HungerHunger

We define individual hunger as consumption We define individual hunger as consumption of a diet insufficient to support normal of a diet insufficient to support normal growth, health, and activity. growth, health, and activity.

This definition leaves open questions of This definition leaves open questions of whether norms are fixed across populations whether norms are fixed across populations and over time, and of what nutritional and over time, and of what nutritional requirements are associated with them. requirements are associated with them.

… … DeRose and MillmanDeRose and Millman

HungerAnalytical ProblemsAnalytical Problems

►MeasurementMeasurement► Trends and PatternsTrends and Patterns► ExplanationExplanation► InterventionIntervention

Thematic FramesThematic Frames

Political EconomyPolitical Economy Health and NutritionHealth and Nutrition Social ConditionsSocial Conditions

Topics in Political EconomyTopics in Political Economy

• Food Shortage: area and population.Food Shortage: area and population.• Food Poverty: household.Food Poverty: household.• Food Deprivation: individualFood Deprivation: individual

Famine and CalamityFamine and Calamity Episodic, Seasonal, Chronic HungerEpisodic, Seasonal, Chronic Hunger Provisioning Institutions: Markets, States, Provisioning Institutions: Markets, States,

NGOs, development agenciesNGOs, development agencies Interventions: Programs and policies, Interventions: Programs and policies,

Structural AdjustmentStructural Adjustment

Topics in Topics in

NUTRITIONNUTRITION

Protein-energy Protein-energy malnutritionmalnutrition

Micronutrient DeficiencyMicronutrient Deficiency IronIron IodineIodine Vitamin AVitamin A

Disease InteractionsDisease Interactions Environmental Environmental

InteractionsInteractions

HEALTHHEALTH

BirthBirth GrowthGrowth DevelopmentDevelopment MortalityMortality MorbidityMorbidity CapabilityCapability

Social ConditionsSocial Conditions

Inequality: Inequality: Nationality, Class, Race Gender, Nationality, Class, Race Gender,

EthnicityEthnicity

Girl, Woman, MotherGirl, Woman, Mother Fetus, Newborn, Infant, ChildFetus, Newborn, Infant, Child

Minority, Discrimination, DisabilityMinority, Discrimination, Disability Dislocation, Displacement, WarDislocation, Displacement, War

Nutrition and HealthNutrition and Health

Some basic issues Some basic issues

Protein-energy malnutrition Protein-energy malnutrition (PEM) (PEM)

► Combined insufficiency of calories and Combined insufficiency of calories and protein protein the most widespread form of hunger.the most widespread form of hunger.

► kilocalories daily requirement collapses kilocalories daily requirement collapses protein/calories into single calories protein/calories into single calories measuremeasure Food-based poverty lines based on PEM Food-based poverty lines based on PEM

thresholdthreshold

Food Requirements and Poverty Lines In Food Requirements and Poverty Lines In BangladeshBangladesh

► DCI – Direct Calorie Intake – poverty lineDCI – Direct Calorie Intake – poverty line 1,805 kcal/day for the hardcore poor1,805 kcal/day for the hardcore poor 2,122 kcal/day for the absolute poor2,122 kcal/day for the absolute poor

► FEI – Food Energy Intake – poverty lineFEI – Food Energy Intake – poverty line monthly expenditure (income) required for calories = monthly expenditure (income) required for calories =

food/energy requirement at 2,122 kilocalories/day in rural food/energy requirement at 2,122 kilocalories/day in rural areas and 2,112 kcal/day in urban areas. areas and 2,112 kcal/day in urban areas.

1995 FEI poverty line = Tk 419.70 per month in rural areas 1995 FEI poverty line = Tk 419.70 per month in rural areas and and

and Tk 707.8 per month in urban areasand Tk 707.8 per month in urban areas► CBN – Cost of Basic needs – poverty line CBN – Cost of Basic needs – poverty line

FEI poverty line PLUS non-food poverty line. FEI poverty line PLUS non-food poverty line. Non-food poverty line is set at two levels (upper and lower) Non-food poverty line is set at two levels (upper and lower)

for each of 14 regions. for each of 14 regions. ““Absolute poor” are people below the upper line, and Absolute poor” are people below the upper line, and

“hardcore poor” are people below the lower line. “hardcore poor” are people below the lower line. In 1995, the upper lines ranged from Tk563/mo in rural In 1995, the upper lines ranged from Tk563/mo in rural

areas of Khulna, Jessore, and Kushtia, to Tk 950 per month areas of Khulna, Jessore, and Kushtia, to Tk 950 per month in Dhaka (standard metropolitan area). in Dhaka (standard metropolitan area).

