FAO sees decline in 'undernutrition', but the number of hungry continues to grow.

FAO sees decline in "undernutrition', but the number of hungry continues to grow

For the first time in 40 years a decline in the incidence of undernutrition in the developing world has been detected by the Food and Agriculture Organization (FAO). Rapid population growth, however, has pushed the number of hungry people slightly upwards, according to FAO's Fifth World Food Survey, published in December.

"There is evidence of a turn in the tide', FAO Director-General Edouard Saouma states in the foreword to the Survey. But he cautions that there are no grounds for complacency. "As we have seen from the current African food crisis, widespread malnutrition can all too quickly turn into actual famine and starvation'.

The Survey provides both high and low estimates of the undernourished, which reflect two interpretations of the body's energy requirements. According to lower estimates, at least 335 million people in the developing market economies were undernourished in 1979-1981, some 10 million more than a decade before. However, the proportion of people suffering from hunger dropped from 19 to 15 per cent of the total population.

Higher estimates indicate that at least 494 million people were undernourished in these same countries at the end of the 1970s--an increase of 22 million over the decade. In the meantime, the incidence of hunger dropped from 28 to 23 per cent of the population.

"The fact that the increases in numbers of undernourished were so small implies that it was possible to provide fairly adequate nutrition for the vast majority of the 470 million increase in the population of the developing market economy countries during the 1970s', the Survey notes. The grouping of developing market economies excludes countries with centrally-planned economies in Asia, such as China.

Area highs, lows: Despite global gains, the Survey records a widening gap in per capita food consumption between the richest and poorest countries. There is a "malnutrition of abundance' in developed countries, where food consumption now averages 3,390 calories per person a day and where obesity appears to be increasing.

At the other end of the scale, in 26 developing countries with 238 million people, daily per capita food consumption plummeted over the decade, in some cases to below 1,800 calories per day. The least developed countries comprise the only economic group to experience an increase in the percentage of their population afflicted by malnutrition.

Regionally, Africa is falling behind the rest of the developing world in increasing food supplies. In the 1970s Africa had the slowest rate of growth in per capita dietary energy supplies (0.4 per cent a year), and the largest increase in the number of undernourished people. Under the higher estimate, there were 99 million undernourished people in Africa in 1979-1981, compared to 81 million the decade before.

While Africa swung into a negative growth rate in per capita food supplies, the Far East showed an improvement. Asian centrally planned economies nearly doubled an already high annual rate of increase. Latin America, which saw slight increases in the 1970s, now records stagnant growth. The Near East's impressive gains in per capita food supplies are slackening somewhat in the 1980s but are still growing at more than 1 per cent a year.

Changes in food consumption patterns are also recorded in the Survey. In developed market economies people consumed fewer cereals and potatoes and more fats and oils, meat and alcoholic beverages. Rapid urbanization in developing countries, particularly in Africa and Latin America, has caused a shift away from roots, tubers and traditional cereals to wheat and rice.

Malnourished children: The Survey notes that young children are the first to suffer from the effects of malnutrition and that they constitute a disproportionately large number of the malnourished population in developing countries. Rural children appear to be more at risk than those living in cities.

Profiles of malnourished families are included in the Survey for the first time. One cites a poor farm family of six in Africa which subsists on an average of only 1,340 calories per person a day. The older children are 20 centimetres shorter than the established standard. As sorghum yields decline on their family plot, the father works a few days a year at a state farm, but his daily wage only covers the family's food needs for one day.

In another profile, a poor urban family in Latin America subsists on an average of 1,400 calories per person a day. The 6-year-old daughter is 12 centimetres shorter than the standard for her age. Seventy per cent of the family income goes for food and 20 per cent for rent (see inserts).

"Multi-dimensional' causes

Though poverty is the most important reason for hunger, the causes of malnutrition are multi-dimensional, the Survey states. "Policies to attack malnutrition should also be multi-dimensional', states Director-General Saouma. "Accelerated agricultural and economic development and more equitable income distribution will provide the only long-term solution. But much more needs to be done for those who for a long time will be bypassed by general growth and development.' Mr. Saouma calls for large-scale mounting of nutrition intervention programmes, targeted as closely as possible on the most deprived rural households.

Malnutrition does not have equal impact on all population groups, the Survey states. In any society, the poorest people, such as the unemployed and landless, suffer most because of lack of resources to obtain an adequate diet. Within those groups, young children and pregnant and lactating women are the most vulnerable because of their extra nutritional requirements. Preschool children are the most seriously affected, and their risk of malnutrition is often increased by one or more diverse factors such as large family size, high birth order (of four or more), illiterate parents, single parentage, maternal age, short stature of the mother, low per capitaland availability, and poor access to social services.

In rural areas of developing countries, income from both home-produced food and payments received in kind, is generally more important than food purchases in determining food availability in a household. In urban areas food availability is mainly determined by cash income.

