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7. Conclusions

Patterns of risk
Policy implications
Works cited

Ellen Messer

In 1995, hunger numbers indicated that 800 million people were food poor, tens of millions suffered iron, iodine, and vitamin A deficiencies, and millions were food short because conflict made it impossible for market or relief food to compensate for local shortfalls. The hunger numbers and profile (Uvin 1996), viewed against the findings of the foregoing chapters, suggest the following generalizations about where the hungry are located and certain themes for intervention to prevent and relieve nutritional suffering.

Patterns of risk

Food shortage

Those most at risk of food shortage tend to be located in conflict zones, where food cannot reach them. Weather and hazardous climatic or environmental conditions are less important than politics influencing food production and distribution. Active and post-conflict zones suffering food shortage predominate in sub-Saharan Africa and, to a lesser degree, in South-East and western Asia. Conflict zones, even if they are receiving food aid, tend to be food poor. Social and climatic disaster usually combine to create situations of resource poverty that set the stage for chronic food poverty for years to come.

Seasonal or periodic hunger constitutes the second general case of food shortage. This persists outside conflict zones in local settings where food production combined with other economic activities is insufficient to support adequate diets year-round or from year to year where single-year productivity is variable and low. Increasingly, these pockets of food shortfall are reached by intervention programmes, that provide relief food, often through "food-for-work" employment programmes, Where markets or food relief penetrate relatively isolated local food systems, as in many parts of Africa and South Asia, food shortage is removed but is replaced by chronic food poverty (Messer 1989).

Food poverty

The main factors influencing food poverty are shortage (especially related to conflict), entitlement strategies that are not sufficiently remunerative and diversified, and macroeconomic policies, especially the early stages of structural adjustment, that make food and other services less affordable.

Proportionately more food-poor households exist in food-short regions, but adequate food in a region does not guarantee freedom from hunger. Undiversified production; low food prices for rural produce relative to other commodities; excessive taxation; lack of transport and market facilities; and lack of control over land, labour, wages, and prices - all contribute to households being unable to meet their own needs. Food poverty is most severe in sub-Saharan Africa, largely because of shortage. It poses enormous problems also in most countries of Asia and Latin America, where aggregate food supply should be sufficient but severe inequalities persist in income and food distribution.

Within urban areas, underemployment and underremuneration contribute to incapacities to meet food needs although, in urban areas, subsidized food, health care, and other compensatory services tend to be more available. Food poverty is greater in rural areas, which tend to be more at risk of being excluded from government social services and safety nets should crops and income strategies fail.

Income diversification is usually cited as one of the "solutions" for food poverty. Those with multiple income streams tend to be less at risk of hunger when any of the streams fails. But transitions often constitute potential hazards as well. Since the 1980s, analysts observe that those households experiencing transition economies, which are in the process of shifting from subsistence to cash-cropping and other sources of income, and from customary kinship and community to state-organized safety nets, may be more vulnerable to hunger. In addition, those countries undergoing economic (structural) adjustment may be more vulnerable: they need special anti-poverty and social programmes to avoid intolerable and conflict-potentiating food poverty.

In both urban and rural areas, food-poor households experience synergisms between malnutrition, illness, and unhealthy environment that reduce wellbeing and increase hunger. Meta-analysis of the sources of child mortality indicate that even mild-to-moderate malnutrition potentiates child mortality from infectious disease (Pelletier 1994). Household poverty restricts access to both nutrition and health care.

Food deprivation

Chapter 5 examined issues of intra-household distribution of food whether the burden of food poverty is shared equally among household members, and also what types of individuals are likely to suffer from food deprivation in the absence of food poverty. Significant variables are gender and age. Pregnant and lactating women are generally the most vulnerable to hunger because they have elevated nutritional needs that may or may not be perceived and that, for cultural as well as economic reasons, are likely to go unmet in food-poor (but also not so poor) households. Analysts point out that estimates of female nutritional needs (requirements) often incorporate gender bias: they assume smaller body size and therefore lower nutritional needs, and also tend to underestimate women's physical activities and caloric expenditures. These underestimates operate to reduce expected and standard nutrient intakes of females from very young ages. Additionally, the extra nutritional requirement for pregnant and lactating women deserves greater emphasis: women in the developing world still spend much of their adult lives in these reproductive states with their heightened nutritional needs.