1985 WHO Minimum daily caloric requirements by sector and gender Urban Rural

Age categories Male Female Male Female0 to 1 year 820 820 820 820>1 to 2 years 1,150 1,150 1,150 1,150>2 to 3 years 1,350 1,350 1,350 1,350>3 to 5 years 1,550 1,550 1,550 1,550>5 to 7 years 1,850 1,750 1,850 1,750>7 to 10 years 2,100 1,800 2,100 1,800>10 to 12 years 2,200 1,950 2,200 1,950>12 to 14 years 2,400 2,100 2,400 2,100>14 to 16 years 2,600 2,150 2,600 2,150>16 to 18 years 2,850 2,150 2,850 2,150>18 to 30 years 3,150 2,500 3,500 2,750>30 to 60 years 3,050 2,450 3,400 2,750>60 years 2,600 2,200 2,850 2,450

Source: Caloric requirements are from WHO (1985, Tables 42 to 49).Notes: Requirements used are for men weighing 70 kilograms and for women weighing 60 kilograms. Urban

individuals are assumed to need 1.8 times the basal metabolic rate (BMR), while rural individuals are assumed

to need 2.0 times the average BMR. Children under one year of age are assigned the average caloric need of

children either 3–6, 6–9, or 9–12 months old.

YearYear SectorSector BBS FEI BBS FEI 1991 1991 methodmethod

Ahmed Ahmed et al. et al. (1991)(1991)++

RavallioRavallion & Sen n & Sen (1994)(1994)

Rahman Rahman & Haque & Haque (1988)(1988)

Hossain Hossain & Sen & Sen (1992)(1992)

Sen & Sen & Islam Islam (1993)(1993)

Muqtada Muqtada (1986)(1986)

1973/1973/

19741974RuralRural

UrbanUrban

82.982.9

81.4 (5.6)81.4 (5.6)

-- -- 65.365.3

62.562.5

71.371.3

n.a.n.a.

n.a.n.a.

63.263.2

55.955.9

37.837.8

1981/1981/

19821982RuralRural

UrbanUrban

73.873.8

66.066.0

71.871.8

65.365.3

-- 79.179.1

50.750.7

65.365.3

n.an.a

n.a.n.a.

48.448.4

--

1983/1983/

19841984RuralRural

UrbanUrban

57.057.0

66.066.0

n.a.n.a.

n.a.n.a.

53.853.8

40.940.9

49.849.8

39.539.5

50.050.0

n.a.n.a.

n.a.n.a.

42.642.6

--

1985/1985/

19861986RuralRural

UrbanUrban

51.051.0

56.056.0

51.651.6

66.866.8

45.945.9

30.830.8

47.147.1

29.129.1

41.341.3

n.a.n.a.

n.a.n.a.

30.630.6

--

1988/1988/

19891989Rural Rural

UrbanUrban

48.048.0

44.044.0

-- 49.749.7

35.935.9

-- 43.843.8

n.a.n.a.

n.a.n.a.

33.433.4

--

1991/1991/

19921992RuralRural

UrbanUrban

50.050.0

46.846.8

-- 52.952.9

33.633.6

-- -- -- --

Head-count of Absolute Poverty for Bangladesh

LBW, Wasting, Stunting, obesity BMI MUAC LBW, Wasting, Stunting, obesity BMI MUAC obstetric risk, inf and mat mortal, child obstetric risk, inf and mat mortal, child

developmentdevelopment► http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?

cmd=Retrieve&db=PubMed&list_uids=12259584&dopt=Abstract cmd=Retrieve&db=PubMed&list_uids=12259584&dopt=Abstract ► Child development indicators and public health. Child development indicators and public health.

► Measurements of physical development - height, weight, cranial Measurements of physical development - height, weight, cranial circumference, and arm measurements - are called better predictors circumference, and arm measurements - are called better predictors of nutritional and developmental status than mortality and morbidity of nutritional and developmental status than mortality and morbidity figures. figures.

► Low birth weight is directly associated with poor maternal nutrition Low birth weight is directly associated with poor maternal nutrition while poor development is associated with malnutrition or while poor development is associated with malnutrition or undernutrition of the child. undernutrition of the child.

► There is a critical period from Month 6 of pregnancy to about Year 2 There is a critical period from Month 6 of pregnancy to about Year 2 of life when brain cells develop; poor nutrition during this critical of life when brain cells develop; poor nutrition during this critical period will result in permanent lack of mental capacity. period will result in permanent lack of mental capacity.

