Malnutrition is a condition resulting from a dietary deficiency, such as a lack of access to a specific nutrient or due to a lack of access to food in general.

Undernourishment is simply when people consume too little food over a certain period of time.

Famine

Causes

• Drought - A lack of rainfall leads to a lack of water in the water table for plants. This can result in crops failing and the death of livestock, leading to food shortages, primarily for subsistence farmers, but in more extreme cases whole countries.
• Disease - A spread of disease through crops can quickly eliminate a years harvest leading to mass famine.
• Population Increase - If the population of an area increases too quickly, perhaps due to an influx of refugees, the food supplies may not be able to scale to the demand, leading to a famine.
• Cost - When the quantity of available food and livestock falls, the demand and hence cost of food increases. As food prices inflate, people become unable to afford food and begin to starve.

Famine in Ethiopia

Location

Ethiopia itself is located in the east of Africa to the south of the country of Eritrea, north of Kenya. The area is landlocked due to Eritrea splitting off during a civil war. The areas affected by the civil war include Eritrea and Tiya, where the civil war has been taking place. Refugees from the civil war in these areas have fled to Koram, which hosted the majority of the famished during a famine in 1984. More recently, a drought in Ethiopia has led to famine in Gode, in the south of Ethiopia.

When

• The initial famines due to civil war and drought were in 1984 - 1985.
• Famines occurred again in 2000 due to drought.

Causes

• In all cases, drought led to the failure of crops which resulted in famines. In 2000 and 1984-1985 there had been poor rainfall for 3 years. This causes crops to fail and also forced herdsman to slaughter their cattle. The slaughtering of cattle was unusual, since the cattle are generally used for milking, not for meat.
• The lack of rain was due to cooler sea temperatures in the Atlantic & Pacific, so less evaporation occurred and hence less rain fell.
• A civil war between Ethiopia and Eritrea had been waged for several years and made it difficult to get food into Ethiopia, including aid, since Ethiopia is landlocked and Eritrea was the only country to have access to a port. In addition, it soon emerged that some of the aid that had been sent over to Ethiopia had been used to feed Ethiopian soldiers and the vehicles used to transport the aid were used for military use.
• The population of Ethiopia had grown exponentially by 2000 meaning there was too little food to feed the population.

Effects

• In the 1984 famine, 40,000 refugees in Koran were at risk of starving. Of the 40,000 people, some 15,000 children were effected by the famine. A third of these children were severely malnourished.
• In the 1984 famine, 1 person died every 20 minutes due to undernourishment.
• During the 2000 famine, 95% of the livestock had been killed either due to the drought or by their herdsmen, desperate for food.
• 1 million people were killed in both famines.
• The price of food during the 2000 famine rose greatly due to the mass migration of farmers and livestock in search of water and fresh ground. This put substantial pressure on places where there wasn’t enough water and pasture, leading to more deaths.
• Due to the killing of cattle that were intended to be used for milk, milk became scarce leading to malnutrition, especially in pregnant women and children.
• The 2000 famine effected 43% of the population.
• The conditions of the refugee camps and the presence of malnourishment in them led to the spread of diseases such as TB.

Responses

• Initially, multiple non government organisations such as Oxfam and Doctors Without Borders attempted to provide aid for those in need. Eventually, international governments became involved in providing aid.
• Live Aid was immensely successful at raising awareness and money for the famine and was responsible for getting governments involved in providing aid to Ethiopia.
• An early warning system was setup to predict poor rainfall so that food and aid can be acquired in preparation.
• Since the 1984 drought, the government holds 350,000 (metric) tonnes of food in reserve in the of a drought. The resources are supposed to be replenished as soon as they are used but during the 2000 drought, the reserves fell to 50,000 tonnes without being replaced.
• Donations of clothing and dry food from the west.

Problems With Responses

• Aid wasn’t well distributed. The poor infrastructure of Ethiopia and its landlocked nature made getting aid into the country hard.
• When Ethiopia appealed for aid, the world didn’t respond with aid due to other problems in the world and reports that donated money was going into the army rather than towards food.
• Medical workers were killed due to the ongoing civil war.

Issues Relating to Famine

• Over dependence on aid by countries can result in a worsened situation and damage to the agricultural economy.
• Disaster fatigue, were people become tired of donating money or want to do more to help than donating money but can’t.
• Coordination between aid agencies and governments can fall apart during crisis resulting wasted aid and more deaths.
• Any food sent must be non-perishable, easily transported and of local tastes. During the 1984 famine in Ethiopia, a stupid mistake meant people sent powdered milk to a country suffering from drought. Powdered milk requires water.

Obesity

Obesity is the excessive gain of body fat to the point at which it impairs a person’s health. Obesity is most often caused when a person’s energy input is greater than their output (i.e., they eat too much and don’t exercise enough). In some situations though, genetic conditions can trigger unpreventable obesity in a person. BMI is the ratio of a person’s weight to their height squared. It’s used to categorise a person as obese, overweight, normal or underweight. You can calculate it using this simple formula:

\[ \text{BMI}\left(\text{kgm}^{-2}\right) = \frac{\text{mass}\left(\text{kg}\right)}{\left(\text{height}\left(\text{m}\right)\right)^{2}} \]

A person’s BMI falls into one of a range of categories:

Note that these categories are only applicable for adults. Children’s' BMI is categorised using a different set of ranges.

The Obesity Epidemic

Obesity is a global problem and the leading preventable cause of deaths. Many people view obesity as the biggest health problem of the 21^st century and despite commonly being caused by lifestyle choices, it is now classified as a disease. Also note that “The Obesity Epidemic” isn’t a sensationalist headline, the World Health Organisation does classify obesity as a global epidemic.

