2014-2015 Global Food Policy Report
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CHAPTER 2 REACHING THE MISSING MIDDLE Chapter 2 REACHING THE MISSING MIDDLE Overcoming Hunger and Malnutrition in Middle Income Countries Shenggen Fan and Ertharin Cousin SUMMARY Eliminating hunger and malnutrition around the globe cannot be achieved without a new approach to dealing with the problem in middle income countries. Here’s why this is so, how the middle income countries should respond, and what the international community can do to help. unger and malnutrition are not problems exclusive to low income countries. Middle income countries (MICs), despite some being global economic powerhouses, are home to the major- ity of the world’s hungry and malnourished.1 These vulnerable populations, the “missingH middle,” tend not to either benefit from or contribute to the rapid eco- nomic growth that is characteristic of many MICs. That is why the international community cannot realize its ambitious inter- national agenda of achieving zero hunger and malnutrition without a renewed focus on MICs. That these countries have increased both their economic resources and their government capacities over the last two decades is a major boon to the development effort but not yet a victory. Economic progress must also be accompanied by sustained investment—from both governments and international partners—in reducing inequalities and improving human capital. This is particularly important in countries where just a relatively few policy and budget commitments can translate into significant progress in the food security and nutrition situation of millions of people. The challenges and opportunities to end the burden of malnutrition within MICs are as diverse as the countries themselves. Yet several unique trends and corresponding opportunities can be identified if we focus on key MICs that have had or are currently experiencing periods of rapid economic growth while housing large populations of hungry and malnourished people. Brazil, China, India, Indonesia, and Mexico are among the world’s most populous countries while also being ranked in the top 20 economies in terms of gross domestic product (GDP). They have each also made remarkable progress in addressing hunger and undernutrition. For example, between 1990 and 2014 Shenggen Fan is director general, International Food Policy Research Institute, Washington, DC. Ertharin Cousin is executive director, World Food Programme, Rome, Italy. hunger was reduced in Brazil by almost two-thirds providing models for effective policies that could and in China and Indonesia by more than one- help other countries succeed. Moreover, investing half.2 Child stunting improved significantly in in and implementing properly targeted social safety China from 1990 to 2013 and in Brazil from 1989 net and economic development programs can also to 2007, declining by about two-thirds in both provide the necessary conditions to achieve the kind countries.3 of population-inclusive growth needed to avoid or In 2014, MICs continued to implement policies escape the “middle-income trap,” a development sit- to improve food security and nutrition at home. uation whereby rapidly growing economies stagnate Brazil, for example, released new dietary guidelines at middle-income levels. With the right policies and to encourage consumers to limit the consumption priorities that include a larger share of the popula- of unhealthy foods.4 Additionally, the role of MICs tion in economic growth, middle income countries as influential actors in global food policy contin- will have the chance to sustainably and equitably ued to increase. Brazil and China, for instance, grow their economies while increasing stability and continued to expand investments in agriculture prosperity, a feat only achieved so far by a handful and share knowledge and technologies with the of countries. global South.5 Yet to assist the poorest and most vulnerable, THE BURDEN OF HUNGER AND even more action is required. Government food MALNUTRITION IN MICs security and nutrition efforts are constrained by several challenges, many of which are not exclusive In countries like Brazil, China, India, Indonesia, and to MICs. If these challenges are properly addressed, Mexico, despite the progress that has been made these MICs and others can make a twofold contri- in reducing the number of those chronically hun- bution to significantly enhancing global food secu- gry, there remains a potential threat to sustained, rity and nutrition: first by alleviating hunger and inclusive growth. Close to half of the world’s hungry, malnutrition within their countries and second by or 363 million people, live in these five countries TABLE 1 Key characteristics of select middle income countries Years in Total Population Population GDP growth middle-income population undernourished overweight and Country (2003–2013) Gini coefficient† status (millions) (millions) obese (millions) China 9.6 42.1 15 1,368 150.8 341.9 India 6.1 33.9 7 1,260 190.7 141.1 Indonesia 4.3 35.6 11 251 