guinea-Bissau 132 Pakistan 21.4Congo, DR 128 Nepal 20.9Mozambique 126 Guinea-Bissau 19.5Mauritania 120 Comoros 18.4Chad 118 Burkina Faso 18.3Ethiopia 117 Philippines 17.5

Source: UNICEF (2003).

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Methods based on sample surveys

Food intake assessment:• Dietary recall (e.g., for last 24 hours, 7 days)• Dietary record (food weighting)• Disadvantage: there can be factors influencing nutrition

status other than food intake (e.g., intestinal parasites)Clinical assessment:• Assessment of symptoms (e.g., loss of pigment, edema)• Biochemical assessment (e.g., analysis of blood, urine)

Anthropometric assessment:• Low height-for-age (stunting)• Low weight-for-age

(underweight)

• Low weight-for-height (wasting)• Low body mass index

(BMI<18.5 is FAO cutoff)

Representative household surveys are relatively costly, so that often they are only carried out occasionally (if at all).

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Country ranking based on anthropometry

Source: UNICEF (2003).

Stunted(low height-for-age)

Underweight(low weight-for-age)

Wasted(low weight-for-height)

Country % Country % Country %N Korea 59.5 N Korea 60.0 Afghanistan 25.0Zambia 59.0 Afghanistan 48.0 N Korea 18.7Burundi 56.8 Bangladesh 47.8 Somalia 17.2Nepal 54.1 Ethiopia 47.1 Maldives 16.8Afghanistan 52.0 Nepal 47.1 Eritrea 16.4Yemen 51.7 India 47.0 India 15.5Ethiopia 51.2 Yemen 46.1 Laos PDR 15.4Malawi 49.0 Cambodia 45.1 Cambodia 15.3Madagascar 48.6 Burundi 45.1 UAE 15.2Guatemala 46.4 Eritrea 43.7 Mauritius 15.0Cambodia 46.0 Mali 43.3 Sri Lanka 15.0India 45.5 Maldives 43.2 Benin 14.3Nigeria 45.5 Laos PDR 40.0 Niger 14.1

Note: Measurement for children <5.

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Who are the hungry?

Smallholder farmers, 50%

Urban poor, 20%

Pastoralists, fishers, forest-dependent,

10%

Rural landless,

20%Source: Hunger Task Force (2004).

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Literacy and prevalence of rural child undernutrition

0

20

40

60

80

0-19% 20-34% 35%+Underweight rural children under 5 years old

% L

itera

cy

FemaleMale

Source: FAO (2004).

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Rural education and nutrition in Kerala and India as a whole

0 20 40 60 80 100

Female literacy

Female enrolment

Childrenunderweight

Infant mortality (per1000 live births)

%

IndiaKerala

Source: UNDP (2004).

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Correlation of socioeconomic variables with percentage of standard body weight-for-age for pre-school children in the Philippines

Variable Correlation coefficient

Number of households

Schooling years of mother 0.27*** 721Schooling years of father 0.26*** 716Income, farming families 0.12* 213Income, non-farming families 0.35*** 499Age of weaning 0.34*** 545Type of infant feeding(1=breast, 2=mixed, 3=bottle)

-0.37*** 718

Number of household members -0.25*** 722Birth order of subject child -0.21*** 722

*,**,*** Significant at 10%, 5%, and 1% level, respectively.

Source: Arnold et al. (1981). as quoted in Leathers and Foster (2004).

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AIDS and undernourishment

25

30

35

40

1979 - 1981 1990 - 1992 1999 - 2001

% o

f pop

ulat

ion

unde

rnou

rishe

d

Countries in Sub-Saharan Africa with HIV prevalence > 5% in 1991All countries in Sub-Saharan AfricaCountries in Sub-Saharan Africa with HIV prevalence < 5% in 1991

Source: WHO and FAO (2004).

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Seasonality of hunger

Harvest season “Hunger” seasonCalories 91% 63%Protein 148% 79%Vitamin A 23% 88%Niacin 103% 64%Calcium 42% 42%Iron 92% 64%

Nutrient adequacy ratios for a sample of smallholder farmers in Mozambique

Source: Rose et al. (1999).

