THE STATE OF

FOOD SECURITY
AND NUTRITION
IN THE WORLD
TRANSFORMING FOOD SYSTEMS
FOR FOOD SECURITY, IMPROVED NUTRITION
AND AFFORDABLE HEALTHY DIETS FOR ALL
This flagship publication is part of The State of the World series of the Food and Agriculture Organization
of the United Nations.

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FAO, IFAD, UNICEF, WFP and WHO. 2021. The State of Food Security and Nutrition in the World 2021.
Transforming food systems for food security, improved nutrition and affordable healthy diets for all. Rome, FAO.
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VIET NAM. A woman with a traditional conical hat selling fruit on the beach.
ISSN 2663-8061

THE STATE OF
FOOD SECURITY
AND NUTRITION
IN THE WORLD
TRANSFORMING FOOD SYSTEMS FOR FOOD
SECURITY, IMPROVED NUTRITION AND
AFFORDABLE HEALTHY DIETS FOR ALL

Food and Agriculture Organization of the United Nations

Rome, 2021
CONTENTS
FOREWORD vi ANNEXES 129
METHODOLOGY viii
ACKNOWLEDGEMENTS ix
ANNEX 1A
Statistical tables to Chapter 2 130
ACRONYMS AND ABBREVIATIONS xi
KEY MESSAGES xii ANNEX 1B
EXECUTIVE SUMMARY xv Methodological notes for the food security
and nutrition indicators 156
CHAPTER 1
INTRODUCTION 1 ANNEX 2
Methodologies Chapter 2 170
CHAPTER 2
FOOD SECURITY AND NUTRITION AROUND
ANNEX 3
THE WORLD 7
Country exposure to the drivers and PoU
2.1 Food security indicators – latest updates
change point analysis in Chapter 3 179
and progress towards ending hunger and ensuring
food security 8 ANNEX 4
2.2 Nutrition indicators – latest updates and Country group definitions and lists of countries
affected by drivers in Chapter 3 181
progress towards global nutrition targets 29
2.3 Ending hunger and all forms of malnutrition ANNEX 5
by 2030 38 Country group definitions for the analysis
of food insecurity and drivers in 2020 186
CHAPTER 3
MAJOR DRIVERS OF RECENT FOOD SECURITY ANNEX 6
AND NUTRITION TRENDS 51 Glossary 188
3.1 A food systems lens is critical to address
the major drivers of recent food security and NOTES 194
nutrition trends 52
3.2 Impact of major drivers on food security
and nutrition 60

CHAPTER 4
WHAT NEEDS TO BE DONE TO TRANSFORM FOOD
SYSTEMS FOR FOOD SECURITY, IMPROVED
NUTRITION AND AFFORDABLE HEALTHY DIETS? 85
4.1 Six pathways to address major drivers behind
recent food security and nutrition trends 87
4.2 Building coherent portfolios of policies
and investments 109

CHAPTER 5
CONCLUSION 125

| ii |
TABLES 13  Key policy areas and goals for strengthening food
environments and changing consumer behaviour to
1  Prevalence of undernourishment (PoU) in the promote dietary patterns with positive impacts on
world, 2005–2020 11 human health and the environment 108
2  Number of undernourished people in the world, A1.1  Progress towards the Sustainable Development
2005–2020 12 Goals (SDGs) and global nutrition targets: Prevalence
3  Prevalence of food insecurity at severe level only, of undernourishment, moderate or severe food
and at moderate or severe level, based on the Food insecurity, selected forms of malnutrition, exclusive
Insecurity Experience Scale, 2014–2020 17 breastfeeding and low birthweight 130

