PRB Discuss Online: Who Is Malnourished or Hungry in the World? Why? What Can We Do to Help?

(December 2006) How many malnourished or hungry people are there in the world, and why? Is the situation improving or worsening?

During a PRB Discuss Online, Bill Butz, president and CEO of PRB, answered participants’ questions about malnutrition, hunger, and food security.

Dec. 6, 2006 10 AM EST

Transcript of Questions and Answers

Dr.B.Vijayakumar: The causes for malnourishment is universally same. But it is different from hungry,but can be related. In places like highly vegetative African nations,even though nutrient natural foods are available,the population suffers. How the problem can be solved?
Bill Butz: Indeed, malnutrition and hunger are related, although malnutrition is more straightforward to define and measure. You raise an interesting question about natural or traditional foods. In many parts of the world, these have been a source of good nutrition for centuries, at least. Amaranth (a kind of greens that are boiled) and Bambara Bean are among many such foods in Africa. Environmental degradation has decreased production of natural crops in some areas. And generally, peoples’ food preferences change toward more “modern” grains and toward animal protein as their income rises and as they become exposed to mass media messages. Compared to research on more modern crops, very little agricultural research has been devoted to improving the characteristics and production of native crops, with exceptions like the the substantial research on casava.

Carlos Teller: Why is the main donor response (in dollars) to problems of hunger and malnutrition in the world is food aid? Evaluation research has shown that this has very little effect on the causes and prevention. what can be done to get over the overly “FOOD FIRST” approach?
Bill Butz: Well, it’s natural to think that a good way to help a hungry person or a hungry nation is just to provide food. And that is a correct approach in the case of famine and starvation, where the problem is acute and the need is urgent. For the longer run, though, when there is chronic malnutrition and hunger that continues, providing food has the unfortunate effect of lowering food prices in the receiving country and thereby blunting the incentives for local farmers to produce. This usually worsens the situation in the long run. Keep in mind that one of the main impetuses behind food aid programs is not reducing hunger in the receiving country but propping up product prices in the sending country! When the U.S. government, for example, buys grains and dairy products on the U.S. market, it keeps those prices higher for farmers. If there’s no world market at those prices, the U.S. government and others have frequently given the food away abroad or sold it abroad for local currencies.

Christopher Wamala: One who is Hungry or malnourished is one who is sick or who doesn’t have the tools or the seeds or the knowledge to have to use to fight hunger or malnutrition. One can be affected of war or by disease. Kind people, individuals or organisations, should make grants to the poor direct to them, not through governments. Donors should insist on such projects that encourage giving out tools or seeds to involving the people themselves in food productions. Donors should arrange to help to end wars which have been the major causes od hunger or malnutrition of the whole world.
Bill Butz: In one sentence, Christopher, you hit most of the direct causes of malnutrition and hunger: disease, farmers’ lack of inputs, and lack of knowledge about healthy eating and other behaviors. More broadly, it’s useful to think about three levels of causes: food availability, food access, and food utilization. “Availability” has to do with food production. “Access” has to do with income, education, information, and other cultural and economic factors that affect how consumers obtain food. “Utilization” refers principally to how the body makes use of its nutrient intake and what the results are. You’re right that grants through governments have a spotty history. But the other ways of getting resources to poor people have their problems, too. For instance, most NGO’s (non-governmental organizations) don’t have nearly a universal reach to all the malnourished or hungry in a country; instead they may serve city dwellers, or people who make use of a particular service. As for wars, yes, these along with severe civil disturbances and natural disasters like floods, droughts and earthquakes do still cause famine and starvation. But these are very far from the major causes of malnutrition and hunger, anymore. Chronic malnutrition is a much more important problem in terms of the numbers of people affected and the results for themselves and their countries.

Joanna Vandenberg: Many scientists now say that the green revolution was a bad idea. It created a huge population living under sub-standard conditions. do you agree or disagree with that? and can you explain why?
Bill Butz: The green revolution (improved cereal grain varieties and associated changes in other agricultural inputs and practices, from the late 1960s through the early 1980s) had many effects. Certainly, it substantially raised the production of cereal grains in South and Southeast Asia and Latin America. In those same regions, these increases in food production and availability reduced malnutrition and hunger, and thereby decreased infant mortality and increased life expectancy. So there are indeed many more people living in the world today than would have been without the green revolution. To the extent that this is a bad thing, then the green revolution (along with other important factors) was responsible. The green revolution led also to increased use of chemical fertilizer and pressure on groundwater supplies. The green revolution hardly took effect in Africa, so the effects are missing there. Personally, I think that the green revolution was on net an enormous benefit to humankind, not withstanding it’s flaws, from which I think we’ve learned.

