Global hunger is on the rise in 2020, with 821 million people undernourished at the beginning of 2019. This means that roughly 10.5% of the world’s population are currently living with hunger, with the continent of Africa disproportionately affected (over half of those suffering acute hunger are located on this continent). Greater food insecurity is predicted this year as a result of the COVID-19 pandemic, which is disrupting food supply systems and affecting economies in the middle of 55 concurrent food crises across the globe.
We talk a lot about hunger on this website, because that’s the way it’s often talked about in the media and outside of the humanitarian world. It’s an easy way to explain the work that organizations like Concern do when we say we’re working towards the goal of Zero Hunger. And yet, the work we do is actually focused on nutrition. Our community healthcare workers diagnose the children they screen with malnutrition, not hunger. So where does hunger end and nutrition begin?
What we talk about when we talk about hunger
The technical definition of Hunger via the Food and Agriculture Organization is “the uncomfortable or painful physical sensation caused by insufficient consumption of dietary energy (calories).” We all experience hunger from time to time, and that feeling that the FAO describes as uncomfortable or physically painful should be familiar to all of us.
Chronic hunger is when this feeling is a common occurrence, usually due to food insecurity. When these situations of insecurity become more severe through time or an increasing lack of access, not having the required dietary energy becomes a greater problem and a threat to living a normal, active, and healthy life.
Why we focus on nutrition
Hunger is a broad concept and is focused more on the physical and psychological experience of going without food than on the more quantifiable nutritional aspects and physical outcomes we associate with good nutrition.
Chronic hunger leading to chronic undernutrition has a more lasting effect, which can increase mortality rates and decrease the chances that people (especially children) have to break the cycle of poverty and lead healthy, fulfilling, and creative lives. Malnutrition is also in some ways more pervasive: While approximately 1 in 10 people are living with hunger on a global scale, one in every three people is malnourished. Collectively, all forms of malnutrition account for more poor health than any other cause (this includes stunting, wasting, and micronutrient deficiencies, as well as forms of overnutrition including obesity and diet-related non-communicable diseases).
Malnutrition most often refers to a person’s physical state when they don’t have the right balance of food necessary for their health and growth. They may also have faced illness that inhibits their ability to process the food they do eat so that they’re absorbing the nutrients.
Acute malnutrition is a below-average weight proportionate to height (also known as wasting). This is due to nutritional deficiencies, either from poor intake or poor absorption of nutrients. Wasting, much like stunting, is an especially high risk for children who are still growing, as growth and development are reduced in order for their bodies to conserve as much energy as possible. This halt on activity can also leave a person more susceptible to low blood sugar, hypothermia, and compromised immune systems.
The two most common diagnoses of acute malnutrition are moderate acute malnutrition (MAM) and severe acute malnutrition (SAM).
Moderate Acute Malnutrition (MAM)
Also known as moderate wasting, a child or an adult is diagnosed with moderate acute malnutrition when their weight for height is less than 80% that of the median range.
Severe Acute Malnutrition (SAM)
Severe acute malnutrition (SAM) is, as the name would suggest, more severe than moderate acute malnutrition. When a child or an adult’s weight for height is less than 70% of the median score, their diagnosis moves from moderate to severe. We can also diagnose severe acute malnutrition with MUAC (mid-upper arm circumference) tape, and check for children whose mid-upper arm circumference is less than 110 mm.
Both moderate and severe acute malnutrition can lead to higher fatality rates; as of 2015, the average fatality rate for children under 5 years of age with moderate acute malnutrition was 4%. That number almost doubled for children under 5 with severe acute malnutrition (7%).
Often (but not always), acute malnutrition is caused in part due to sudden shocks and circumstances, such as drought or conflict. These events upset food supply chains, cause inflation, and compromise the success of family farms, making it harder to consistently eat three nutrient-rich meals each day.
In contexts where there is relative political stability, the main nutrition problem we see (especially among children) is chronic malnutrition, also known as stunting. This indicates a lower than average height for age, one that’s at least two standard deviations below the WHO’s Child Growth Standards Median.
The effects of chronic malnutrition, however, can be just as long-lasting, leaving children more susceptible to infections and other developmental setbacks.
The costs of malnutrition are high
Malnutrition in all its forms costs the global economy as much as $3.5 trillion USD, owing to human capital lost, premature mortality, increased healthcare costs, compromised school performance, and adult productivity. A global pandemic will impact the countries that already struggle to maintain effective and comprehensive health systems, provide social protection and quality education, and ensure food and nutrition security and livelihoods.
In 2020, 144 million children under the age of 5 (21.6% of the global child population) are stunted (chronic malnutrition) and 47 million (6.9% of the global child population) are wasted (acute malnutrition). All forms of undernutrition account for half of all deaths in children under 5.
Concern’s approach to nutrition (and hunger)
As part of our work to support those living in extreme poverty to achieve lasting improvements in their lives, we understand that hunger and malnutrition are two of the most critical manifestations of extreme poverty as well as two of the key drivers of extreme poverty. Hunger is often indicative of inequality and vulnerability, and perpetuates these same conditions making those living with hunger more susceptible to risks and hazards.
The overall goal of Concern’s nutrition programming is to improve nutrition security. We measure this against a reduction in both acute and chronic malnutrition in children under 5 (we also work to ensure that women are maintaining healthy diets during pregnancy and breastfeeding, avoiding common diagnoses like anaemia). We work nutrition into non-nutrition programs, and also respond to the direct causes of malnutrition through 5 evidence-based interventions:
We work with mothers to advocate exclusive breastfeeding for the first six months of a child’s life, and continuing with other forms of feeding in the first year.
2. Complementary Feeding
After the first six months, we recommend appropriate weaning and complementary feeding with attention paid to the quality and quantity of a child’s diet.
3. Micronutrient supplements for infants and children: Vitamin A and Preventative zinc
Data support Vitamin A and preventative zinc.
4. Supplements for pregnant and breastfeeding women
We recommend folic acid, micronutrients or iron-folate, calcium, and balanced energy protein to ensure that mothers-to-be are healthy throughout their pregnancy and that new mothers are passing on nutrients to their children through breastmilk.
5. Management of severe and moderate acute malnutrition
Focusing on the first four points is proven to reduce the instances of severe and acute malnutrition in children under 5. In cases where children are still diagnosed with malnutrition on some level, however, there are treatment options. The current standard of choice is the Community Management of Acute Malnutrition (CMAM), which includes community-based diagnosis and treatment through therapeutic foods.