World hunger is something we hear about. Remember the pictures of children on television suffering from marasmus or kwashiorkor? Now, not so much. Is it still a problem or have we solved it for the most part?

Status of world health. The good news is that we are living longer. Much of that longer life traces to less hunger and related diseases around the globe. Global life expectancy rose from 66.8 years in 2000 to 73.3 in 2019. Did you know that it was that high? I did not. Life expectancy does not take into account infirmities that increase with age. The Health-Adjusted Life Expectancy (HALE) takes these infirmities into account. See the life expectancy (LE) and HALE for low-income (LIC) and high-income countries (HIC):

                    Global        LIC             HIC

LE 2019         73.3          65.1             80.9

HALE 2019    63.7          56.7             66.0

Note the difference between LE and HALE. The gap in high-income countries is greater than in low-income countries. Increases in LE and HALE in low-income countries are dramatic. Longer lives come from better health care, better diets, and better agricultural practices.

Progress against world hunger has been dramatic. The leading causes of death on the globe are heart disease and stroke. The World Health Organization places more emphasis on preventing chronic disease than on hunger. And yet, hunger still exists in the world and demands our attention. Over 10% of the world’s population is undernourished. That amounts to 805 million people. Most at risk are children under five. About 7% of them will die before their fifth birthday. Poverty is the major cause of hunger. Related diseases, not hunger as such, cause these deaths.

Population changes affect global hunger. The population at the beginning of 2000 was 6.1 billion. At the end of 2019 it was 7.8 billion. In those 20 years, including all 2000 and 2019, the world fed 1.7 billion more mouths. At the same time life expectancy increased by 6.7 years! Where did all that food come from to exceed global needs? World population growth is slowing, but it has not stopped growing. Estimated population growth peaked at 2.09% in 1968/69. By 2020 it was down to 1.05%.

Projections estimate world population will be 9.8 billion by 2050. The predicted range is between 8.7 and 10.5. The low end suggests a rapid death rate due to world-wide famine or a major war. The high end suggests population growth out of control. Regardless, we will have between 1 and 2.5 billion more mouths to feed. Will we be able to continue to close the gap in life-expectancy between rich and poor nations? Or will world hunger again become more prevalent? Also, why 2050? It is a nice round number, and it is the projected break point in global climate change circles. If we can’t get emissions down to net-zero by then, we will be in big trouble!

Most hunger today occurs in South-East Asia, Sub-Saharan Africa, and the Middle East. These are also the areas where population growth is the greatest. It is not clear if world hunger will decrease in these danger zones without concerted effort. The remarkable increase in life expectancy and health-adjusted life expectancy gives us hope. Elimination of world hunger may be out of reach. Continued reduction of it is not.

Concerns about hunger also include nutrition and food safety. Insufficient reserves of nutrients in the body affect personal health. There are four stages of nutrient sufficiency. When storage is adequate, the nutrient functions well in the body. Suboptimal levels of a nutrient affects cell metabolism. At this point no clinical symptoms appear. Less of the nutrient in the leads to clinical signs not associated with a specific deficiency disease. It is only later that a full-blown deficiency disease becomes obvious. At stages before development of a deficiency disease, the immune system weakens. Then the person becomes more susceptible to other diseases. The danger increases with two or more subclinical, nutrient deficiencies. Food and water safety are also critical. Microbial illness further weakens an immune system challenged by inadequate nutrients.

Iron and vitamin A are critical for health in low-income countries. Iron insufficiency affects mothers with little or no access to meat. Lack of enough iron also affects the health of their suckling babies. Iron deficient babies can grow up to be iron-deficient adults. Ready-to-Use Therapeutic Foods (RUTFs) can supply mothers with iron and other micronutrients. Fortified foods made from local ingredients help both mothers and their children thrive. In countries where rice is the main staple, vitamin A is limiting in many dietary patterns. Blindness affects more children around the world than any other nutritional disorder. Biofortification with β-carotene yields golden rice which can reduce blindness in children. Limiting acceptance of golden rice is lack of authorization by Asian governments. Mothers must also be comfortable in feeding the funny-looking rice to their children.

Measuring nutritional status by upper arm circumference. Photo by R. Dixon Phillips

Agroecology and biotechnology represent opposite approaches to feeding sub-Saharan Africa. Agroecology represents the work-with-Mother-Nature view. It “centers on food production that makes the best use of nature’s goods and services while not damaging its resources.” It works to strengthen “local ecosystems” without “chemical inputs.” Agroecology emphasizes small farms, local distribution of healthy foods, and social justice. GMOs are the product of biotechnology. It takes knowledge gained from molecular biology to increase food availability. GMOs can increase crop yield, reduce susceptibility to pests, and improve nutritional quality. GMOs tend to thrive on larger farms supported by large multinational corporations.

Proponents of agroecology and biotechnology point out each other’s flaws. I would rather see each group emphasize its attributes. I tire of such arguments in the food culture wars. Let’s see more A AND B rather than C BUT NOT D approaches. Time is running out. It seems that competing visions would enhance our chances to meet our goals.

The war in Ukraine and other factors could reverse progress to a hungry-free world. We live on an interconnected planet. Countries specializing in certain crops that they grow well is great in times of peace. In times of war, not so much. Even more problems occur when countries who grow important crops are at war with each other. Ukraine and Russia are both suppliers of grain and fertilizer. Look for shortages to hurt sub-Saharan Africa. Reports that Russia is capturing, shipping, and selling Ukranian grain further complicates the problem. Should African nations turn away stolen but needed grain? Disruption of supply chains will continue to disrupt access to needed food. World inflation will also affect the ability of low-income families to feed themselves.

Climate change threatens to make hunger worse rather than better. As climates change, prime locations to grow crops may face dramatic shifts over time. Adjustments for annual crops are easier than those that produce over several years. Subsistence-level farmers will not be as flexible as those on larger farms. Drought, severe storms, and other weather calamities will displace people and crops. Expect such events to increase in numbers and intensity. Often such events lead to climate refugees. Displaced families migrate to cities or nearby countries. The resulting humanitarian crises lead to shortages of food and shelter.

Bottom line. For those of us who have not kept up, the fight to conquer world hunger has produced dramatic results. Hunger still exists and exists in too many places around the world. Eating to excess in rich countries while others starve is unacceptable. Hunger is not confined to development of classical deficiency diseases. Hunger leads to subclinical depletion of essential nutrients. This condition affects the immune system and susceptibility to other diseases. Fortification of processed foods and biofortification of staple crops show promise. War, inflation, and climate change hamper the fight to overcome world hunger. Will we be able to continue the strides made against hunger in the last two decades?

Next week: Can we overcome global climate change?