PART 2

The spectrum of malnutrition

Adequate nutrition is essential for economic growth,good health and physical and cognitive development. Itrequires a diverse diet including staple foods, vegeta-bles, fruits, animal-source foods and where needed, for-tified foods. Levels of nutrition are affected not only byfood availability and access but also by sanitation – suchas access to safe drinking water – and disease. In addi-tion, education can play a key role in improving nutri-tional intake and balance.

Chronically food-insecure populations are characterizedby high or very high levels of undernutrition and re-current high levels of acute malnutrition (wasting, lowweight-for-height). These factors limit the developmentof individuals and societies. Undernutrition accounts forapproximately 12 percent of deaths worldwide, and indeveloping countries, 60 percent of deaths in the under-five age group are linked with the low weight (i.e. onethird of the 8.8 million annual child deaths). The mal-nourished are exposed to a high risk of diarrhoeal dis-ease from contaminated water and food, and in turn diar-rhoea worsens the effects of malnutrition, as it compro-mises the human body’s capability to utilize nutrients.

Underweight children whose growth is stunted (when achildren’s height is low for their age – a telling indicatorof chronic undernutrition) and wasting (when children’sweight is low for their height – a measure of acute un-dernutrition) are highly unlikely to reach their full ed-ucational and productive potential, especially if theseconditions are present under the age of two. This af-fects both the individuals and their countries’ long-termprospects for economic growth and development. SouthAsia has the highest levels of stunting and wasting inthe world, with 46 percent of its children stunted and 15percent wasted. Sub-Saharan Africa has the next highestproportion of stunted children, with a prevalence as highas 41 percent in Eastern/Southern Africa, and 28 percentof its children underweight.

According to the United Nations Children’s Fund(UNICEF), more than 20 million infants are born eachyear weighing less than 2.5 kg. This represents 17 per-cent of the total number of births in developing coun-tries. Infants with low birth weight are at high risk ofmortality during their early months. Those who surviveare often afflicted with an impaired immune system andare prone to suffer chronic illnesses in later life. Over96 percent of cases of low birth weight occur in devel-oping countries, where there is a high likelihood of be-ing born in poor socio-economic conditions, and wherewomen often undertake physically demanding work dur-ing pregnancy and are prone to infection and poor diets.The high prevalence is also symptomatic of intergenera-tional transmission of poor nutritional status, the conse-quences of which are passed to children by mothers whoare themselves in poor health or undernourished.

Map 21:

No Data < 5 5 − 15 15 − 20 20 − 25 > 25

Share of children under 5 who are underweight (%, 2009*)

Source: WHO-WHS

Metalink: P2.HUN.WHO.GHO.CHLD.UW, p. 170

→ Children living in rural areas of develop-ing regions are two times more likely tobe underweight than are urban children

→ Insufficient nutritional achievement byage two condemns a child to being lessacademically capable, receiving lowerincomes as an adult, and in the caseof girls, being at greater risk of difficultchildbirth and maternal mortality

96

THE SPECTRUM OF MALNUTRITION

No Data < 5 5 − 15 15 − 20 20 − 25 > 25

Share of children under 5 who are underweight (%, 2009*)

Chart 42: South Asia has the highest prevalence of underweight children in the world

Share of children under 5 who are underweight (2009*)

%

0

10

20

30

40

EastAsia

L.Amer. &Carib.

SouthAsia

Sub-SAfrica

Source: WHO-WHS

Metalink: P2.HUN.WHO.GHO.CHLD.UW, p. 170

97

PART 2

Early childhood nutrition plays a key role in cognitiveachievement, learning capacity and ultimately house-hold welfare. Available studies have shown that lowbirth weight, protein energy malnutrition in childhood,childhood iron-deficiency anaemia and iodine deficiency(e.g. being born to a mother with goitre) are all linkedto cognitive deficiencies and the effects are more or lessirreversible by the time a child is ready to go to school.

