PART 2 Hunger dimensions In 2010–2012, about 870 million people – or one in eight of the people in the world – did not consume enough food to cover their minimum dietary energy requirements. Of these people, 852 mil- lion were in developing countries, making up 14.9 percent of the to- tal population of these countries. While undernourishment remains stubbornly high in absolute terms, the prevalence of undernourish- ment has fallen by 36 percent against the 1990–1992 benchmark set by the Millennium Development Goals (MDGs). If current trends con- tinue, developing countries as a group could be close to achieving the goal of halving the percentage of people suffering from chronic hunger by 2015. Although the prevalence of undernourishment offers a first idea of the extent and distribution of hunger in the world, food security is too complex an issue for all of its dimensions to be caught in a single indicator. To understand the complexity of the problem and identify measures for addressing it, its dimensions and manifestations, the underlying factors have to be assessed and measured.
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PART
2Hunger dimensions
In 2010–2012, about 870 million people – or one in eight of thepeople in the world – did not consume enough food to cover theirminimum dietary energy requirements. Of these people, 852 mil-lion were in developing countries, making up 14.9 percent of the to-tal population of these countries. While undernourishment remainsstubbornly high in absolute terms, the prevalence of undernourish-ment has fallen by 36 percent against the 1990–1992 benchmark setby the Millennium Development Goals (MDGs). If current trends con-tinue, developing countries as a group could be close to achievingthe goal of halving the percentage of people suffering from chronichunger by 2015.
Although the prevalence of undernourishment offers a first idea ofthe extent and distribution of hunger in the world, food security istoo complex an issue for all of its dimensions to be caught in a singleindicator. To understand the complexity of the problem and identifymeasures for addressing it, its dimensions and manifestations, theunderlying factors have to be assessed and measured.
Food insecurity arises in different contexts for different reasons. Itcan be driven by insufficient availability of or insufficient access tofood. While it is often portrayed as an access problem, its relation-ship with poverty is not always straightforward. Its intensity usuallyvaries with social and economic conditions, especially income levelsand food prices, but it is also affected – often to a large extent – bypolitical instability and the presence of natural hazards. An inade-quate diet may also result from a lack of vitamins or micronutrientsor an imbalance in the availability of macronutrients. Food insecuritycan even arise when a sufficient and balanced diet is available, butfood safety and hygiene or access to health care are lacking. Whateverthe causes of food insecurity, it usually takes a huge toll on labourproductivity, and thus perpetuates a vicious circle where food inse-curity causes low labour productivity, low incomes and thus furtherfood insecurity. This is the “hunger trap”.
To capture the multifaceted character of food insecurity and facili-tate its analysis, FAO has recently compiled a suite of indicators thatsupplements measurements of the number and prevalence of under-nourishment. However, the indicators selected are not always idealfor describing food insecurity in all its facets. Indicator selection isalso conditioned by the availability of reliable data and the possibil-ity of establishing meaningful comparisons across regions and timeperiods.
Some indicators look at food insecurity as an outcome: this is thecase of the number of undernourished people, the prevalence of un-dernourishment in the population, the extent of nutrition gaps, andanthropometric evidence. Other indicators focus on the conditionsthat generate food insecurity, such as poverty; food availability, ac-cess, affordability and utilization; and vulnerability and instability.
This chapter presents the main food security indicators computed byFAO, starting from outcomes and moving on to consider the condi-tions that characterize and can generate food insecurity.
The presence of several indicators for one phenomenon poses signif-icant measurement challenges. One challenge is consistently sum-marizing the information conveyed by multiple indicators; another isunderstanding and tracing how the various indicators relate to eachother. The following sections outline some of the associations andregularities that emerge among different indicators. These are meantto signal areas for further investigation, and do not necessarily implyformal or causal relationships.