Max: Extreme poverty often occurs in developing countries with high rate of unemployment. So if more people from these countries can migrate to rich,developed countries with underpopulation problems, will it help to relieve poverty?
Bill Butz: International migration is, indeed, one of the ways that people improve their economic condition. Migration from developing to developed countries is widespread, but migration between developing countries is on the rise. Guatemalans crossing into Mexico, for example. Such migration does generally improve the standard of living of the migrants (and often also of the family they leave behind but send money to). That fact doesn’t do away, though, with the issues and arguments that attend such migration in both sending and receiving countries!

Soma Dey: Do you think that the hungry nations are a threat to the world security? Hungry people are more dangerous than nuclear weapons?
Bill Butz: Personally, Soma, I think that the fact that about half of all the child deaths in the world this year have a cause in malnutrition is the most important reason to be concerned about the things we’re all talking about this morning. That’s 15,000 deaths a day.Hunger used to be an important cause of conflict, but research indicates that it’s much less so today. Other causes predominate. Some observers think that hunger may again become a major factor in world insecurity if natural resource degradation causes food production declines so severe to cause acute malnutrition and famine in particular areas in the future.

Christine: After working this summer in a nutrition program that was an integrated part of a child survival program in Rwanda, I concluded that unless nutrition programs are implemented alongside microfinance or microenterprise programs, their efficacy may be limited. Could you comment on this?
Bill Butz: Community involvement is a key to solving “access” constraints that produce malnutrition. What direction this involvement best takes depends strongly on local conditions. Much research supports this conclusion. I have not personally seen research that links microfinance or microenterprise programs to child survival. But I certainly expect that where access to credit and to income are constraining food access and other contributors to child survival, such programs can be effective. I am a strong supporter of them for other reasons, as well.

Anonymous: How effective are programs like “Feed the children”, “Save a child” and “wateraid” in helping to combat malnourishment among children, particularly the poor?
Bill Butz: Programs that deliver food to famine areas have become more and more effective in recent decades. The principal constraint is getting the food from the loading dock to needy people’s mouths. Country governments are sometimes unhelpful, and civil disrest and civil war are just as often the problem. To reduce chronic malnutrition, a sustained approach that does not directly supply food from abroad and therefore does not reduce the incentives for local farmers to produce food and and reduce farmers’ income is the right idea. There are many programs that can do this, including ones that raise the income of the poor, that increase the schooling and status of women, and that improve food-related behaviors through information. Fortunately, there are many excellent programs, rich country-based and international, that take one or another of these approaches and contribute importantly.

Robert Prentiss: A nation’s IMR, if less than 50, has been used to determine whether that country has succeeded in ending hunger. If you consider that methodology to be valid, what countries have managed to lower their IMR’s to below 50 in the past 5 years. Have any backslided in that period to above 50?
Bill Butz: Falling infant mortality rates are one of humankinds’ major successes of the 20th century, first in the developed countries, then also in the developing world in the last 40 years. Accompanying these mortality declines, and partly responsible for them, have been substantial reductions in malnutrition. The number of undernourished people in developing countries fell from 920 million in 1980 to 798 million in 2001. The proportion undernourished fell from 28% to 17 percent. These numbers are extraordinary and give us substantial hope that IF WE CONTINUE AND IMPROVE THE INVESTMENTS WE’VE BEEN MAKING OVER THIS PERIOD, malnutrition and infant mortality can continue to fall. Quite a number of countries have moved under the 50 mark in the last decade. Few have backslid; these would include HIV/AIDS ravaged countries like Zimbabwe.

Okpechi Felix-Mary Uzochi: It is inherent in the millennium development goals to eradicate extreme hunger and poverty by the year 2015.Do you think this is possible in African Countries (especially sub-saharan countries) where most people live below the poverty line?
Bill Butz: I do think it is possible. This is something we know how to do, thanks to laboratory science, controlled trials, field experiments and demonstrations, epidemiological studies, and the accumulated experiences of local actions in many places around the developing world. What will it take? Here are a few ideas:

  • reduction of agricultural subsidies and trade barriers in the high-income countries, notably Europe and the United States
  • direct nutritional intervention programs to supplement micronutrients, fortify foods, and changed dietary behaviors. Community-based health and nutrition programs can work—we know that-—and the successful models should be widely adapted and scaled up.
  • continued and accelerated increases in girl’s schooling and women’s status. Research is quite clear that these result directly in improved nutritional status and reduced mortality.

