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close this bookBriefs for Food, Agriculture, and the Environment - 2020 Vision : Brief 1 - 64 (IFPRI)
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View the document2020 BRIEF 1 - AUGUST 1994: ECONOMIC GROWTH AND DEVELOPMENT
View the document2020 BRIEF 2 - AUGUST 1994: WORLD SUPPLY AND DEMAND PROJECTIONS FOR CEREALS, 2020
View the document2020 BRIEF 3 - AUGUST 1994: WORLD PRODUCTION OF CEREALS, 1966-90
View the document2020 BRIEF 4 - AUGUST 1994: SUSTAINABLE FARMING: A POLITICAL GEOGRAPHY
View the document2020 BRIEF 5 - OCTOBER 1994: WORLD POPULATION PROJECTIONS, 2020
View the document2020 BRIEF 6 - OCTOBER 1994: MALNUTRITION AND FOOD INSECURITY PROJECTIONS, 2020
View the document2020 BRIEF 7 - OCTOBER 1994: AGRICULTURAL GROWTH AS A KEY TO POVERTY ALLEVIATION
View the document2020 BRIEF 8 - OCTOBER 1994: CONSERVATION AND ENHANCEMENT OF NATURAL RESOURCES
View the document2020 BRIEF 9 - FEBRUARY 1995: THE ROLE OF AGRICULTURE IN SAVING THE RAIN FOREST
View the document2020 BRIEF 10 - FEBRUARY 1995: A TIME OF PLENTY, A WORLD OF NEED: THE ROLE OF FOOD AID IN 2020
View the document2020 BRIEF 11 - FEBRUARY 1995: MANAGING AGRICULTURAL INTENSIFICATION
View the document2020 BRIEF 12 - FEBRUARY 1995: TRADE LIBERALIZATION AND REGIONAL INTEGRATION: IMPLICATIONS FOR 2020
View the document2020 BRIEF 13 - APRIL 1995: THE POTENTIAL OF TECHNOLOGY TO MEET WORLD FOOD NEEDS IN 2020
View the document2020 BRIEF 14 - APRIL 1995: AN ECOREGIONAL PERSPECTIVE ON MALNUTRITION
View the document2020 BRIEF 15 - APRIL 1995: AGRICULTURAL GROWTH IS THE KEY TO POVERTY ALLEVIATION IN LOW-INCOME DEVELOPING COUNTRIES
View the document2020 BRIEF 16 - APRIL 1995: DECLINING ASSISTANCE TO DEVELOPING-COUNTRY AGRICULTURE: CHANGE OF PARADIGM?
View the document2020 BRIEF 17 - MAY 1995: GENERATING FOOD SECURITY IN THE YEAR 2020: WOMEN AS PRODUCERS, GATEKEEPERS, AND SHOCK ABSORBERS
View the document2020 BRIEF 18 - MAY 1995: BIOPHYSICAL LIMITS TO GLOBAL FOOD PRODUCTION
View the document2020 BRIEF 19 - MAY 1995: CAUSES OF HUNGER
View the document2020 BRIEF 20 - MAY 1995: CHINA AND THE FUTURE GLOBAL FOOD SITUATION
View the document2020 BRIEF 21 - JUNE 1995: DEALING WITH WATER SCARCITY IN THE NEXT CENTURY
View the document2020 BRIEF 22 - JUNE 1995: THE RIGHT TO FOOD: WIDELY ACKNOWLEDGED AND POORLY PROTECTED
View the document2020 BRIEF 23 - JUNE 1995: CEREALS PROSPECTS IN INDIA TO 2020: IMPLICATIONS FOR POLICY
View the document2020 BRIEF 24 - JUNE 1995: REVAMPING AGRICULTURAL R&D
View the document2020 BRIEF 25 - AUGUST 1995: MORE THAN FOOD IS NEEDED TO ACHIEVE GOOD NUTRITION BY 2020
View the document2020 BRIEF 26 - AUGUST 1995: PERSPECTIVES ON EUROPEAN AGRICULTURE IN 2020
View the document2020 BRIEF 27 - AUGUST 1995: NONDEGRADING LAND USE STRATEGIES FOR TROPICAL HILLSIDES
View the document2020 BRIEF 28 - AUGUST 1995: EMPLOYMENT PROGRAMS FOR FOOD SECURITY IN SUB-SAHARAN AFRICA
View the document2020 BRIEF 29 - AUGUST 1995: POVERTY, FOOD SECURITY, AND THE ENVIRONMENT
View the document2020 BRIEF 30 - JANUARY 1996: RISING FOOD PRICES AND FALLING GRAIN STOCKS: SHORT-RUN BLIPS OR NEW TRENDS?
View the document2020 BRIEF 31 - APRIL 1996: MIDDLE EAST WATER CONFLICTS AND DIRECTIONS FOR CONFLICT RESOLUTION
View the document2020 BRIEF 32 - APRIL 1996: THE TRANSITION IN THE CONTRIBUTION OF LIVING AQUATIC RESOURCES TO FOOD SECURITY
View the document2020 BRIEF 33 - JUNE 1996: MANAGING RESOURCES FOR SUSTAINABLE AGRICULTURE IN SOUTH ASIA
View the document2020 BRIEF 34 - JUNE 1996: IMPLEMENTING THE URUGUAY ROUND: INCREASED FOOD PRICE STABILITY BY 2020?