Key ResourcesThe State of Food Insecurity in the World (SOFI)
The State of Food Insecurity in the World raisesawareness about global hunger issues, discussesunderlying causes of hunger and malnutrition andmonitors progress towards hunger reduction tar-gets established at the 1996 World Food Summitand theMillennium Summit. The publication is tar-geted at a wide audience, including policy-makers,international organizations, academic institutionsand the general public with a general interest inlinkages between food security, and human andeconomic development.
2012: Economic growth is necessary but not suffi-cient to accelerate reduction of hunger and malnu-trition
2011: How does international price volatility affectdomestic economies and food security?
2010: Addressing food insecurity in protracted crises
Publication cycle: Annual
Webpage: www.fao.org/publications/sofi/en/
Safeguarding Food Security in Volatile Global Markets
Safeguarding Food Security in Volatile Global Mar-kets is a four-part volume that gathers togetherthe latest thinking on the issues and controver-sies surrounding price volatility in global foodmar-kets. Drawing from theory, empiricism and heuris-tic evidence, the book contributes to the debate onthe causes, consequences, and challenges of foodprice volatility. Food security and vulnerability areplaced at centre stage, especially in their demandson shaping innovative policy design.
Number undernourished and their preva-lence in the population
To monitor progress towards the World Food Summit andMDG targets, FAO regularly computes and publishes updatedestimates of the number of undernourished people and theirprevalence in the total population. In brief, this indicatorrefers to the number and proportion of the populationwhoseenergy intake is likely to fall below minimum requirements.Figures presented in FAO’s The State of Food Insecurity in theWorld 2012 (SOFI) show that an estimated 870 million peo-ple, or 12.5 percent of the world’s population, were under-nourished in 2010–2012. Of these people, 852 million werereported to be citizens of developing countries.
The estimates for 2010–2012 were based on an improvedmethodology, which was also applied to re-estimate datafrom previous periods. Undernourishment remains dis-turbingly high in absolute terms, and progress in its reduc-tion has slowed in the last few years. However, the declinefrom 1990 to 1992 appears greater than previously thought,meaning that the world is closer to achieving the MDG tar-get. Progress has been faster in Asia and Latin America.Both regions, considered as a whole, seem to be on trackfor achieving the MDG target. Improvements have also beenrecorded in sub-Saharan Africa, albeit at a slower pace. How-ever, estimates for countries such as Burundi, Haiti, Eritrea,Timor-Leste, the Comoros, Mozambique, the Sudan (former),Yemen andmany others give cause for considerable concern.
As part of FAO’s new suite of indicators, additional figures arepresented for the prevalence of food inadequacy, which indi-cates the risk that individuals will be living on a diet that pre-vents them from effectively discharging an economic activ-ity requiring significant physical effort. Compared with theprevalence of undernourishment, the prevalence of food in-adequacy also includes individuals with a food energy deficitwho would not be considered undernourished under normalconditions, but who may be undernourished when carryingout the intense physical work they engage in owing to a lackof alternatives. Trends for this indicator are similar to thosefor the prevalence of undernourishment, but the indicator’slevel offers insights into the inadequacy of food supply.
In more than one country, the difference between the preva-lence of undernourishment and the prevalence of food inad-equacy seems significant, showing that a considerable shareof the population is suffering from inadequate food intake,even though chronic undernourishment is not widespread.This is the case of countries that do not rank among the high-est in terms of undernourishment, such as Bangladesh, In-dia, the Dominican Republic, Ecuador, Swaziland and Kenya.Further analysis of this type of evidence may provide a basisfor more targeted food policy interventions.
Further reading
• FAO The State of Food Insecurity in the World 2012 - Eco-nomic Growth Is Necessary but Not Sufficient to Acceller-ate Reduction of Hunger and Malnutrition (www.fao.org/publications/sofi/en/)
• FAO Hunger Portal (www.fao.org/hunger)
CHART 24: Undernourishment in the developing world(1990-1992 to 2010-2012)
980
901 885852 852
23.2
18.3
16.815.5
14.9
500
600
700
800
900
1 000
12
15
18
21
number
prevalence
1992 2001 2006 2009 2012 2015
percentundernourished
millions
a
a
a
a
Prevalence
Number
Prevalence, WFS target
Number, MDG target
Source: FAO, Statistics Division.