4  Number of people experiencing food insecurity at A1.2  Progress towards the Sustainable
severe level only, and at moderate or severe level, Development Goals (SDGs) and global nutrition
based on the Food Insecurity Experience Scale, targets: Number of people who are affected by
2014–2020 18 undernourishment, moderate or severe food
insecurity and selected forms of malnutrition;
5  Healthy diets were still unaffordable for around number of infants exclusively breastfed and number
3 billion people in the world in 2019. The number of of babies born with low birthweight 143
people unable to afford healthy diets increased in
Africa and in Latin America and the Caribbean A2.1  Ranges of PoU and NoU nowcasted in 2020 171
between 2017 and 2019 27 A2.2  Regression coefficients from three models
6  The global nutrition targets endorsed by the World estimated on historic CVy values (2000–2019) 175
Health Assembly and their extension to 2030 31 A2.3  Rules for progress assessment against the
7  Most regions have made some progress, but not global nutrition targets 177
enough to achieve global targets if trends (before A4.1  List of countries by combination of drivers 184
COVID-19) continue; no subregion is on track for the
low birthweight target, and adult obesity has been
worsening in all subregions 42 FIGURES
8  Key policy areas and goals for integrating 1  The number of undernourished people in the world
humanitarian, development and peacebuilding continued to rise in 2020. Between 720 and
efforts in conflict-affected areas 92 811 million people in the world faced hunger in 2020.
Considering the middle of the projected range
9  Key policy areas and goals for scaling up climate
(768 million), 118 million more people were facing
resilience across food systems 95
hunger in 2020 than in 2019 – or as many as 161
10  Key policy areas and goals for strengthening million, considering the upper bound of the range 10
resilience of the most vulnerable to economic
2  More than half (418 million) of the people in the
adversity 98
world affected by hunger in 2020 were in Asia and
11  Key policy areas and goals for intervening along more than one-third (282 million) in Africa 13
food supply chains to lower the cost of nutritious
3  All subregions of Africa and Latin America and the
foods 101
Caribbean, and most subregions of Asia, show
12  Key policy areas and goals for tackling structural increases in the prevalence of undernourishment
inequalities, ensuring interventions are pro-poor from 2019 to 2020, with the sharpest increase in
and inclusive 105 Western Africa 14

| iii |
CONTENTS

4  Moderate or severe food insecurity has been 14  Impacts of various drivers are transmitted
climbing slowly for six years and now affects more throughout food systems, undermining food
than 30 percent of the world population 19 security and nutrition 53

5  The concentration and distribution of food 15  Low- and middle-income countries face
insecurity by severity differs greatly across the increasing frequency and intensity of drivers 61
regions of the world 20
16  While poverty declines around the world, income
6  Globally and in every region, the prevalence of inequality remains high, with an increase in 2020 in
food insecurity is higher among women than men 22 low- and middle-income countries 64

7  Reaching the 2025 and 2030 global nutrition 17  More than half of low- and middle-income
targets remains a challenge. In 2020, an estimated countries experienced increasing PoU change points
22 percent of children under 5 years of age were in correspondence with one or more drivers (conflict,
affected by stunting, 6.7 percent by wasting and climate extremes, and economic slowdowns and
5.7 percent by overweight. Nearly 30 percent of downturns) between 2010 and 2018 66
women aged 15 to 49 years were affected by
18  The 2020 increase in the number of
anaemia in 2019 32
undernourished was more than five times greater,
8  Stunting is the only indicator showing substantial than the highest increase in undernourishment in the
improvements in multiple regions since 2000. last two decades, and the economic downturn was
Two indicators – child overweight and anaemia twice as severe, than previously recorded in low- and
among women of reproductive age – have seen no middle-income countries 68
progress in two decades. Adult obesity is rising
19  In 2020, most low- and middle-income countries
sharply in all regions 34
hit by economic downturns exhibit an increase in the
9  Around 90 percent of countries surveyed reported PoU, but oftentimes economic downturns occur
changes in coverage of key nutrition services due to simultaneously with climate-related disasters and
COVID-19 in August 2020. While 80 percent reported climate extremes 69
disruptions in coverage, a small proportion witnessed
20  The majority of undernourished people and
improved coverage 36
stunted children live in countries affected by multiple
10  The COVID-19 scenario projects a small drivers (2019) 73
decrease in global hunger between 2021 and 2030,
21  Hunger is higher and has increased more in
with wide variation in evolution across regions 40
countries affected by conflict, climate extremes or
11  Some progress has been made on malnutrition, economic downturns, or with high inequality 74
but the pace must be accelerated, and trends in
22  Low-income countries affected by conflict and
some forms of malnutrition must be reversed to
climate extremes show the largest increase in the
achieve the 2025 and 2030 global nutrition targets 44
PoU, while for middle-income countries, the largest
12  Around half of children live in countries that are increase occurs during economic downturns 76
not on track to reach one of the 2030 SDG targets for
23  Latin America and the Caribbean feature the
child stunting, wasting and overweight 46
highest increase in the PoU from multiple drivers,
13  Conservative estimates of the potential impacts while Africa is the only region where the PoU
of the COVID-19 pandemic indicate that an additional increased under the influence of all three drivers
5 to 7 million children may be stunted, and from 2017 to 2019 78
570 thousand to 2.8 million more wasted, in low- and
middle-income countries in the year 2030. However,
the estimate of accumulated additional cases of
wasting from 2020 to 2030 is 16 to 40 million 48

