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THE STATE OF

FOOD SECURITY
AND NUTRITION
IN THE WORLD
SAFEGUARDING AGAINST
ECONOMIC SLOWDOWNS
AND DOWNTURNS
This flagship publication is part of THE STATE OF THE WORLD series of the Food and Agriculture Organization of
the United Nations.

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FAO, IFAD, UNICEF, WFP and WHO. 2019. The State of Food Security and Nutrition in the World 2019.
Safeguarding against economic slowdowns and downturns. Rome, FAO.
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COVER PHOTOGRAPH ©Shutterstock/Valeriya Anufriyeva

DEMOCRATIC REPUBLIC OF THE CONGO. Young woman selling fruit at a street market.
ISSN 2663-8061

2019
THE STATE OF
FOOD SECURITY
AND NUTRITION
IN THE WORLD
SAFEGUARDING AGAINST ECONOMIC
SLOWDOWNS AND DOWNTURNS

Food and Agriculture Organization of the United Nations


Rome, 2019
CONTENTS

FOREWORD vii ANNEXES 121


METHODOLOGY x
ACKNOWLEDGEMENTS xi ANNEX 1A
Statistical tables to Part 1 122
ACRONYMS AND ABBREVIATIONS xiii
KEY MESSAGES xiv
ANNEX 1B
EXECUTIVE SUMMARY xvi
Methodological notes to statistical tables 148
PART 1
FOOD SECURITY AND NUTRITION ANNEX 2
AROUND THE WORLD IN 2019 1 Methodologies Part 1 159
1.1 Recent trends in hunger and food insecurity 3
1.2 Progress towards global nutrition targets 27 ANNEX 3
PoU change point definitions, methodology
1.3 Towards an integrated understanding of food and country lists 165
security and nutrition for health and well-being 42
1.4 Conclusions 46 ANNEX 4
Economic growth and change in PoU
PART 2 between 2011 and 2017 169
SUSTAINED ESCAPES FROM FOOD INSECURITY
AND MALNUTRITION IN THE FACE OF ECONOMIC ANNEX 5
SLOWDOWNS AND DOWNTURNS 49 The main drivers of crisis-level acute
2.1 Economic slowdowns and downturns food insecurity in 2018 176
and their impact on food security and nutrition 51
2.2 Commodity dependence and its relevance ANNEX 6
Commodity dependence definitions
for food security and nutrition 61
and country lists 178
2.3 Nexus between economic growth,
poverty, and food security and nutrition: ANNEX 7
the role of inequality 79 Glossary 185
2.4 Policies for achieving sustainable escapes
from food insecurity and malnutrition in the NOTES 191
context of economic slowdowns and downturns 102
2.5 Conclusions 118

| ii |
TABLES, FIGURES AND BOXES

TABLES 11  Coping strategies, their A4.2  Regression of the change


availability in times of economic in PoU and economic growth
1  Prevalence of undernourishment slowdowns and downturns and between 2011 and 2017 173
(PoU) in the world, 2005–2018 8 possible negative effects 78
A4.3  Regression of the change
2  Number of undernourished 12  Multisectoral policies for in PoU between 2011 and 2017 and
people in the world, 2005–2018 9 reducing poverty, and the constraints the three drivers of PoU increase 174
3  Prevalence of moderate or severe that must be overcome to improve
A4.4a  Estimated coefficients of
food insecurity, and severe food food security and nutrition 116
the regressions between the change in
insecurity only, measured with the A1.1  Progress towards the Sustainable PoU (between 2011 and 2017) and the
Food Insecurity Experience Scale, Development Goals (SDGs): Prevalence three drivers of PoU – drivers regressed
2014–2018 15 of undernourishment, moderate or severe separately for each income group 175
4  Number of people experiencing food insecurity, selected forms of
A4.4b  Estimated coefficients of
moderate or severe food insecurity, malnutrition, exclusive breastfeeding
the regressions between the change in
and severe food insecurity only, and low birthweight 122
PoU (between 2011 and 2017) and the
measured with the Food Insecurity A1.2  Progress towards the Sustainable three drivers of PoU – drivers regressed
Experience Scale, 2014–2018 18 Development Goals (SDGs): Number together for each income group 175
5  Association between food of people who are affected by
A5.1  Countries and territories
insecurity and various forms of undernourishment, moderate or severe
with food crises in correspondence
malnutrition: cross-country analysis food insecurity and selected forms
with economic shocks, 2018 176
based on national data 44 of malnutrition; number of infants
exclusively breastfed and number of A6.1  Definition of country
6  Association between food babies born with low birthweight 135 commodity-export and
insecurity and overweight or commodity-import dependence 179
obesity in different age groups: A2.1  Definition of variables
micro-level data analysis from and sources 160 A6.2  Countries and territories by
selected countries 45 typology of primary commodity
A2.2  Definition of variables
dependence (1995–2017) 179
7  Association between household and sources 162
food insecurity, child stunting and A6.3  Countries with economic
A2.3 Results 162
wasting, and anaemia in women of slowdowns or downturns in
reproductive age: micro-level data A2.4  Malnutrition indicators correspondence to an increase
analysis from selected countries 46 by age/sex class in PoU change point and/or
(dependent variables) 163 affected by food crises 180
8  Economic shocks were significant
secondary and tertiary drivers of A2.5  Independent variables 164
FIGURES
food crises in 2018 60 A3.1  Countries with an increase
in PoU change point corresponding 1  The number of undernourished
9  High levels of commodity-export
to economic slowdowns or people in the world has been on
and -import dependence negatively
downturns, years 2011–2017 166 the rise since 2015, and is back to
affect food security 67
levels seen in 2010–2011 6
10  Government spending on A4.1  Descriptive statistics of PoU
and economic growth between 2  Undernourishment is rising
social and health sectors and
2011 and 2017 172 rapidly in Western Africa 10
UHC coverage in high
commodity-dependent countries 76

| iii |
TABLES, FIGURES AND BOXES

3  Undernourishment increases 13  The numbers of undernourished 23  Consecutive years of economic
sharply in countries affected by and of food insecure have been on slowdowns and downturns since
conflict in sub-Saharan Africa 10 the rise in recent years, after a 2011 in many subregions 54
decade-long decline in extreme
4  Droughts are one of the 24  PoU increasing change points
poverty and undernourishment 22
factors behind the recent associated with the occurrence
increase in undernourishment in 14  In every continent, the prevalence of economic slowdowns and
sub-Saharan Africa 11 of food insecurity is slightly higher for downturns 55
women than for men, with the largest
5  Western Asia is the only 25  Low-income countries face
differences found in Latin America
subregion in Asia where higher increases in hunger as a
(2016–2018 three-year averages) 23
undernourishment is on the rise 12 result of decreases in economic
15  Progress on malnutrition is too growth (between 2011 and 2017) 58
6  Undernourishment is on the rise in
slow to achieve the 2025 and 2030
Western Asian countries affected by 26  Commodity prices (though high)
global nutrition targets 29
popular uprisings in the recent past 12 fell year on year from 2011 to 2016 63
16  Stunting, wasting and overweight
7  Increasing undernourishment in South 27  Many low- and middle-income
still impact the lives of far too many
American countries is putting upward countries are high commodity-dependent
children under 5 years 30
pressure on the Latin America and the countries 65
Caribbean regional average 13 17  Overweight prevalence increases
28  Between 2003 and 2017, high
over the life course and is highest
8  The Bolivarian Republic of Venezuela commodity-dependent countries faced
in adulthood 33
shows a significant increase in the steeper declines in economic growth
prevalence of undernourishment in 18  Across all regions, the prevalence compared to low commodity-dependent
recent years 13 of overweight is increasing in all age countries – for those with rising hunger
groups, with particularly steep trends the situation was even worse 66
9  Even though Asia still predominates,
among adults and school-age
more than thirty percent of the 29  Potential negative impacts of
children, including adolescents 34
undernourished in the world live international commodity price reductions
in Africa 14 19  The increase in prevalence of on food security and nutrition in
obesity between 2000 and 2016 commodity-dependent economies:
10  Over the past five years
has been even larger than that transmission channels 69
(2014–2018), total levels of food
of overweight 35
insecurity have been on the rise at the 30  Falling commodity prices
global level, mainly due to increases 20  The gap between urban and triggered a devaluation of the
in Africa and Latin America 19 rural areas in mean body mass Colombian and Chilean currencies 71
index is closing 36
11  The concentration and 31  Prevalence of undernourishment
distribution of food insecurity by 21  Examples of policies and (PoU) and child stunting rates are
severity differs greatly across the programmes aimed at preventing or correlated with extreme poverty at
regions of the world 20 reducing overweight and obesity 39 the country level 87

12  As the country level of income falls, 22  Real GDP per capita growth has 32  High levels of child stunting
the prevalence of food insecurity been uneven since the 2008–2009 are not only found in the poorest
increases and so does the proportion of sharp global downturn 53 households 88
severe food insecurity over the total 21

| iv |
33  Most of the world’s extreme 3  Computing FIES-based estimates so 13  Explaining poverty and food
poor now live in Africa, but the that they are globally comparable 16 security and nutrition trends in China
majority of the world’s hungry and and India: the pattern of growth
4  How do estimates of food insecurity
children affected by stunting live and initial inequalities 82
compare to other important indicators
in Asia 89
of human development? 25 14  Addressing inequality in the
34  High and persistent levels of context of economic growth in
5  Different food security assessments
income inequality in low- and Brazil – a way out of hunger
for different objectives 26
middle-income countries 92 and malnutrition 95
6  Overweight and obesity and
35   Income inequality is rising in 15  Increasing opportunities for
the effect of malnutrition throughout
nearly half the countries of the world, indigenous populations is key to
the life cycle 32
including in several low-income nurturing their dietary diversity 100
countries and some middle-income 7  Risk factors for overweight and
16  Gender dimensions of
countries 93 obesity in school-age children 38
inequality in agriculture and
36  Some countries have reduced 8  Double-duty actions to address rural areas 101
income inequality, while for others all forms of malnutrition in the
17  Social protection is critical for
it has worsened 94 context of humanitarian assistance 41
food security and nutrition, especially
37  Inequality in the distribution of 9  What are economic slowdowns during economic slowdowns
agricultural land is high in many and downturns? 52 and downturns 105
countries in sub-Saharan Africa 98
10  Why did world hunger not 18  Homegrown school feeding
rise during the global food and as a way to prevent undesirable
BOXES financial crises? 56 coping strategies 106
1  Two indicators for SDG Target 2.1 11  What is commodity dependence 19  Boosting small-scale farming
to monitor progress on ending hunger and how is it measured? 64 for diversification and market
and ensuring access to food for all 4 integration in Sao Tome and
12  Economic slowdown and the
2  Revised series of estimates of Principe, and Senegal 111
cost of basic food in Colombia 73
the prevalence of undernourishment 20  Trade policy, food systems,
and projections for 2018 7 and food security and nutrition 113

| v |
TAJIKISTAN
Fresh Tajik puff cakes being
prepared as part of a project
supporting inclusive agriculture
and food security initiatives.
©FAO/Nozim Kalandarov
FOREWORD

The 2030 Agenda for Sustainable Development Recent editions of the report showed that the
puts forward a transformational vision decline in hunger the world had enjoyed for
recognizing that our world is changing, over a decade was at an end, and that hunger
bringing with it new challenges that must be was again on the rise. This year, the report
overcome if we are to live in a world without shows that the global level of the prevalence
hunger, food insecurit y and malnutrition in of undernourishment has stabilized; however,
any of its forms. the absolute number of undernourished people
continues to increase, albeit slowly.
The world population has grown steadily,
with most people now living in urban More than 820 million people in the world are
areas. Technolog y has evolved at a dizzying still hungr y today, underscoring the immense
pace, while the economy has become challenge of achieving the Zero Hunger
increasingly interconnected and globalized. target by 2030. Hunger is rising in almost all
Many countries, however, have not witnessed subregions of Africa and, to a lesser extent, in
sustained growth as part of this new economy. Latin America and Western Asia. We welcome
The world economy as a whole is not growing the great progress seen in Southern Asia
as much as expected. Conf lict and instabilit y in the last five years, but the prevalence of
have increased and become more intractable, undernourishment in this subregion is still
spurring greater population displacement. the highest in Asia.
Climate change and increasing climate
variabilit y and extremes are affecting Another disturbing fact is that about
agricultural productivit y, food production 2 billion people in the world experience
and natural resources, with impacts on food moderate or severe food insecurit y. The lack
systems and rural livelihoods, including a of reg ular access to nutritious and sufficient
decline in the number of farmers. All of this food that these people experience puts them
has led to major shifts in the way in which at greater risk of malnutrition and poor
food is produced, distributed and consumed health. Although primarily concentrated in
worldwide – and to new food securit y, low- and middle-income countries, moderate
nutrition and health challenges. or severe food insecurit y also affects
8 percent of the population in Northern
This is the third year that we have jointly America and Europe. In ever y continent,
produced The State of Food Security and Nutrition the prevalence rate is slightly higher among
in the World. It reaffirms our commitment to women than men.
working together to overcome these emerging
challenges and free the world from hunger, With regard to nutrition indicators, we are faring
food insecurit y and malnutrition. no better. If current trends continue,

| vii |
FOREWORD
FOREWORD

we will meet neither the 2030 SDG Target to This year, importantly, the report notes
halve the number of stunted children nor the that hunger has been increasing in many
2025 World Health Assembly target to reduce countries where economic growth is lagging.
the prevalence of low birthweight by 30 percent. Strikingly, the majorit y of these countries are
This year’s report warns that one in seven live not low-income countries, but middle-income
births (20.5 million babies born globally) was countries and countries that rely heavily on
characterized by low birthweight in 2015 – many international trade of primar y commodities.
of these low birthweight babies were born to Economic shocks are also prolonging and
adolescent mothers. The trends of overweight and worsening the severit y of acute food insecurit y
obesit y give us additional reason for concern, as in food crisis contexts. Left unattended, these
they continue to rise in all regions, particularly trends may have ver y unwelcome implications
among school-age children and adults. The most for malnutrition in all its forms. Moreover, we
recent data show that obesit y is contributing to see that economic slowdowns and downturns
4 million deaths globally and is increasing the disproportionally challenge food securit y and
risk of morbidit y for people in all age groups. nutrition where inequalities in the distribution
of income and other resources are profound.
Our actions to tackle these troubling trends
will have to be bolder, not only in scale but We must recognize the importance of
also in terms of multisectoral collaboration, safeg uarding food securit y and nutrition in
involving the agriculture, food, health, water times of economic difficult y. We must invest
and sanitation, education, and other relevant wisely during periods of economic booms
sectors; and in different policy domains, to reduce economic v ulnerabilit y and build
including social protection, development capacit y to withstand and quickly recover
planning and economic policy. when economic turmoil erupts. We must
foster pro-poor and inclusive structural
As we seek solutions, we must keep in mind transformation focusing on people and
the fragile state of the world economy. placing communities at the centre to reduce
Since the sharp 2008 –2009 global economic economic v ulnerabilities and set ourselves on
downturn, there has been an uneven pace of track to ending hunger, food insecurit y and
recover y in many countries, and the global all forms of malnutrition while “leaving no
economic outlook is darkening again. one behind”.

| viii |
To make our transformational v ision pro-poor This will require accelerated and aligned actions
and inclusive, we must integ rate food securit y from all stakeholders and countries, including
and nutrition concerns into povert y reduction tireless and more integrated support from the
efforts to make the most of the sy nerg ies United Nations and the international communit y
between eradicating povert y, hunger, food to countries in support of their development
insecurit y and malnutrition. We must also priorities, through multilateral agreements and
ensure that reducing gender inequalities and means of implementation, so that countries can
social exclusion of population g roups is either embark on a pro-poor and inclusive path to
the means to, or the outcome of, improved transformation in a people-centred way to free
food securit y and nutrition. the world from povert y, inequalities, hunger,
food insecurit y and malnutrition in all its forms.

José Graziano da Silva Gilbert F. Houngbo Henrietta H. Fore


FAO Director-General IFAD President UNICEF Executive Director

David Beasley Tedros Adhanom Ghebreyesus


WFP Executive Director WHO Director-General

| ix |
METHODOLOGY

The State of Food Security and Nutrition in the World 2019 has been prepared by the FAO Agricultural
Development Economics Division in collaboration with the Statistics Division of the Economic and Social
Development Department and a team of technical experts from FAO, IFAD, UNICEF, W FP and W HO.

A senior advisor y team consisting of designated senior managers of the five UN publishing partners
g uided the production of the report. Led by FAO, this team decided on the outline of the report and
defined its thematic focus. It further gave oversight to the technical writing team composed of experts
from each of the five co-publishing agencies. Background technical papers were prepared to support the
research and data analysis undertaken by the members of the writing team.

The writing team produced a number of interim outputs, including an annotated outline, first draft
and final draft of the report. These were reviewed, validated and cleared by the senior advisor y team at
each stage in the preparation process. The final report underwent a rigorous technical review by senior
management and technical experts from different divisions and departments within each of the five
UN agencies, both at headquarters and decentralized offices. Finally, the report underwent executive
review and clearance by the heads of agency of the five co-publishing partners.

| x |
ACKNOWLEDGEMENTS

The State of Food Security and Nutrition in the World 2019 was jointly prepared by the Food and
Agriculture Organization of the United Nations (FAO), the International Fund for Agricultural
Development (IFAD), the United Nations Children’s Fund (UNICEF), the World Food Programme
( W FP) and the World Health Organization ( W HO).

Under the overall g uidance of Maximo Torero Cullen, the direction of the publication was carried
out by Marco V. Sánchez Cantillo and José Rosero Moncayo, with the overall coordination of
Cindy Holleman, the Editor of the publication, all of whom are from the FAO Economic and Social
Development Department (ES). The development of the report was g uided by a Steering Committee
consisting of agency representatives from the five co-publishing partners: Marco V. Sánchez Cantillo
(Chair), Sara Savastano (IFAD), Victor Ag uayo (UNICEF), Arif Husain ( W FP) and Francesco Branca
( W HO). Rui Benfica, Alessandra Garbero and Tisorn Songsermsawas (IFAD), Roland Kupka (UNICEF),
Yvonne Forsén ( W FP), and Marzella Wüstefeld ( W HO) contributed to the coordination and provided
technical editorial support. Valuable comments and final approval of the report were provided by the
executive heads and senior staff of the five co-authoring agencies.

Part 1 of the report was coordinated by Anne Kepple (FAO). Section 1.1 was prepared by Carlo Cafiero with
Juan Feng, Mauro Del Grossi, Anne Kepple and Sara Viviani with input from Piero Conforti and
Meghan Miller (FAO). Section 1.2 was prepared by Chika Hayashi and Vrinda Mehra (UNICEF) and
Laurence Grummer-Strawn ( W HO), with input from Anna Lartey, Dalia Mattioni and Trudy Wijnhoven
(FAO); Julia Krasevec, Richard Kumapley and Roland Kupka (UNICEF); Mica Jenkins and Jennifer
Rosenzweig ( W FP); and Melanie Cowan, Katrin Engelhardt, Kaia Engesveen, Karen McColl, Kuntal
Saha and Marzella Wüstefeld ( W HO), with design support from Nona Reuter (UNICEF). Section 1.3 was
prepared by Carlo Cafiero with Abdul Sattar, Cristina Alvarez, Juan Feng, Mauro Del Grossi, Adeeba
Ishaq, Anne Kepple and Firas Yassin (FAO); with input from Laurence Grummer-Strawn ( W HO).
José Rosero Moncayo provided editorial support and input to Part 1.

Part 2 of the report was coordinated by Cindy Holleman (FAO). Sections 2.1, 2.2 and 2.3 were prepared by
Cindy Holleman with input from Giovanni Carrasco Azzini, Valentina Conti, Kostas Stamoulis,
Margaret Wagah and Trudy Wijnhoven (FAO); Aslihan Arslan, Rui Benfica, Antonella Cordone,
Mattia Prayer Galletti, Steven Jonckheere and Tisorn Songsermsawas (IFAD); Oscar Caccavale,
Friederike Greb and Lena Hohfeld ( W FP); and Karen McColl, Nicole Valentine and Marzella Wüstefeld
( W HO). Section 2.4 was prepared by Ana Paula de la O Campos, with input from Kostas Stamoulis and
Leopoldo Tornarolli (FAO); Anja Lund Lesa (IFAD); Enrique Delamónica and Roland Kupka (UNICEF);
Carmen Burbano and David Ryckembusch ( W FP) and Lina Mahy, Karen McColl, Helen Walls and
Marzella Wüstefeld ( W HO). Marco V. Sánchez Cantillo provided editorial support and input to Part 2.

Numerous colleag ues from different technical units and departments across the five co-publishing
agencies provided valuable technical comments and input to the report. An agency-wide technical
clearance process facilitated a comprehensive technical review by many technical experts.

| xi |
ACKNOWLEDGEMENTS

Filippo Gheri was responsible for preparing the undernourishment estimates and projections under
the supervision of Carlo Cafiero (FAO). Chiamaka Nwosu was responsible for preparing the aggregates
for the FIES-based estimates, based on input files prepared by Marinella Cirillo under the supervision
of Carlo Cafiero and Sara Viviani (FAO). Supporting data were provided by Salar Tay yib and the Food
Balance Sheets team of the FAO Statistics Division and by Boubaker Ben Belhassen, Josef Schmidhuber
and the Commodity Balance Sheet team of the FAO Trade and Markets Division. Richard Kumapley
(UNICEF) was responsible for consolidating the nutrition data, with input from Chika Hayashi, Julia
Krasevec and Vrinda Mehra (UNICEF); and Elaine Borghi and Lisa Rogers (WHO). Valentina Conti (FAO)
was responsible for preparing the data and econometric analysis for Part 2 and Annexes 3 – 6 under the
supervision of Cindy Holleman, with data analysis support from Stefania Di Giuseppe and conflict and
food crises data input from Aurelien Mellin (FAO).

Support for report production came from Giovanni Carrasco A zzini, A ndrew Park and Daniela Verona
in the FAO Economic and Social Development Department.

The FAO Meeting Prog ramming and Documentation Ser v ice prov ided printing ser v ices and carried out
the translations, in addition to the contributors mentioned above.

The FAO Librar y and Publications Group (OCCP), part of the Office for Corporate Communication,
prov ided editorial support, desig n and layout, as well as production coordination, for editions in all six
official lang uages. The FAO Internet and Internal Communications Group (OCCI) prov ided additional
desig n support for Part 1.

| xii |
ACRONYMS
AND ABBREVIATIONS

BMI Body mass index LAC Latin America and the Caribbean
CGP Child Grant Programme LICs Low-income countries
CH Cadre Harmonisé (harmonized MDER Minimum dietary energy requirement
framework)
MENA Middle East and North Africa
CV Coefficient of variation
MGNREGS Mahatma Gandhi National Rural
DEC Dietary energy consumption Employment Guarantee Scheme
DES Dietary energy supply
MICs Middle-income countries
FAO Food and Agriculture Organization
NCD Non-communicable disease
of the United Nations
PAFA Agricultural Value Chains Support Project
FDI Foreign direct investment
FIES PAL Physical activity level
Food Insecurity Experience Scale
FImod+sev Prevalence of moderate or severe PoU Prevalence of undernourishment
food insecurity PPP Purchasing power parity
FIsev Prevalence of severe food insecurity PSNP Productive Safety Net Programme
FSIN Food Security Information Network RFM Risk Financing Mechanism
GAM Global acute malnutrition SDGs Sustainable Development Goals
GDP Gross domestic product
SIDS Small Island Developing States
GIEWS Global Information and Early Warning
ToT Terms of trade
System on Food and Agriculture
UHC Universal health coverage
GIS Geographic information system
GRFC UNDP United Nations Development Programme
Global Report on Food Crises
HLPE High Level Panel of Experts on Food UNESCO United Nations Educational, Scientific
Security and Nutrition and Cultural Organization
HSNP Hunger Safety Net Programme UNICEF United Nations Children's Fund
ICN2 Second International Conference on USD United States dollar
Nutrition WASH Water, sanitation and hygiene
IFAD International Fund for Agricultural WDI World Development Indicators
Development
WFP World Food Programme
ILO International Labour Organization
WHA World Health Assembly
IPC Integrated Food Security Phase
Classification WHO World Health Organization

| xiii |
KEY MESSAGES

è After decades of steady decline, the trend in è Considering all people in the world affected by
world hunger – as measured by the prevalence of moderate levels of food insecurity together with
undernourishment – reverted in 2015, remaining those who suffer from hunger, it is estimated that
virtually unchanged in the past three years at a level over 2 billion people do not have regular access to
slightly below 11 percent. Meanwhile, the number of safe, nutritious and sufficient food, including
people who suffer from hunger has slowly increased. 8 percent of the population in Northern America
As a result, more than 820 million people in the and Europe.
world were still hungry in 2018, underscoring the
immense challenge of achieving the Zero Hunger è One in seven newborns, or 20.5 million
target by 2030. babies globally, suffered from low birthweight in
2015; no progress has been made in reducing
è Hunger is on the rise in almost all African low birthweight since 2012. The number of
subregions, making Africa the region with the highest children under five years in the world affected by
prevalence of undernourishment, at almost 20 percent. stunting, by contrast, has decreased by 10 percent
Hunger is also slowly rising in Latin America and the in the past six years. However, with 149 million
Caribbean, although its prevalence is still below children still stunted, the pace of progress is too
7 percent. In Asia, Western Asia shows a continuous slow to meet the 2030 target of halving the
increase since 2010, with more than 12 percent of its number of stunted children.
population undernourished today.
è Overweight and obesity continue to increase
è This year’s report introduces a second indicator for in all regions, particularly among school-age
monitoring SDG Target 2.1: the Prevalence of children and adults. In 2018, an estimated
Moderate or Severe Food Insecurity based on the 40 million children under five were overweight.
Food Insecurity Experience Scale (FIES). While severe In 2016, 131 million children 5–9 years old,
food insecurity is associated with the concept of 207 million adolescents and 2 billion adults were
hunger, people experiencing moderate food insecurity overweight. About a third of overweight
face uncertainties about their ability to obtain food, adolescents and adults, and 44 percent of
and have been forced to compromise on the quality overweight children aged 5–9 were obese.
and/or quantity of the food they consume. The economic costs of malnutrition are staggering.

| xiv |
è Analysis of household and individual level data from è Economic slowdowns or downturns
selected countries across all regions shows that food disproportionally undermine food security and
insecurity plays an important role as a determinant of nutrition where inequalities are greater. Income
many different forms of malnutrition. In upper-middle- inequality increases the likelihood of severe food
and high-income countries in particular, living in a insecurity, and this effect is 20 percent higher for
food-insecure household is a predictor of obesity in low-income countries compared with middle-
school-age children, adolescents, and adults. income countries. Income and wealth inequalities
are also closely associated with undernutrition,
è Previous editions of this report show how conflict while more complex inequality patterns are
and climate variability and extremes are exacerbating associated with obesity.
the above trends. This year the report shows that the
uneven pace of economic recovery and continuing è To safeguard food security and nutrition, it is
poor economic performance in many countries after critical to already have in place economic and
the 2008–2009 global economic downturn are also social policies to counteract the effects of adverse
undermining efforts to end hunger and malnutrition. economic cycles when they arrive, while avoiding
Episodes of financial stress, elevated trade tensions and cuts in essential services, such as health care and
tightening financial conditions are contributing to education, at all costs. In the longer term,
uncertain global economic prospects. however, this will only be possible through
fostering pro-poor and inclusive structural
è Hunger has increased in many countries where the transformation, particularly in countries that rely
economy has slowed down or contracted, mostly in heavily on trade in primary commodities.
middle-income countries. Furthermore, economic shocks
are contributing to prolonging and worsening the è To ensure that structural transformation is
severity of food crises caused primarily by conflict and pro-poor and inclusive requires integrating food
climate shocks. security and nutrition concerns into poverty
reduction efforts, while ensuring that reducing
è Out of 65 countries where recent adverse impacts of gender inequalities and social exclusion of
economic slowdowns and downturns on food security population groups is either the means to, or
and nutrition have been strongest, 52 countries rely outcome of, improved food security and nutrition.
heavily on primary commodity exports and/or imports.

| xv |
EXECUTIVE SUMMARY

ADVANCING THE MONITORING OF “eradicate hunger”, but also to “ensure access by


FOOD SECURITY AND NUTRITION IN all people […] to safe, nutritious and sufficient
THE ERA OF THE 2030 AGENDA FOR food all year round” (SDG Target 2.1) and to
“eradicate all forms of malnutrition”
SUSTAINABLE DEVELOPMENT (SDG Target 2.2). Fortunately, data-gathering
Two years ago, this annual report was and measurement tools are rapidly evolving to
transformed to meet the needs of a new era meet the monitoring challenges presented by the
in monitoring the progress made towards new agenda and this report now includes this
achieving a world without hunger and new indicator of food insecurit y. The report thus
malnutrition in all its forms, within the ref lects a more comprehensive approach to
framework of the Sustainable Development monitoring progress towards eliminating hunger,
Goals (SDGs). Specifically, the report began food insecurit y and malnutrition and to
in 2017 to monitor progress towards both understanding the interrelationships
the targets of ending hunger and ensuring between them.
access to food by all (SDG Target 2.1) and
of eliminating all forms of malnutrition
(SDG Target 2.2). Given the broadened scope
AFTER A DECADE OF STEADY DECLINE,
to include a focus on nutrition, the report THE NUMBER OF PEOPLE SUFFERING
was renamed The State of Food Security and FROM HUNGER IN THE WORLD HAS
Nutrition in the World, and UNICEF and the SLOWLY INCREASED FOR SEVERAL
World Health Organization ( W HO) joined YEARS IN A ROW, UNDERSCORING
the traditional partnership of FAO, IFAD THE IMMENSE CHALLENGE OF ENDING
and W FP in preparing it. To provide better
g uidance on how to meet the challenges
HUNGER BY 2030
of the changing world, the report was also The two most recent editions of this report
expanded to include an in-depth thematic already offered evidence that the decline
analysis on the underlying factors and drivers seen in the prevalence of undernourishment
behind the obser ved food securit y and in the world over a decade had ended,
nutrition trends, and to link progress towards and that hunger was slowly on the rise.
improved food securit y and nutrition with Evidence available this year confirms that
other SDGs. the global level of the prevalence of
undernourishment has remained virtually
This report has traditionally tracked world hunger unchanged in the last three years, at a level
using the prevalence of undernourishment (PoU), slightly below 11 percent. The absolute number
one of the indicators used to monitor global of people suffering from hunger, however,
progress towards SDG Target 2.1. This year the continues to increase, albeit slowly. More than
report takes another step forward by reporting, 820 million people in the world are hungr y
for the first time, another indicator of the global today, underscoring the immense challenge of
SDG monitoring framework: the prevalence of achieving the Zero Hunger target by 2030.
moderate or severe food insecurit y based on the
Food Insecurit y Experience Scale (FIES). The 2030 Hunger is on the rise in almost all
Agenda, by including this indicator, recognizes subregions of Africa, where the prevalence
that food insecurit y is more than hunger. of undernourishment has reached levels of
The Zero Hunger goal aims not simply to 22.8 percent in sub-Saharan Africa, and to

| xvi |
a lesser extent in Latin America. In Asia, CHILDHOOD STUNTING IS DECREASING
despite great progress in the last five years, TOO SLOWLY AND ANAEMIA IN WOMEN
Southern Asia is still the subregion where the PERSISTS; BUT OVERWEIGHT AND
prevalence of undernourishment is highest, OBESITY ARE ACTUALLY RISING IN MOST
at almost 15 percent, followed by Western
Asia, at over 12 percent, where the situation
COUNTRIES, CALLING ATTENTION TO THE
is worsening. Looking across regions, the NEED FOR GREATER EFFORTS TO HALT
undernourished population is distributed AND REVERSE THIS GROWING EPIDEMIC
unevenly, with the majorit y living in Asia
(more than 500 million). The number has This year the report takes a closer look at
been increasing steadily in Africa where data on overweight and obesit y, a serious
it reached almost 260 million people in public health challenge affecting people of
2018, with more than 90 percent living in all ages. Obesit y is on the rise in almost all
sub-Saharan Africa. countries, contributing to 4 million deaths
globally. The increase in prevalence of
A broader look at the extent of food obesit y between 2000 and 2016 has been even
insecurit y, beyond hunger, shows that faster than that of overweight. No region
17.2 percent of the world population, or is exempt from the epidemic of overweight
1.3 billion people, have experienced food and obesit y. The prevalence of overweight is
insecurit y at moderate levels. This means that increasing in all age groups, with particularly
they do not have reg ular access to nutritious steep increases among school-age children
and sufficient food – even if they are not and adults. Throughout the world, most
necessarily suffering from hunger, they are at school-age children do not eat enough fruit or
greater risk of various forms of malnutrition vegetables, reg ularly consume fast food and
and poor health. The combination of carbonated soft drinks, and are not physically
moderate and severe levels of food insecurit y active on a daily basis. Multifaceted,
brings the estimate to 26.4 percent of the multisectoral approaches are needed to
world population, amounting to a total of halt and reverse the obesit y epidemic.
about 2 billion people. Policies to protect, promote and support
breastfeeding and to increase the availabilit y
In high-income countries, too, sizeable and affordabilit y of nutritious foods that
portions of the population lack reg ular access constitute a healthy diet are required, along
to nutritious and sufficient food. Eight percent with measures to create healthier food
of the population in Northern America and environments and limit consumption of
Europe is estimated to be food insecure, harmful fats, salt and sugars.
mainly at moderate levels of severit y.
It is encouraging to note that the number of
A closer examination of the estimates of stunted children has declined by 10 percent
food insecurit y (moderate and severe) points over the past six years, but this rate of
also to a gender gap. In ever y continent, reduction is too slow to achieve the 2030
the prevalence of food insecurit y is slightly target of a 50 percent reduction in the number
higher among women than men, with the of stunted children. While the prevalence of
largest differences found in Latin America. stunting is decreasing in almost ever y region,
the extent of progress varies considerably.

| xvii |
EXECUTIVE SUMMARY

Africa has made the least progress in reducing by up to 11 percent in Africa and Asia, while
stunting prevalence since 2012. In 2018, obesit y costs USD 2 trillion annually, largely
Africa and Asia accounted for more than nine driven by the value placed on lost economic
out of ten of all stunted children globally, productivit y, plus direct healthcare costs
representing 39.5 percent and 54.9 percent of worldwide. The various forms of malnutrition
the global total, respectively. are intertwined throughout the life cycle and
between generations, with undernutrition in
In the next ten years, urgent action is needed foetal and early life contributing to stunted
to achieve other global nutrition targets as physical growth and higher risk of overweight
well. Only 40 percent of infants under six and chronic diseases like diabetes later in
months are exclusively breastfed, which is far life. The UN Decade of Action on Nutrition,
from the 2030 target of 70 percent. In 2018, based on the ICN2 Framework for Action,
7.3 percent of children were wasted, and this emphasizes that tackling malnutrition in all
must be reduced by more than half to reach its forms is not the domain of any one sector
the target of less than 3 percent by 2030. alone. The health, education, agriculture,
Anaemia currently affects 33 percent of women social protection, planning and economic
of reproductive age – more than double the policy sectors all have a role to play, as well as
2030 target of 15 percent. legislators and other political leaders.

Low birthweight estimates are included Moderate levels of food insecurit y – defined
for the first time in this year’s edition of as uncertain access to food of sufficient
the report, following the release of new qualit y and/or quantit y, but not so extreme
global estimates. They indicate that one that it causes insufficient dietar y energ y
in seven live births, or 20.5 million babies intake (undernourishment) – can increase
globally, suffered from low birthweight in the risk of seemingly divergent forms of
2015. New evidence this year also shows malnutrition, including overweight and
that no progress has been made in reducing obesit y. Analysis of household and individual
the prevalence of low birthweight since level data from selected countries across all
2012. This lack of progress signals that regions reveals that food insecurit y plays an
it will be difficult to achieve the World important role as a determinant of different
Health Assembly global goal of a 30 percent forms of malnutrition in all countries studied.
reduction in the prevalence of low birthweight In upper-middle- and high-income countries,
infants by 2030. This is concerning, as low living in a food-insecure household is a
birthweight newborns have a higher risk of predictor of obesit y in school-age children,
dying in the first month of life, and those adolescents and adults. Factors that help to
who sur vive are more likely to suffer from explain the link between food insecurit y and
stunted growth and face increased risk of overweight and obesit y include the higher
adult-onset chronic conditions including cost of nutritious foods (and their substitution
obesit y and diabetes. with cheaper foods that are high in fats and
sugar), the stress of living with uncertain
Beyond the immense human costs of access to food, and physiological adaptations
malnutrition, the economic costs are to food restrictions.
staggering. It is projected that undernutrition
will reduce Gross Domestic Product (GDP)

| xviii |
ECONOMIC SLOWDOWNS AND middle-income countries. Economic shocks
DOWNTURNS POSE CHALLENGES FOR have also prolonged and worsened the impact
FOOD SECURITY AND NUTRITION; of conf lict and climate events on acute food
CREATING SUSTAINED ESCAPES REQUIRES insecurit y requiring urgent humanitarian
assistance in food crisis countries. In more
SAFEGUARDING AGAINST THESE AND than half of the countries affected by food
TACKLING INCREASING INEQUALITIES crises in 2018, the compounding impact
Previous editions of this report identified that of multiple economic shocks worsened the
conf lict, climate variabilit y and extremes, and severit y of acute food insecurit y, affecting
economic slowdowns were behind the recent 96 million people.
rise in hunger. The previous two editions
respectively provided an in-depth analysis Marked declines in primar y commodit y prices
on the first two drivers. This year the report have contributed to economic slowdowns
looks closely at the third key driver, economic and downturns during the 2011–2017 period,
slowdowns, broadening the focus to also mainly affecting countries highly dependent
include economic downturns. on primar y commodit y exports and/or
imports. Most countries (52 out of 65) that saw
The risk that the unwelcome trends in undernourishment rise during recent economic
hunger, food insecurit y and malnutrition slowdowns and downturns are countries
described above will continue is particularly whose economies are highly dependent on
high today, considering the fragile state and primar y commodities for export and/or imports.
worrisome outlook of the world economy. In 2018, most of the countries (81 percent)
The latest global economic prospects warn of where economic shocks worsened the
slowing and stalled economic growth in many severit y of the food crises were high primar y
countries, including emerging and developing commodit y-dependent countries.
economies. Most regions rebounded after the
sharp 2008 –2009 global economic downturn, Economic events generally affect food securit y
but the recover y has been uneven and short and nutrition, depending on the extreme
lived, as many countries have experienced povert y level, but also on the existence of
generally declining trends in economic inequalities in income distribution as well as
growth since 2011. Episodes of financial in access to basic ser v ices and assets, many
stress, elevated trade tensions and tightening of which result from social exclusion and the
financial conditions are clouding global marg inalization of g roups. W here inequalit y is
economic prospects. g reater, economic slowdowns and downturns
have a disproportionate effect on food
New evidence confirms hunger has been securit y and nutrition for lower-income
on the rise for many of the countries where populations. Inequalit y increases the
the economy slowed down or contracted. likelihood of severe food insecurit y and this
Most countries (65 out of 77) that experienced effect is 20 percent higher for low-income
a rise in undernourishment between countries compared w ith middle-income
2011 and 2017 simultaneously suffered countries. Income and wealth inequalities are
an economic slowdown or downturn. also closely associated w ith undernutrition,
Strikingly, the majorit y of these cases while more complex inequalit y patterns are
involved not low-income countries, but associated w ith obesit y.

| xix |
EXECUTIVE SUMMARY

This report calls for action on two fronts: primar y commodities foster such inclusive
the first, safeg uarding food securit y and structural transformation to reduce their
nutrition through economic and social economic v ulnerabilit y.
policies that help counteract the effects of
economic slowdowns or downturns, including This structural transformation, involving
g uaranteeing funding of social safet y nets agriculture and food systems, must help ensure
and ensuring universal access to health that food securit y and nutrition objectives are
and education; and, the second, tackling met. This will depend on the t y pe of commodities
existing inequalities at all levels through and the qualit y of food that is generated under
multisectoral policies that make it possible to this process, and will require fostering better
more sustainably escape from food insecurit y access to more nutritious foods that constitute
and malnutrition. Acting on these two a healthy diet to all. Policymakers must also
fronts requires short- and long-term policy ensure that policies that facilitate trade also help
responses that will depend on institutional achieve nutrition objectives. Integrating food
capacit y and availabilit y of contingency securit y and nutrition concerns into povert y
mechanisms and funds to support them. reduction efforts, while increasing synergies
The latter, in turn, requires strengthening between povert y reduction, hunger and
the savings capacit y of the economy when malnutrition eradication must also be part of the
it is growing, so as to make countercyclical transformation. Furthermore, reducing gender
policies feasible when the need arises. inequalities and those inequalities arising from
social discrimination and exclusion of population
In the short term, countries need to protect groups needs to be either the means to improving
incomes and purchasing power, particularly food securit y and nutrition, or the outcome of
for the most affected households, through doing so.
social protection programmes, including cash
transfers and school feeding; public works The trends, findings and policy
programmes that help reduce unemployment; recommendations brief ly presented in this
health sector policies that protect the poor executive summar y are discussed in much
against catastrophic out-of-pocket healthcare greater detail in the two parts of this report.
costs; and, if needed, policies aimed at reducing
excessive volatilit y of food prices. In the Part 1 presents the most recent trends in
longer term, countries need to invest wisely hunger, food insecurit y and malnutrition in all
during periods of economic booms to reduce its forms with a focus on monitoring progress
economic v ulnerabilities and inequalities; on SDG Targets 2.1 and 2.2. It introduces for
build capacit y to withstand shocks; maintain the first time one of the indicators of the SDG
health and other social expenditures; use policy monitoring framework for SDG Target 2.1:
tools to create healthier food environments; the prevalence of moderate or severe food
and quickly recover when economic turmoil insecurit y based on the Food Insecurit y
erupts. This requires balancing a set of policies Experience Scale (FIES). This year’s report
and investments to achieve a structural also presents for the first time low birthweight
transformation that also fosters povert y estimates. The last section of Part 1 presents
reduction and more egalitarian societies. new evidence on the links between moderate
It is imperative, in particular, that countries or severe food insecurit y and the various forms
with economies that are highly dependent on of malnutrition.

| xx |
Part 2 looks closely at the role that economic signs in the world economy, so that policy
slowdowns and downturns have played in considerations are relevant to achieving
recent food securit y and nutrition trends. the goals of ending hunger and all forms of
The analysis ultimately points to g uidance malnutrition by 2030 (SDG Targets 2.1 and
on what short- and long-term policies are 2.2) as well as other related SDGs, especially
necessar y to safeg uard food securit y and – though not exclusively – eradicating
nutrition, either during episodes of economic extreme povert y (SDG 1), ensuring decent
turmoil or in preparation for them. This is work and inclusive economic growth (SDG 8),
particularly relevant today given the alarming and reducing inequalities (SDG 10).

| xxi |
SAGAING REGION,
MYANMAR
A rural woman benefitting
from an FAOSOUTH SUDAN
project to restore
livelihoodsA and
woman
enhance
prepares
resilience sorghum
of disaster-affected
for her family
communitiesin front
in Myanmar.
of her home.
©FAO/Hkun ©FAO/Stefanie
Lat Glinski
PART 1
FOOD PART 1
SECURITY
FOOD SECURITY
AND NUTRITION
AND NUTRITION
AROUND
AROUND
THE
THEWORLD
WORLD
ININ2019
2019
PART 1

FOOD SECURITY AND


NUTRITION AROUND
THE WORLD IN 2019
Much has changed since 1974, when FAO first forms of malnutrition” (SDG Target 2.2). For this
began reporting on the extent of hunger in the reason, this report was renamed The State of
world. The world population has grown steadily, Food Security and Nutrition in the World in 2017.
with most people now living in urban areas. Since then it has reported on nutrition indicators,
Technolog y has evolved at a dizzying pace, in addition to food securit y indicators.
while the economy has become increasingly
interconnected and globalized. All of this has Part 1 of this year’s report aims to bring new
led to major shifts in the way in which food is ways of thinking to bear on the latest trends
produced, distributed and consumed worldwide. in hunger, food insecurit y, and various forms
But these transformations have also brought of malnutrition. Section 1.1 presents global,
about worr ying developments in malnutrition. regional and subregional fig ures of hunger and
Although the prevalence of child stunting introduces a new indicator of food insecurit y that
has decreased significantly over the past 20 goes beyond hunger to include moderate levels
years, overweight and obesit y, and diet-related of food insecurit y. Section 1.2 presents the latest
non-communicable diseases, are rapidly on fig ures for seven nutrition indicators, including
the rise. three SDG 2 indicators of child malnutrition
(stunting, wasting and overweight), with a
This vastly different world calls for new ways of spotlight on the rapid rise in overweight and
thinking about hunger and food insecurit y and obesit y. The links between food insecurit y and
their consequences for nutrition. The imperative nutritional outcomes – particularly overweight
is to make sure no one suffers from hunger. and obesit y – are explored in Section 1.3. n
But we must also recognize that there are many
people who, while not “hungr y” in the sense that
they suffer physical discomfort caused by severe
lack of dietar y energ y, may still be food insecure.
They have access to food to meet their energ y
requirements, yet are uncertain that it will last,
and may be forced to reduce the qualit y and/or
quantit y of the food they eat in order to get by.
This moderate level of severit y of food insecurit y
can contribute to various forms of malnutrition
and has serious consequences for health and
well-being.

The UN member countries recognized the


importance of going beyond hunger when they
set universal and ambitious targets for the 2030
Agenda for Sustainable Development. The “Zero
Hunger” goal aims not simply to “eradicate
hunger”, but also to “ensure access by all people
[…] to safe, nutritious and sufficient food all year
round” (SDG Target 2.1) and to “eradicate all

| 2 |
THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2019

1.1RECENT TRENDS but they lack regular access to nutritious and sufficient
food, putting them at greater risk of various forms of
IN HUNGER AND malnutrition and poor health.

FOOD INSECURITY è   This new indicator also reveals that even in


high-income countries, sizeable portions of the
population lack regular access to nutritious and
KEY MESSAGES
sufficient food; 8 percent of the population in
è  After decades of steady decline, the trend in Northern America and Europe is estimated to be
world hunger – as measured by the prevalence of food insecure, mainly at moderate levels.
undernourishment – reverted in 2015, remaining
virtually unchanged in the past three years at a level è   In every continent, the prevalence of food
slightly below 11 percent. Meanwhile, the number of insecurity is slightly higher among women than men,
people who suffer from hunger has slowly increased. with the largest differences found in Latin America.
As a result, more than 820 million people in the world
are still hungry today, underscoring the immense
challenge of achieving the Zero Hunger target by 2030. Food insecurity is more than just hunger
The main indicator for monitoring progress on
è   This recent trend is confirmed by estimates of
the eradication of hunger in the world reported in
severe food insecurity in the world based on the
this report is the prevalence of undernourishment,
Food Insecurity Experience Scale (FIES), which is
or PoU (SDG Indicator 2.1.1). Beginning in 2017,
another way to monitor hunger.
the prevalence of severe food insecurit y based
on the Food Insecurity Experience Scale (FIES)
è   Hunger is on the rise in almost all subregions was also included in the report as another,
of Africa, the region with the highest prevalence of complementar y indicator of hunger using a
undernourishment, at almost 20 percent. It is also different approach.
rising slowly in Latin America and the Caribbean,
although the prevalence there is still below 7 percent. This year's report now takes a step forward by
In Asia, where undernourishment affects 11 percent also reporting, for the first time, estimates of the
of the population, Southern Asia saw great progress prevalence of moderate or severe food insecurity
in the last five years but is still the subregion with based on the FIES (SDG Indicator 2.1.2).
the highest prevalence of undernourishment, at This indicator provides a perspective on global
almost 15 percent, followed by Western Asia at over food insecurit y relevant for all countries of the
12 percent, where the situation is worsening. world: one that looks beyond hunger towards
the goal of ensuring access to nutritious and
è   Estimates of SDG Indicator 2.1.2, which monitors sufficient food for all (Box 1). As estimates of
progress towards the target of ensuring access to food SDG Indicator 2.1.2 refer to the total number of
for all, reveal that a total of about 2 billion people in people suffering from food insecurit y, including
the world experience some level of food insecurity, at moderate levels, it should come as no surprise
including moderate. People who are moderately food that they correspond to a much higher number of
insecure may not necessarily suffer from hunger, people than those who suffer from hunger.

| 3 |
PART 1 FOOD SECURITY AND NUTRITION AROUND THE WORLD IN 2019

BOX 1
TWO INDICATORS FOR SDG TARGET 2.1 TO MONITOR PROGRESS ON ENDING HUNGER
AND ENSURING ACCESS TO FOOD FOR ALL

The SDG framework endorsed by member countries estimate of the proportion of the population that lacks
of the UN Statistical Commission in March 2017 enough dietary energy for a healthy, active life.
and adopted by the UN General Assembly on SDG Indicator 2.1.2, the prevalence of moderate
6 July 20171 includes two indicators for monitoring or severe food insecurity in the population (FImod+sev)
SDG Target 2.1: the prevalence of undernourishment – based on the Food Insecurity Experience Scale
PoU (SDG Indicator 2.1.1) and prevalence of moderate (FIES), was developed by FAO to complement the
or severe food insecurity based on the Food Insecurity information provided by the PoU and to provide a
Experience Scale – FIES (SDG Indicator 2.1.2). broader perspective on the food access dimension
SDG Indicator 2.1.1, the prevalence of of food security.2 The approach relies on data
undernourishment (PoU), is FAO’s traditional indicator obtained by directly asking people through surveys
used to monitor hunger at the global and regional about the occurrence of conditions and behaviours
levels. It is computed from aggregated country-level that are known to reflect constrained access to
data on food available for human consumption food. Based on their responses to the FIES Survey
(compiled annually for most countries in the world in Module items, the individuals surveyed are assigned
FAO’s Food Balance Sheets) and on less frequently a probability of being in one of three classes, as
obtained data on food consumption from surveys, defined by two globally set thresholds: food secure
available for a growing (but still partial) number of or marginally insecure; moderately food insecure;
countries. For each country, the distribution of average, and severely food insecure. The FImod+sev is the
daily dietary energy consumption in the population is cumulative probability of being in the two classes
compared with the distribution of dietary energy needs of moderate and severe food insecurity. A separate
(derived from the composition of the population by indicator (FIsev) is computed by considering only the
age, gender and physical activity levels) to produce an severe food insecurity class.

