© t. m. whitmore today synergy between nutrition and disease continued especially vulnerable...

© T. M. Whitmore

TODAY

•Synergy between nutrition and disease continued

•Especially vulnerable populations

•Four faces of hunger

•Global Hunger

© T. M. Whitmore

Questions?•Human Nutrition

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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

• Diseases interfere with nutrient absorption and/or actively deplete nutrients from our bodies

© 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

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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

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Especially vulnerable populations

• Increased likelihood of malnutrition and more serious consequencesWomen in general Pregnant womenLactating womenElderlyChildren

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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)

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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

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Four Faces of Hunger IIMalnutrition/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 childrenStunting - stature too short for age/sex

(adjusted for local norms) => chronicWasting – weight too light for age/sex

(adjusted for local norms) => acute

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Four Faces of Hunger IIIMicro-nutrient deficiencies

•Vitamin and mineral shortages

•Sometimes called “hidden hunger”

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Four Faces of Hunger IVNutrition-depleting illnesses

•Secondary malnutrition

•Most common nutrient depleting diseases are infant/weanling diarrheas – 5 million deaths annually world wide

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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”

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Global Trajectories of Hunger I• Proportions undernourished (or food

insecure) in global southLate 1970s ~ 28%Late 1990s ~17%Thus, real progressLess progress in absolute numbers

• Micro-nutrient deficienciesIron: 40% of global southIodine: 12% of global southVitamin A: 14% of kids in global south

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Global Trajectories of Hunger II• Absolute numbers undernourished (or food

insecure)1970s ~ 900m; 2000 ~ > 800 m => decrease of ~ 100m in absolute

numbers (but smaller %)

• Children 1993 ~ 200 m; now ~ 175 m

• World food summit target in 2015 => 400mCurrent trajectory => 475-500m by 2015

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Regional differences malnourished or food insecure

• Global SouthSub-Saharan AfricaE. Asia, SE Asia, & PacificSouth AsiaLatin America & CaribbeanNear East & N. Africa

• Developed Economies (mostly N America)

Source: FAO

Source: FAO

IFPA 2005

IFPA 2005

Source: FAO

Source: FAO

Number of malnourished children, 1993, 2010, and 2020

Source: IFPRI IMPACT simulations.

IFPA 2005

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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)

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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 assistance (State or NGO) (could be money or food directly)

Via own production (requires access or ownership of enough quality land)

•Most households do not rely on a single source or type

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

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

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

© T. M. Whitmore

The “Geographical Hunger Model”

•Underlying ProcessesWorks at all scales

• Immediate CausesRegional/household/individual

scales

•Hunger SituationsRegional/household/individual

scales•Direct Consequences

Regional/household/individual scales

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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)

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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

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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)

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Irish “hunger” Process II

•Eventually the English government also initiated relief schemesWorkhouses 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.

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Irish “hunger” Process III• Peel was replaced in office in 1846 by Lord

John Russell and a Whig administration dedicated to a laissez-faire policyCharles 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

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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