In the hunger season, not only less is consumed, but there is also a substitution of food products (e.g., less grain, more root andtuber crops and wild fruits and vegetables).

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Micronutrient malnutrition• 852 million people worldwide suffer from undernutrition,

that is, PEM.• All three macronutrients, fat, carbohydrates, and protein,

provide energy (calories).• But apart from macronutrients, which humans need in

substantial amounts, the body needs minimum amounts of micronutrients, including trace minerals (iron, iodine, zinc, calcium etc.) and vitamins.

• A large part of the population suffers from micronutrient malnutrition (“dietary deficiency”), which is also called “hidden hunger”.

• For most micronutrients, there is a strong negative correlation between degree of deficiency and consumers’ income levels.

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Prevalence of iron deficiency

0

20

40

60

80

100

Africa Americas SE Asia Europe E Med. W Pacific Total

%

Iron deficiency anemiaIron deficiency

1.5b

3.7b

Note: Only countries at risk are included.Source: UN ACC/SCN (2000).

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Prevalence of iodine deficiency

2.2b

0.7b

0

20

40

60

80

Africa

America

s

SE Asia

Europe

E Med

W Pac

ific

Total

%

Affected by goiterAt risk population

Note: Only countries at risk are included.Source: UN ACC/SCN (2000).

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Prevalence of vitamin A deficiency

127m

19m

Note: Only countries at risk are included.Source: UN ACC/SCN (2000).

0

10

20

30

40

Africa Americas SE Asia E Med. W Pacific Total

%

ChildrenLactating women

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The triple burden of malnutrition

1. Undernutrition (hunger)2. Micronutrient malnutrition (hidden hunger)3. Overnutrition (overweight, obesity)

Worldwide, an estimated 700 million people are overweight, and 300 million are obese (total 1 billion).

World Health Organization (WHO) classification:

• Underweight: BMI < 18.5 kg/m2 (more severe < 17)

• Overweight: BMI > 25.0-29.9 kg/m2

• Obesity: BMI > 30.0 kg/m2

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Prevalence of underweight and obesity in adults

5.86.9

8.9

2.4 1.6

8.2

4.8

1.8

17.1

20.4

0

5

10

15

20

25

Global Developingcountries

LDCs Transitioncountries

Industrializedcountries

Pre

vale

nce

(%)

BMI smaller than 17.0BMI larger than 30.0

Source: WHO (2000).

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Health problems associated with obesityObesity contributes to:• diabetes• hypertension• stroke

• cardiovascular diseases• some forms of cancer

There is growing evidence that LBW and stunting in early childhood increase the risks of growing up to develop diabetes, heart disease, and other ailments commonly associated with too much food and too little physical activity.This may be the result of “fetal programming”, in which the body adapts to nutritional deprivation in ways that help short-term survival but endanger long-term health.This has become known as the “Barker hypothesis”.The phenomenon is worrisome for many developing countries.

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1.2 The Economic Cost of Malnutrition

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Productivity losses associated with micronutrient malnutrition

5%

17%

4%

10%

20%

0%

5%

10%

15%

20%

IDA and lightblue-collar

work

IDA and heavymanual labour

-10% Hb andmanual labour

IDA/cognitionand earnings

offspring ofmother with

goiter

IDA: iron deficiency anemiaHb: hemoglobin (of which iron is the main component)

Source: compiled by Stein (2005).

Results from various intervention studies

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Methods to quantify the cost1. Cost-of-illness (COI) approach2. Cross country regression approach3. Disability-adjusted life year (DALY) approach

Cost-of-illness approach• quantifies the direct and indirect costs that illnesses and

disabilities related to malnutrition cause

• direct cost: medical costs of treating affected individuals

• indirect cost: lost productivity and lost income caused by premature death, absenteeism, and lower physical and mental capacity

• Disadvantage: the human life is largely reduced to its economic capacity

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(1) Cost-of-illness (COI) approach

Considering that about 20 million LBW children are born every year in developing countries, the annual cost of doing nothing adds up to

US$ 19.7 billion

Source: Alderman et al. (2004).