TWO INDICATORS FOR SDG TARGET 2.1 TO MONITOR PROGRESS ON ENDING HUNGER AND ENSURING ACCESS TO FOOD FOR ALL

DATA FROM
DATA FROM PARAMETERS
PARAMETERS
MULTIPLE
MULTIPLE
SOURCES
SOURCES

AGE/SEX/HEIGHT
AGE/SEX/HEIGHT MinimumMinimum
dietary dietary SDG SDG
INDICATOR
INDICATOR
2.1.12.1.1
OF THEOF
POPULATION
THE POPULATION energy energy
neededneeded
UN population statistics statistics
UN population for healthy
for and
healthy
active
andlives
active lives PREVALENCE
PREVALENCE
OF OF
UNDERNOURISHMENT
UNDERNOURISHMENT
(PoU) (PoU)

FOOD CONSUMPTION
FOOD CONSUMPTION Inequalities
Inequalities
STATISTICAL
STATISTICAL HUNGER HUNGER
Household consumption
Household consumption in accessintoaccess
dietarytoenergy
dietary energy MODELMODEL
and expenditure surveys surveys
and expenditure in the population
in the population EstimateEstimate
of how ofmany
howpeople
many people
lack enough
lack enough
dietarydietary
energyenergy
FOOD AVAILABILITY
FOOD AVAILABILITY DietaryDietary
energy energy
supply supply
Country Country
Food Food for human
for human
Balance Balance
Sheets Sheets consumption
consumption

SDG SDG
INDICATOR
INDICATOR
2.1.22.1.2
DATA COLLECTED
DATA COLLECTED
DIRECTLY
DIRECTLY
FROM PEOPLE
FROM PEOPLE
PREVALENCE
PREVALENCE
OF MODERATE
OF MODERATE
OR SEVERE
OR SEVERE
FOOD INSECURITY
FOOD INSECURITY
BASEDBASED
ON THEON
FIES
THE FIES
PEOPLE’S PEOPLE’S
EXPERIENCE
EXPERIENCE
OF FOOD OF INSECURITY
FOOD INSECURITY ACCESS ACCESS
TO FOODTO FOOD
FOR ALL FOR ALL
Responses
Responses
to 8 questions
to 8 questions
in national
in national STATISTICAL
STATISTICAL
population
population
surveys surveys
about conditions
about conditions MODELMODEL EstimateEstimate
of how ofmanyhowpeople
many people
do not do
havenot have
and behaviours
and behaviours
that reflect
that reflect accessaccess
to nutritious
to nutritious
and sufficient
and sufficient
food food
constraints
constraints
on food on
access
food access due to due
lack toof lack
money
of money
or otherorresources
other resources

SOURCE: FAO.

| 4 |
THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2019

People experiencing moderate food insecurity face relevant for countries where severe food deprivation
uncertainties about their ability to obtain food and have may no longer be of concern, but where sizeable
been forced to reduce, at times during the year, the pockets of food insecurity still remain. In this sense, it
quality and/or quantity of food they consume due to is an indicator that is fully aligned with the universality
lack of money or other resources. It thus refers to a lack principles of the 2030 Agenda.
of consistent access to food, which diminishes dietary As a measure of access to adequate food,
quality, disrupts normal eating patterns, and can Indicator 2.1.2 brings the perspective of the Right to
have negative consequences for nutrition, health and Food to the SDG monitoring framework. Countries can
well-being. People facing severe food insecurity, on the use the FIES to obtain data-based evidence about the
other hand, have likely run out of food, experienced distribution and severity of food insecurity to build
hunger and, at the most extreme, gone for days without political will and implement policies to effectively
eating, putting their health and well-being at grave risk. realize the human right to adequate food, leaving no
The figure below illustrates the meaning of food one behind.
security, moderate food insecurity and severe food The full potential of the FIES to generate statistics
insecurity, with each category shown as a proportion that inform policy is realized when the tool is applied
of the total population. FIsev can be considered a in large national population surveys that allow for
complementary indicator to the PoU in measuring detailed analyses of the food-insecurity situation by
the extent of hunger. SDG Indicator 2.1.2 (FImod+sev) is income, gender, age, race, ethnicity, migratory status,
the proportion of the total population represented by disability, geographic location, or other policy-relevant
those who experience food insecurity at moderate or characteristics. This is already the case for a growing
severe levels combined. This indicator is particularly number of countries.

EXPLANATION OF FOOD-INSECURITY SEVERITY LEVELS MEASURED BY THE FIES IN SDG INDICATOR 2.1.2

FOOD SECURITY
Adequate access to food in both quality
and quantity

MODERATE FOOD INSECURITY


People experiencing moderate food
insecurity face uncertainties about their
ability to obtain food, and have been
forced to compromise on the quality
and/or quantity of the food they consume

SEVERE FOOD INSECURITY


People experiencing severe food insecurity
have typically run out of food and, at
worst, gone a day (or days) without eating

SDG INDICATOR 2.1.2


The prevalence of moderate or severe food
insecurity in the population based on the FIES
SOURCE: FAO.

1
UN. 2017. United Nations Statistical Commission – 48th Session (2017). In: UNSD – United Nations Statistical Commission [online]. New York, USA. [Cited 4 April 2019].
https://unstats.un.org/unsd/statcom/48th-session; and UN. 2017. Indicator 2.1.2: Prevalence of moderate or severe food insecurity in the population, based on the Food Insecurity
Experience Scale (FIES). [Cited 4 April 2019]. https://unstats.un.org/sdgs/metadata/files/Metadata-02-01-02.pdf
2
The other three dimensions of food security are food availability, utilization and stability.

| 5 |
PART 1 FOOD SECURITY AND NUTRITION AROUND THE WORLD IN 2019

FIGURE 1
THE NUMBER OF UNDERNOURISHED PEOPLE IN THE WORLD HAS BEEN ON THE RISE
SINCE 2015, AND IS BACK TO LEVELS SEEN IN 2010–2011

19 1 237

17 1 107

15 947.2 977

14.5%

13 822.3 814.4 821.6 847


811.7
PERCENTAGE

796.5

MILLIONS
785.4

11.8%
11 11.6% 717

10.7% 10.8% 10.8%


10.6%

9 587

7 457

5 327
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018*

YEARS

Prevalence of undernourishment (percentage) Number of undernourished (millions)

NOTES: * Values for 2018 are projections as illustrated by dotted lines and empty circles. The entire series was carefully revised to reflect new information made available since the
publication of the last edition of the report; it replaces all series published previously. See Box 2.
SOURCE: FAO.

SDG Indicator 2.1.1 increasing for several years in a row.1 This means
Prevalence of undernourishment (PoU) that today, a little over 820 million people suffer
The two most recent editions of The State of from hunger, corresponding to about one in ever y
Food Security and Nutrition in the World already nine people in the world (Figure 1, Tables 1 and 2).
offered evidence that the decades-long decline This underscores the immense challenge posed
in the prevalence of undernourishment in the by achieving the Zero Hunger target by 2030.
world had ended and that hunger was slowly
on the rise. Additional evidence available this The situation is most alarming in Africa,
year confirms that the global level of the PoU where since 2015 the PoU shows slight but steady
has remained virtually unchanged at a level increases in almost all subregions. It has reached
slightly below 11 percent, while the total number levels of 26.5 percent and 30.8 percent in Middle
of undernourished (NoU) has been slowly and Eastern Africa, respectively, with rapid

| 6 |
THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2019

BOX 2
REVISED SERIES OF ESTIMATES OF THE PREVALENCE OF UNDERNOURISHMENT
AND PROJECTIONS FOR 2018

The PoU series is always revised prior to publication and meats. These rates were deduced from the series
of each new edition of The State of Food Security of commodity balances prepared by FAO’s Trade and
and Nutrition in the World. This is done in order to Markets Division.1
take into account any new information that FAO has An estimate of the coefficient of variation (CV) of
received since the release of the previous edition. per capita levels of habitual, daily energy consumption
As this process usually implies possible backward in the population was obtained from suitable national
revisions of the entire series, readers should household surveys and carried forward from the last
avoid comparing the PoU values across different available year. For countries for which there was
editions of this report and always refer to the most no food consumption survey covering the period
current report, including the time series covering 2014–2018, the CV was projected based on indirect
past years. evidence, including observed changes in the reported
This year’s main revision involved an update of the prevalence of severe food insecurity estimated using
Food Balance Sheet series used to estimate the average the FIES. This was done in order to capture possible
Dietary Energy Supply (DES) for the 53 countries with recent changes in the inequality on access to food,
the largest number of undernourished people, bringing which would be reflected in FIsev.
them up to date through 2017. When needed to Minimum dietary energy requirements (MDER) for
produce PoU estimates for the most recent periods, 2018 were computed based on the 2018 projected
the DES was projected based on rates of growth in population structure from The World Population
the total availability of dietary energy from cereals Prospects, 2017 Revision.2

1
FAO Trade and Markets Division has developed and maintained a Commodity Balance Sheet database (XCBS) that provides up-to-date and elementary information for analysis of the state
of agricultural commodity markets at global and regional levels, as well as the food situation of all countries in the world. The XCBS contains balance sheet-structured data for the major
commodities in the following groups: cereals, dairy, meat, oil-bearing crops, sugar, tropical beverages, bananas and citrus since the 1980s. Data from the XCBS are used in a number of
systems and publications, such as FAO Global Information and Early Warning System, Agricultural Market Information System, Food Outlook and Crop Prospects and Food Situation.
2
For further details, see the methodological note in Annex 1B.

growth in recent years, especially in Western A n even more dramatic, longer-term impact
Africa (Figure 2). on food securit y seems to be associated with
exposure to drought. Countries classified as
As highlighted in past editions of this report, drought-sensitive 3 in sub-Saharan A frica have
these trends are mostly driven by a combination seen the prevalence of undernourishment
of factors, including conf licts and extreme increase from 17.4 to 21.8 percent over the
weather events, currently affecting a number last six years, while in the same period the
of countries in Africa. In conf lict-affected PoU actually dropped (from an average of 24.6
countries in sub-Saharan Africa 2 for instance, to 23.8 percent) in the other countries of the
the number of undernourished people increased reg ion. The number of undernourished people
by 23.4 million between 2015 and 2018 – a in drought-sensitive countries has increased
significantly sharper increase compared with by 45.6 percent since 2012 (Figure 4).
countries not exposed to conf licts (Figure 3).

| 7 |
PART 1 FOOD SECURITY AND NUTRITION AROUND THE WORLD IN 2019

TABLE 1
PREVALENCE OF UNDERNOURISHMENT (PoU) IN THE WORLD, 2005–2018
  Prevalence of undernourishment (%)
2005 2010 2015 2016 2017 2018*
WORLD 14.5 11.8 10.6 10.7 10.8 10.8
AFRICA 21.2 19.1 18.3 19.2 19.8 19.9
Northern Africa 6.2 5.0 6.9 7.0 7.0 7.1
Sub-Saharan Africa 24.3 21.7 20.9 22.0 22.7 22.8
Eastern Africa 34.3 31.2 29.9 31.0 30.8 30.8
Middle Africa 32.4 27.8 24.7 25.9 26.4 26.5
Southern Africa 6.5 7.1 7.8 8.5 8.3 8.0
Western Africa 12.3 10.4 11.4 12.4 14.4 14.7
ASIA 17.4 13.6 11.7 11.5 11.4 11.3
Central Asia 11.1 7.3 5.5 5.5 5.7 5.7
Eastern Asia 14.1 11.2 8.4 8.4 8.4 8.3
South-eastern Asia 18.5 12.7 9.8 9.6 9.4 9.2
Southern Asia 21.5 17.2 15.7 15.1 14.8 14.7
Western Asia 9.4 8.6 11.2 11.6 12.2 12.4
Western Asia and Northern Africa 8.0 7.1 9.2 9.5 9.8 9.9
LATIN AMERICA AND THE CARIBBEAN 9.1 6.8 6.2 6.3 6.5 6.5
Caribbean 23.3 19.8 18.3 18.0 18.0 18.4
Latin America 8.1 5.9 5.3 5.5 5.7 5.7
Central America 8.4 7.2 6.3 6.1 6.1 6.1
South America 7.9 5.3 4.9 5.3 5.5 5.5
OCEANIA 5.5 5.2 5.9 6.0 6.1 6.2
NORTHERN AMERICA AND EUROPE < 2.5 < 2.5 < 2.5 < 2.5 < 2.5 < 2.5
NOTES: * Projected values. See Box 2 and Annex 1B for a description of how the projections are made. For country compositions of each regional/subregional aggregate,
see Notes on geographic regions in statistical tables inside the back cover.
SOURCE: FAO.

This overall dire picture of undernourishment in the f undamental determinants of


Africa is consistent with the extent of povert y undernourishment related to underlying economic
in the reg ion. With a headcount ratio of structures and inequalities are discussed in
41 percent, sub-Saharan A frica accounted for Part 2 of this report.
56 percent of the world’s extreme poor in 2015,
according to the World Bank Group. 4 However, In Asia, the PoU has been steadily decreasing
this is not just a problem of extreme povert y. in most regions, reaching 11.4 percent in 2017.
Even resource-rich countries in these reg ions The exception is Western Asia, where the PoU
still have high rates of undernourishment has increased since 2010 to reach more than
( Tables A1.1 and A1.2 in A nnex 1A), suggesting that 12 percent of the population (Figure 5). This level in
something more crucial is at play in terms of the region is second only to Southern Asia, which,
the structure of their food systems, and that despite great progress in the last five years, is
still much more should be done to improve still the subregion where undernourishment is
distribution and consumption of food. Some of highest, at almost 15 percent.

| 8 |
THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2019

TABLE 2
NUMBER OF UNDERNOURISHED PEOPLE IN THE WORLD, 2005–2018
  Number of undernourished (millions)
2005 2010 2015 2016 2017 2018*
WORLD 947.2 822.3 785.4 796.5 811.7 821.6
AFRICA 196.0 199.8 217.9 234.6 248.6 256.1
Northern Africa 9.7 8.5 15.5 16.1 16.5 17.0
Sub-Saharan Africa 176.7 180.6 202.4 218.5 232.1 239.1
Eastern Africa 113.5 118.6 119.3 126.9 129.8 133.1
Middle Africa 36.2 36.5 37.9 41.1 43.2 44.6
Southern Africa 3.6 4.2 5.0 5.5 5.4 5.3
Western Africa 33.0 31.9 40.3 45.0 53.7 56.1
ASIA 688.6 572.1 518.7 512.3 512.4 513.9
Central Asia 6.5 4.6 3.8 3.8 4.0 4.1
Eastern Asia 219.1 178.4 138.1 137.8 138.1 137.0
South-eastern Asia 103.8 75.9 61.9 61.9 61.1 60.6
Southern Asia 339.8 293.1 286.1 278.3 276.4 278.5
Western Asia 19.4 20.1 28.8 30.5 32.7 33.7
Western Asia and Northern Africa 29.1 28.6 44.3 46.6 49.2 50.6
LATIN AMERICA AND THE CARIBBEAN 51.1 40.7 39.1 40.4 41.7 42.5
Caribbean 9.1 8.0 7.7 7.6 7.7 7.8
Latin America 42.1 32.6 31.5 32.9 34.0 34.7
Central America 12.4 11.6 10.9 10.6 10.7 11.0
South America 29.6 21.1 20.6 22.2 23.2 23.7
OCEANIA 1.8 1.9 2.3 2.4 2.5 2.6
NORTHERN AMERICA AND EUROPE n.r. n.r. n.r. n.r. n.r. n.r.
NOTES: * Projected values. See Box 2 and Annex 1B for a description of how the projections are made.
n.r. = not reported, as the prevalence is less than 2.5 percent. Regional totals may differ from the sum of subregions, due to rounding. For country compositions of each
regional/subregional aggregate, see Notes on geographic regions in statistical tables inside the back cover.
SOURCE: FAO.

Within the Western Asian subregion, the largely as a consequence of the situation in South
difference is striking between countries that America, where the PoU increased from 4.6 percent
have been affected by popular uprisings in in 2013 to 5.5 percent in 2017 (Figure 7). In fact,
Arab states and other conf licts, 5 and those South America hosts the majority (68 percent)
that have not been affected. For those affected of the undernourished in Latin America.
countries, Figure 6 shows an increase in the PoU The increase observed in recent years is due to
from the already higher value of 17.8 percent, the economic slowdown in several countries,
to 27.0 percent, almost doubling the number particularly the Bolivarian Republic of Venezuela,
of undernourished between 2010 and 2018. where the PoU increased almost fourfold, from
The PoU did not change during the same period 6.4 percent in 2012–2014 to 21.2 percent in
in the other countries in the region. 2016–2018 (Figure 8). During the same recession
period, inf lation in the countr y was reported to
In Latin America and the Caribbean (LAC), rates of have reached circa 10 million percent and growth
undernourishment have increased in recent years, in the real GDP worsened, going from negative

| 9 |
PART 1 FOOD SECURITY AND NUTRITION AROUND THE WORLD IN 2019
FIGURE 2
UNDERNOURISHMENT IS RISING RAPIDLY IN WESTERN AFRICA

35

30.8 30.8
30.2
30
26.4 26.5
25.1
25
PERCENTAGE

19.8 19.9
20 18.3

14.4 14.7
15

10.8

10 8.3 8.0
7.6

7.2 7.0 7.1


5
2013 2014 2015 2016 2017 2018*

YEARS

Eastern Africa Middle Africa AFRICA Western Africa Southern Africa Northern Africa

NOTES: * Projected values, illustrated by dotted lines and empty circles.


SOURCE: FAO.

FIGURE 3
UNDERNOURISHMENT INCREASES SHARPLY IN COUNTRIES AFFECTED BY CONFLICT
IN SUB-SAHARAN AFRICA

35 131.6 140
126.9
33
120
108.2
31

95.6 105.2 107.5 100


29

94.2
27
80
PERCENTAGE

85.0
MILLIONS

25 23.9% 23.8%
23.1%
60
23 22.5%

21 21.9% 22.1%
40

19 20.1%
19.7%
20
17

15 0
2010 2011 2012 2013 2014 2015 2016 2017 2018*

YEARS

PoU – conflict countries NoU – conflict countries PoU – other countries NoU – other countries
(left axis) (right axis) (left axis) (right axis)

NOTES: * Projected values, illustrated by dotted lines and empty circles.


SOURCE: FAO.
| 10 |
THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2019

FIGURE 4
DROUGHTS ARE ONE OF THE FACTORS BEHIND THE RECENT INCREASE IN
UNDERNOURISHMENT IN SUB-SAHARAN AFRICA

35 140
127.1
124.4
33
112.2 112.0 120
110.6
31 106.2 107.7

29 100
90.2

27 76.9
74.4 80
PERCENTAGE

MILLIONS
25
25.0%
24.6% 60
23 23.9% 23.8%
22.9%
21 21.8%
21.5% 40

19
18.9% 20
17 17.7%
17.4%

15 0
2010 2011 2012 2013 2014 2015 2016 2017 2018*

YEARS

PoU – drought-sensitive countries NoU – drought-sensitive countries PoU – other countries NoU – other countries
(left axis) (right axis) (left axis) (right axis)

NOTES: * Projected values, illustrated by dotted lines and empty circles.


SOURCE: FAO.

3.9 percent in 2014 to an estimated negative Analysis of the distribution of the


25 percent in 2018. 6 undernourished population across regions in
the world shows that the majorit y (more than
By contrast, prevalence rates of 500 million) live in Asia (Figure 9). The number
undernourishment in Central America and the has been increasing steadily in Africa, where
Caribbean, despite being higher than those in it reached almost 260 million people in
South America, have been decreasing in recent 2018, with more than 90 percent living in
years. This is consistent with the economic sub-Saharan Africa.
growth pattern observed in these subregions,
where real GDP grew at a rate of about 4 percent Given these fig ures and the trends obser ved
between 2014 and 2018, with moderate rates over the last decade, achieving Zero Hunger
of inflation consistently below 3 percent in the by 2030 appears to be an increasingly
same period. 7 daunting challenge.

| 11 |
PART 1 FOOD SECURITY AND NUTRITION AROUND THE WORLD IN 2019
FIGURE 5
WESTERN ASIA IS THE ONLY SUBREGION IN ASIA WHERE UNDERNOURISHMENT
IS ON THE RISE

19

17.3
17

14.6 14.8 14.7


15

14.2
PERCENTAGE

13 12.2 12.4

11 11.8
11.4 11.3
9.4 9.2
9.0
9

8.4 8.3
7 7.8
5.7 5.7

5
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018*

YEARS

Central Asia Eastern Asia ASIA Western Asia Southern Asia South-eastern Asia

NOTES: * Projected values, illustrated by dotted lines and empty circles.


SOURCE: FAO.

FIGURE 6
UNDERNOURISHMENT IS ON THE RISE IN WESTERN ASIAN COUNTRIES AFFECTED
BY POPULAR UPRISINGS IN THE RECENT PAST

30 50
27.0% 27.0%
25.0% 45
25
40

35
20 17.8%
28.5 29.0
30
PERCENTAGE

25.4
MILLIONS

15 25

16.2 20
10
15

5 2.8% 10
2.8% 2.6%
2.2%
5
3.9 4.2 4.7
3.4
0 0
2010 2011 2012 2013 2014 2015 2016 2017 2018*

YEARS

PoU – Arab countries affected by popular uprisings (left axis) PoU – other countries in Western Asia (left axis)
NoU – Arab countries affected by popular uprisings (right axis) NoU – other countries in Western Asia (right axis)

NOTES: * Projected values, illustrated by dotted lines and empty circles.


SOURCE: FAO.

| 12 |
THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2019
FIGURE 257
INCREASING UNDERNOURISHMENT IN SOUTH AMERICAN COUNTRIES IS PUTTING
UPWARD PRESSURE ON THE LATIN AMERICA AND THE CARIBBEAN REGIONAL AVERAGE

20

19.1
18.4
18.0

15
PERCENTAGE

10

6.9 6.5 6.5


6.1
6.1
6.2
5 5.5 5.5
4.6

0
2013 2014 2015 2016 2017 2018*

YEARS

Caribbean Central America LATIN AMERICA AND THE CARIBBEAN South America

NOTES: * Projected values, illustrated by dotted lines and empty circles.


SOURCE: FAO.

FIGURE 8
THE BOLIVARIAN REPUBLIC OF VENEZUELA SHOWS A SIGNIFICANT INCREASE
IN THE PREVALENCE OF UNDERNOURISHMENT IN RECENT YEARS
25

20 21.2

15
PERCENTAGE

10

6.8 6.5

5
5.3 5.4

3.1

0
2009–2011 2010–2012 2011–2013 2012–2014 2013–2015 2014–2016 2015–2017 2016–2018*

THREE-YEAR PERIODS

Venezuela (Bolivarian Republic of) Latin America and the Caribbean South America

NOTES: * 2018 estimates in the 2016–2018 three-year averages are projected values.
SOURCE: FAO.

| 13 |
PART 1 FOOD SECURITY AND NUTRITION AROUND THE WORLD IN 2019

FIGURE 9
EVEN THOUGH ASIA STILL PREDOMINATES, MORE THAN THIRTY PERCENT
OF THE UNDERNOURISHED IN THE WORLD LIVE IN AFRICA

DISTRIBUTION OF UNDERNOURISHMENT IN THE WORLD (IN MILLIONS) IN 2018*

LATIN AMERICA
AND THE
ASIA CARIBBEAN
513.9 42.5
WORLD
POPULATION UNDERNOURISHED
7 632.8 821.6

AFRICA 6.5 2.6


256.1 OTHER OCEANIA,
NORTHERN
AMERICA
AND EUROPE

NOTES: * Projected values.


SOURCE: FAO.

SDG Indicator 2.1.2 The 2019 edition introduces estimates of


Prevalence of moderate or severe food the prevalence of food insecurit y combining
insecurity in the population, based on the FIES moderate and severe levels to report on
SDG Indicator 2.1.2 (Box 1). This second
The 2017 and 2018 editions of The State of Food indicator thus refers to an expanded range
Security and Nutrition in the World already of food-insecurit y severit y that encompasses
presented estimates of the prevalence of severe moderate levels. This was in response to the
food insecurit y. As explained in those editions, need, in the context of the universal 2030
the prevalence of severe food insecurit y is Agenda, for indicators that are relevant for all
expected to approximate the PoU, as both countries in the world – “developed” as well as
indicators ref lect the extent of severe food “developing” countries – to monitor progress
deprivation. However, differences may exist towards the ver y ambitious target of ensuring
because these indicators are based on different access to safe, nutritious and sufficient food
sources of data and methodologies (Box 1). by all people (SDG Target 2.1).

| 14 |
THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2019

TABLE 3
PREVALENCE OF MODERATE OR SEVERE FOOD INSECURITY, AND SEVERE FOOD INSECURITY ONLY,
MEASURED WITH THE FOOD INSECURITY EXPERIENCE SCALE, 2014–2018
Prevalence of severe food insecurity Prevalence of moderate or severe food
 
in the total population (%) insecurity in the total population (%)
2014 2015 2016 2017 2018 2014 2015 2016 2017 2018
WORLD 8.0 7.7 8.0 8.7 9.2 23.2 23.2 24.1 25.6 26.4
AFRICA 18.1 19.0 21.9 22.9 21.5 47.6 48.3 52.6 54.3 52.5
Northern Africa 8.6 7.2 9.3 10.1 8.0 27.1 22.9 27.8 35.2 29.5
Sub-Saharan Africa 20.3 21.7 24.8 25.8 24.6 52.4 54.2 58.3 58.7 57.7
Eastern Africa 23.9 25.1 27.8 28.7 25.9 58.2 59.7 64.8 65.5 62.7
Middle Africa n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a.
Southern Africa 21.4 20.6 30.7 30.8 30.6 45.3 45.9 53.5 53.6 53.6
Western Africa 12.9 14.4 16.5 17.7 17.6 43.7 45.3 47.3 47.7 47.9
ASIA 7.0 6.3 5.9 6.4 7.8 20.0 19.4 19.5 20.6 22.8
Central Asia 2.0 1.8 2.8 3.6 3.2 11.2 11.1 12.6 17.3 17.3
Eastern Asia 0.5 < 0.5 0.9 1.0 1.1 6.5 6.4 6.5 10.3 9.8
South-eastern Asia 4.5 3.7 4.2 5.8 5.2 19.6 17.3 19.0 21.5 20.4
Southern Asia 13.7 12.4 10.6 10.9 14.4 31.4 30.8 30.3 28.1 34.3
Western Asia 8.7 8.9 9.3 10.3 9.9 29.1 29.1 28.3 30.1 29.5
Western Asia and Northern Africa 8.6 8.1 9.3 10.2 9.0 28.1 26.2 28.1 32.5 29.5
LATIN AMERICA AND THE CARIBBEAN n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a.
Caribbean n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a.
Latin America 7.7 6.5 7.8 9.9 9.0 24.2 25.9 28.5 33.8 30.9
Central America 12.9 10.3 8.5 12.7 10.6 36.7 33.7 26.2 37.3 31.5
South America 5.6 4.8 7.5 8.8 8.3 19.1 22.7 29.5 32.3 30.6
OCEANIA n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a.
NORTHERN AMERICA AND EUROPE 1.5 1.5 1.2 1.2 1.0 9.6 9.6 8.7 8.5 8.0
NOTES: n.a. = not available, as data are available only for a limited number of countries, representing less than 50 percent of the population in the region.
For country compositions of each regional/subregional aggregate, see Notes on geographic regions in statistical tables inside the back cover.
SOURCE: FAO.

T he F IES-based food-insecurit y estimates levels of food insecurit y in 2018, implying


presented in this edition are based on a reductions in the quantit y of food consumed to
combination of data: those collected by FAO the extent that they have possibly experienced
using the F IES sur vey module in more than hunger (Tables 3 and 4). Not surprisingly,
140 countries, and those collected by national the fig ure for 2018 and the levels over the
instit utions in a number of countries in the period between 2014 and 2018, are broadly
A mericas, A f rica and A sia using the F IES or consistent with those of the prevalence
other similar ex perience-based food-securit y of undernourishment, confirming the
questionnaires. Results are made comparable complementarit y between the two indicators
for all countries by calibrating them against the in monitoring the extent of severe food
F IES global reference scale (Box 3). 8 deprivation, or “hunger”.

Severe food insecurity However, there is a slight difference in trends over


According to the latest estimates, 9.2 percent the five-year period, with FI sev increasing slowly
of the world population (or slightly more than and the PoU remaining unchanged. This can be
700 million people) were exposed to severe explained by the fact that while the PoU estimates »

| 15 |
PART 1 FOOD SECURITY AND NUTRITION AROUND THE WORLD IN 2019
BOX 3
COMPUTING FIES-BASED ESTIMATES SO THAT THEY ARE GLOBALLY COMPARABLE

Experience-based food security measurement scales position of each item on this scale of severity is not
have been in use for many years in a number imposed a priori, and may vary across countries.
of countries, mainly in the Americas. To create The statistical measurement model used to analyse the
categories for different levels of food insecurity, each data (Rasch model)2 allows for the identification of the
country has chosen its own national thresholds, as relative position of the various items along a severity
well as its own naming systems. For example, in the scale, based on patterns of responses to the eight
United States of America households are classified as items, with the basic idea being that the more severe
having “high”, “marginal”, “low” or “very low food an experience is, the less likely respondents are to
security”; while in Brazil or in Mexico they use the report it. Each country thus obtains its own scale but
terms “mild”, “moderate” or “severe” food insecurity. they are not directly comparable across countries.
However, although the labels used are similar, the To establish the global FIES reference scale,
resulting
FIES measures classes
obtained inare not directly comparable across
Country A
FAO followed a process that is similar to what
different
different countries.
countries need to be has been common in many other applications
Country B Global FIES reference scale
equatedWith
beforethe objective
comparing them, of ensuring truly comparable of measurement principles, for example, the
toclassifications, FAO launchedCountry
make sure they are expressed the CVoices of the establishment of the Coordinated Universal Time,
clocks Moderately
Food secure Severely
onHungry Project scale,
the same reference in 2012. As described
... below, it was which is used to regulate
or mildly
and time globally.
food insecure food insecure
andnecessary to establish
common thresholds are used.a global reference
Country Z scale on In that case, the average of the time kept by
food insecure
which the thresholds for classification into severe over 400 highly precise atomic clocks in over
and moderate food insecurity could be set, and to 50 laboratories worldwide is used to ensure one
develop procedures to calibrate scores obtained in common standard reference time. To establish the
different countries against this global standard.1 FIES reference scale, FAO used data collected in
The eight items (questions) that compose the FIES more than 140 countries worldwide, from 2014
survey module are chosen to represent a range of through 2016 and followed process (consisting
experiences, common to many cultures, that cover a mainly of two steps) that led to assigning each
broad range of severity on the underlying scale of FIES item a position on what became the standard
food insecurity, from mild to severe. However, the severity scale.

FIES measures obtained in Country A


different countries need to be Global FIES reference scale
Country B
equated before comparing them,
to make sure they are expressed Country C
Food secure Moderately Severely
on the same reference scale, ...
or mildly food insecure food insecure
and common thresholds are used. Country Z food insecure

Step 1. Assigning a severity level to each item


The FIES Survey Module
During the last 12 months, was there a time when, 3.0
because of lack of money or other resources: The FIES survey module Distribution of
severity across
has been applied in more than 2.5 all countries
1 You were worried you would not have enough food to eat? 140 countries worldwide.
2.0
2 You were unable to eat healthy and nutritious food? This has generated a distribution
Density

3 You ate only a few kinds of foods? of severity levels for each of eight 1.5

4 You had to skip a meal? the items (questions) that


1.0
compose the FIES survey module.
5 You ate less than you thought you should?
0.5
6 Your household ran out of food? The median value is chosen as
0.0
7 You were hungry but did not eat? the severity level associated to
-3 -2 -1 0 1 2 3
8 You went without eating for a whole day? the item on the global FIES scale.
Logit units

| 16 |
Step 1. Assigning a severity level to each item
The FIES Survey Module
During the last 12 months, was there a time when,
THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2019

Step 2. Mapping the severity levels on the FIES global reference scale
1 2 3 4 5 6 7 8

Step 2. Mapping the severity levels on the FIES global reference scale
1 1 3 22 3 5 4 4 5 6 67 7 8 8
FIES GLOBAL SCALE

Once the global reference scale has been known. In the FIES methodology, such anchor
established,
1 3 2the process of calibrating each
5 4 6 points are given
7 by the subset of items that can
8
country’s FIES measures against the FIES global be considered common FIEStoGLOBAL
the national
SCALE and the
standard is a relatively simple one and can global scale, once the national scale has been
be referred to as an “equating” procedure. appropriately rescaled.
Conceptually, converting FIES-based measures It is important to mention that, though unlikely,
obtained in a given country at a given moment, differences in interpretation based on language or
into measures expressed on the global reference cultural context could potentially limit the ability to
scale is like converting temperature readings accurately produce estimates using the FIES global
Calibrating the national
from Fahrenheit scale
to Celsius, against the
or measures of FIES global reference scale scale. Research is ongoing to further refine
reference
length from the Imperial to the metric system. the current methodology and to limit the potential
It simply requires the identification of “anchor” risk of inducing aCOUNTRY
bias when adjusting
SCALE country
before equating
points for which measures in the two scales are results to the global reference scale.
1 3 2 5 4 6 7 8

COUNTRY SCALE after equating


Calibrating the national scale against the FIES global reference scale
1 3 2 5 4 6 7 8

COUNTRY SCALE before equating


1 3 2 5 4 6 7 8
1 3 2 5 4 6 7 8
FIES GLOBAL SCALE
COUNTRY SCALE after equating
1 3 2 5 4 6 7 8
COMMON ITEMS UNIQUE ITEMS
(used as anchor points for equating and for measurement) (not used as anchor points, but also used for measurement)

1 3 2 5 4 6 7 8
FIES GLOBAL SCALE

COMMON ITEMS UNIQUE ITEMS


(used as anchor points for equating and for measurement) (not used as anchor points, but also used for measurement)

1
See C. Cafiero, S. Viviani and M. Nord. 2017. Food security measurement in a global context: the Food Insecurity Experience Scale. Measurement, 116 (February 2018): 146–152.
2
The Rasch model is a statistical model used in various fields of human and social sciences, to obtain estimates of the magnitude of unobservable, measurable traits (i.e. “latent” traits)
from discrete data that represent the responses given to a set of appropriately chosen items. For a thorough introduction to the Rasch model, see T.G. Bond and C.M. Fox. 2015. Applying
the Rasch model: fundamental measurement in the human sciences. London, Routledge; and M. Nord. 2014. Introduction to item response theory applied to food security measurement:
basic concepts, parameters, and statistics [online]. Rome, FAO. [Cited 24 April 2019]. http://www.fao.org/3/a-i3946e.pdf

| 17 |
PART 1 FOOD SECURITY AND NUTRITION AROUND THE WORLD IN 2019

TABLE 4
NUMBER OF PEOPLE EXPERIENCING MODERATE OR SEVERE FOOD INSECURITY, AND SEVERE FOOD INSECURITY
ONLY, MEASURED WITH THE FOOD INSECURITY EXPERIENCE SCALE, 2014–2018
Number of severely Number of moderately or severely
 
food-insecure people (millions) food-insecure people (millions)
2014 2015 2016 2017 2018 2014 2015 2016 2017 2018
WORLD 585.0 568.2 600.4 657.6 704.3 1 696.3 1 712.3 1 801.9 1 929.6 2 013.8
AFRICA 210.7 226.7 268.2 287.5 277.0 554.1 577.1 644.1 682.0 676.1
Northern Africa 19.1 16.3 21.2 23.6 19.0 59.8 51.6 63.8 82.1 70.2
Sub-Saharan Africa 191.6 210.4 246.9 263.9 258.0 494.3 525.5 580.3 599.9 605.8
Eastern Africa 93.0 100.2 114.3 121.3 112.5 226.1 238.4 266.0 276.3 271.7
Middle Africa n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a.
Southern Africa 13.4 13.1 19.8 20.1 20.2 28.3 29.1 34.4 34.9 35.3
Western Africa 44.4 50.9 59.6 66.0 67.2 149.9 159.7 171.1 177.6 182.8
ASIA 305.9 280.0 264.8 288.5 353.6 875.6 858.2 871.1 928.0 1 038.5
Central Asia 1.3 1.2 1.9 2.5 2.3 7.6 7.6 8.8 12.2 12.4
Eastern Asia 7.5 6.8 15.4 16.6 18.4 105.4 104.4 106.3 169.9 162.7
South-eastern Asia 27.9 23.7 27.3 37.5 34.3 123.2 109.9 122.1 139.6 134.0
Southern Asia 247.1 225.4 195.8 204.2 271.7 565.7 561.3 559.6 525.8 649.1
Western Asia 21.9 22.9 24.5 27.6 27.0 73.7 75.0 74.3 80.6 80.2
Western Asia and Northern Africa 41.0 39.2 45.7 51.2 46.0 133.4 126.6 138.1 162.7 150.5
LATIN AMERICA AND THE CARIBBEAN n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a.
Caribbean n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a.
Latin America 45.1 38.0 46.5 59.8 54.7 141.2 152.6 170.0 203.2 187.8
Central America 21.9 17.8 14.8 22.5 19.0 62.5 58.2 45.9 66.1 56.7
South America 23.1 20.2 31.7 37.3 35.7 78.7 94.4 124.1 137.1 131.2
OCEANIA n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a.
NORTHERN AMERICA AND EUROPE 16.1 16.3 13.4 13.6 10.6 105.2 104.7 95.8 93.7 88.7
NOTES: n.a. = not available, as data are available only for a limited number of countries, representing less than 50 percent of the population in the region.
For country compositions of each regional/subregional aggregate, see Notes on geographic regions in statistical tables inside the back cover.
SOURCE: FAO.

» reflect structural factors that influence the Consistent with the findings for the PoU, Africa
availability of and the inequality in access to food, is the region with the highest prevalence of
FI sev estimates are more sensitive to short-term severe food insecurit y, reaching 21.5 percent in
factors affecting people’s direct experiences 2018, up from 18.1 percent in 2014.
in accessing food, as reported in surveys. In
addition, the PoU for recent years is computed Severe food insecurit y is also increasing in
based on inevitably less timely data, particularly Latin America, driven by South America where
those from household surveys. Therefore the FI sev reached 8.3 percent in 2018.
PoU may fail to capture the impact of very recent
phenomena that might have affected the extent Finally, Asia shows a mixed picture. While the
of inequality in food consumption. Estimates of percentage of people exposed to severe food
FI sev, instead, fully reflect these phenomena. It is insecurit y decreased from 2014 to 2017 –
expected that the two series will tend to converge a trend that is consistent with the PoU results
more closely over time.9 – FI sev shows a marked increase in 2018 that

| 18 |
THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2019

FIGURE 10
OVER THE PAST FIVE YEARS (2014–2018), TOTAL LEVELS OF FOOD INSECURITY HAVE
BEEN ON THE RISE AT THE GLOBAL LEVEL, MAINLY DUE TO INCREASES IN AFRICA AND
LATIN AMERICA

60 Total
54.3 Moderate food insecurity
52.6 52.5
Severe food insecurity
50 47.6 48.3

40 Total
31.4
30.7 31.0 33.8
PERCENTAGE

30.9
Total 29.5 29.3
30 28.5
25.6 26.4 25.9
23.2 23.2 24.1 Total
22.8
24.2
20.0 19.4 19.5 20.6 23.8
20 21.9
20.7
16.9 17.2 16.5 19.5
Total
15.2 15.5 16.1 15.1
13.0 13.1 13.6 14.2
10 21.9 22.9 21.5 9.6 9.6 8.7 8.5 8.0
18.1 19.0
8.7 9.2 9.9 8.1 8.1 7.5
7.3 7.1
8.0 7.7 8.0 7.0 7.8 7.7 7.8 9.0
6.3 2.9 6.4 6.5
1.5 1.5 1.2 1.2 1.0
0
2014 2015 2016 2017 2018 2014 2015 2016 2017 2018 2014 2015 2016 2017 2018 2014 2015 2016 2017 2018 2014 2015 2016 2017 2018

WORLD AFRICA ASIA LATIN AMERICA NORTHERN AMERICA AND EUROPE

NOTES: Differences in total are due to rounding of figures to the nearest decimal point.
SOURCE: FAO.

is not mirrored by the projected PoU values. This implies that these additional 1.3 billion
The increase is concentrated in Southern people did not have reg ular access to nutritious
Asia, where FI sev increased from less than and sufficient food, even if they were not
11 percent in 2017 to more than 14 percent in necessarily suffering from hunger, thus putting
2018. This possibly ref lects an increase in the them at greater risk of various forms of
unemployment rate in India between 2017 and malnutrition and poor health than the food
2018,10 and especially in Pakistan, where growth secure population.
is expected to slow down significantly.11
The combination of moderate and severe
Moderate or severe food insecurity levels of food insecurit y brings the estimated
A broader look at the extent of food insecurit y FI mod+sev (SDG Indicator 2.1.2) to 26.4 percent
beyond severe levels and hunger reveals that of the world population, amounting to a total
an additional 17.2 percent of the world of about 2 billion people (Table 3 and 4). Figure 10
population, or 1.3 billion people, have shows that, since 2014 when FAO first started
experienced food insecurit y at moderate levels. collecting FIES data, levels of food insecurit y

| 19 |
PART 1 FOOD SECURITY AND NUTRITION AROUND THE WORLD IN 2019

FIGURE 11
THE CONCENTRATION AND DISTRIBUTION OF FOOD INSECURITY BY SEVERITY
DIFFERS GREATLY ACROSS THE REGIONS OF THE WORLD

Total population
7 633 million

Total population
4 545 million
NUMBER (MILLIONS) 2018

Total population Total population


1 288 million 1 106 million
Total population
608 million
2 014
1 039 676
704 277
354 188
89 11 55

WORLD ASIA AFRICA NORTHERN AMERICA LATIN AMERICA


AND EUROPE

Total population Moderate or severe food insecurity Severe food insecurity

SOURCE: FAO.

have been on the rise at the global level as well at its lowest in Northern Africa (29.5 percent),
as in most regions of the world. where the food-insecurity profile is much more
similar to that of the Western Asia region than
Total food insecurit y (moderate or severe) is that of the other regions in Africa.
much higher in Africa than in any other part of
the world. Here FI mod+sev affects more than half The distribution of food-insecure people in the
of the population. Latin America is next, with world presented in Figure 11 shows that, from a
a prevalence of food insecurit y of more than total of 2 billion suffering from food insecurit y,
30 percent, followed by Asia at 23 percent and 1.04 billion (52 percent) are in Asia; 676 million
Northern America and Europe at 8 percent. (34 percent) are in Africa; and 188 million
(9 percent) are in Latin America. The fig ure also
Also revealing are the differences obser ved illustrates the difference across regions in the
within regions (Table 3). In Asia, total food distribution of the population by food-insecurit y
insecurity is much higher for Southern Asia severit y level. For example, in addition to being
(34.3 percent in 2018) than for Eastern Asia (less the region with the highest overall prevalence of
than 10 percent). In Africa, total food insecurity is food insecurit y (Table 3), Africa is also the region
also higher for the Southern region (53.6 percent where severe levels represent the largest share
in 2018) and the Eastern region (62.7 percent) of the total. In Latin America, and even more in
compared with Western Africa (47.9 percent). It is Northern America and Europe, the proportion

| 20 |
THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2019

FIGURE 12
AS THE COUNTRY LEVEL OF INCOME FALLS, THE PREVALENCE OF FOOD INSECURITY
INCREASES AND SO DOES THE PROPORTION OF SEVERE FOOD INSECURITY OVER THE TOTAL

Total population
Total population 3 097 million
2 640 million

Total population
NUMBER (MILLIONS) 2018

1 197 million
Total population
695 million

982
434
342
102 373 190
104
21

HIGH-INCOME UPPER-MIDDLE-INCOME LOWER-MIDDLE-INCOME LOW-INCOME


COUNTRIES COUNTRIES COUNTRIES COUNTRIES

Total population Moderate or severe food insecurity Severe food insecurity

SOURCE: FAO.

of food insecurit y experienced at severe levels is A combined look at past and recent trends in
much smaller. hunger, food insecurity and poverty
The introduction of a new indicator to measure
Different patterns in food-insecurit y severit y food insecurit y allows for a more nuanced view
emerge also when countries are grouped by of the state of food insecurit y in the world and of
income level. Figure 12 shows that, as the level recent trends.
of income falls, not only does the prevalence
of food insecurit y increase, but so does the Figure 13 shows trends in the number of
proportion of severe food insecurit y over the undernourished, food-insecure and extreme
total. In 2018, low-income countries, with a total poor 12 people in the world from 2005 to 2018,
population of only 695 million, were home to contrasting them against the growth in the
434 million food-insecure individuals (62 percent world’s population over the same period.
of the total), 190 million of whom (equivalent
to 27 percent of the total population) were These indicators provide a consistent picture.
severely food insecure. In contrast, high-income Both extreme poverty and undernourishment
countries were home to 102 million food-insecure have been declining from 2005 to 2015,
individuals (9 percent of the total), of whom though at different rates. The number of
21 million (barely 2 percent of the total) were undernourished and the number of extreme
considered to be severely food insecure. poor were ver y close as of 2015, with both

| 21 |
585 568.2 600.4 657.6

2010 2011 2012 2013 2014 2015 2016 2017 2018


1 929.6 2 013.8
1 712.3 1 801.9
PART 1 FOOD SECURITY AND NUTRITION AROUND THE WORLD 1IN
696.3
2019
1 354.2 1 235.7 1 092.4 964.9 730.9
912.4 807.9 785.4 796.5 811.7 821.6
947.2 913.5 879.0 857.1 841.7 822.3 814.4 807.6 800.1 788.8 704.3
585 568.2 600.4 657.6

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
Year

Total Population Undernourished Extreme poverty Moderate or severe food insecurity Severe food insecurity

FIGURE 13
THE NUMBERS OF UNDERNOURISHED AND OF FOOD INSECURE HAVE BEEN ON THE RISE IN
RECENT YEARS, AFTER A DECADE-LONG DECLINE IN EXTREME POVERTY AND UNDERNOURISHMENT

7 632.8
1 929.6 2 013.8
1 696.3 1 712.3 1 801.9
6 542.2

964.9 912.4 730.9 785.4


807.9 796.5 811.7 821.6
MILLIONS OF PEOPLE

814.4 807.6 800.1 788.8 704.3


585 568.2 600.4 657.6

2010 2011 2012 2013 2014 2015 2016 2017 2018

1 929.6 2 013.8
1 696.3 1 712.3 1 801.9
1 354.2 1 235.7 1 092.4 964.9 730.9
912.4 807.9 785.4 796.5 811.7 821.6
947.2 913.5 879.0 857.1 841.7 822.3 814.4 807.6 800.1 788.8 704.3
585 568.2 600.4 657.6

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

YEARS

Total population Number of Number of people Number of moderately or severely Number of severely
undernourished in extreme poverty food insecure, combined food insecure

SOURCE: FAO for number of undernourished, number of moderately or severely food insecure and number of severely food insecure; PovcalNet: an online analysis tool for global poverty
monitoring. In: The World Bank [online]. Washington, DC. [Cited 9 May 2019]. http://iresearch.worldbank.org/PovcalNet/home.aspx for number of people in extreme poverty.

slightly higher than the number of severely The fig ure also reveals the benefits of using FIES
food insecure. data to obtain a more detailed assessment of the
most recent years. By zooming in on the period
To put this in context, one can obser ve in Figure 13 between 2014 and 2015, one notes the close
that even with an increase in world population correspondence between the number of severely
from 6.5 to 7.6 billion during 2005 –2018, the food insecure, extreme poor and undernourished,
number of undernourished has fallen from and also the comparable increasing trends
almost 950 million people to about 820 million. between the number of undernourished and
This is ref lected in a reduction of the PoU from the number of people affected by severe
14.5 percent in 2005 to 10.8 percent in 2018. food insecurit y.

| 22 |
THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2019

FIGURE 14
IN EVERY CONTINENT, THE PREVALENCE OF FOOD INSECURITY IS SLIGHTLY HIGHER FOR
WOMEN THAN FOR MEN, WITH THE LARGEST DIFFERENCES FOUND IN LATIN AMERICA
(2016–2018 THREE-YEAR AVERAGES)

70
Moderate food insecurity
Total
Severe food insecurity
Total 57.9
60
56.1

50

31.2
30.1
40
PERCENTAGE

Total
Total 29.9
30 25.4 Total
Total
24.0 Total 24.8
Total
20.6 21.3
20 19.9
15.4 16.2 16.6 Total
14.5 Total 11.7
26.1 26.7 14.2
10.1
10
7.4 9.0
8.6 9.1 8.3 10.0
6.4 6.8
2.7 2.7
0
MEN WOMEN MEN WOMEN MEN WOMEN MEN WOMEN MEN WOMEN

WORLD AFRICA ASIA LATIN AMERICA NORTHERN AMERICA AND EUROPE

NOTES: Differences in total are due to rounding of figures to the nearest decimal point.
SOURCE: FAO.