► Studies in Africa, Latin America, and Asia all point out the extremely Studies in Africa, Latin America, and Asia all point out the extremely damaging effects of poor nutrition during this critical period. damaging effects of poor nutrition during this critical period. Malnutrition or undernutrition occuring later in life can be reversed Malnutrition or undernutrition occuring later in life can be reversed with proper feeding. with proper feeding.

► The problems of obesity are as serious as those of malnutrition. The The problems of obesity are as serious as those of malnutrition. The baby who collects a surplus of fat cells under the skin during the 1st baby who collects a surplus of fat cells under the skin during the 1st year of life is likely to be overweight most of the rest of his life. year of life is likely to be overweight most of the rest of his life. Lowering age of maturation is another indication of improving Lowering age of maturation is another indication of improving nutrition. This phenomenon has been observed in all industrialized nutrition. This phenomenon has been observed in all industrialized countries and is the basis of much of the adolescent PROBLEM. countries and is the basis of much of the adolescent PROBLEM.

► Child development indicators should be used to point out areas of a Child development indicators should be used to point out areas of a country or sectors of the population in need of additional health or country or sectors of the population in need of additional health or nutritional aid. nutritional aid.

Wasting and StuntingWasting and Stunting

► PEM reduces growth in childrenPEM reduces growth in children

► Energy expenditure in excess of consumption leads to Energy expenditure in excess of consumption leads to metabolizing nutrition reserves in the form of stored metabolizing nutrition reserves in the form of stored body fat. body fat.

► Lean body mass in the form of muscle and even Lean body mass in the form of muscle and even organ tissue will also be consumed if PEM persists. organ tissue will also be consumed if PEM persists.

► Weight loss accompanies the initial stages of Weight loss accompanies the initial stages of inadequate energy intake but, if prolonged, is inadequate energy intake but, if prolonged, is followed by wasting, called in its severe clinical form, followed by wasting, called in its severe clinical form, marasmus. marasmus.

► In children, PEM delays or permanently stunts growth In children, PEM delays or permanently stunts growth and increases morbidity and mortality. and increases morbidity and mortality.

Measuring Healthy Growth Measuring Healthy Growth ► Body Mass Index (BMI) Body Mass Index (BMI)

► BMI is a measure that adjusts bodyweight for height. It is BMI is a measure that adjusts bodyweight for height. It is calculated as weight in kilograms divided by height in meters calculated as weight in kilograms divided by height in meters squared. Overweight for children and adolescents is defined squared. Overweight for children and adolescents is defined as BMI at or above the sex-and age-specific 95th percentile as BMI at or above the sex-and age-specific 95th percentile BMI cut points from the 2000 CDC Growth Charts. Healthy BMI cut points from the 2000 CDC Growth Charts. Healthy weight for adults is defined as a BMI of 18.5 to less than 25; weight for adults is defined as a BMI of 18.5 to less than 25; overweight, as greater than or equal to a BMI of 25; and overweight, as greater than or equal to a BMI of 25; and obesity, as greater than or equal to a BMI of 30.obesity, as greater than or equal to a BMI of 30.

► http://www.cdc.gov/nccdphp/dnpa/bmi/calc-bmi.htmhttp://www.cdc.gov/nccdphp/dnpa/bmi/calc-bmi.htm► BMIWeight Status: BMIWeight Status: ► < < Below 18.5 = Underweight. Below 18.5 = Underweight. ► 18.5 – 24.9 Normal. 18.5 – 24.9 Normal. ► 25.0 – 29.9 Overweight 25.0 – 29.9 Overweight ► 30.0 and AboveObese 30.0 and AboveObese

► lbw in US < 5 lbs 8 oz or 2500 g lbw in US < 5 lbs 8 oz or 2500 g ► very low birth weight (VLBW) <1500 grams very low birth weight (VLBW) <1500 grams

► The following charts are from NATIONAL CENTER FOR HEALTH The following charts are from NATIONAL CENTER FOR HEALTH STATISTICS http://www.cdc.gov/nchs/ STATISTICS http://www.cdc.gov/nchs/

OK135S053

OK135S054

OK135S055

OK135S056

OK135S057

OK135S058

OK135S059

OK135S060

OK135S061

OK135S062

OK135S063

OK135S064

OK135S065

OK135S066

OK135S067

OK135S068

OK135S069

OK135S070

OK135S071

OK135S072

Child Morbidity and MortalityChild Morbidity and Mortality► Health statistics tend to ascribe child deaths to Health statistics tend to ascribe child deaths to

malnutrition or infectious disease, but causes tend to be malnutrition or infectious disease, but causes tend to be interlinked.interlinked.