The UN Standing Committee on Nutrition (SCN) has esti-mated that the economic costs of anaemia in Bangladeshalone, for example, amount to 7.9 percent of the coun-try’s Gross Domestic Product (GDP). More widely, whena significant proportion of the population is undernour-ished, potential rates of GDP growth can be curtailed.For example in South Asia, adult productivity losses aris-ing from the combined effect of stunting, iodine defi-ciency and iron deficiency are equivalent to a loss of 2to 4 percent of GDP every year.

In adults, a commonly used measure to detect malnutri-tion is the body mass index (BMI), defined as the ratio ofbodyweight in kilograms to the square of height in me-tres. BMI can clearly vary over a person’s lifetime, butphysical stature is determined by the time an individualreaches adulthood. Low stature and low BMI are associ-ated with lower labour force participation – not only dopeople with lower stature or BMIs earn less, but they areless likely to be in a position to earn wages at all.

At the other end of the malnutrition spectrum is theproblem of overnourishment, which leads to overweightand obesity. Already a well-known phenomenon in de-veloped countries, obesity is also increasing in the devel-oping world, especially among urban dwellers. The issueof obesity has not been givenmuch attention in develop-ing countries because of the more compelling problemsat the other end of the scale. Overnutrition is a resultof diets that are characterized by energy-dense, nutrientpoor foods that are high in fat, sugar and salt. It is amajor contributor to heart disease, stroke, diabetes andcancer, and is compounded by low levels of physical ac-tivity and by tobacco consumption. Worldwide obesityhas more than doubled since 1980. At 1.5 billion adultsaged 20 and over, there are more overweight adults inthe world today than there are undernourished. Of them,over 200 million men and nearly 300 million women areobese.

Further reading

• FAONutrition and Consumer Protection Division (www.fao.org/food/)

• UNICEF Nutrition (www.unicef.org/nutrition/)• WHO Nutrition and disorders (www.who.int/topics/nutrition_disorders/)

Chart 43: One in nine children under five are low weight-for-height in developing countries. Stunting and wastingare caused by long-term insufficient nutrient intake

Share of children under 5 that are stunted and wasted (2009*)

%

0

10

20

30

40

DevelopedEastAsia

L.Amer. &Carib.

SouthAsia

Sub-SAfrica

Stunted Wasted

Source: WHO-WHS

Metalink: P2.HUN.WHO.GHO.CHLD.STNT, p. 170

Chart 44: Insufficient iron in diets is a primary cause ofanaemia, and is common in vegetal-based diets

Availability of dietary iron (2005-07)

mg/person/day

0

10

20

30

40

50

60

DevelopedEastAsia

L.Amer. &Carib.

SouthAsia

Sub-SAfrica

Source: WHO-WHS

Metalink: P2.HUN.FAO.MCN.IRON, p. 165

98

THE SPECTRUM OF MALNUTRITION

Map 22: Undernourished women are more likely to raise children who are undernourished, reinforcing the intergenerationalcycle of malnutrition

No Data < 5 5 − 10 10 − 15 15 − 25 > 25Share of women with a BMI of less than 18.5 (%, 2009*)

Source: WHO-WHS

Metalink: P2.HUN.WHO.GHO.ADLT.LBMIF, p. 170

Map 23: Obesity is an entrenched problem in many developed countries, but under- and over-nutrition co-exist in manycountries, leading to a double burden of malnutrition

No Data < 15 15 − 25 25 − 40 40 − 50 > 50Share of adults which are overweight or obese (%, 2009*)

Source: WHO-WHS

Metalink: P2.HUN.WHO.GHO.ADLT.OBSx, p. 170

99

PART 2

Trade, food stability and food security

Against the backdrop of deepening international mar-kets, convertible domestic currencies, improved inter-national transportation networks and diminishing pub-lic stock regimes, trade plays an increasingly importantrole in stabilizing food availability in almost all coun-tries. When agricultural-based countries experience de-clining per capita production of staple foods, the role oftrade becomes pivotal in their food security.

Equally, trade assists food security in staple food pro-duction systems undergoing wide fluctuations caused byvariable climates, especially in those systems that arerain-fed. High coefficients in the variation of staple foodproduction – 10 percent and above – are common inmuch of sub-Saharan Africa. This means that a short-fall of at least 10 percent of average staple productionoccurs every six years.

