Undernutrition and famine UTV 1000, Autumn 2004

1. Undernutrition and famineUTV 1000, Autumn 2004 Dan Banik, Ph.D. University of Oslo Centre for Development and the Environment (SUM) Phone: 22 85 87 35 Email: dan.banik@sum.uio.no Website: http://folk.uio.no/danbanik/

2. Lecture outline • “Hunger” & malnutrition (overnutrition versus undernutrition) • Extent of undernutrition in the world • Causes of undernutrition • Measurement of undernutrition • Undernutrition, starvation and famine • Famine definitions • Theories of famine • Food Availability Decline (FAD) theories) • Economic theories • Socio-political theories • Democracy and famine prevention

3. “Hunger” and malnutrition Hunger (“sult”) Refers to a broad range of phenomenon of varying levels of severity and there is no agreement on applicable methods of measuring it. At the most general level, hunger is a “symptom or a sensation which is expressed as a craving for food”. However, this sensation or craving may result from a wide variety of causes; some voluntary while other involuntary. Sometimes hunger is “a signal of desperation” while at other times it may simply be “an expression of keen healthy appetite.” Malnutrition (“feilernæring”) Malnutrition is caused by an imbalance of nutrients in the food consumed by an individual. It may develop simply from the consumption of incorrect kinds of food.

4. 2 types of malnutrition Overnutrition(“overernæring”): The consumption of excessive food or the excessive intake of one or more nutrients. Causes obesity and other health problems Undernutrition (“underernæring”): The result of inadequate intake of food and/or poor absorption and utilisation of food and its nutrients. Causes starvation. Malnutrition is thus the overall term used for a whole range of bodily conditions that result not only from the quantity of food consumed (excessive or inadequate) but also the quality of food intake (e.g. lack of vitamins, protein and micronutrients). “Chronic hunger” = sustained undernutrition

5. Extent of undernutrition in the world It is estimated that over 800 million people in the world still cannot meet basic needs for energy and protein and hundreds of millions suffer from diseases caused by unsafe food or by unbalanced food intake. Undernutrition results in poor physical and cognitive development as well as lower resistance to illness. Approx. 6.6 million out of 12.2 million deaths among children under-five years in developing countries is associated with undernutrition.

6. Causes of undernutrition (UNICEF 1998) Immediate causes (individual level): - inadequate dietary intake (low quality food, with poor energy and nutrient concentrations) - illness (infections & diseases). E.g. diarrhoea, acute respiratory infections, measles and malaria. Underlying causes (household level): - food insecurity (insufficient access to food) - inadequate or poor care for mothers and children - unhealthy environment (poor water/ sanitation and inadequate health services). Basic causes (societal level): - quantity and quality of potential resources available to a country or community (human, economic and organisational, and the way they are controlled) - political, cultural, religious, economic and social factors, (including the status of women) which affect the utilisation of actual resources.

7. Measurement of undernutrition Difficulties (p. 52 textbook) - No single medical test which unequivocally indicates level of individual undernutrition - There is uncertainty regarding the minimum dietary energy supply required below which life and activity becomes difficult - Difficult and expensive to measure what people eat. Measuring undernutrition: • “Stunting” (shortness, as a result of poor diet or disease), In 2001, stunting affected 230 million children • “Wasting” (process that produces substantial weight loss, usually as a consequence of acute shortage of food and/ or disease), In 2001, wasting affected 174 million children under 5 years of age.

8. Global measures of undernutrition Overall estimates of global undernutrition are usually made in 2 ways (Page 66 in textbook): • Measures of national food availability: involves the comparison of average availability of food per individual with a minimum necessary dietary energy supply (e.g 2400 KiloCalories per day). • Average income of poor and vulnerable households compared with the cost of the food necessary to provide a minimum level of nutrition. Table 3.2 (page 66 in textbook) shows measurements of global undernutrition undertaken by FAO

9. Food intake Starvation Famine Physiological condition Undernutrition Health (disease), sanitation, care Undernutrition – starvation - famine Source: Banik (2003)

10. Undernutrition – starvation - famine Undernutrition and starvation are familiar events in a society and consequently, communities that experience it have a repertoire of customary adjustments (“coping strategies”) by means of which they avoid social disruption. In contrast, famine is an episode of starvation that is attended by sharply increased mortality rates and marked disruptions in community life. An operational definition of famine (Banik 2003: see separate slide) Malnutrition Chronic undernutrition Threat of starvation Famine 1 Famine 2

11. Famine (“hungersnød”) Famine is ... hard to define but glaring enough when recognised. (A. E. Taylor) Dictionary definitions: - “Extreme and protracted shortage of food, causing widespread and persistent hunger, emaciation of the affected population, and a substantial increase in the death rate” - Most dictionary definitions of famine range from extreme/ severe/ broad/ acute scarcity or shortage of food leading to violent hunger to acute shortage of anything. - These definitions, however, describe merely a few symptoms of famine where broader definitions are required.

