October 29, 2019
My intention in writing this article is to give readers an overview of one element of the global nutrition crisis – undernourishment. This is a fairly information heavy article, because, well, there is a lot of information to cover, but please bear with me – it is a topic extremely close to my heart and I will refer back to this overview in future posts.
With this article, I wanted to look into what it means to be undernourished, the effects it can have on the world, and ask myself and my readers is there anything we can do to help? How can we proactively address this challenge?
Last year, the Food and Agriculture Organization (FAO) of the United Nations stated that the number of people facing hunger globally has increased over the previous year to reach a horrifying 821 million.4 How is it possible that nearly one billion people, more than one-eighth of the world’s population, don’t have access to a decent food source? That’s the highest it has been since 1990.
Undernutrition, or undernourishment, is categorized by the FAO as being “a state, lasting for at least one year, of inability to acquire enough food, defined as a level of food intake insufficient to meet dietary energy requirements.”4
Undernutrition makes people, children especially, much more susceptible to disease and death.3
It is estimated that around 45 percent of mortality among children under 5 years old is linked to undernutrition, and these deaths largely materialize in low- and middle-income countries.3 At the same time, in these same countries and communities, rates of childhood obesity are on the rise, but more on this Double Burden of Malnutrition (DBM) later.
There are four general categories of undernutrition outlined by the FAO and WHO: stunting, wasting, underweight, and deficiencies in vitamins and minerals.3
Stunting is identified by a low height-for-age (too short for one’s age) measurement determined by the WHO’s Child Growth Standards, typically deriving from chronic or repeated undernutrition.1 Stunting is a sign of severe malnutrition, and such conditions can have a grave effect on a child’s physical and mental cognitive potential.5 The life-long effects of stunting are widely deemed irreversible after the first 1,000 days of life.1
Correlations have been made between higher rates of stunting and poor socioeconomic conditions, poor maternal health and nutrition, recurring illness, poor hygiene, and insufficient infant and juvenile nutrition in early life.3
It is estimated that approximately 155 million children under the age of five are stunted.3 I think nowadays we have become almost immune to facts such as this. We hear it in the news or read in the paper and think to ourselves, “how horrible, how scary, at least my child is okay…”. It is important to not just glance over these numbers but to sit with them and really think about what they mean. 155 million children under five years old have been physically and mentally affected by an extreme lack of nutrition to the point that these challenges could likely have a permanent impact on their health. 155 million. What’s more, this staggering number does not even include the millions more undernourished children who fall in the categories below. This is something we can put an end to. This is something that everyone reading this blog can alleviate to some degree.
Wasting is identified by a low weight-for-height (being critically thin for one’s height) measurement determined by the WHO’s Child Growth Standards, typically deriving from recent and severe weight loss.3 This weight loss can be due to a lack of access to food and/or an infectious disease (such as diarrhea). Moderate to severe wasting is incredibly dangerous to health, especially to a young child, and increases the risk of death.3
A child is categorized as wasted if their weight (depending on height) is more than “two standard deviations below the median for the international reference population ages 0-59 months.”1
An estimated 52 million children under five years old are considered moderately wasted. Another 17 million are deemed severely wasted.3
Fortunately, unlike stunting, wasting can be treated. By improving nutritional intakes, proper healthcare, and treatment of infection, the effects of wasting can be waylaid.1
In 2014 WHO calculated that nearly 462 million adults in the world were underweight.3
Deficiencies in vitamins and minerals, also known as, ‘micronutrient malnutrition,’ is identified as having an inadequate intake of micronutrients. Micronutrients are vital in the production of enzymes, hormones, and other materials crucial for healthy growth and development.3
Iodine, vitamin A, and iron are the three most at risk micronutrients and pose a very real threat to health worldwide–again, especially for children in low- and middle- income countries.3
These deficiencies in vitamins and minerals are often responsible for a link between undernutrition and obesity, which is known as the ‘Double Burden of Malnutrition’ (DBM).
So, to make matters worse, most countries also face DBM, which happens when undernutrition and obesity coexist within the same country, region, community, household, and individual.3
At a high level, most countries, communities, and regions have some degree of undernourishment as well as having climbing obesity rates.
DBM can also affect people who reside in the same household. A parent may be anemic and underweight while their child has a significantly higher than optimal BMI.