► Using case studies from poor countries, David Pelletier Using case studies from poor countries, David Pelletier concluded that malnutrition contributed to 56 per cent concluded that malnutrition contributed to 56 per cent of all child deaths, owing to its interaction with of all child deaths, owing to its interaction with infectious disease. infectious disease.

► About 83 per cent of these malnutrition-related deaths About 83 per cent of these malnutrition-related deaths were attributed to mild-to-moderate malnutrition. were attributed to mild-to-moderate malnutrition.

► Elevated morbidity and mortality are also associated Elevated morbidity and mortality are also associated with micronutrient malnutrition, especially vitamin A with micronutrient malnutrition, especially vitamin A and iron deficiencies. and iron deficiencies.

Disease InteractionsDisease Interactions► The relationship between malnutrition and infection is The relationship between malnutrition and infection is

reciprocal and synergistic. reciprocal and synergistic. ► Disease leads to a deterioration in nutritional status at the Disease leads to a deterioration in nutritional status at the

same time that malnutrition increases susceptibility to same time that malnutrition increases susceptibility to disease. disease.

► Effects of disease on nutritional status involve shifts in the Effects of disease on nutritional status involve shifts in the types and quantities of foods consumed (whether due to types and quantities of foods consumed (whether due to custom or loss of appetite) and to decreased absorption custom or loss of appetite) and to decreased absorption and diarrhea. and diarrhea.

► Parasitic organisms, as in malaria or schistosomiasis, or Parasitic organisms, as in malaria or schistosomiasis, or intestinal worms, divert nutrients for their own use.intestinal worms, divert nutrients for their own use.

► Energy, protein, and micronutrient needs are elevated in Energy, protein, and micronutrient needs are elevated in order to fight off infection. order to fight off infection.

► Immune function deteriorates with extreme PEM; evidence Immune function deteriorates with extreme PEM; evidence is more mixed as to possible increases in susceptibility to is more mixed as to possible increases in susceptibility to infection with mild to moderate malnutrition. infection with mild to moderate malnutrition.

water water sewage sewage

pollution pollution

parasites parasites diarrheadiarrhea

malnutritiomalnutritio

n n dehydratiodehydration sicknessn sickness

(WDR2000/1)(WDR2000/1)

Iron DeficiencyIron Deficiency

► Iron deficiency is believed to be the most common Iron deficiency is believed to be the most common micronutrient deficiency in the world today. micronutrient deficiency in the world today.

► It appears most common in South Asia and Africa. It appears most common in South Asia and Africa.

► About 22 per cent of the world's population is About 22 per cent of the world's population is thought to have deficiencies of iron extreme thought to have deficiencies of iron extreme enough to cause anemia. enough to cause anemia.

► Iron deficiency is especially common among Iron deficiency is especially common among reproductive-aged women, whose requirements reproductive-aged women, whose requirements are higher than those of others. are higher than those of others.

Anemia in Bangladesh Gender and Ethnic InequalityGender and Ethnic Inequality

UNICEF/BRAC/BBS 2004 study of anemia prevalence:

urban adolescent girls = 29%urban adolescent boys = 17% (lowest of

all groups)

Chittagong Hill Tracts adolescent boys = 40%

CHT adolescent girls = 50%

Iodine Deficiency Iodine Deficiency Effects are physical and Effects are physical and mentalmental

► CretinismCretinism results from severe deficiency during results from severe deficiency during gestation. It is irreversible and includes "profound gestation. It is irreversible and includes "profound mental deficiency.” mental deficiency.”

► GoitreGoitre, a pronounced swelling of the thyroid gland, , a pronounced swelling of the thyroid gland, may develop at any time. may develop at any time.

► High rates of milder mental impairment have been High rates of milder mental impairment have been found in areas where goitre and cretinism are found in areas where goitre and cretinism are common.common.

► UNICEF estimated that 30 per cent of the world's UNICEF estimated that 30 per cent of the world's population is at risk of mental and physical impairment population is at risk of mental and physical impairment due to iodine deficiency, though less than half that due to iodine deficiency, though less than half that number manifest visible signs of goitre or cretinism. number manifest visible signs of goitre or cretinism.

► According to Stanbury (1991), According to Stanbury (1991), "Iodine deficiency is "Iodine deficiency is the most frequent cause of preventable mental the most frequent cause of preventable mental retardation today." retardation today."