CHART 25: Number of people undernourished(1990-1992 and 2010-2012)
Anthropometric measures are an important element of thenew FAO suite of food security indicators. They convey infor-mation on themost dramatic and long-lasting consequencesof chronic and acute undernourishment. Measures in chil-dren under five years of age can approximate the nutritionalstatus of a population. Stunting is the outcome of prolongedinadequate nutrition and/or repeated infections; wasting re-sults from acute malnutrition; and low body weight reflectsa combination of chronic and acute malnutrition. Anthropo-metric data are less readily available than other indicatorsand are not updated as regularly, which prevents full com-parisons across countries, regions and time periods.
Between 2005 and 2011, one of four African countries re-ported a stunting rate of at least 40 percent, which is con-sidered very high prevalence by the World Health Organi-zation (WHO). Countries with high stunting rates are con-centrated mainly in Middle and Southeastern Africa and theHorn of Africa, but pockets are also found in parts of WesternAfrica. Over the 2005–2011 period, stunting rates also ex-ceeded 40 percent in South and South East Asia, with peaksin Timor-Leste, Nepal, India and Lao People’s DemocraticRepublic. African countries show the highest rates of un-derweight prevalence. Between 2005 and 2011, 16 Africancountries showed underweight rates of at least 20 percent,with the highest levels recorded in the Horn of Africa.
Nutrition-related disorders are also prevalent in countrieswhere the number of undernourished is relatively low. InGhana, for instance, the prevalence of undernourishmentwas reported to be less than 5 percent in 2010–2012, butmore than 28 percent of children under five years of agewere reported to be stunted in 2005–2011. A similar pictureemerges from the same indicators in Mali, where the preva-lence of undernourishment was reported to be 8 percent,with 28 percent of children under five years of age found tobe underweight. In Viet Nam, the prevalence of undernour-ishment was estimated to be 9 percent, while more than 20percent of children under five years of age were reportedto be underweight. Such differences in trends and levels offood security indicators may provide the basis for in-depthanalyses and the design of specific policy interventions. InGhana, for instance, policies may emphasize interventionsthat ensure utilization of safe and nutritious food, and hy-gienic conditions. At the same time, the high availability offood in the country, as shown by the average dietary energysupply adequacy (see the section on Food availability), sug-gests that interventions to increase food supply could grad-ually be de-emphasized.
Further reading• FAO The State of Food Insecurity in the World 2012 - Eco-nomic Growth Is Necessary but Not Sufficient to Acceller-ate Reduction of Hunger and Malnutrition (www.fao.org/publications/sofi/en/)
• FAONutrition and Consumer Protection Division (www.fao.org/food/)
• UNICEF Nutrition (www.unicef.org/nutrition/)• WHO Nutrition and disorders (www.who.int/topics/nutrition/en/)
CHART 26: Percentage of children under 5 years of agewho are stunted and underweight, countries with
Poverty is the main determinant of hunger. Poor house-holds generally spend large shares of their incomes on food,and many of them – even those engaged in farming – arenet food buyers. Poor families’ inability to consume enoughfood to meet dietary requirements can have long-lasting im-pacts on labour productivity, which hampers developmentprospects.
There has been considerable progress in poverty reductionover recent decades, but improvements have been unevenacross regions. In 1990, the share of people living in ab-solute poverty was still 43 percent. Since then, povertyhas fallen rapidly and significantly in China and other Asiancountries, while many countries in sub-Saharan Africa andSouthern Asia have shown less and slower progress. Over-all, the MDG target of halving the number of people livingin absolute poverty has already been achieved, and furtherprogress can be expected by 2015.
