Why Hunger Amidst Plenty?

I had the pleasure of doing a keynote talk at the “Ending Global Hunger Conference” at the Center for Global Food Security of Purdue University . My talk was entitled “Why Hunger Amidst Plenty?” My slides are here.

The punchline of the talk was this: We are living in a complex world made up of multiple burdens of malnutrition. While the obstacles to address the burden are daunting for citizens, there are tools to solve it. We just need political will, global cooperation, and immediate action.

The malnutrition burden is massive. But the story is mixed - there is the good, the bad, and the ugly. Let’s start with the good. Stunting is coming down - in some places quite fast - like Ethiopia, Bangladesh and Nepal. Also, the risk of dying from a famine has become much, much smaller than at any time in history. Then there is the bad. For the third year in a row, there has been a rise in world hunger. The absolute number of undernourished people has increased to nearly 821 million in 2017, from around 804 million in 2016. These are levels from almost a decade ago. Further, “hidden” hunger remains significant but is shrouded in mystery. We don’t know the state of micronutrient deficiencies, particularly among the nutritionally vulnerable populations, such as children under five years of age, women and adolescent girls. And now the ugly. Overweight and obesity is rising everywhere and among every stage of life. No country has stopped the trends we are witnessing.

The question remains why?

• Why do we still have hunger & undernutrition?

• Why are we not seeing improvements? And in some cases reversals of progress?

• How did we get to this place of paradox: hunger & obesity?

• What can we do about it?

I argue that hunger is still rampant because of poverty, conflict change, conflict, poor infrastructure, unstable markets, food loss and waste, and periods of seasonal hunger in rural places.

But how did we get to this place of paradox? That is complex but in a nutshell, our lives and lifestyles are transforming as are our diets and food systems. Many in the world are now consuming sub-optimal diets, exercising less and hence are more sedentary, and these contribute to the risk of disease and death. At the same time, healthy diets are not accessible to all.

As a result, many people are now affected by both food insecurity and obesity at the same time.  Food-insecure populations, really no matter where they live, are subject to the same, but unique influences in trying to consume a healthful diet:

• Limited resources and lack of access to healthy, affordable foods

• Cycles of food deprivation and overeating

• High levels of stress, anxiety and depression

• Limited access to health care

• Fewer opportunities for physical activity

• Greater exposure to marketing of obesity-promoting products

The question remains, what to do? There is no one simple measure that can successfully shift the burden at the national or global scale. Rather, a constellation of different approaches and strategies, operating across scales and supply chains, and targeted at different people and organizations will be required. I argue for 10 actions:

1. Care. We need governments, industry and citizens to care about their diets and their nutrition, climate change and food systems.

2. Push for countries to develop a food systems policy. No country has implemented a full range of updated, comprehensive, and evidence informed strategies to encourage a healthier and more equitable food system.

3. Consider the situation a “Syndemic” and take on triple duty actions.

4. Consider options for keeping the food system within environmental limits. Dietary, technological change on farms, and reductions in food loss and waste are critical to reduce environmental impacts of our food system on the planet.

5. Don’t forget about who will continue to feed the world. As Ruth DeFries eloquently wrote: “Now we are transforming from farmers to urbanites. Our newest experiment-to feed massive numbers of people from the work of a few-is just beginning. The outcome is yet to be seen.” Who will feed us when the average age of the world’s farmer is 60?

6. Invest in small and medium holder farmers. Smallholder farmers have more diversified landscapes, making important contributions to the overall dietary diversity for the world’s population. 53-81% of micronutrients in the food supply are produced by small and medium farms. These farms make up 84% of all farms and 33% of the land areas globally and are more predominant in Asia and sub-Saharan Africa.

7. Maximize net increases of nutrition along value chains. Identify points in the chain that can be “leveraged for change.” Leverage points can cause nutrients to be lost or exit the value chain as well as enhance the nutritional value of select nutrient-rich foods.

8. Engage and empower women in on- and off-farm opportunities. Women need social capital including information and access to new technologies and farming practices and tapping into social networks that may assist in times of hardship. Women need access to credit with greater ability to invest in infrastructure and to smooth consumption or production shocks. And last, we need to improve their human human capital and agency - give them opportunities for education, and increase their ability to get health and nutrition services.