There are other important interventions also. One would be general economic development that benefits poor people. This is also known scientifically to be important, but with the 2015 deadline you gave me, progress on this front would be too slow acting, by itself. Good question!

Adekola Olalekan: If you are told to choose one to focus on, which will you choose? Which is more important? Malnourishment or hunger? This is a case of choosing between quality and quantity.
Bill Butz: Both malnourishment and hunger have multiple dimensions, and their effects differ somewhat depending on the setting. If you tied me down and made me answer your question, though, I would choose malnutrition as more important. Partly, I admit, this is because it is a much clearer thing in terms of concept and measurement, so I know for sure whether what its prevalence is in subpopulations and how the prevalence is changing over time. Hunger is more difficult to define and measure, as evidenced by the U.S. National Academy of Sciences report that made the press last week, recommending, among many other things, that the word “hunger” be replaced in official U.S. government data and reports by phrases that are closer to what is actually measured. Some others would differ with my 1-2 ranking of importance, I bet.

Elba Velasco: Would it be possibly to combine education, with food aid and therefore strengthen the self worth of hungry people? Just giving away food is not enough, it has being proved over and over again
Bill Butz: As we discussed earlier, giving away food is best in famine situations and problematic, at best, in chronic situations. Education is very important, especially for women, who are predominately the persons who have the most influence over access to food and utilization of food in their families. So even apart from strengthening self-worth directly, education contributes to other things like income and empowerment that also contribute to self worth.

Meredith Uttley: The knowledge that so many in the world have so little when dumpsters of food are thrown away daily in the U.S. is so depressing. Is there anything positive to point to?
Bill Butz: There is a great deal positive to point to, Meredith. Despair in the face of success is, in my view, a dangerous phenomenon, because it disregards the lesson that we CAN make things better through directed action. Earlier, I documented the decreases in malnutrition in most developing countries of the world, and the improvements in infant mortality and life expectancy. We should use this information to counter the proposition that “nothing can be done so let’s quit throwing money down a rathole and use it for something that works.” Nonsense! Instead of despair, let us find and document the approaches that have been successful. Let us collect the data and use appropriate statistical and qualitative methodologies to evaluate these successful approaches, including identifying the conditions under which they really work. Let us then adapt them to other places and conditions and, when they are ready which I think many now are, scale them up. The science here is far ahead of information in the hands of decisionmakers and policy makers. Here’s where Population Reference Bureau comes in! Our principal job is to inform people around the world about population, health and the environment, and empower them to use that information to advance the well-being of current and future generations. That is, to narrow this gap between what the data and the research indicate should be done, and what policy and program people are actually doing. Important work.

C. Teller: Can you be more specific about who are the “we” in the question? What are the most policy-relevant groups that could most effectively help? Such as PRB to communicate the issue, private citizen to give money to the most effective NGOs, experts working in this field of hunger and malnutrition who give “pro-bono” advice, humanitarian, research and other speciality organizations, etc. Is there an advocacy group in the US that has clout in the US Congress to mobilize substantial resources to address this continuing scourge of the 21st (esp. in Africa and S. Asia)?
Bill Butz: The “we” in the title of this on-line discussion refers to ALL of us. Your list is a good one and needs no elucidation from me. I’m not going to mention particular U.S. organizations, but I will say clearly that aid (money and technical assistance) from the U.S., other rich countries, and international organizations, for combatting the problems we’re talking about this morning is FAR less that it should be, relative to other purposes of aid, IF RELIEF OF HUMAN SUFFERING AND ITS ECONOMIC EFFECTS IS THE CRITERION. Just as one component, I would emphasize that U.S. foreign aid/assistance to agriculture in developing countries had only very slow increases from 1980 to 92, then fell from 1992-96 and has increased only very slowly thereafter, never coming close to the levels of the 1980s. We’ve already seen this morning the extent that malnutrition contributes to child deaths. Add to that the deleterious effects on disease incidence and outcome in adults (including micronutrient-caused morbidity from vitamin A, iron, and iodine deficiency, and on adults’ work behavior and output (and therefore on national GDP), and the result is a well-documented rate of return on investments in nutrition that surpasses the rates of return on some other prominent (and worthwhile) uses of foreign aid and assistance.