Geographically, the problem of reproductive-aged women's malnutrition is most pronounced in parts of India and neighbouring countries in South Asia. Children in South Asia and South-East Asia, and in pockets in sub-Saharan Africa, also experience elevated risk of vitamin A- and iodine-deficiency diseases. Reproductive-aged women the world over are at risk for iron deficiency. Even as women appear to be getting greater access to food calories, as shown in the Indian data provided in this volume, they still may not be getting their fair share of micronutrients and other high-quality foods, and this affects their well-being, fertility, and longevity.

Nutrition incorporates notions of food, health, and care, any of which may or may not show gender bias. Food-energy-intake data are mixed, especially for Africa and Asia, where apparent patterns of both male and female bias coexist in different national samples. The conventional wisdom, that females are less well nourished than males because they encounter discrimination in food allocation, does not always conform to the evidence: counter-evidence is accumulating from Africa, where females tend to be more autonomous and economically active; contrary evidence is also emerging from South and South-East Asia. Anti-female discrimination in food-energy intakes, where staple foods are relatively affordable, appears less than expected. Food poverty, moreover, does not appear to be the main determinant of preferential feeding of males over females: positive male-gender bias in India appears to operate more forcefully in households that have more, not fewer, resources.

Gender differences in age-specific survival persist in the face of this seemingly contradictory evidence. Accumulating evidence indicates that bias is less likely to occur as a result of differences in food (energy) distribution than it is as a result of differences in health-care allocation. Skewed male survivorship, plus ethnographic evidence, suggest that males, indeed, are favoured in expenditures for health care. They may also be favoured in consumption of luxury foods, rich in protein and micronutrients. This interpretation is supported also in recent anthropological studies of South Asia and South America that found evidence of anti-female gender bias in health care and survival but mixed data on gender-skewing in food intake (Messer 1997). Whereas food energy may be relatively inexpensive and accessible as a result of agricultural improvement programmes and government safety nets, health care may be more available but less accessible to poor households, which therefore may ration use to (male) members who are considered to be more valuable economically or socially over their lifetimes.

Evidence of nutritional discrimination against infants and young children also contains errors due to data-collection bias or omissions. The authors point out that many countries omit breastmilk from records of food intake of very young children, so of course they appear to be horrendously undernourished! Reports of infant intakes that leave out breastmilk, and children's diets that refer to absolute intakes instead of intakes relative to gender-based standards, appear to account for some proportion of such biases communicated in the literature. However, these revised interpretations of the data on energy intakes must be accepted with caution and extremely important qualifications. Breast-fed children may still be moderately or severely underfed relative to their needs. Female children may still suffer life-threatening discrimination in allocations of health and other types of care, as well as of higher-quality nutrient-rich foods. These new data and interpretations suggest that food-energy biases are less common even in Indian regions of endemic excess female mortality, but they do not contradict the indirect evidence - appalling excess female mortality - of anti-female bias. Indian women need to have access to better health care and higher-nutrient-density foods, particularly during their reproductive years. Households and individuals, in cases of the better-off households, need education about nutritional needs and the value of women's health and work; poorer households also need additional economic resources.

Policy implications

Food and nutrition policies tend to be either short (5-10 years) or medium (2050 years) term and to have measurable versus general programmatic goals. We connect here two recent plans to reduce world hunger to our hunger typology and analysis.

The Bellagio Declaration: "Overcoming Hunger in the 1990s"

A significant short-term effort to identify what could be done for hunger by the end of the decade was "Overcoming Hunger in the 1990s." This international NGO effort, promulgated as a Bellagio Declaration in 1989, aimed to reduce half the world's hunger in 10 years. It introduced a focused but multi-faceted scheme that set four achievable (measurable) goals: (1) to end famine deaths, especially by moving food into zones of armed conflict; (2) to end hunger in half the world's poorest households; (3) to eliminate at least half the hunger of women and children by expanding maternal child health coverage; and (4) to eliminate vitamin A and iodine deficiencies as public health problems. The Bellagio Declaration also affirmed food as a human right, and insisted that progress will come only through the joint efforts and energies of grass-roots and community organizations combined with state and international agencies. A five-year report concluded that progress was being made on all except the first goal: conflict continued to be an intractable problem. Progress reported for China, Indonesia, and Thailand contributed to the global downward trend in numbers malnourished and to meeting the "halfway" goals to halve hunger. The mid-decade assessment also suggested that additional investments in women's education and health, clean water, infrastructure, and community organizing would go far toward eliminating hunger in the future (Messer and Uvin 1996). In short, the report, while hopeful, was far from complacent.