12. Famine definitions Conventional definitions (starvation is a prerequisite for famine) - A set of definitions see famine in terms of ‘mass starvation’ - Another approach defines famine as a community crisis/breakdown, when entire communities lose their ability to support marginal members. This leads to families dying from starvation (lack of access to adequate food) and starvation related diseases. - Still others prefer to see famine in terms of excess mortality, measured by comparing normal death rates in an area with death rates during a particular period of drought and food shortage. “Famines imply starvation, but not vice-versa. And starvation implies poverty, but not vice versa” (Amartya Sen 1981: 39).

13. Famine definitions Famines without mass starvation (de Waal) - Famine mortality in recent African famines like the Darfur famine in Sudan in the 1980s was more a result of disease than starvation. - Local understandings (e.g. in Sudan): “famines that kill” versus “famines that do not kill” - In “famines that kill”, people die primarily due to hardship, social disorder, disease and epidemics resulting from unhygienic conditions in (e.g. in overcrowded refugee camps).

14. FAD theories Economic theories Socio-political theories • Climate • Natural resources • Population • Entitlements • Market failure War Government policy Policy / Institutional Failure - Inappropriate policies - Failure to intervene Resource/ logistical constraints Theories of famine Source: Banik (1997)

15. The Food Availability Decline (FAD) theories FAD theories include explanations of famine based on food supply shortages. 1) Climate: Famine could result as the end result of a chain of events triggered by too much rainfall (floods), too little rainfall (drought), cyclones, earthquakes, etc. Whether a famine takes place will depend on: - the conditioning of the ecology - the availability of a forecast on the likelihood of high or low rainfall - the ability of the socio-political system to respond to the forecast Rainfall and biotic factors like pests and animal diseases, can affect agriculture and the quality of harvest. Famine can occur as a result of the combination of any number of these factors.

16. The Food Availability Decline (FAD) theories 2) Mismanagement of natural resources: There are three major types of arguments relating to the degradation of natural resources in increasing famine vulnerability: - famines are caused by inexorable “natural processes” (e.g. encroachment of deserts on previously arable land); - the “ignorance” or “irrationality” of the local population who become victims due to their own inefficient agricultural methods or due to conflicts arising out of the private and social ownership of resources; - ecological degradation as a natural result of colonial or post-colonial exploitation between classes, and between people and nature. Consequently, when indigenous social and economic practices are disrupted by capitalist penetration, famine is seen to be inevitable.

17. The Food Availability Decline (FAD) theories 3) Population: The main Malthusian argument is that land is limited but population has a tendency of increasing indefinitely. The demand for food will eventually outstrip any potential food production and consequently, starvation will act as a natural check on population growth. Famine will, in fact, restore the balance between food demand and food supply. Neo-Malthusians insist that famines occur as there are ‘too many people, too little food’. According to one such line of argument, high population growth rates perpetuate poverty at the household level and famine vulnerability at the regional level, as excessive partition of land among heirs takes place. There is also the argument that modern medicine keeps more people alive, thereby accentuating the pressures on land. Thus, the single prescription, according to neo-Malthusians is birth control.

18. Economic Theories Entitlement theory: Amartya Sen (Nobel laureate in economics 1998) criticises the FAD approach and argues that famines can, and do occur, even in the presence of an abundance of food in the country or region. According to Sen, the problem is lack of access to food and weak purchasing power. E.g.. Famines in Ethiopia (1980s), The Great Bengal Famine (1944) Sen’s criticism of FAD approach: overall production or availability of food may be an inaccurate indicator of what vulnerable groups actually require. Instead, the entitlement approach concentrates on the “forces that determine the bundles of commodities over which a family or an individual can establish command”.

19. The Entitlement Approach This, since a person can starve if some economic change makes it no longer possible for him or her to acquire any commodity bundle with enough food. Such economic change may result from: - a fall in endowment (e.g. alienation of land, or loss of labour power due to ill health) - or when an unfavourable shift in the conditions of exchange (e.g. loss of employment, rise in food prices, reduction of social security provisions, etc.) Sen’s approach sees famine-prevention as basically a question of “entitlement protection”. This involves re-creating the lost entitlements of vulnerable groups, the promotion of participative economic growth, the protection of the environment, the abolition of armed conflicts, and the development of social security systems.