The picture also highlights that most of the Gender differences in food insecurity
increase in food insecurit y since 2014, from The FIES data collected by FAO in more than
1.7 billion to 2.0 billion, has occurred at moderate 140 countries over five years at the individual
levels (as seen in the sharper increase for total (rather than household) level provide a unique
food insecurit y compared with that of severe food opportunit y to conduct a differential analysis of
insecurit y). This increase parallels the troubling the incidence of food insecurit y by gender.
increase in overweight and obesit y covered in
Section 1.3, which will explore in detail the links Figure 14 presents the prevalence of food
between food insecurit y at moderate or severe insecurit y estimated separately for men and
levels and various forms of malnutrition, with a women worldwide and in all continents (except
focus on overweight and obesit y. Oceania). It reveals that in ever y continent,

| 23 |
PART 1 FOOD SECURITY AND NUTRITION AROUND THE WORLD IN 2019

the prevalence of food insecurit y is slightly sample of nearly 140 countries,14 and two others
higher in women than in men, with the focusing specifically on sub-Saharan Africa15 and
largest differences found in Latin America. Arab countries 16 – concluded that the likelihood
Differences are statistically significant, as they of being food insecure was higher for people
extend beyond the margins of error represented who were unemployed and had low levels of
with small vertical bars in the fig ure. education and household income, corroborating
the results of the analysis of countr y-level
A more extensive analysis conducted by pooling indicators presented in Box 4. In the first study, it
all data collected by FAO in 145 countries in 2014, was also found that people with low social capital
2015, 2016 and 2017, shows that area of residence, and weak social networks were more likely to be
povert y status and education level are significant food insecure. Elsewhere, yet another study using
determinants of the difference in food insecurit y the global FIES data found that food insecurit y
levels between men and women (see Annex 2 for was strongly and negatively associated with
the methodolog y). Globally, the gender gap in subjective well-being, regardless of household
food insecurit y appears to be larger among the income level or social support. This was found
less-educated, poorer strata of the population, to be true in countries of all income classes, but
and in urban (large cit y and suburbs) settings. more so in high-income countries. In fact, food
After controlling for area of residence (rural or insecurit y explained poor physical health and
small town versus large cit y or suburbs), povert y lower subjective well-being more than other
status and education level of the respondents, indicators of living conditions such as household
the chances of being food insecure are still income, shelter and housing, and employment.17
approximately 10 percent higher for women than
for men. This finding reveals that other – possibly Food insecurit y can affect health and
subtler – forms of discrimination make access to well-being in many ways, with potentially
food more difficult for women, even when they negative consequences for mental, social
have the same income and education levels as and physical well-being. Many studies using
men and live in similar areas. experience-based food-insecurit y scales have
documented negative psychosocial effects
Another study using global FIES data found of food insecurit y in women and children.18
that gender differences in household income, Furthermore, one particular study using the
educational attainment and social networks global FIES data found that food insecurit y
explain most of the gender gap in food is associated with poorer mental health and
insecurit y.13 This suggests that policies that specific psychosocial stressors across global
address gender inequalit y in employment regions independent of socio-economic status.19
opportunities and educational attainment may
also have an impact on food insecurit y. Part 2 There is also a large body of evidence on the
of this report looks more closely at the different links between food insecurit y and nutritional
gender dimensions of inequalit y that affect food outcomes (as described in the 2018 report).
securit y and nutrition, both within communities Together with the evidence cited above, this
and within households, and outlines the policies growing body of research highlights the value
and approaches needed to address these. of experience-based measures of food insecurit y
like the FIES. It is worth emphasizing, as well,
Global FIES data provide evidence of both causes that the FIES-based indicators and the PoU are
and consequences of food insecurity at the not to be confused with indicators used in food
household and individual levels crisis situations (Box 5).
Studies using the FIES or comparable
experience-based food-insecurit y measures The next section presents the latest fig ures
comprise a growing body of evidence on causes on progress towards ending all forms of
and consequences of food insecurit y at the malnutrition, with a special focus on overweight
household and individual levels. Three studies in and obesit y. The final section of Part 1 discusses
particular – one using FIES data collected by FAO new evidence on the relationship between food
through the Gallup® World Poll in the global insecurit y and various forms of malnutrition. n

| 24 |
THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2019
BOX 4
HOW DO ESTIMATES OF FOOD INSECURITY COMPARE TO OTHER IMPORTANT
INDICATORS OF HUMAN DEVELOPMENT?

National prevalence estimates of moderate or severe ratio) and a larger percentage of the population
food insecurity (FImod+sev) based on the FIES rank living in rural areas. Prevalence of food insecurity is
countries in ways that are strongly correlated with the also lower in countries with greater political stability
rankings produced by other key indicators of human and less violence, a theme addressed in depth in the
development (see table below). As one would expect, 2017 edition of this report.
countries with a lower prevalence of food insecurity Countries where health expenditure per capita
also tend to have lower levels of poverty and income is lower, and where a larger proportion of the
inequality and higher labour force participation rates, population lacks access to safely managed water
GDP per capita, literacy rates and gender equity. and sanitation, also tend to be countries with a
Additionally, countries with a lower prevalence of food higher prevalence of food insecurity. Access to these
insecurity tend to have higher Human Capital Indices, health-related public services also has a strong effect
pointing to a strong link between food security and the on two key indicators of the state of a nation’s health
well-being and development of nations. – child mortality and life expectancy – with which
The table also shows that the prevalence of food national prevalence of food insecurity are highly
insecurity is higher in countries with higher ratios of correlated. Child mortality tends to be higher and life
dependents (people younger than 15 and older than expectancy lower in countries with higher rates of
64) to the working-age population (age dependency food insecurity.

CORRELATION BETWEEN COUNTRY ESTIMATES OF FOOD INSECURITY AND OTHER COUNTRY-LEVEL INDICATORS
OF HUMAN DEVELOPMENT AND WELL-BEING
FI mod+sev
Indicator Period
N 2016–2018
Poverty, inequality and economic growth
GDP per capita 2017 138 -0.829
Poverty headcount 2013–2017* 88 0.752
GINI index income inequality 2013–2017* 104 0.622
Labour force participation rate 2017 137 -0.229
Human capital and gender
Human Capital Index 2017 132 -0.895
Literacy rate 2013–2017* 61 -0.675
Gender Development Index 2017 137 -0.426
Demographics
Age dependency ratio 2015 138 0.612
Rural population 2015 135 0.517
Political stability and absence of violence 2017 140 -0.589
Health-related public services
Health expenditure per capita 2015 135 -0.829
Basic drinking water services 2015 137 -0.806
Basic sanitation services 2015 138 -0.792
Health and well-being
Child mortality rate, under 5 years 2017 137 0.874
Life expectancy at birth 2016 139 -0.815
Prevalence of undernourishment (PoU) 2016–2018 133 0.842
NOTES: The table presents coefficients of Spearman rank correlations, all significant at the p = 0.01 level. The Spearman rank correlation between two variables is the linear
correlation between the ranked values of those two variables – i.e. in the above analysis, the correlation between country rankings based on the two variables. * Used value for
the most recent year available during this period. N = number of countries with valid values. For a description of the variables and details of the analysis, see Annex 2.
SOURCE: FAO.

| 25 |
PART 1 FOOD SECURITY AND NUTRITION AROUND THE WORLD IN 2019

BOX 5
DIFFERENT FOOD SECURITY ASSESSMENTS FOR DIFFERENT OBJECTIVES

The State of Food Security and Nutrition in the World Security Phase Classification/Cadre Harmonisé
and the Global Report on Food Crises (GRFC)1 are (IPC/CH). Since timeliness is of the essence in
both multi-partnership efforts that provide assessments crisis situations, rapid estimates are needed of
of food security around the world which complement how many people are facing crisis conditions or
each other. However, they have distinct objectives worse (IPC/CH Phase 3 or above), at the worst
and rely on different data and methodologies, so it is (peak) moment in the year, based on all available
important to clarify the difference between the numbers evidence, including non-official sources.
that these two reports provide. In other words, while chronic food insecurity as
While the GRFC has a narrow focus on acute food captured by PoU or FIsev is a long-term or persistent
insecurity for countries experiencing food crises, the inability to meet food consumption requirements,
scope of this report is much broader: its objective is acute or transitory food insecurity as captured in
to monitor food insecurity in the entire world, on a GRFC numbers is a short-term, possibly temporary,
regular basis. It is obvious, then, that the two reports inability to meet food consumption requirements
must be informed by different types of data and related to sporadic crises, conditions that can be
analytic methods. highly susceptible to change and can manifest in a
All the indicators used for SDG monitoring and population within a short time frame, as a result of
reported here are arguably ill suited to reflect the sudden changes or shocks.
most current conditions during emergencies, This is why this report's estimates of the
a reason why current data for some of the countries number of undernourished people in the world
that are experiencing conflicts are not reported in at 821.6 million in 2018 must not be directly
this report. However, that is not the purpose of the compared with the figure of around 113 million
report. The two indicators used here to measure people in 53 countries facing crisis conditions or
hunger (PoU and FIsev), for example, are meant worse in 2018, as reported in the 2019 GRFC.
to reliably capture long-term trends at global and Having clarified that, however, it is worth
regional levels, while providing the best possible stressing again how the two reports are highly
assessment of the most recent structural situation at complementary. Acute and chronic food
country level. For this reason, they should not be insecurity are not mutually exclusive phenomena.
too conditioned by possibly temporary, short-term Indeed, repeated shocks and persistent crises can
fluctuations, typical of acute crises, which are the provoke upticks in severe food insecurity, eventually
main focus of the indicators presented in the GRFC. forcing households into destitution and chronic
PoU and FIsev estimate the extent of severe food poverty, and potentially leading to starvation.
deprivation in a population, seen as a chronic While acute food insecurity may require shorter-term
condition, and are based on validated, official data interventions that address immediate causes,
which are available with some delay due to various interventions tackling root causes may also be
rounds of cleaning and vetting. important to prevent repeated transitory acute food
The GRFC, on the other hand, focuses on insecurity, which may lead to chronic food insecurity.
acute food insecurity and is mainly based on Decision makers worldwide can largely benefit from
analytic approaches such as the Integrated Food the findings of the two reports.

1
FSIN. 2019. Global Report on Food Crises 2019 [online]. Rome. [Cited 9 May 2019]. http://www.fsinplatform.org/sites/default/files/resources/files/GRFC_2019-Full_Report.pdf

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THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2019

PROGRESS TOWARDS
1.2
è   Both overweight and obesity are significant health
problems, but obesity in particular is linked to higher
GLOBAL NUTRITION mortality and morbidity risks.

TARGETS è   Throughout the world, most school-age children


do not eat enough fruit or vegetables, regularly
KEY MESSAGES consume fast food and carbonated soft drinks, and
are not physically active on a daily basis.
è   Low birthweight estimates, included for the first
time in this year’s edition of the report following the è   Tackling all forms of malnutrition will require
release of new global estimates, indicate that one bold multisectoral action, involving the health,
in seven live births – 20.5 million babies globally food, education, social protection, planning and
– suffered from low birthweight in 2015. If current economic policy sectors. Food environments must be
trends continue, the 2025 World Health Assembly transformed to make nutritious foods more available
target of a 30 percent reduction in the prevalence of and affordable. Relevant actions that countries can
low birthweight will not be met. implement as outlined in the ICN2 Framework for
Action are encouraged under the UN Decade of
è   Globally, the prevalence of stunting among Action on Nutrition.
children under five years is decreasing. The number
of stunted children has also declined by 10 percent This section assesses global and regional trends
over the past six years, but with 149 million children and patterns to track progress towards seven
still stunted, progress needs to be accelerated to nutrition indicators used to monitor global
achieve the 2030 target of halving the number of World Health Assembly targets for nutrition.
stunted children. This year the report takes a closer look at data on
overweight and obesit y, a serious public health
è   A closer look at the SDG indicators of wasting, challenge affecting people of all ages. For the
stunting, and childhood overweight reveal striking first time, data on overweight and obesit y among
regional differences. In 2018, Africa and Asia school-age children and adolescents are included
bear the greatest share of all forms of malnutrition, and the section highlights some of the dietar y
accounting for more than nine out of ten of all and physical activit y behaviours that contribute
stunted children, over nine out of ten of all wasted to overweight and obesit y in this age group.
children, and nearly three-quarters of all overweight The trends described emphasize the urgent
children worldwide. need for actions aimed at improving access to
nutritious and sufficient food for all.
è   Malnutrition is linked across the life cycle, with
Malnutrition exists in multiple forms.
undernutrition in foetal and early life contributing to
Maternal and child undernutrition contributes
both immediate and long-term health problems such
to 45 percent of deaths in children under five. 20
as stunted physical growth, coronary heart disease,
Overweight and obesit y are on the rise in almost
stroke, diabetes, and abdominal obesity, as well as
all countries, contributing to 4 million deaths
economic costs due to loss of human capital.
globally. 21 The economic costs of malnutrition
are staggering – obesit y is projected to cost
è   Globally, the prevalence of overweight is USD 2 trillion annually, largely driven by the
increasing in all age groups, with particularly steep value placed on lost economic productivit y plus
increases among school-age children and adults. direct health care costs worldwide, 22 while it is
The increase in prevalence of obesity between projected that undernutrition will reduce GDP by
2000 and 2016 has been even faster than that up to 11 percent in Africa and Asia. 23 The various
of overweight. forms of malnutrition are intertwined throughout
the life cycle, with maternal undernutrition, low
birthweight and child stunting giving rise to
increased risk of overweight later in life.

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PART 1 FOOD SECURITY AND NUTRITION AROUND THE WORLD IN 2019

Global trends As of 2016, one in three (32.8 percent) women


of reproductive age (15 – 49 years) across the
This year, also for the first time, low birthweight globe was still affected by anaemia. Since 2012,
estimates are included in the report. These indicate the global prevalence of anaemia has remained
that one in seven live births, or 20.5 million unchanged, making it extremely challenging to
babies globally, suffered from low birthweight achieve the 2025 target of a 50 percent reduction.
in 2015. 24 Low birthweight newborns have a At the same time, adult obesit y continues to rise,
higher risk of dying in the first 28 days of life; from 11.7 percent in 2012 to 13.2 percent in 2016.
those who sur vive are more likely to suffer from As a result, we are not on track to meet the global
stunted growth and lower intelligence quotient target to halt the rise in adult obesit y.
IQ, and face increased risk of adult-onset chronic
conditions including obesit y and diabetes. 25
Data show that little progress has been made
Regional patterns
since 2012, with an estimated 14.6 percent of Global estimates of various nutrition indicators
all babies worldwide born with low birthweight do not reveal the wide variations that exist
in 2015 (Figure 15). If current trends continue, the between regions. For instance, in 2015, an
goal to achieve a 30 percent reduction in the estimated 14.6 percent of babies born globally
prevalence of low birthweight infants by 2025 were low birthweight, with wide variations across
will not be met. regions – from 7.0 percent in Northern America
and Europe to 17.3 percent in Asia. 26
Estimates of exclusive breastfeeding reveal some
progress at the global level, with 41.6 percent A closer look at the SDG indicators of wasting,
of infants under six months being exclusively stunting, and childhood overweight reveals
breastfed in 2018 (based on the most recent striking regional differences as well (Figure 16).
data for each countr y between 2013 and 2018) While the prevalence of stunting is decreasing
compared with 37 percent of infants in 2012 in almost ever y region, the extent of progress
(based on the most recent data for countries varies considerably, with Africa seeing the
between 2005 and 2012). least progress in reducing stunting prevalence
since 2012. In 2018, Africa and Asia accounted
Globally, the prevalence of stunting among for more than nine out of ten of all stunted
children under five years is decreasing, with children globally, representing 39.5 percent and
21.9 percent affected in 2018. The number 54.9 percent respectively (bottom of Figure 16).
of stunted children has also decreased from No clear conclusions can be made for Oceania,
165.8 million in 2012 to 148.9 million in 2018. as the confidence limits around the estimates are
Although this represents a 10.1 percent decline ver y wide for this region.
over this six-year period, it falls short of the
20 percent decline required over the same period In 2018, 49.5 million children under five were
to be on track for the 2030 target of reducing the affected by acute malnutrition or wasting.
number of children by one-half with reference to All regions had prevalence levels considered
the 2012 baseline. “medium” (between 5 and 9 percent) for
childhood wasting except Latin America and
Globally, 7.3 percent (49.5 million) children the Caribbean, which had a ver y low prevalence
under five years of age are wasted, which falls (1.3 percent). In Asia and Oceania, nearly one in
short of the target of reducing and maintaining ten (9.4 percent) children were wasted. Overall in
childhood wasting to less than 5 percent for 2018, more than two-thirds of all wasted children
2025 and 3 percent for 2030. In 2018, childhood under five lived in Asia.
overweight affected 40.1 million children
under five worldwide. The global prevalence Globally, overweight affected 40.1 million
of overweight among children under five has children under five years of age in 2018.
not improved, increasing from 5.5 percent in While Asia and Africa had the lowest overweight
2012 (the baseline year of the W H A targets) to prevalence (5.2 percent and 4.9 percent
5.9 percent in 2018. respectively), together they accounted for »

| 28 |
THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2019

FIGURE 15
PROGRESS ON MALNUTRITION IS TOO SLOW TO ACHIEVE THE 2025 AND 2030
GLOBAL NUTRITION TARGETS

70.0 2025 WHA Global Nutrition Targets

70 2025 targets extended to 2030 to be


aligned with the SDG timeline

60

50.0

50
41.6

32.8
40
36.9

30.3
PERCENTAGE

30
25.0
21.9
15.0
14.6

20 15.2
14.6 15.2

13.2
10.5 10.5 12.2 11.7 11.7
7.3

10
5.9

5.5
5.5

5.0
3.0 3.0

0
2012
2015
2025
2030

2012
2018
2025
2030

2012
2018
2025
2030

2018
2025
2030

2012
2018
2025
2030

2012
2016
2025
2030

2012
2016
2025

Low Exclusive Stunting Wasting* Overweight Anaemia Obesity


birthweight breastfeeding (under 5 years) (under 5 years) (under 5 years) (women of (adults)
(< 6 months) reproductive age)

NOTES: * Wasting is an acute condition that can change frequently and rapidly over the course of a calendar year. This makes it difficult to generate reliable trends over time with the input
data available and, as such, this report provides only the most recent global and regional estimates.
SOURCES: Data for stunting, wasting and overweight are based on UNICEF, WHO and International Bank for Reconstruction and Development/World Bank. 2019. UNICEF-WHO-The World
Bank: Joint child malnutrition estimates – Levels and trends (March 2019 edition) [online]. https://data.unicef.org/topic/nutrition, www.who.int/nutgrowthdb/estimates, https://data.
worldbank.org; data for exclusive breastfeeding are based on UNICEF. 2019. Infant and Young Child Feeding: Exclusive breastfeeding, Predominant breastfeeding. In: UNICEF Data:
Monitoring the Situation of Children and Women [online]. https://data.unicef.org/topic/nutrition/infant-and-young-child-feeding; data for anaemia are based on WHO. 2017. Global
Health Observatory (GHO). In: World Health Organization [online]. Geneva, Switzerland. [Cited 2 May 2019] http://apps.who.int/gho/data/node.imr.PREVANEMIA?lang=en; data for
adult obesity are based on WHO. 2017. Global Health Observatory (GHO). In: World Health Organization [online]. Geneva, Switzerland. [Cited 2 May 2019]. http://apps.who.int/gho/
data/node.main.A900A?lang=en; and data for low birthweight are based on UNICEF and WHO. 2019. UNICEF-WHO Low Birthweight Estimates: levels and trends 2000–2015, May 2019.
In: UNICEF data [online]. New York, USA, UNICEF [Cited 16 May 2019]. https://data.unicef.org/resources/unicef-who-low-birthweight-estimates-levels-and-trends-2000-2015

| 29 |
PART 1 FOOD SECURITY AND NUTRITION AROUND THE WORLD IN 2019
FIGURE 16
STUNTING, WASTING**** AND OVERWEIGHT STILL IMPACT THE LIVES OF FAR TOO MANY
CHILDREN UNDER 5 YEARS

AFRICA ASIA* LATIN AMERICA AND THE CARIBBEAN OCEANIA** GLOBAL***

60

50

37.7 38.2
40
PREVALENCE
2012–2018

32.6
PERCENTAGE

30.0
30 27.3
25.0
22.7 21.9

20

11.1
9.0
10 9.4 9.4
9.1 7.3
7.1
7.2 7.5 7.3
4.8 4.9 4.7 5.2 5.5 5.9
1.3
0
2012 2018 2012 2018 2012 2018 2012 2018 2012 2018

58.8 81.7 4.8 0.5


149.0 million
NUMBERS AFFECTED (MILLIONS)

33.8 49.5
2018

14.0 0.7 0.1


million

9.5 18.8 4.0 0.1 40.1


million

2018
Stunting Wasting Overweight 2012

NOTES: * Asia excluding Japan; ** Oceania excluding Australia and New Zealand; *** the Global total factors in estimates for “more developed regions” (includes Australia,
New Zealand, Northern America and Europe) but estimates for these regions are not displayed due to low population coverage.
**** Wasting is an acute condition that can change frequently and rapidly over the course of a calendar year. This makes it difficult to generate reliable trends over time with the
input data available – as such, this report provides only the most recent global and regional estimates.
SOURCES: UNICEF, WHO and International Bank for Reconstruction and Development/World Bank. 2019. UNICEF-WHO-The World Bank: Joint child malnutrition estimates – Levels and
trends (March 2019 edition) [online]. https://data.unicef.org/topic/nutrition; www.who.int/nutgrowthdb/estimates; https://data.worldbank.org

| 30 |
THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2019

» nearly three-quarters of all overweight as weight-for-height greater than 2 standard


under-fives in the world (46.9 percent in Asia deviations above the W HO growth reference
and 23.8 percent in Africa). Oceania has the standard median. The term “obesit y” is generally
highest prevalence of overweight, with almost not used for children under five. For school-age
one in ten (9.1 percent) affected. This region is an children and adolescents (aged 5 –19 years),
example of a population affected by the multiple being overweight indicates having a body mass
burden of malnutrition, with prevalence of both index (BMI)-for-age greater than 1 standard
acute malnutrition (wasting) and overweight deviation above the W HO growth reference
approaching the 10 percent cut-off for being standard median, whereas obesit y is defined as
classified at “high” levels in 2018. There has having a BMI-for-age of more than 2 standard
not been a significant change in prevalence deviations above the median. In the case of
or numbers of children under five affected adults, overweight is defined as having a BMI
by overweight for any region between 2012 greater than or equal to 25; likewise, obesit y is
and 2018. defined as a BMI greater than or equal to 30.
For this report, the term overweight is used to be
In 2018, Africa and Asia had the highest inclusive of obesit y among school-age children,
prevalence of exclusive breastfeeding with adolescents and adults unless otherwise noted.
more than two in five infants under six months
benefiting from this life-saving practice. At its most basic level, overweight results
Conversely, however, these two regions have the from a persistent condition of dietar y energ y
highest prevalence of anaemia among women consumption exceeding energ y expenditure.
of reproductive age. In 2016, the prevalence While genetics can increase an individual’s
of anaemia among women of reproductive susceptibilit y to overweight, it cannot
age in Africa and Asia was more than double explain population-level increases over time.
the rate in Northern America and Europe, Intrauterine growth, infant feeding, and
with no region showing a decline in anaemia eating habits during preschool are significant
among women of reproductive age since 2012. determinants of overweight and obesit y
(Regional patterns for adult overweight are during adulthood. There is increasing evidence
discussed in the next section). indicating the importance of good nutrition and
physical activit y in early life as a determinant
of long-term energ y balance. Unfortunately,
Spotlight on overweight and obesity modernization and economic development have
Overweight and obesit y pose health problems led to an increased availabilit y of energ y-dense
throughout the life cycle. Among adults, obese foods and to poor dietar y practices, while at the
people have higher rates of mortalit y due to an same time reducing levels of physical activit y,
increased risk of cardiovascular disease, cancer a major determinant of energ y expenditure.
and diabetes. Children who are overweight are Food securit y, i.e. access to nutritious and
at a higher risk of t ype 2 diabetes, high blood sufficient food, is also known to be a key factor.
pressure, asthma and other respirator y problems, Box 6 provides a more in-depth description of the
sleep disorders, and liver disease. 27 They may links between maternal nutrition, malnutrition in
also suffer from the psychological effects of low early life and overweight later in life, illustrating
self-esteem, depression, and social isolation. 28 life-cycle and intergenerational effects.
Overweight and obesit y during childhood
often persist into adulthood, leading to lifelong In 2018, an estimated 5.9 percent (40 million)
health problems. The national economic costs, children under five were affected by overweight.
resulting from increased healthcare costs and lost Globally in 2016, one in five school-age children
economic productivit y, are tremendous. 29 (20.6 percent) and adolescents (17.3 percent)
were overweight, or 131 million children aged
The definitions of overweight and obesit y are 5 –9 years and 207 million adolescents. In the
somewhat different depending on the age group, same year, nearly two in five adults (38.9 percent)
making comparisons between them difficult. were overweight, representing 2 billion adults
For children under five, overweight is defined worldwide (Figure 17).

| 31 |
PART 1 FOOD SECURITY AND NUTRITION AROUND THE WORLD IN 2019
BOX 6
OVERWEIGHT AND OBESITY AND THE EFFECT OF MALNUTRITION THROUGHOUT
THE LIFE CYCLE

An increased risk for overweight and obesity can be birth to low-birthweight babies, thus projecting
imprinted early in life through intergenerational and poor nutrition alongside increased NCD risk to the
early life influences; such influences have contributed next generation.3
to a growing crisis in overweight since 2000, In addition to the link between early undernutrition
as shown in Figure 18. During foetal and early life, and subsequent risk of NCDs, another mechanism
undernutrition, potentially due to food insecurity, leads that increases NCD and obesity risk along the life
to changes in physiology and metabolism that not only cycle is that overweight or excess weight gain during
stunt physical growth and negatively impact human pregnancy increases the risk of gestational diabetes
capital, but also increase the risk of non-communicable and large size at birth, which in turn is linked to
diseases (NCDs) later in life.1 To illustrate, there is increased risk of overweight and obesity later in life.4
ample evidence linking low birthweight to increased Irrespective of birthweight, excessive weight gain in
risks of coronary heart disease, stroke, diabetes, and early childhood is predictive of overweight and obesity
abdominal obesity.2 The adverse effect of poor foetal in adolescence5 and adulthood.6 To effectively address
growth on NCD risk can be amplified by growth the growing problem of overweight and obesity and to
failure in the first years after birth and rapid weight prevent its perpetuation across generations, it is clear
gain later in life.1 Girls who experienced poor foetal that a life-cycle approach is required that promotes
growth, especially when coupled with poor catch-up access to nutritious foods, optimal infant feeding and
growth during infancy, are more likely to become nutrition as well as healthy growth along the entire life
stunted as adults and consequently more likely to give course, from foetal life to adulthood.

AN INCREASED RISK OF OVERWEIGHT AND OBESITY CAN BE IMPRINTED EARLY IN LIFE


THROUGH INTERGENERATIONAL AND EARLY LIFE INFLUENCES

INCREASED RISK
INFANCY AND
PRE-CONCEPTION PRENATAL EARLY CHILDHOOD OF OVERWEIGHT
AND OBESITY

SOURCE: UNICEF.

1
C.G. Victora, L. Adair, C. Fall, P.C. Hallal, R. Martorell, L. Richter and H.S. Sachdev. 2008. Maternal and child undernutrition: consequences for adult health and human capital.
The Lancet, 371(9609): 340–357.
2
D. Barker and C. Osmond. 1986. Infant mortality, childhood nutrition, and ischaemic heart disease in England and Wales. The Lancet, 327(8489): 1077–1081; C. Osmond, D.J. Barker,
P.D. Winter, C.H. Fall and S.J. Simmonds. 1993. Early growth and death from cardiovascular disease in women. BMJ (Clinical research ed.), 307(6918): 1519–1524; I. Darnton-Hill,
C. Nishida and W. James. 2004. A life course approach to diet, nutrition and the prevention of chronic diseases. Public Health Nutrition, 7(1a): 101–121; A.C. Ravelli, J.H. van der Meulen,
C. Osmond, D.J. Barker and O.P. Bleker. 1999. Obesity at the age of 50 y in men and women exposed to famine prenatally. The American Journal of Clinical Nutrition, 70(5): 811–816.
3
I. Darnton-Hill, C. Nishida and W. James. 2004. A life course approach to diet, nutrition and the prevention of chronic diseases. Public Health Nutrition, 7(1a): 101–121.
4
R.C.W. Ma and B.M. Popkin. 2017. Intergenerational diabetes and obesity – A cycle to break? PLoS Medicine, 14(10): e1002415.
5
M. Geserick, M. Vogel, R. Gausche, T. Lipek, U. Spielau, E. Keller, R. Pfäffle, W. Kiess and A. Körner. 2018. Acceleration of BMI in early childhood and risk of sustained obesity.
New England Journal of Medicine, 379(14): 1303–1312.
6
Z.J. Ward, M.W. Long, S.C. Resch, C.M. Giles, A.L. Cradock and S.L. Gortmaker. 2017. Simulation of growth trajectories of childhood obesity into adulthood. New England Journal of
Medicine, 377(22): 2145–2153.

| 32 |
THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2019
FIGURE 17
OVERWEIGHT PREVALENCE INCREASES OVER THE LIFE COURSE AND IS HIGHEST IN ADULTHOOD

Preschool children (< 5 years)


Total population = 678 million, of whom

40 million
(or 5.9%) are overweight

School-age children (5–9 years)


Total population = 638 million, of whom

131 million
(or 20.6%) are overweight

Adolescents (10–19 years)


Total population = 1.2 billion, of whom

207 million
(or 17.3%) are overweight

Adults (18+ years)


Total population = 5.1 billion, of whom

2 billion
(or 38.9%) are overweight

SOURCES: Data for overweight in preschool children are based on UNICEF, WHO and International Bank for Reconstruction and Development/World Bank. 2019. UNICEF-WHO-The World
Bank: Joint child malnutrition estimates – Levels and trends (March 2019 edition) [online]. https://data.unicef.org/topic/nutrition, www.who.int/nutgrowthdb/estimates, https://data.
worldbank.org; data for overweight in school-age children, adolescents and adults are based on NCD Risk Factor Collaboration (NCD-RisC). 2017. Worldwide trends in body-mass index,
underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128.9 million children, adolescents, and adults. The Lancet,
390(10113): 2627–2642.

The prevalence of overweight is increasing in steep in Asia and appears to be accelerating.


all age groups, with particularly steep trends In Northern America, on the other hand, while
among school-age children and adults (Figure 18). the prevalence of overweight is higher than in
Among school-age children, the prevalence has any other region, the trend shows some sign of
nearly doubled since 2000. Over half of adults levelling off in recent years. Among preschool
and over a quarter of school-age children in children (under five years old), however, the
Northern America, Oceania, Latin America and prevalence of overweight is much lower and
the Caribbean, and Europe were overweight trends are less dramatic – only in Northern
in 2016. America and Oceania has overweight increased
in this age group by more than a percentage
No region is exempt from this overweight crisis. point since 2000.
All have experienced an increase of roughly ten
percentage points in the prevalence of overweight While the rise in the prevalence of overweight
among adults since 2000. Among school-age in children and adults is alarming, of even
children, the upward trend is particularly greater concern is the high proportion of

| 33 |
PART 1 FOOD SECURITY AND NUTRITION AROUND THE WORLD IN 2019

FIGURE 18
ACROSS ALL REGIONS, THE PREVALENCE OF OVERWEIGHT IS INCREASING IN ALL AGE
GROUPS, WITH PARTICULARLY STEEP TRENDS AMONG ADULTS AND SCHOOL-AGE CHILDREN,
INCLUDING ADOLESCENTS

NORTHERN OCEANIA* LATIN AMERICA EUROPE** AFRICA ASIA GLOBAL


AMERICA AND THE CARIBBEAN

70
67.5

65
62.7

60 59.6
58.7
58.3
55
54.5
51.8
50 49.8

45
41.0
40 38.9
PERCENTAGE

35.9
35 34.8 34.1
30.6
30 29.8 30.8

26.8 27.1 27.3


25
21.6
20 20.1 19.8 18.4
15.9
15
13.3

10 8.8 9.1 10.3


7.5
6.7 6.6 7.2 6.7
4.9 5.2 4.9 5.9
5 4.7 5.0 4.0

0
2000
2005
2010
2015
2018

2000
2005
2010
2015
2018

2000
2005
2010
2015
2018

2000
2005
2010
2015
2018

2000
2005
2010
2015
2018

2000
2005
2010
2015
2018

2000
2005
2010
2015
2018

< 5 years ≥ 5–19 years Adults (18+ years)

NOTES: * Estimates for children under five for Oceania exclude Australia and New Zealand. ** Estimates for children under five for Europe are not displayed due to insufficient
population coverage. Trends in prevalence of overweight for children under five are based on data between 2000 and 2018. Trends for school-age children and adolescents (5–19 years)
and adults are based on data between 2000 and 2016.
SOURCES: Data for overweight in preschool children are based on UNICEF, WHO and International Bank for Reconstruction and Development/World Bank. 2019. UNICEF-WHO-The World
Bank: Joint child malnutrition estimates – Levels and trends (March 2019 edition) [online]. https://data.unicef.org/topic/nutrition, www.who.int/nutgrowthdb/estimates, https://data.
worldbank.org; data for overweight in school-age children, adolescents and adults are based on NCD Risk Factor Collaboration (NCD-RisC). 2017. Worldwide trends in body-mass index,
underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128.9 million children, adolescents, and adults.
The Lancet, 390(10113): 2627–2642.

| 34 |
THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2019

FIGURE 19
THE INCREASE IN PREVALENCE OF OBESITY BETWEEN 2000 AND 2016 HAS BEEN EVEN LARGER
THAN THAT OF OVERWEIGHT

40

25.8
Overweight,
not obese
Total
35 overweight
Obese

30 22.1

25
PERCENTAGE

20 11.6 38.9

11.7
15 30.8

13.1

10 7.3 20.6
7.5 17.3
9.0 8.7

11.2
5 9.9 5.6
3.9
2.4
0
2000 2016 2000 2016 2000 2016

CHILDREN ADOLESCENTS ADULTS


(5–9 years) (10–19 years) (18+ years)

SOURCE: NCD Risk Factor Collaboration (NCD-RisC). 2017. Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of
2416 population-based measurement studies in 128.9 million children, adolescents, and adults. The Lancet, 390(10113): 2627–2642.

prevalence represented by obesit y, as obese were obese (Figure 19). In addition, the relative
people face far more severe health consequences rate of increase in the prevalence of obesit y
and higher mortalit y risks compared with between 2000 and 2016 has been even faster
non-obese people. As of 2016, about a third than that of overweight: the prevalence of
of overweight adolescents and adults, and obesit y more than doubled among children and
44 percent of overweight children aged 5 –9, adolescents over this time period.

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PART 1 FOOD SECURITY AND NUTRITION AROUND THE WORLD IN 2019

FIGURE 20
THE GAP BETWEEN URBAN AND RURAL AREAS IN MEAN BODY MASS INDEX IS CLOSING

30

25

20
MEAN BODY MASS INDEX (kg/m2)

15

10

0
1985 2017 1985 2017
MEN WOMEN

Urban Rural

SOURCE: NCD Risk Factor Collaboration (NCD-RisC). 2019. Rising rural body-mass index is the main driver of the global obesity epidemic in adults. Nature, 569: 260–264.

Globally, mean BMI among adults is from one dominated by undernutrition to a


higher in urban areas than in rural areas. sig nificant problem of the multiple burden
However, this gap has been closing as BMI has of malnutrition. A mong children under five,
been increasing more rapidly in rural areas differences in the prevalence of over weight
than in urban areas (Figure 20). This pattern is by areas of urban or rural residence are
seen worldw ide, but particularly in low- and quite small. Additionally, there is no notable
middle-income countries. 30 The problem of difference in the prevalence of over weight by
malnutrition in rural areas is clearly shifting sex for any age g roup.

| 36 |
THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2019

Taking action to promote better nutrition and prevent and treat overweight and obesit y.
and reverse obesity trends Schools can play an inf luential role by providing
environments that shape and enable healthier
Several global initiatives provide roadmaps food choices through exposure to nutritious
to halt and reverse the obesit y epidemic. foods, combined with nutrition education
The creation of an environment that enables and and limiting exposure to foods or beverages
promotes healthy diets is central to all of these, high in fats, sugars or salt and to marketing
referring to a balanced, diverse and appropriate communication for such foods in or around
selection of foods eaten over time to ensure that schools. More broadly, transformation of food
the needs for essential nutrients are met, and systems is essential in delivering safe, affordable
that consumption of harmful fats, salt and sugars and sustainable diets. Social protection
is limited. 31 Unhealthy diet is now the leading programmes can also support access to nutritious
risk factor for deaths worldwide. To counter food especially for disadvantaged populations.
this, the Global Action Plan for the Prevention
and Control of Noncommunicable Diseases Poorer communities often face physical and
2013 –2020 outlines policy options for promoting economic barriers to obtaining nutritious foods,
physical activit y and healthy diets. 32 Another putting them at higher risk of food insecurit y
initiative, the W HO Commission on Ending and malnutrition. There is growing recognition
Childhood Obesit y proposes strategies to end of the need for actions that address factors at the
childhood obesit y that focus on healthy diets, communit y and national levels. 37 Governments
physical activit y, preconceptional and prenatal have a range of policy options to choose from
care, school health, and weight management. 33 to improve access to affordable healthy diets.
It includes actions that are urgently needed These range from “hard” policies such as
to address the problems of unhealthy diets standards and reg ulations to “soft” policies such
and inadequate physical activit y found to be as the provision of information and education.
prevalent among school-age children around Figure 21 presents examples of policies and
the world (Box 7). Finally, the Comprehensive programmes being implemented by countries
Implementation Plan for Maternal, Infant and and cities with the aim of preventing or reducing
Young Child Nutrition, endorsed by the World overweight and obesit y. Some of these actions are
Health Assembly in 2012, has challenged the described below.
world to prevent any increase in preschool
overweight over the next decade. 34 Nutritious foods that contribute to a healthy diet
must be readily available and affordable. In order
These initiatives highlight the need for a to foster greater physical access to nutritious foods,
multifaceted, multisectoral approach to address local governments can take several measures,
the burden of overweight and obesit y globally. such as providing fiscal or non-fiscal incentives
In light of this, in 2016, the United Nations to increase the number of food outlets that offer
endorsed the ICN2 Framework for Action 35 and fresh and nutritious food in neighbourhoods
declared a Decade of Action on Nutrition. 36 and communities 38 (including open-air markets),
Tackling all forms of malnutrition is not the discouraging the sale of fast food near schools
domain of any one sector alone: the health, through zoning, 39 and improving the availability
education, agriculture, social protection, of nutritious foods in restaurants through the
planning and economic policy sectors all have use of non-fiscal incentives such as voluntary
a role to play, as well as legislators and other certification schemes. 40
political leaders. A range of actions is needed,
aimed at the individual, household, communit y, Nutritious foods have become relatively more
national and even global levels. expensive than foods high in fat, sugar and/
or salt, in high-income countries as well as
Healthcare systems must provide appropriate emerging economies such as Brazil, China,
support, education and counselling for Mexico and South Africa. 41 The affordabilit y of
individuals and families to promote breastfeeding highly processed, energ y-dense foods (as well
(starting with supportive policies in hospital) as spatial-temporal access to nutritious food) »

| 37 |
PART 1 FOOD SECURITY AND NUTRITION AROUND THE WORLD IN 2019
BOX 7
RISK FACTORS FOR OVERWEIGHT AND OBESITY IN SCHOOL-AGE CHILDREN

The Global School-Based Student Health Survey Roughly half of the countries reported that between
(GSHS) provides a standard methodology to enable 10 and 30 percent of students do not eat any fruit
countries to collect comparable information on health at all, and a quarter reported that between 10 and
status, risk behaviours and protective factors related 30 percent of their students do not eat any vegetables
to the leading causes of morbidity and mortality at all. All but one of the countries found that the
among 13–15 year old students.1 The survey includes majority of their students ate less than five or more
information on a number of risk factors for overweight servings of fruit or vegetables per day, and in all but
and obesity in school-age children, including low 15 of these countries over two-thirds of students did
intake of fruits and vegetables, eating at fast food not eat this recommended amount (see figure below).
restaurants, consumption of soft drinks, low physical Fruit and vegetable consumption is highest among the
activity, and sedentary behaviour.2 The data provide countries of Oceania.
insights on prevalence and behavioural trends and can Nearly 70 percent of countries reported that at
be used for advocacy, programme planning, targeting least half of their students eat fast food on a weekly
and evaluation. The data presented here include results basis. Furthermore, 27 countries reported that at
from 73 countries that have carried out surveys in the least two in every ten students eat fast food at least
past ten years. three times per week.
The GSHS asks students to report on their fruit All countries found that one out of five students
and vegetable consumption in the past 30 days. consumed carbonated soft drinks at least once a

THROUGHOUT THE WORLD, BEHAVIOURS OF SCHOOL-AGE CHILDREN


INCREASE THEIR RISK OF BECOMING OVERWEIGHT OR OBESE

ATE LESS THAN 5


FRUITS/VEGETABLES
PER DAY

ATE FAST FOOD


AT LEAST ONCE
A WEEK

DRANK SODA
AT LEAST ONCE
A DAY   

NOT
PHYSICALLY
ACTIVE

0 10 20 30 40 50 60 70 80 90 100

PERCENTAGE

Africa Asia Latin America Oceania

NOTES: Each point represents data from each country in the region.
SOURCE: WHO. 2019. NCDs | Global school-based student health survey (GSHS). In: World Health Organization [online] Geneva, Switzerland. [Cited 25 April 2019].
https://www.who.int/ncds/surveillance/gshs/en

| 38 |
THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2019
BOX 7
(CONTINUED)

day, with more than half reporting that at least in sedentary activities. None of the countries
one out of every two students consumed soft drinks reported that a majority of their students had
daily. Soda consumption was found to be highest in attained the recommended level of physical
Latin America. activity, and all but one reported having fewer
Regarding physical activity and sedentary than one in three students who had attained the
behaviour, students were asked how many days recommended level. More than half of the countries
in the past seven days they had been physically reported that at least one in three students were
active for at least 60 minutes per day – the spending three or more hours in sedentary
recommended level of activity for this age group – activities every day.
as well as how much time per day they had spent

1
WHO. 2019. NCDs | Global school-based student health survey (GSHS). In: World Health Organization [online]. Geneva, Switzerland. [Cited 25 April 2019].
https://www.who.int/ncds/surveillance/gshs/en
2
WHO. 2013. Global School-Based Student Health Survey (GSHS) 2013 Core Questionnaire Modules [online]. Geneva, Switzerland.
https://www.who.int/ncds/surveillance/gshs/GSHS_Core_Modules_2013_English.pdf

FIGURE 21
EXAMPLES OF POLICIES AND PROGRAMMES AIMED AT PREVENTING OR REDUCING
OVERWEIGHT AND OBESITY

Standards Restrict
for healthy marketing of
school meals Provision
of free access breast-milk
Regulate Breastfeeding substitutes
levels of salt, to safe piped Nutrition
drinking water promotion labelling of
sugar and fat
in products pre-packaged
foods

Accessible Media
fresh food campaigns
Voluntary to promote INFORMATION, Food-based
certification AVAILABILITY markets
healthier EDUCATION dietary
schemes for OF FOOD food options guidelines
restaurants selling AND MARKETING
healthier meals
Ban/restrict
sugar-sweetened Regulate Menu
beverages Taxes on marketing of labelling
Reduce in schools sugar-sweetened foods and
portion size Restrict non-alcoholic
sale of fast food beverages or on Mandatory
foods high in salt, beverages nutrition
around schools to children
through fat and sugar education
zoning policies in schools

FISCAL AND
PRICING
POLICIES
Food coupons
to vulnerable
Grants/tax breaks groups for fresh
for vendors produce markets
to provide
healthier options
on their menu

SOURCE: Developed by WHO and FAO for this publication based on: World Cancer Research Fund International. 2019. NOURISHING database. In: World Cancer Research Fund
International database [online]. London. [Cited 25 April 2019]. https://www.wcrf.org/int/policy/nourishing-database; WHO. 2019. Global database on the Implementation of
Nutrition Action (GINA). https://www.who.int/nutrition/gina/en

| 39 |
PART 1 FOOD SECURITY AND NUTRITION AROUND THE WORLD IN 2019

» has been identified as a main determinant of beverages to children, and reg ulator y standards
whether food insecurit y is associated with for maximum levels of salt, sugar and fat in
obesit y in low- and middle-income countries; specific products. Government-led reformulation
such foods tend to be widely available in programmes can lead to reductions in the levels
upper-middle- and high-income countries, and of salt, sugar and fat across the spectrum of
are often cheaper than fresh and nutritious processed food and drink products, including the
foods. 42 To increase economic access to healthy elimination of industrially produced trans fats. 49
diets, effective options are available to local and
national governments, such as food assistance Importantly, no single measure alone can reverse
programmes that provide low-income families the overweight and obesit y trends; rather, there
and individuals with supplemental funds to must be a multifaceted approach that combines
purchase fruit and vegetables or promotion different t ypes of policies and inter ventions.
of healthy food retail development through
fiscal incentives. Some studies have shown This section of the report has documented the
that consumption of subsidized fruits and persistent challenge of undernutrition coupled
vegetables can be increased in the range of 10 to with rising overweight and obesity, known
30 percent. 43 Policymakers can also use economic as the “multiple burden of malnutrition”.
incentives such as taxes aimed at decreasing Recognizing that both the drivers and solutions
the demand for foods high in fat, sugar and/ to the multiple facets of this burden are
or salt and subsidies to make nutritious foods intricately linked, “double-duty actions” have
more affordable. 44 Taxes on sugar-sweetened been identified that can address the problems
beverages in particular have been found to of undernutrition and obesity simultaneously. 50
reduce purchases and/or consumption of these The potential impact for double-duty actions
products, not only due to the price increase, but emerges from addressing the shared drivers
also by raising awareness about the resulting underlying different forms of malnutrition, and
health benefits. 45 There is some evidence that the from shared platforms that can be used to address
effects of food taxes are stronger on low-income them. Many of the policies outlined above are
groups because they are more price-responsive, examples of such actions. For example, initiatives
and may therefore gain the most health benefits to promote and protect breastfeeding can protect
– especially if taxes are complemented with against stunting and wasting in childhood, reduce
targeted subsidies for more nutritious foods. 46 the risk of overweight and obesity later in life,
Furthermore, such taxes can also prompt and regulate maternal weight in the postpartum
manufacturers to reformulate their products (e.g. period. School food and nutrition programmes
by reducing sugar content). 47 can include the provision of meals to children
who are food insecure while also ensuring
There are a number of other policy tools available that they are exposed to nutritious foods.
to national governments to promote healthy Social protection programmes aimed at ensuring
eating and prevent overweight and obesit y. food security for vulnerable populations can be
These include incentives to encourage fruit and designed in a manner which supports healthy
vegetable production, reg ulator y instruments that eating habits and promotes dietary diversity.
shape nutrition labelling, 48 food standards and
appropriate procurement rules for schools and Double-dut y actions thus offer integrated
other public institutions, and national food-based solutions that address the shared drivers of
dietar y g uidelines. Provision of free access to safe different forms of malnutrition in many different
and affordable piped drinking water is crucial to contexts, including the context of humanitarian
promoting health ever y where; easy accessibilit y emergencies and protracted crises, where physical
to safe piped drinking water in schools provides access to and affordabilit y of nutritious foods
a healthy alternative to the consumption of is often severely compromised. Even in such
sugar-sweetened beverages. Other important contexts, where the priorit y is often to treat and
policy measures include restrictions on prevent undernutrition, these actions are needed
marketing of breast-milk substitutes, reg ulation to combat the multiple burden of malnutrition by
of the marketing of foods and non-alcoholic promoting healthy diets (Box 8). »

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THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2019

BOX 8
DOUBLE-DUTY ACTIONS TO ADDRESS ALL FORMS OF MALNUTRITION IN THE CONTEXT
OF HUMANITARIAN ASSISTANCE

Approximately two billion people live in countries amount of cash relative to people’s needs, and
affected by fragility, conflict and violence.1 Although people’s choices on how to use it, affect the potential
humanitarian programmes must focus on saving lives impact that this cash can have on nutrition. In many
and providing food in sufficient quantities to protect contexts, a strong strategy for social and behavioural
and promote food security, there is increasing change communication may be required to ensure
recognition of the existence of multiple forms of that cash is used to purchase nutritious food and does
malnutrition in crisis situations that must also be not contribute to an increased risk of overweight
addressed.2 and obesity.
The reality of the global distribution of different In Bangladesh for instance, e-vouchers distributed
types of malnutrition is complex.2 Wasting and to refugees for use in designated food outlets in camps
stunting occur in both crisis and stable contexts, allow individuals to improve their diets through the
and there is significant overlap in the risk factors for purchase of nutritious, fresh foods. E-vouchers provide
and consequences of these forms of malnutrition.3 access to 20 different food items, 12 of which are
Simultaneously, there is growing awareness of the mandatory (i.e. e-voucher recipients are required to
shared drivers of obesity and undernutrition,4 and the purchase these specific items) while the remaining
existence of diet-related non-communicable diseases in 8 can be chosen from other food items that are
humanitarian contexts.5 available in the store. This approach helps to ensure
This complexity demands an increase in focus on the quality of the foods purchased while still respecting
all forms of malnutrition in both humanitarian and individual choices. Guidelines set for retailers aim
development contexts. Double-duty actions are needed, at selling at least three items of fresh food including
with a dual focus on meeting immediate needs and fruits and vegetables. The financial support provided
reducing future risk and vulnerability. In order to design through e-vouchers combined with nutrition education
context-specific programmes able to respond to the and awareness-raising (e.g. on healthy diets and
multiple burden of malnutrition, programme designers cooking methods) is a strong example of a package
and policymakers also need to make better use of of double-duty interventions that can simultaneously
data, with a focus on certain key questions: Is there address multiple forms of malnutrition.
an enabling environment for good nutrition in a given Although progress has been made in improving
context? Is nutritious food available? Can people afford the affordability and accessibility of high-quality,
it? Do they choose it? nutritious foods for vulnerable people, challenges
Humanitarian actors currently use a variety persist related to supply and demand. Ongoing work
of approaches to protect food security, promote to strengthen local markets, improve efficiencies
good nutrition and ultimately save lives. in the retail sector, reduce the price of food while
Conditional cash-based assistance, for example, maintaining or increasing profitability, and utilize
can improve access to and affordability of nutritious point-of-sale data to understand purchasing patterns,
foods, thus enabling vulnerable people, including are all double-duty actions than can help address
those affected by crises, to improve their diets by the growing problem of the multiple burden of
purchasing food through retail outlets. Both the malnutrition in humanitarian contexts.