Jennifer Dixon: Hello Bill. Do you think it would be a good idea for the government to mandate for every actor and actress (who are worth millions) to give a percentage of their earnings to a relief fund for the people who are suffering from hunger all around the world?
Bill Butz: Hi Jennifer- Did you know that charitable giving is higher in the U.S. (absolutely and relative to our national income) than in just about any other country? That is also true for charitable giving directed to other countries. So we are a very generous people—more so in our private giving than in our government foreign aid programs, perhaps. As I argued previously, I’d like to see a larger proportion of our charitable giving (by you and me, as well as by wealthy actors) go to combating chronic malnutrition and failed food security. When we give for food, we’re much more likely to do it in response to a natural disaster. That’s important too, but it does little or nothing to improve the longer run problems, and it is they that cause most of the suffering.

Mojisola Eseyin: The issue of hunger is a third world issue. It is particularly that of the children of the world.What role can the developed countries play to facilitate delivery of food at their tables outside what appears to be a fanfare approach via NGOs and funding agencies?
Bill Butz: I hope I’ve already provided some specific answers to your question, Mojisola. I would caution, though, against disparaging the approaches of NGOs and funding agencies. Many of these do excellent work, and cost-effective work. I think that a key to doing better is well-done evaluation studies that point out the approaches that really work. This may be even more important than putting more money in across the board. Evaluation studies of nutrition interventions is a weak area, in my view. More is known methodologically about how to do it than is in common practice. Nutrition interventions and policies are not the only area in which more and more informed investment in evaluation may be the highest pay-off activity of all. Governments and foundations would well consider this in their investment decisions.

Farzana Shahnaz Majid: In my view the poor, illiterate, war affected and people of natural disaster prone country are the most malnourished and hungry. Amongst women are most malnourished, ill health and suffers from morbidity due to extreme poverty specially in the third world then that of men. Women represent a significance of the total population and substantially contributing in the Gross National Product and Gross Domestic product. Do you think that in third world country if we take special measures to eliminate the poverty and malnourishment so the country will be benefitted and people will become nourished.
Bill Butz: The evidence is that, among the factors you list, poverty and illiteracy are is much more widespread causes of malnourishment and hunger than are war and natural disasters. As I keep emphasizing, women, especially women of reproductive age, are key to the puzzle. You’re right to add their contribution to the national economy to the factors I’ve listed in other answers. Poverty and malnourishment are linked in the research, but there are many poor people in the world who are not malnourished, and many malnourished people who are not poor. Lessening poverty is excellent for other reasons, but it has to be said that it would act slowly on a world level to reduce undernutrition, so other directed approaches are also important. (No one’s asked about over-nutrition or obesity, but this is a rapidly growing phenomenon not just in rich countries but in poor ones as well…and with important health and mortality consequences.)

Vanishree: In traditional rural Indian society undernourishment and hunger are closely associated with women. The major cause for this is “women will eat last and least”. The tradition twined with poverty severely affects the health of the women. How this can be challenged?
Bill Butz: Women’s literacy, women’s schooling, women’s status, and women’s rights. We know how to increase each of these. There is absolutely no mystery about it. What’s lacking is getting the science-based information into the hands of policymakers and into the minds of women and men. This information shows clearly the payoffs—economic and otherwise—to making these investments. As Mark Twain wrote, “In legislative bodies [actually, he was more specific than this], the truth is just another lobby.” But it IS a lobby, and if it isn’t there among all the other influences on policy makers, in the form of evidence-based information, surely more productive policies will not come to pass.

Bronke: We see in Countries with a high infant mortality rate that the growth figure is also very high I have mapped it from your statistics. Why are people still saying that too much care for low income people will give only a high population. It is the other way around. Please maybe you can demonstrated this in one of the upcoming bulletins?
Bill Butz: You are exactly correct. We’ll have a look at explicating the strong evidence that underlies your statement in a forthcoming PRB Population Bulletin. Incidentally, I hope you’ll all have a look at our Bulletins, four a year now for decades. You can access them on line, thereby getting up to date quickly on the latest data and research on such a wide variety of important topics on population, health, and the environment.