| iv |
24  In 2020, Africa, Asia, and Latin America and the 6  Methodology: estimates of potential additional
Caribbean witnessed significant increases in the PoU cases of stunting and wasting due to the COVID-19
while being hit by economic downturns combined pandemic based on a scenario 47
with climate-related disasters, conflict, or a
7  Impact channels of the COVID-19 pandemic on
combination of both 79
food security and nutrition 56
25  The unaffordability of healthy diets in 2019 is
8  Definition of countries affected by conflict,
strongly associated with higher levels of both severe
climate extremes, economic downturns and with
and moderate or severe food insecurity 81
high income inequality 71
26  In 2019, countries affected by multiple drivers
9  Home-grown school feeding as a lever for food
and countries affected by conflict (alone or
systems transformation 97
combined with other drivers) exhibited among the
highest percentage of the population who cannot 10  The Quito Agri-Food Pact: facilitating the
afford a healthy diet and are moderately or severely transformation of the city’s food systems 100
food insecure 82
11  Accelerating food systems transformation by
27  Possible pathways towards food systems empowering women and youth 104
transformation to address major drivers of food
insecurity, malnutrition and unaffordability of 12  Protecting children from the harmful impacts of
healthy diets 88 food marketing 106

28  Steps towards food systems transformation for 13  Nutrition policy measures to enhance benefits
more affordable healthy diets 89 and minimize risks of trade 107

29  Key elements of a portfolio of policies and 14  Indigenous Peoples’ systemic approaches
investments 110 provide extensive knowledge for the sustainable and
inclusive transformation of food systems 122
30  Ensuring coherence and complementarity
among agri-food*, environmental, health, social
protection and other** systems for food systems
transformation for food security, improved nutrition
and affordable healthy diets for all 111

A4.1  Countries by combination of drivers 183

BOXES
1  Major drivers and underlying factors challenging
food security and nutrition in the world: a synthesis
from the previous four editions of this report 3

2  Updates to the prevalence of undernourishment

and methodology for the 2020 nowcast 9

3  Adapting FIES data collection in the context of the

COVID-19 pandemic in 2020 16

4  Using the FIES to guide and target responses to

the COVID-19 pandemic at subnational level 23

5  Assessment of progress towards 2030 targets for

nutrition indicators 43

|v|
FOREWORD
The world is at a critical juncture: it is ver y under 5 years of age who were affected by
different to where it was six years ago when it stunting (149.2 million), wasting (45.4 million)
committed to the goal of ending hunger, food or overweight (38.9 million). Child malnutrition
insecurit y and all forms of malnutrition by continues to be a challenge, particularly in
2030. At the time, while we understood that Africa and Asia. Adult obesit y also continues
the challenges were significant, we were also to increase, with no reversal in the trend in
optimistic that with the right transformative sight at global or regional levels. Efforts to
approaches, past progress could be accelerated, eradicate malnutrition in all its forms have
at scale, to put us on track to achieve that goal. been challenged by disruptions in essential
Nonetheless, the past four editions of this report nutrition inter ventions and negative impacts
revealed a humbling realit y. The world has on dietar y patterns during the COV ID-19
not been generally progressing either towards pandemic. On the health front, the interaction
Sustainable Development Goal (SDG) Target between the pandemic, obesit y and diet-related
2.1, of ensuring access to safe, nutritious and non-communicable diseases has underlined the
sufficient food for all people all year round, or urgency of ensuring access to affordable healthy
towards SDG Target 2.2, of eradicating all forms diets for all. Such myriad setbacks hide some
of malnutrition. important achievements – such as the increasing
prevalence of exclusive breastfeeding of infants
Last year’s report stressed that the COV ID-19 under 6 months.
pandemic was having a devastating impact on the
world’s economy, triggering an unprecedented The situation could have been worse without
recession not seen since the Second World War, governments’ responses and the impressive social
and that the food securit y and nutrition status protection measures they have put in place during
of millions of people, including children, would the COVID-19 crisis. However, not only have
deteriorate if we did not take swift action. measures to contain the spread of the pandemic
Unfortunately, the pandemic continues to expose resulted in an unprecedented economic recession,
weaknesses in our food systems, which threaten but also other important drivers are behind
the lives and livelihoods of people around the recent setbacks in food security and nutrition.
world, particularly the most v ulnerable and those These include conflict and violence in many parts
living in fragile contexts. of the world as well as climate-related disasters
all over the world. Given the past and present
This year, this report estimates that between interactions of these drivers with economic
720 and 811 million people in the world faced slowdowns and downturns, as well as high and
hunger in 2020 – as many as 161 million more persistent (and in some countries growing) levels
than in 2019. Nearly 2.37 billion people did of inequality, it is not surprising that governments
not have access to adequate food in 2020 – an could not keep the worst-case scenario for food
increase of 320 million people in just one year. security and nutrition from materializing and
No region of the world has been spared. The high affecting millions of people all over the world.
cost of healthy diets and persistently high levels
of povert y and income inequalit y continue Hence, the world is at a critical juncture, not only
to keep healthy diets out of reach for around because we have to overcome more significant
3 billion people in ever y region of the world. challenges to ending hunger, food insecurit y and
Moreover, new analysis in this report shows that all forms of malnutrition, but also because, with
the increase in the unaffordabilit y of healthy the fragilit y of our food systems widely exposed,
diets is associated with higher levels of moderate we have an opportunit y to build forward better
or severe food insecurit y. and get on track towards achieving SDG 2.
The UN Food Systems Summit, to be held later
While it is not yet possible to fully quantif y the this year, will bring forward a series of concrete
impact of the COV ID-19 pandemic in 2020, we actions that people, food system actors and
are concerned by the many millions of children governments from all over the world can take