1
International Development Association (IDA). 2019. Conflict and Fragility. In: IDA – World Bank Group [online]. Washington, DC. [Cited 25 April 2019].
http://ida.worldbank.org/theme/conflict-and-fragility
2
Development Initiatives. 2018. Global Nutrition Report 2018. Shining a light to spur action on nutrition. Bristol, UK.
3
Emergency Nutrition Network (ENN). 2018. Child wasting and stunting: Time to overcome the separation. A Briefing Note for policy makers and programme implementers [online].
[Cited 25 April 2019]. https://www.ennonline.net/attachments/2912/WaSt-policy-brief.pdf
4
WHO. 2017. Double-duty actions for nutrition. Policy Brief [online]. Geneva, Switzerland. [Cited 24 April 2019].
https://apps.who.int/iris/bitstream/handle/10665/255414/WHO-NMH-NHD-17.2-eng.pdf?ua=1
5
S. Aebischer Perone, E. Martinez, S. du Mortier, R. Rossi, M. Pahud, V. Urbaniak, F. Chappuis, O. Hagon, F. Jacquérioz Bausch and D. Beran. 2017. Non-communicable diseases in
humanitarian settings: ten essential questions. Conflict and Health, 11(17).

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PART 1 FOOD SECURITY AND NUTRITION AROUND THE WORLD IN 2019

» In summar y, many of the policies discussed To accelerate progress towards ending


here aim to increase access to nutritious and hunger and achieving food securit y and
sufficient food – an objective embedded in improved nutrition, as required by SDG 2, it
SDG Target 2.1 to “end hunger and ensure is important to fully grasp the connections
access by all people, in particular the poor between food insecurit y and malnutrition,
and people in v ulnerable situations, including and the drivers underlying both. A better
infants, to safe, nutritious and sufficient food understanding of these links can lead to more
all year round”. In the section that follows, the effective policies aimed at addressing the
focus will be on how restricted access to food, specific challenges faced by countries and the
i.e. food insecurit y as measured by the FIES, international communit y. As discussed in the
is linked to different forms of malnutrition. n preceding section, forms of undernutrition
such as child stunting and anaemia in women
are persistent problems in many countries,

TOWARDS
1.3 and countries of all income levels are seeing
a rise in overweight and obesit y. The total
AN INTEGRATED number of obese people in the world (roughly
822 million, including overweight children
UNDERSTANDING OF under five, for whom obesit y data are not

FOOD SECURITY AND


available) surpassed the total number of
undernourished people (796.5 million, derived

NUTRITION FOR HEALTH from the PoU) in 2016. 51

AND WELL-BEING Moderate levels of food insecurit y – defined


as uncertain access to food of sufficient
qualit y and/or quantit y, but not so extreme
KEY MESSAGES that it causes insufficient dietar y energ y
consumption (undernourishment) – can
è   Countries with higher prevalence of moderate or
increase the risk of seemingly divergent
severe food insecurity based on the FIES tend to have forms of malnutrition. The 2018 edition of the
higher rates of adult obesity, when controlling for report 52 described multiple pathways whereby
national rates of undernourishment and poverty. food insecurit y may contribute to different
forms of malnutrition, including overweight
è   A closer look at household and individual level and obesit y. Household food insecurit y can
data from selected countries across all regions, reveals affect the quantit y and qualit y of dietar y
that food insecurity plays an important role as a intake, hence impacting on maternal nutrition,
determinant of different forms of malnutrition. child growth and development and potentially
increasing v ulnerabilit y to infectious diseases,
as well as the risk of anaemia in women.
è   In upper-middle- and high-income countries, living
Mothers who are food insecure are also
in a food-insecure household is a predictor of obesity
more stressed and likely to be depressed,
in school-age children, adolescents and adults.
which can negatively affect breastfeeding
and care practices. Other factors that help to
è   In low- and lower-middle-income countries, explain the link between food insecurit y and
household food insecurity tends to be negatively overweight and obesit y include the higher cost
associated with overweight and obesity, or is not of nutritious foods (and their substitution with
associated at all. cheaper foods that are high in fats and sugar),
the stress of living with uncertain access to
è   Children living in households classified as food, and physiological adaptations to periodic
moderately or severely food insecure in a number food restrictions.
of countries in Latin America and Africa are more
likely to be stunted compared with those living in This section presents new evidence on the
food-secure households. links between moderate or severe food

| 42 |
THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2019

insecurit y and various forms of malnutrition. such as the incidence of povert y. To explore
The analytic approach is two-pronged, but whether the detected link exists because
conditioned by data availabilit y. First, as moderate or severe food insecurit y is relevant
measures of the prevalence of food insecurit y per se, and not simply a ref lection of other
and of the various forms of malnutrition in the structural indicators, a cross-countr y reg ression
national population exist for many countries, analysis was conducted for each of the nutrition
the analysis looks at whether the prevalence outcome indicators, against the prevalence of
of moderate food insecurit y helps to explain moderate or severe food insecurit y, introducing
differences between countries in the prevalence national measures of undernourishment (as a
of adult obesit y, overweight among school-age prox y for severe food insecurit y) and extreme
children and adolescents, child stunting and povert y as controls. 54
wasting, and anaemia in women. Next, there is
a more in-depth study of the role of household The results (Table 5, bottom panel) show that
food insecurit y in predicting malnutrition when controls are included, the correlation
outcomes in individuals using data at the micro with moderate or severe food insecurit y
level from a limited number of countries in remains significant only for adult obesit y –
Africa, Asia and the Americas. but in reverse direction – and for anaemia
in women.

Links between food insecurity and various The reversal of the sign of the association
forms of malnutrition at the country level between moderate or severe food insecurit y
and adult obesit y, which becomes positive,
The top panel of Table 5 reports the results of means that moderate food insecurit y can indeed
the Spearman rank correlation coefficient contribute to obesit y, in certain conditions.
between the prevalence of moderate or severe If one focuses attention on countries of similar
food insecurit y and that of each of the five levels of undernourishment and povert y, obesit y
forms of malnutrition, across all countries rates are higher in those where moderate food
for which both indicators are available at the insecurit y is also higher. This result is in line
national level. 53 with the preliminar y findings described in the
2017 report which showed how national rates of
The correlations bet ween the prevalence food insecurit y were positively associated with
of moderate or severe food insecurit y and adult obesit y in high- and upper-middle-income
all nutrition outcomes are statistically countries. 55 Combined with the negative
sig nificant (p-values < 0.01). The exception correlation that is found for extreme povert y,
is child wasting, where sig nificance is only this provides additional evidence of the fact
marg inally below the 10 percent p-value. that, as national economies grow, people facing
The correlation is negative for adult obesit y, difficulties in accessing food, as captured by an
over weight among both children and experience-based indicator of food insecurit y,
adolescents, and positive for child stunting have a higher risk of obesit y. 56
and anaemia in women of reproductive age
( Table 5, top panel). This analysis presents a number of
limitations due to the nature of the data
In other words, it appears that countries w ith used, i.e. global data at the macro level. It is
a higher prevalence of moderate or severe food clearly insufficient to fully account for the
insecurit y (combined) tend to have a lower reasons for the differential impact of food
prevalence of child and adolescent over weight insecurit y on adult obesit y and other forms
and adult obesit y and a higher prevalence of of malnutrition in different conditions.
anaemia and child stunting. Such correlations, More insights can be gained from analysis of
however, could be spurious – for example, they data at the household and indiv idual levels
could be due to a correlation that exists, across that combine measures of food insecurit y
countries, bet ween the prevalence of moderate and of nutritional outcome, as explored in the
or severe food insecurit y and other aspects, next section.

| 43 |
PART 1 FOOD SECURITY AND NUTRITION AROUND THE WORLD IN 2019

TABLE 5
ASSOCIATION BETWEEN FOOD INSECURITY AND VARIOUS FORMS OF MALNUTRITION:
CROSS-COUNTRY ANALYSIS BASED ON NATIONAL DATA
  Obesity Overweight Stunting Wasting Anaemia
School-age
Children Children Children Women
Adults children and
< 5 years < 5 years < 5 years 15–49 years
adolescents
Spearman rank correlations Correlation coefficients (p-values)
Prevalence of moderate -0.442*** -0.525*** -0.543*** 0.632*** 0.292* 0.577***
or severe food insecurity (0.000) (0.000) (0.000) (0.000) (0.057) (0.000)
Regression analyses Coefficients (p-values)
Prevalence of moderate 0.308** -0.033 -0.132 0.001 -0.035 0.404**
or severe food insecurity (0.031) (0.813) (0.503) (0.995) (0.885) (0.011)
-0.379*** -0.279** -0.064 0.222* 0.305* 0.161
Prevalence of undernourishment
(0.002) (0.016) (0.675) (0.077) (0.096) (0.214)
-0.635*** -0.470*** -0.438** 0.638*** 0.211 0.090
Prevalence of extreme poverty
(0.000) (0.000) (0.041) (0.001) (0.404) (0.542)
Number of countries 86 86 47 43 43 87
NOTES: The Spearman rank correlation between two variables is the linear correlation between the ranked values of those two variables – i.e. in the analysis presented in the first row
above, the correlation between country rankings based on the two variables. p-values in parathenses. * p < 0.1; ** p < 0.05; *** p < 0.01. Adults are ≥ 18 years old; school-age
children and adolescents are 5–19 years old. For a description of the variables and details of the regression model, see the technical note in Annex 2.
SOURCE: M. Del Grossi, A. Sattar, C. Alvarez-Sanchez, A. Ishaq, S. Viviani, J. Feng, F. Yassin and C. Cafiero. forthcoming. The relevance of food security for nutrition: an empirical
analysis at country level. Technical Paper. Rome, FAO.

Links between food insecurity and various to be able to provide a global assessment.
forms of malnutrition at the household and Nevertheless, the study provides useful
evidence from eight countries of diverse income
individual levels levels from three main regions of the world.
This section presents the results of a statistical
analysis of micro-level data obtained from As a preliminary step, the food-insecurity
nationally representative sur veys that included measure in each survey was calibrated to
measures of household food insecurit y and the global reference scale following the FIES
also of nutritional outcomes of their members. methodolog y. This resulted in a measure that
The ultimate objective of the analysis was permitted classification of each household
to determine if living in a food-insecure as being food secure or food insecure in a
household increases the probabilit y of consistent way across the countries covered
being affected by one of the various forms (Box 3). Then, logistic regressions of the
of malnutrition. nutrition outcome condition were run at
the individual level for each of the relevant
To ensure consistent measurement of food population groups, as a function of the
insecurit y, one of the criteria used to select the household food-insecurity status, controlling
sur veys was that they should include either for age, sex, socio-economic status, household
the FIES or a similar experience-based tool to size/dependency ratio, and urban/rural
measure household food insecurit y, along with residence. For child malnutrition outcomes,
the nutritional outcome measures of individuals the analyses also controlled for maternal
in the household. Although the number of education and for access to clean drinking
such sur veys covering both food securit y at the water and basic sanitation facilities (see
household level and nutrition at the individual Annex 2 and Ishaq et al. 57 for a full description
level has increased, there are still too few of the methodolog y and results).

| 44 |
THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2019

TABLE 6
ASSOCIATION BETWEEN FOOD INSECURITY AND OVERWEIGHT OR OBESITY IN DIFFERENT AGE GROUPS:
MICRO-LEVEL DATA ANALYSIS FROM SELECTED COUNTRIES
  Country
United
Malnutrition
Population group States of Mexico Brazil Pakistan Nepal Kenya Nigeria Malawi
outcome
America
Odd-ratios (p-values)
0.893 0.927 1.422* 0.848 0.818 0.735*
Children < 5 years Overweight n.a. n.a.
(0.731) (0.522) (0.061) (0.152) (0.279) (0.099)
0.905 0.933 1.698** 0.684*** 0.951 0.774***
School-age Overweight n.a. n.a.
(0.407) (0.260) (0.042) (0.009) (0.924) (0.000)
children and
adolescents 1.487* 1.098 2.866** 0.573**
Obesity n.a. n.a. n.a. n.a.
(0.055) (0.117) (0.015) (0.027)
1.499*** 1.170*** 1.223** 0.564** 0.999 0.708***
Adults Obesity n.a. n.a.
(0.001) (0.006) (0.018) (0.031) (0.995) (0.000)
NOTES: Coefficient estimates are standardized and transformed to represent odd-ratios. Values less than one indicate negative associations. p-values in parathenses. * p < 0.1;
** p < 0.05; *** p < 0.01. All p-values are based on robust standard errors taking into account clustering of individuals by household. “n.a.” data not available or insufficient
number of observations to run the regression. Adults are ≥ 18 years old: school-age children and adolescents are 5–19 years old. Control variables differ by country, depending on
each outcome. See the technical note in Annex 2 for details and Ishaq et al. for more detailed results.
SOURCE: A. Ishaq, C. Alvarez-Sanchez, M. Del Grossi, S. Viviani, J. Feng, F. Yassin, A. Kepple, A. Sattar and C. Cafiero. forthcoming. The relevance of household food security for
nutrition: an empirical analysis based on survey data. Technical Paper. Rome, FAO.

The analysis (full results not shown here) at least in some age groups. In Brazil, food
reveals that living in a household classified as insecurit y is statistically correlated with
food insecure contributes to explain the status obesit y in the two age groups considered
of being affected by one or another form of (p-value < 0.05), while in the United States
malnutrition in different population groups, of America and Mexico the statistical
in seven of the eight countries studied. significance of the association is strong
Indeed, in five of them, household food (p-value < 0.01) for adults. The association
insecurit y is found to be associated with for obesit y in school-age children and
more than one form of malnutrition. adolescents is less strong for the United
Table 6 summarizes the results of regressions States and not statistically significant at the
of overweight and obesit y on household food conventional significance levels for Mexico
insecurit y only, not showing the coefficient (p-value = 0.117). Although this analysis was
estimates of other covariates. 58 not designed to prove the hy pothesis, the
different direction of the association of food
The table shows how the association of food insecurit y with adult obesit y depending on the
insecurit y with overweight and obesit y (across income level of the countr y is consistent with
different age groups) varies depending on the other evidence that a positive relationship
income level of the countr y. In the low- and is more likely in settings where highly
lower-middle-income countries considered, processed, energ y-dense foods are low-cost. 59
living in a food-insecure household either As mentioned in Section 1.2, in upper-middle-
decreases the likelihood of being overweight and high-income countries, such foods are
or obese (Kenya and Pakistan) or has a ver y ubiquitously available and cheap, while fresh,
weak (Malawi) or no association (Nepal and nutritious foods are often out of reach for
Nigeria). In upper-middle- and high-income those living on lower incomes. But in many
countries (Brazil, Mexico and the United low- and lower-middle-income countries,
States of America), food insecurit y increases highly-processed, energ y-dense foods are not
the likelihood of being overweight or obese, readily available or affordable.

| 45 |
PART 1 FOOD SECURITY AND NUTRITION AROUND THE WORLD IN 2019

TABLE 7
ASSOCIATION BETWEEN HOUSEHOLD FOOD INSECURITY, CHILD STUNTING AND WASTING, AND ANAEMIA
IN WOMEN OF REPRODUCTIVE AGE: MICRO-LEVEL DATA ANALYSIS FROM SELECTED COUNTRIES
  Country
United
Malnutrition
Population group States of Mexico Brazil Nepal Kenya Nigeria Malawi
outcome
America

Odd-ratios (p-values)

1.215** 1.665* 1.029 1.224* 0.906 1.373**


Stunting n.a.
(0.045) (0.097) (0.814) (0.099) (0.705) (0.022)
Children
1.291 0.727 2.791** 1.019
Wasting n.a. n.a. n.a.
(0.127) (0.125) (0.010) (0.947)

Women, 0.709 1.132** 1.410** 1.069


Anaemia n.a. n.a. n.a.
15–49 years (0.207) (0.035) (0.035) (0.597)

NOTES: Coefficient estimates are standardized and transformed to represent odd-ratios. Values less than one indicate negative associations. p-values in parathenses. * p < 0.1;
** p < 0.05; *** p < 0.01. All p-values are based on robust standard errors, taking into account clustering of individuals by household. “n.a.” data not available or insufficient
number of observations to run the regression. Adults are ≥ 18 years old: school-age children and adolescents are 5–19 years old. Control variables differ by country, depending on
each outcome. See the technical note in Annex 2 for details and Ishaq et al. for more detailed results.
SOURCE: A. Ishaq, C. Alvarez-Sanchez, M. Del Grossi, S. Viviani, J. Feng, F. Yassin, A. Kepple, A. Sattar and C. Cafiero. forthcoming. The relevance of household food security for
nutrition: an empirical analysis based on survey data. Technical Paper. Rome, FAO.

Table 7 summarizes the results of the analysis of As the analysis was conducted by controlling
association between household food insecurit y for income levels, 60 it shows that, in general,
and child undernutrition and anaemia in the experience of food insecurit y has
women of reproductive age, when controlling implications for malnutrition regardless of
for other factors (see Annex 2 for details). the socio-economic status of the household.
Household food insecurit y is associated with This points to the need for policies to go
indicators of child undernutrition in most beyond merely addressing povert y and
of the countries studied. Children living specifically improve access to food. n
in food-insecure households in Brazil,
Kenya, Malawi and Mexico are more likely

CONCLUSIONS
to be stunted compared with those living in
1.4
food-secure households. In Nigeria they are
more likely to be wasted. No association is
found in Nepal. The trends in food insecurit y and malnutrition
in all its forms described in Part 1 pose a
The association between food insecurit y and significant challenge to achieving SDG 2.
anaemia in women of reproductive age could The numbers of people suffering from hunger
only be analysed in four of the eight countries and food insecurit y are no longer declining –
due to data availabilit y. In Brazil and Mexico, on the contrar y, they have been slowly on the
living in a food-insecure household was rise in the last few years. While progress in
found to increase the likelihood of women bringing down the prevalence of stunting in
being anaemic. In Nepal the prevalence of children and increasing the rate of exclusive
anaemia is similar among food-secure and breastfeeding is to be commended, the rapid
food-insecure women. No association between increase in obesit y is alarming, and no
food insecurit y and anaemia is found in the region or income group is exempt from this
United States of America. problem. The global number of obese people
surpassed the number of undernourished
people already in 2016. Children facing hunger

| 46 |
THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2019

and food insecurit y may have a higher risk of Trends of the past several decades, as well
overweight, obesit y and NCDs later in life, as persistent socio-economic and geographic
and unhealthy diets are now the leading risk inequalities in food insecurit y and malnutrition,
factor for deaths worldwide. Therefore, it is highlight the need to address factors operating
imperative to continue addressing the urgent at the communit y, national and international
needs of those who are hungr y, while at the levels that contribute to such inequalities.
same time going beyond hunger and ensuring The second part of this report delves deeper
access not only to sufficient food, but also to into some of the fundamental determinants
nutritious foods that constitute a healthy diet. of food insecurit y and malnutrition related
In the search for a better understanding of how to underlying economic structures and
to achieve this, the new FIES-based indicator of inequalities. n
moderate or severe food insecurit y represents a
valuable tool.

| 47 |
SAGAING REGION,
MYANMAR AFGHANISTAN
A rural woman
A shopkeeper
benefitting
taking part
from an FAOin anproject
FAO irrigation
to restore
livelihoodsproject
and enhance
spraying water
resilience onto
of disaster-affected
vegetables at a
communitiesgrocery
in Myanmar.
market.
©FAO/Hkun ©FAO/Shah
Lat Marai
PART 2
SUSTAINED
ESCAPES
FROMPART
FOOD
1
FOOD SECURITY
INSECURITY AND
MALNUTRITION
AND NUTRITION
INAROUND
THE FACE
OF ECONOMIC
THE WORLD
SLOWDOWNS AND
IN 2019
DOWNTURNS
PART 2

SUSTAINED ESCAPES FROM FOOD


INSECURITY AND MALNUTRITION
IN THE FACE OF ECONOMIC
SLOWDOWNS AND DOWNTURNS
As shown in Part 1 of this report, almost one Indeed, episodes of financial stress, elevated
out of ever y nine people in the world suffers trade tensions and tightening financial conditions
from hunger, and the number of hungr y people are all contributing to bleaker global economic
is growing, albeit slowly. At the same time, prospects.1
reductions in child stunting are insufficient to
meet global goals, and obesit y and overweight Importantly, the impact of economic slowdowns
are on the rise. and downturns on food securit y and nutrition
cannot be separated from the root causes of
Previous editions of this report have identified hunger and malnutrition: povert y, inequalit y and
three drivers behind these problematic trends: marginalization. Part 2 therefore looks closely
conf lict, climate and economic slowdowns. at the relationship between povert y and food
These drivers are complex and often interact securit y and nutrition, and how they interact
with compounding effects that challenge with inequalit y and marginalization to threaten
food securit y and nutrition in multiple ways. food securit y and nutrition.
Unless greater and more targeted efforts
are made to address these drivers and the The purpose of the analysis is to provide
underlying causes of hunger and malnutrition, g uidance on how these challenges can be
it is increasingly clear that the goal of ending overcome to end hunger and malnutrition in
hunger and all forms of malnutrition by 2030 all its forms. The last section thus presents
will not be achieved. policies and programmes that can protect the
most v ulnerable from the impact of economic
In 2017, this report made it clear that slowdowns and downturns, while fostering food
efforts to fight hunger and malnutrition in securit y and nutrition from a perspective of
conf lict-affected situations must go hand in more inclusive economic growth. Ending hunger
hand with actions for immediate humanitarian and malnutrition by 2030 (SDG Targets 2.1 and
assistance and long-term development that 2.2) will require greater efforts and integrated
builds resilience and helps sustain peace. approaches to eradicate extreme povert y (SDG 1),
In 2018, the report called for urgent action ensure decent work and inclusive economic
to scale up and accelerate policies and growth (SDG 8), and reduce inequalities
programmes to build climate resilience. (SDG 10). n

This year, this second part of the report looks


more closely at how the third key driver,
economic slowdowns – and, more specifically,
also economic downturns – has contributed to the
recent rise in hunger with possible implications
for nutrition. This is critical to understanding
future trends in hunger and malnutrition,
especially given the dark predictions of the
latest global economic prospects, with slowing
and stalled economic growth in many countries,
including emerging and developing economies.

| 50 |
THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2019

ECONOMIC
2.1
è   Rises in the prevalence of undernourishment in
countries that faced economic downturns tend to be
SLOWDOWNS AND higher (5.1 percentage points) than countries
vulnerable to climate extremes (2.3 percentage points
DOWNTURNS AND higher) and countries that experienced conflict

THEIR IMPACT ON
(2.2 percentage points higher).

FOOD SECURITY How are economic slowdowns and downturns


AND NUTRITION relevant to the quest to eradicate hunger and
malnutrition?
KEY MESSAGES Hunger has been on the rise in many countries
where the economy has slowed down or
è   The outlook for the global economy has darkened,
contracted. Between 2011 and 2017, this
reflecting risks of increasing trade tensions and rising
increase coincided with an economic slowdown
global borrowing costs.
or downturn in 65 out of 77 countries.
Economic shocks that t y pically result in economic
è   Hunger has been on the rise in countries where the slowdowns or downturns tend to be significant
economy has slowed down or contracted. The uneven secondar y and tertiar y drivers that prolong and
pace of global economic recovery raises concerns worsen the severit y of food crises, especially
regarding prospects for ending hunger and in countries experiencing acute food insecurit y
malnutrition in all its forms. requiring urgent humanitarian assistance. 2 In
2018, economic shocks featured prominently in
è   Most countries (84 percent) that experienced a rise 33 out of the 53 countries that suffered from food
in undernourishment between 2011 and 2017 crises, affecting more than 96 million people
simultaneously suffered an economic slowdown or (Table 8).
downturn – and the majority of these are
middle-income countries. An economic slowdown generally means
economic activit y is sluggish, although it
continues to grow. When there is no growth,
è   While conflict and climate shocks were the key the economy has reached a downturn (Box 9).
drivers of food crises in 2018, economic shocks were These economic phenomena often lead to a rise
significant secondary and tertiary drivers in more than in unemployment and decline in wages and
half of the countries affected by food crises and incomes, challenging access to food and essential
worsened the severity of these food crises for social ser vices for the poor. People’s access to
96 million people. high-qualit y, nutritious food, which tends to be
less affordable – especially for poor people who
spend a large portion of their income on food –
can be affected, as can access to basic ser vices
such as health care.

| 51 |
PART 2 SUSTAINED ESCAPES FROM FOOD INSECURITY AND MALNUTRITION

BOX 9
WHAT ARE ECONOMIC SLOWDOWNS AND DOWNTURNS?

One of the primary measures used to gauge the health or short-term downturn in economic growth, usually
of a country’s economy is gross domestic product occurring over at least two consecutive quarters of
(GDP). Often referred to as the size of the economy, decline. Stagnation is period where an economy grows
it is the total value of economic activity within a at an extremely low rate without actually entering
country measured as the total value of goods and a recession.
services produced during a given period of time. An economic shock is an unexpected or
The economic growth rate is the percentage increase unpredictable event that is external to the specific
or decrease of GDP from one period to another. economy and can either harm or boost it. A global
An economic slowdown is when economic activity financial crisis causing bank lending or credit to fall,
is growing at a slower pace. In other words, there still or an economic downturn in a major trading partner
is growth in economic activity, but at a slower rate than of a country, reflect demand-side shocks that can
before. An economic slowdown occurs when real GDP have multiple effects on spending and investment.
growth declines from one period of time to another but A steep rise in oil and gas prices, natural disasters
is still positive, usually measured in quarters of a year. that result in sharp falls in production, or conflict
An economic downturn is when there is no growth, that disrupts trade and production, are examples of
but rather a period of decline in economic activity. supply-side shocks.
It refers to a period of economic contraction or See Annex 3 for the full definitions used in the
negative economic growth as measured by the growth analysis of this report, as well as the methodology
rate in real GDP. An economic recession,1 often used applied in the measuring of economic slowdowns
synonymously with economic downturn, is a temporary and downturns.

1
S. Claessens and M. Ayhan Kose. 2009. What is a recession? Finance & Development, March 2009, 46(1). (also available at https://www.imf.org/external/pubs/ft/
fandd/2009/03/basics.htm).

The uneven pace of global economic recover y could weaken growth even further. 5 Moreover,
from slowdowns further raises concerns the outlook for commodit y prices, especially
regarding prospects for ending hunger and oil, is v ulnerable to policy-related risks and
malnutrition in all its forms. Recent world the collective inter vention of many countries –
economic reports highlight that slowdowns, particular through trade policies – may amplif y
stagnation and outright recessions are evident international price movements, and may not
in several economies and already leading be effective in protecting the most v ulnerable
to increased unemployment and declines in populations groups. 6
income. 3 There may soon be yet another global
economic downturn. Early this year, the IMF Trade tensions, which are increasingly taking
revised its forecast for global growth to the a toll on business confidence, are a particular
lowest level since the global financial crisis a concern. After strong growth in 2017 and
decade ago, as the outlook dimmed in most 2018, the global economy’s slowdown ref lects
major economies. 4 a conf luence of factors, including US– China
trade tensions. Global trade has also slowed
This dark outlook ref lects increasing risks considerably. Moreover, escalation and tariff
related to rising trade tensions, weakening hikes between the two largest economies of the
investments, increasing government and world could further weaken growth and put
corporate debt, and rising borrowing costs. pressure on the price of commodities. This is
According to the World Bank, further escalation because higher tariffs will increase the price of
of trade tensions and the associated uncertaint y imported goods, disrupt global value chains,

| 52 |
THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2019

FIGURE 22
REAL GDP PER CAPITA GROWTH HAS BEEN UNEVEN SINCE THE 2008–2009
SHARP GLOBAL DOWNTURN

6
ANNUAL GDP PER CAPITA GROWTH (%)

-2

-4

-6
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

YEARS

Africa Asia Latin America and the Caribbean Northern America and Europe Oceania

NOTES: Annual rate of per capita GDP growth at constant 2010 prices that occurred in the five regions during the period 1996–2017.
SOURCES: UN. 2019. National Accounts – Analysis of Main Aggregates. In: UNSTATS [online]. New York, USA. [Cited 6 May 2019] https://unstats.un.org/unsd/snaama; and for
North America and Europe UNCTAD. 2019. Gross domestic product: Total and per capita, growth rates, annual. In: UNCTADSTAT [online]. New York, USA. [Cited 14 May 2019].
https://unctadstat.unctad.org/wds/TableViewer/tableView.aspx?ReportId=109

reduce productivit y, increase uncertaint y and countries around the world, including in several
weaken investment. 7 low- and middle-income countries. 9

Global demand for commodities could slow down


by one-third over the next decade, 8 especially for
Trends in economic slowdowns and downturns
agriculture and metals, and countries dependent The percentage variation of real GDP per capita
on commodit y exports may struggle to adjust. growth from one period to another, or economic
Rising risks combined with high v ulnerabilities growth rate, is t y pically used to gauge whether
will challenge emerging and developing an economy is slowing down or contracting.
economies’ abilit y to manage economic shocks. In most regions, this rate rebounded after the
sharp 2008 –2009 global economic downturn.
A bleak economic outlook may translate into But the recover y was uneven and short lived, as
more povert y and inequalit y, hindering efforts many countries experienced generally declining
to eradicate hunger and malnutrition in all its trends in growth since 2011 (Figure 22). Real GDP
forms. While extreme povert y rates have declined per capita growth is also being challenged
from 54 percent in 1990 to 41 percent in 2015 particularly in countries with rapidly growing
in sub-Saharan Africa, the number of extreme populations, like those in Africa and South
poor increased by 136 million people during this Asia, regions with some of the highest levels of
period, i.e. from 277 to 413 million. Even more food insecurit y and malnutrition in the world
worr ying, inequalit y is rising in nearly half of the (Table 1).

| 53 |
PART 2 SUSTAINED ESCAPES FROM FOOD INSECURITY AND MALNUTRITION
FIGURE 23
CONSECUTIVE YEARS OF ECONOMIC SLOWDOWNS AND DOWNTURNS SINCE 2011
IN MANY SUBREGIONS

6
AVERAGE ANNUAL GDP PER CAPITA GROWTH

-2

-4

-6
Western Asia Middle Africa Western Africa Eastern Africa Southern Africa Central America South America

1998–2017 2011 2012 2013 Average low-income countries 1998–2017


2014 2015 2016 2017 Average middle-income countries 1998–2017

NOTES: Annual rate of per capita GDP growth at constant 2010 prices for seven subregions during the period 1998–2017.
SOURCE: UN. 2019. National Accounts – Analysis of Main Aggregates. In: UNSTATS [online]. New York, USA. [Cited 6 May 2019] https://unstats.un.org/unsd/snaama

Within subregions, the situation is worse. In the disrupt production and trade f lows and lead
last few years, real GDP per capita growth to migration.
on average declined in seven subregions,
five of which experienced negative growth in
different years (Figure 23). In 2018, these five
Rises in undernourishment in places where the
subregions combined were home to almost economy slowed down or contracted
263 million undernourished people and more
than 56 million stunted children under the age As seen from Part 1, both the prevalence
of five. Further setbacks are expected to continue of undernourishment and the number of
in many of these regions, including in Middle, undernourished people in the world began to
Southern and West Africa; Western Asia; and increase in 2016. For many countries, especially
Latin America and the Caribbean.10 low- and lower-middle-income countries,
as well as countries affected by conf lict and
Economic slowdowns and downturns can be adverse climate events, undernourishment
triggered by myriad factors. International was on the rise as early as 2011. It was only in
factors can negatively affect economic growth 2016 that the number of countries with rising
for specific countries through trade f lows, world undernourishment became sufficient for the
prices, foreign direct investment (FDI) and other increase to be ref lected in the global aggregate of
foreign exchange f lows (remittances, foreign world hunger.11
borrowing, aid and so forth). National factors,
notably monetar y, fiscal and trade policies, as Establishing a direct causal relationship between
well as investment and sectoral policies can economic growth and undernourishment is
also drive economic slowdowns and downturns. complicated, given how the PoU is computed
But there may also be non-economic factors and smoothed over time.12 On the other hand,
driving economic deceleration, including examining whether increasing change points in
political factors, conf lict and climate shocks. the prevalence of undernourishment is inversely
Some of these factors can be felt across borders. associated with the real GDP per capita growth
For example, widespread civil insecurit y can rate is straightforward.13 An increasing change

| 54 |
THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2019
FIGURE 24
PoU INCREASING CHANGE POINTS ASSOCIATED WITH THE OCCURRENCE OF ECONOMIC
SLOWDOWNS AND DOWNTURNS

VENEZUELA
(BOLIVARIAN REPUBLIC OF)
25 SAO TOME AND PRINCIPE

SURINAME

JORDAN

BOLIVIA KYRGYZSTAN COSTA RICA


(PLURINATIONAL
STATE OF) ARMENIA NIGERIA
UNITED
20 REPUBLIC TURKEY MALAYSIA
OF TANZANIA
BENIN MAURITANIA TURKMENISTAN

GABON TURKMENISTAN SAO TOME AND PRINCIPE

MOROCCO ARGENTINA NICARAGUA

TURKMENISTAN CAMEROON ARMENIA

15 TOGO PANAMA GUYANA


NUMBER OF COUNTRIES

CAMEROON NICARAGUA EGYPT

CHINA NIGER MYANMAR

ARGENTINA MAURITIUS TONGA


VENEZUELA
(BOLIVARIAN
REPUBLIC OF) ZIMBABWE GABON GUINEA
CENTRAL
10 AFRICAN SOUTH AFRICA TAJIKISTAN GAMBIA
REPUBLIC
PANAMA MOZAMBIQUE NIGERIA NIGER

UNITED MAURITANIA ZAMBIA GEORGIA SURINAME


REPUBLIC
OF TANZANIA CENTRAL YEMEN CÔTE D’IVOIRE MALI PANAMA
AFRICAN
BANGLADESH REPUBLIC ERITREA NIGERIA MONGOLIA GUATEMALA

5 TURKMENISTAN LIBERIA BRAZIL BURKINA FASO KAZAKHSTAN KENYA UKRAINE SAMOA

NAMIBIA VENEZUELA THAILAND MALAWI MONGOLIA TURKEY MALAYSIA KAZAKHSTAN MONGOLIA


(BOLIVARIAN REPUBLIC OF)
NIGERIA JAMAICA MONTENEGRO GUATEMALA LEBANON GUINEA-BISSAU UGANDA BURUNDI CONGO VANUATU CAMEROON

CÔTE D’IVOIRE BELIZE ARMENIA AFGHANISTAN JAMAICA JORDAN ZIMBABWE BOTSWANA INDONESIA MALI GAMBIA CABO VERDE

UKRAINE CAMBODIA HONDURAS GHANA BELIZE BELARUS ECUADOR UZBEKISTAN UKRAINE NIGER TONGA TURKEY
0
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

YEARS

Africa Asia Eastern Europe Latin America and the Caribbean Oceania

NOTES: The number of countries with an increasing change point in the prevalence of undernourishment (PoU) which occurs in correspondence with an economic slowdown or downturn
by year, between 2006 and 2017, where each year is the middle year for the PoU three-year average; that is, for example, 2017 for 2016–2018. See Annex 3 for the methodology and
list of countries with PoU increasing change points related to economic slowdowns or downturns.
SOURCES: FAO for PoU; for economic slowdowns and downturns, UN. 2019. National Accounts – Analysis of Main Aggregates. In: UNSTATS [online]. New York, USA. [Cited 6 May 2019].
https://unstats.un.org/unsd/snaama

point refers to the statistically significant countries, the rise in undernourishment since
increase in the prevalence of undernourishment 2011 coincided with the occurrence of economic
for two consecutive years (see Annex 3 for the slowdowns or downturns. Moreover, many of
methodolog y). these countries saw increasing change points in
PoU coinciding with an economic slowdown or
During the period 2011–2017, out of the downturn in more than one year: 17 countries
120 increasing change points in the PoU of saw them in two years, and seven countries
77 countries (out of a sample of 134 low- and saw them in three out of the seven years.
middle-income countries), 96 increasing change The period 2014–2015 is particularly striking as it
points in 65 countries corresponded with corresponds to the years in which many regions
the occurrence of an economic slowdown or and countries had experienced three or more
downturn (Figure 24, see Annex 3 for the list of years of economic slowdown, often culminating
countries). This means that for 84 percent of the in economic downturn. Interestingly, the PoU

| 55 |
PART 2 SUSTAINED ESCAPES FROM FOOD INSECURITY AND MALNUTRITION

BOX 10
WHY DID WORLD HUNGER NOT RISE DURING THE GLOBAL FOOD AND FINANCIAL CRISES?

As seen from Part 1 of this report, the number of such as street foods or fast foods instead of more
people undernourished in the world as a whole nutritious, diversified but costly diets. While these
declined steadily from 2005 to 2015 (Figure 1). coping mechanisms of households help maintain overall
The global food crisis of 2007–2008 and the global dietary energy reduction, they may affect nutrition with
financial crisis of 2008–2009 occurred in between. long-term and potentially intergenerational negative
So how was this possible? effects on health and productivity.4
These crises were preceded by a period of The global financial crisis, on the other hand,
sustained economic growth in the world (Figure 22), originated as a result of a financial “meltdown” in
including in different developing regions, which developed countries with serious implications for the
are home to millions of undernourished people and real economy, affecting several parts of the world.
people affected by malnutrition. Subsequently, the However, with the exception of transition countries in
global economic downturn in Latin America and the Central and Eastern Europe, financial institutions in
Caribbean, North America and Europe, and slowdown developing countries were not affected by “financial
in other regions during 2008–2009 was short lived contagion”. Developing countries’ banks did not
and the world economy started to grow again in 2010. hold “contaminated” assets (i.e. those including
While this refers to aggregate trends for the world and sub-prime mortgages). Therefore, the major channels
across regions, it is still interesting to see that only nine of transmission were through trade and financial
countries witnessed the simultaneous occurrence of an flows between developed and developing countries.
economic slowdown or downturn and an increase in The effects were short lived considering the resumption
the PoU during these crises (Figure 24). of economic growth in 2010 (Figure 22).
In addition to growth, other factors came Many developing countries took advantage
into play to prevent an increase in the number of of the period of sustained economic growth
undernourished people during these crises. During the preceding the crisis to implement fiscal and
global food crisis, for example, international food economic reforms. Following the Latin American
prices increased sharply between 2007 and early and Asian crises of the 1990s, several countries
2008, reaching their highest level in the summer of had carried out macroeconomic reforms to make
2008.1 Many countries responded to the food price their economies more resilient to shocks, including
surge with policies softening the pass-through of closer bank supervision and reserve accumulation.
international prices on markets and households2 – a Many countries were also able to implement policies
transmission mechanism explained later in this report. aimed at reducing or neutralizing antisocial effects
There is evidence that the increase in domestic prices of economic cycles, such as policies encouraging
was significantly lower and that domestic prices were spending during downturns – also known as
also less volatile than world prices.3 Furthermore, countercyclical policies. Using a sample of 33 low-
FAOSTAT data show that the production of cereals and middle-income countries, a study shows that
increased in low- and middle-income countries during the majority of these (20 countries) increased public
the global food crisis. This may also have been an social expenditure relative to total public expenditure
important factor mediating the increase in domestic during the global financial crisis.5
prices and contributing to employment creation and Although hunger declined steadily during both
improvements in food security. the global food crisis and financial crisis, not only
An additional explanation would be the coping for the world but also across developing regions
mechanisms of net food-consuming households. (see Table 1 in Part 1 for changes in the PoU between
A cross-country analysis of how families coped with 2005 and 2010), it is likely that the state of food
the high food price crisis shows relatively large security and nutrition did change in some countries6
increases in dietary energy consumption among the and some population groups may have experienced
highest income quintiles in urban areas in Guatemala, increased hunger or malnutrition. The variation
Honduras and Nicaragua. This indicates that may not have been reflected in the numbers at
households were consuming more energy-dense foods the national level, however, as probably only the

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THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2019

BOX 10
(CONTINUED)

most vulnerable households before the two crises, different forms of malnutrition in certain population
experienced food insecurity during these crises, groups: in China, for example, the prevalence
as studies for some countries show.6 Some national of stunting among infants7 in poorer rural areas
reports also point to increased prevalence of increased between 2008 and 2010.8

1
For more details on the factors behind rising food prices during this period, see: C.L. Gilbert. 2010. How to understand high food prices. Journal of Agricultural Economics, 61(2):
398–425.
2
M. Demeke, G. Pangrazio and M. Maetz. 2011. Country responses to turmoil in global food markets. In A. Prakash, ed. 2011. Safeguarding food security in volatile global markets,
pp. 183–209. Rome, FAO.
3
D. Dawe, C. Morales-Opazo, J. Balié and G. Pierre. 2015. How much have domestic food prices increased in the new era of higher food prices? Global Food Security, 5: 1–10.
4
M. Robles and M. Torero. 2009. Understanding the impact of high food prices in Latin America. Economía, 10(2): 117–164.
5
UN. 2016. World Economic and Social Survey 2014/15. Learning from national policies supporting MDG implementation. New York, USA.
6
M. Vilar-Compte, S. Sandoval-Olascoaga, A. Bernal-Stuart, S. Shimoga and A. Vargas-Bustamante. 2015. The impact of the 2008 financial crisis on food security and food
expenditures in Mexico: a disproportionate effect on the vulnerable. Public Health Nutrition, 18(16): 2934–2942.
7
Children under 2 years of age.
8
C. Chen, W. He, Y. Wang, L. Deng and F. Jia. 2011. Nutritional status of children during and post-global economic crisis in China. Biomedical and Environmental Sciences, 24(4): 321–328.

only increased in a handful of countries during A sharp and persistent reduction of commodit y
two consecutive crises: the global food crisis and prices affects commodit y-dependent countries,
the global financial crisis (for explanations of triggering a number of economy-wide effects,
this, see Box 10). including reductions in foreign exchange and tax
revenue, with potentially adverse impacts on food
The greatest number of countries where rising securit y and nutrition.
undernourishment occurred while the economy
slowed down or stagnated are in Africa (32). To provide statistical evidence that the relationship
Several are in Asia (17), followed by Latin between changes in undernourishment and
America and the Caribbean (11), Oceania (3) economic slowdowns and downturns is more than
and Eastern Europe (2). The majorit y of them a simple corresponding occurrence, a regression
(44 out of 65) are middle-income countries; analysis comparing the difference in the PoU and
19 (out of 65) are low-income countries, of which the real GDP per capita growth between 2011 and
17 are located in Africa with the exception of 201715 was carried out. It points to a statistically
Tajikistan and Yemen. significant correlation between the two (see
Annex 4 for model and results). On average, a ten
Notably, 80 percent of the countries (52 out percent decrease in economic growth between
of 65) that experienced an increase in 2011 and 2017 corresponds to a 1.5 percentage
undernourishment while their economy slowed point increase in the PoU between 2011 and 2017.
down or contracted depend highly on food and Furthermore, countries that have experienced
fuel commodit y imports and/or oil and other economic downturns show significant increases
primar y commodit y exports for foreign exchange in the PoU between 2011 and 2017, equal to
and tax revenue generation (see Annex 6 for 5.1 percentage points higher than countries with
list of countries by commodit y dependence).14 economies that have not contracted.
As noted above, world prices are one of the
international factors that can contribute to the The correlation, as expected, varies from countr y
deterioration of a countr y’s economic state. to countr y. On average, low-income countries

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PART 2 SUSTAINED ESCAPES FROM FOOD INSECURITY AND MALNUTRITION

FIGURE 25
LOW-INCOME COUNTRIES FACE HIGHER INCREASES IN HUNGER AS A RESULT OF DECREASES
IN ECONOMIC GROWTH (BETWEEN 2011 AND 2017)

30

CENTRAL AFRICAN REPUBLIC

20

VENEZUELA
(BOLIVARIAN REPUBLIC OF)
DIFFERENCE IN PoU BETWEEN 2011 AND 2017

MADAGASCAR

ZIMBABWE
10
UGANDA
AFGHANISTAN DEMOCRATIC REPUBLIC
OF THE CONGO
NIGERIA KENYA
DEMOCRATIC PEOPLE'S
REPUBLIC OF KOREA NIGER
GUINEA-BISSAU MOZAMBIQUE
SYRIAN ARAB REPUBLIC WEST BANK AND GAZA PAPUA NEW GUINEA RWANDA
MAURITANIA GRENADA IRAQ
ERITREA REPUBLIC
SURINAME ESWATINI MAURITIUS OF MOLDOVA
BRAZIL COMOROS
CONGO TURKMENISTAN
DOMINICA PHILIPPINES
JAMAICA TURKEY
0
GEORGIA
SOUTH SUDAN MICRONESIA TAJIKISTAN MALI
ALGERIA
CHAD (FEDERATED STATES OF)
AZERBAIJAN
ZAMBIASENEGAL GHANA
SOLOMON ISLANDS HONDURAS NICARAGUA
EL SALVADOR UNITED
MALAWI
SUDAN CABO TOGO REPUBLIC
TANZANIA
OF SRI LANKA
VERDE
MONGOLIA
COLOMBIA
BOLIVIA DOMINICAN
(PLURINATIONAL STATE OF) REPUBLIC
NAMIBIA
SAO TOME AND PRINCIPE
−10
ETHIOPIA
−50 −40 −30 −20 −10 0 10 20 30 40 50

ECONOMIC GROWTH BETWEEN 2011 AND 2017

Low-income countries Lower-middle-income countries Upper-middle-income countries Quadratic fitted line

NOTES: Difference in the level of the PoU between the years 2011 and 2017 (y-axis) is plotted against the economic growth (expressed in percentage) between the years 2011 and 2017
(x-axis). Economic growth is computed using GDP per capita at constant 2010 prices, comparing the level of GDP per capita in 2011 and 2017. The three categories of countries are
defined based on the level of country income that follows the World Bank classification in 2017. Country names are not reported for countries falling inside the 95 percent confidence
interval (close to the fitted line), but a list of these countries is provided in Annex 3. West Bank and Gaza is a territory and follows the World Bank classification.
SOURCES: FAO for PoU; UN. 2019. National Accounts – Analysis of Main Aggregates. In: UNSTATS [online]. New York, USA. [Cited 6 May 2019] https://unstats.un.org/unsd/snaama
for GDP per capita growth at constant 2010 prices used to compute economic growth.