View the document2020 BRIEF 35 - JULY 1996: SOCIOPOLITICAL EFFECTS OF NEW BIOTECHNOLOGIES IN DEVELOPING COUNTRIES
View the document2020 BRIEF 36 - OCTOBER 1996: RUSSIA'S FOOD ECONOMY IN TRANSITION: WHAT DO REFORMS MEAN FOR THE LONG-TERM OUTLOOK?
View the document2020 BRIEF 37 - OCTOBER 1996: UNCOMMON OPPORTUNITIES FOR ACHIEVING SUSTAINABLE FOOD AND NUTRITION SECURITY - An Agenda for Science and Public Policy
View the document2020 BRIEF 38 - OCTOBER 1996: WORLD TRENDS IN FERTILIZER USE AND PROJECTIONS TO 2020
View the document2020 BRIEF 39 - OCTOBER 1996: REDUCING POVERTY AND PROTECTING THE ENVIRONMENT: THE OVERLOOKED POTENTIAL OF LESS-FAVORED LANDS
View the document2020 BRIEF 40 - OCTOBER 1996: POLICIES TO PROMOTE ENVIRONMENTALLY SUSTAINABLE FERTILIZER USE AND SUPPLY TO 2020
View the document2020 BRIEF 41 - DECEMBER 1996: STRUCTURAL CHANGES IN THE DEMAND FOR FOOD IN ASIA
View the document2020 BRIEF 42 - MARCH 1997: AFRICA'S CHANGING AGRICULTURAL DEVELOPMENT STRATEGIES
View the document2020 BRIEF 43 - JUNE 1997: THE POTENTIAL IMPACT OF AIDS ON POPULATION AND ECONOMIC GROWTH RATES
View the document2020 BRIEF 44 - JUNE 1997: LAND DEGRADATION IN THE DEVELOPING WORLD: ISSUES AND POLICY OPTIONS FOR 2020
View the document2020 BRIEF 45 - JUNE 1997: AGRICULTURE, TECHNOLOGICAL CHANGE, AND THE ENVIRONMENT IN LATIN AMERICA: A 2020 PERSPECTIVE
View the document2020 BRIEF 46 - JUNE 1997: AGRICULTURE, TRADE, AND REGIONALISM IN SOUTH ASIA
View the document2020 BRIEF 47 - AUGUST 1997: THE NONFARM SECTOR AND RURAL DEVELOPMENT: REVIEW OF ISSUES AND EVIDENCE
View the document2020 BRIEF 48 - FEBRUARY 1998: CHALLENGES TO THE 2020 VISION FOR LATIN AMERICA: FOOD AND AGRICULTURE SINCE 1970
View the document2020 BRIEF 49 - APRIL 1998: NUTRITION SECURITY IN URBAN AREAS OF LATIN AMERICA
View the document2020 BRIEF 50 - JUNE 1998: FOOD FROM PEACE: BREAKING THE LINKS BETWEEN CONFLICT AND HUNGER
View the document2020 BRIEF 51 - JULY 1998: TECHNOLOGICAL OPPORTUNITIES FOR SUSTAINING WHEAT PRODUCTIVITY GROWTH TOWARD 2020
View the document2020 BRIEF 52 - SEPTEMBER 1998: PEST MANAGEMENT AND FOOD PRODUCTION: LOOKING TO THE FUTURE
View the document2020 BRIEF 53 - OCTOBER 1998: POPULATION GROWTH AND POLICY OPTIONS IN THE DEVELOPING WORLD
View the document2020 BRIEF 54 - OCTOBER 1998: FOSTERING GLOBAL WELL-BEING: A NEW PARADIGM TO REVITALIZE AGRICULTURAL AND RURAL DEVELOPMENT
View the document2020 BRIEF 55 - OCTOBER 1998: THE POTENTIAL OF AGROECOLOGY TO COMBAT HUNGER IN THE DEVELOPING WORLD
View the document2020 RESUMEN No. 56 - OCTUBRE DE 1998: AYUDA A LA AGRICULTURA EN LOS PAÍSES EN DESARROLLO: INVERSIONES EN LA REDUCCIÓN DE LA POBREZA Y NUEVAS OPORTUNIDADES DE EXPORTACIÓN
View the document2020 BRIEF 57 - OCTOBER 1998: ECONOMIC CRISIS IN ASIA: A FUTURE OF DIMINISHING GROWTH AND INCREASING POVERTY?
View the document2020 BRIEF 58 - FEBRUARY 1999: SOIL DEGRADATION: A THREAT TO DEVELOPING-COUNTRY FOOD SECURITY BY 20207
View the document2020 BRIEF 59 - MARCH 1999: AGRICULTURAL GROWTH, POVERTY ALLEVIATION, AND ENVIRONMENTAL SUSTAINABILITY: HAVING IT ALL
View the document2020 BRIEF 60 - MAY 1999: CRITICAL CHOICES FOR CHINA'S AGRICULTURAL POLICY
View the document2020 BRIEF 61 - MAY 1999: LIVESTOCK TO 2020: THE NEXT FOOD REVOLUTION
View the document2020 BRIEF 62 - OCTOBER 1999: NUTRIENT DEPLETION IN THE AGRICULTURAL SOILS OF AFRICA
View the document2020 BRIEF 63 - NOVEMBER 1999: PROSPECTS FOR INDIA'S CEREAL SUPPLY AND DEMAND TO 2020
View the document2020 BRIEF 64 - FEBRUARY 2000: OVERCOMING CHILD MALNUTRITION IN DEVELOPING COUNTRIES: PAST ACHIEVEMENTS AND FUTURE CHOICES
View the document2020 BRIEF 65 - MARCH 2000: COMBINING INTERNAL AND EXTERNAL INPUTS FOR SUSTAINABLE INTENSIFICATION