"2020 Vision for Food, Agriculture, and the Environment"

The "2020 Vision for Food, Agriculture, and the Environment" initiated by the International Food Policy Research Institute (IFPRI) in 1994, aimed to set medium-term priorities and actions to avert a future world food crisis. Concept background papers assembled opposing views on pertinent issues such as ecological resources, population, trade, poverty, and nutrition. The goal of the series was to develop a consensus, among the many parties concerned about world food and nutrition, on a global plan of action to secure adequate food, healthy populations, and sustainable environment for the next century.

Overall, the 2020 project offered a diverse menu of actions that might be taken to prevent food shortage, prevent food insecurity, and meet the nutritional health needs of all the world's people. In their series of six "priority areas for action," number one was "Strengthen the capacity of developing country governments to perform appropriate functions" (IFPRI 1995: 23), which involves both more effective action by governments (in partnership with other sectors) in policy-making and implementation, and also the prerequisite of "improved security and personal safety." Specific actions include giving priority to conflict resolution and prevention in areas where armed conflicts and civil strife are occurring or are imminent. National and international development agencies need to incorporate conflict prevention into programme and project planning, by identifying and then targeting for intervention those areas where the potential for conflict is high, and defusing them by delivering aid in manners that avoid competition and that foster (or demand) cooperation among groups or communities. Conventionally, agricultural research focused on areas of high growth potential, especially when implementing Green Revolution seed-water-fertilizer technologies

that were dependent on good soils and reliable water supply. The 2020 report recommends that the very poorest or seemingly hopeless areas also receive special priority, as these may be areas of high conflict potential; resources should be directed toward these areas that are conflict prone, by finding and promoting "engines of growth" that might overcome and move people beyond perceived scarcities and thereby preclude disruptive and destructive negative growth that has characterized conflict areas over the past three decades.

Other recommendations addressed issues such as more secure agricultural production in manners that promote rural livelihoods and protect environment, aspects of ecological management, and ways to create more efficient and effective markets for agricultural inputs and outputs. A separate recommendation was to improve productivity and health of low-income people, who also need increased access to employment and productive assets.

This vision focuses on sustainable food supply to meet nutritional and environmental goals for the next century. It attempts to expand the agricultural agenda at the same time that it tries not to depart too greatly from its principal mission theme of "food." It leaves priorities to regions or countries.


Key points of contact between these policy exercises and the hunger typology are their recognition of the need for greater cooperation between the different sectors of society that potentially impact on Food Policy, their focus on conflict and conflict prevention, and their emphasis on improving the lives and livelihoods of women. The policy exercises also share a common concern that, although the world is in crisis, there are already many tools to help prevent and relieve further suffering. Both exercises urge support for legal mechanisms to promote people's right to adequate food and nutrition.

Analysis of hunger situations provides guidance for policy makers to map nutritional suffering in time and space for more effective action. Recent world summits on environment, population, social development, and food all emphasize the potential for better mapping of vulnerable regions, communities, and households. This is, in part, a technical recommendation. They also emphasize the need for a stabler political environment in which diagnosis of, and response to, hunger problems can take place. Hunger situations ultimately are amenable to political solutions, much as their existence and persistence are due to political causes. International committees, which seem to be gaining both political wisdom and technological expertise, still need to acquire greater political will to act.

Works cited

International Food Policy Research Institute (IFPRI). 1995. A 2020 Vision for Food, Agriculture, and the Environment The Vision, Challenge, and Recommended Action. Washington, D.C.: IFPRI.

Messer, Ellen. 1989. "Seasonality in Food Systems: An Anthropological Perspective on Household Food Security." In: D. Sahn, ed. Seasonal Variability in Third World Agriculture: The Consequences for Food Security. Baltimore: Johns Hopkins University Press, pp. 151-175.

_____. 1997. "Intrahousehold Allocation of Food and Health Care. Recent Anthropological Findings and Understandings." Social Science and Medicine 44, No. 11: 1675-1684.

_____, and Peter Uvin, eds. 1995. The Hunger Report: 1995. Amsterdam: Gordon & Breach.

Pelletier, David. (1994). "The Potentiating Effects of Malnutrition on Child Mortality: Epidemiological Evidence and Policy Implications." Nutrition Reviews 52, No. 12: 409-415.

Uvin, Peter. 1996. "The State of World Hunger." In: E. Messer and P. Uvin, eds. The Hunger Report: 1995. Amsterdam: Gordon & Breach, pp. 1-18.

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