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THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2019

had higher increases in the PoU between 2011 Economic slowdowns and downturns
and 2017 when compared with middle-income
countries (Figure 25 and Table A4.2 in Annex 4).
worsen global food crises
Countries experiencing crisis levels of acute food
It is also important to explore the interaction insecurit y also t y pically experience economic
between economic downturns with the two other disarray. In the last three years (2016 –2018),
drivers of the rising trend in hunger: conf lict more than 100 million people ever y year
and climate. Economic downturns show the have faced periods of acute food insecurit y.18
highest correlation with increases in PoU in In 2018, 113 million people across 53 countries
terms of magnitude of the estimated coefficient, and territories faced crisis levels of acute food
almost double that of v ulnerabilit y to climate insecurit y or worse (IPC Phase 3 and above or
and conf lict. In fact, countries with economic equivalent)19 where urgent humanitarian actions
downturns have a 5.1 percentage point higher were needed to save lives and livelihoods,
PoU than countries without, whereas countries as well as to address high or above-average
with v ulnerabilit y to climate and conf lict have acute malnutrition.
a 2.3 and 2.2 percentage point higher PoU,
respectively (see Table A4.3 in Annex 4). Analysis of acute food insecurit y, including the
drivers behind the food crisis, carried out at
When PoU increases are estimated within the countr y level, sheds light on how economic
income groups, upper-middle-income countries slowdowns and downturns worsen food crises. 20
with economic downturns show the highest It shows that, in 2018, conf lict remained the key
PoU increase, i.e. a 6.3 percentage point higher driver of food crises, affecting around 74 million
PoU increase between 2011 and 2017 than people, two-thirds of whom faced acute food
upper-middle-income countries without economic insecurit y. Climate and natural disasters were
downturns. On the contrary, low-income the primar y driver of acute food insecurit y for
countries are those with the highest PoU increase another 29 million people. Economic shocks were
associated with climate vulnerability and conflict. the primar y driver of acute food insecurit y for
These countries experience a 4.8 percentage point 10.2 million people.
higher PoU increase in the presence of climate
vulnerability compared to low-income countries While economic shocks are rarely the primar y
without and, when affected by conflict, they report drivers of food crises, they are significant
a 5.5 percentage point higher PoU (see secondar y or tertiar y drivers of them. In many
Tables A4.4a and b in Annex 4). First, this is in line instances, significant economic shocks – or even
with studies suggesting that conflicts are more not-so-significant shocks that occur in fragile
likely to erupt in low-income economies, leading to economies – can undermine economic activit y,
the most dangerous increases in hunger.16 Second, worsen the severit y of acute food insecurit y,
low-income countries are the only countries that and prolong the duration of the crisis. In fact,
experience a significant PoU increase associated more than 96 million people in 33 countries who
with vulnerability to climate (see Tables A4.4a and b in suffered from acute food insecurit y in 2018 lived
Annex 4). Quite importantly, this result deriving in places where the economy was undergoing
from a macro-level analysis, confirms extensive economic shocks of rising unemployment, lack
findings from the microeconomic literature – of reg ular work, currency depreciation and high
that climate extremes have a disproportionately food prices (Table 8 and Annex 5 for the list of
negative effect on the poorest populations living countries by economic shock). 21 The economy
in remote areas in terms of consumption and of most of these countries (27 out of 33) was
food security.17 Although a correlation analysis contracting, according to their real GDP per
describes the association between the three capita growth for 2015 –2017.
drivers and the change in PoU, it is difficult to
disentangle the contribution of each of the three In food crisis contexts, the interaction between
drivers, given that conflict and climate shocks conf lict and economic slowdowns and
can also affect economic growth, and therefore downturns is particularly important. Not only
indirectly affect undernourishment. is conf lict the main driver behind food crises,

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PART 2 SUSTAINED ESCAPES FROM FOOD INSECURITY AND MALNUTRITION

TABLE 8
ECONOMIC SHOCKS WERE SIGNIFICANT SECONDARY AND TERTIARY DRIVERS OF FOOD CRISES IN 2018
NUMBER (millions)
DRIVERS OF FOOD CRISES people in IPC/CH
Phase 3 and 4
Economic IPC/CH IPC/CH
Conflict
Economic shocks slowdown Conflict Climate Phase 3 Phase 4
and climate
or downturn (Crisis) (Emergency)
Central African Madagascar,
Cameroon,
Republic, El Salvador,
Slowdown Djibouti, Kenya, 8.3 1.2
Jordan,* Guatemala,
Myanmar
Lebanon* Honduras

Downturn Mozambique Nigeria, Uganda 7.6 0.6

Eswatini,* Niger, Syrian


Slowdown Ukraine* 10.5 0.1
Pakistan* Arab Republic*

+
$ Downturn Malawi
Chad,
Afghanistan
11.6 3.3

$
$
$ $
$
$
$
$ Slowdown Palestine Zambia Sudan 8.2 0.9
+
Burundi,
Democratic
and/or Republic of
Downturn Iraq, Turkey Zimbabwe 33.2 10.5
the Congo,
$ South Sudan,
Yemen, Haiti

79.4 16.6

96.0

Currency depreciation Unemployment,


$
$

High food price $


$ $
$
$
$
$ and worse terms of trade loss of income

NOTES: Countries affected by food crises in 2018 where economic shocks are a driver of acute food insecurity as identified by the Global Report on Food Crises 2019 (GRFC). Information
on economic shocks as drivers of food crises was not available in the GRFC 2019 for Jordan, Lebanon, Myanmar and Turkey. For these countries the information is obtained from the FAO
Global Information and Early Warning System (GIEWS) Country briefs referring to the year 2018. When the main driver of a food crisis is conflict, countries are highlighted in red; when
the main driver is climate shocks, countries are highlighted in blue; when the main driver is economic shocks, countries are highlighted in green. Countries denoted by the asterisk (*) do
not experience economic slowdowns or downturns. Economic slowdowns and downturns are identified when they either occur in years 2015–2016 or 2016–2017 and are computed using
the annual rate of per capita growth at constant prices. See Annex 5 for the list of food crisis countries with a full description of economic shocks.
SOURCES: FAO elaboration based on FSIN. 2019. Global Report on Food Crises 2019 [online]. [Cited 24 April 2019]. http://www.fsinplatform.org/sites/default/files/resources/files/
GRFC_2019-Full_Report.pdf and for economic slowdowns and downturns, UN. 2019. National Accounts – Analysis of Main Aggregates. In: UNSTATS [online]. New York, USA. [Cited 6
May 2019]. https://unstats.un.org/unsd/snaama and for additional information on economic shocks, FAO. 2019. GIEWS - Global Information and Early Warning System. In: FAO
[online]. Rome. [Cited 19 June 2019]. http://www.fao.org/giews/en/

but it also often triggers economic slowdowns, difference of 2.4 percentage points in economic
downturns and deep economic recessions growth between years 2014 and 2017. 23
that compound the severit y and duration of
the food crisis. 22 In 2018, conf lict and civil Economic slowdowns and downturns often lead
insecurit y were the major driver of food crises to increased levels of unemployment and limited
in 21 countries – 14 of them experienced deep income opportunities, which erode household
economic recessions with an average negative purchasing power, exacerbating food insecurity

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THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2019

and malnutrition. 24 The loss of income and


unemployment in turn feature as key contributing
COMMODITY
2.2

factors in several of the food crises, especially in DEPENDENCE AND ITS


RELEVANCE FOR FOOD
countries facing economic downturns (Table 8).

As the next section shows, persistent slowdowns


and sharp downturns in the economy can drain SECURITY AND
foreign currency reser ves, potentially triggering
national currency depreciations with a number of
NUTRITION
knock-on effects detrimental to food securit y and
nutrition, including food price inf lation. This is KEY MESSAGES
especially the case for countries dependent è   Eighty percent of the countries (52 out of 65) with
on food imports. Sevent y-five percent of the a rise in hunger during recent economic slowdowns
countries with food crises that also suffered from and downturns are countries whose economies are
economic shocks are net food importers (25 out highly dependent on primary commodities for export
of 33) with the value of food imports outweighing and/or import.
the countr y’s value of food exports.
è   In 2018, 807 million undernourished people and
Economic slowdowns and downturns can 154 million stunted children under the age of five lived
constrain national financial capacities to provide in low- and middle-income countries: of these,
essential ser vices, protect the poor and respond respectively, around 381 million and 73 million lived
effectively to crises. Furthermore, political in high commodity-dependent countries. The latter
instabilit y limits the capacit y of governments to also were home to almost 109 million out of the
support their populations during food crises, and 113 million people facing crisis levels of acute food
therefore economic downturns, especially if they insecurity requiring urgent humanitarian actions.
are severe, can further compound the impacts of
this instabilit y on food crises. è   Changes in commodity prices affect the relative
value of exports and imports in these countries.
Economic slowdowns and downturns can also Foreign exchange drains, depreciation and
lower the resilience capacit y of households to devaluation of currencies may pass through the
respond to other shocks – including climate economic system, resulting in rising domestic prices,
shocks. For example, the climatic impact of El unemployment, loss of wages, and consequently loss
Niño in Southern Africa in 2016 led to more of incomes.
than 12 million food-insecure people in need
of urgent humanitarian action in six countries. è   These events pose macroeconomic aggregate
The impact of this phenomenon was intensified shocks affecting multiple households, rather than
by already ongoing economic slowdowns and idiosyncratic shocks that only affect a single
downturns in several countries, which weakened household. Many vulnerable households see their
households’ capacit y to respond effectively to purchasing power reduced, while coping strategies
the climate shock and contributed to lowering they use during idiosyncratic once-off shocks are
the resilience of households already debilitated not effective.
by a poor agricultural season in 2015. This was
the case for Eswatini (formerly Swaziland), è   The need to change consumption patterns can
Mozambique and Zimbabwe. While households lead vulnerable households to cut spending on a
may be able to cope with and recover from range of basic services for health and disease
transitor y shocks, multiple and recurring prevention or shift away from nutrient-rich foods
shocks are increasingly the norm, adding to towards more energy-dense but nutrient-poor foods.
the v ulnerabilit y of the poor. Aggregate and Households may also see the supply of basic services
recurring shocks tend to result in povert y traps compromised if the fiscal space to provide essential
or slips back into povert y, generating harmful social public expenditure becomes more limited.
effects on present food securit y and nutrition,
and on future generations. 25 n

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PART 2 SUSTAINED ESCAPES FROM FOOD INSECURITY AND MALNUTRITION

Commodity price trends and booms for this. Diversification and upgrading of the
productive structures and capabilities from
International, regional and national factors can which wealth is created and distributed are not
harm economic activit y in ways that challenge easy tasks and take years to achieve. 27 Effective
food securit y and nutrition. Understanding policies, effective collaboration between public
the mechanisms through which economic and private sectors, and high levels of investment
slowdowns and downturns contribute to the are also needed.
recent, unwelcoming trends in food securit y
and nutrition can be approached from different Furthermore, benefits during boom periods
angles as it is ultimately countr y-specific. are by far outweighed by the negative impacts
However, there is a steady trend affecting caused by price volatilit y and low-price
many of the countries where hunger is lately on periods, which tend to be longer than boom
the rise. periods. 28 Moreover, the negative impacts on
net food importers during periods of high food
Low- and middle-income countries are, by and prices can be extremely severe, as witnessed
large, well integrated with the world economy, during the food price crises of 2007−2008 and
though to different degrees and in different 2010−2012.
ways. They trade goods and ser vices with other
countries, invest in them or receive investors
from them, and exchange different t ypes of
Why does commodity dependence matter?
f lows, including financial capital, foreign aid, Commodit y dependence matters because it
foreign borrowing, remittances and others. increases the v ulnerabilit y of countries to world
This integration, of course, exposes them to price swings. The v ulnerabilit y to changing
external v ulnerabilities depending on the commodit y prices arises as countries produce and
structural features of their economies. trade commodities and, in most cases, low- and
middle-income countries are world price-takers
In this regard, a key v ulnerabilit y arises relating that cannot affect them. They may not be in
to what these countries produce and what they a position to inf luence these prices alone.
trade with the rest of the world: essentially, They may also not be in a position to undergo
primar y commodities. The trend in rising the structural transformation to move them away
commodit y prices that started in 2003 and from commodit y dependence.
the period of extreme price volatilit y in 2008
have been followed by largely declining global The association between economic performance
commodit y prices for five consecutive years from and commodit y prices in commodit y-dependent
2011 to 2016 (Figure 26). As a result, commodit y countries is strong and therefore makes them
prices fell by more than nine percent in this especially v ulnerable to the volatilit y of global
period. As indicated earlier, global commodit y commodit y prices. 29 Recent slowdowns and
demand is also in decline and the outlook is downturns in economic growth in many regions
that its growth could slow over the next decade, are largely explained by marked declines in
especially for agriculture and metals. commodit y prices. This is mainly affecting
countries dependent on primar y commodit y
Although global commodit y price levels are still exports, particularly in South America, but also
higher than during the pre-commodit y price other regions including Asia and some countries
boom in 2007–2008, most countries that are in Africa. 30
highly dependent on exporting commodities to
generate revenues have not been able to use their Countries from these regions are commodit y-
commodit y windfalls during commodit y price export-dependent as they derive the bulk
booms to diversif y their economies and reduce of their export earnings from primar y
their v ulnerabilit y to price shocks. Today many commodities. This report not only focuses on
are as commodit y dependent as before, if not this t y pe of countries, but also on countries
more so, with few exceptions such as Argentina, showing commodit y-import dependence and
China and Mexico. 26 There are many reasons net food-import dependence (see Box 11 for

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THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2019

FIGURE 26
COMMODITY PRICES (THOUGH HIGH) FELL YEAR ON YEAR FROM 2011 TO 2016

300

250

200
PRICE INDEX

150

100

50

0
2000 M1
2000 M7
2001 M1
2001 M7
2002 M1
2002 M7
2003 M1
2003 M7
2004 M1
2004 M7
2005 M1
2005 M7
2006 M1
2006 M7
2007 M1
2007 M7
2008 M1
2008 M7
2009 M1
2009 M7
2010 M1
2010 M7
2011 M1
2011 M7
2012 M1
2012 M7
2013 M1
2013 M7
2014 M1
2014 M7
2015 M1
2015 M7
2016 M1
2016 M7
2017 M1
2017 M7
2018 M1
2018 M7
YEAR/MONTH

FAO food price index FAO cereal price index Metals and minerals price index Crude oil price index

NOTES: The plot shows the trend of FAO monthly food and cereal price indices (composite measures of food prices) expressed as a percentage of 2002–2004 averages, the crude oil
price index expressed as a percentage of 2016 (the average of three spot prices: Dated Brent, West Texas Intermediate, and the Dubai Fateh), and the metals and minerals price index
expressed as a percentage of 2010. Monthly food prices are plotted for years 2000–2018.
SOURCES: FAO. 2019. FAO Food Price Index. In: FAO – World Food Situation [online]. Rome. [Cited 5 May 2019]. http://www.fao.org/worldfoodsituation/foodpricesindex for food and
cereal food price indices; IMF. 2019. IMF Primary Commodity Prices. In: IMF [online]. Washington, DC. [Cited 6 May 2019]. https://www.imf.org/en/Research/commodity-prices for the
crude oil index; World Bank. 2019. Commodity Markets. In: World Bank [online]. Washington, DC. [Cited 6 May 2019] http://www.worldbank.org/en/research/commodity-markets for
metals and minerals index

definitions). Commodit y-import-dependent commodit y dependence, whereas the remaining


countries have a high ratio of food and fuel 32 are low commodit y dependent.
imports to total merchandise trade, while
commodit y-export-dependent countries derive High commodit y-dependent countries exhibit
the bulk of their export earnings from primar y combinations of commodit y-import and -export
commodities. Net food importers are countries dependence, which entail different v ulnerabilities
where the value of imports of basic foodstuffs to commodit y prices and links with food securit y
outweighs the value of food exports. Out of a and nutrition. For example, out of 134 low- and
total of 134 low- and middle-income countries middle-income countries in the period 1995 –2017,
studied for the period 1995 –2017, 102 countries 34 are high commodit y-export-dependent
are classified according to the three t ypes of high but low commodit y-import-dependent, 25 are

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PART 2 SUSTAINED ESCAPES FROM FOOD INSECURITY AND MALNUTRITION

BOX 11
WHAT IS COMMODITY DEPENDENCE AND HOW IS IT MEASURED?

Commodity-export-dependent countries or territories total import merchandise traded. This includes essential
derive the bulk of their export earnings from primary goods, such as food items and fuel. The report defines
commodities, such as minerals, ores, metals, fuels, high commodity-import-dependent countries as those
agriculture raw materials and food. This report defines where the share of the value of food and fuel imports
high commodity-export-dependent countries as those is more than 30 percent of the total merchandise.
who generate more than 60 percent of their This threshold is the average for developing countries
merchandise export revenues from food, agriculture in 1995–2014 and the one applied in the UNCTAD
and raw materials; minerals, ores, and metals; and/or and FAO1 analysis.
energy commodities. Following UNCTAD and FAO,1 Net food importers are countries or territories
this threshold corresponds to the minimum threshold where the value of imports of basic foodstuffs
denoting the most negative association between outweighs the value of exports of basic foodstuffs.
commodity-export dependence and This report defines high net food importers as those
human development. countries having a negative average food trade
Commodity-import-dependent countries or balance in the years from 2013 to 2015, following the
territories have a high ratio of commodity imports to UNCTAD and FAO definition.2

1
UNCTAD and FAO. 2017. Commodities and Development Report 2017. Commodity markets, economic growth and development. New York, USA, UNCTAD.
2
See Annex 6 for the methodology and list of countries by different categories.

high commodit y-import-dependent but low which are net food-import dependent
commodit y-export-dependent, and 43 are both (25 out of 33), inflationary pressure stemming
high commodit y-export- and commodit y-import- from the depreciation of national currencies
dependent (Figure 27). against the US dollar was a key factor that
contributed to an escalation in food prices. In 2018
Out of the 134 low- and middle-income countries, most (27 out of 33 or 81 percent) of the food
97 are net food importers. Of these, 80 also crisis countries where economic shocks worsened
show some degree of commodit y dependence: the severity of acute food insecurity were high
23 high commodit y-export dependence, 20 high primary commodity-dependent countries.
commodit y-import dependence, and 37 have
both t ypes of dependence (Figure 27, see Annex 6 In 2018, 807 million undernourished people and
for the list of countries by t ype of commodit y 154 million stunted children under the age of
dependency and income level). five lived in low- and middle-income countries:
of these, respectively, around 381 million and
International commodit y price shocks and 73 million lived in high commodity-dependent
volatilit y can potentially create harmful countries. For countries facing food crises, the 2018
impacts for food securit y and nutrition in all situation was even worse: almost 109 million out of
combinations of high commodit y dependence. the 113 million people facing crisis levels of acute
For example, as highlighted above, most of the food insecurity requiring urgent humanitarian
countries (52 out of 65) that experienced rising actions 31 also lived in low- and middle-income,
undernourishment in correspondence with high commodity-dependent countries.
economic deceleration during 2011–2017 are
highly dependent on primar y commodit y exports A close examination of real GDP per capita
and/or imports, of which many (42 out of 65) growth in low- and middle-income countries
rely heavily on oil and other primar y commodit y during the recent period of commodit y price
export revenues. For several of the countries declines between 2011 and 2017 exposes a
affected by food crises considered above, most of staggering difference in economic growth

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THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2019

FIGURE 27
MANY LOW- AND MIDDLE-INCOME COUNTRIES ARE HIGH COMMODITY-DEPENDENT COUNTRIES

Low commodity-dependent (low import and low export) countries High commodity-import- and low commodity-export-dependent countries Net food importers
High commodity-export- and low commodity-import-dependent countries High commodity-dependent (high import and high export) countries

Low commodity-dependent (low import and low export) countries High commodity-import- and low commodity-export-dependent countries Net food importers
NOTES: The map shows low- and middle-income countries by the four categories of export (CXD) and import (CMD) commodity dependence: i) low commodity-import- and low commodity-
export-dependent;
High commodity-export- andii)low
lowcommodity-import-dependent
commodity-export- and high commodity-import-dependent;
countries iii) high commodity-export-
High commodity-dependent (high importand
andlow
highcommodity-import-dependent;
export) countries iv) high commodity-export- and
high commodity-import-dependent. High commodity-export (-import) dependence is identified when CXD > 0.6 (CMD > 0.3). Net food importers are those countries with a negative average
food trade balance during the years 2013–2015. For further information see Annex 6. Areas with insufficient data coverage are denoted in grey.
The final boundary between the Republic of the Sudan and the Republic of South Sudan has not yet been determined. Final status of the Abyei area has not yet been determined.
SOURCES: Typology of commodity dependence is an FAO elaboration based on UNCTAD. 2019. UNCTADStat. In: UNCTAD [online]. New York, USA. [Cited 13 May 2019]
https://unctadstat.unctad.org/wds/ReportFolders/reportFolders.aspx; UNCTAD. 2019. Economic groups and composition [online]. New York, USA. [Cited 29 May 2019].
https://unctadstat.unctad.org/EN/Classifications/DimCountries_EconomicsGroupings_Hierarchy.pdf

between countries with high commodit y food crisis situation during the same period.
dependence and those without this characteristic For these countries, economic slowdowns were
during this period. Average real GDP per sharper and economic downturns were deeper
capita growth for high commodit y-dependent and longer lasting.
countries declined sharply and steadily between
2012 and 2015, followed by some improvement Many of the high commodit y-dependent
in economic growth but still significantly countries experienced deep economic recessions
lower than that of low commodit y-dependent with negative economic growth (downturns)
countries (Figure 28). Moreover, many of the high occurring over several consecutive years
commodit y-dependent countries (67 out of 102) between 2011 and 2017. Twent y-three high
also witnessed a rise in hunger or a worsening commodit y-dependent countries underwent

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PART 2 SUSTAINED ESCAPES FROM FOOD INSECURITY AND MALNUTRITION

FIGURE 28
BETWEEN 2003 AND 2017, HIGH COMMODITY-DEPENDENT COUNTRIES FACED STEEPER
DECLINES IN ECONOMIC GROWTH COMPARED TO LOW COMMODITY-DEPENDENT COUNTRIES –
FOR THOSE WITH RISING HUNGER THE SITUATION WAS EVEN WORSE

7
6.5
6
5.5
5
PER CAPITA GDP GROWTH (%)

4.5
4
3.5
3
2.5
2
1.5
1
0.5
0
-0.5
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

YEARS

Low commodity-dependent High commodity-dependent High commodity dependence Net food importers
countries countries with PoU change point increase
and/or food crisis

NOTES: Trends in real GDP per capita (2003–2017) plotted for high commodity-dependent countries denoted by the red line (either high commodity-export dependence, high
commodity-import dependence, or both high commodity-export/commodity-import dependence); high commodity-dependent countries that also experience PoU change point increase
and/or food crisis (orange line); net food importers (green line); low commodity-dependent countries (blue line). The trend of per capita GDP growth is shown for the four categories as
an unweighted average.
SOURCES: FAO for PoU; FSIN. 2019. Global Report on Food Crises 2019 [online]. [Cited 24 April 2019]. http://www.fsinplatform.org/sites/default/files/resources/files/GRFC_2019-Full_
Report.pdf for countries affected by food crises; and UN. 2019. National Accounts – Analysis of Main Aggregates. In: UNSTATS [online]. New York, USA. [Cited 6 May 2019] https://unstats.
un.org/unsd/snaama for real GDP per capita growth.

two or more consecutive years of negative 35 percent (14 out of 40) of the countries with
growth and most of these (15 countries) also downturns in 2016–2017 were dependent on
saw rises in undernourishment in this period said exports.
or a worsening food crisis situation in 2018 (see
Table A6.3 in Annex 6 for the list of countries and A recent FAO study sampling 129 low- and
the number of consecutive years of downturns). middle-income countries during 1995–2017 finds
that high levels of export and import dependence
Among high commodity-dependent countries, on primary commodities have a statistically
especially high commodity-export-dependent significant and negative effect on food security
countries, increases in undernourishment (Table 9). 32 In the period considered, an average
associated with economic slowdowns or increase of primary commodity-export dependence
downturns depend on the main sector of country by 1 percent leads to a 2.2 percent increase in the
exports. Countries dependent on exports of fuel, PoU per year on average. For commodity-import
minerals and metals have been the most exposed dependence, the correlation is stronger, as it
to downturns – even if these commodities causes an average increase in undernourishment
come from very different sectors. Specifically, of 3.8 percent per year. This average effect is

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THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2019

TABLE 9
HIGH LEVELS OF COMMODITY-EXPORT AND -IMPORT DEPENDENCE NEGATIVELY AFFECT FOOD SECURITY
Effect of commodity dependence on undernourishment (PoU) Elasticities
Commodity-export dependence 2.2%***
Commodity-import dependence (food plus fuel dependence) 3.8%**
Food-import dependence 8%**
Fuel-import dependence 1.4%
Years of the commodity boom (2003–2011) -0.01%**
NOTES: Elasticities show the response of the PoU to a one unit increase in each of the commodity dependence variables reported (the values of commodity-export and commodity-
import dependence range from 0 to 1). Elasticities should be interpreted as an average percentage increase (where positive) or decrease (where negative) in PoU per year.
Commodity-export and -import dependence are defined in Box 11. Food-import and fuel-import dependence refer to the two components of commodity-import dependence and
are also considered separately. See Annex 5 for further details on the computation of these variables. The period of commodity price boom refers to years 2003–2011 (excluding
years 2008–2009 of declining price trends). Statistical significance is reported for p-value < 0.01 (***) and p-value < 0.05 (**). The estimated coefficient for fuel-import
dependence is not statistically significant.
SOURCE: C. Holleman and V. Conti. forthcoming. Commodity dependence and food insecurity. FAO Agricultural Development Economics Working Papers 19-05. Rome, FAO.

shown to be even stronger for low-income countries during the 2007–2008 global food
countries, compared with middle-income crisis (Box 10).
countries, since they experience a higher level of
the PoU in the presence of commodity dependence. New FAO evidence suggests that economic
growth, even if strong during price booms for
The same FAO study also finds that, when high commodit y-export-dependent countries,
commodity-import dependence is unpacked, does not necessarily translate into improved food
food-import dependence has a bigger and stronger securit y and nutrition. 33 This study finds that,
effect on the PoU than fuel-import dependence. during the period 1995 –2017, both food-import
Food-import dependence is associated with an dependence and export dependence on primar y
8 percent increase in PoU per year on average, commodities have a negative effect on PoU, even
whereas fuel-import dependence does not report a when controlling for the price booms between
statistically significant coefficient. 2003 and 2011 (excluding the sharp commodit y
price drop in 2008 –2009, see Figure 26). The years
The two successive and sharp commodit y price of the commodit y price booms seem to have a
booms in 2007–2008 and 2010 –2011 offered an positive effect on hunger, although the effect is
economic bonanza to most commodit y-export- ver y small (Table 9). Economic growth in many of
dependent countries (Figure 26 and 28). Many these cases is not fairly distributed and does not
registered a large increase in export revenues trickle down sufficiently, and in some cases not
and generally saw increased economic growth. at all to the poorest and most food-insecure and
For net food importers and high commodit y- malnourished populations – as further explained
import-dependent countries, however, such next in the report.
price booms can create additional challenges
for food securit y and nutrition. This can This is consistent with a recent comprehensive
particularly be the case for net buyers of food study of 202 countries over the period between
through imported food price inf lation. On the 1995 and 2014, which finds that high levels
other hand, high food prices, especially cereal of commodit y dependence are statistically
prices, can be a strong incentive for increased significant and negatively affect social (education
agricultural production, whereby the positive and health) and human development in
effects of this outweigh the negative effects of general and results are statistically significant.
high food prices (e.g. for net buyers of food) This effect was found to pass through several
with overall positive net effects on food securit y channels, including the negative secular terms
and nutrition. This was the case in many of trade affecting commodit y-dependent

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PART 2 SUSTAINED ESCAPES FROM FOOD INSECURITY AND MALNUTRITION

developing countries, slow economic growth, Terms of trade, exchange rate and balance
high macroeconomic instabilit y and political of payments
instabilit y. 34 This finding is further supported Macroeconomic performance in commodity-dependent
by another study that finds “non-monetar y” countries tends to move with commodity price
indicators of development (e.g. health and cycles. Economic activity and growth and external
education) are negatively correlated with and fiscal balances deteriorate/improve during
commodit y dependence through macroeconomic commodity price downswings/upswings, whether
volatilit y and distributional inequalities. 35 the latter entail long periods of falling/rising
commodity prices or shorter commodity price
swings that last only few years. 36
Commodity dependence and food security
and nutrition: transmission channels From the perspective of low-income countries,
especially those where the principal means of
Designing policies to help offset the foreign exchange earnings come from the exports
v ulnerabilit y that arises with high commodit y of primar y commodities, unstable commodit y
dependence requires a thorough understanding prices create macroeconomic instabilities and
of the potential effects. These effects are complicate macroeconomic management (Figure 29).
mediated through a number of direct and
indirect channels that link global commodit y Terms of trade shocks and volatility
markets with domestic economic, social and Sharp declines or increases in international
human development outcomes, including primar y commodit y prices can lead to
food securit y and nutrition. The transmission changes in the terms of trade (ToT) for
channels in such contexts are complex, and commodit y-dependent countries. That is to say,
a given commodit y price change does not the ratio between the prices at which a countr y
affect all commodit y-dependent countries in a sells its exports and the prices it pays for its
uniform manner. Figure 29 presents a simplified imports is affected. A reduction in this ratio
over view of these transmission channels. ref lects a deterioration in the ToT which can have
implications on economic growth, with further
The transmission channels can be grouped into economy-wide implications as both supply and
four broad areas, which are the main subject of demand factors respond to the shock.
analysis in this section. They are:
In fact, ToT shocks have been shown to carr y
„ „Direct impacts emanating as the change the highest economic output costs among a
in commodit y prices affects terms of trade, range of external shocks for a large number of
exchange rate adjustments and the balance developing countries. 37 Low-income countries
of payments. are especially v ulnerable. The IMF has found
„ „Secondary indirect effects of these that low-income countries are almost six times
macroeconomic impacts on: more often affected by severe ToT f luctuations
„ „ domestic prices, including food; and changes than developed countries. 38
„ „ unemployment, declining wages and loss of
income; and World economic reports confirm that sharp and
„ „ health and social ser vices. continuous declines in international commodit y
prices from 2011 to 2016 led to substantial shifts
Ultimately, an important critical factor that in the ToT and a sharp deterioration of GDP
determines whether the direct and indirect growth in commodit y-dependent countries. 39
impacts affect food securit y and nutrition is the Of course, the extent to which a variation in the
abilit y of individuals and households to cope export or import price of a commodit y affects
with these economic-related shocks. The last part the ToT will depend on the relative share of the
of this section takes a closer look at how people commodit y in the countr y’s total exports and
cope and when their coping capacities fail. imports, as well as on the magnitude of the price
shock. Similar variations in export and import
prices may also offset one another.

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THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2019

FIGURE 29
POTENTIAL NEGATIVE IMPACTS OF INTERNATIONAL COMMODITY PRICE REDUCTIONS ON FOOD
SECURITY AND NUTRITION IN COMMODITY-DEPENDENT ECONOMIES: TRANSMISSION CHANNELS

INCREASED
UNEMPLOYMENT

DECREASED FOOD
TERMS OF TRADE SHOCKS LOWER WAGES AVAILABILITY

FOOD STABILITY
AND VOLATILITY GROWTH
LOSS OF INCOME FOOD
ACCESS

PURCHASING POWER

COPING STRATEGIES
FOOD FOOD

LOSS OF
FOOD AND UTILIZATION SECURITY
EXCHANGE RATE DOMESTIC NON-FOOD PRICE
VOLATILITY PRICE SHOCKS AND
INCREASES VOLATILITY
COMMODITY
PRICE CARE AND
REDUCTION FEEDING
BALANCE OF PAYMENTS NUTRITION
VOLATILITY HEALTH SERVICES
AND HEALTH
CURRENT LOSS OF ENVIRONMENT
ACCOUNT LOWER FOOD
GOVERNMENT IMPORTS
REVENUES
CAPITAL
ACCOUNT LOWER
GOVERNMENT
EXPENDITURES,
SOCIAL PROTECTION,
HEALTH SERVICES,
SAFETY NETS

SOURCE: Based on diagram from UNCTAD and FAO. 2017. Commodities and Development Report 2017. Commodity markets, economic growth and development. New York, USA, UNCTAD,
but modified for this report to focus on the specific transmission channels that affect food security and nutrition.

Most fuel and mineral exporters (e.g. Congo, secular decline in primar y commodities
Gabon, Nigeria, Zambia) witnessed a relative to prices of manufactured goods.
deterioration of their ToT as a result of the price Therefore, reliance on commodit y exports
declines between April 2011 and Aug ust 2015. 40 that lose value over time is not such a viable
This, combined with the depreciation in their strateg y for boosting economic growth 42 – let
exchange rates and a loss of commodit y revenue, alone for eliminating external v ulnerabilit y
led to deteriorations in the fiscal stance and through diversification.
stung GDP growth.
Shocks transmitted from ToT through
Studies also show that commodit y price the economy are also challenging to
volatilit y can result in less economic growth, government budgets. In many low-income
even over longer periods of time, especially in commodit y-dependent countries, especially
resource-rich, commodit y-export-dependent commodit y-export-dependent countries, sharp
countries. 41 This is because the ToT of declines and persisting low prices in the main
economies dependent on primar y commodities export commodities can drain not only export
tend to deteriorate in the long run due to revenues but also fiscal revenues.

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PART 2 SUSTAINED ESCAPES FROM FOOD INSECURITY AND MALNUTRITION

Recent declines in commodit y prices since A change in the foreign exchange available to
2011 led to a deterioration in public finances an economy will be ref lected in the price of
for many commodit y-export-dependent foreign goods relative to the price of domestic
countries (oil and non-oil exporters) in Asia, goods, or real exchange rate. A net inf low/net
Africa, North Africa and the Middle East, outf low of foreign exchange will thus result
and in Latin America and the Caribbean. in an appreciation/depreciation of the real
For example, public revenues of African exchange rate – other things being equal. By this
commodit y-dependent countries shrank definition, both the ToT and the real exchange
from an average of 26 percent of GDP during rate may be affected simultaneously.
2004−2007 to 21 percent of GDP in 2011−2014.
This partially explains why these countries’ When countries’ reser ves of foreign exchange are
average primar y budget balances went from insufficient to prevent unfavourable exchange
a surplus of 3.6 percent of GDP to a deficit of rate adjustments, they may adjust the number
1.8 percent of GDP between the two periods. of units of their currency that are needed to
In response, many commodit y-dependent purchase a unit of a given foreign currency
countries increased their borrowing in order to or nominal exchange rate, so as to restore
shore up their finances. 43 the balance of payments. Lower commodit y
prices, for example, may lead to a decrease
Such deteriorations in the fiscal stance may of foreign exchange in the markets of the
threaten the continuit y of social programmes, commodit y-exporting countries as their export
safet y nets, and other components of economic revenues fall, thus causing a real exchange
and social development plans. Food access can rate depreciation. Countries that possess a
be negatively affected owing to governments’ domestic currency may devalue it to restore
more limited fiscal space to protect poor the income of their exporters in local currency.
households against rising domestic prices. Depreciation and devaluation of currencies may
Generally, lower foreign exchange could pass through the system resulting in domestic
also affect food availabilit y through reduced price increases.
food-import capacit y. Contingency mechanisms
and funds are critical to prevent these In Colombia and Chile, for example, falling
v ulnerabilities from potentially harming food international prices for the countries’ export
securit y, as further explained in Section 2.4. commodities – respectively crude oil and copper
– led to reduced export earnings and declining
Commodit y-dependent countries that face reserves in United States dollars (USD), triggering
such reductions in fiscal revenues in the a devaluation of the local currency against USD
wake of low or declining commodit y prices (Figure 30). Conditional on international price
may need to increase borrowing to cover developments for agricultural commodities, this
shortfalls, thus leading to increasing public can imply more expensive food imports, reduced
debt, which in turn can further compromise domestic food availability, and rising food prices.
long-term growth and development, and
lead to higher debt-repayment schedules. For many commodit y-dependent countries that
For instance, many South American experienced an increase in undernourishment or
commodit y exporters have seen sharp worsening food crises, the decline in commodit y
increases in fiscal deficits that resulted in prices from 2011 to 2016 is associated with
higher public debt-to-GDP ratios. 44 significant depreciations. This was especially the
case for many commodit y-dependent countries
Exchange rate adjustment and balance in Africa. For example, in 2015 many currencies
of payments including the Zambian kwacha, the Angolan
Commodit y prices affect the amount of foreign kwanza and the Nigerian naira, recorded some
exchange in commodit y-dependent countries, of their strongest depreciations against USD
as they alter the value of exports and imports in several years. 45 This pushed up the prices of
in foreign currency. The balance of payments non-commodit y imports, further amplif ying the
records these economic transactions. sharp deterioration in their terms of trade.

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THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2019

FIGURE 30
FALLING COMMODITY PRICES TRIGGERED A DEVALUATION OF THE COLOMBIAN AND
CHILEAN CURRENCIES

A) COLOMBIAN PESO AND CRUDE OIL PRICE B) CHILEAN PESO AND COPPER PRICE
10 000
800

3 000

7 500
100 600
USD PER BARREL

USD PER TONNE


COP/USD

CHP/USD
2 000

400 5 000

50
1 000
200 2 500

2005 2010 2015 2020 2005 2010 2015 2020

NOTES: The figure shows the relationship between Colombian exchange rates and crude oil price (graph A) and Chilean exchange rates and copper price (graph B) for years 2001–2018.
Daily data are used to plot exchange rates and monthly data for commodity prices. COP (CHP) is Colombian peso (Chilean peso) and COP/USD (CHP/USD) refers to the amount of
Colombian peso (Chilean peso) for 1 USD.
SOURCES: WFP elaboration based on Trading Economics. 2019. Trading Economics [online]. [Cited 25 April 2019]. https://tradingeconomics.com for exchange rate data; World Bank.
2019. Commodity Markets. In: World Bank [online]. Washington, DC. [Cited 6 May 2019]. http://www.worldbank.org/en/research/commodity-markets for commodity prices

Rising domestic prices, including food increases, including food prices. An alternative
International commodit y price f luctuations situation may be that food imports become
can also transmit effects into the economy more expensive owing to rising international
through exchange rate adjustments (Figure 29). commodit y prices, with domestic food
Large depreciations are associated with domestic prices following suit. Both situations can be
price increases and large devaluations tend to particularly challenging to net food importers.
be associated with large declines in output, While the degree and speed of pass-through
consumption and imports. 46 The pass-through depends on the countr y in either of these two
of international commodit y price developments situations, the effect of higher food prices
to local domestic prices varies by commodit y, will f low through the food value chain from
countr y and over time. 47 Nonetheless, it can be wholesale to retail prices. This poses a challenge
particularly challenging for food securit y and to food securit y and nutrition if the countr y
nutrition, as it can affect people’s access to food, has limited capacit y to substitute food imports
care and feeding, as well as access to health with domestically produced food, and it is not
ser vices – unless exceptional conditions prevail obvious that all domestic food producers will
to offset these effects, as seems to have been the benefit from higher food prices.
case during the global food and financial crises
(Box 10). South Sudan’s currency devaluations in 2015,
for example, immediately triggered significant
As highlighted above, declining commodit y food price inf lation and eroded purchasing
prices may result in depreciation and power of a majorit y of the countr y’s poor and
devaluation of currencies that may pass v ulnerable. In cases like this, devaluation
through the system resulting in domestic price usually raises imported food prices and shifts

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PART 2 SUSTAINED ESCAPES FROM FOOD INSECURITY AND MALNUTRITION

the food parit y price (the rural–urban terms of A complex interplay between the nature
trade) in favour of agriculture/local produce. and magnitude of food price changes,
However, insignificant tradeable surplus by most food availabilit y, and the nutrient content
farmers (due to low agricultural productivit y), of substitutes will determine the impact
coupled with low levels of market integration of rising prices on nutrition. The effect
and linkages, may exclude a number of farming does not, however, take place uniformly.
populations from benefiting from rising prices of Households in low-income countries are prone
locally produced commodities. This was the chain to being disproportionately affected 53 as are
of events in South Sudan, which led to increased urban households 54 and women and children. 55
levels of acute food insecurit y and malnutrition Whereas the inf luence of food price increases
levels, as populations struggled to access food on nutrition through qualit y substitution is
– particularly troubling, given that 43 percent immediate, less direct channels are seen in
of the population of South Sudan are market the long term. For example, limiting health
dependent for their food needs. 48 expenditure to save money for food can lead to
more frequent, prolonged or more severe illness.
In these situations, households that need to This has negative implications for the body’s
buy food are immediately affected by higher uptake of essential nutrients. 56
domestic retail prices as the cost of food relative
to their incomes increases (Box 12). While this is Unemployment and loss of income and wages
clearly the case in urban areas, it holds in rural World and domestic price adjustments, such
settings as well. Even farmers, labourers or rural as those described so far, bring about complex
landowners, who are involved in agricultural responses in the real economy. These responses
activities, can be net food buyers and negatively from the supply and aggregate-demand
affected by higher prices. Moreover, when sides will generate a number of “quantit y”
rural incomes are strongly interlinked through adjustments, including in employment and
multiplier effects, 49 food price drawbacks might other areas, that can in turn trigger additional
spill over to net food sellers and leave even economy-wide effects, including in domestic
them worse off. 50 However, once transmitted prices and income.
to producers, higher food prices also stimulate
agricultural production. In the medium term, For commodit y-dependent countries, sluggish
they can thus work to the benefit of the economic activit y as a result of falling commodit y
rural communit y by increasing agricultural prices can lead to unemployment, loss of wages
employment and generating opportunities to and, consequently, loss of incomes (Figure 29). 57
earn an income up the value chain. However, And unemployment and loss of income are
the example of South Sudan shows that when significantly related to food insecurit y for the
agricultural productivit y and market integration general population. 58
are low, a number of farming populations
may not benefit from rising prices of locally For example, the declining economic and
produced food. negative growth obser ved in Latin America and
the Caribbean during 2012–2016 was largely
Food prices play a key role also for dietar y associated with marked declines in commodit y
diversit y. Even for smallholder farmers who cover prices, mainly affecting South America. 59
most of their dietar y energ y from subsistence The urban unemployment rate reached
production, purchased foods can critically 8.9 percent in 2016, representing an increase of
contribute to the variet y and qualit y of their 1.6 percentage points from 2015. The declining
diets. 51 Costs tend to rise with dietar y qualit y, 52 GDP and the rise in unemployment resulted
and a common strateg y for coping with reduced in lower wages or other forms of household
purchasing power is to shift dietar y patterns incomes. After several years of marked
towards cheaper food. As a result, nutrient intake reductions in povert y, the number of poor
is compromised in the wake of surging prices. people rose from 166 million to 175 million
This coping strateg y seems to have been used between 2013 and 2015, increasing from
during the global food crisis (Box 10). 28.1 percent to 29.2 percent of the population. »

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THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2019

BOX 12
ECONOMIC SLOWDOWN AND THE COST OF BASIC FOOD IN COLOMBIA

The case of Colombia illustrates the effects of an To make the impact of this economic slowdown on
economic slowdown on the affordability of food via the affordability of food more tangible, it is helpful to
the described transmission channels. look at the cost of a basic plate of food; for example,
Falling international prices for Colombia’s export through the “Counting the beans” index developed by
commodities, particularly crude oil, led to reduced WFP, which provides a cross-country comparison of
export earnings and declining reserves in United a stew made of beans or other pulses, paired with a
States dollars, triggering a devaluation of the carbohydrate staple that matches local preferences.1
Colombian peso (COP) against the United States The building block of the index is the meal-to-income
dollar (USD) – see Figure 30. ratio, which is the cost of a stew of beans as a share
Between 2012 and 2017, GDP per capita growth of daily earnings. The effect of the economic slowdown
plummeted, along with significant current account on the affordability of food is obvious in the Colombian
imbalances and local currency depreciation. At the case: in 2016, every Colombian had to allocate on
same time, household income stayed put when average three percent of their daily income to afford
expressed in real terms, while inflation rose steadily up such a basic plate of food, which is more than the
to 2016 (see table below). yearly allocation in the 2012–2015 period.