| vi |
to support a transformation of the world’s food pathways needed to specifically address the
systems. We must build on the momentum key drivers behind the recent rise in hunger
that the run-up to the Summit has already and slowing progress towards reducing all
generated and continue to build the evidence forms of malnutrition. The report recognizes
base on inter ventions and engagement models that these transformation pathways are only
that best support the transformation of food feasible if they help meet certain conditions,
systems. This report aims to contribute to this including creating opportunities for traditionally
global effort. marginalized people, nurturing human health
and protecting the environment. Getting on
We are aware that transforming food systems track towards ending hunger and all forms of
so that they provide nutritious and affordable malnutrition will require a move away from
food for all and become more efficient, resilient, silo solutions towards integrated food systems
inclusive and sustainable has several entr y points solutions, as well as policies and investments that
and can contribute to progress across the SDGs. address the global food securit y and nutrition
Future food systems need to provide decent challenges immediately.
livelihoods for the people who work within
them, in particular for small-scale producers in This year offers a unique opportunit y for
developing countries – the people who har vest, advancing food securit y and nutrition through
process, package, transport and market our food. transforming food systems with the upcoming
Future food systems also need to be inclusive and UN Food Systems Summit, the Nutrition for
encourage the full participation of Indigenous Growth Summit and the COP26 on climate
Peoples, women and youth, both individually and change. The outcomes of these events will
through their organizations. Future generations certainly shape the actions of the second half of
will only thrive as productive actors and leading the UN Decade of Action on Nutrition. We stand
forces in food systems if decisive action is taken firmly committed to take advantage of the
to ensure that children are no longer deprived of unprecedented opportunit y for these events to
their right to nutrition. generate commitments towards transforming
food systems to eradicate food insecurit y
While this broader food systems transformation and malnutrition in all its forms and deliver
is currently at the centre of global attention, affordable healthy diets for all, and to build
this report identifies the transformation forward better from the COV ID-19 pandemic.

Qu Dongyu Gilbert F. Houngbo Henrietta H. Fore

FAO Director-General IFAD President UNICEF Executive Director

David Beasley Tedros Adhanom Ghebreyesus

WFP Executive Director WHO Director-General

| vii |
METHODOLOGY

The State of Food Security and Nutrition in the World 2021 has been prepared by the FAO Agrifood
Economics Division in collaboration with the Statistics Division of the Economic and Social Development
Stream and a team of technical experts from FAO, IFAD, UNICEF, W FP and W HO.

A senior advisor y team consisting of designated senior managers of the five UN publishing partners
g uided the production of the report. Led by FAO, this team decided on the outline of the report and
defined its thematic focus. It further gave oversight to the technical writing team composed of experts
from each of the five co-publishing agencies. Background technical papers were prepared to support
the research and data analysis undertaken by the members of the writing team. This year’s report
also included a global call for “best practices in transforming food systems for affordable healthy diets
and addressing key drivers of food insecurity and malnutrition”, which generated inputs from more than
80 development institutions and individuals worldwide. Further inputs were derived from an online
webinar organized through the Global Forum on Food Securit y and Nutrition (FSN Forum), which
included an expert panel discussion and ref lection on the report’s theme.

