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.

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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?

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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:

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  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 21 - 27

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

Environmental effects per serving of food produced

Environmental effects per serving of food produced

The EAT Lancet Commission report entitled: “Food in the Anthropocene: the EAT–Lancet Commission on healthy diets from sustainable food systems” came out this week. It was both praised and demonized but regardless, it made a big splash across many media outlets. I was part of the Commission and I must say, I felt pretty worn out with interviews and podcasts after the first week of its release. So what is the report? It was made up of 37 scientists that came together to do three things: The first was to quantitively describes a universal healthy reference diet that would provide major health benefits, and also increase the likelihood of attainment of the Sustainable Development Goals. The second was to define six scientific boundaries for food systems that would ensure a safe operating space within six Earth systems, towards sustaining a healthy planet. The third outlined five strategies needed for the “Great Food Transformation.” Establishing targets has its benefits but it also breeds controversy. I will write in some detail on the politics of the report at a later date, but for now, the link above has all the deets including a podcast I did with Professor Tim Lang.

On the same week as the EAT Lancet, a paper was quietly published in the New England Journal of Medicine by Andy Haines urging for a renewed focus on climate and health. The authors argue that “climate change is expected to alter…climate-sensitive health outcomes and to affect the functioning of public health and health care systems.” One could argue, we know this, but the fact that it was in a clinical medical journal shows the breadth of how climate change will impact all facets and medical professionals need to be thinking about how this will impact their patient populations, particularly the more vulnerable.

What wasn’t discussed much in the EAT Lancet were “food environments.” These are the places where consumers make a decision about what to buy, order or have delivered. Food environments are markets or cafeterias, or restaurants or food trucks. They look different everywhere. My colleague, Shauna Downs and I published an article in Public Health Nutrition looking at consumers’ perceptions of their food environments and their food consumption patterns and preferences in urban and rural Myanmar. The study shows that the availability of diverse foods had increased over time, while the quality of foods had decreased. Most consumers greatest concern about the foods available was the safety. Consumers preferred fruits, vegetables and red meat compared with highly processed snack foods/beverages. Although consumers reported low intakes of highly processed snack foods, Burmese street food was consumed in high quantities.

One food environment that could improve is the office. A study done by the CDC shows that nearly a quarter of respondents ate food obtained directly at their office. And the foods they ate were not necessarily healthy. Think the leftover pizza, the corporate snack bar, the candy in the jar, the cake for someone’s birthday. The study found that what they officemates ate during work hours was “high in empty calories, sodium, and refined grains, and low in whole grains and fruit.” Shocker? Not really but I do think work places need to stop making it so hard for their colleagues to eat healthy.

Enough with the studies! How about a podcast? A great one has just been started by our friends at NPR. It is called Life Kit and they “help you cut through all the nutrition noise” and provide guidance on how to eat healthy. And there is indeed a lot of noise out there. I listened to three of their podcasts - only about 20 minutes long - and they had some stellar nutrition experts including Dary Mozaffarrian who is the Dean of Tufts Friedman School and Doctors David Katz and David Ludwig. They are great, and I think provide sound advice on nutrition and what to eat. Listen to them on your way to work or even better, while exercising!

And speaking of eating healthy, here is an old video of Andy Warhol, eating a hamburger. Took him about 4 minutes.