Iodine DeficiencyIodine Deficiency

►The most severe problem is restricted to The most severe problem is restricted to areas with iodine-poor soils, typically areas with iodine-poor soils, typically mountainous, glaciated, and/or subject to mountainous, glaciated, and/or subject to heavy rainfall or flooding. heavy rainfall or flooding.

►Milder forms may occur in these and other Milder forms may occur in these and other regions (including European countries) regions (including European countries) where intakes of iodine-adequate foods are where intakes of iodine-adequate foods are low.low.

►The greatest concentrations of population The greatest concentrations of population in areas of iodine deficiency are in South-in areas of iodine deficiency are in South-East Asia, and pockets of Africa and Latin East Asia, and pockets of Africa and Latin America. America.

Vitamin A DeficiencyVitamin A Deficiency► Deficiency of vitamin A was estimated to affect some Deficiency of vitamin A was estimated to affect some

231 million children in 1994, over half of them in just 231 million children in 1994, over half of them in just three countries - Bangladesh, India, and Indonesia. three countries - Bangladesh, India, and Indonesia.

► Vitamin A comes from a wide range of vegetable and Vitamin A comes from a wide range of vegetable and animal sources but children, especially, may lack animal sources but children, especially, may lack adequate access, owing to culture or economic adequate access, owing to culture or economic restrictions in diet. restrictions in diet.

► Vitamin A deficiency is a major cause of blindness, Vitamin A deficiency is a major cause of blindness, mainly in childhood. mainly in childhood.

► Many of those blinded die shortly thereafter. Many of those blinded die shortly thereafter. ► It has been linked to increased vulnerability to It has been linked to increased vulnerability to

infectious disease, with some studies claiming infectious disease, with some studies claiming dramatic reduction in child mortality when vitamin A dramatic reduction in child mortality when vitamin A supplementation is provided to all children in areas supplementation is provided to all children in areas in which even a few show the visible signs of vitamin in which even a few show the visible signs of vitamin A deficiency A deficiency

Maternal and Child Maternal and Child MalnutritionMalnutrition

►Malnutrition of pregnant women may lead Malnutrition of pregnant women may lead to serious problems for children.to serious problems for children.

►Most dramatic is cretinism resulting from Most dramatic is cretinism resulting from severe maternal iodine deficiencysevere maternal iodine deficiency

►More commonly, children born to More commonly, children born to chronically undernourished women are chronically undernourished women are likely to be small at birth. likely to be small at birth.

►Low birth weight is associated with Low birth weight is associated with increased risk of mortality and with a increased risk of mortality and with a range of health and developmental range of health and developmental problems. problems.

JAMA MUAC BMI JAMA MUAC BMI (see link syllabus)(see link syllabus)

► MUAC measurement was easier to perform on severely MUAC measurement was easier to perform on severely malnourished adults than BMI assessment. malnourished adults than BMI assessment.

► For MUAC, the patient could be standing, sitting, or, in For MUAC, the patient could be standing, sitting, or, in extreme cases, lying. For BMI, patients were required to extreme cases, lying. For BMI, patients were required to stand. Measuring BMI requires a height board, weighing stand. Measuring BMI requires a height board, weighing scales, and mathematical calculations; to measure MUAC, scales, and mathematical calculations; to measure MUAC, only a tape measure is required. only a tape measure is required.

► A correlation between measurements of MUAC and BMI was A correlation between measurements of MUAC and BMI was demonstrated (r=0.88; 95% confidence interval, 0.82-0.92 demonstrated (r=0.88; 95% confidence interval, 0.82-0.92 P<.001). The proportions of the population and the actual P<.001). The proportions of the population and the actual individuals identified as malnourished by the 2 indicators were individuals identified as malnourished by the 2 indicators were similar. similar.

► CONCLUSIONS: The MUAC measurement reflects adult CONCLUSIONS: The MUAC measurement reflects adult nutritional status as defined by BMI. During famine, MUAC nutritional status as defined by BMI. During famine, MUAC may be better suited to screening admissions to adult feeding may be better suited to screening admissions to adult feeding centers than BMI. Studies to assess the capacity of MUAC centers than BMI. Studies to assess the capacity of MUAC cutoffs to predict mortality in severe adult malnutrition are cutoffs to predict mortality in severe adult malnutrition are needed. needed.

Risk factors for stunting and wasting at age six, twelve and Risk factors for stunting and wasting at age six, twelve and twenty-four months for squatter children of Karachi, Pakistan.twenty-four months for squatter children of Karachi, Pakistan.