DBM can even happen on an individual level. One such example is an obese person with serious deficiencies of one or more vitamins or minerals because they are consuming low-quality or low nutritional valued foods. Another case is an obese adult who struggled with and was stunted by undernourishment as a child, and even cases where they were stunted in the womb.3
Almost all of the over 800 million people considered chronically undernourished live in developing countries, namely Africa and Asia.2 The remainder (about 20 million people) of the chronically undernourished live in low- and middle- income communities within developed countries.2
Around 40 countries in the world are facing dangerous food deficits. In 12 of those countries, including Haiti, Zambia, Central African Republic, Namibia, North Korea, and Chad (see graph below), about one-third of the population are afflicted by severe undernourishment.2
These are the 19 countries whose undernourishment rate is higher than the global average of 11%:
|RANK||COUNTRY||PERCENT POPULATION UNDERNOURISHED|
|3||Cent. African Rep.||47%|
Source: United Nations Food and Agriculture Organization (FAO). *Famine countries.2
The level of undernourishment can also vary greatly within the countries themselves. For example, while some countries in Africa have reported quite low levels of undernourishment (around 7 percent or less), those affected aren’t just moderately undernourished–they are at risk of, or in the case of four countries, actually facing famine.2 These four countries battling with famine are Nigeria, Somalia, South Sudan, and Yemen. In fact, the food shortages have become so critical that more than 20 million people are facing starvation.6
Other examples are India and China, who have also reported relatively low proportions of undernourished populations (15 percent and 9 percent). This, however, doesn’t paint the full picture. Because of their extreme population sizes, India and China account for about 40 percent of the global undernourished population (approximately 330 million people).7
Food insecurity is defined by the UN FAO as the "situation when people lack secure access to sufficient amounts of safe and nutritious food for normal growth and development and an active and healthy life."4 Food insecurity is a considerably large cause of global malnutrition and is largely based on inadequate quality or quantity of food. This is measured by the FAO using its Food Insecurity Experience Scale (FIES) global reference scale.4
Insecurity of food can be caused by a number of factors, namely the lack of access to food, unaffordable food, and uneven circulation of food within the household.1
Food insecurity is broken up into three major categories (highlighted in the image below). Mild food insecurity is described along the lines of not knowing where your next meal is going to come from or having to compromise the quality of your food to have enough food. Moderate food insecurity is generally described as the lack of ability to have access to regular healthy, nutritious meals (it is at this level that the prevalence of micronutrient deficiencies start to appear). Severe food insecurity is related to lack of quantity and quality of food where an individual is at extreme risk of or experiencing hunger/starvation.1
To be able to adequately grasp and measure the progress on undernutrition within a single metric, the International Food Policy Research Institute (IFPRI) have defined a score system termed the 'Global Hunger Index' (GHI).8 The Global Hunger Index measures the nature of hunger at global, regional, and national levels by combining four key indicators (which we have discussed above) of malnutrition into a single index score.8
These four indicators are:
These measurements are used to create a 100-point scale. A value of 0 is the best, meaning there are no signs of undernourishment in that country or region. A value of 100 is the opposite. No single country has a score of 0 or 100, but all are somewhere in the middle.8
The GHI scores are intended to raise awareness to areas, countries, and regions where hunger levels are at their highest and measure the successes and setbacks globally in fighting hunger.8
Learn. It all starts with you. Taking small steps, such as reading this article, to further educate yourself on the plight of others can make all of the difference in the world. Opening yourself up to what is going on is the beginning of your journey to make a difference and just by doing so you already have. You are now one more person that knows the danger of undernutrition, one more voice to add to the volume of a movement, and one more heart dedicated to eradicating hunger – knowledge is power, and it is in your hands.
Donate. There are so many outstanding organizations dedicated to ending hunger – all of which can do so much good even with the smallest contribution. Check out the following organizations for some inspiration and donate today:
Serve. Volunteer at your local food shelter or find an organization such as those listed above and reach out to see how you can help. Help is always needed and always deeply appreciated. If you have the time, don’t be afraid to plan that big trip overseas and volunteer abroad. Travelling is a great way to see new places, encounter new cultures, and get to know communities far removed from your own.
Support. Do your research and support companies that make an effort to put a dent in hunger. You can make a difference with products that you already purchase! Check out this blog which highlights a number of companies that do their part to make a positive difference in the world.
Educate and Share. Just as educating yourself is the first step on your journey to making a difference, sharing what you have learned with friends, family, acquaintances, that stranger you met on the bus, and on social media could be the first step for so many other people, voices and hearts to join the fight against hunger.