Estimated benefits of shifting one infant from LBW status

0

100

200

300

400

500

600

700

800

900

1000

Lower infant mortality 94.66

Total 985.61

Less neonatal care 41.80 Reduced illness 83.83

Higher productivityfrom less stunting 180.17

Higher productivityfrom higher ability 434.06

Lower cost of chronicdiseases 73.83

Intergenerational benefits

Discounted present value US$

122.26

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Benefits of reaching WFS goal

• Using the COI approach, FAO has estimated what the benefits would be, if the WFS goal, of reducing the number of hungry by 50% by 2015 (i.e., to 400m), would be met, as compared to what they consider likely (i.e., 600m).

• The total discounted benefit would be US $3 trillion.

• The annuity (average annual benefit) would $120 billion.

• The estimated extra public investment required to reach this goal would only be $24 billion per year.

Source: FAO (2004).

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(2) Cross country regression approachEstimate a model of the following type:

itititit XZY εγβα +⋅+⋅+=where Y is the growth rate of per capita GDP in country i at time t, Z is a vector of control variables, and X is the undernutrition variable.

0.00014***Average DES

-0.0047**

Simulated average impact of eliminating undernutrition on per

capita GDP growth

4.76 percentage points higher

2.94 percentage points higher

Note: The simulation results assume that mean prevalence of undernutrition is reduced to zero, and that mean DES is increased to 2770 kcal/day.Source: FAO (2001).

Coefficient estimates and simulation results

Prevalence of undernutrition

CoefficientVariable included as X

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(3) Disability-adjusted life year (DALY) approach• The COI and regression approaches quantify only those

health costs that can be measured economically.• The DALY approach quantifies the health burden from a

broader perspective.• It combines morbidity and mortality in a single index, and

adds up the “healthy” life years lost due to disease.

DYLDYLLDALYsdiseaseofBurden lost ⋅+==

where YLL is years of life lost, YLD is years of life with disability, and D is the disability weight associated with a particular health condition (D=0 for absolute health, and D=1 for death).Malnutrition is usually associated with different health conditions such as increased child mortality, stunting, reduced physical and mental capacity etc.

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…DALY approach

∑ ⎟⎟⎠

⎞⎜⎜⎝

⎛ −=

−

i

rd

iilost reDIPDALYs

i1

where P is the size of the population, Ii is the incidence rate for health condition i, Di is the corresponding disability weight, di is the duration of the health condition, and r is a discount rate.

Example: the annual burden of iron deficiency in India

Health condition DALYs lostImpaired physical activity 1.88 millionImpaired mental development 1.86 millionMaternal mortality 0.18 millionAssociated stillbirth and infant mortality 0.06 millionTotal DALYs lost 3.98 million

Source: Stein et al. (2005).

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DALY cost of micronutrient malnutrition in India

0

1

2

3

4

5

6

7

8

Iron deficiency Zinc deficiency Vitamin Adeficiency

Mill

ion

DA

LYs

a

nd

Bill

ion

US$ DALYS lost

US$ (1 DALY = per capita GNI)

0.37% of

GDP0.26%

of GDP

0.21% of

GDP

US$ (1 DALY = 3 x per capita GNI)

1.10% of

GDP 0.78% of

GDP 0.64% of

GDP

Source: Stein et al. (2005).

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The global burden of disease is 1.5 billion DALYs

0 1 2 3 4 5 6 7 8 9 10

Risk factors for injuryPhysical inactivity

Low fruit and vegetable intake*Vitamin A deficiency*

Zinc deficiency*Overweight*

Iron deficiency*Indoor smoke from solid fuels

High cholesterol*Unsafe water and sanitation*

Alcohol*Tobacco

High blood pressure*Unsafe sex

Underweight*

% DALYs

High mortality developing countriesLow mortality developing countriesDeveloped countries

Attributable DALYs by risk factor

Source: WHO (2002).