Individual food entitlement within a household is affected by family size and many other socio-cultural variables. Housing, water supply, sanitation, fuel, and health care can also have substantial effects on food utilization and on individual nutritional requirements. The type, quality, and nutritional value of available food and its handling are also important. Economic, food production, social, cultural, and environmental factors are among those acting as determinants of malnutrition.

Economic: It may be self-evident, says the Survey that families with greater economic resources, higher and more assured income, and assets on which to rely in times of stress, should be at less risk of malnutrition. However, exceptions are found, particularly in child malnutrition, where many non-economic variables can intervene.

Production patters: Climate, soil and vegetation largely determine the quantity and type of food grown in an area. Some areas are more susceptible to droughts, floods, and other natural factors which cause fluctuations in production. In other areas soil is deficient in nutrients, such as iodine or iron. Other factors are seasonality and the extent to which subsistence has given way to marketed production. Where there is only one rainy season, as in West Africa, malnutrition seems most severe during the pre-harvest wet season. This coincides with high energy expenditure for farm work, high food prices, heavy indebtedness, and depleted food stocks. Although harmful effects are borne by all, children suffer most as their body stores are usually less. Child mortality has been shown to peak in this period with families headed by women and those with large numbers of small children being particularly vulnerable.

Contingency measures taken by rural people in developing countries to meet seasonal shortfalls include mixed cropping, selling livestock, and taking off-farm employment. Minor crops and gathering of wild foods play a particularly important role in household food security of the poor during the pre-harvest season. In many parts of the developing world, women carry a very heavy burden of farm work, and especially in Africa they are often the principal food producers. This often imposes constraints on child care, including abrupt weaning when the planting season starts.

Where there are two rainy seasons in the year, as in East Africa and equatorial West Africa, seasonal stresses are less well marked and consequences have also been limited in many areas by irrigation, enabling multiple cropping, or by road improvements.

Natural calamities such as droughts, floods and severe outbreaks of plant and animal pests and diseases can greatly reduce food production from year to year resulting in widespread hunger and malnutrition. Over the long run, soil depletion and erosion often induced mainly by population pressure and over-grazing, decrease the food production potential of many areas. Substantial and reduceable post-harvest losses of food further diminish the possibility of adequate nutrition.

Social conditions: Rapid urbanization has greatly altered the demographic structure of the population in many parts of the developing world and has a major impact on nutrition. In rural areas of Africa in particular, the elderly and women with young children are left to produce food. Not only is food production reduced, but the time women have for child care is further curtailed.

Data from Zimbabwe indicate that in rural families with an absent migrant worker, the incidence of severe malnutrition in children is six times higher when money is not sent home. Available evidence indicates that while food consumption tends to be lower in urban than in rural areas, malnutrition in young children is markedly worse among the rural population, states the Survey. Although the reasons for this paradox are not definitely known, the Survey suggests that perhaps account has not been taken of all food eaten outside the home in urban areas. It seems most likely, however that the apparently lower urban food consumption may in fact be adequate and the higher rural consumption less than adequate because of higher energy demand for physical activity in rural occupations.

Rural diets also tend to be less varied and more affected by crop failure and seasonal scarcity. Diversion of food to productive members of rural households at times of peak seasonal labour demand could be a particularly important factor. Less adequate access to medical services could also explain why rural children are more vulnerable to malnutrition than urban ones.

In urban areas, the brunt of nutritional deprivation appears to fall on the poor and unemployed recent migrants residing in peri-urban slums and shanty towns, the Survey notes. A comparison between planned residential quarters and slum areas in Manila, the Philippines, showed that the incidence of low birth weight was five times higher in the latter, infant mortality three times higher, and severe and moderate malnutrition and anaemia twice as high.

The urban poor seldom have access to central markets without using public transport--an expense they can ill afford--and are thus compelled to buy food in small quantities from local shops at higher prices. Since adults and older children are all involved in money-seeking activities, the urban poor generally have little time to prepare food. Sometimes there is no suitable cooking space or no money for fuel. They therefore rely greatly on made-up or easily prepared foods, which are not only expensive, but of low-nutritional value. Moreover, these foods are often prepared by small vendors with little regard for food safety or hygiene.

Although the impact of "modernization' on diets is particularly evident in towns, it is also spreading rapidly in the countryside. Many nutritious traditional foods and drinks are being replaced by processed ones such as bread made from refined flour, highly-milled rice, soft drinks, and teas. The most deleterious effect of this kind, however, is the decline in breast-feeding, which again is much more marked in urban areas.

Cultural factors: Evidence indicates, says the Survey that food distribution within the family is generally related to hierarchical position, with the household head and the income-earning family members receiving preference as regards both quantity and quality of food. Studies in Bangladesh, Ghana, Guatemala, Nigeria and Papua New Guinea, indicate that mothers and young children generally receive a smaller share of the family's food in relation to their nutritional requirements, with children's diets commonly being 20 to 30 per cent below their energy requirements.