Estimates of relative poverty, or inequality, generate a mixedpicture. In several Asian countries, inequality – measuredby the Gini coefficient – has been increasing since the early1990s, reflecting growing disparities between rural and ur-ban populations, fast industrialization, and increasing re-turns to more skilled labour. In contrast, inequality has de-clined in Africa because of faster economic growth, mainlyover the last decade. Even countries in Latin America and theCaribbean, where inequality was significant some decadesago, have made considerable progress.
Similar to food security, poverty is a multidimensional phe-nomenon, and needs to be assessed through several indica-tors; as already mentioned, the relative and absolute dimen-sions of poverty need to be taken into account. Even morecomplex is the relationship between indicators of poverty onthe one hand, and those of malnutrition and undernourish-ment on the other. The indicators presented here show thatthese two measures can frequently diverge.
In some countries, a large proportion of the populationliving on less than US$2 per day is associated with ahigh prevalence of undernourishment, such as in Burundi,Ethiopia, Mozambique and Zambia. In other countries, how-ever, a high proportion of population below the US$2 per daypoverty line is associated with a prevalence of food insecu-rity close to the regional average of 26 percent. This is thecase of the Central African Republic, Madagascar, Rwanda,Liberia and Guinea. At the opposite extreme, there are coun-tries – Nigeria for example – where a high level of poverty isassociated with prevalence of undernourishment below 10percent.
It is also worth noting that the data available for a numberof important countries are not sufficiently complete to en-able elaborate analyses about trends. For instance, in theDemocratic Republic of the Congo and Eritrea, poverty ratesare high but data on the prevalence of undernourishmentare not available.
Further reading• World Bank Poverty Reduction and Equity Group (wwwr.worldbank.org/poverty)
CHART 27: People living on less than 2005 PPP $1.25and $2 a day (1981-2005)
1.5
2.0
2.5
1980 1985 1990 1995 2000 2005
billionpeople
$1.25 $2
Source: World Bank (WDI).
CHART 28: Gini coefficient (1990-1992 and 2007-2009)
Availability is an important dimension of food security. Sup-plying enough food to the reference population is a neces-sary, but insufficient, condition for ensuring adequate accessfor individuals.
Over recent decades, trends in food production per capitahave been generally positive across most regions. However,growth rates in Africa have been lower for the last 20 years,despite notable exceptions. On average, agricultural produc-tion in Africa has increased at slightly less than 1 percent peryear, compared with about 2 percent in developing countriesoverall.
Insights into the availability dimension of food security canbe gathered through a number of indicators. The averagedietary energy supply adequacy, which expresses the dietaryenergy supply as a percentage of the average dietary energyrequirement, has increased globally from 114 to 120 in thelast 20 years. At the same time, the share of energy providedby cereals, roots and tubers has been gradually shrinking,reaching 51 percent in 2007–2009. The amount of availableprotein per person per day increased by 13 percent at theworld level between 1990–1992 and 2007–2009. However,Africa still ranks low in this indicator compared with otherregions. The share of livestock products in protein supplyhas also been growing globally, with developing countriesmaking great progress.
In most countries and regions, high food availability is asso-ciated with relatively low prevalence of undernourishment.However, outcome indicators show that high food availabil-ity does not always guarantee high food security. In Egypt,for instance, stunting affects 31 percent of children underfive years of age, while dietary supply adequacy is 45 per-cent higher than the average requirement. Similar situationsarise in Benin, Malawi, the Niger, Kazakhstan and Nicaragua,where supply adequacy varied from approximately 110 to140, while average stunting between 2005 and 2010 was re-ported to range from 20 to 45 percent. These data may pointto the presence of specific population groups suffering fromacute undernourishment, despite abundant food supplies.
Further reading
• FAO The State of Food Insecurity in the World 2012 - Eco-nomic Growth Is Necessary but Not Sufficient to Acceller-ate Reduction of Hunger and Malnutrition (www.fao.org/publications/sofi/en/)
CHART 29: Average dietary supply adequacy(1990-1992 and 2007-2009)
80
100
120
140
160
80 100 120 140 1601990-1992
2007-2009
Africa
Asia
Europe
LAC
Oceania
Source: FAO, Statistics Division.