MEAL-TO-INCOME IN COLOMBIA DURING AN ECONOMIC SLOWDOWN


Colombia 2012 2013 2014 2015 2016 2017
GDP per
Slowdown capita (a) (annual %) 2.99 3.85 3.41 2.12 1.15 0.91
growth
Current
account (a) (million, in USD) -11.366 -12.504 -19.768 -18.586 -12.129 -10.359
balance
Exchange (a) Nominal 1.797 1.869 2.002 2.742 3.054 2.951
Transmission rate
channels COP/USD* Real 2.65 3.29 3.48 3.77 4.24 5.21

Income (b) Nominal 30.596 32.683 34.675 34.837 37.078 39.229


(in COP*) Real 28.677 30.027 30.960 29.626 29.328 29.746
Prices Inflation (annual %) 3.17 2.02 2.9 4.99 7.51 4.31
(c) Nominal 892 756 792 1.009 1.117 965
Stew of
Cost of
beans Real 836 694 707 858 883 731
basic food
(in COP)
Meal-to-income (%) 2.91 2.31 2.28 2.9 3.01 2.46
NOTES: *COP is Colombian peso and COP/USD refers the amount of Colombian peso for 1 USD.
SOURCES: (a) World Bank. 2019. World Development Indicators. In World Bank DataBank [online]. Washington, DC [Cited 10 February 2019]. https://databank.worldbank.org;
(b) ILO. 2019. Data collection on wages and income. In: International Labour Organization [online]. Geneva, Switzerland. [Cited 6 May 2019] https://www.ilo.org/travail/
areasofwork/wages-and-income/WCMS_142568/lang--en/index.htm; and (c) WFP calculations based on WFP. 2019. Economic Analysis. In: VAM – Food security
analysis [online]. Rome. [Cited 13 May 2019]. http://dataviz.vam.wfp.org/economic_explorer/prices and FAO. 2019. GIEWS FPMA Tool - monitoring and analysis of food prices.
In: FAO [online]. Rome. [Cited 13 May 2019]. http://www.fao.org/giews/food-prices/tool/public/#/home and NUMBEO. 2019. Prices by country. In: NUMBEO [online].
[Cited 13 May 2019]. https://www.numbeo.com/cost-of-living/prices_by_country.jsp

1
WFP. 2017. Counting the beans: the true cost of a plate of food around the world. Rome.

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PART 2 SUSTAINED ESCAPES FROM FOOD INSECURITY AND MALNUTRITION

» The pass-through effects on unemployment agricultural production from rural areas. 61


and income will var y from countr y to countr y Shrinking employment opportunities, including
depending on what sectors are producing the those for rural migrants, result in lower
primar y commodities upon which the countr y is remittances from urban areas and more limited
dependent. For example, the oil and diamonds farm investments in rural space.
sectors t ypically create little employment
and are weakly linked with the rest of the Among the four dimensions of food securit y
economy. On the other hand, in agriculture, – availabilit y, access, utilization and stabilit y –
particularly where export crops are grown by access is the principal channel between economic
smallholder producers, the impacts can be more shocks and food securit y and nutrition, mainly
widely spread. through two pillars of availabilit y (supply
through the market or home-production) and
Sharp and declining commodit y prices may, affordabilit y (household income from farm and
through reduced incomes, force households to non-farm activities), both of which are directly
adopt coping strategies that do not necessarily related to agricultural income and non-farm
improve food securit y and nutrition. employment. 62

Agricultural employment and smallholder Downturns and price volatilit y can significantly
food producers undermine the livelihoods and income of
The impacts of economic slowdowns and small-scale food producers, agricultural
downturns can be felt particularly hard in labourers and the rural poor, in particular those
agriculture, both because of what happens who are net food buyers, forcing them to reduce
within the sector and because of urban–rural their consumption in quantit y and qualit y. 63
linkages. These impacts can be especially Conversely, in some circumstances price spikes
harmful to countries lagging behind in terms of might be beneficial for farmers, as, due to
economic development and transformation. increased prices, they have a higher incentive
to produce crops. Often, food producers
The levels of structural and rural transformation cope with the impacts of economic shocks by
of the economies (i.e. the relative levels of focusing their production and consumption of
dependence on ag riculture, deg ree of food on staple crops. While doing so allows
ag ricultural and non-farm diversification, them to sustain dietar y energ y intake, it might
commercialization and productiv it y), w ill lead to a deterioration, in dietar y diversit y.
determine the extent to which economies are In other words, improving their productivit y
capable of coping w ith the challenges. and the availabilit y of cash income along with
The extent to which rural–urban linkages nutrition-sensitive behavioural change are
weaken as the economy deteriorates w ill critical for them to access higher qualit y and
determine the impacts on ag ricultural and more diversified diets. Broad-based income
rural off-farm employ ment and the welfare of growth, grounded on a diversified set of
smallholder food producers. economic activities, including off-farm
activities, can bring shifts in nutrition towards
The impacts on agriculture can be particularly balanced dietar y patterns.
significant in low-income countries.
The agricultural sector accounts for substantial The impacts of economic slowdowns on food
shares of employment and output in these securit y and nutrition are demonstrated in
countries. In 2017, agricultural employment Haiti, Nepal and the Niger. Amid a global
accounted for 68 percent of total employment, financial crisis coupled with high food prices,
and agricultural output accounted for about households’ food securit y, as measured by
26 percent of GDP in low-income countries. 60 dietar y diversit y, reduced by 5 percent in Nepal,
8 percent in the Niger, and 23 percent in Haiti
More generally, as employment, wages and due to increased food prices. 64 In the Indian
household income fall, particularly in urban Himalayas, economic slowdown coupled with
areas, there will likely be less demand for natural resource depletion and climate change

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THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2019

negatively impacted on food production and through nutrition pathways such as improved
employment opportunities. This resulted in feeding practices. 71
increased threats to food securit y due to lower
purchasing power. 65 By ensuring universal health coverage and
providing social safet y nets, government
Recent research on the effects of export-led spending on these essential ser vices contribute
agricultural growth on agricultural labour to povert y reduction and improving population
shows that high-value export sectors health, which in turn reinforce food securit y
create formal employment opportunities and nutrition. 72 However, economic slowdowns
in rural areas and can transform the and downturns caused by unfavourable
low-productivit y smallholder based labour commodit y price shocks can drain fiscal revenues
market into a high-productivit y modern and have implications for public budgets in
agro-industrial sector, thereby fostering rural commodit y-dependent countries, which are not
transformation. 66 When the agro-industr y and all in a position to counteract these changes.
the smallholder sector are spatially close to
each other, direct investment and consumption Cuts in health spending could affect nutrition
linkages can lead to increased incomes and through reduced provision of, or access to,
non-farm employment, 67 which improve qualit y essential ser vices for infant, young
household capacit y to deal with risks – child and maternal nutrition mainly delivered
including those caused by economic slowdowns through the health system. Reductions in
and downturns. The ultimate effects of other areas of social spending could impact
slowdowns and downturns on households directly or indirectly on nutrition due to a
depend on whether they are global, regional deteriorating health environment, increasing the
or national. Whereas a global downturn may risk of infectious diseases that can exacerbate
stall the overall rural transformation process malnutrition, or due to reduced provisions for
by setting back the direct and spillover effects social protection such as school feeding, cash or
of export sectors on labour markets (and hence food vouchers.
livelihoods), a regional or national economic
slowdown or downturn could potentially be Despite the global recession and slow economic
weathered if countries are sufficiently open to growth experienced over the past decade, it has
international trade. 68 been obser ved that government fiscal capacit y,
as measured by the share of overall government
Health and social intersectoral effects spending in GDP, had grown across all groups
Cuts to health and social sector spending of countries. 73 However, allocations from fiscal
precipitated by economic slowdowns or space to essential social expenditure overall have
downturns can have negative impacts on been under pressure since 2010, after an initial
food securit y and nutrition, particularly in period of expansion following the economic crisis
high commodit y-dependent countries with of 2008 –2009. 74
potentially lifelong and intergenerational
implications for health and development Public health expenditure as a percentage of
(Figure 29). total government expenditure, while increasing
in some countr y groupings, has decreased in
Social sector expenditure – comprising health, low-income countries overall from 7.9 percent
education and welfare/social protection in 2000 to 6.8 percent in 2016. In high
spending – are core pillars for promoting commodit y-dependent countries, the decrease
health, well-being and health equit y in current has been even greater. 75 Health expenditure as
and future generations. 69 Within the health a percentage of total government expenditure
sector, the universal health coverage (UHC) in high commodit y-dependent countries
approach has demonstrated positive impacts on during the 2008 –2015 period contracted by
population health and health equit y. 70 Similarly, 1.3 percent for low-income countries (compared
education and social welfare policies have with an increase for this specific period in
demonstrable impacts on health and well-being other low-income countries), by 0.6 percentage

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TABLE 10
GOVERNMENT SPENDING ON SOCIAL AND HEALTH SECTORS AND UHC COVERAGE IN HIGH COMMODITY-DEPENDENT COUNTRIES
Public spending on health as a percent Proportion of total government spending UHC essential
of general government spending (%)** on essential services (education) service coverage
(%)*** (%)****

High
High High
All other countries All other countries commodity-dependent
commodity-dependent countries commodity-dependent countries
countries
Countr y 2008 2008 2015
Change Change Change Change
income n 2008 2015 n 2008 2015 n 2015 n n 2015
(%) (%) (2007–10) (%) (2007–10) (2011–15) (%)
group

Low 18 10.1 8.8 -1.3 16 15.9 17.1 1.2 14 16.0 15.7 -0.3 16 15.9 17.1 1.2 19 40

Lower-
11 9.7 9.1 -0.6 23 17.3 17.5 0.2 6 14.9 12.6 -2.3 22 17.3 17.5 0.2 10 49
middle

Upper-
13 11.9 11.6 -0.3 32 15.3 15.4 0.1 7 16.3 15.0 -1.3 31 15.3 15.4 0.1 12 65
middle

High* 2 10.9 13.9 3.0 45 12.9 13.0 0.1 1 11.0 10.4 -0.6 48 12.9 13.0 0.1 1 68

Total 44 116 28 117 42

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NOTES: * For the high-income country group, among high commodity-import- and commodity-export-dependent countries, two countries counted in food and fuel group (Seychelles and Palau) and one country counted in food group (Palau). UHC refers to universal health
coverage.
SOURCES: ** WHO. 2017. Global Health Observatory (GHO). In: World Health Organization [online]. Geneva, Switzerland. [Cited 2 May 2019]. http://apps.who.int/gho/data/node.imr.PREVANEMIA?lang=en); *** UN. 2019. SDG Indicators. In: United Nations – Sustainable
Development Goals [online]. New York, USA. [Cited 6 May 2019] https://unstats.un.org/sdgs/indicators/database; **** WHO. 2018. World health statistics 2018: monitoring health for the SDGs. Geneva, Switzerland.
PART 2 SUSTAINED ESCAPES FROM FOOD INSECURITY AND MALNUTRITION
THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2019

points for lower-middle-income countries, school meals, which are particularly important
and by 0.3 percent percentage points for for food securit y and nutrition. 82
upper-middle-income countries (Table 10).
Decreased public health expenditure coupled In addition, the ways in which families have
with low rates of expenditure and reductions in to cope with economic crises can impact infant
other essential social expenditure have health and young childcare, including breastfeeding
repercussions through impaired food securit y practices. Economic pressures on mothers to
and nutrition and other impact pathways, in work soon after childbirth can reduce their
particular for poorer populations. abilit y to exclusively breastfeed for six months,
while pressures on government budgets and
Reduced health spending affects the qualit y private sector employers may undermine
and effectiveness of health ser vices, for example maternit y provision. Resource constraints can
through less frequent ser vice provision, also compromise caregivers’ abilit y to provide
shortages of medication and equipment or optimal care to infants and young children due
supplies, and reduced staff numbers and lower to increased workload, time pressures or poor
staff morale. This can impact nutrition directly health. 83
through reduced micronutrient supplementation,
breastfeeding support and other essential How households cope and when they fail
nutrition actions for mothers, infants and young Households facing a reduction in purchasing
children; and indirectly through reduced ser vices power as a result of economic events have to look
affecting family planning, antenatal care and for ways to cope with these shocks to maintain
inter ventions to prevent or control infectious food securit y and consumption to the extent
diseases or diet-related non-communicable possible (Figure 29).
diseases. 76 During economic crises, populations
tend to switch from private to public ser vices, Due to their economy-wide nature, economic
when funding and ser vices are already under slowdowns and downturns pose macroeconomic
pressure. 77 Moreover, user fees are often aggregate shocks affecting multiple households,
introduced or increased, which can lead to delays which are different from idiosyncratic shocks
in seeking health care and ultimately to poorer that affect only a single household, such as the
health outcomes. 78 These user fees can also illness of a household member. This means that
drive people into povert y, 79 limiting household many coping strategies that are used during
budgets for needed food. idiosyncratic shocks are ineffective in the face of
such aggregate shocks. 84 
Similarly, reduced government budgets
can affect other important social During economic slowdowns and downturns,
expenditures, including for education wages can decline and jobs might be more
(Table 10). Education expenditures for high difficult to find, and consequently households
commodit y-dependent countries decreased as losing their employment might have to take up
a percentage of total government expenditure lower paying jobs, often in the informal sector.
between 2008 and 2015 – by 0.3 percentage In such circumstances, household members
points and 2.0 percentage points in low-income normally not involved in salaried activities –
and lower-middle-income countries, respectively. for example, women and younger members still
Reduced education expenditures is a problem in in school – might need to look for employment.
its own right, but it also means less investment Households may also tr y to make use of any
in school infrastructure relevant to health, savings or insurance mechanism at their disposal
such as for safe water and sanitation, which (Table 11).
affects the risk of infectious disease, 80 such as
diarrhoea, and can exacerbate or be exacerbated However, with increased prices, savings will buy
by undernutrition. 81 Governments also struggle less food than before. Households might find it
to maintain social protection measures during more difficult to borrow from family members or
economic slowdowns and downturns, including access informal insurance groups such as village
cash and food transfers, food vouchers and funds, if many households are facing economic

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PART 2 SUSTAINED ESCAPES FROM FOOD INSECURITY AND MALNUTRITION

TABLE 11
COPING STRATEGIES, THEIR AVAILABILITY IN TIMES OF ECONOMIC SLOWDOWNS AND DOWNTURNS
AND POSSIBLE NEGATIVE EFFECTS
 Coping strategy Availability in times of economic Possible negative effects of applying
slowdowns and downturns  the coping strategy 
Adjusting labour supply     
Changing employment Lower availability and lower wages than Lower wages leading to lower income and
in economically strong situations. potential participation in the informal sector.
Possibility of increased underemployment
levels.
Taking up of additional Lower availability and lower wages than Reduction of other activities such as
employment (also former in economically strong situations. breastfeeding and care work, taking children
non-employed household Internal and international migration to out of school, with possible negative effects
members such as children unaffected areas/countries might be an on human capital formation and the
and women), outmigration  option, if household can afford it. intergenerational cycle of malnutrition.
Increased work burdens for family members
left behind when other family members
migrate out.
Loss of labour if there is outmigration.
Return migration to the Effective only if labour productivity is Reduction of remittances and, potentially,
village, employment in high enough and there is significant unemployment when labour demand shrinks.
agriculture labour demand.
Increased food prices are an advantage
if household can increase agricultural
production.
Adjusting disposable income    
Using savings  Less effective when purchasing power Depletion of resources (which are the basis
weakens. of livelihoods) and, as a result, weakened
resilience against future shocks. 
Selling (productive) assets, Asset prices might be reduced if many Depletion of resources, reduction of future
including land people sell their assets.  earnings potential. 
Formal or informal Informal networks might be weakened Risk of indebtedness. 
borrowing through aggregate shocks; interest rates
might be high for vulnerable households. 
Formal public safety nets Public spending on formal safety nets Quality of safety net programmes could be
might be reduced. affected. Increased food insecurity and
malnutrition for the most vulnerable groups if
food or cash transfers are reduced.
Formal private insurance Often no access for most vulnerable None.
schemes households.
Involvement in criminal or Less effective if applied by many Loss of human dignity and social status in
socially unacceptable members of the community. the community, may face legal prosecution.
activities such as begging or
prostitution
Adjusting consumption     
Reducing spending on other Availability not affected. Costs of public- Possible reduction of health and education
goods in order to maintain sector health services may increase if expenditures might have negative long-term
food consumption  budgetary constraints lead to an effects on health and human capital.
increase in user fees.
Shifting dietary patterns  Availability not affected. Increased consumption of street foods and
towards cheaper foods  shifting towards more starchy foods and
away from micronutrient rich vegetables,
fruits, meat and dairy products can lead to
various forms of malnutrition with negative
long-term effects.
Reducing food consumption   Availability not affected. Will lead to malnutrition with negative short
and long-term effects.
Reducing number of Difficult, if most households of the social Splits up families.
household members, by network are affected.
sending away children, for
example

SOURCE: WFP with inputs from FAO and WHO.

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THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2019

difficulties at the same time. Also, public


spending on safet y nets might decrease during
NEXUS BETWEEN
2.3

economic slowdowns, thereby leaving behind ECONOMIC GROWTH,


POVERTY, AND FOOD
many households in need. 85

One coping strateg y which has been shown in


some countries to work well in times of economic SECURITY AND
slowdowns and downturns is return migration to
the village of origin. As food prices rise, farmers
NUTRITION: THE ROLE
benefit from the labour supply of returned
migrants and from increased agricultural
OF INEQUALITY
production, enabling them to better cope with
job losses and reduced remittances of affected KEY MESSAGES
migrants. 86 Alternatively, workers might seek job
è   Economic events will ultimately affect food security
opportunities in other countries, thus increasing
and nutrition, depending on extreme poverty levels
the inf low of remittances.
and the extent to which the poor face exclusion due to
different inequalities. However, outcomes may vary
While the availabilit y of coping strategies is
from country to country.
restricted for households in general, coping
is particularly challenging for v ulnerable
households, as they are endowed with fewer è   While extreme poverty is one of the underlying
assets to deplete and often have weaker social causes of food insecurity and malnutrition,
networks for support. They are more often forced food-insecure and malnourished people are not
to take up coping strategies that help in the always members of the poorest households. Most of
short term while jeopardizing future earning the hungry and undernourished populations today live
possibilities and the human capital of the in middle-income countries.
household, such as taking children out of school,
possibly leading them into an intergenerational è   Inequalities are one of the myriad reasons why
povert y trap. 87 extreme poverty reduction does not necessarily
translate into improved food security and nutrition.
For example, they may have to sell assets Socially excluded and marginalized groups are at
that are essential for their livelihood, such increased risk of food insecurity, unhealthy diets,
as the last female animals in their livestock, malnutrition in all its forms and poor health outcomes.
productive tools or seeds, or they may be forced
to incur too much debt. The need to change
consumption patterns can lead to reduced è   Income inequality is rising in several low- and
spending on education and health, or shifts in middle-income countries. Inequalities are also seen in
nutrition away from nutrient-rich foods, such accessing basic services and assets, between and
as vegetables or meat, towards more starchy within households. All of this is making it more difficult
foods. While securing access to sufficient dietar y for poor and marginalized groups to benefit from
energ y in the short term, this behaviour will have economic growth.
negative long-term effects on people’s nutrition
and health and human capital 88 as seen during è   Inequalities not only prevent the most
the global food crisis (Box 10). n food-insecure and malnourished people from being
helped by economic growth; they also make these
people more vulnerable in the face of economic
slowdowns and downturns.

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PART 2 SUSTAINED ESCAPES FROM FOOD INSECURITY AND MALNUTRITION

Poverty and socio-economic inequalities linked with malnutrition, and there may be
also matter other factors at play. For example, stunting
in children is not only related to the qualit y
Economic slowdowns and downturns generate a of diet, but also to hygiene, health care and
number of direct and indirect impacts that f low maternal nutrition during pregnancy, among
through different transmission channels and others. High-qualit y foods might not be evenly
challenge food securit y and nutrition. Many of distributed among household members or
these impacts can be generalized. They are households may not have access to adequate
transmitted through prices and economy-wide sanitation, safe drinking water and health care.
responses that would behave in a similar manner
in most low- and middle-income countries. The next section explores the nexus between
Declining commodit y prices trigger unambig uous economic growth, povert y, 92 and food securit y
economic effects in high commodit y-dependent and nutrition. In doing so, it looks at the central
countries with implications for food securit y role of inequalit y in shaping the outcomes
and nutrition. of food securit y and nutrition in this nexus.
Understanding the relationships is critical
The final impact on food securit y and nutrition, if countries are to design targeted policies
however, depends on how many poor people and programmes to address food insecurit y
live in the countr y and the extent to which they and malnutrition.
face exclusion due to inequalities. On the one
hand, economic slowdowns and downturns A key feature of the 2030 Agenda for
tend to be correlated with increases in povert y Sustainable Development is the recognition
and inequalit y. On the other hand, povert y, of the interconnectedness between the SDGs.
inequalities and marginalization are some of the Ignoring the nexus between economic growth,
underlying causes of hunger and malnutrition in povert y, food securit y and nutrition, and the role
all its forms. But the relationships between these inequalities play within this nexus, could push
factors are not so simple, for a number of reasons. policies and programmes designed to end hunger
and malnutrition to miss their mark and fail.
First, it is not always true that robust economic Rooting out hunger and malnutrition in all its
growth helps to reduce povert y and improve forms will require an integrated understanding to
food securit y and nutrition. 89 Economic growth, inform solutions that are not exclusively relevant
although necessar y, may not be sufficient for SDG 2 (ending hunger and malnutrition in
to ensure povert y reduction, food securit y all its forms) but also other SDGs, particularly
and nutrition. Many countries have achieved – albeit not exclusively – SDG 1 (ending povert y
economic growth, but show poor records in terms in all of its manifestations), 93 SDG 8 (promoting
of povert y alleviation 90 and improvements in food inclusive and sustainable economic growth), and
securit y and nutrition. SDG 10 (reducing inequalities).

Second, povert y, food securit y and nutrition do


not always move in unison. Countries can achieve
Disentangling the nexus
robust economic growth and povert y reduction, To better understand the nexus between
but this does not always translate into improved economic growth, povert y, and food securit y
food securit y and nutrition. The disconnect and nutrition, it is important to recognize
has become even more apparent recently, as that these are multidimensional concepts
many countries have made significant progress that are multidirectional in their relationship
in reducing povert y but not in improving food to one another (e.g. hunger is a result of
securit y and nutrition indicators. 91 povert y, but hunger itself is a cause of
povert y). Evidence also indicates that stunting
Third, when povert y reduction does result in contributes to intergenerational transmission of
increased food securit y, this does not necessarily povert y and deprivation, which often explains
mean nutritional status will be improved as intergenerational effects on linear growth of
well. Povert y and food insecurit y is only weakly children. 94

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THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2019

Povert y, food securit y and nutrition are of economic growth can lead to different rates of
interrelated, but they are also distinct from one povert y reduction.
another. 95 They often move together, but they
are also different and have unique determinants, The rate at which povert y shrinks as growth
so they are not always correlated. For example, accelerates differs from countr y to countr y,
povert y can be on the decline, while progress given the initial level of income inequalit y in
in reducing food insecurit y and malnutrition the countr y and changes in income inequalit y
stagnates or even reverses course. over time. 99 For example, Senegal and Burkina
Faso had similar levels of economic growth –
Unpacking the nexus between economic growth, 2.2 percent per capita per year – over a similar
povert y, food securit y and nutrition is complex. timeframe.100 But povert y declined by 2.5 percent
Therefore, this section will look at three separate annually in Senegal and by just 1.8 percent
linkages and relationships. First, evidence on in Burkina Faso. Senegal made more progress
the links between economic growth and povert y because it had less inequalit y as a result of
reduction will be reviewed, followed by the links pro-poor growth policies introduced in the 1990s.
between economic growth and food securit y and Another study found that for countries where
nutrition, and then the links between povert y income inequalit y was ver y high, a 1 percent
and food securit y and nutrition. increase in average household income levels had
a much lower impact on povert y (0.6 percent
Economic growth and poverty reduction reduction) than it did in countries where
Sustained economic growth is one of the inequalit y was low (4.3 percent).101
most critical factors in alleviating povert y.
Numerous cross-countr y studies and statistical By comparison, between 2001 and 2017, Mali
evidence confirm that the main determinant experienced limited economic growth with an
of povert y reduction is the pace of economic average GDP per capita growth of 1.9 percent.102
growth. 96 There is clear evidence for the positive However, the countr y still made significant
association, but the magnitude or strength of the strides in reducing povert y and improving social
effect varies across countries. indicators. An important part of Mali’s success
in povert y reduction can be attributed to its
For example, one study found that growth in remarkable performance in reducing inequalit y.
average incomes as measured by GDP per capita The countr y’s Gini coefficient has fallen from
explained approximately half of the variations 39.9 in 2001 to 33 in 2011, making Mali’s growth
in short-run changes of povert y level. 97 Another performance an inclusive one. More importantly,
study on 14 countries between 1990 and 2003 calculations by the World Bank 103 show that
found that a one percent increase in GDP per 82 percent of the povert y reduction performance
capita reduced povert y by 1.7 percent. 98 For some of the countr y between 2001 and 2010 can be
countries such as Viet Nam, the reduction was attributed to better distribution of consumption
spectacular – a halving of the povert y rate from among households – the remaining 18 percent
58 percent to 29 percent, or almost 8 percent seems to be mostly explained by the average
a year. Povert y rates have declined between increase in consumption. Of course, these gains
3 percent and 6 percent per year in El Salvador, have been threatened by the conf lict in the
Ghana, India, Tunisia and Uganda. countr y that erupted in 2012.

World price shocks and macroeconomic In addition to the initial level of income inequality,
adjustments affecting economic growth directly, the pattern of economic growth and different
such as those described in Section 2.2, can initial conditions in human development reflecting
potentially affect povert y. For countries with a number of other inequalities beyond income also
high primar y commodit y dependence, the factor in to determine whether economic growth
degree of macroeconomic stabilit y, in particular translates into poverty reduction (Box 13).
avoiding inf lationar y shocks, is a critical factor.
The sectoral composition of economic growth Income inequalit y can also reduce the impact of
can also explain in some cases why given rates future economic growth on povert y reduction.104 »

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PART 2 SUSTAINED ESCAPES FROM FOOD INSECURITY AND MALNUTRITION

BOX 13
EXPLAINING POVERTY AND FOOD SECURITY AND NUTRITION TRENDS IN CHINA
AND INDIA: THE PATTERN OF GROWTH AND INITIAL INEQUALITIES

China and India have enjoyed significant economic with poverty reduction rates of 1.51 percent. During the
growth in recent years. Between 1990 and 2017, the same period, India had an income elasticity of poverty
two countries had an average GDP per capita growth of only 0.4.
rate of 8.6 percent and 4.5 percent, respectively.1 Regarding hunger and malnutrition, the PoU
However, the effects of growth within each country decreased from 15.9 percent in 2002–2004 to
have been different. 8.8 percent in 2015–2017 in China, compared
The figure below shows that in both countries the with a decrease from 22.2 percent in 2002–2004
increase in GDP per capita has been accompanied to 14.8 percent in 2015–2017 in India. Stunting in
by poverty reduction. China’s poverty rate declined children under five years of age fell from 17.8 percent
from 88 percent in 1981 to 0.7 percent in 2015. in 2000 to 8.1 percent in 2013 in China. In India, it
In comparison, India’s poverty reduction seems fell from 54.2 percent to 38.4 percent between 2000
relatively more modest1 − moving from 48.9 percent in and 2015, which is still a high prevalence, compared
1987 to 21.2 percent in 2011, or to 13.4 percent in with a global average of 23.2 percent in 2015.1, 3
2015 if another World Bank source is used.2 For the The unique growth patterns and inequality levels
period 1999–2005, the income elasticity of poverty in each country may help explain the differences
in China was estimated at 1.51. This means that a observed in the countries in terms of poverty and food
1 percent increase in GDP per capita was associated security and nutrition trends:

DECREASING POVERTY HEADCOUNT RATIO AND RAISING GDP PER CAPITA


IN CHINA AND INDIA (1981–2015)

100 7 000

6 000
POVERTY HEADCOUNT RATIO (%)

80
5 000
REAL GDP PER CAPITA

60 4 000

3 000
40
2 000
20
1 000

0 0
1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009 2011 2013 2015

China poverty headcount ratio India poverty headcount ratio


China real GDP per capita India real GDP per capita

NOTES: Poverty headcount ratio in China and India (left axis) refers to USD 1.90 a day (2011 PPP); GDP per capita (right axis) is expressed in constant USD 2010.
SOURCE: FAO elaboration based on World Bank. 2019. PovcalNet: an online analysis tool for global poverty monitoring. In: World Bank [online]. Washington, DC.
[Cited 9 February 2019]. http://iresearch.worldbank.org/PovcalNet/home.aspx.

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THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2019

BOX 13
(CONTINUED)

a. The pattern of economic growth in China, the Gini coefficient for urban and rural areas in
especially in the 1980s, shows that the primary 1983–84 was 24.7 and 18.5, respectively, in
sector, where most of the poor derive their China, compared with 30.0 in urban areas and
livelihoods, was one of the most dynamic 33.3 in rural areas in India. 7
sectors behind GDP growth. On the other hand, c. Finally, different initial conditions in human
in India the rate of growth has been higher development also played an important role.
in the industrial and services sectors than in Health and education standards were much
agriculture. 4 better in China in the 1980s than they were in
b. The responsiveness of poverty reduction to India. 8 In 1980, China had 2.2 hospital beds
growth is generally higher when initial inequality per 1 000 people compared with 0.8 in India.
is lower. This seems to have been the case for This number increased to 3.8 in 2011, while it
income inequality in China, where in 1983 the decreased to 0.7 in India. Differences in literacy
Gini coefficient was 28.3. In India, the Gini rates were also important. Only in 2011 India
coefficient that year was 31.5. 5 At the same time, was able to reach the levels of literacy that
land was much more equally allocated in China China had in 1982, amounting to more than
than in India during the 1980s. 6 Furthermore, 65 percent.9

1
World Bank. 2019. World Development Indicators. In: World Bank DataBank [online]. Washington, DC. [Cited 10 February 2019]. https://databank.worldbank.org
2
World Bank. 2019. Poverty & Equity Brief – India. April 2019 [online]. Washington, DC. [Cited 16 May 2019]. https://databank.worldbank.org/data/download/poverty/33EF03BB-
9722-4AE2-ABC7-AA2972D68AFE/Global_POVEQ_IND.pdf
3
FAO. 2019. FAOSTAT. In: FAO [online]. Rome. [Cited 8 February 2019]. www.fao.org/faostat/en/#home; FAO, IFAD, UNICEF, WFP and WHO. 2018. The State of Food Security and
Nutrition in the World 2018. Building climate resilience for food security and nutrition. Rome, FAO.
4
Agricultural growth is three times as effective in reducing extreme poverty as growth in other sectors. L. Christiaensen, L. Demery and J. Kuhl. 2011. The (evolving) role of agriculture
in poverty reduction—an empirical perspective. Journal of Development Economics, 96 (2): 239–254; M. Ravallion. 2009. A comparative perspective on poverty reduction in Brazil,
China and India. Policy Research Working Paper 5080 [online]. Washington, DC, World Bank. [Cited 29 April 2019]. http://documents.worldbank.org/curated/
en/952341468218101551/pdf/WPS5080.pdf; I.S. Gill, A. Revenga and C. Zeballos. 2016. Grow, invest, insure: a game plan to end extreme poverty by 2030. Policy Research Working
Paper 7892 [online]. Washington, DC, World Bank. [Cited 29 April 2019]. http://documents.worldbank.org/curated/en/924111479240600559/pdf/WPS7892.pdf
5
United Nations University-World Institute for Development (UNU-WIDER). 2019. UNU-WIDER, World Income Inequality Database (WIID4). In: UNU-WIDER [online]. Helsinki
[Cited 20 March 2019]. https://www.wider.unu.edu/database/world-income-inequality-database-wiid4
6
M. Ravallion. 2009. A comparative perspective on poverty reduction in Brazil, China and India. Policy Research Working Paper 5080 [online]. Washington, DC, World Bank.
[Cited 29 April 2019]. http://documents.worldbank.org/curated/en/952341468218101551/pdf/WPS5080.pdf
7
World Bank. 2019. PovcalNet: an online analysis tool for global poverty monitoring. In: The World Bank [online]. Washington, DC. [Cited 9 February 2019].
http://iresearch.worldbank.org/PovcalNet/home.aspx
8
I.S. Gill, A. Revenga and C. Zeballos. 2016. Grow, invest, insure: a game plan to end extreme poverty by 2030. Policy Research Working Paper 7892 [online]. Washington, DC,
World Bank. [Cited 29 April 2019]. http://documents.worldbank.org/curated/en/924111479240600559/pdf/WPS7892.pdf
9
World Bank. 2019. PovcalNet: an online analysis tool for global poverty monitoring. In The World Bank [online]. Washington, DC [Cited 9 February 2019].
http://iresearch.worldbank.org/PovcalNet/home.aspx

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PART 2 SUSTAINED ESCAPES FROM FOOD INSECURITY AND MALNUTRITION

» One study found that a fall in income inequalit y, The relationships between economic growth
as measured by the Gini coefficient from and child stunting can also differ by region.
0.55 to 0.45, would cause povert y to drop by For example, cross-countr y time series data
more than 15 percentage points in ten years. suggest that the relationship is weaker in
However, it would take 30 years to achieve the sub-Saharan Africa than in other regions.111
same reduction in povert y if inequalit y remained For Africa as a whole, other variables such as
unchanged.105 maternal education, socio-economic status and
poor maternal nutrition are more important in
Economic growth, food security and nutrition explaining the slow progress in reducing child
The relationship between economic growth undernutrition.112
and food securit y and nutrition has important
policy implications. These involve pro-poor Not only can economic growth affect child
growth strategies to reduce hunger and child stunting, but the reverse may occur.113 A new
malnutrition, as well as the need for direct study finds that a 10 percent increase in GDP
food securit y and nutritional investments. per capita would reduce stunting prevalence
By extension, the implications also affect how by 2.7 percent. However, the reverse causalit y
limited financial resources are competitively impacts of stunting on current growth estimate
allocated between different t ypes of investments. that a one percentage point increase in stunting
prevalence would result in a 0.4 percent
How does economic growth contribute decrease in current GDP per capita. The study’s
to nutrition? back-of-the-envelope calculation suggests that
The relationship between increased national stunting costs on average about 13.5 percent of
income (GDP per capita) and nutrition works GDP per capita in developing countries.114
through two complementar y channels. If these recent findings on the negative reverse
When economic growth stimulates average causalit y are correct, it implies that the results of
incomes, populations may spend a larger part earlier studies could be biased downwards and
of their incomes on healthy, nutrition-relevant overstate the actual impact of economic growth
goods and ser vices. Increased GDP may also towards child stunting reductions.
boost state provision of nutrition-relevant
ser vices as well as social and health Despite the debate on the magnitude of
infrastructure – if governments use newly effects, it is clear that while economic growth
generated tax revenues to invest in them. contributes to improvements in child nutrition,
it does so only modestly and is not sufficient in
The role of economic growth in reducing many settings to accelerate reductions in child
child undernutrition remains a highly undernutrition. What matters most is addressing
debated issue. For example, there is extensive other causes of undernutrition, including
empirical evidence that economic growth and access to nutritious foods for a healthy diet,
child stunting are negatively correlated (i.e. improvement in women’s status and education,
the higher the economic growth, the lower feeding and care practices and qualit y health
the child stunting). However, evidence on the ser vices. This requires implementation of
magnitude of this relationship varies across nutrition-specific policies and inter ventions with
studies.106 One study finds a prominent role for a focus on v ulnerable populations, regardless of
economic growth, in which a 10 percent increase whether there is economic growth.115
in GDP per capita would lead to a 6 percent
reduction in child stunting prevalence.107 As for obesit y and overweight, their relationship
While this is in line with the findings of several with economic growth is less clear-cut due to
studies,108 others find that child stunting the paucit y of research. However, evidence does
would be decreased even more, for example suggest that the relationship varies depending on
by 7.3 percent.109 In contrast, still others find the income setting of the countr y. For example,
the relationship to be much weaker or even a study using data from 175 countries found a
nonexistent.110 positive relationship between body weight and
GDP per capita growth. Sevent y-two countries

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THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2019

where GDP was below USD 3 000 showed reconfirmed a negative relationship between
a significantly positive linear relationship GDP per capita and severe food insecurit y.120
between the body mass index (BMI) and GDP,
whereas 102 countries where GDP was above An FAO analysis found that the relationship
USD 3 000 showed no significant relationship between GDP per capita and undernourishment
between the two.116 Clearly, income growth (as measured by the prevalence) was also
alone does not necessarily g uarantee healthier negative. However, it was highly nonlinear,
diets and improved nutritional status; other meaning that the relationship became
policies, for example those that create healthy progressively weaker at higher levels of
food environments and facilitate and promote development. The most recent data show that the
physically active lives, among others, are strength of the relationship decreases sharply up
also needed. to USD 2 000 per capita in constant prices, which
is within the lower-middle-income categor y
How does economic growth contribute to (countries with income of USD 996 –3 895 per
food security? capita). In other words, economic growth is more
There is even less empirical evidence on effective in reducing the PoU in low-income
the links between economic growth and countries; as the level of a countr y’s GDP per
food securit y, partially due to the lack of capita rises, the effect weakens. Most of the
common food-insecurit y measures and data. world’s hungr y, however, live in middle-income
Empirical analysis is increasingly common, countries (see next section). So the potential
however, given the development of the Food contributions of economic growth to ending
Insecurit y Experience Scale (FIES) by FAO hunger are weaker than expected.
and with the newly available FIES panel
data (for more details about FIES see Part 1). Poverty reduction and food security and nutrition
Recent studies provide consistent results and It is commonly understood that povert y goes
an important first indication of the relationship, hand in hand with hunger and malnutrition.
although evidence is not conclusive and more Povert y is indeed one of the underlying causes of
research is required. food insecurit y and malnutrition. However, they
do not always move in unison, and in some cases
The results generally confirm that with increases they diverge from what is expected. Investigating
in economic growth, there are concurrent declines why this is the case is critical for eradicating food
in severe food insecurity. However, similar to insecurit y and malnutrition.
child stunting, the magnitude of this relationship
varies across countries. In this case, it varies by The relationship between povert y, food
income level and the degree of income inequality securit y and nutrition is also bidirectional,
of the country.117 meaning that food securit y and nutrition are
both determinants and dimensions of povert y.
One recent study for Latin America and the Food insecurit y, poor health and malnutrition
Caribbean finds that a 10 percent increase in a are often reasons why households end up
countr y’s GDP per capita lowered the likelihood in povert y or sink further into it, if they are
of moderate and severe food insecurit y by already poor.121
11.5 percentage points and severe food insecurit y
by 9.7 percentage points.118 Another study of One reason is that povert y, food insecurit y
134 countries also finds the same negative and malnutrition are distinct and multifaceted
relationship, but with much smaller effects and phenomena.122 Not all people who are food
with statistically significant results only for insecure and malnourished necessarily live
low- and high-income countries.119 in the poorest households. This is especially
so when the problems of food insecurit y and
To complement these two studies, a new FAO malnutrition are greater. Additionally, povert y
analysis was conducted for this report, using reduction may not necessarily translate into
newly available cross-countr y FIES panel data for better food securit y and nutrition due to
75 low- and middle-income countries. The results existing inequalities.

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PART 2 SUSTAINED ESCAPES FROM FOOD INSECURITY AND MALNUTRITION

By definition, extreme povert y is the lack to food, health and nutrition v ulnerable to
of sufficient income to meet basic dietar y economic shocks.
needs. It affects the abilit y of individuals and
households to access healthy, nutritious foods In addition to income variabilit y, access to food
that constitute a healthy diet through purchase is also conditioned by people’s awareness and
or production, and is linked to minimal or knowledge of food qualit y, as well as other
inadequate access to essential health ser vices. factors that can cause significant differences
when it comes to malnutrition among members
The World Bank defines extreme povert y as of households at similar levels of povert y.
living on less than USD 1.90 per day, which Other factors include diverse consumption and
generally ref lects the cost of enough dietar y intra-household distribution patterns, dietar y
energ y and other essentials to meet basic needs. habits, climate conditions and cultural factors.124
This is a ver y low povert y threshold, as it is There is also an array of public policies that can
estimated based on the average of the national significantly affect non-income-based access to
povert y lines of 15 ver y poor countries, adjusted food and utilization of food, and access to basic
for inf lation using 2011 prices and taking into health and social ser vices critical to nutrition, as
account differences in prices across countries outlined in the ICN2 Framework for Action.125
(i.e. purchasing power parit y – PPP). The main
purpose is to help obtain a measure of extreme At the household level, there is clear evidence
povert y comparable across countries. that low levels of household income and
household wealth are associated with different
Higher levels of extreme povert y as defined by forms of malnutrition. For example, the poorest
the World Bank are correlated with higher rates children are 2.26 times more likely to be
of undernourishment as measured by the PoU, stunted than the richest children. However, the
and higher rates of child stunting at the countr y extent of the income inequalit y in stunting
level, with the latter relationship being nonlinear varies considerably. For example, there is an
(Figure 31). The correlation coefficient between elevenfold difference between the richest and
extreme povert y and undernourishment is 0.68, the poorest children in Peru, and more than
and it is 0.62 between extreme povert y and child fivefold differences in Bolivia (Plurinational
stunting. This indicates a moderate-to-strong State of ), Gabon, Honduras and Jordan.126
correlation between povert y and these two Other multi-countr y studies confirm that
measures of food securit y and nutrition. stunting prevalence is higher in households
with lower wealth and income.127 Countr y data
Povert y explains around half of the obser ved from Cambodia,128 Colombia,129 India,130 and
variation in undernourishment and child stunting Pakistan131 find a similar pattern.
(i.e. R-squared of 0.50 and 0.57 for PoU and child
stunting, respectively). However, there are also While the analysis of selected countr y microdata
a number of countries where undernourishment also confirms that higher levels of child
and child stunting are higher than predicted stunting are found in the poorest households,
by extreme povert y (countries above the line in it also shows that not all stunted children live
Figure 31) and countries that have lower levels than in the poorest households. In some countries
predicted by extreme povert y (countries below this number can be quite large (Figure 32).
the line in Figure 31). For example, a recent study of 30 countries in
sub-Saharan Africa found that around 75 percent
Beyond the absolute levels of income or povert y, of underweight women and children were not
variabilit y of income is critical and is often one in the poorest 20 percent of households, and
of the main causes of food insecurit y.123 Income around half were not in the poorest 40 percent of
variabilit y, even within the same year, can have a households.132 The study also found that a larger
significant impact on food access. It is caused by share of undernourished people are members
a convergence of factors, such as weather-related of non-poor families in countries with a higher
shocks, that limit households’ abilit y to smooth overall incidence of undernutrition. »
consumption over time, rendering access

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THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2019
FIGURE 31
PREVALENCE OF UNDERNOURISHMENT (PoU) AND CHILD STUNTING RATES ARE CORRELATED
WITH EXTREME POVERTY AT THE COUNTRY LEVEL

A) RATIO BETWEEN EXTREME POVERTY AND PoU


4
ZIMBABWE HAITI ZAMBIA
CONGO UGANDA
MADAGASCAR
YEMEN CHAD LIBERIA RWANDA
IRAQ SAINT LUCIA
NAMIBIA BOTSWANA TIMOR-LESTE KENYA
BOLIVIA UNITED REPUBLIC
PAKISTAN (PLURINATIONAL STATE OF) COMOROS OF TANZANIA
DJIBOUTI
3
BHUTAN GUATEMALA MALAWI
MONGOLIA NICARAGUA
JORDAN PARAGUAY PHILIPPINES TOGO
LESOTHO
DOMINICAN REPUBLIC
LEBANON WEST BANK AND GAZA GABON CAMEROON SENEGAL
VIET NAM
NEPAL BENIN
CHINA SRI LANKA PERU
SOLOMON
PoU (LOG)

KYRGYZSTAN EL SALVADOR VANUATU


THAILAND ISLANDS SAO TOME
2 AND PRINCIPE
MAURITIUS
SERBIA SOUTH
COLOMBIA GHANA AFRICA
TONGA MEXICO
FIJI NORTH MACEDONIA
MOROCCO BULGARIA TUVALU
SAMOA BRAZIL
KAZAKHSTAN MICRONESIA
(FEDERATED STATES OF)
1
REPUBLIC OF MOLDOVA
BELARUS BOSNIA AND HERZEGOVINA

RUSSIAN FEDERATION
MONTENEGRO
ROMANIA
TURKEY
0
0 1 2 3 4

Log PoU Fitted line EXTREME POVERTY (LOG) R-squared = 0.50

B) RATIO BETWEEN EXTREME POVERTY AND STUNTING PREVALENCE


BURUNDI
4
GUATEMALA YEMEN TIMOR-LESTE
NIGER
PAKISTAN INDONESIA BANGLADESH INDIA
PHILIPPINES ETHIOPIA
NAMIBIA NEPAL
MYANMAR GUINEA-BISSAU
KENYA
VIET NAM MAURITANIA VANUATU
CÔTE D'IVOIRE CONGO TOGO
MALAYSIA EGYPT HAITI LESOTHO
3 BURKINA FASO
GHANA
SRI LANKA SAO TOME
BOLIVIA AND PRINCIPE SENEGAL
PERU (PLURINATIONAL STATE OF)

MEXICO
STUNTING (LOG)

CHINA ARMENIA
2
MONGOLIA ECUADOR DOMINICAN REPUBLIC
SERBIA PARAGUAY
SAMOA

0
0 1 2 3 4

Log stunting 2018 Fitted line EXTREME POVERTY (LOG) R-squared = 0.57

NOTES: Correlation analysis between prevalence of undernourishment and extreme poverty (graph A) and child stunting and extreme poverty (graph B). Extreme poverty is measured by the Poverty
Headcount Ratio at USD 1.90 per day; child stunting for children under 5 years of age and prevalence of undernourishment (PoU) are measured in year 2018. Extreme poverty is measured in the latest
year available at country level between years 2010–2017. R-squared is 0.50 for the association between extreme poverty and the PoU, and 0.57 for the association between extreme poverty and child
stunting. Country names are not reported in the graph for countries that fall inside the 95 percent confidence interval (close to the fitted line), but a list of these countries is provided in Annex 3. The
Former Yugoslav Republic of Macedonia is now officially called North Macedonia. West Bank and Gaza is a territory and follows the World Bank classification.
SOURCES: For poverty data, World Bank. 2019. World Development Indicators. In: World Bank DataBank [online]. Washington, DC. [Cited 9 May 2019]. https://databank.worldbank.org. For child
stunting and PoU, see Annex 1A.

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PART 2 SUSTAINED ESCAPES FROM FOOD INSECURITY AND MALNUTRITION

FIGURE 32
HIGH LEVELS OF CHILD STUNTING ARE NOT ONLY FOUND IN THE POOREST HOUSEHOLDS
PREVALENCE OF CHILDHOOD STUNTING IN CHILDREN YOUNGER THAN 5 YEARS (%)

70

60

50

40

30

20

10

0
BURUNDI (2010)

GUATEMALA (2015)

PAKISTAN (2013)

INDIA (2006)

NEPAL (2011)

NIGERIA (2013)

DEMOCRATIC REPUBLIC
OF THE CONGO (2014)

BANGLADESH (2014)

NIGER (2012)

MALAWI (2016)

SIERRA LEONE (2013)

BURKINA FASO (2015)

CHAD (2015)

KENYA (2014)

MOROCCO (2004)

HAITI (2012)

GHANA (2014)

COLOMBIA (2010)

JORDAN (2012)

DOMINICAN REPUBLIC
(2013)

Highest quintile Middle quintile Lowest quintile

NOTES: Prevalence of stunting in children under five, by household income, plotted with range of income quintile from highest to lowest. The year when stunting is available is indicated
in parentheses. Data are from the Demographics and Health Surveys (DHS) Program.
SOURCE: A. De la O Campos, C. Villani, B. Davis and M. Takagi. 2018. Ending extreme poverty in rural areas: sustaining livelihoods to leave no one behind. Rome, FAO.

» An important explanation of this finding is the child stunting, including child wasting,134
existence of intra-household inequality, which is low birthweight,135 anaemia in women,136
in line with evidence from a number of studies and diet-related non-communicable diseases
that find vulnerable individuals do not necessarily (NCDs).137
live in households that would normally be
considered poor. As such, they are hidden from Lastly, in unpacking the linkages between
view in standard data sources on poverty.133 povert y and food insecurit y and malnutrition,
it is important to keep in mind that povert y
There are numerous studies that find that low reduction does not ensure increased food
socio-economic status is negatively associated securit y, and even when it does happen,
with other nutrition-related indicators beyond increased food securit y does not necessarily

| 88 |
THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2019

imply improved nutritional status. Povert y or


food insecurit y and malnutrition are linked, FIGURE 33
but food securit y is only one underlying cause MOST OF THE WORLD’S EXTREME POOR NOW
of nutrition besides adequate care for children LIVE IN AFRICA, BUT THE MAJORITY OF THE
and women, and sufficient health ser vices and WORLD’S HUNGRY AND CHILDREN AFFECTED
a healthy environment. Therefore, the linkages
between food insecurit y and malnutrition may
BY STUNTING LIVE IN ASIA
be weak.
A) SHARE OF EXTREME POVERTY 0.36% 1.44%
For example, high-qualit y foods might not
be evenly distributed among household 2015
members, ref lecting intra-household inequalit y.
Households may not have access to basic
ser vices, such as adequate sanitation, safe 1990
drinking water and health care, which are
critical underlying determinants of food securit y 0% 20% 40% 60% 80% 100% 0.16% 0.19%
and nutrition. Adequate access to food and basic
ser vices often play a more important role in Africa Latin America and Asia Oceania Europe
the Caribbean
fighting hunger and delayed child growth and
other forms of malnutrition, despite economic
B) SHARE OF UNDERNOURISHMENT 0.26% 0.52%
growth and income.138

Evidence for the possible disconnect between 2015

povert y reduction and eradication of food


insecurit y and malnutrition has important policy
1990
implications, given that anti-povert y policies in
developing countries often assume that targeting
0% 20% 40% 60% 80% 100%
poor households will be reasonably effective in 0.11% 0.11%

reaching those who are malnourished. From a Africa Latin America and Asia Oceania Europe
policy perspective, the evidence suggests that the Caribbean
targeting relatively poor households will tend to
work less well than reaching v ulnerable women C) SHARE OF STUNTED CHILDREN 0.32%

and children in countries where the overall


problem of malnutrition is greater. 2015

Furthermore, most of the hungr y and


undernourished people today do not live in the 1990
world’s poorest countries. In 2017, more than
75 percent of the world’s hungr y, 78 percent 0% 20% 40% 60% 80% 100% 0.16%
of the stunted children and 64 percent of the
Africa Latin America and Asia Oceania
extreme poor lived in middle-income countries the Caribbean
– and only in a handful of these countries.139
Although the highest rates of povert y, hunger NOTES: Since the latest available data for extreme poverty are for 2015, for
and child stunting are t ypically found in comparability, the share of undernourished and stunted children are also taken
low-income countries, they do not make a from year 2015. The number of stunted children is not available for Europe.
SOURCES: World Bank. 2019. PovcalNet: an online analysis tool for global poverty
substantive contribution to the total number of
monitoring. In: The World Bank [online]. Washington, DC [Cited 9 May 2019].
extreme poor nor the hungr y in the world. http://iresearch.worldbank.org/PovcalNet/home.aspx for extreme poverty;
FAO for PoU; UNICEF, WHO and World Bank. 2019. UNICEF-WHO-The World Bank:
The geographical distribution of the number Joint child malnutrition estimates – Levels and trends (March 2019 edition) [online].
of extreme poor, undernourished and stunted https://data.unicef.org/topic/nutrition; www.who.int/nutgrowthdb/estimates;
https://data.worldbank.org for stunting.
children also show a different pattern (Figure 33).
The distribution of global extreme povert y has

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PART 2 SUSTAINED ESCAPES FROM FOOD INSECURITY AND MALNUTRITION

shifted dramatically from Asia to sub-Saharan Overweight and obesit y increase the risk of
Africa between 1990 and 2015. Most of the non-communicable diseases, which, in turn,
world’s hungr y and children affected by stunting can be linked to loss of income or earning
still live in Asia. potential due to illness as well as increased
healthcare costs.
Relationship between poverty, overweight
and obesity
Like other indicators, in the case of overweight
The role of inequalities and marginalization in
and obesit y, the relationship with povert y is not shaping food-security and nutrition outcomes
so clear and generally tends to var y depending on
the general income level of the countr y. It is clear from the evidence presented up until
now that economic growth alone is not sufficient
A systematic review of obesit y shows that the to reduce extreme povert y or improve food
association between socio-economic status securit y and nutrition. In most cases, the rate
and obesit y appears to be positive for both at which extreme povert y shrinks as growth
men and women in low-income countries. accelerates differs from countr y to countr y,
Those who are more aff luent or with higher given the initial level of income inequalit y in
educational attainment tend to be more likely to the countr y and changes in income inequalit y
be obese.140 On the other hand, more extensive over time.
evidence shows that in middle- and high-income
countries, overweight and obesit y are linked to Inequalit y, not only in the distribution of
lower socio-economic settings among women, income, but also in access to nutrition-relevant
with no association obser ved among men.141 ser vices and social and health infrastructure is
In middle-income countries, the association critical in understanding why economic growth
becomes largely mixed for men and mainly alone will not significantly reduce extreme
negative for women. Obesit y in children appears povert y or food insecurit y and malnutrition.
to be predominantly a problem of the rich in low- Income inequalit y itself can result not only in
and middle-income countries.142 undernutrition, but also overweight and obesit y,
as the higher costs of nutritious foods induces
The burden of obesit y tends to shift towards the poor to resort to cheap, energ y-dense and
poorer populations as countries move through nutrient-poor foods.
the nutrition transition.143 This shift towards
overweight and obesit y in people with lower Furthermore, inequalities within households
socio-economic status seems to be happening help explain why even when economic growth
faster in low-income countries than it did in translates into extreme povert y reduction, it
high-income countries.144 may not necessarily reduce food insecurit y
and malnutrition. Thus, reducing inequalit y
However, there are still inconsistencies in the plays an important role in reducing both
data on this issue. A meta-analysis of the data undernourishment and malnutrition.
from 62 scientific papers published between
1990 and 2015 concludes that the studies This is true at all times, not only for periods
that investigated the association between of economic boom. Inequalities are structural
socio-economic status and obesit y in children characteristics of countries that prevent the
point to ambig uous results.145 This meta-analysis most food-insecure and malnourished people
finds that children with lower socio-economic from being helped by economic growth,
status had higher risks of overweight and obesit y, but they also expose and make them more
but the risks did not seem to increase with the v ulnerable during periods of economic
income level of countries. Moreover, the inverse turmoil. In fact, evidence indicates that in
relationship – a higher risk of overweight and countries that have greater levels of inequalit y,
obesit y associated with higher socio-economic economic slowdowns and downturns have a
status – was found in high-income countries and disproportionately negative effect on food and
in more economically developed areas. nutrition securit y.146

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THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2019

This section looks more closely at the different However, when focusing only on low- and
forms of inequalit y and the evidence on how middle-income countries, the income
these inequalities work to shape outcomes distribution trend is mixed. In Figure 36, countries
of food securit y and nutrition. Five forms of above the line have seen an increase in
inequalit y are explored: income inequalit y, income inequalit y from 2000 to 2015, whereas
inequalities between rural and urban those below the line have seen a reduction.
populations, inequalities in asset distribution, Notably, several countries in Africa and Asia
marginalization and social exclusion, and have seen large increases in income inequalit y
intra-household inequalit y. over the last 15 years. Of the 78 countries shown
in the fig ure, 58 are high commodit y-dependent
It is important to acknowledge that any analysis countries. In 12 of these countries, income
on inequalit y is challenging, as there is a lack of inequalit y remained unchanged, while
data disaggregated by wealth quintile, gender, for 26 of these, inequalit y increased.
age, geography and disabilit y, which poses a More importantly, 20 out of these 26 are high
significant barrier to addressing inequalit y and commodit y-dependent countries.
tackling undernourishment and malnutrition
in marginalized groups.147 Data on prevalence Income inequalit y is shaped by the t y pe of
and national averages of undernourishment economic growth and the distribution of
and malnutrition are not sufficient to fully earnings from factor markets, particularly
understand and address these issues. those of labour and capital. Countries in Latin
America, where inequalit y remains high,
Inequality in income distribution implemented many reforms beginning in the
Income inequalit y is a defining issue of our 1990s to open up their economies and promote
time. It is also a cause of entrenched uncertaint y export-led growth. Costa Rica is an example
and v ulnerabilit y.148 A countr y experiences in the region of a countr y where the export
income inequalit y when not ever y member of sector was diversified. Interestingly, income
its population gets exactly the same share of the inequalit y rose in Costa Rica as a result of the
income the economy is generating. Although the skill intensit y of the new export sectors, which
world has made remarkable progress in reducing contributed to widening wage gaps.153
extreme povert y, income inequalit y remains
high. This means that most of the reduction in Income inequalit y also shapes the impact of
povert y has been achieved through increased economic growth. For instance, if economic
economic growth, not through reductions in growth is associated with rising income
income inequalit y.149 inequalit y (Kuznets cur ve),154 the poorest may
not benefit from increased national income.155
Income inequality has remained constant and The links between economic growth with
high over the last 15 years (Figure 34).150 As a region, increased average incomes and increased food
Latin America and the Caribbean shows the and nutrition securit y can be weaker than
most progress in reducing income inequality, but expected, especially if there are high levels of
still has the highest levels of inequality globally income inequalit y. In the context of economic
(Figure 34). Nonetheless, this overall progress in growth with high inequalit y, inequalities must
income distribution does not seem to be shown in be addressed to ensure a way out of hunger
the distribution of workers’ remuneration.151 and malnutrition (Box 14).