2020 BRIEF 6 - OCTOBER 1994: MALNUTRITION AND FOOD INSECURITY PROJECTIONS, 2020

Marito Garcia

Marito Garcia is an economist with the World Bank.

THE NUTRITION-HEALTH CONNECTION

In 1990 a total of 780 million people out of 4 billion in the developing world are living on diets that are not sufficient to maintain a healthy life, according to the Food and Agriculture Organization of the United Nations (FAO). This implies food insecurity for every fifth person in the developing world. Insufficient food consumption is one of the primary causes of malnutrition; the other is infection and poor health. The nutrition situation reports of the United Nations ACC/SCN (Administrative Committee on Coordination/Sub-Committee on Nutrition) found that protein-energy malnutrition (PEM), measured by the proportion of children falling below the accepted weight standards, affects 34 percent of all preschool children in the Third World. In 1990 the problem affected some 184 million children, based on national anthropometric measurements. A recent study by Pelletier et al. shows that PEM, even in its mild-to-moderate form, contributes to 56 percent of child deaths in 53 developing countries, suggesting that malnutrition has a far more powerful impact on child mortality than is generally believed.

In addition to PEM, insufficient food consumption leads to other problems that are of public health significance. Among these are deficiency in iron, which causes iron-deficiency anemia; deficiency in vitamin A, which leads to blindness (xerophthalmia); and deficiency in iodine, which contributes to iodine deficiency disorders and goiter. Preschool children and pregnant and lactating women are the most vulnerable groups. Every year, 250,000-500,000 children go blind due to vitamin A deficiency. Estimates by ACC/SCN indicate that in 1990, 370 million women between 15 and 49 years of age were anemic, a condition that contributes to high maternal mortality rates, especially during childbirth. The World Health Organization (WHO) estimates that the lifetime chance of maternal death in North America is better than 1 in 6,000 and in Africa it is 1 in 20. A recent assessment by WHO indicates that some 655 million people in the developing world are affected by goiter. This figure is nearly three times previous estimates.