CHART 30: Trend of the value of food production(1992-2009)
Access to food is primarily determined by incomes, foodprices and the ability of households and individuals to ob-tain access to social support. Individuals’ access to food isalso heavily influenced by social variables, including genderpositioning and power hierarchies within households.
According to Engel’s law, the share of food expenditure indisposable income is expected to decline as income levelsrise. This means that poor households spend a relativelyhigh share of their disposable incomes on food, making themvulnerable to sudden increases in food prices or losses ofincome. Empirically, the degree of exposure to real incomeswings can be captured by the domestic food price level in-dex, which is the ratio of the food purchasing power parity(FPPP) to the general PPP. This indicator captures the im-portance of food in the overall consumption basket. The in-dex is highest in least developed countries, and showed apronounced spike during the 2007/2008 rise in food prices.More recently, the index has normalized overall, but is stillon a rising trend in developing countries.
The recent rise in international food prices has had diverseconsequences for consumers at the country level becauseof several factors. These include the less than completeprice transmission from international to domestic markets,which has several causes, including policies; and the extentto which vulnerable population groups are net food buyersor sellers. The result is that consumers have suffered a se-rious decline of purchasing power in some countries, whileremaining largely unaffected by higher prices in others.
Information on price changes is sparse, but sufficient toindicate that the price increases of recent years have haddifferent impacts on food security outcomes. In Uganda,for instance, food prices increased by 25 percent between2003–2005 and 2010–2012, in step with an increase in theprevalence of undernourishment by almost 30 percent; asimilar pattern has emerged in Paraguay. In some countrieshowever, a declining prevalence of undernourishment hasbeen accompanied by rising food prices, such as in China,Nepal and Pakistan.
As well as economic affordability, physical access to food isalso facilitated by adequate infrastructure, such as railwaylines and paved roads. These facilitate the functioning ofmarkets, help reduce price arbitrage, and improve the deliv-ery of food and non-food products among regions and be-tween rural and urban areas. Information on infrastructureis even sparser than that on prices, but it shows a clear asso-ciation with food security outcomes in more than one coun-try.
Further reading
• FAO The State of Food Insecurity in the World 2012 - Eco-nomic Growth Is Necessary but Not Sufficient to Acceller-ate Reduction of Hunger and Malnutrition (www.fao.org/publications/sofi/en/)
CHART 34: Relative price of food by level of economicdevelopment (2000-2012)
1.2
1.4
1.6
1.8
2000 2005 2010
index
World Developed Developing LDC
Source: FAO, Statistics Division.
CHART 35: Relative price of food by region (2000-2012)
Access to clean water and sanitation facilities affects thehealth conditions of individuals and households, and hencetheir ability to utilize food. The body’s capacity to absorbnutrients requires a good health status, especially in youngindividuals. Time poverty, related to women’s roles in wa-ter collection and storage, and the link between safe wa-ter and good sanitation on one hand, and child health andwell-being on the other also exert a profound influence onthe ability to utilize food.These two indicators are thereforeconsidered an important part of the suite of food securityindicators computed and monitored by FAO.
In 2010, an estimated 11 percent of the world’s populationwas living without access to adequate drinking-water. Thelast 20 years have seen significant progress in this area, anda decline from the much higher level of 24 percent in 1990.The relevant MDG target (MDG 7, target 7.C) has already beenreached at the global level, but remarkable disparities per-sist among and within countries.
Ninety percent of the population in Latin America and theCaribbean have access to safe water. Similar trends existin Northern Africa and Eastern Asia. But it is as low as 61percent in sub-Saharan Africa and 53 percent in Oceania.Similar disparities are found within countries, particularlybetween urban and rural areas.
In several countries, low levels of access to clean water areassociated with high levels of undernourishment and of un-derweight children, such as in Ethiopia, Mozambique, theSudan (former) and Zambia. While this association does notallow the establishment of causality, it certainly warrantsfurther investigation.