Veronica Fynn: As an African refugee, I have been fortunate to not only experience poverty and hunger to the maximum but also see the blatant waste characterized by Western cultures (especially in USA). In my daily pursuit to return to my people and my culture I always find huge challenges and road blocks in the form of discrimination, lack of privilege and opportunities to excel. I know in my heart of hearts I can effectively contribute to positive change on the continent given my educational qualification and unparallel real life experiences. In my struggles I have realized that education seems to be the one significant factor that can bring immense change to anyone’s life but of course not in isolation. So, my question is how can we (on behalf of poor and hungry African refugee children) penetrate the diplomatic, profit-driven Western society in order to give something back to our people? How could we (African youths) be given the opportunity to get involve in Africa’s political system with security and peace? I believe, in as much as outsider can contribute to changing the situation in Africa, Africans with unique experiences are also capable of effecting far better change on the continent as well. Too many innocent children are dying each day just for lack of care and provision of life’s necessities–food, water, peace and happiness.
Bill Butz: How can a single person, particularly an African, make a contribution to this bewilderingly complicated problem? The answer I believe most passionately in is to find—for yourself, for each of us—where the world’s needs intersect with your passions…and then prepare to work or to contribute your time or money charitably in that intersection! Is it local action? Is it scientific research? Is it persuasion of others, including policy makers, to take these problems seriously? It is becoming so interested in politics that you, yourself, become active in your country’s organized political system. Each of these and all the other possible intersections imply particular preparation on your part. So first, where’s your passion. Second, prepare. Third, act. Others may disagree, but for me, I think this is the path…and that we’ll get there.

Patrick Rea: Given the fact that a countries growth rate, fertility ratio, % of the population under 15, literacy rate, cultural and religious opposition to birth control, adverse environmental conditions, and political discontent are major factors contributing to malnourishment, how can the United States be a more effective benefactor when addressing the issue of world hunger?
Bill Butz: I suggest that the U.S. and other “donor” countries pay more attention to sustained effort to combat chronic malnutrition, hunger and food insecurity, rather than expending so much of our political reserves and good will reserves on crisis situations and then forgetting about it.

Dianne Holcomb: The USDA recently changed the language in the USDA Food Security Survey tool, eliminating the word “hunger” in describing people, i.e., “food insecure with hunger” to “very low food security”. This poses an increased challenge to those of us whose work is to educate the public that there is an overwhelming and increasing number of Americans who are HUNGRY. This makes our jobs as advocates even more difficult, and further marginalizes American citizens who are in crisis. At the same time, feeding program usage in the U.S. is increasing. What more can we do to achieve systemic change to end hunger in our country and how can we prioritize this as a national goal?
Bill Butz: I would personally pay less attention to the change in terminology, which was after all a science-based recommendation from the National Academy of Sciences. Hunger and undernutrition in the US are strongly associated with poverty and with poor food-related knowledge and practice. Overnutrition in the US is also associated with those same two factors, strangely enough. Teaching parents, again especially mothers and other women of childbearing age, the dire consequences of mal (both under- and over-) nutrition of their children and teaching them how their kids can eat more properly is an important part of the answer. Research is clear on this. Well, time for me to sign off. What excellent questions…and so many more that must go unanswered! I am encouraged by all of your concerns and the intelligence of what you ask and say. I apologize if I have not gotten to your particular question or comment! 

Mike Sage: I read both the questions and answers will hope but no one seems to ask the question which is on the mind of most environmental scientist, and that is there are just too many people on the planet to remain sustainable in it’s resources. Without education for all, this challenge will only become a greater danger to all that live here. Scientific progress takes time, implementation adds to this slow forward movement but the population continues to move higher each year. What have we done to reduce what is considered the world’s number one problem?
Bill Butz: Thanks for bringing this important consideration in, Mike. This is one of the areas I referred to earlier where there has been substantial success that we should recognize and use to propel forward the investments that have led to the success. The success is that fertility rates in virtually every country of the world are now falling. The US is one of the few exceptions) Nevertheless, world fertility will continue to grow for likely a half century because of the momentum of high (although falling) fertility rates in many countries, along with the large numbers of women of childbearing ages due to past high fertility. So…what has caused these fertility declines. Science has firmly identified four causal factors:

  1. Declining mortality rates. These cause more people to live to adulthood so that couples need fewer births to produce the same number of offspring to help in agricultural and housework and to care for them in old age.
  2. Increasing literacy, schooling and status of women. This tends to lower desired family size, give women increased opportunities to do things other than raise children, and increase their influence in the family and the community.
  3. Increasing the income of poor people. As people’s income increases from low levels, they have fewer births, a nearly universal pattern.
  4. Providing access to modern contraceptives and information about them. This enables women and couples to attain the lower fertility they desire as factors 1, 2, and 3 operate.

How now to sustain the fertility declines and hasten the day when they world’s population will no longer grow? It’s easy to say: Continue and expand these same four factors. If we do not do this, there is no reason to expect, based on the past half century’s evidence, that fertility rates will continue to fall in the now poor countries. If we do, this same evidence is convincing that fertility rates will continue falling.

Bye to all!