The writing team produced a number of interim outputs, including an annotated outline, first draft
and final draft of the report. These were reviewed, validated and cleared by the senior advisor y team at
each stage in the preparation process. The final report underwent a rigorous technical review by senior
management and technical experts from different divisions and departments within each of the five UN
agencies, both at headquarters and decentralized offices. Finally, the report underwent executive review
and clearance by the heads of agency of the five co-publishing partners.

| viii |
ACKNOWLEDGEMENTS

The State of Food Security and Nutrition in the World 2021 was jointly prepared by the Food and
Agriculture Organization of the United Nations (FAO), the International Fund for Agricultural
Development (IFAD), the United Nations Children’s Fund (UNICEF), the World Food Programme ( W FP)
and the World Health Organization ( W HO).

The publication was carried out under the direction of Marco V. Sánchez Cantillo and José Rosero
Moncayo, with the overall coordination of Cindy Holleman, the Editor of the publication, and the overall
g uidance of Máximo Torero Cullen, all of whom are from the FAO Economic and Social Development
Stream (ES). The development of the report was g uided by a Steering Committee consisting of agency
representatives from the five co-publishing partners: Marco V. Sánchez Cantillo (Chair), Sara Savastano
(IFAD), Victor Ag uayo (UNICEF), Arif Husain ( W FP) and Francesco Branca ( W HO). Alessandra Garbero
and Tisorn Songsermsawas (IFAD), Chika Hayashi and Jo Jewell (UNICEF), Eric Branckaert and Saskia
de Pee ( W FP) and Marzella Wüstefeld ( W HO) contributed to the coordination and provided technical
support. Valuable comments and final approval of the report were provided by the executive heads and
senior staff of the five co-authoring agencies.

Chapter 1 of the report was written by Cindy Holleman with inputs from Marco V. Sánchez Cantillo and José
Rosero Moncayo (FAO).

Chapter 2 of the report was coordinated by Anne Kepple (FAO). Section 2.1 was prepared by Carlo Cafiero
with inputs from Piero Conforti, Valentina Conti, Juan Feng, Cindy Holleman, Anne Kepple and Sara
Viviani (FAO). Section 2.2 was prepared by Chika Hayashi, Richard Kumapley, Vrinda Mehra and Ann
Mizumoto (UNICEF) and Elaine Borghi and Monica Flores Urrutia ( W HO), with input from Anne Kepple
(FAO), Julia Krasevec (UNICEF), and Katrina Lundberg, Juan Pablo Peña-Rosas and Marzella Wüstefeld
( W HO). Section 2.3 was prepared by Carlo Cafiero (FAO); Chika Hayashi, Julia Krasevec, Richard
Kumapley, Vrinda Mehra (UNICEF); and Elaine Borghi ( W HO), with input from Anne Kepple (FAO),
Saskia de Pee ( W FP) and Monica Flores Urrutia and Katrina Lundberg ( W HO). Olivier Lavagne d’Ortig ue
(FAO) provided support for data visualization and José Rosero Moncayo (FAO) provided editorial support
and input to Sections 2.1 and 2.3. Nona Reuter (UNICEF) provided support for data visualization in
Sections 2.2 and 2.3.

Chapter 3 of the report was coordinated and written by Cindy Holleman and Valentina Conti (FAO), with input
from Aurelien Mellin and Trudy Wijnhoven (FAO); Aslihan Arslan, Romina Cavatassi, Ilaria Firmian,
Stefania Gnoato, Caterina Ruggeri Laderchi, Tisorn Songsermsawas, Isabelle Stordeur and Sakiusa Tubuna
(IFAD); Chika Hayashi and Jo Jewell (UNICEF); Eric Branckaert, Saskia de Pee, Simone Gie and Sarah
Piccini (WFP); and Elaine Borghi, Karen McColl, Leanne Margaret Riley and Marzella Wüstefeld (WHO).
Updated agro-climate analysis and prevalence of undernourishment change point detection were provided by
Maria Dimou, Michele Meroni, Felix Rembold, Anne-Claire Thomas, Andrea Toreti, Ferdinando Urbano and
Matteo Zampieri (European Commission – Joint Research Centre), while updates to climatology indicators
were provided by Christopher Jack with inputs from Olivier Crespo and Pierre Kloppers (University of Cape
Town). Marco V. Sánchez Cantillo provided editorial support to the sections of this chapter.