The quantity of water available, the distance of wells fromdwellings, and the time needed for collection are just as im-portant as access. Collecting water may constitute a signifi-cant burden for a substantial part of the population, partic-ularly women, for whom water collection may come at theexpense of other productive activities.
Unlike the water target, the MDG sanitation target has notyet been reached at the global level; given the current trend,it is unlikely to be achieved by 2015. Substantial progresshas been recorded in developing countries over the last twodecades, with access to improved sanitation increasing from36 to 56 percent of the population. Sub-Saharan Africa andSouthern Asia are the regions with the lowest coverage,but while fast improvements are reported for Southern Asia,sub-Saharan Africa records slower progress.
There also appears to be a clear relationship betweenhunger and access to improved sanitation at the countrylevel. For instance, Burundi, Zambia and the Comoros reporthigh levels of undernourishment (48 to 73 percent) and lowlevels of access to improved sanitation (50 percent). How-ever, there are also clear deviations from this rule: access toimproved sanitation is even lower in Cambodia, India andNepal, where the prevalence of undernourishment is lessthan 20 percent.
CHART 36: Percentage of population withoutreasonable access to improved water sources (2010)
0
10
20
30
40
World
Developed
Developing
Africa
Asia
LAC
Oceania
percent
1990 2010
Source: FAO, Statistics Division.
CHART 37: Percentage of population withoutreasonable access to improved sanitation facilities
Since the mid-2000s, food and agricultural markets haveentered an unexpectedly turbulent phase, characterized bylarge supply shortfalls, price swings and increased uncer-tainty about the world’s ability to feed itself. These uncer-tainties have had direct and adverse impacts on food se-curity. On the demand side, high and volatile prices havemeant not only that consumers have had to adjust their cur-rent food intake, but also that they have been forced to pre-pare for higher volatility in the future, hence saving more.The poorer the household, the stronger the impact, as poorhouseholds spend a proportionally higher share of their in-comes on food. On the supply side, more variability implieslower ability to invest and a higher risk of losing the investedcapital and inputs.
At the country level, the outcome of the recent instability hasbeen affected by local conditions and the degree of integra-tion into world markets. High food prices and high volatilityhave caused considerable concerns in many countries withparticular exposure to world markets. These countries in-clude Mexico for maize, the Philippines for rice, and Egyptfor wheat and bread.
Countries’ vulnerability to price changes on world marketsalso depends on their ability to generate foreign exchangethrough exports. For this reason, a relevant indicator of foodsecurity at the national level is the value share of staplefood imports relative to the value of merchandise exports.Among regions, this indicator is highest for Oceania and sev-eral African countries.
CHART 38: Value of cereal imports over totalmerchandise exports (1990-1992 and 2007-2009)
0
5
10
15
20
World
Developed
Developing
Africa
Asia
LAC
Oceania
percent
1990-1992 2007-2009
Source: FAO, Statistics Division.
CHART 39: Cereal import dependency ratio (1990-1992and 2007-2009)
Fluctuations in food production, supply and prices also con-vey important information about the vulnerability of coun-tries and their populations. Three indicators are computedas deviations of the relevant three variables from the trendfor the previous five years. Plotting of these indicators high-lights sharp fluctuations over recent years, but no trends.High-income countries show high variability of production,but smaller price variability than in other country groups.In developing countries, production variability tends to belower than price variability. Among major regions, Oceaniaand Latin America and the Caribbean show the widest fluc-tuations in production over the past decade, while variabilityhas been lower in Asia.
In some countries, a high prevalence of undernourishmenthas been associated with relatively low variability in supplyin recent years. For instance, in Burundi, Eritrea and Zambia,between 2005 and 2011, the prevalence of undernourish-ment varied between 47 and 73 percent, while the deviationof production from the trends was within 30 percent. At theother extreme, are countries such as Kazakhstan, where sup-ply variability has been as high as 143 percent since 2005,but the prevalence of undernourishment has remained be-low 5 percent.