Instability in food production can also lead to problemsin global markets. While a handful of countries contin-ues to dominate supply in the international arena, thereis an increasing number of countries at the margin thatparticipate in exports. Those that have emerged recentlyas regular international suppliers instil a great degree ofuncertainty in the global marketplace owing to the highyear-to-year variability of their production. This is partic-ularly true for several rain-fed grain producing countriesin the Black Sea region, which triggered turmoil in mar-kets midway in 2010 when weather problems loweredexport availabilities. This feature can also shift the net-trade status of large producing and consuming countriesfrom one year to the next, bringing uncertainty to mar-kets (as in the case of rice).

Beyond production instability, trade deficits in many ofthe most food-insecure countries have become struc-tural over the past two decades. Expensive inputs, highshipment costs and high losses from farms to marketshave lowered the competitiveness of the agriculture sec-tor in many developing countries. At the same time,large global suppliers have benefited from subsidies inexport markets and the transformation of the retail sec-tor in importing countries, resulting in a growing preva-lence of higher foreign standards. These factors con-tributed to the growing trade deficit of many develop-ing countries, which shifted their trade status from aposition of net exporters to that of net importers. Themost economically vulnerable group, including least de-veloped countries (LDCs), has been hardest hit; their netfood and agriculture import bills have soared over thepast 20 years to a level of nearly USD 27 billion by 2010.

Map 24:

No Data < 75 75 − 100 100 − 125 125 − 150 > 150

Caloric self−sufficiency (%, 2009)

Source: FAO, Statistics Division

Metalink: P2.HUN.FAO.TFS.SSCAL, p. 165

→ Underperforming productive sectorsand/or a lack of resource endowmentsare behind low rates of food self suf-ficiency, requiring imports to fill fooddeficits

→ Many countries in sub-Saharan Africaand Latin America and the Caribbean donot produce enough food to cover do-mestic food needs

→ However, food security should not beconfounded with food self sufficiency

100

TRADE, FOOD STABILITY AND FOOD SECURITY

No Data < 75 75 − 100 100 − 125 125 − 150 > 150

Caloric self−sufficiency (%, 2009)

Chart 45: Much of Latin America more than self-sufficient in food but the converse inAfrica

Caloric self-sufficiency (1990-2009)

90

95

100

105

110

115

1990 1995 2000 2005

Developed East Asia South Asia Sub-S Africa L. Amer. & Carib.

Source: FAO, Statistics Division

Metalink: P2.HUN.FAO.TFS.SSCAL, p. 165

101

PART 2

With the global cost of purchasing food on the interna-tional marketplace surpassing USD 1 trillion in 2010 (asit did in 2008), food import bills for LDCs have climbedthe most. At 17 percent, their increase far exceeded thatof the global level. The sheer encumbrance facing someof the world’s poorest countries in importing food canbe contrasted to that of developed nations, whose foodimport bills rose by only 8 percent in 2010. Seen ina broader perspective, expenditures on imported food-stuffs for vulnerable countries account for roughly 18percent of all their expenditures on imports, comparedto a world average of around 7 percent.

Rising import bills could lead to increased stress if thereis insufficient income growth or export earnings to ac-commodate the higher pace of food import costs. Higherfood import bills can place a severe burden on the bal-ance of payments, depriving disadvantaged countries oflimited foreign exchange reserves that could be used forimporting other essential goods and services, such asfuel and inputs. Sovereign credit ceilings also constrainthe ability to finance imports and to meet unforeseenhigher procurement costs.

The on-going instability in international food marketshas prompted rising mistrust in many food-importingcountries about the reliability of international marketsas suppliers of affordable food. Several countries haveexplored the possibility of becoming less reliant on foodimports in the context of safeguarding their own foodsecurity. The notion of food security often becomes con-flated with ideas about food self-sufficiency.

