1. © T. M. Whitmore TODAY Synergy between nutrition and disease continued Especially vulnerable populations Four faces of hunger Global Hunger

2. © T. M. Whitmore Questions? Human Nutrition

3. © T. M. Whitmore Synergy: nutrition and disease Poor nutrition (protein-calorie or other nutrient shortages) => reduced ability to fend off new infections or makes existing ones more severe Poor nutrition Diseases interfere with nutrient absorption and/or actively deplete nutrients from our bodies Diseases interfere

4. © T. M. Whitmore How poor nutrition => disease Reduction in the body's innate immunities (that react to general patterns of proteins in pathogens) Reduction in ability to generate acquired immunities - the specific immunities one acquires to a particular disease pathogen

5. © T. M. Whitmore How disease => poor nutrition Most infections interfere with the body's ability to absorb nutrition and/or actively deplete nutrients Predominantly diarrheas, but also intestinal parasites, cholera, & various types of dysentery (1.8 billion cases/yr of infant weanling GI diseases ) – oral rehydration

6. © T. M. Whitmore Especially vulnerable populations Increased likelihood of malnutrition and more serious consequences  Women in general  Pregnant women  Lactating women  Elderly  Children

7. © T. M. Whitmore Especially vulnerable populations- children Malnutrition in infants and children very problematic if timing coincides with critical growth processes  Up to age 5 risk is greatest Especially at weaning age (approx 2 yrs) Due to impure water used to make weaning foods (not sufficiently boiled due to lack of fuel) and general low hygiene =>  Kids die from diarrheal diseases and dehydration and malnutrition Weaning foods are typically not nutrient-rich enough (e.g., maize gruels)not nutrient-rich enough

9. © T. M. Whitmore Four Faces of Hunger I Starvation/Famine Widespread to complete lack of protein/calorie nutrition A small percentage of global hunger – perhaps 1% at risk annually Leads to increased mortality (usually to infectious diseases not starvation per se) Great social disruption => increased problems with diseases and access to food In any famine not all starve – the well off can buy food -- thus NOT usually only a simple shortage

10. © T. M. Whitmore Four Faces of Hunger II Malnutrition/Undernutrition Seasonal or periodic P/C under-nutrition Most serious effects on kids and special needs adults (pregnant and lactating women, the elderly) Measures of undernutrition in children  Stunting - stature too short for age/sex (adjusted for local norms) => chronic  Wasting – weight too light for age/sex (adjusted for local norms) => acute

11. © T. M. Whitmore Four Faces of Hunger III Micro-nutrient deficiencies Vitamin and mineral shortages Sometimes called “hidden hunger”

12. © T. M. Whitmore Four Faces of Hunger IV Nutrition-depleting illnesses Secondary malnutrition Most common nutrient depleting diseases are infant/weanling diarrheas – 5 million deaths annually world wide

13. © T. M. Whitmore Global Hunger Global situation late 1990s Data drawn from FAO’s SOFA report 2002 The International Food Policy Research Institute The concept of “food security”

14. © T. M. Whitmore Global Trajectories of Hunger I Proportions undernourished (or food insecure) in global south Proportions  Late 1970s ~ 28%  Late 1990s ~17%  Thus, real progress  Less progress in absolute numbers Micro-nutrient deficiencies  Iron: 40% of global south  Iodine: 12% of global south  Vitamin A: 14% of kids in global south

15. © T. M. Whitmore Global Trajectories of Hunger II Absolute numbers undernourished (or food insecure) Absolute numbers  1970s ~ 900m; 2000 ~ > 800 m  => decrease of ~ 100m in absolute numbers (but smaller %) Children 1993 ~ 200 m; now ~ 175 m Children World food summit target in 2015 => 400m World food summit target  Current trajectory => 475-500m by 2015

16. © T. M. Whitmore Regional differences malnourished or food insecure Global South  Sub-Saharan Africa  E. Asia, SE Asia, & Pacific  South Asia  Latin America & Caribbean  Near East & N. Africa Developed Economies (mostly N America) Developed Economies