Political stability and the absence of civil strife and violenceare other key determinants of food security. The basic ratio-nale behind this relationship is straightforward and reflectsthe functioning of the overall economy, people’s ability togenerate income and governments’ capacity to support thepoor. Women and children are normally more vulnerableto political and economic instability. Low political stabilityis associated with a high prevalence of undernourishment,ranging from approximately 20 to 70 percent in countriessuch as Côte d’Ivoire, the Central African Republic, Burundiand Ethiopia.
Further reading
• FAO The State of Food Insecurity in the World 2012 - Eco-nomic Growth Is Necessary but Not Sufficient to Acceller-ate Reduction of Hunger and Malnutrition (www.fao.org/publications/sofi/en/)
• Global Information and Early Warning System (www.fao.org/giews/english/index.htm)
Defeating chronic hunger and poverty requires investmentsin people and their productivity. Health care, clean waterand sanitation, social services and education are primarymeans of improving a population’s potential and its abilityto generate sustainable incomes.
Education, particularly for women, is a proven and importantmeans of combating child malnutrition and infant mortal-ity. Literacy and education show a positive correlation withliving conditions for women and their children, along withknowledge on improved child feeding practices, food preser-vation and better sanitation.
The average primary completion rate in low- and middle-income countries increased by 15 percent between the early1990s and 2010, with faster improvements for girls. How-ever, wide disparities remain in both access to and equalityof educational attainments for girls and boys, both amongand within countries, particularly in those dominated bylarge rural poor populations. In Africa, 72 percent of chil-dren completed primary school, compared with nearly 100percent in most parts of Latin America. Relatively low edu-cation levels are found to be associated with a high preva-lence of undernourishment, ranging from 40 to 70 percentin countries such as Eritrea and Uganda.
The extent and quality of health care systems, especially forpoor and vulnerable population groups, is a key determinantof food access conditions and hence food security outcomes.
Health care systems are mostly financed from a mix of gov-ernment resources, the private sector, non-governmental or-ganizations (NGOs) and foreign assistance. The distributionof expenditure on health care across countries is vastly un-even, as are the amounts of resources employed. The In-ternational Labour Organization (ILO) found that only onein five people in the world had broad-based social securityprotection against illness, while more than half the world’spopulation lacked social protection.
In 2010, an average of 10 percent of global GDP was spenton health care, ranging from 17 percent in Northern Amer-ica, to 7.7 percent in Latin America and the Caribbean and 3.6percent in South-Eastern Asia. Estimates vary more widelyat the country level. In general, a low share of GDP investedin health care is associated with a high prevalence of under-nourishment. Examples include countries such as Eritrea,the Plurinational State of Bolivia and Sri Lanka.
Further reading
• UNESCO education (www.unesco.org/new/en/education/)• UNICEF Water, Sanitation and Hygiene (www.unicef.org/wash/)
• UNDPHumanDevelopment Report 2010 - The RealWealthof Nations: Pathways to Human Development (hdr.undp.org/en/reports/global/hdr2010/)
• O’Donovan (2008)
CHART 45: Girls’ and boys’ enrolment in primaryeducation (2010)
40
60
80
100
40 60 80 100girls (percent net)
boys(percentnet)
Africa
LAC
Asia
Europe
Oceania
Source: World Bank (WDI).
CHART 46: Total health expenditure, share of GDP(1995-2010)
Armed conflict and natural disasters threaten food secu-rity, especially in countries and areas where poverty is high,livelihoods are unsustainable and institutions are fragile.Risks tend to be higher for women and vulnerable popula-tion groups. FAO has identified 22 countries in a state ofprotracted crisis, defined as “those environments in whicha significant proportion of the population is acutely vulner-able to death, disease and disruption of livelihoods over aprolonged period of time” (FAO, 2010b). Of these countries,17 are in sub-Saharan Africa.
Food insecurity is one of the most common outcomes forcountries in protracted crises. Those identified by FAO con-tain approximately 160 million undernourished people, whoaccount for nearly 40 percent of the countries’ combinedpopulation and 20 percent of all the undernourished peo-ple in the world.