9. Help consumers navigate this complex web. Give them the information and knowledge the make healthy choices. Make them affordable, accessible and culturally appropriate. But consumers are super, duper confused…

10. Dig deeper. We must address the underlying social determinants that impact malnutrition. Every country is impacted by poverty but its determinants may be different, or the same…

Food Bytes: Weekly Nibbles from Jan 1 - 7

Food Bytes is a weekly blog post of “nibbles” of information on all things food and nutrition science, policy and culture.

As the world slowly wakes up to a new year, there are already some interesting food nibbles published this week.

Great commentary in Lancet Planetary Health on a new, longitudinal study being led by researchers at the Australian National University to understand the relationship between culture and health of the Aboriginal and Torres Strait Islander people, a group of indigenous peoples who have been discriminated against, underserved and disrespected for too long. The study is actually being designed BY and WITH Aboriginal and Torres Strait Islander people and will gather comprehensive data to explore the links between land, culture, and health amidst the “backdrop of an evolving human civilization and changing state of planetary health.” Looking forward to seeing the results and the transferability of the research to other indigenous peoples.  

In light of the frightening IPCC report on climate change, the Washington Post asked activists, politicians and researchers for 11 climate policy ideas that offer hope. Two involve food. One is about cutting the food we waste in half and is a “win-win-win-win-win for waste mitigation, jobs, economic activity, food security and of course, the climate.” The second is reducing the expansion of CAFOs - concentrated animal feeding operations, and instead, supporting smaller-scale farmers practicing sustainable grazing practices, expanding the infrastructure for grass-fed beef and dairy markets, and enforcing fair market and fair contract rules for the livestock industry.

The Lancet published a very short piece on how digital technologies may revolutionize nutritional sciences. One big gap in the science is that we do not know what people eat, and for everyone who does eat (which is everyone…), we have no way of tracking the health of those foods without going through a very laborious process. Now, with the advancement of technology, we may be able to carry our own personal nutritionist in our pocket, that is, through our smart phones. “By synchronizing various health data types from multiple sources, such as wearable sensors, electronic health records, metabolic profile, gut microbiome, and diet, all analyzable in real-time using machine or deep-learning algorithms, a person’s smartphone has the potential to function as a digital nutritionist.” I am particularly keen to see how the photo-based dietary tracking through automated food image recognition that determines calorie and nutritional content will work.

Gerald Nelson and colleagues published a Nature Sustainability paper and a follow-up op-ed piece in the Washington Post that the global agriculture sector’s narrow focus on feeding the world, in the form of carbohydrate calories (mainly maize, rice and wheat), has led us and will continue to lead us down a dangerous path. In their study, they found that there will be more than enough food per capita to feed 10 billion people by 2050, even with the business as usual climate change pathway. They argue that the focus on carbohydrates has been a contributor to the rising rates of obesity and continued micronutrient deficiencies. They recommend that agriculture shift gears and increase production of major nutrient-rich foods such as fruits, vegetables, nuts, seeds and beans instead of the forty-year focus on staple grains.

Good enough

As we begin a new year, I have noticed a common theme on twitter and newsfeeds -- How rough 2018 was for so many people, and how much they looked forward to its end. The Washington Post wrote, “…around the globe, 2018 was a year of enduring complex conflicts.”

I would agree that sometimes, it seems the world really is on its knees. With the white house in complete chaos, picking fights with everyone from Mexico to China, the looming Brexit, the DRC, Yemen and Syria in disarray, and the “demise of the liberal order” with right wing populist Bolsonaro winning the Brazilian elections, the political climate is alarming to say the least. The violence we do to each other seems never ending – particularly in the U.S. with gun-related injuries and deaths continually plaguing Americans. Climate change is barreling down on us, with natural disasters ramping up, becoming less predictable and more destructive.

But when we look at the whole picture and try to not react to the sensationalized news feed that inundates us 24/7, things have actually improved for many people around the world. Just look at the statistics of people living in extreme poverty (number of people living on less than $1.90 a day). In the 25 years from 1990 to 2015, the extreme poverty rate dropped an average of a percentage point per year – from nearly 36% to 10%. That is a massive decline! During the same time period, the mortality rate of children under the age of five has fallen by more than half since 1990 – from a rate of 93 (meaning, 93 children die out of every 1,000 live births) to 39.