Food security and food self-sufficiency, however, are dif-ferent concepts, and are often at odds with one another.Self-sufficiency policies that distort market signals usingprotectionist strategies, such as import bans, have highsocial costs given their distributional effects. They placefood self-sufficiency at variance with the goals of foodsecurity and poverty reduction. But, by improving agri-cultural productivity and domestic competitiveness, im-ports are likely to be deterred, and consequently, higherlevels of self-sufficiency will be compatible with food se-curity and poverty reduction.

Further reading

• FAO World Food Situation (www.fao.org/worldfoodsituation/en/)

• FAO Food Outlook (www.fao.org/giews/english/fo/index.htm)

• Prakash (2011b)

Chart 46: Production variability remains high in manyfood-insecure regions

Index of variability of food production (1990-2009)

%p.a.

6

8

10

12

14

16

1990 1995 2000 2005

DevelopedEastAsia

L.Amer. &Carib.

SouthAsia

Sub-SAfrica

Source: FAO, Statistics Division

Metalink: P2.HUN.FAO.TFS.QPVAR, p. 165

Chart 47: Global cereal stocks on the decline owing topolicy shifts and greater dependence on trade

World cereal stocks-to-utilization (1980-2010)

20

25

30

35

1980 1985 1990 1995 2000 2005 2010

Source: FAO, Statistics Division

Metalink: P2.HUN.FAO.TFS.STU, p. 165

102

TRADE, FOOD STABILITY AND FOOD SECURITY

Chart 48: Barring Asia, cereal stocks are sufficient tomeet less than two months of consumption

Months of cereal self-provisioning capacity (2010)

Months

0

1

2

3

4

DevelopedE & SEAsia

L.Amer. &Carib.

Sub-SAfrica

Source: FAO, Statistics Division

Metalink: P2.HUN.FAO.TFS.STU, p. 165

Chart 49: Food import bills have risen markedly in thepast few years, driven by a combination of higher inter-national prices and greater trade

Food import bills (1995-2010)

BillionUS$ 300

400

500

600

20406080100120140

1996 1998 2000 2002 2004 2006 2008 2010

Developed

OtherRegions

DevelopedEastAsia

SouthAsia

Sub-SAfrica

L.Amer. &Carib.

Source: FAO, Statistics Division

Metalink: P2.HUN.FAO.TFS.FIB, p. 165

Chart 50: The burden of food and energy import bills ishigh when measured against GDP

Food and energy import bills, share of GDP (2010)

%

0

2

4

6

DevelopedEastAsia

L.Amer. &Carib.

SouthAsia

Sub-SAfrica

Food Fuel

Source: FAO-IMF

Metalink: P2.HUN.FAO.TFS.FIB, p. 165

Chart 51: ... and also on a per capita basis

Food and fuel import bills per capita (2010)

US$

0

200

400

600

800

1000

DevelopedEastAsia

L.Amer. &Carib.

SouthAsia

Sub-SAfrica

Food Fuel

Source: FAO-UNSD

Metalink: P2.HUN.FAO.TFS.FIB, p. 165

103

PART 2

Food prices and food price volatility

High food prices pose a major threat to food security.By reducing real incomes, rising prices can worsen theprevalence of hunger and malnutrition because they re-duce the quantity and quality of food consumed. The im-pact of high prices falls heaviest on the poor, especiallyfemale-headed households and the landless, which mayspend as much as 80 percent of their income on food.The lack of dietary diversification aggravates the prob-lem, as price increases in one staple cannot easily becompensated by a switch to other foods. The lack of ad-equate social and income safety nets, such as savings,compounds price increases.

Vulnerable households often deal with soaring prices byselling assets, which are very difficult to rebuild, andby cutting down on health and education expenditures.These short-term coping mechanisms have long-termnegative, sometimes irreversible, effects on livelihoods.