Measured by the shared prosperit y premium152 Income inequalit y shapes the impact of economic
– the difference between the annual income deceleration or contraction on food securit y
or consumption growth rate of the bottom and nutrition. In countries where inequalit y is
40 percent and the annual growth rate of the greater, economic slowdowns and downturns
mean in the economy – inequalit y is rising have a disproportionate effect on low-income
in nearly half of the countries in the world, populations in terms of food and nutrition
including many low- and middle-income securit y, since they use large portions of their
countries (Figure 35). income to buy food.

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PART 2 SUSTAINED ESCAPES FROM FOOD INSECURITY AND MALNUTRITION

FIGURE 34
HIGH AND PERSISTENT LEVELS OF INCOME INEQUALITY IN LOW- AND MIDDLE-INCOME COUNTRIES

A) GINI INDEX INCOME INEQUALITY – BY REGION

0.6

0.5

0.4

0.3

0.2

0.1

0
Africa Latin America Asia Oceania Europe
and the Caribbean
2000 2015

B) RATIO BETWEEN THE INCOME SHARE OF THE RICHEST AND THE POOREST 20% OF THE POPULATION – BY REGION

20

18

16

14

12

10

0
Africa Latin America Asia Oceania Europe
and the Caribbean
2000–2003 2012–2015

NOTES: Europe refers to low-income and middle-income countries in Eastern Europe. In particular, European countries include Albania, Belarus, Bosnia and Herzegovina, Bulgaria,
Montenegro, North Macedonia, Republic of Moldova, Romania, Russian Federation, Serbia and Ukraine.
SOURCES: World Bank. 2019. PovcalNet: an online analysis tool for global poverty monitoring. In: The World Bank [online]. Washington, DC. [Cited 9 May 2019].
http://iresearch.worldbank.org/PovcalNet/home.aspx for the Gini index, World Bank. 2019. World Development Indicators. In: World Bank DataBank [online]. Washington, DC.
[Cited 9 May 2019]. https://databank.worldbank.org for the income shares used to compute the ratios.

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THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2019

FIGURE 35
INCOME INEQUALITY IS RISING IN NEARLY HALF THE COUNTRIES OF THE WORLD,
INCLUDING IN SEVERAL LOW-INCOME COUNTRIES AND SOME MIDDLE-INCOME COUNTRIES

4
SHARED PROSPERITY PREMIUM (PERCENTAGE POINTS)

-1

-2

-3

-4

COUNTRIES ORDERED FROM LOWEST TO HIGHEST SHARED PROSPERITY PREMIUM

Low-income countries Lower-middle-income countries Upper-middle-income countries High-income countries

NOTES: Shared prosperity premium is defined as the difference in growth between the average consumption or income per capita (2011 PPP USD per day) of the bottom 40 percent of
the population, and the growth in income or consumption per capita of the mean population in a country. Since it is a difference between two growth rates, the shared prosperity
premium is expressed in percentage points. Data on shared prosperity premium are available for 93 countries in the period 2011–2016. A positive (negative) shared prosperity
premium means that the poorest 40 percent in a country are getting a larger (lower) share of the overall income.
SOURCE: World Bank. 2019. Global Database of Shared Prosperity. In: World Bank [online]. Washington, DC. [Cited 19 March 2019].
http://www.worldbank.org/en/topic/poverty/brief/global-database-of-shared-prosperity

Inequalit y increases the likelihood of severe in household income are highly correlated
food insecurit y, and this effect is 20 percent with a reduction in severe food insecurit y.
higher for low-income countries compared with Where there is high inequalit y, this effect is
middle-income countries. An FAO study for 75 almost three times more that of lower levels of
low- and middle-income countries finds that on inequalit y. A 10 percent increase in household
average countries with a high Gini coefficient income is associated with a 0.8 or 0.3 percentage
(higher than 0.35) have a 33 percentage point point lower likelihood of severe food insecurit y
higher probabilit y of experiencing severe food in countries with, respectively, high or
insecurit y.156 Indeed, the prevalence of severe lower inequalit y.
food insecurit y is almost three times higher
in countries with high income inequalit y Income and wealth inequalities are also closely
(21 percent) compared with countries with low associated with undernutrition, while more
income inequalit y (7 percent). complex inequalit y patterns are associated with
obesit y. Such inequalit y patterns associated
Moreover, the same FAO study finds that in with health conditions are seen in low- and
countries with high levels of inequalit y, increases middle-income countries. Economic inequalities

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PART 2 SUSTAINED ESCAPES FROM FOOD INSECURITY AND MALNUTRITION

FIGURE 36
SOME COUNTRIES HAVE REDUCED INCOME INEQUALITY, WHILE FOR OTHERS IT HAS WORSENED

SOUTH AFRICA

60
SURINAME
ZAMBIA

BELIZE
COLOMBIA
GUINEA-BISSAU BRAZIL
50 CONGO HONDURAS
TURKMENISTAN CAMEROON
BENIN COSTA RICA PARAGUAY
GUYANA CABO VERDE
TURKEY JAMAICA
DJIBOUTI VENEZUELA COMOROS BOLIVIA
(PLURINATIONAL STATE OF)
MADAGASCAR TOGO (BOLIVARIAN REPUBLIC OF) ECUADOR
GINI INDEX IN 2015 (%)

CHAD MEXICO
ZIMBABWE NIGERIA PERU
RUSSIAN MYANMAR PAPUA NEW GUINEA
FEDERATION DEMOCRATIC ANGOLA
VANUATU TUVALU CÔTE D'IVOIRE REPUBLIC OF HAITI
40 THE CONGO EL SALVADOR
KIRIBATI BHUTAN MICRONESIA
YEMEN MAURITIUS (FEDERATED STATES OF) DOMINICAN
INDONESIA TONGA SAMOA MALDIVES REPUBLIC
ROMANIA SUDAN FIJI SOLOMON ISLANDS
UZBEKISTAN THAILAND
TAJIKISTAN GEORGIA
BOSNIA AND HERZEGOVINA MONGOLIA INDIA
VIET NAM
NORTH MACEDONIA
CHINA
MONTENEGRO SYRIAN ARAB REPUBLIC
LEBANON ARMENIA
30 ALBANIA
IRAQ
WEST BANK AND GAZA
KYRGYZSTAN SERBIA
AZERBAIJAN
KAZAKHSTAN REPUBLIC OF MOLDOVA
UKRAINE BELARUS

20
20 30 40 50 60

GINI INDEX IN 2000 (%)

Africa Asia Europe Latin America and the Caribbean Oceania

NOTES: As the Gini index is not available for all countries for all years, data available for 1996–2002, and for 2011–2015 are used to inform on Gini index in the past (2000) and on
Gini index in recent years (2015), respectively. Only countries for which the Gini index is available in both the periods are used (total of 78 low- and middle-income countries, according
to the World Bank classification of country income in 2017). Europe refers to the following low- and middle-income countries: Albania, Belarus, Bosnia and Herzegovina, Montenegro,
North Macedonia, Republic of Moldova, Romania, Russian Federation, Serbia and Ukraine. West Bank and Gaza is a territory that follows the World Bank classification.
SOURCE: C. Holleman and V. Conti. (forthcoming). Role of income inequality in shaping outcomes on food insecurity. FAO Agricultural Development Economics Working Papers 19-06.
FAO. Rome.

play a significant role as lower levels of income Inequality in access to basic services – within and
compromise access to health, nutrition and between rural and urban areas
care. For example, in most countries, stunting Around 40 percent of the inequalit y in low- and
prevalence among children younger than lower-middle-income countries is due to the
five years of age is about 2.5 times higher in the gap in living standards between rural and urban
lowest wealth quintile compared with the highest populations,158 with the standards being lower for
wealth quintile.157 Moreover, within countries, people living in rural areas. Around two-thirds of
there are also substantial inequalities between the world’s poor live in rural areas with an even
regions and population subgroups. higher share in low-income countries.159 »

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THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2019

BOX 14
ADDRESSING INEQUALITY IN THE CONTEXT OF ECONOMIC GROWTH IN BRAZIL –
A WAY OUT OF HUNGER AND MALNUTRITION

Brazil’s high and persistent inequalities in income and considerable progress in reducing stunting, obesity
in access to basic services such as education and rates remained high and continue to climb.
health care are well known. However, in the 2000s The increase in household income combined with
inequality declined substantially, while the economy strong and coordinated social, education, health
grew at an annual rate of 3.2 percent between 1999 policies as well as policies favourable to the productive
and 2014.1 The Gini coefficient dropped from 59 in sectors have been key for poverty and inequality
1999 to 51 in 2014, and income grew substantially reduction during 2002–2014. Nearly two-thirds of
among the poorest. As a result, the reductions in the annual poverty reduction rate in the country could
poverty and inequality followed a similarly be explained by the effects of median-income growth,
impressively downward pattern during the 2000s especially up until 2008.4 The effect of coordinated
(figure below): 26.5 million Brazilians exited poverty policies was also important, especially when the
between 2004 and 2014. growth effect diminished.
The prevalence of undernourishment (PoU) was Among these policies, Fome Zero represented a key
reduced from 11.9 percent in 1999–2001 to less than initiative of the new Brazilian Government in 2003.
2.5 percent in 2008–2010.2 At the same time, the It transformed food security and nutrition into a crucial
rate of stunting for children under five years of age issue in the social and economic policy strategy,
was reduced by 6 percent per year between 1996 and also mainstreamed hunger eradication into the
and 2007, reaching 7.1 percent.3 While Brazil made political agenda.5

DECREASING POVERTY HEADCOUNT RATIO AND GINI INDEX IN BRAZIL (YEARS 1999–2015)

16 60

14 58

12
POVERTY HEADCOUNT RATIO (%)

56

10
GINI INDEX (%)

54
8
52
6

50
4

2 48

0 46
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Poverty headcount ratio Gini index

NOTES: Poverty headcount ratio in Brazil (left axis) refers to USD 1.90 a day (2011 PPP). Since data on the Gini index and extreme poverty are not available for
2000 and 2010, mean imputation is applied for these years using information on the year before and after. For instance, the Gini index in 2000 is the average of
the Gini index in 1999 and 2001.
SOURCE: FAO elaboration based on data from World Bank. 2019. PovcalNet: an online analysis tool for global poverty monitoring. In: The World Bank [online].
Washington, DC. [Cited 9 May 2019]. http://iresearch.worldbank.org/PovcalNet/home.aspx

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PART 2 SUSTAINED ESCAPES FROM FOOD INSECURITY AND MALNUTRITION

BOX 14
(CONTINUED)

Fome Zero and its successor, Brasil sem Miseria, of extreme poverty reduction and near 15 percent of
coordinated several programmes in diverse sectors: poverty reduction since 2004.8 Its distribution effect
cash transfers, school feeding, access to health, could explain between 1 percent and 1.5 percent of
family farming, productive inclusion and access the annual Gini coefficient reduction in the country.9
to water, housing and sanitation facilities, among Other policies directed specifically to rural populations
others.6 One of these is Bolsa Família, Brazil’s have been important for the observed poverty and
flagship conditional cash transfer (CCT) programme. inequality reduction process. For example, Brazil is
Between 2004 and 2014, Bolsa Familia increased one of the few countries of the LAC region that has
its expenditure from 0.29 percent to 0.46 percent of a non-contributive pension mechanism especially
annual GDP, and household coverage from 6.6 million designed towards rural populations – Previdência
to 14 million households.7 Rural. Several studies have shown the importance
It is estimated that the cash transfer component of of the programme for the income of vulnerable rural
Bolsa Familia has been responsible for 25 percent populations.10

1
World Bank. 2019. World Development Indicators. In: World Bank DataBank [online]. Washington, DC. [Cited 9 May 2019]. https://databank.worldbank.org
2
FAO. 2019. FAOSTAT. In: FAO [online]. Rome. [Cited 6 May 2019]. http://www.fao.org/faostat/en/#home
3
M. Keefe. 2016. Nutrition and equality: Brazil’s success in reducing stunting among the poorest. In IFPRI. 2016. Nourishing millions: Stories of change in nutrition, pp. 99–105.
Washington, DC.
4
Economic Commission for Latin America and the Caribbean (ECLAC). 2018. Panorama Social de América Latina 2017. Santiago de Chile.
5
C. Guerra Tomazini and C. Kerches da Silva Leite. 2016. Programa Fome Zero e o paradigma da segurança alimentar: ascensão e queda de uma coalizão? Revista de Sociologia e
Politica, 24(58): 13–30.
6
T. Campello, T. Falcão and P. Vieira da Costa. 2015. Brasil sin Miseria. Brasilia, Ministerio de Desarrollo Social y Combate al Hambre.
7
S. Cecchini and B. Atuesta. 2017. Programas de transferencias condicionadas en América Latina y el Caribe: Tendencias de cobertura e inversión. Santiago de Chile, ECLAC.
8
National poverty lines of R$ 89 and R$ 178 (2018), respectively.
9
P.H.G. Ferreira de Souza, R.G. Osorio, L.H. Paiva and S. Soares. 2018. Os efeitos do Programa Bolsa Família sobre a pobreza e a desigualdade: um balanço dos primeiros 15 anos.
In Silva, Falcão Tiago. 2018. Bolsa Família 15 anos (2003 – 2018), pp. 155–191. Brasilia, ENAP.
10
R.P. De Oliveira and J.R. De Aquino. 2017. A previdência rural e sua importância para as famílias pobres no nordeste: resultados de um estudo de caso no Rio Grande do Norte.
Revista Economica do Nordeste, 48(1): 115–130; G.D. Nunes Souto, C. Becker and A. Troian. 2018. Effects of rural social security in a settlement of agrarian reform: case study in
Santana do Livramento/RS. Brazilian Journal of Development, 4(6): 2876–2897.

» Despite recent progress, rural areas may compared to urban areas, according to joint
not always fully benefit from advances in W HO, UNICEF and World Bank global data on
national economic development and may malnutrition.161 Furthermore, according to a
experience lower levels of public investment in pooled data analysis from multiple countries,
infrastructure and poorer access to essential women in rural areas have an increased risk
ser vices, including qualit y health care, of anaemia compared with those living in
education, water and sanitation,160 which urban areas, especially among women with
negatively impacts people’s livelihoods, food lower socio-economic status.162 However, the
securit y and nutrition. differences in prevalence of overweight among
young children between urban and rural areas
Countr y-level data show that in many low- and are quite small, and the gap in adult obesit y rates
middle-income countries, the prevalence of between urban and rural areas is narrowing
stunting among children is higher in rural as (see Part 1 of this report).

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THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2019

Regarding feeding practices, research findings low- and middle-income countries, bringing
indicate that infants in rural areas have higher with it increased risk of overweight, obesit y and
levels of exclusive breastfeeding and continued diet-related diseases.172
breastfeeding for the first and second year than
their urban peers. However, the complementar y The poorest of the poor are, therefore, most
feeding practices are of poorer qualit y compared v ulnerable to economic slowdowns and
with those of urban areas. In urban areas, infants downturns whether they live in rural or urban
and young children are more likely to be fed with areas.173 Inclusive development policies aligned
more diverse and frequent meals.163 Alarmingly, across sectors, which address the v ulnerabilit y
only one out of ever y six children aged 6 –23 of the rural poor and protect and increase the
months in low- and middle-income rural and resilience of the poorest urban populations,
urban settings receives a minimum acceptable are needed. These are particularly important in
diet – i.e. one that meets both the minimum the face of economic slowdowns or downturns.
number of meals and minimum diet diversit y.164 They can protect the poor when public and
private expenditures in basic ser vices are cut
Inequalities in accessing basic ser vices due to lack of fiscal space. And they can protect
that are critical to eradicating hunger and the poor from undesirable coping strategies with
malnutrition are also seen within urban negative impacts on food securit y and nutrition,
areas. Massive rural-to-urban migration165 is as described in Section 2.2.
creating “hidden cities” of extreme poor urban
populations, including over 800 million people As has already been shown, during economic
living in slum conditions who are often not crises, access to health care often deteriorates,
accounted for in official statistics.166 These urban particularly for poorer population groups.174
poor are particularly v ulnerable to financial Government spending on publicly funded
crises or food price hikes.167 While urban health ser vices is often reduced in real terms,
populations enjoy better health on average, while healthcare demand tends to shift from
moving to or living in an urban area does not private to public ser vices because of the lower
necessarily g uarantee this health for ever yone, cost.175 Resource constraints during economic
and inequalities within urban populations are slowdowns and downturns may result in
growing. For example, rates of stunting among restricted access to health care, availabilit y,
the poorest urban populations can be as high cost and deterioration in the qualit y of ser vices
or even higher than rates among poor rural provided, especially among the poor and
children.168 One-third of the world’s stunted marginalized groups.176 These conditions are
children now live in urban areas.169 likely to disrupt treatment and subsequently
worsen disease outcomes.177
For poor urban households, food securit y
and nutrition are more dependent on families Economic downturns and slowdowns also
having cash to buy food and meet other needs affect access to education. During times of
than in poor rural households. This means that economic crisis, governments’ capacit y to
households rely on labour markets to provide fund education is often reduced, and families
jobs for family members with women often may be less able to invest in education. At the
dependent on employment in the informal sector. same time, resource constraints may negatively
Parents and other caregivers have to spend more impact the qualit y of education.178 Again, these
time outside home with potential consequences constraints disproportionately affect poor
for childcare and feeding.170 Furthermore, access and marginalized groups. Unless there are
to ser vices such as health care, safe water and contingency mechanisms and funds in place to
sanitation is unequal.171 Alarmingly, the nutrition reverse such effects on education, there may be
transition, which has seen shifts in consumption long-term effects on human capital and a higher
patterns from traditional foods that are often risk that children are taken out of school so that
more healthy to highly processed foods often they can contribute to a household’s income,
high in dietar y energ y, saturated fat, sugars and with consequences for their nutrition, as further
salt, is happening fastest in the urban areas of explained below.179

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PART 2 SUSTAINED ESCAPES FROM FOOD INSECURITY AND MALNUTRITION

Land-resource scarcit y and inequities are


growing, with poor and marginalized population
FIGURE 37 groups worldwide often having the least access
to land. They are confined to “povert y traps”
INEQUALITY IN THE DISTRIBUTION OF of marginal and degraded lands of poor qualit y
AGRICULTURAL LAND IS HIGH IN MANY soils, where they are v ulnerable to climate
COUNTRIES IN SUB-SAHARAN AFRICA variabilit y and have no secure tenure.181 Women,
for instance, make essential contributions to
agriculture in low-income countries; yet, they
have less access to productive resources and
0.7 opportunities than men.182
0.6
Even in the context of sub-Saharan Africa, where
0.5
arable land is relatively abundant as a whole
GINI INDEX

0.4 compared with other regions, data at the countr y


0.3 level reveal that the amount of suitable land per
rural inhabitant varies considerably, and that
0.2
about one-third of the countries have less than
0.1 one hectare of land suitable for agriculture.
0 Furthermore, recent data on inequalit y of land
distribution shows that surplus land in the region
ALGERIA
BOTSWANA
DEMOCRATIC REPUBLIC OF THE CONGO
EGYPT
ETHIOPIA
GUINEA
GUINEA-BISSAU
KENYA
LESOTHO
MALAWI
MOROCCO
MOZAMBIQUE
NAMIBIA
RWANDA
SENEGAL
SOUTH AFRICA
SWAZILAND (ESWATINI)
TOGO
TUNISIA
UGANDA
UNITED REPUBLIC OF TANZANIA
ZAMBIA

is not only concentrated within relatively few


countries, but that unequal distribution of land is
ver y high in many countries (Figure 37).183

Inequalit y in land ownership not only challenges


livelihoods, but also undermines the productive
capacit y of the population. One study found
NOTES: The figure reports the Gini index for land distribution, mostly referring to that less inequalit y in land ownership across
year 2000 or around.
SOURCE: N. Cuffaro and G. D’Agostino. 2017. Land inequality and growth:
agricultural populations, as opposed to inequalit y
meta-analysis and relevance for contemporary development in Africa. Working within the landholding class, has been associated
Paper n° 222 [online]. Rome, Università di Roma Tre. [Cited 5 May 2019]. with greater public provision of education.184
http://dipeco.uniroma3.it/db/docs/WP%20222.pdf
Women often have no securit y of tenure or access
to financial credit.185 They are disproportionately
represented among landless populations that
face food insecurit y and are unable to meet basic
Inequality in the distribution of productive assets needs. This often pushes them into wage farm
Evidence shows that equitable access to assets labour and endangers their livelihoods (Box 16).186
is a way through which economic progress for
ever yone can be enhanced.180 The greater the Like land access, water availabilit y affects the
inequalit y in asset distribution such as land, livelihoods of billions globally and contributes
water, capital, finance, education and health, to food securit y, nutrition and environmental
the more difficult it is for the poor to participate health.187 Inequalities in water access in terms
in economic growth processes. This then slows of availabilit y, access, safet y and sustainabilit y
the progress in reducing food insecurit y and are defined across geographical regions on
malnutrition. For example, poor people often the basis of gender, economic, political and
have little education, which prevents them from power relations, and thus work prominently
participating in labour markets that offer higher to the disadvantage of women, smallholder
wages. This in turn reduces the rate of overall farmers, indigenous communities and
economic growth, further harming the poor and pastoralists.188 Unfortunately, the multiple
challenging their food securit y and nutrition. linkages between water, land, soils, food and

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THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2019

inequalities are rarely addressed in policies and Although analyses are limited, data from
programmes for inclusive economic growth and more developed economies show that socially
sustainable development. disadvantaged groups are often at increased
risk of malnutrition. Evidence from several
Marginalization and social exclusion middle- and high-income countries suggests that
Social exclusion is a dynamic process embedded mothers from socially disadvantaged groups,
in unequal power relationships that operate including ethnic minorities and indigenous
across economic, political, social and cultural populations, have a higher risk of giving birth
dimensions. The economic dimension is to babies of low birthweight 193 and of being
defined by access to and distribution of affected by anaemia.194 Furthermore, in low-
material resources necessar y to sustain life. and lower-middle-income countries differences
The political dimension relates to power in rates of childhood overweight between
dynamics and unequal patterns of both formal ethnic groups have been obser ved.195 In some
rights and the conditions in which rights are high-income countries, rates of overweight and
exercised, including access to ser vices.189 obesit y among children and adolescents have
These dimensions also affect food securit y been rising faster in minorit y ethnic populations
and nutrition. living in low-income communities.196

Given this context, socially excluded and Inequality within households


marginalized groups – such as ethnic and Inequalities of social, political and economic
religious minorities, indigenous populations power are not only seen within societies as a
and people with disabilities – are likely to be whole, but also within households. They can
hit particularly hard by economic downturns. make economic events particularly beneficial for
These groups already have poorer access to some, but not for all members of the household.
resources and essential ser vices, and these
inequalities are likely to increase during At the household level, differential inequalities
economic crises.190 are determined by who has the power in
deciding, for example, what is consumed.197
Indigenous populations around the world, for “Bargaining-power” models within households
example, are often affected by poor food securit y suggest that incomes are rarely pooled
and nutrition. They frequently live in extreme together.198 Consequently, gender inequalities
povert y and in environments that have been and power struggles tend to exacerbate povert y
damaged; or they have lost their land and no and deprivation of food and nutritional securit y
longer have access to traditional food sources. during periods of economic slowdown or
As a result, they are particularly exposed to downturn. Such intra-household inequalities
different t ypes of shocks, including climate and often affect children negatively, depending on
economic shocks (Box 15). factors like gender, age, birth order, and mother’s
socio-economic status.199
Minorit y ethnic groups are often at higher risk
of different forms of malnutrition. Children in The allocation of food can be severely constrained
most disadvantaged ethnic groups in low- and during economic slowdowns and downturns and
lower-middle-income countries have on average this can be particularly challenging for some
2.8 times the rate of stunting and six times members of the household. More generally, while
the rate of wasting compared with their more no systematic bias at the global level has been
advantaged peers, although the disparities are obser ved towards one specific age or sex group
much higher in some countries. Additionally, within a household concerning intra-household
ethnic disparities appear to be increasing in food distribution, 200 wide consensus posits that
many countries.191 People living with a disabilit y women are disadvantaged in the allocation
are also often more v ulnerable to food insecurit y of food (Box 16). Also, pregnant women tend
and malnutrition, and this relationship is to receive relatively lower allocations, with
bidirectional through poor living conditions and likelihood of serious consequences for their own
lack of access to health ser vices.192 and their child’s nutritional status. 201 Moreover, »

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PART 2 SUSTAINED ESCAPES FROM FOOD INSECURITY AND MALNUTRITION
BOX 15
INCREASING OPPORTUNITIES FOR INDIGENOUS POPULATIONS IS KEY TO NURTURING
THEIR DIETARY DIVERSITY

Indigenous peoples are disproportionately represented development, they have been able to maintain
among food-insecure and hungry populations.1 For biodiversity on these lands over millennia, which
instance, Native Americans in the United States of is central to their livelihoods and natural resource
America are at least twice as likely to be food management strategies.9
insecure as non-Native Americans.2 In Guatemala, Indigenous peoples’ traditional food systems
indigenous children aged below five are twice as involve the production of diverse foods with minimal
likely to be stunted compared to non-indigenous negative impact to the environment. These systems
children.3 Similarly, indigenous peoples are are anchored in sustainable livelihood practices,
disproportionately affected by the prevalence of adapted to ecosystems of their territories, and are
poverty. Despite their contributions to economic rooted in biodiversity conservation which ensures
empowerment and social development, indigenous adequate dietary diversity.10 Many neglected and
women often face marginalization and discrimination underutilized species that they cultivate are nutrient
even within their own communities.4 While indigenous dense, functional foods, rich source of micronutrients,
peoples represent 5 percent of the world's population, and have an untapped livelihood and nutritional
they represent 15 percent of the world's poor.5 In potential. For instance, Marula, native in Southern
Ecuador, while the national poverty rate was and Eastern Africa, provides four times the content
30 percent in 2012, it was at 60 percent for the of vitamin C contained in an orange. Marula has
indigenous peoples.6 been promoted as a sustainable plant food for rural
The prevalent loss of control over their territories development.11 Indigenous peoples’ traditional farming
and resources have left indigenous peoples practices including diversification of land use, crop
impoverished in many countries. Resource-extracting rotations and crop diversification supports adaption to
development models pose threats to their lands,7 climate change. Their diets from foods harvested from
especially in the absence of documented land rights forests to nutrient rich local fish, are diversified and
and tenure security. Recent changes in economic suited to the local environments, and are a response
conditions, climate and access to natural resources to malnutrition.
have adversely affected their livelihood strategies, Greater attention to address the inequalities that
which further exacerbates the prevalence of poverty, prevent harnessing the knowledge and nurturing
food insecurity and hunger among these groups. indigenous peoples’ traditional food systems, including
Indigenous peoples’ territories cover about through increased access through the natural resources
22 percent of the global surface and contain they rely upon, will facilitate making their dietary
80 percent of the world’s biodiversity.8 Because their diversity more sustainable in the face of economic and
lands and territories have not been subject to intensive climate shocks.

1
I. Anderson, B. Robson, M. Connolly, F. Al-Yaman, E. Bjertness, A. King, M. Tynan et.al. 2016. Indigenous and tribal peoples’ health (The Lancet-Lowitja Institute Global Collaboration):
a population study. The Lancet, 388(10040): 131–157; S. Lemke and T. Delormier. 2017. Indigenous peoples’ food systems, nutrition, and gender: conceptual and methodological
considerations. Maternal & Child Nutrition, 13: e12499.
2
C. Gundersen. 2007. Measuring the extent, depth, and severity of food insecurity: an application to American Indians in the USA. Journal of Population Economics, 21(1): 191–215.
3
S. Fukuda-Parr. 2016. Re-framing food security as if gender equality and sustainability mattered. In M. Leach, ed. Gender equality and sustainable development, pp. 82–104.
London, Routledge; New York, USA, Taylor & Francis Group.
4
UN. 2010. Gender and indigenous peoples [online]. New York, USA. [Cited 6 May 2019]. https://www.un.org/esa/socdev/unpfii/documents/Briefing%20Notes%20Gender%20
and%20Indigenous%20Women.pdf
5
H.V. Kuhnlein. 2017. Gender roles, food system biodiversity, and food security in indigenous peoples’ communities. Maternal & Child Nutrition, 13: e12529.
6
L. Cord, M.E. Genoni and C. Rodríguez-Castelán, eds. 2015. Shared prosperity and poverty eradication in Latin America and the Caribbean. Washington, DC, World Bank.
7
Economic Commission for Latin America and the Caribbean (ECLAC). 2014. Guaranteeing indigenous people’s rights in Latin America: Progress in the past decade and remaining
challenges. Summary. Santiago de Chile.
8
C. Sobrevila. 2008. The role of indigenous peoples in biodiversity conservation: the natural but often forgotten partners. Washington, DC, World Bank.
9
A. Kelles-Viitanen. 2008. Custodians of culture and biodiversity: Indigenous peoples take charge of their challenges and opportunities. Rome, IFAD.
10
IFAD. 2015. Second global meeting of the Indigenous Peoples’ Forum at IFAD. In: IFAD [online]. Rome. [Cited 24 April 2019]. https://www.ifad.org/en/web/latest/event/
asset/39008834
11
R. Wynberg, J. Cribbins, R. Leakey, C. Lombard, M. Mander, S. Shackleton and C. Sullivan. 2002. Knowledge on Sclerocarya birrea subsp. caffra with emphasis on its importance as a
non-timber forest product in South and southern Africa: a summary. Part 2: Commercial use, tenure and policy, domestication, intellectual property rights and benefit-sharin.
The Southern African Forestry Journal, 196(1): 67–77.

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THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2019
BOX 16
GENDER DIMENSIONS OF INEQUALITY IN AGRICULTURE AND RURAL AREAS

Women play an indispensable role in on-farm and women face greater difficulty than men accessing
off-farm activities, particularly in rural areas, which agricultural labour and formal financial services.2
contribute to economic welfare and food security of Agricultural production outcomes also differ greatly
their households. Approximately 43 percent of the between men and women. There is evidence that
global agricultural workforce is made up of women.1 the gaps in agricultural productivity between women
The contribution of women to labour in African and men with similar-sized plots in a similar context
agriculture is regularly quoted in the range of range from 23 percent in United Republic of Tanzania,
60–80 percent. Using individual, plot-level labour 24 percent in Ethiopia, 25 percent in Malawi,
input data from nationally representative household 33 percent in Uganda, and to 66 percent in the
surveys across six sub-Saharan African countries, Niger.5 Traditional roles also require women to spend
recent evidence2 challenges the conventional wisdom significant amounts of time on household chores and in
by estimating the average female labour share in crop caring for infants and young children, which limits their
production at 40 percent. The evidence shows that this participation in income-generating opportunities that
share was slightly above 50 percent in Malawi, arise when economies grow.6 In developing countries,
Uganda and United Republic of Tanzania, and estimates indicate that women spend three hours more
substantially lower in Nigeria (37 percent), Ethiopia per day on unpaid work than men.2 Finally, when
(29 percent) and the Niger (24 percent). rural women migrate in search of greater employment
The agricultural productivity of women has direct opportunities, they often face barriers seeking decent
implications on income as well as on the food security work, training opportunities, assets and personal safety.7
of their households. Evidence suggests that increased However, narrowing the gender dimensions
income for women is associated with greater food of inequality goes beyond strengthening women's
consumption and improved nutritional status of economic opportunities and decision-making capacities
household members.3 in groups and organizations. It also requires an
As economies grow and transform, new in-depth understanding of intra-household dynamics
opportunities emerge for rural populations. where, in some parts of the world, men and women
Improved infrastructure and services, increased access within the same household pursue separate livelihood
to education, information, credit, technology, technical strategies. While women are typically disadvantaged
skills as well as improved access to agricultural in terms of access to resources, services and markets,
value chains and markets open up new economic and burdened by more onerous daily tasks, they
opportunities for both men and women. However, the also lack a voice in determining household priorities,
extent to which women and men are able to benefit spending patterns and distribution of benefits.
from these growing opportunities differs.4 Women often This includes gender inequalities in intra-household
face greater challenges in accessing input factors (i.e. food allocation, which can result in a gender gap
land, labour and financial services). For instance, less in food and nutrition security.8 Consequently, what
than 5 percent of women in North Africa and West happens inside the family has substantial implications
Asia are agricultural landholders. In sub-Saharan not only for individual motivation and well-being, but
Africa, the proportion of women holding agricultural also for productivity and investments in agriculture and
land ranges widely from less than 5 percent in Mali up rural development, and more importantly for food and
to 30 percent in Botswana and Malawi.1 Further, many nutrition security within the household.

1
FAO. 2011. The State of Food and Agriculture 2010–11. Women in agriculture, closing the gender gap for development. Rome.
2
A. Palacios-Lopez, L. Christiaensen and T. Kilic. 2017. How much of the labor in African agriculture is provided by women? Food Policy, 67: 52–63.
3
D. Thomas. 1990. Intra-household resource allocation: an inferential approach. The Journal of Human Resources, 25(4): 635–664; G.J. Bobonis. 2009. Is the Allocation of Resources
within the Household Efficient? New Evidence from a Randomized Experiment. Journal of Political Economy, 117(3): 453–503.
4
IFAD. 2016. Rural Development Report 2016. Fostering inclusive rural transformation. Rome.
5
World Bank and ONE Campaign. 2014. Levelling the field: improving opportunities for women farmers in Africa [online]. Washington, DC, World Bank [Cited 6 May 2019].
http://documents.worldbank.org/curated/en/579161468007198488/pdf/860390WP0WB0ON0osure0date0March0180.pdf
6
C.M. Blackden and Q. Wodon, eds. 2006. Gender, time use, and poverty in sub-Saharan Africa. World Bank Working Papers No. 73. Washington, DC, World Bank.
7
International Organization for Migration (IOM). 2012. Rural women and migration [online]. Geneva, Switzerland. [Cited 6 May 2019]. https://www.iom.int/jahia/webdav/shared/
shared/mainsite/published_docs/brochures_and_info_sheets/Rural-Women-and-Migration-Fact-Sheet-2012.pdf
8
A. Chinyophiro. 2017. Gender in food and nutrition security: towards attaining the right to food [online]. UN Women, IFAD, FAO, WFP Expert Group Meeting – ‘Challenges and
opportunities in achieving gender equality and the empowerment of rural women and girls’. Rome, 20–22 September 2017. EGM/RWG/EP.4. [Cited 7 May 2019].
http://www.unwomen.org/-/media/headquarters/attachments/sections/csw/62/egm/ep4%20%20amon%20chinyophiro.pdf?la=en&vs=2826

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» studies done in some regions in South Asia have


found that in periods of critical food shortages,
POLICIES FOR ACHIEVING
2.4

the highest inequit y within households tends SUSTAINABLE ESCAPES


FROM FOOD INSECURITY
to occur in households experiencing severe or
unexpected food insecurit y. 202

Increasingly, evidence on associations between AND MALNUTRITION IN


intra-household inequalities and malnutrition
indicates that females score worse on nutritional
THE CONTEXT OF
indicators compared with males. In Bangladesh, ECONOMIC SLOWDOWNS
AND DOWNTURNS
for instance, household sur vey data reveal that
men tend to have much smaller dietar y energ y
shortfalls compared with women. 203 Of growing
concern is the coexistence of underweight or
KEY MESSAGES
stunted children with overweight mothers
in the same households in various low- and è   Responding to economic events that constrain
middle-income countries, such as Bangladesh, households’ purchasing power requires short- and long-term
Ghana, India, Kenya and Peru. 204 This suggests policy responses to safeguard food security and nutrition.
increasing inequalities in economic and social Actions will depend on institutional capacity and availability
access to resources. The combination of different of contingency mechanisms and funds to respond.
inequalities contributing to stunting and
overweight phenomena have been linked to
maternal age at first birth, maternal short stature, è   Countries need to protect incomes in the short term,
family size and socio-economic status. 205 n particularly for the most affected households, through
social protection programmes, public works programmes,
or policies aimed at stabilizing food prices. At the same
time, they need to avoid cuts in essential social services.

è  Countries need to invest wisely during periods of


economic boom to reduce economic vulnerabilities and
build capacity to quickly recover when economic turmoil
erupts. This requires balancing a set of policies for an
inclusive transformation that is characterized by economic
diversification, human capital accumulation and universal
access to health care and other social services.

è   Given the rising importance of global trade in food and


agricultural commodities, trade policy also needs to feature
prominently in the minds of policymakers when promoting
economic transformation that helps achieve food security
and nutrition objectives.

è   Integrating food security and nutrition concerns into


poverty reduction efforts, while increasing synergies
between poverty reduction and hunger eradication, helps
accelerate both goals.

è   When implementing these policies, reducing gender


inequalities and social exclusion of population groups
needs to be either the means to, or outcome of, improved
food security and nutrition.

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THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2019

The imperative of safeguarding food security Policies to respond to the key transmission
and nutrition channels of economic slowdowns and
In the absence of policies and resilience downturns
capacit y to face economic slowdowns and The main transmission channels linking the
downturns when they occur, households effects of economic slowdowns and downturns
will suffer a decline in their purchasing to food securit y and nutrition (Figure 29) feature
power, either through income loss, higher prominently in the earlier analysis of this second
domestic prices, or both. In attempting to part of the report for a ver y good reason: their
meet their food needs with reduced budgets, understanding is critical for policymakers to
while perhaps also facing higher food prices, decide what to do when these economic events
households may resort to coping strategies that begin to appear. External events, including
can further weaken their food securit y and commodit y price f luctuations, can have direct
nutritional status. impacts through terms of trade, exchange rate
and balance of payments. Secondar y indirect
While adverse economic conditions affect effects may arise through inf lation and food
food securit y and nutrition in all countries prices; unemployment, wages and income; and
through the channels analysed in Section health expenditures. Food securit y and nutrition
2.2, their impact was stronger in countries will be affected depending on the abilit y of
depending heavily on commodit y imports individuals and households – strengthened
and exports in the most recent 2011–2017 by appropriate policies – to cope with these
period. Moreover, as was also discussed economic events.
previously, economic slowdowns and
downturns have different impacts on As shall be seen below, food securit y and
different population groups, and their effects nutrition will ultimately be affected depending on
on food securit y and nutrition cannot be the policy responses put in place to either bring
separated from the underlying factors of about economic adjustment (e.g. through fiscal
povert y and inequalit y. and trade policies), or to help strengthen the
resilience of households to economic shocks,
This final section spells out potential policy and thus prevent undesirable coping strategies
responses to safeg uard food securit y and (e.g. through social protection or social sectoral
nutrition in the face of economic slowdowns policies), or both. Indeed, there needs to be a
and downturns. It considers short-term policies unique set of policies to address the myriad of
that can directly and immediately tackle the potential transmission channels that economic
main transmission channels from which the slowdowns and downturns present for food
impacts of economic slowdowns and downturns securit y and nutrition. Known as countercyclical
f low. In the longer term, the responses will policies, these should aim at smoothing out the
need to be g uided by a vision of development cycles by targeting both the demand side and the
that fosters pro-poor and inclusive structural supply side of the economy. Some of these policy
transformation, allowing countries to diversif y responses are discussed here, in relation to the
their economies and reduce their commodit y key transmission channels.
dependence, and ultimately lower their
economic v ulnerabilit y. Moreover, this section At the same time, the following discussion
makes the case for the need to enhance the also shows that, in addition to responding to
synergies among different policies towards the transmission channels, policymakers must
reducing povert y, inequalities, food insecurit y continue with some key existing policies for
and malnutrition, as these phenomena are not nutrition and health, including maintaining the
easily dissociated. deliver y and the qualit y of relevant care and
health ser vices and ensuring universal access to
those ser vices as well as adequate access to water
and sanitation. These basic policies tend to be
highly affected by cuts in social spending during

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PART 2 SUSTAINED ESCAPES FROM FOOD INSECURITY AND MALNUTRITION

economic slowdowns and downturns if there is the food supply, consumption subsidies for
no contingency to prevent them. certain essential food items, and import tariff
and consumption/sales tax cuts, among others.
Curbing rising food prices or offsetting their effects While implementing some of these policies can
International commodit y price shocks and be necessar y for political reasons, 207 it should
volatilit y transmit effects into the economy be stressed that they may not necessarily be
through exchange rate adjustments, as first-best policies. Some of these measures can
highlighted before. Declining commodit y prices be rather costly if they provide a price subsidy
have resulted in currency depreciations and not only to poor and v ulnerable households, but
devaluations leading to domestic price increases. to the general population. They can also create
Policy responses in the face of this trend are per vasive market distortions and, in a trade
both short and long term in nature. In the short context, can create negative externalities for
term, there may be actions to offset the effect on other countries.
domestic price increases, particularly food prices.
In a different scenario, international food prices Social protection measures and other policies
may rise, even if other commodit y prices decline. aimed at protecting purchasing power and access
In the long term, policies will target the supply to social ser vices constitute the second group.
side of the economy (to boost economic activit y Social protection programmes play a critical
and diversification) so as to face down the secular role in both helping households avoid negative
downward trend of commodit y prices, as further coping mechanisms and in accelerating recover y
explained below. after adverse economic episodes, through the
creation of new economic opportunities and
Countries that depend on food imports are the fostering of human capital in the long run
particularly v ulnerable to commodit y price (Box 17). For example, homegrown school feeding
f luctuations leading to an increase in food is a social protection strateg y with proven effects
prices. When these prices rise significantly, poor in preventing undesirable coping strategies
households and those that are net food buyers (Box 18). These measures aimed at producing
can be highly affected. In most cases, the group positive results in the short and long term may be
of net food buyers includes poor farmers, who preferable to policies aimed at reducing excessive
may not be able to take advantage of the rise in volatilit y of food prices. In many cases these
food prices by increasing their production (and measures are targeted to those that most need
earnings) and accessing markets. them. But it is also important to ensure universal
coverage to social ser vices and social protection
To mitigate the negative impact of rising as this protects families in times of economic
food prices on food securit y and nutrition, crisis from having to decide whether to spend
policymakers should consider different factors: money on food or health.
the specific food items affected by the rising
prices; the distribution of households between The third group comprises medium- and
net food buyers and sellers; the possibilit y long-term policies to boost domestic production
of substitution among different food items, of food, such as free or subsidized input
without negatively affecting the qualit y of diets; distribution, import-tariff or value-added tax
and the potential negative effects of the policy cuts on fertilizers and technolog y for agricultural
response itself. production, government-funded agricultural
research and extension activities, and
The most common policies that countries subsidies for the adoption of new technologies
implement to promote food securit y and and irrigation.
nutrition in the context of rising food prices
can be classified into three groups. 206 The first These policies need to be carefully designed and
group includes universal policies aimed at implemented to avoid unintended consequences.
reducing excessive volatilit y of food prices in For example, consumer subsidies for staple food
the short term, such as restrictions on exports (cereals, oil, sugar) in many countries of the
of staple food items, use of food stocks to boost Near East and North Africa region seem to be »

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THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2019
BOX 17
SOCIAL PROTECTION IS CRITICAL FOR FOOD SECURITY AND NUTRITION, ESPECIALLY
DURING ECONOMIC SLOWDOWNS AND DOWNTURNS

Low-income countries are increasingly expanding their low-income households, and include complementary
social protection systems, particularly social assistance, nutritional features.8
which may include social transfers and other In the humanitarian context, cash transfer
programmes that ensure access to social services, programmes are also being increasingly used.
social support and care services, in addition to An analysis of these programmes in over 62
legislation and policy reforms that ensure equity and countries9 finds that they can support access to food
non-discrimination. Social protection plays a critical and livelihoods, and prevent deteriorations in child
role in improving poor households’ access to food and nutrition.10
health care, which are essential for adequate nutrition, Launched in 2005, Ethiopia’s Productive Safety Net
particularly for women and children.1 Programme (PSNP) is one of the most important and
Cash transfer programmes are social assistance largest social safety net programmes in Africa.11
programmes that are usually targeted at poor and It contributes to both reducing poverty and strengthening
vulnerable groups.2 Available evidence shows that the resilience of vulnerable households in the face of
these programmes improve household dietary diversity, recurrent climate hazards and other shocks. The PSNP
increase food consumption3 and enhance productive is the only social protection programme which has
capacity, with positive effects on the availability considered food security and nutrition as well as
of more and higher quality food.4 However, their Disaster Risk Reduction in its design since its inception.
impact on diet diversity among young children is It is therefore a reference for other African countries on
still inconclusive,5 and likewise the evidence in child shock-responsive social protection. It currently covers
nutritional status.6 Potential explanations include 8 million beneficiaries nationwide. Most notably, the
the multidimensional nature of the determinants of PNSP included a contingency budget equivalent to
malnutrition, which require multisectoral approaches 20 percent of the base programme cost and a risk
to see long-term changes; limited attention to explicit financing facility designed to respond to transitory needs
nutrition goals and actions; and poor service quality, of the chronically food insecure. When such contingency
which may explain the lack of overall nutrition was exhausted, a Risk Financing Mechanism (RFM)
benefits.7 Studies suggest that programmes with larger was developed. The financial facility and the RFM were
impacts are those that have a larger transfer size and crucial to the impact and effectiveness of the PNSP in
are of long duration, are targeted at young children in response to the 2011 Horn of Africa crises.12

1
R. de Groot, T. Palermo, S. Handa, L.P. Ragno and A. Peterman. 2015. Cash transfers and child nutrition: what we know and what we need to know. Office of Research Working Paper
No. 2015-07 [online]. Florence, Italy, UNICEF. [Cited 7 May 2019]. https://www.unicef-irc.org/publications/pdf/Social%20protection%20and%20nutrition_layout.pdf; M.T. Ruel and
H. Alderman. 2013. Nutrition-sensitive interventions and programmes: how can they help to accelerate progress in improving maternal and child nutrition? The Lancet, 382(9891):
536–551.
2
UNICEF. 2012. Integrated social protection systems: enhancing equity for children. UNICEF Social Protection Strategic Framework. New York, USA.
3
M. Adato and L. Bassett. 2009. Social protection to support vulnerable children and families: the potential of cash transfers to protect education, health and nutrition. AIDS Care,
21(Suppl. 1): 60–75.
4
B. Davis, S. Handa, N. Hypher, N. Winder Rossi, P. Winters and J. Yablonski, eds. 2016. From evidence to action: the story of cash transfers and impact evaluation in sub-Saharan Africa.
New York, USA, UNICEF, Rome, FAO and Oxford, UK, Oxford University Press.
5
R. de Groot, T. Palermo, S. Handa, L.P. Ragno and A. Peterman. 2017. Cash transfers and child nutrition: pathways and impacts. Development Policy Review, 35(5): 621–643.
6
F. Bastagli, J. Hagen-Zanker, L. Harman, V. Barca, G. Sturge, T. Schmidt and L. Pellerano. 2016. Cash transfers: what does the evidence say? A rigorous review of programme impact
and of the role of design and implementation features. London, Overseas Development Institute (ODI); J. Manley, S. Gitter and V. Slavchevska. 2013. How effective are cash transfers at
improving nutritional status? World Development, 48: 133–155.
7
M.T. Ruel and H. Alderman. 2013. Nutrition-sensitive interventions and programmes: how can they help to accelerate progress in improving maternal and child nutrition? The Lancet,
382(9891): 536–551.
8
R. de Groot, T. Palermo, S. Handa, L.P. Ragno and A. Peterman. 2015. Cash transfers and child nutrition: what we know and what we need to know. Office of Research Working Paper
No. 2015-07 [online]. Florence, Italy, UNICEF. [Cited 7 May 2019]. https://www.unicef-irc.org/publications/pdf/Social%20protection%20and%20nutrition_layout.pdf; M.T. Ruel and
H. Alderman. 2013. Nutrition-sensitive interventions and programmes: how can they help to accelerate progress in improving maternal and child nutrition? The Lancet, 382(9891):
536–551; F. Bastagli, J. Hagen-Zanker, L. Harman, V. Barca, G. Sturge, T. Schmidt and L. Pellerano. 2016. Cash transfers: what does the evidence say? A rigorous review of programme
impact and of the role of design and implementation features. London, ODI.
9
WFP. 2019. Cash transfers. In: World Food Programme [online]. Rome. [Cited 5 May 2019]. https://www1.wfp.org/cash-transfers
10
P. Harvey and S. Bailey. 2011. Cash transfer programming in emergencies. Good Practice Review 11, June 2011. London, Humanitarian Practice Network, ODI.
11
S. Coll-Black and J. Van Domelen. 2012. Designing and implementing a rural safety net in a low income setting: lessons learned from Ethiopia’s Productive Safety Net Program 2005–
2009. Washington, DC, World Bank.
12
M. Hobson and L. Campbell. 2012. How Ethiopia’s Productive Safety Net Programme (PSNP) is responding to the current humanitarian crisis in the Horn. Humanitarian Exchange,
Number 53, February 2012. (also available at https://odihpn.org/wp-content/uploads/2012/03/humanitarianexchange053.pdf).

