The Hungry Billion

COPENHAGEN – Hunger has slipped from the rich world’s consciousness. Televised images of Third World children with distended bellies no longer shock viewers. Polls show that developed nations now believe that the world’s biggest problems are terrorism and climate change. 

Yet malnutrition in mothers and their young children will claim 3.5 million lives this year. Global food stocks are at historic lows. Food riots have erupted in West Africa and South Asia. Progress is distressingly slow on the United Nations’ goal of halving the number of hungry people by 2015. Those suffering the most are the billion people who survive on a dollar or less a day.

Individual tragedy and national hardship go hand in hand. Shortened lives mean less economic output and income. Hunger leaves people more susceptible to disease, requiring more health-care spending. Those who survive the effects of malnutrition are less productive; physical and mental impairment means children benefit less from education.

Eighty percent of the world’s undernourished children are in South Asia and sub-Saharan Africa. Specific interventions to help these regions’ people would have massive benefits. Research undertaken by the Copenhagen Consensus shows that an excellent approach would be to devote more money to providing the micronutrients that are lacking in poor communities’ diets. 

Rich nations have all but eliminated goiter (swelling of the thyroid) by using iodized salt – a preventive measure lacking in 30% of developing world households, but that costs just $0.05 a year per person. Vitamin A capsules, which help avoid problems affecting eyesight and immunity, cost just another $0.20. Iron deficiency, one of the most significant micronutrient problems, causes anemia, which makes people weaker and less productive. The Flour Fortification Initiative aims to fortify 70% of roller mill wheat flour with iron and folic acid by the end of 2008. The annual cost? As little as $0.10 per person.

Scaling up these programs – and adding folate and zinc supplements – to ensure provision for 80% of South Asians and sub-Saharan Africans would cost about $347 million per year, but would yield a massive $5 billion from improved future earnings and reduced healthcare spending.

There are other ways to make a difference quickly and inexpensively. Intestinal parasites such as roundworm, whipworm, and hookworm strip iron from sufferers’ guts, causing disease and intellectual retardation. De-worming treatments eliminate an impediment to healthy nutrition. A Kenyan school-based treatment program was so successful that more teachers had to be hired because schools filled up.

And there are benefits to treating even younger children. De-worming pre-schoolers will lock in the benefits of motor and language development at an annual cost of $0.50 per child. Reaching 53 million children in South Asia and sub-Saharan Africa would yield economic benefits six times higher than the astonishingly modest annual cost of $26.5 million.

Each of these policy options would address only one component of the overall malnutrition problem. Therefore, developing nation policymakers should consider encouraging households to change their food practices.

One of the most important opportunities to provide educational messages about nutrition comes during pregnancy. A mother’s diet, breastfeeding choice, and weaning practices are critically important for her child’s well being. Programs to increase breastfeeding can be challenging in poor communities where mothers are typically engaged in agriculture and intensive work.

But promoting breastfeeding at the time of delivery can be effective. Weighing the mother-to-be, and weighing and measuring the baby, are important tools with which to frame educational messages, and educational sessions can also be used to provide micronutrient supplements and de-worming intervention.

Community-based, volunteer-managed education campaigns covering 80% of South Asia and sub-Saharan Africa would cost $798 million a year. The annual benefits would total $10 billion.

In a world with many challenges and not enough money, we have to make hard choices, and we can’t do it all. But surely addressing hunger in the most cost-efficient way should be a top global priority.

So, if the world’s poor need educational messages about breastfeeding and nutrition, rich nations require a different kind of education. We must drive home the message that Third World hunger remains a massive global problem to which we have a moral responsibility to respond. For a small investment, we could start to make it yesterday’s problem.