FikreeFikree FF FF, , RahbarRahbar MH MH, , BerendesBerendes HW HW..

►

At two years the proportion of stunting and wasting was At two years the proportion of stunting and wasting was 41.8% and 10.6% respectively. 41.8% and 10.6% respectively.

► Intrauterine growth retarded children had a higher risk Intrauterine growth retarded children had a higher risk of stunting and wasting at all reference ages as of stunting and wasting at all reference ages as compared to children who were appropriate for compared to children who were appropriate for gestational age. gestational age.

► In the logistic regression models, intrauterine growth In the logistic regression models, intrauterine growth retardation was the only significant risk factor that retardation was the only significant risk factor that remained in all models at each reference age. remained in all models at each reference age.

► CONCLUSION: The consistent association of IUGR for CONCLUSION: The consistent association of IUGR for stunting and wasting adds to the growing body of stunting and wasting adds to the growing body of evidence that by improving maternal health we will evidence that by improving maternal health we will ultimately break the vicious cycle of malnourishment ultimately break the vicious cycle of malnourishment and improve the health and well-being of future and improve the health and well-being of future generations.generations.

Malnutrition among girls can affect their Malnutrition among girls can affect their

babies later in lifebabies later in life ► Undernutrition in childhood can cause growth Undernutrition in childhood can cause growth

stunting and influence the size of the child a stunting and influence the size of the child a woman can bear later in life. woman can bear later in life.

►Maternal pelvic size is a strong determinant of Maternal pelvic size is a strong determinant of neonatal survival and universally correlated neonatal survival and universally correlated with height in populations. with height in populations.

► The proportions of low birth-weight infants are The proportions of low birth-weight infants are much higher in populations identified as much higher in populations identified as poorly nourished according to adult poorly nourished according to adult anthropometric indicators, ranging from lows anthropometric indicators, ranging from lows of 4-6% in affluent countries to highs of 25% of 4-6% in affluent countries to highs of 25% or more in Pakistan, India, Bangladesh, and or more in Pakistan, India, Bangladesh, and Laos. Laos.

Food Shortage. Food SupplyFood Shortage. Food Supply

► Is there enough food for population in Is there enough food for population in given area?given area?

►““Global” supply scenario is Global” supply scenario is aggregation of national scenarios:aggregation of national scenarios: gross food supply (total production)gross food supply (total production) net food stocks (after waste, import net food stocks (after waste, import

export, animal feed, etc) export, animal feed, etc)

How do markets influence food How do markets influence food shortage? Discuss shortage? Discuss (from Uvin)(from Uvin)

► p.4. “A low food self-sufficiency ratio is not p.4. “A low food self-sufficiency ratio is not an indicator of hunger within countries, nor an indicator of hunger within countries, nor is a high food self-sufficiency ratio a is a high food self-sufficiency ratio a guarantee of the absence of hunger.”guarantee of the absence of hunger.”

► ““The smaller and poor a country, the more The smaller and poor a country, the more pronounced will be its vulnerability to … pronounced will be its vulnerability to … fluctuations [in world markets], and the less fluctuations [in world markets], and the less it will be capable of influencing them.”it will be capable of influencing them.”

► ““To the extent that declining food self-To the extent that declining food self-sufficiency ratios reflect declining sufficiency ratios reflect declining entitlements to [farmers and agricultural entitlements to [farmers and agricultural laborers] declining rations can coincide with laborers] declining rations can coincide with icnreasing hunger.”icnreasing hunger.”

Countries with DES below requirement, 1988-90Countries with DES below requirement, 1988-90 ((Uvin Uvin

table 1.6)table 1.6), , and FAO 1992 est of malunourishedand FAO 1992 est of malunourished ((table table

1.10)1.10), , Number of Number of CountriesCountries

Population, Population,

millions (%)millions (%)

SS AfricaSS Africa 3232 459 (57)459 (57)

Near East Near East and North and North

Africa Africa

11 13 (2)13 (2)

AsiaAsia 44 262 (33)262 (33)

Latin Latin AmericaAmerica

77 67 (8)67 (8)

N Am, Aus, N Am, Aus, Europe, CISEurope, CIS

00 0 (0)0 (0)

Small Small IslandsIslands

44 1 (0)1 (0)

TotalTotal 4848 802802

People People malnourishemalnourishe

dd

% total% total

128128 1616

1515 22

653 653 (w/China)(w/China)

7777

4747 66

11

843843 100100