21.6 52.1 Brazil 2.5 52.7 >27 200 ns 105.6 Mexico 1.3 48.1 >27 120 ns 82.6 Subtotal 3,198 363.1 723.3 World 2.7 38.5 7,125 805.3 2,458.0 Sources: Data on GDP growth, Gini coefficients, years in middle income, and population are from the World Development Indicators 2014 (Washington, DC: World Bank, 2013), http://databank.worldbank.org/data/views/variableSelection/selectvariables.aspx?source=world-development-indicators. Data on undernourishment are from the Food and Agriculture Organization of the United Nations, The State of Food Insecurity in the World—2014 (Rome: 2014), http://www.fao.org/publications/sofi/2014/en/. Data on obesity are estimated by multiplying population by prevalence of obesity, found in the Food and Agriculture Organization of the United Nations, The State of Food and Agriculture in the World—2013 (Rome: 2013), http://www.fao.org/publications/ sofa/2013/en/. Note: Use of ns refers to not significant. †The Gini coefficient is a measure of inequality. A Gini coefficient value of 0 refers to perfect equality, while a value of 100 refers to perfect inequality—a sit- uation where only one person has all of the income and everyone else has no income. Each Gini coefficient in Table 1 refers to a year from 2010 to 2012. 14 OVERCOMING HUunge AND MLlnTtiin i Mdl IncMm CountriS FIGurE 1 Hunger and malnutrition in Brazil, China, India, Indonesia, and Mexico, % of population 69 UNDERNOURISHMENT CHILD STUNTING 54 OBESITY 47.9 OVERWEIGHT 35.6 32.8 25 19.5 21 15.2 14 10.6 11 7.1 9.4 8.7 5.6 4.7 2 Brazil China India Indonesia Mexico Sources: Data on undernourishment are from the Food and Agriculture Organization of the United Nations, The State of Food Insecurity in the World—2014 (Rome: 2014). Data on child stunting, overweight, and obesity are from the Food and Agriculture Organization of the United Nations, The State of Food and Agriculture in the World—2013 (Rome: 2013). KEY FACTORS THAT CHARACTERIZE alone. Undernutrition, the result of prolonged FOOD SECURITY AND NUTRITION IN MICs inadequate intake of macro- and micronutrients, is also widespread. Despite the diversity of MICs, a shared set of factors At the same time, in each country, overnutri- influences the scale and nature of their food secu- tion (in the form of overweight and obesity) is high rity and nutrition. Many of these factors affect food or rising. Various contributing factors are reported security and nutrition in MICs according to each to include urbanization, demographic shifts, diet country’s stage of economic development. For exam- changes associated with increased income, low ple, China and India, which are experiencing rapid awareness about good nutrition, and increasingly growth, face a heavier burden of hunger and under- sedentary lifestyles.6 Modernized value chains that nutrition while Brazil and Mexico also face a heavy have increased the availability of processed foods are trend of rising overweight and obesity. also likely contributors.7 Malnutrition also imposes high economic costs. Rising Inequality Micronutrient deficiencies, for example, cost India Persistent or rising inequalities across wealth, gender, up to 3 percent of its annual GDP.8 Overweight and and access to education add to the burden of hunger obesity increase the risk of such diseases as diabetes and malnutrition. Impressive economic growth and and heart disease, which in turn strain national bud- poverty reduction can exist alongside the multiple gets. In Mexico, noncommunicable diseases related burdens of malnutrition.10 Inequities in education, to overweight and obesity were estimated to com- health, and nutrition impede human capital forma- prise 13 percent of total healthcare expenditures in tion and jeopardize sustained, long-term growth.11 2008.9 Losses in human capital development brought The government in each of these countries rec- about by malnutrition are deepened both by a lack ognizes the challenges these issues present. As a of equal access to quality education and by gender result they are implementing a variety of activities to gaps.12 Unequal access to quality education has been address these issues while recognizing more action shown to contribute to the dual burden of child is required. stunting and obesity.13 Reaching the Missing Middle 15 IMPROVING FOOD SECURITY AND Urbanization and Changing Consumer NUTRITION IN MICs AND BEYOND Preferences As part of a global trend, rising urbanization and sub- Middle income countries can learn from the expe- sequent changes in consumer preferences from tradi- riences of other countries. South Korea and Chile tional cereal-based to protein-rich diets present new have made great progress in eliminating hunger and challenges, particularly for MICs that are facing or malnutrition while promoting the kind of durable, have faced rapid and at times massive urbanization.14 inclusive growth that has helped them avoid being Rapid urbanization and shifting diets have con- stuck in the middle income trap and moved them tributed to modernized food value chains,15 which from middle- to upper-income status.