Throughout the 20^th century obesity became a widespread problem in developed countries. By 2011, 24% of adult males and 26% of adult females were considered obese in the UK. This has risen from 13% and 16% respectively in 1993. Only 34% of adult males and 39% of adult females were thought to have a healthy BMI in 2011 in the UK.

Countries which are undergoing rapid development are seeing rising obesity rates as high energy food becomes more readily available and people’s lifestyles become less active. In China—a newly industrialised country—25% of the population has a BMI greater than 25 kgm^-2 while 5.6% of the population is obese.

Source: The World Health Organisation: Global Health Observatory (Accessed 2014-05-11)

Causes of the Obesity Epidemic

The main reason for the dramatic growth in obesity levels throughout the 20^th and 21^st centuries is a change in people’s lifestyle. In the 19^th century most people had jobs that involved manual labour and physical activity. This was the case for less developed countries well into the 20^th century too. The modernisation and mechanisation of industry though means that fewer people maintain manual jobs nowadays. Most people now have desk jobs that involve little physical activity or, in the current economic climate, no job at all.

Increased private vehicle ownership has also reduced people’s physical activity. Most people don’t walk to work or school any more instead taking a bus or driving a car. The way people get entertainment has also changed over the years. The average American spends 5 hours per day watching television. This number will be similar throughout the western world (I’m not just picking on America). Assuming a person works 8 hours a day and has an hours commute by car, watching 5 hours of TV doesn’t leave a lot of time for physical exercise. Video games also contribute to the problem both in the younger and older generation (*cough* *cough*¹).

Changes in how people work and play is only partly responsible for the obesity epidemic though. High calorie food is now easily accessible in developed countries and is becoming more accessible in less developed countries too. This food is fast to cook, satisfies our craving for sugar and—most importantly—is cheap. As a result of this, people’s energy intake has soared while their energy output has dropped.

The availability of cheap energy dense food has been a particular problem in America and Europe. In the United States, the U.S. Farm Bill subsidised the production of, amongst things, corn. This has greatly reduced the cost of corn from which fructose (a type of sugar found in plants) can be produced. This, in turn, has greatly reduced the cost of energy dense foods, a key reason for the rise in obesity rates in America. Similar policies in the European Union² have produced the same effect.

Consequences of the Obesity Epidemic

There are few benefits of an obese population which is why I use the term “consequences” rather than “impacts”. On the individual level, obesity leads to a reduced life expectancy and quality of life. Obese individuals tire more easily and are faced with social stigmatisation, especially in developing countries where obesity is a relatively new and unaccepted disease. Obesity has been shown to increase the risk of developing many physical and mental diseases including high blood pressure, diabetes and depression.

On a larger scale, obesity negatively affects societies. Obesity places a greater strain on public healthcare systems leading to a reduced quality of care for everybody. It could also lead to increased healthcare taxes in developed countries with public healthcare or increased insurance rates in less developed countries without a public healthcare system.

Obesity creates problems where you wouldn’t expect them. Airlines have to take the weight of passengers into account when planning for flights. The effect of weight on fuel consumption is considerable and it’s estimated that an increased average passenger weight has cost nearly $270M in additional fuel yearly.

Other problems stemming from obesity include the need to modify various day-to-day products. Cars, doors, clothes, even coffins, need to be modified to accommodate for the larger average size of a person. These modifications take up extra space, especially for buildings. Space is something which is at a premium in urban areas where obesity is at its worst.

Reducing the Prevalence of Obesity

Obesity is a preventable disease and so in the majority of (but not all) cases, it is possible to prevent a person from becoming obese. On an individual level, the onset of obesity can be prevented by maintaining a healthy diet and carrying out regular exercise. Diets should limit the consumption of energy dense foods and match the consumption of carbohydrate rich foods to an individual’s level of activity. For the majority of people in developed countries, this would involve cutting carbohydrate consumption substantially.

Many governments attempt to promote healthy living because of the potential impacts obesity can have on a population. Public health programmes focus heavily on school children by running education programmes in schools, altering school meals so they are healthier and promoting daily activity. Adults aren’t forgotten about however. Health programmes aimed at adults also encourage daily exercise and lowered calorie intake.

Some countries, such as the UK, have introduced laws that require foods to simplify their labelling and make it clear how much energy a portion contains so that it is easier for people to manage their diets. If it is easier for people to know what is in their food, they are more likely to take action and manage their diet accordingly.

Some countries have gone one step further and introduced taxes on unhealthy foods. In 2011, Denmark introduced a “fat tax” on butter, milk, meat and a variety of other processed foodstuffs. The aim was to reduce the consumption of fatty foods by increasing their cost, countering one of the main causes of the obesity epidemic. The scheme was abandoned in 2012 when it proved unsuccessful in changing Danes' eating habits.

In some cases, private companies have taken it upon themselves to improve the healthiness of the products they make. Coca Cola is a prominent example of this producing a range of low sugar brands of its drink that have ultimately proven to be more popular than its original product. Other companies have reduced the amount of fat or sugar in their foods or been more upfront with consumers about what is in their food without government intervention. They do have a good reason to do this (beyond the whole “for the good of humanity” thing). Although you wouldn’t think it from the obesity statistics, people do care about their health and if presented with a healthy version of their favourite food, they’ll chose it, if the price is right.

Managing Obesity in Brazil

Brazil implemented several different laws to try and reduce obesity within the country before it developed to too high levels. The government led Family Health Programme helps to raise awareness of different exercise programmes and healthy food choices. In addition, the government closely monitors obesity trends within adults and children to attempt to prevent any increases in obesity before it actually happens. Food advertising laws mean that foods that receive TV time or space in a newspaper and are high in fat and sugar have to put warning signs within the advert to alert consumers of the potential health risks (similar to the health warnings found on cigarette packets).