20. Market failure Market failure: When markets are unreliable, a dependence on the market for food is very risky. For instance, the hoarding of food for precautionary or speculative reasons can increase food shortages and lead to a further increase in prices. A sudden sharp change in relative prices may therefore bring about famine as the poor get “priced out of the market”. Example: Drought, flood, etc., bring about crop failure, which sets into motion a chain of events - increased market demand for food, declining marketed food supplies, hoarding and speculation, rising food prices, falling asset prices, and ultimately famine for the poor. The failure of the market was one of the factors in the Bangladesh famine of 1974, when hoarding of rice following pessimistic forecasts led to a major shortfall in marketed supplies.

21. Socio-political theories War: Even though many famines occur in peaceful situations, wars often function as triggers or catalysts. One can identify at least four major facets of war as a triggering mechanism for famine: 1) War diverts financial, human and manufacturing resources to military spending. 2) War disrupts the local economy (e.g. a squad of troops living off a village and then taking a months supply of food when it leaves). 3) During war, there is often the deliberate use of food as a weapon especially in the form of food blockades and sieges. 4) War invariably helps to create a refugee population, especially from rural areas - when small-scale farmers and landless labourers are forced to migrate, having little in the way of assets to take with them.

22. Socio-political theories (war) History is replete with examples of famines being triggered in politically unstable areas, torn by war and civil strife such as in: - Russia in the aftermath of the revolution and civil strife that followed after World War I; - Northern Ethiopia in 1972-74; parts of Mozambique; and Cambodia in the 1970s. - Chad and Sudan Hence, political instability, in the form of both locally generated and externally financed wars, can trigger famine by hampering food production, coping mechanisms and relief aid.

23. Socio-political theories (government policies) Government policies: Through their economic and political policies, governments can “cause” famines. Institutional failure: arising out of government inaction or action, in spite of the presence or absence of early warning mechanisms, can trigger off a famine and/or deliberately accentuate an already critical the situation. The availability and distribution of food can be seriously impaired if a government, on racial, ethnic, religious or class grounds, is hostile to sections of its population. Incompetent and inadequate administration of famine-relief can lead to famines. Speedy intervention by the government amid a scarcity of resources calls for a calculated reliance on existing distributional mechanisms, like for example, the operation of private trade stimulated by cash support to famine victims.

24. Democracy and famine prevention Amartya Sen argues that independent India has successfully prevented famines in contrast to China. In spite of near-famine conditions in 1965-66, 1970-73, and during the more recent droughts in the 1980s and the 1990s, the last major famine in India, the Bengal Famine, occurred in 1943-44. In contrast, and as a direct consequence of the disastrous policies of the “Great Leap Forward”, China experienced a famine that lasted for three years (1958-61) and resulted in the deaths of 25-30 million people. According to Sen, the primary reason for India’s success at preventing famine is India’s democratic political system, in contrast to China’s dictatorship.

25. Democracy and famine prevention Sen highlights three main features of public action which has helped India prevent famine. First, since widespread starvation does not hit an economy simultaneously in all sectors and in all regions, a sensitive system for “early warning” and “prediction” of famines can be made possible “by making discriminating use of available information”. In this context, an active and vigorous newspaper system can usefully supplement the work of economic analysis “by reporting early signs of distress with predictive significance”. Second, the primary agency responsible for providing relief and taking other steps for curing famine threats is the government of the country. Even though both international and domestic, voluntary and aid agencies may provide relief, the emphasis here is on government responsibility and co-ordination, covering both the political and the administrative spheres.

26. Democracy and famine prevention Third, how soon, how urgently, and how effectively the government will act will largely be determined by the nature of politics in the country, and the forces that operate on the government to act without delay. Hence, it follows that the extent of freedom enjoyed in society and the scope of “public knowledge of and involvement in social issues” is vital. It is argued that by influencing government policy via political activism, criticism and opposition, many actors in Indian society contribute towards eliminating famine. Yet chronic hunger persists.

27. Democracy and famine prevention Drèze & Sen (1989) have gone on to propose that the prevention of famines in India has been a direct result of extensive entitlement protection efforts. Such efforts are said to rely on the operation of two complementary forces. First, the administrative system intelligently aims at recreating lost entitlements caused by floods, droughts, economic slumps, etc. Second, the political system is instrumental in getting the administrative system to work as and when required. Drèze & Sen argue that an administrative structure can be non-operational and ineffective in the absence of a political trigger. (For further details see Box 3.3 on page 63 of textbook)

28. Democracy and famine prevention Critique: - The importance of definitions regarding what constitutes a famine - The problem with comparing India versus China - The actual role of the press and opposition parties in a democracy - The competence and willingness of the bureaucracy - democracies have a poor record of combating undernutrition - governments often react to sensational reports (e.g. starvation deaths in India) and generally do little to improve general nutritional status - the politics of famine relief within countries - the politics of international emergency assistance