Soaring food prices have triggered worldwide concernabout threats to global food security, and have shakenthe unjustified complacency caused bymany years of lowcommodity prices. Up until 2006, the cost of the globalfood basket had fallen by almost a half over the previ-ous thirty years or so when adjusted for inflation. De-clining real prices as a result of technological advancesput farmers under considerable strain, except mainly indeveloped countries, where governments were able toprovide support to agricultural producers through sub-sidies and price guarantees. Elsewhere, public and pri-vate sectors saw limited need or incentive to invest inagricultural production and infrastructure. These factorsrendered production in many developing countries un-profitable and entrenched the role of a handful of coun-tries in regularly supplying the world with food. Changesin the market and policy setting were also instrumentalin reducing stock levels and have led to far more planneddependence on imports as an efficient way of achievingfood security.

Taken together, these developments have imposed aheavy responsibility on major exporting countries tosupply international markets when called upon. It isthus unsurprising that when production shortages occurin such countries, global supplies are stretched and theensuing market tightness manifests both higher pricesand higher volatility. This was precisely the case in therun-up to the high-price episodes that the world has wit-nessed in recent years. Other contributory factors in-cluded dependence on new exporting zones, where rain-fed crop outcomes are much more prone to weather va-garies, growing demand for food from other sectors (e.g.,energy), faster transmission of macroeconomic factorsonto commodity markets, and lack of trade policy dis-cipline, especially in the context of export restraints.

Map 25:

No Data < 0 0 − 5 5 − 10 10 − 15 > 15

Food price inflation (%, 2010)

Source: FAO, Statistics Division

Metalink: P2.HUN.FAO.FPV.FCPI, p. 164

→ Food purchases can account for as muchas 80 percent of household expenditurein developing countries

→ Rising prices of food are particularlyharmful in these circumstances

→ Affected households often respond byselling productive assets, which are dif-ficult to rebuild, and by cutting downon health and education expenditures,leading to longer-term problems

104

FOOD PRICES AND FOOD PRICE VOLATILITY

No Data < 0 0 − 5 5 − 10 10 − 15 > 15

Food price inflation (%, 2010)

Chart 52: The international price of the global food basket has soared in recent years

FAO Global Consumption Price Index (1990-2010)

2002-04=100

100

150

200

1990 1995 2000 2005 2010

Source: FAO, Statistics Division

Metalink: P2.HUN.FAO.FPV.GCI, p. 164

105

PART 2

In 2011, international prices rose to levels not seen indecades. The export-weighted FAO food price climbed toa record 238 points in February and remained stubbornlyhigh throughout much of the year. Escalating worldprices for cereals, vegetable oils and sugar (40, 35 and25 percent, respectively over the past year) have fuelledmuch of the increase. The FAO global food consump-tion index, which uses global average calorie shares asweights, also rose to a record level, climbing 26 percentfrom 2010.

Movements of prices in global markets may seem lessimportant than price movements within domestic mar-kets, as international trade accounts for a low percent-age of global transactions. The issue is how global pricemovements affect domestic prices and markets for agri-cultural products inside countries (and, potentially, viceversa) and how international prices are transmitted dif-ferentially to producers and to consumers.

Measuring price transmission is often plagued with diffi-culties, but as markets are increasingly integrated in theworld economy, price changes in the international arenacan potentially transpire and spread to domestic marketsmuch more quickly than before.

There is emerging consensus that the global food sys-tem is becoming more vulnerable to episodes of highprices and volatility. Price volatility is by nomeans a newphenomenon in developing countries, where significantseasonal or annual price fluctuations remain features ofrural life. With poor infrastructure, local prices may besubject to substantial variation. While price volatility isin part a function of the interplay between global anddomestic factors, it is also a structural problem.

Bouts of high price volatility come at a cost, as mar-ket participants have difficulty planning ahead and ad-justing to fluctuating market signals. As unpredictablechanges, or “shocks”, surpass a certain critical size andpersist at those levels, traditional policy prescriptionsand coping mechanisms are likely to fail. For instance,high price volatility can result in large income fluctua-tions for farmers, who have little or no recourse to sav-ings and insurance. The delay between production deci-sions and actual production creates additional risks, asfarmers base their investment and planning on expectedprices.