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PART 2 SUSTAINED ESCAPES FROM FOOD INSECURITY AND MALNUTRITION

BOX 18
HOMEGROWN SCHOOL FEEDING AS A WAY TO PREVENT UNDESIRABLE
COPING STRATEGIES

During periods of economic difficulty, children face the savings. At the same time, this may also generate new
risk of being taken out of school to contribute to the economic activity.
household income as well as of having less access to Linking local consumption to local production
nutritious and balanced meals. Homegrown school helps create a stable and predictable market for
feeding, which features among a number of possible local farmers, especially smallholders, including
social protection programmes, may help policymakers many women and mothers. In Brazil, for example,
to reduce this risk. This innovative approach links 30 percent of all purchases for school feeding come
school feeding programmes with local smallholder from smallholder agriculture. Another example of a
farmers to provide millions of school children with large-scale homegrown programme is in Nigeria,
food that is safe, diverse, nutritious and above all where 6 million locally sourced eggs and 80 tonnes of
local. Nearly half the world’s school children, some fish are consumed by 9.2 million schoolchildren across
310 million, in low- and middle-income countries eat a the nation every week.
daily meal at school, making this the most widespread With the schools as reliable markets, farmers earn
safety net. Moreover, homegrown school feeding can more income, which they spend in other parts of the
not only tackle food insecurity for school-age children, economy. As the process continues, school feeding
but can also provide income benefits to communities programmes create local income multipliers and
at large. spillovers by linking the school feeding programmes
The last ten years have seen a growing global to caterers, traders, households, businesses and other
consensus that school feeding programmes generate activities in the local economy.2 The Homegrown
positive impacts, with the available evidence pointing School Feeding Programme in rural Kenya, for
to multiple benefits.1 School feeding generates instance, has a large income multiplier: each United
high returns in four critical areas that translate into States dollar (USD) transferred to a school for food
human capital growth and sustainable development: purchases creates an additional USD 2.74 of total
increasing access to education, especially for girls; household nominal (cash) income in rural areas.
improving nutrition and health which, in turn, benefits In recognition of the importance of school feeding
cognition and learning, especially for the most programmes, many countries are including these
vulnerable children; providing essential safety nets for initiatives in their strategies for achieving food security
poor children and their families; and stimulating local and implementing the 2030 Sustainable Development
economies, especially in the agricultural sector. Agenda. Many governments are increasingly sourcing
The value of meals in school is equivalent to food for school feeding locally from smallholder
about 10 percent of families’ income. For families farmers in a bid to boost local agriculture, strengthen
with several children, that can mean substantial local food systems and move people out of poverty.

1
D.A.P. Bundy, N. de Silva, S. Horton, D.T. Jamison and G.C. Patton, eds. 2018. Re-imagining school feeding: a high-return investment in human capital and local economies. Child and
Adolescent Health and Development, Volume 8. Washington, DC, World Bank.
2
J.E. Taylor and M.J. Filipski. 2014. Beyond experiments in development economics: local economy-wide impact evaluation. Oxford, UK, Oxford University Press.

» promoting unbalanced diets, increasing the risk expenditures of households and have economic
of malnutrition and health among the population. impact on countries in terms of lost productivit y
Poor diets distorted by subsidies can contribute and foregone economic growth associated with
to greater disease burden, lead to excess health stunting and obesit y.

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THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2019

Boosting job creation and incomes can be particularly challenging during an


The real economy responds to world and economic slowdown or downturn if this leads
domestic price adjustments in various ways, as to cuts in public social protection spending due
noted already. When sluggish economic activit y to reduced government revenue. It requires
is the result, this will lead to unemployment, both the existence of contingency mechanisms
loss of wages and, consequently, loss of income. and funds – generated during periods of
Before policies can be put in place to achieve economic growth – and adequate institutional
the structural transformations that can shield capacit y. The successful scaling up of the system
the economy against these external shocks, contributes to protect poor and v ulnerable
policymakers may need to resort to other t y pes households, minimizing the likelihood that
of short-term responses to minimize or, even they use negative copying strategies with
better, fully offset the impacts on food securit y long-term consequences.
and nutrition.
Kenya’s Hunger Safet y Net Programme (HSNP)
Social protection programmes can enable is an example of a f lexible and scalable social
countries to protect the poor and v ulnerable in protection programme that provides a rapid
the event of an economic slowdown or downturn, response at times when the income of households
safeg uarding their food securit y and nutrition, is affected. 210 During more stable times,
while also triggering other economic benefits. it functions like a standard social assistance
The example of school feeding illustrates the programme, delivering cash transfers to poor
dual functionalit y of social protection in terms households in northern counties of Kenya.
of improving food securit y and nutrition while However, the HSNP is also prepared to quickly
promoting local economic activit y (Box 18). scale up its coverage to other v ulnerable
But social protection can also foster human households during climate shocks, like
capital in the long run, including through the droughts. 211 For that purpose, the programme
impacts on food securit y and nutrition, while has registered all households living in high-risk
enhancing the productive capacit y of beneficiar y locations and has opened a bank account for each
households (Box 17). And because social protection of them. Using satellite data, an early warning
is usually targeted towards poor and v ulnerable system indicates when an area is affected by a
groups, mainly through social assistance, it is a severe weather event, allowing the programme to
policy strateg y than can tackle the inequalities respond by delivering additional cash transfers to
that prevent many people from improving their all the households in the affected areas.
food securit y and nutrition during economic
booms – as has been the case for some low- and Another important set of social assistance
middle-income countries. 208 programmes are Public Works Programmes.
These can be used as a short-term safet y net
To enhance their impact and role, countries to protect the purchasing power of poor and
are starting to develop risk-informed and v ulnerable households at times of economic
shock-responsive systems during times of slowdowns or downturns. 212 Unlike cash transfers
stabilit y, strengthening certain mechanisms in (Box 17), public works programmes do not require
order to identif y not only the poorest households, detailed information to identif y their intended
but also those which could be most affected and beneficiaries. They offer low-skill, low-paying
in need of assistance when a shock occurs. 209 temporar y jobs, usually attracting those workers
Key features of these programmes include that are not able to find a job in the labour
comprehensive social registries with information market. Through the generation of public jobs
on poor and v ulnerable households; and in the construction and rehabilitation of local
early-warning information systems to alert when, infrastructure, this kind of programme provides
and in what manner, a programme response poor households with a stable source of income
is required. To be effective, these programmes during critical times and improves their access
should be able not only to maintain the support to basic ser vices in the longer term. There are
provided at times of stabilit y, but also to scale many costs and implications in terms of design
up at times of economic slumps. However, this and implementation, however, which should

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be taken into account when deciding on this First and foremost, it is critical to strengthen
t y pe of inter vention vis-à-vis unconditional the savings capacit y of the economy before an
cash transfers, particularly in fragile and crisis economy slows down or contracts, so as to make
contexts. 213 countercyclical policies feasible in the first place.
Commodit y-dependent countries, in particular,
In some countries, for example the Republic would need to save more during periods of high
of Korea after the crisis in 1997, public works commodit y prices, and rely more on a set of
programmes were implemented with the existent tools such as, inter alia, automatic fiscal
main objective of providing temporar y jobs to stabilizers, stabilization funds, sovereign wealth
unemployed workers. In others, such as funds, macro-prudential norms, and the like.
Sri Lanka after the 2004 tsunami, programmes However, more broadly, there should also be
pursued a double objective: providing affected actions to raise average saving rates in order to
households with a reliable source of income more durably insulate the stabilit y of aggregate
and, at the same time, rebuilding communit y demand and avoid episodes of large (though
and basic infrastructure to speed up the temporar y) real exchange rate appreciations.
recover y. Then there is the Mahatma Gandhi By limiting the size of macroeconomic
National Rural Employment Guarantee Scheme disequilibria and providing more breathing room,
(MGNREGS), introduced by India in 2005, higher saving rates should help reduce the risks
which is the largest public works programme of falling into restrictive policies, as has been the
in the world. Unlike the previous cases, the case in some countries. 214 This can be critical to
MGNREGS was not designed to address avoid reductions in public expenditure in priorit y
employment problems arising from an economic sectors for food securit y and nutrition.
downturn or to rebuild infrastructure damaged
by a natural disaster. Building on the experience Fiscal policy also provides other instruments
of the state of Maharashtra, the MGNREGS for generating funding, provided implementing
instead g uarantees up to 100 days of unskilled reforms is fiscally and politically feasible.
manual work on public projects during the lean The available evidence 215 indicates that most
seasons, at the statutor y minimum wage, to all developing countries should enact reforms that
rural households. In this way, the programme simultaneously enhance the redistributive impact
helps rural households to stabilize their and improve the efficiency of fiscal policies.
earnings and to smooth their consumption all This would help generate additional fiscal space
along the year. to safeg uard policies aimed at protecting food
securit y and nutrition at the time of slowdowns
Initial feasibility and subsequent sustainability of and downturns. On the tax side, developing
countercyclical policies countries may have room to increase the
One of the most important challenges faced magnitude of tax revenues, and at the same time
by policymakers at the time of economic improve their composition (e.g. moving from
slowdowns or downturns is the limited amount of indirect consumption taxes to direct income
government resources to fund the implementation taxes). On the spending side, fiscal space could
of public policies. Insufficient funding, or other be generated by avoiding the fragmentation or
political priorities, can hinder the possibilit y of inefficiency of social assistance programmes.
maintaining and scaling up the support provided The targeting of the different programmes
by the public sector to poor and v ulnerable could be improved as well, but this would
households. Establishing countercyclical financial entail additional costs and requirements that
mechanisms to safeg uard reg ular, risk-informed might make it unfeasible if economic conditions
and shock-responsive policies is fundamental were unfavourable.
to increasing resilience of households during
critical times. Of course, this requires adequate When contingency funds are available,
institutional capacit y to capitalize on episodes of programmes can be scaled up by, for example,
economic boom in order to have the finances on providing extra support to current beneficiaries
hand when the situation becomes critical. and/or by including new households among
the beneficiaries. Two developing countries

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THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2019

that were able to accomplish this in the past This includes safeg uarding and increasing
are Chile and Colombia. In these cases, expenditures on essential social ser vices that
countercyclical spending was financed by will increase the resilience of households,
lowering overall spending in good times and and decrease population v ulnerabilit y to food
increasing spending and/or borrowing in times insecurit y and malnutrition, as prioritized in the
of economic downturns. 216 In the case of the state Sustainable Development Goals. 218
of Maharashtra in India, on the other hand, the
rural Employment Guarantee Scheme is financed Balancing policies and investments for inclusive
with taxes collected from the relatively richer transformation
urban households. In pursuing a longer-term development
strateg y, countries will need to balance a set of
In the absence of contingency funds, countries policies and investments to achieve a structural
can prioritize social spending during economic transformation that also fosters povert y reduction
crises to increase their redistributive impact and and more egalitarian societies: i.e. pro-poor and
protect food securit y and nutrition. A suitable inclusive transformation. During the early
alternative is refocusing policy responses towards stages of transformation, countries need to seek
those households most affected by the downturn broad-based growth that is labour intensive
and, in this way, increasing the positive effect (especially for low-skilled labour), while
of policies on food securit y and nutrition of the investing heavily in the generation of human
households most in need. Another alternative capital to enable the development of highly
is relying on contributions of partners and productive sectors and the diversification of
donors. This is the case of the HSNP in Kenya, their economies.
although the agency in charge (the National
Drought Management Authorit y) is also working It is also important to understand labour markets
to increase the contribution of different levels and balance the right policies to meet labour
of government. demand and supply. As noted earlier, export-led
growth strategies in Latin America led to a
more unequal income distribution, precisely
Fostering inclusive structural transformation because of insufficient employment growth in
to reduce economic vulnerability modern sectors. There is evidence that investing
in human capital without sufficient creation of
Section 2.2 of this report shows that the group skilled jobs results in high rates of unemployment
of countries at higher risk of compromised (particularly for youth) and skill mismatches
food securit y and nutrition from economic in the labour market, resulting in negative
slowdowns and downturns is mostly repercussions in terms of rising inequalit y of
comprised of low- and lower-middle-income income and opportunities, and less povert y
countries with high commodit y dependence. reduction. 219 On the other hand, as economies
Nevertheless, commodit y dependence may be continue to grow, countries (like many in Asia)
often unavoidable, particularly for countries are confronted by the need to upgrade the
in the first stages of development and skills of their labour force to catch up with the
structural transformation. labour demand of newly growing industries. 220
It is important to overcome sectoral and spatial
These countries should use the periods of mismatches in the labour market looking at all
commodit y booms to invest wisely in order employment possibilities (for example, through
to develop other sectors of the economy and green jobs, entrepreneurship, skill training,
foster human capital accumulation to reduce diversification of on-farm/off-farm activities,
inequalities and increase economic resilience. and so forth) as well as incentives for sectoral
During these periods, these countries should mobilit y and migration (including seasonal/
not only ensure the adequate countercyclical circular migration).
mechanisms discussed previously but also
implement long-term development actions with Low- and lower-middle-income countries need
a structural development pathway in mind. 217 to develop and expand their social protection

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systems while they wait the required time to see subsidies, etc.) leading to the development
transformation in their economies and reap the of so-called “non-traditional exports” (i.e.
rewards of investing in human capital. This may pineapples, cut f lowers, shrimps and textiles),
start from social assistance programmes that not which already in the 1990s had outpaced
only g uarantee food securit y and a minimum traditional exports (notably coffee and bananas).
income, but also support the poorest through At the same time, food-related manufacturing
both human capital accumulation and economic developed and export-processing zones helped
participation in societ y. 221 As countries move attract foreign direct investment inf lows in
to more advanced stages of transformation, the manufacturing and high-tech sectors.
different t ypes of social protection are needed Growth in the ser vices sector also contributed to
to permanently support people’s capacit y to the establishment of the strong tourism industr y
manage risk across the life cycle, moving from that exists today. 225 These transformations
social insurance towards contributor y social bore fruit to a large extent also because
securit y. 222 In this context, setting up measures to large investments had been made in human
insure against setbacks to families, nations and development. Costa Rica’s education system has
regions, due to disabilities, recessions, disasters been a pioneer among Latin American countries,
and disease, is another fundamental investment and has played an important role in the countr y’s
for safeg uarding the progress made. 223 Investing economic performance and in maintaining its
in universal health coverage and primar y health democratic stabilit y. 226
care is another important safeg uard against such
setbacks, and protects families from damaging The role of agricultural development is also
out-of-pocket healthcare costs that can push key for reducing food-import dependence and
families into povert y. for achieving structural transformation in both
low- and middle-income countries. 227 Countries
For transformation to be pro-poor and inclusive, with more suitable agricultural potential could
in addition to investments, key reforms are invest to acquire a certain level of national
often needed to enable more equal distribution staple production in order to lower food-import
of resources and access to social ser vices. dependency. 228 At the same time, however, these
Examples of past reforms of this kind, and their countries should also seek to develop other
positive impacts, have been seen in several sectors, capitalizing on initial investments in
countries, 224 including the land reforms that agriculture and its related industries. For “late
transferred more land to poor farmers in the transforming” low-income countries, where
Republic of Korea and Taiwan Province of China industrialization is lagging, agro-industrial
(1940s to 1960s), and in Viet Nam (in the late development and strengthened rural–urban
1980s and 1990s). China’s establishment of the linkages have large potential for improving
household responsibilit y system (1979) that held livelihoods and contributing to the eradication
farmers responsible for the losses and profits of of povert y. 229 Investing to diversif y and better
their agricultural activit y boosted production and integrate small-scale agriculture into markets
also massively reduced povert y in that countr y. in low-income countries can lead to positive
The expansion of universal health insurance in outcomes in terms of income generation (Box 19),
Thailand (2000s) helped increase human capital, which can potentially reduce povert y, food
thus facilitating the participation of the poor in insecurit y and malnutrition. Encouraging more
the economy. diverse diets and enabling the accessibilit y
of more diverse foods can help lower demand
The example of Costa Rica shows that moving for food staples, 230 while stimulating the
away from commodit y dependency is indeed diversification of agricultural products, including
possible. As noted earlier, this countr y has that of local foods. 231 Finally, designing policies
diversified its exports through trade reforms and inter ventions with a territorial perspective,
and an export-led growth strateg y. Starting in recognizing the linkages of rural/agricultural
the 1980s, it set up a number of initiatives to areas with small cities/towns and larger cities,
stimulate the diversification of the economy, can lead to more dynamic growth of economic
including financial incentives (tax exemptions, opportunities, including beyond agriculture. 232 »

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BOX 19
BOOSTING SMALL-SCALE FARMING FOR DIVERSIFICATION AND MARKET INTEGRATION
IN SAO TOME AND PRINCIPE, AND SENEGAL

Developing agro-industrial value chains opens up The project was successful in increasing production
market opportunities for small-scale farmers,1 commercialization of crops that had mainly been
particularly in commodity-dependent countries such as grown for domestic consumption. It also helped farmers
Sao Tome and Principe, and Senegal. Sao Tome and to transition away from groundnut production, by
Principe exports cocoa, and Senegal oil fuel, fishery investing in poultry rearing and vegetable growing.6
products and gold; both are highly dependent on food Evidence from an impact assessment of the project
imports.2 Commodity dependence makes them more found that as a result of PAFA, crop income increased
vulnerable to commodity price shocks. Efforts by these by 48 percent, and total income increased by
countries to develop a sustainable and diversified 11.3 percent, within those households participating in
agricultural sector in recent years have included the project.7
policies and programmes to increase access to The experience of Sao Tome and Principe
markets for small-scale producers (who make up the shows that inclusive rural transformation can
majority of these countries’ workforces) while also be achieved through strengthening linkages
improving the quality of agricultural production.3 between farms and markets, while also achieving
Senegal’s agricultural sector accounts for positive outcomes in food security and nutrition.
17.5 percent of its GDP.4 The country has experienced The Government launched the Participatory
an economic slowdown since 2006, with its Smallholder Agriculture and Artisanal Fisheries
agricultural sector facing several shocks that have Development Programme (PAPAFPA) in 2003,
weakened its full potential. To address this challenge, followed by the Smallholder Commercial Agriculture
the Government stepped up investment in agriculture Project (PAPAC) in 2015. This helped promote the
to more than 10 percent of GDP annually beginning in commercialization of organic, high quality cocoa,
2009, and committed to transforming the agricultural coffee and pepper by creating farmer cooperatives
sector.5 The Agricultural Value Chains Support and establishing family plantations to increase
Project (PAFA), for example, was implemented in the sales to domestic and export markets. Results from
Groundnut Basin, a region that has suffered from the impact assessment of these programmes
high levels of poverty and food insecurity following demonstrated positive and significant impacts on
a decline in global groundnut prices. The project agricultural incomes (an increase of 46 percent,
aimed to improve the rural livelihoods and incomes 77 percent of which was derived from cocoa, coffee
of 16 035 households by integrating small-scale and pepper); and on dietary diversity (an increase
producers into profitable and diversified value chains, of 5 percent). Another result of the project was an
and also to improve access to markets by establishing increase in take-up of organic certification among the
commercialization contracts with market operators. participants of the project.8

1
T. Reardon, C.B. Barrett, J.A. Berdegué and J.F. Swinnen. 2009. Agrifood industry transformation and small farmers in developing countries. World Development, 37(11): 1717–1727.
2
UNCTAD. 2017. The State of Commodity Dependence 2016. Geneva, Switzerland, and New York, USA.
3
IFAD. 2016. Rural Development Report 2016. Fostering inclusive rural transformation. Rome.
4
FAO. 2015. Senegal: country fact sheet on food and agriculture policy trends [online]. Rome. [Cited 7 May 2019]. http://www.fao.org/3/a-i4841e.pdf
5
USAID. 2019. Increasing inclusive economic growth in Senegal. In: USAID [online]. Updated 9 April 2019. Washington, DC. [Cited 7 May 2019]. https://www.usaid.gov/senegal/fact-
sheets/increasing-inclusive-economic-growth-senegal
6
IFAD. 2018. Results from the field. IFAD Results Series Issue 3. Rome.
7
A. Garbero, D. Diatta and M. Olapade. forthcoming. Impact assessment report: Agricultural Value Chains Support Project, Senegal.
8
A. Garbero, M. Improta and S. Gonçalves. forthcoming. Impact assessment report: Smallholder Commercial Agriculture Project and Participatory Smallholder Agriculture and Artisanal
Fisheries Development Programme, Sao Tome and Principe.

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» Actions that foster agricultural development Global, regional and unilateral trade policies are
could, at the same time, lower the negative more important than ever. It was highlighted
impacts of economic slowdowns and downturns earlier that a number of universal policies can
on food securit y and nutrition; however, help stabilize food prices, including restrictions
agricultural transformation does not always on exports of staple food items, or import-tariff
necessarily meet food-securit y and nutrition cuts. The latter can also boost domestic
objectives. Besides the pro-poor nature production of food in the medium and long term.
of transformation, the positive effects of However, the importance of trade policies extends
agricultural transformation on food securit y and beyond their role in stabilizing food prices and
nutrition will depend on the t ype of commodities boosting food production. These policies need to
and the qualit y of food that is generated under be carefully crafted to be among the triggers of a
this process, and on fostering better access for sustainable transformation.
ever yone to more nutritious foods. 233 The overlap
of policies for food securit y and nutrition with World agricultural and food markets are
others seeking to foster economic development, increasingly integrated. This is largely driven by
particularly those with a focus on povert y trade and investment policy, which inf luences
reduction, is further discussed in the last section. food systems at global, regional and national
levels, shaping aspects of food environments
Finally, an important point is that mobilizing such as food availabilit y, prices, qualit y, and
investments for achieving economic food-securit y and nutrition outcomes. 235
diversification requires effective political
leadership to address the related issues of Broadly speaking, trade is good for food securit y.
governance and the political economy of By moving food from surplus to deficit countries,
economic and social transformation. For example, trade can ensure the availabilit y and variet y
investment in human development in of food, and promote access and stable prices.
commodit y-dependent countries, which are often Trade can also promote dietar y diversit y, which
low-income countries, tends to be low. 234 This is is recognized as essential for adequate nutrient
explained not only by lack of resources, but also intake and human health. For some countries,
by the level of democratization of governments especially low-income ones, diets ref lect the
and capacit y of government institutions. diversit y of foods produced, such as in Nepal. 236
When democratization and institutional capacit y At the same time, trade is associated with the
are lacking, it may result in some forms of “nutrition transition” where diets become richer
rent-seeking that impede economic growth (or in animal sourced foods, and highly-processed
prevent countries from fully taking advantage foods often high in fat, sugar and salt are more
of commodit y price booms) and create further widely available as average income increases.
social inequalities. For example, Mexico’s exposure to food imports
from the United States of America explains four
percent of the rise in obesit y prevalence among
Making the most of trade for food security Mexican women between 1988 and 2012. 237
and nutrition
In spite of the benefits, policymakers still need
While economic and export diversification and to be careful that trade policies and agreements
domestic market development are necessar y to are not detrimental to nutrition objectives –
reduce the external v ulnerabilit y that challenges especially given that these policies rarely, if
food securit y and nutrition, import diversification ever, consider healthy diets as their underlying
is also needed as part of a larger transformation, rationale. 238 This is quite important, considering
including in food systems, towards healthier that global trade in food and agricultural
diets. Therefore, international trade as a whole, commodities has increased significantly, so
and the global, regional and unilateral policies there is potential for it to contribute to nutrition
that shape it, also need to feature prominently objectives, as noted above. This will not only
in the minds of policymakers when promoting require considering the impacts of trade policy
this transformation. on nutrition, but also enhanced coherence »

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THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2019

BOX 20
TRADE POLICY, FOOD SYSTEMS, AND FOOD SECURITY AND NUTRITION

International trade has the potential to make healthy Increased trade in food and agricultural
foods available to populations and foster demand for commodities has been accompanied by significant
healthier food commodities. Nonetheless, trade policy changes in the governance of trade. Increasingly,
rarely, if ever, considers healthy diets as its underlying trade agreements are negotiated outside of the
rationale. Thus, rather than driving healthy diets, trade multilateral system of the World Trade Organization
is often associated with forms of malnutrition.1 (WTO). The trade agreements negotiated both
As depicted in the figure below, trade of agricultural within the WTO system and outside of the WTO
and food products is among the key factors mediating system are often characterized by power imbalances
between trade policy and the food environment. between participating countries and can be
Other key factors include foreign direct investment and strongly influenced by the interests of multinational
domestic policies addressing nutrition goals. companies. Particularly problematic are regional
Global trade in food and agricultural commodities and bilateral trade agreements that include
has increased significantly in the past half century, both unprecedented clauses, particularly strong investor
in terms of the quantity and value of commodities traded.2 protections with potentially deep impacts on domestic
Also, foreign direct investment (FDI) has been on the rise, policy space.4
partly as a result of trade agreements. FDI in food and It is critical for country decision makers to
agriculture is a way of “domesticating” the food supply consider the impacts of trade policy on nutrition,
and deepening the capacity of the national food system, and to enhance coherence between trade policy and
without increasing food imports. The health impacts of action on nutrition. However, achieving such policy
these changes are mixed and dependent on various coherence will require collaboration and coordination
factors, including whether the food products traded between two different stakeholder groups – from both
or the type of food-related FDI is healthy or unhealthy. the “trade” and “nutrition” communities – including
FDI has been shown to be a key driver of growth in agreement on policy objectives. This poses a significant
sugar-sweetened beverage (SSB) consumption.3 challenge given the different worldviews, institutional

CONCEPTUAL FRAMEWORK OF KEY RELATIONSHIPS BETWEEN TRADE POLICY, NUTRITION AND HEALTH OUTCOMES

TRADE POLICY FOOD ENVIRONMENT FOOD ACQUISITION NUTRITION


AND CONSUMPTION AND HEALTH
KEY AREAS OF MEDIATING IMPACT Availability – and accessibility OUTCOMES
Prices – and affordability
Trade in goods (imports/exports)
Vendor and product characteristics
Foreign direct investment
Marketing and regulation
Shaping policy and regulatory space for
addressing nutrition goals

SOURCES: Adapted from C. Turner, A. Aggawal, H. Walls, A. Herforth, A. Drewnowski, J. Coates, S. Kalamatianou and S. Kadiyala. 2018. Concepts and critical perspectives for food
environment research: a global framework with implications for action in low- and middle-income countries. Global Food Security, 18: 93–101; S.G.D. Cuevas, L. Cornelsen, R. Smith and
H. Walls. 2019. Economic globalization, nutrition and health: a review of quantitative evidence. Globalization and Health, 15: 15.

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PART 2 SUSTAINED ESCAPES FROM FOOD INSECURITY AND MALNUTRITION

BOX 20
(CONTINUED)

norms, interests and power imbalances between the on the ICN2 commitments, the UN Decade of Action
two communities.5 on Nutrition7 identified six cross-cutting action areas,
However, the positive news is that there have including: “trade and investment for improved
already been some agreements negotiated that point nutrition”, focusing on identification of opportunities
in the right direction. At the Second International to achieve global food security and nutrition targets
Conference on Nutrition (ICN2),6 164 Members of through trade and investment policies; and the
FAO and WHO agreed upon and recognized the implementation of the Principles for Responsible
important impact of trade on nutrition, recommending Investments in Agriculture and Food Systems.8 Trade
two policy actions to improve availability and access and investment are of critical importance in supporting
of the food supply through trade, to ensure that trade healthier diets and contribute to the achievement of
agreements do not have a negative impact on the right SDG 2 (ending hunger and reducing malnutrition in all
to adequate food in other countries. Further, building its forms by 2030).

1
The food environment can be defined as “the interface that mediates people’s food acquisition and consumption within the wider food system. It encompasses external dimensions
such as the availability, prices, vendor and product properties and promotional information; and personal dimensions such as the accessibility, affordability, convenience and
desirability of food sources and products” from C. Turner, A. Aggarwal, H. Walls, A. Herforth, A. Drewnowski, J. Coates, S. Kalamatianou and S. Kadiyala. 2018. Concepts and critical
perspectives for food environment research: a global framework with implications for action in low- and middle-income countries. Global Food Security, 18: 93–101; H. Walls, R. Smith,
S. Cuevas and J. Hanefeld. forthcoming. International trade and investment: still the foundation for addressing nutrition-related non-communicable diseases in the era of Trump?
2
FAO. 2018. The State of Agricultural Commodity Markets 2018. Agricultural trade, climate change and food security. Rome.
3
P. Baker, S. Friel, A. Schram and R. Labonte. 2016. Trade and investment liberalization, food systems change and highly processed food consumption: a natural experiment
contrasting the soft-drink markets of Peru and Bolivia. Globalization and Health, 12(1): 24; A. Schram, R. Labonte, P. Baker, S. Friel, A. Reeves and D. Stuckler. 2015. The role of trade
and investment liberalization in the sugar-sweetened carbonated beverages market: a natural experiment contrasting Vietnam and the Philippines. Globalization and Health, 11(1): 41.
4
R. Baldwin. 2011. 21st Century Regionalism: Filling the gap between 21st century trade and 20th century trade rules. Staff Working Paper ERSD-2011-08 [online]. Geneva, Switzerland,
World Trade Organization (WTO). [Cited 6 May 2019]. https://www.wto.org/english/res_e/reser_e/ersd201108_e.pdf; H.L. Walls, R.D. Smith and P. Drahos. 2015. Improving
regulatory capacity to manage risks associated with trade agreements. Globalization and Health, 11: 14; D. Gleeson and S. Friel. 2013. Emerging threats to public health from regional
trade agreements. The Lancet, 381(9876): 1507–1509.
5
H. Walls, P. Baker and R. Smith. 2015. Commentary: Moving towards policy coherence in trade and health. Journal of Public Health Policy, 36(4): 491–501.
6
FAO and WHO. 2014. Conference Outcome Document: Framework for Action [online]. Second International Conference on Nutrition. Rome, 19–21 November 2014. ICN2 2014/3
Corr.1. [Cited 7 May 2019]. http://www.fao.org/3/a-mm215e.pdf
7
UN. 2019. Decade of Action on Nutrition (2016–2025). In: United Nations [online]. New York, USA. [Cited 7 May 2019]. www.un.org/nutrition
8
Committee on World Food Security (CFS). 2014. Principles for responsible investment in agriculture and food systems - decision box [online]. Forty-first Session - “Making a Difference
in Food Security and Nutrition”. Rome, 13–18 October 2014. CFS 2014/41/4 Add.1. [Cited 7 May 2019]. http://www.fao.org/3/a-ml620e.pdf

» between trade policy and action on nutrition. Multisectoral policies for sustaining escapes
Achieving such policy coherence depends on
strengthening cross-sectoral collaboration and from food insecurity and malnutrition,
coordination, and improving governance of with a focus on poverty and inequalities
policymaking processes at global, regional and
countr y levels (Box 20). As seen earlier in the report, the impact of
economic slowdowns and downturns on food
securit y and nutrition cannot be separated from
povert y and inequalit y issues. The interactions
between povert y and hunger and malnutrition

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THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2019

form a vicious trap, where povert y is a cause nutrition should be emphasized and addressed
of hunger and where a lack of adequate and more comprehensively. 242 Table 12 helps explain
proper nutrition is itself an underlying cause of the ways in which policies and actions for
povert y. 239 However, povert y reduction strategies reducing povert y can follow a more coherent
and policies are not sufficient to reduce hunger multisectoral approach to food securit y and
and malnutrition, including in the context of nutrition, using the four pillars of food securit y.
economic slowdowns and downturns, particularly The table also highlights constraints that may
if important inequalities prevail. This last prevent the povert y reduction policies from
section looks at how multisectoral policies for helping to improve food securit y and nutrition.
food securit y and nutrition are linked to policies Sociocultural factors may play an important
for the reduction of povert y and inequalit y. role for the feasibilit y of all these multisectoral
It points to the importance of reinforcing these policies; however, they can be rather context
with specific actions, focusing particularly specific. The table, nonetheless, identifies some
on nutrition. of the cultural characteristics that generally act
as constraints to achieving outcomes in food
How does poverty reduction play a role and what securit y and nutrition.
policies can be strengthened?
The disconnect between povert y alleviation and Overcoming the constraints listed in Table 12
improvements in food securit y and nutrition requires looking at coherent integrated policies
has recently become more apparent, as seen for povert y reduction and eradication of food
in Section 2.3. Several countries have made insecurit y and malnutrition. However, because
significant progress in reducing povert y; the relationship between these phenomena may
however, similar progress in food securit y and be bidirectional, actions towards sustainable
nutrition has not been realized. food securit y and nutrition should also consider
a long-term view of povert y reduction and
Of course, the relationship between povert y and economic growth, as well as resilience through
food securit y and nutrition is also complicated by preparedness mechanisms and shock-responsive
the different ways in which these two phenomena social protection.
are measured, and by the limited research that
has addressed both in a comparative manner. A number of countries have been strengthening
Moreover, v ulnerabilit y to povert y and to food food security and nutrition outcomes in
insecurit y and malnutrition is also defined their poverty-reduction interventions.
through different concepts; thus, in practice, it Social protection (social assistance in particular)
may be difficult to identif y which phenomenon can help address some of the economic and social
manifests first in a given situation in order to determinants of malnutrition, including when
understand causal relationships. 240 For example, targeting all nutritionally vulnerable populations
poor households may go hungr y after a period to food insecurity and malnutrition (including
of utilizing and depleting their resource base, infants and young children, pregnant and
showing povert y and v ulnerabilit y to food lactating women, people living with HIV/AIDS,
insecurit y, but not actual undernourishment. older people, and those who are sick) or when
Similarly, food may suddenly become physically ensuring that appropriate linkages with health,
unavailable to a household due to a idiosyncratic education and agriculture are strategically made
shock, even for non-poor households with the for food security and nutrition.
resources to buy nutritious food. Higher incomes
can also increase food consumption, but this does Nutrition-sensitive social protection (NSSP) can
not g uarantee positive outcomes in nutrition. 241 be made possible by fostering policy coherence
across these sectors, and by facilitating
From a policy perspective, these complexities programmes that integrate different components
have important implications. While similar like social assistance (e.g. cash transfers), access
policy instruments may apply in some cases to nutrition education, health ser vices, and
for achieving both povert y reduction and food nutrition-sensitive agriculture. 243 For example,
securit y, the specificities of food securit y and since 2013, Lesotho has been working to »

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TABLE 12
MULTISECTORAL POLICIES FOR REDUCING POVERTY, AND THE CONSTRAINTS THAT MUST BE OVERCOME
TO IMPROVE FOOD SECURITY AND NUTRITION
Poverty reduction policies addressing each food security pillar Constraints to achieving sustainable outcomes
in food security and nutrition
Physical availability of food*
} } Promoting poor farmers’ productivity increases the } } Supporting poor farmers’ food production may not
production and the availability of food for the poor at provide enough food supply at national level because of
the national level; however, this depends on the potential market failures or lack of supply response.
of the production frontier, type of crop and the market } } Additional policies in relation to food imports, trade and
where agricultural production is sold. investments (see Box 20), utilization of food production,
} } Facilitating trade of food products allows poor consumers and available stocks for emergency situations to supply
to access food commodities at lower prices. safety net mechanisms may not be in place.

Economic and physical access to food**


} } Several poverty reduction policies aim to increase } } Cultural characteristics related to gender and social
economic inclusion of the poor, which also expand their inequalities, as well as other behavioural aspects, could
access to food and to productive resources (including affect equal access to food by all members in the
land and water) and markets; and provide support to household. They could also affect the prioritization of
increase productivity and develop other income- food, particularly of quality food, over other expenditures.
generating opportunities. These factors affect both poor and non-poor households.
} } Ensuring a minimum income can be achieved through: } } Supporting women’s economic empowerment, as part of
social protection systems, work promotion programmes; poverty reduction efforts, may present trade-offs in terms
supporting agricultural production of poor farmers and of their time for breastfeeding, caring for infants and
their access to markets; and more broadly, rural young children, and food preparation. Poverty-reduction
development programmes, investment in employment programmes often fail to address these constraints and
generation, and developing entrepreneurship. provide additional support, including working with the
} } Supporting long-term investments in children’s education whole household to reconsider existing gender roles and
and school feeding, and ensuring their access to share household responsibilities; this can compromise
appropriate care and health services, also helps to women's nutritional well-being as well as that of their
expand their future economic prospects and reduce the families.
intergenerational transmission of poverty. } } Raising the profile of traditional foods and ensuring their
} } Basic infrastructure and roads, particularly in rural affordability would also require that enhanced support is
areas, and the development of markets in urban and provided to poor farmers.
peri-urban areas facilitates physical access to food. } } In urban areas, fostering more enabling environments for
healthy food choices can be supported by zoning
policies and social support systems, including safe
redistribution of unsold food for charities to improve
access to healthy foods; promotion of urban agriculture;
and shorter food supply chains that reconnect cities to
their zones of influence.
} } In the absence of universal health coverage, poor health
and/or catastrophic out-of-pocket healthcare costs can
undermine achievement or a minimum income or reduce
expenditure available for food.
Food utilization***
} } Basic investments in the quality of diets; quality of health; } } More nutrition-specific interventions that address the
education; and water, sanitation and hygiene (WASH) immediate causes of malnutrition, and some of its
can improve childcare and feeding practices, maternal underlying causes (e.g. lack of nutrition education) are
nutrition, dietary choices of consumers and food often not seen as part of poverty reduction strategies.
preparation. The food accessible to the poor, but also the non-poor,
} } Together with improvements in information on the quality may be suboptimal for improved nutrition and health.
of diets, these can help prevent diseases which can affect Micronutrient deficiencies are often more prevalent
food utilization and exacerbate malnutrition. among the poor.
} } There are other issues related to the microbiome and its
impact on food and agriculture, which simultaneously
affect human nutrition.
} } Women’s lack of empowerment and intra-household
gender relations, and women’s lack of knowledge and
understanding of nutritional issues jeopardize utilization.

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THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2019

TABLE 12
(CONTINUED)
Poverty reduction policies addressing each food security pillar Constraints to achieving sustainable outcomes
in food security and nutrition
Stability of the other three dimensions over time****
} } Actions to sustain economic growth and foster } } In some cases, there is an absence of nutrition-sensitive
preparedness mechanisms can help improve resilience in interventions (including in social sector services and
the face of economic and climate-related shocks more social protection programmes) which help address some
broadly. of the underlying and basic causes of malnutrition by
} } Shock-responsive social protection systems can expand incorporating nutrition goals and actions from a wide
cash transfers (conditional or unconditional depending range of sectors.
on the existing level of institutionality), cash for work or } } In some cases the essential nutrition actions are not
food for work programmes when covariate or intrinsic accessible to people in need.
shocks occur.
} } School feeding programmes and insurance mechanisms
can enable the stability of food security over time.

NOTES: * Food availability addresses the “supply side” of food security and is determined by the level of food production, stock levels and net trade. ** An adequate supply of
food at the national or international level does not in itself guarantee household level food security. Concerns about insufficient food access have resulted in a greater policy
focus on incomes, expenditure, markets and prices in achieving food security objectives. *** Utilization is commonly understood as the way the body makes the most of various
nutrients in the food. Sufficient energy and nutrient intake by individuals are the result of good care and feeding practices, food preparation, diversity of the diet and intra-
household distribution of food. Combined with good biological utilization of food consumed, this determines the nutritional status of individuals. **** Even if your food intake is
adequate today, you are still considered to be food insecure if you have inadequate access to food on a periodic basis, risking a deterioration of your nutritional status. Adverse
weather conditions, political instability, or economic factors (unemployment, rising food prices) may have an impact on your food security status.
SOURCE: Social Protection Interagency Cooperation Board (SPIAC-B). forthcoming. Interagency social protection assessment tool on social protection programmes for food security
and nutrition.

» improve the resilience and food and income infant and young child nutrition during the first
securit y of the extreme poor by creating 1 000 days. In Ethiopia, local evidence convinced
synergies between social protection and policymakers of the need to address anaemia
agriculture inter ventions. Lesotho’s innovative among adolescent girls. In Uganda, participator y
approach complements the existing national district assessments brought stakeholders
cash transfer programme, the Child Grant together around evidence-informed nutrition
Programme (CGP), with home gardening and actions. And in the United Republic of Tanzania,
nutrition kits and training, paying special district-level investments for nutrition increased
attention to those households most affected when capacit y was developed for planning and
by drought, which are not only poor but also budgeting. 246 Universal inter ventions for food
v ulnerable to food insecurit y. Rigorous impact securit y and nutrition like these are necessar y in
evaluations of the CGP and of additional order to avoid leaving out not only the poor but
inter ventions have provided strong evidence also several other, non-poor populations who
that, when all these elements are combined, may be at risk of food insecurit y.
a stronger impact in reducing povert y and
nutrition is simultaneously achieved. 244 Economic and social inequalities impede progress in
food security and nutrition
However, these efforts will not be enough to Inequalit y can limit opportunities for
protect food securit y and nutrition, particularly households to escape povert y, food insecurit y
during periods of economic slowdowns and and malnutrition. Because of income inequalit y,
downturns, if the multisectoral approach does the poor are not able to benefit from economic
not address determinants of nutrition such as booms – as they disproportionally accrue less
food securit y, care, health, and water, sanitation income compared to others – and nor do they
and hygiene ( WASH). The health system is have sufficient income streams to better cope
the primar y channel through which to address during episodes of economic difficult y. But, as
some of these determinants. 245 In recent years, noted earlier, finding sustained escapes from
Ethiopia, Uganda and the United Republic of food insecurit y, malnutrition and povert y also
Tanzania have all been working to scale up their depends on having adequate access to basic
nutrition inter ventions in this regard. These three ser vices, in particular: care, health and WASH.
countries have focused on essential maternal, Unfortunately, there are still great inequalities

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PART 2 SUSTAINED ESCAPES FROM FOOD INSECURITY AND MALNUTRITION

within low- and middle-income countries in the and social protection. In addition to assets
access of these basic ser vices. The reasons for and access to basic ser vices, these approaches
the existing gaps need to be further analysed, should directly address gender inequalities by
including from a perspective of political economy focusing on the people involved: understanding
and corruption prevention. who they want to be, what they want to do, and
how they can achieve their goals using a joint
The stark inequalities that are obser ved between vision and practical strateg y. 248 At the same time,
urban and rural areas in some developing this requires understanding human behaviour,
countries demonstrate how processes of fostering communit y awareness, and identif ying
economic growth and transformation can be effective incentives for women to access ser vices
unequal. Povert y reduction and development and support.
efforts need to focus more on raising
agricultural productivit y and rural incomes, Beyond gender inequalities, other social
generating wider employment opportunities inequalities derived from discrimination
and integrating rural areas more effectively and exclusion of population groups based
into mechanisms of national economic on ethnicit y, caste or religion – also noted
development. In doing so, it is important to earlier – hamper any potential advancement
conceive rural development as an endeavour in ensuring food securit y and good nutrition.
that involves other actions beyond agriculture. Social discrimination and exclusion of these
In the twent y-first centur y, ruralit y cannot be population groups can be reversed only
seen to be synonymous with decline, as this through policies and social mobilization to
view risks neglecting essential opportunities address the multiple challenges they face.
for economic growth and social development. There are a number of possible actions to this
The revalorization of rural spaces is needed, end, including: legal, reg ulator y and policy
and with that, the adoption of rural policies that frameworks to promote social inclusion;
leverage regional assets rather than exclusively national public expenditure; improving access
pursuing a compensator y approach. 247 At the to and adequacy of public ser vices (sometimes
same time, there is a need to increase the exclusively targeted to these population
resilience and address the food securit y and groups); empowering institutions, their
nutrition needs of urban residents living in organizational capacit y and their participation
extreme povert y, including by creating healthier in decision-making processes; increasing
food environments and by ensuring that the accountabilit y to protect human rights; and
urban poor are able to access WASH ser vices working to gradually change discriminator y
from which, despite better urban provision, they attitudes and behaviours. 249
are often excluded.

Often, inequalit y is nested within the household,


2.5 CONCLUSIONS
with gender inequalities still persistent across all
regions, and in both developed and developing This year’s report continues to signal the
countries. As seen in the previous sections and significant challenges that remain in the
in Section 1.1 in Part 1, women are at higher fight against hunger, food insecurit y and
risk of undernourishment than men, and women malnutrition in all its forms. Part 2 calls for
of reproductive age tend to be more v ulnerable bolder actions to address these challenges in the
to food insecurit y and malnutrition. In order face of economic slowdowns and downturns.
to reduce gender inequalities, more dedicated The latest global economic prospects warn of
and comprehensive policies and development slowing and stalled economic growth in many
approaches are required that specifically target countries, including emerging and developing
women’s economic empowerment and nutrition. economies. Episodes of financial stress,
Integrated approaches for women could include elevated trade tensions, declining commodit y
access to reproductive health ser vices and prices, and tightening financial conditions
nutrition ser vices, care ser vices, skills training are all contributing to these increasingly
and access to employment, maternit y protection grim prospects.

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THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2019

Part 2 has presented new evidence or unconditional cash transfers and school
confirming that: feeding; public works programmes that help
reduce unemployment; or policies aimed at
„ „hunger has been on the rise for many stabilizing food prices, and protecting incomes
countries where the economy has slowed from damaging out-of-pocket healthcare costs
or contracted – strikingly, the majorit y of by ensuring full coverage of essential health
these are not low-income countries, but ser vices. The potential unintended consequences
middle-income countries; for nutrition must be carefully considered
„ „economic shocks are prolonging and worsening throughout, and cuts to essential social ser vices,
the severit y of acute food insecurit y, in food including health, must be avoided at all costs.
crisis countries;
„ „economic slowdowns tend to be sharper and In the longer term, countries need to invest
economic contractions deeper and longer wisely during periods of economic booms to
lasting for commodit y-dependent countries; reduce economic v ulnerabilities and build
and capacit y to withstand and quickly recover when
„ „economic events generally have a harsher economic turmoil erupts. This requires balancing
effect on food securit y and nutrition when a set of policies and investments to achieve
extreme povert y and inequalities are greater. an inclusive structural transformation that
diversifies the economy away from commodit y
Inequalities in income and in access to basic dependence, while also fostering povert y
ser vices and assets, as well as social exclusion reduction and more egalitarian societies.
and marginalization of groups, are preventing
large numbers of people from reaping benefits This includes transforming agriculture and food
during times of strong economic growth, or from systems such that the t ype of commodities and
coping adequately during periods of economic the qualit y of food that they produce contribute
slowdowns or downturns. The new evidence in to improving access to more nutritious foods
Part 2 points to the fact that these slowdowns for all. Measures to increase dietar y diversit y
and downturns disproportionally undermine and to create healthier food environments are
food securit y and nutrition where inequalities are required to prevent economic slowdowns or
greater, particularly in middle-income countries. downturns from undermining the nutritional
Income and wealth inequalities are also closely qualit y of diets. Policymakers must ensure
associated with undernutrition, while more that facilitating trade access does not have
complex inequalit y patterns are associated with unintended negative consequences for food
obesit y. Therefore, reducing these inequalities securit y and nutrition in sectors that would in
must be a primar y goal, either as a means to principle be affected by the increase in trade
improving food securit y and nutrition, or as an access. Integrating food securit y and nutrition
outcome of doing so. concerns into povert y reduction efforts, while
increasing synergies between povert y reduction
The report calls for action on two fronts to and hunger eradication, must also be part of
safeg uard food securit y and nutrition from the transformation.
economic slowdowns and downturns. In the short
term, countries need to protect incomes so as to Ensuring that this transformation is pro-poor
counteract economic adversit y. To enhance the and inclusive will not be possible by focusing on
contingency mechanisms and financial capacit y economic growth alone: it will require tackling
that policymakers need to respond, it is critical to existing inequalities at all levels, through
strengthen savings capacit y when the economy is multisectoral policies that keep these inequalities
growing, using available instruments (automatic as the central focus. Ultimately, this kind of
fiscal stabilizers, stabilization funds, sovereign transformation will only materialize if policies
wealth funds, macro-prudential norms, and effectively strengthen the economic resilience
the like), so as to make countercyclical policies of countries to safeg uard food securit y and
feasible. Policies may include targeted social nutrition at those times when the economy slows
protection programmes, including conditional or contracts. n

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MEXICO
A participant in an
FAO-supported food security
project working at his fruit
and vegetable stall.
©Alex Webb/Magnum
Photos for FAO
ANNEX 3

ANNEXES
2015

14.6

15.6

13.9

11.1

14.3

19.9

7.3

7.6

20.1
%
BIRTHWEIGHT
PREVALENCE OF LOW

2012

16.2

14.3

11.2

14.8

20.6

7.4

7.6