While the Rohingya situation in Myanmar is devastating, Steven Pinker, Harvard Professor, and author of The Better Angels of our Nature argues that we are doing better than we did 30 years ago and conflicts and genocides taking place around the world have been on a downward trend since the end of the Second World War. And countries recover from conflict. In Rwanda, at the height of their genocide in 1994, the child mortality rate was 282 children per 1000 live births. Now?  38. What a success story.

Rate of deaths in genocides, 1900-2008 (Source: Our World in Data)

In Martha Nussbaum’s new book, The Monarchy of Fear, she argues the same case. She writes that while the present moment “may look like backsliding from our march toward human equality … it is not the apocalypse” and the world is in a much better place than it was following the Second World War in the 1950s in which women, minorities, and the LGBTQ to name a few, had minimal rights and human injustice was rampant. Nussbaum argues that now is “actually a time when hope and work can accomplish a great deal of good.”

The late and great Hans Rosling also agrees in his book Factfulness: Ten Reasons We're Wrong About the World--and Why Things Are Better Than You Think. He argues that by looking at data over time and in the right way, one can see that the world is making huge strides overall. It is just a matter of looking at the bigger picture and the larger trends over time. Yes, children and mothers die, yes there are displaced peoples, conflicts and famines, and yes, the world is very unfair. But at the same time, largely, humans are progressing in positive ways and the news and media, and probably your twitter feed, often does not reflect that.

Because The Food Archive is all about food, let me get to my point. While progress is happening, there has been less success globally in tackling hunger and malnutrition. Those who are food insecure, or hungry, is still too high and we are seeing an increase in the actual numbers and prevalence of people who are hungry over the last two years. However, when looking at the prevalence over a longer period of time, since 2005 those who are hungry in the world have declined from 14.5% in 2005 to 10.9% in 2017. On the opposite spectrum, in 2000, 8.7% of adults were obese, and now, 13%. That 13% equates to 678 million people in the world who are struggling with obesity, or an unhealthy body mass index.  The trends show increases across the board.

Prevalence of obesity is rising among adult men and women over time (Source: Global Nutrition Report)

That said, as reported by the Global Nutrition Report, there are gleams of hope. Stunting, or chronic undernutrition has been declining. In 2000, 33% of children under the age of five were stunted and now, in 2017, 22%. That is almost a 50% decrease. Asia has made significant progress in stunting going from 38% to 23% as has Latin America and the Caribbean declining from 17% to 10% and Africa from 38% to 30%. The question is, why and how? Places like Nepal, Bangladesh and Lesotho have seen significant declines in stunting while still being quite poor. There are many researchers and publications that are trying to understand why these countries have witnessed success, but I think we can argue that it is a combination of interventions from diet, health care, sanitation and hygiene as well as factors not having to do with nutrition at all – like income generation, women’s status, and jobs and remittances.

So what do I hope 2019 looks like? While progress isn't inevitable, and everything doesn’t always get better for everyone all the time, progress is happening in both small and large ways. We need to seek out that progress, learn from what worked, and get into a mindset of problem-solving. We know a lot about what has worked and why, particularly in places where hunger and undernutrition has rapidly come down – look at China, look at Brazil, look at Ethiopia! We also have pockets of success in tackling poor diets, and overweight and obesity. Effective soda taxes in Mexico! Easy-to-read labels on the front of packaged foods high in sugar, fat and salt in Chile! Traditional diets being kept alive in places like Japan and Italy! Obesity rates actually coming down in some states of the U.S. – shocker!

I am well aware of broken resolves, so I refuse to say this year will be better than the last. It is not that I have completely lost faith in humanity and the endeavor it brings, it is just that I think we will need to find the stitched pockets of progress and small glimmers of hope as the basis of our knowledge to move forward. Now, one could argue that seems like a pretty lame new year’s resolution, and instead we need grand-scale, disruptive change. But for me, now, with our current state of affairs, I think that perspective is as good as it gets. And that is good enough.