Chart 53: Internationally traded food prices reachedrecord highs in 2010

FAO International price indices - traded staples (1990-2010)

2002-04=100

100

150

200

250

300

350

1990 1995 2000 2005 2010

Meat Dairy Cereals Oils Sugar

Source: FAO, Trade and Markets Division

Metalink: P2.HUN.FAO.FPV.FPI, p. 164

Chart 54: Food prices have risen faster than income

Global affordability of food (1990-2010)

2002-04=100

90

100

110

120

130

140

150

1990 1995 2000 2005 2010

Least Developed Countries World

Source: FAO, Statistics Division

Metalink: P2.HUN.FAO.FPV.AFD, p. 164

106

FOOD PRICES AND FOOD PRICE VOLATILITY

Chart 55: Historical volatility of world reference food prices also reached new heights in 2010

International food price volatility (1990-2010)

%

6

8

10

12

14

16

1995 2000 2005 2010

Source: FAO, Statistics Division

Metalink: P2.HUN.FAO.FPV.FPV, p. 164

Chart 56: Of all the prices of major food commodities, global sugar quotations have been most volatile

International food price volatility by food group (1990-2010)

%

10

20

30

40

1995 2000 2005 2010

Meat Dairy Cereals Oils Sugar

Source: FAO, Statistics Division

Metalink: P2.HUN.FAO.FPV.FPV, p. 164

107

PART 2

According to an IFAD survey of farmers in theMiddle Eastand North Africa conducted in the aftermath of the 2006-08 high price episode, it was found that more than 60percent of farmers would have expected to increase thearea under cereals if prices had remained at the high lev-els of early 2008. However, the sharp reduction in pricescreated uncertainty and complicated farmers’ decision-making.

With global markets yet again experiencing turmoil over2010-2011, developing countries must enact measuresto protect the most vulnerable, not by fighting volatil-ity, but by managing its risks and mitigating its conse-quences by providing the poor with access to food. In thelong run, vulnerability can be lowered by raising agricul-tural productivity for a diverse set of both competitiveand sustainable crops, as well as by promoting dietarydiversification.

Reducing market uncertainty may not be among thefastest remedies for lowering the number of hungry. Yet,letting international markets continue in their presentstate, volatile and unpredictable, will only aggravate analready grim outlook for world food security. This is thereason why world leaders have been dwelling at lengthon the issue of price volatility since the start of the year.Such discussions gained momentum in recent months asattention turned towards finding ways to improve the ac-curacy of supply and demand forecasts for major foodcrops as an important first step in promoting stable andtransparent food markets.

In June 2011, the Group of 20 (G-20) established a globalinformation system under the banner of AgriculturalMarket Information System (AMIS). This initiative, pro-posed by a number of international organizations, hasbeen endorsed by all G-20 Members and, subsequently,by the Committee on World Food Security (CFS).

Further reading

• FAO Global Food Price Monitor (www.fao.org/giews/english/gfpm/)

• FAO World Food Situation (www.fao.org/worldfoodsituation/en/)

• Prakash (2011a)• IFAD Rural Poverty Report. New realities, new chal-lenges, new opportunities for tomorrow’s generation(www.ifad.org/rpr2011/)

Map 26:

No Data < 10 10 − 20 20 − 30 30 − 50 > 50

Food price volatility − annualized historical volatility (%, 2010)

Source: FAO, Statistics Division

Metalink: P2.HUN.FAO.FPV.FPVn, p. 164

→ Food price volatility, measured over thepast five years, is highest in many of themost food-insecure countries

→ Bouts of high price volatility come at acost, as market participants have diffi-culty planning ahead and adjusting tofluctuating market signals

→ Food markets are expected to be morevolatile in the future compared to previ-ous decades

108

FOOD PRICES AND FOOD PRICE VOLATILITY

No Data < 10 10 − 20 20 − 30 30 − 50 > 50

Food price volatility − annualized historical volatility (%, 2010)

Chart 57: Historical volatility of a typical food basket on the rise

FAO Global Consumption price volatility (1990-2010)

%

6

8

10

12

14

16

1990 1995 2000 2005 2010

Source: FAO, Statistics Division

Metalink: P2.HUN.FAO.FPV.GCI, p. 164

109