17. Source: FAO

19. IFPA 2005

22. Source: FAO

24. Number of malnourished children, 1993, 2010, and 2020 Source: IFPRI IMPACT simulations.

25. IFPA 2005

27. © T. M. Whitmore Sen’s Entitlement Concept Famines/malnutrition/food scarcity/food insecurity are NOT caused by simple food shortages alone (production shortfalls) The ability of people to command or acquire food is what is key (entitlement shortfalls)

28. © T. M. Whitmore Sen’s Entitlement Concept II Ways to command/acquire food  Via capital (money or goods [e.g., cattle] exchanged for food)  Via income from labor/work (exchanged for food) Via income  Via assistance (State or NGO) (could be money or food directly) Via assistance  Via own production (requires access or ownership of enough quality land) Via own production Most households do not rely on a single source or type

29. A week’s food for family in Chad – virtually all from own production © Peter Menzel (in Hungry Planet, 2005 Ten Speed Press)

30. A week’s food for family in NC – virtually all purchased © Peter Menzel (in Hungry Planet, 2005 Ten Speed Press)

31. A week’s food for refugee family from Darfur, Sudan – virtually all from aid © Peter Menzel (in Hungry Planet, 2005 Ten Speed Press)

32. © T. M. Whitmore The “Geographical Hunger Model”Hunger Model Underlying Processes  Works at all scales Immediate Causes  Regional/household/individual scales Hunger Situations  Regional/household/individual scales Direct Consequences  Regional/household/individual scales

34. © T. M. Whitmore Irish “hunger” of 1846-51 an example of Underlying Processes & background Surplus production and appropriation & resource competition The potato Population growth Crop failures and subsistence crisis throughout the nineteenth century Racist views toward the Irish (probably delayed help)

35. © T. M. Whitmore Irish “hunger” an example of Immediate/Proximate Causes & Processes Environmental Fluctuation – infection of potato crop with Phytophthora infestons a fungal infection (late potato blight) spread by the wind Socio-Economic policies that deprived millions of entitlements to food Process – not a single event Process

36. © T. M. Whitmore Irish “hunger” Process Blight 1845 => 40% loss and famine in 1846 1846 => near 100% loss + severe winter => severe famine & disease in 1847 1847 - 1850 potato crop not blighted but output low due to small planting (people expected blight) approximately 500,000 people were evicted, many of whom died of starvation or disease or relocated to mismanaged and inadequate poor houses (could not pay rent)

37. © T. M. Whitmore Irish “hunger” Process II Eventually the English government also initiated relief schemes  Workhouses as centers of contagion It was at this juncture that the Duke of Norfolk suggested that the Irish should substitute curry powder for the potato and nourish themselves on curry powder mixed with water.

38. © T. M. Whitmore Irish “hunger” Process III Peel was replaced in office in 1846 by Lord John Russell and a Whig administration dedicated to a laissez- faire policy  Charles Trevelyan, Assistant Secretary to the Treasury under Russell, oversaw famine relief efforts.  a “blame the victim” mentality: Irish were at fault for over- dependence on potatoes and high fertility (too many kids)  The British also saw it as a “natural disaster”: blamed it on the weather and the potato fungus Wheat, oats, barley, butter, eggs, beef and pork were exported from the large estates Ireland in large quantities - as many as eight ships left Ireland daily carrying foodstuffs

39. © T. M. Whitmore Irish “hunger” Consequences Starvation and disease became epidemic  More died of disease than of starvation.  Most were weakened from long starvation when they finally succumbed to typhus, cholera, dysentery, and scurvy.  At least 1 million perished 1 – 2 + million emigrated (mostly to US and England) Population of Ireland  1850 = 6.5 m (from 8.5m 5 yrs earlier)  1900 4.5 m => longer-term emigration, much to US