FUTURE TRENDS

If trends in the 1980s persist, it is likely that the number of children with PEM will increase by the year 2000; it is expected to remain at about 200 million by year 2020 despite the projected decline in fertility rates (Figure 1). Two projections into the future - a pessimistic scenario and an optimistic scenario - are mapped based on historical trends. Projections of absolute numbers of malnourished children account for the future trends in fertility, but do not consider possible breakthroughs in food production or for disasters such as the uncontrolled spread of AIDS. The optimistic scenario is built around the "best five-year" historical trends between 1975 and 1990, whereas the pessimistic scenario is based on the "worst five-year" historical trends over the same period. Thus, one could say that "if the trends in 1990 to 2020 are like the rates of improvement in 1975 to 1980, then we will see a reduction in malnourished from. ..." A similar scenario-building approach was used in the Second Report on the World Nutrition Situation (1992) for year 2000 projections; the trend line is extended to the year 2020 for purposes of the present exercise.


Figure 1 - Projections of malnourished preschool children in developing countries, 2020

Source: Marito Garcia.

The projections indicate that a satisfactory nutrition situation will not be realized unless new approaches are tried. The best-case ("optimistic") scenario shows that by year 2020 there would be about 100 million preschool children with PEM. The potentiating effects of malnutrition will likely be responsible for roughly 56 million child deaths in this scenario. The projections show that the goal of reducing child malnutrition prevalence by half by year 2000 set by the World Summit for Children (1990) and the International Conference on Nutrition (1992) will not be attained by 2020 even using the best-case scenario. The worst-case ("pessimistic") scenario looks grim. The proportion of underweight children would likely rise to about 200 million by year 2000.


Figure 2 - Projections of numbers of underweight preschool children, by region, pessimistic scenario, 2020

Source: Marito Garcia.

Historical data indicate that more than half of the world's protein-energy malnutrition problem is in South Asia (Figure 2). Driven by the weight of its population, extremely high prevalences of about 58 percent prevail. In 1990 about 100 million out of the 184 million underweight children in the world were found in the subcontinent comprising India, Pakistan, Bangladesh, Nepal, Sri Lanka, and Bhutan. The next biggest number of underweight children is in Sub-Saharan Africa with about 30 million in 1990, followed by China (24 million) and Southeast Asia (20 million).

The regional projections given in Figure 2, using the pessimistic scenario, and Figure 3, using the optimistic scenario, provide a glimpse of the trends across the continents. Under the optimistic scenario, it is expected that by year 2020 virtually each region in the world will experience a reduction in the absolute numbers of underweight preschool children, with the notable exception of Sub-Saharan Africa. The regions of China and Southeast Asia (Indonesia, Thailand, the Philippines, Vietnam, Malaysia, Myanmar, Laos, and Kampuchea) will likely experience the most dramatic improvements. Reductions in numbers underweight (from 44 million in 1990 to 6 million in 2020) will be brought about by the combined effect of a decline in the prevalence of underweight and a decline in fertility over the 25 year period. The trends in the Sub-Saharan Africa region will be fundamentally different from the rest of the world. Even an optimistic scenario puts the number of malnourished at about 34 million in the year 2020. Current population growth rates of the Sub-Saharan region are estimated at 3.0 percent - the highest in the world - and unless the rates are dramatically reduced, the absolute number of underweight will rise even if the prevalence rates are kept at present levels in 2020.


Figure 3 - Projections of numbers of underweight preschool children, by region, optimistic scenario, 2020

Source: Marito Garcia.

POLICY IMPLICATIONS

The implications from the two scenarios of malnutrition in year 2020 is clear. Unless explicit policies to reduce the numbers of underweight are put in place, the total number of children with protein energy malnutrition will rise, and child deaths associated with malnutrition problems will continue unabated. A number of programs and policies aimed at a systematic attack on PEM have been implemented successfully in several countries, including those in Thailand, Zimbabwe, Indonesia, Costa Rica, Chile, and in Tamil Nadu in India. In Thailand, the prevalence of underweight children was reduced from 36 percent to 13 percent over a period of eight years, through a national program and policy that both attacked poverty and promoted explicit nutrition programs. Increase in incomes and reduction in poverty are important, but experiences in several countries indicate that even where there is no rapid improvement in incomes, malnutrition can be reduced by explicit programs and policies that aim at improving household access to food and health services and improving child care practices such as breastfeeding and proper weaning of infants. A concerted effort to follow the examples of successful countries is needed to reduce the numbers of malnourished children in the future.