Indicators of risks therefore have to be considered amongthose that highlight the causes of food insecurity. Twogroups of indicators are considered here: those from the Of-fice of the United Nations High Commissioner for Refugees(UNHCR), reflecting political and military conditions; andthose from the Centre for Research on the Epidemiologyof Disasters (CRED), reporting on natural disasters such asdroughts, floods and extreme temperatures.
UNHCR computes the number of people exposed to risksarising from political and military events. In 2011, about 31million people were classified as “population of concern” –refugees, people who have been internally displaced by con-flict, and asylum seekers. Four-fifths of the world’s refugeesare hosted in developing countries, including some of theworld’s poorest countries, thus increasing the strain both interms of refugee numbers and in relation to the size of theireconomies.
Prevalence of undernourishment ranging from about 30 to65 percent is associated with large numbers of populationat risk in countries such as Eritrea, Liberia and Sierra Leone.Elsewhere, a high share of the population is at risk, but dataon undernourishment are neither available nor easy to col-lect, such as in Afghanistan and Somalia.
CRED recorded 332 natural disasters in 2011, withmore than30 000 deaths. The single largest event was the flood inChina, which affected 67.9 million people in June 2011. Inmany countries, food insecurity seems to correlate to a highshare of population exposed to natural disasters. Exam-ples include Eritrea and Malawi, where undernourishmentranged from 23 to 65 percent; Swaziland and Zambia, withundernourishment rates of 27 to 47 percent; and Tajikistan,with 30 percent prevalence of undernourishment.
Further reading
• Centre for Research on the Epidemiology of Disasters(www.cred.be/)
• United Nations High Commissioner for Refugees (www.unhcr.org)
UkraineUnited Kingdom 5.1United States of America 0.9 3.2 0.7 2.4Least developed countriesLandlocked developing countriesSmall island developing StatesLow income economiesLower-middle-income economiesLow-income food-deficit countries
average dietary supply value of food production share of energy supply derived average supply ofadequacy per capita from cereals, roots and tubers protein protein of animal origin
index index I$/cap I$/cap % % g/cap/day g/cap/day g/cap/day g/cap/day1990-92 2007-09 1990-92 2007-09 1990-92 2007-09 1990-92 2007-09 1990-92 2007-09
average dietary supply value of food production share of energy supply derived average supply ofadequacy per capita from cereals, roots and tubers protein protein of animal origin
index index I$/cap I$/cap % % g/cap/day g/cap/day g/cap/day g/cap/day1990-92 2007-09 1990-92 2007-09 1990-92 2007-09 1990-92 2007-09 1990-92 2007-09
average dietary supply value of food production share of energy supply derived average supply ofadequacy per capita from cereals, roots and tubers protein protein of animal origin
index index I$/cap I$/cap % % g/cap/day g/cap/day g/cap/day g/cap/day1990-92 2007-09 1990-92 2007-09 1990-92 2007-09 1990-92 2007-09 1990-92 2007-09
average dietary supply value of food production share of energy supply derived average supply ofadequacy per capita from cereals, roots and tubers protein protein of animal origin
index index I$/cap I$/cap % % g/cap/day g/cap/day g/cap/day g/cap/day1990-92 2007-09 1990-92 2007-09 1990-92 2007-09 1990-92 2007-09 1990-92 2007-09
TABLE 17: Vulnerability/StabilityValue of food imports over total merchandise exports Cereal import dependency ratio Percent of arable land equipped for irrigation
TABLE 17: Vulnerability/Stability (continued)Value of food imports over total merchandise exports Cereal import dependency ratio Percent of arable land equipped for irrigation
TABLE 17: Vulnerability/Stability (continued)Value of food imports over total merchandise exports Cereal import dependency ratio Percent of arable land equipped for irrigation
TABLE 17: Vulnerability/Stability (continued)Value of food imports over total merchandise exports Cereal import dependency ratio Percent of arable land equipped for irrigation