In some societies, it is common for young children to eat from a single bowl. This often puts the youngest and weakest children at a further disadvantage in family food-sharing.

In many societies, some foods are culturally more highly prized than others and no meal is considered complete without them. This practice may be disadvantageous to young children when the food is a root or tuber, as a young child with a small stomach capacity is unable to consume enough of such foods. A weaning diet based on roots or tubers is bulky and has a low concentration of nutrients, especially protein, and has been shown to be an important cause of malnutrition in young children.

Child-rearing practices are probably the strongest of all the many influences on the nutritional status of children, states the Survey. Although there has been a general decline in breast-feeding, its frequency and duration are still much higher in rural than in urban areas. Breast milk alone is nutritionally adequate only up to four months and in many rural communities, the introduction of supplementary feeding is delayed too long. When it is started, too little food is offered, and it is mostly based on diluted preparations of staples which are deficient in nutrients, high in water content, and inadequate for a young child's nutritional requirements.

In urban areas breast-feeding is abruptly ended because the mother has to work to help support the family. The bottle is introduced, often under the influence of aggressive commercial advertising for expensive products. In some countries it has been estimated that a low-income household would have to spend about half of the household head's wages to feed a young child adequately in this way. As a result, commercial milk formulas are often over-diluted. Because of lack of facilities together with illiterate mothers' failure to appreciate the importance of cleanliness in child-feeding, they are also usually unhygienically prepared.

Environmental conditions: Housing, sanitation, and water supply are the most important environmental conditions that affect food utilization and thus nutritional status, says the Survey. They do so through their link with infection and infestation. Experience from several developing countries indicates that when sanitation, water supply, and health care programmes are combined for a sufficiently long time, deaths of young children from infectious diseases, diarrhoea, and intestinal parasties can be substantially reduced and growth and health improved.

When an infection such as malaria in a working adult coincides with peak labour demand and food scarcity, the consequences can be very harmful for the nutrition of the whole family. While observing that it is difficult to separate infectious diseases and malnutrition as causes of child mortality, the Survey notes that in Latin America more than half the deaths under five years of age have been assessed as directly or indirectly due to malnutrition. In a Nigerian village, 15 per cent of all child deaths were attributed to malnutrition.

Food aid

The Survey describes food aid as "perhaps the most controversial' of the international policy areas involved in nutritional improvement. Although there is widespread agreement that it can make a highly positive contribution, the principal criticism against it is that it can have disincentive effects on domestic food production.

That food aid is essential in emergency situations is not disputed. In fact, says the Survey, much larger quantities of food aid should be earmarked for such situations, particularly through the International Emergency Food Reserve (IEFR). In many of the poorest countries reserve stocks for food security can only be built up through food aid.

On the other hand it can have negative effects on food production both directly through lower prices and indirectly by enabling Governments to neglect agriculture, thus increasing the danger of the emergency situations it can be so effective in meeting.

The actual impact of food aid depends above all, stated the Survey, on the policies of recipient Governments and the ways in which they and the donors handle it. Many Governments have now accumulated greater skill and experience in this, and are also giving higher priority to agriculture. A few, especially in the Far East, which previously relied heavily on food aid, have managed to make themselves virtually independent of food aid.

The effect of food aid on commercial markets can be limited, says the Survey. For example, if counterpart funds from the sale of food, or other government resources or savings from food aid, are used to reduce agricultural production costs, any short-term downward pressure on farm prices can be at least partly offset. "Food-for-work' programmes, where all or part of the wages are in kind, not only make possible non-inflationary increases in employment, especially for the landless, but can also contribute to expanding food production through constructing and maintaining essential infrastructure such as irrigation facilities and feeder roads.

Recipient countries should aim to better integrate food aid within national food security programmes; develop national preparedness plans to cope with major food shortages, including early warning systems; improve storage and distribution systems; give high priority to food security objectives in the use of counterpart funds; and, where possible, commit greater local resources to food aid projects.

Donor countries should undertake multi-year country food aid programming; improve timeliness and co-ordination of their response to changing requirements, including the prepositioning of stocks; provide more complementary financial and technical assistance together with food aid; and promote triangular transactions of various kinds to diversify food aid commodity composition. At the multilateral level, the guaranteed provisions of the current Food Aid Convention, which is due for renewal in 1986, should be enlarged and improved; and responsiveness to large-scale food shortages should be enhanced through additional stand-by resources for the IEFR, guaranteed increases in food aid to countries experiencing food deficits of a certain magnitude, and an interim system of national food reserves or funds in donor countries to back up their food aid commitments.

Photo: Waiting for food, Wollo distribution centre, Ethiopia.

Photo: Hossein Gatbadu feeding his 3-year-old daughter Belcha Kedir, at relief centre in Ethiopia.

Photo: Children of the city, Bogota, Colombia.