Chapter 4 of the report was coordinated and written by Mark Smulders and Giovanni Carrasco Azzini (FAO),
with input from Melisa Aytekin, Luisa Castañeda, Mariana Estrada, Yon Fernandez de Larrinoa, Ileana
Grandelis, Cindy Holleman, Julius Jackson, Susan Kaaria, Lourdes Orlando, Marzia Pafumi, Luana
Swensson, Mikaila Way and Trudy Wijnhoven (FAO); Tarek Ahmed, Daniel Anavitarte, Ilaria Bianchi,
Antonella Cordone, Isabel de la Peña, Aolin Gong, Caterina Ruggeri Laderchi, Joyce Njoro, Karla Sofia

| ix |
ACKNOWLEDGEMENTS

Pita Vidal and Tisorn Songsermsawas (IFAD); Jo Jewell (UNICEF); Eric Branckaert, Saskia de Pee, Simone
Gie and Sarah Piccini ( W FP); and Maria De Las Nieves Garcia Casal, Katrin Engelhardt, Hy un Jin Kim,
Karen McColl, Benn McGrady, Kathr yn Robertson and Marzella Wüstefeld ( W HO). Further inputs to
Chapter 4 were received from FAO, IFAD, UNICEF, W FP and W HO colleag ues, as well as technical
experts around the world in response to a global call for “best practices in transforming food systems for
affordable healthy diets and addressing key drivers of food insecurit y and malnutrition”. Inputs were also
provided by Grahame Dixie and Erin Sweeney from Grow Asia. More than 80 development institutions
and individuals worldwide responded to a similar call for best practices in transforming food systems
through the Global Forum on Food Securit y and Nutrition (FSN Forum), facilitated by Svetlana Livinets
and Elise Polak (FAO). Chapter 4 also drew lessons from an expert panel through an online webinar
organized by the FSN Forum. The panellists included: Tim Benton (Chatham House), Michael Carter
(Universit y of California, Davis), Jessica Fanzo ( Johns Hopkins Universit y), Ndidi Nwuneli (Sahel
Consulting), David Spielman (International Food Policy Research Institute [IFPRI]) and Robert Townsend
( World Bank). Marco V. Sánchez Cantillo provided editorial support to the sections of this chapter.

Chapter 5 of the report was written by Marco V. Sánchez Cantillo with inputs from Cindy Holleman and José
Rosero Moncayo (FAO).

Numerous colleag ues from different technical units and departments across the five co-publishing
agencies provided valuable technical comments and input to the report. An agency-wide technical
clearance process facilitated a comprehensive review by many technical experts from the five
co-authoring agencies. Listing each of the contributions would be challenging and furthermore increase
the risk of important omissions.

Juan Feng, Abdul Sattar and Sara Viviani were responsible for preparing undernourishment and food
securit y data with input from Verónica Boero, Marinella Cirillo, Filippo Gheri, Adeeba Ishaq, Talent
Manyani, Ana Moltedo, María Rodríg uez, Firas Yassin and under the super vision of Carlo Cafiero in
Section 2.1. Supporting data were provided by the Food Balance Sheets team, led by Salar Tay yib of the
FAO Statistics Division (ESS). Valentina Conti and Cindy Holleman (FAO) were responsible for preparing
the analysis of the cost and affordabilit y of healthy diets in Section 2.1, with input from Yan Bai, Leah
Costlow, Alissa Ebel, Anna Herforth, William A. Masters and Aishwar ya Venkat (Tufts Universit y),
and Piero Conforti, Jean Marie Vianney Munyeshyaka and Michele Vollaro (FAO). Richard Kumapley
(UNICEF) was responsible for consolidating the nutrition data in Section 2.2, with input from Chika
Hayashi, Julia Krasevec and Vrinda Mehra (UNICEF), and Elaine Borghi, Monica Flores Urrutia and
Leanne Riley ( W HO). Carlo Cafiero prepared the 2030 projections of undernourishment with input from
Juan Feng, Adeeba Ishaq and Abdul Sattar (FAO) in Section 2.3. David Laborde generated key input
for the 2030 projected scenarios of undernourishment as part of a research collaboration with IFPRI.
Chika Hayashi and Richard Kumapley (UNICEF) and Elaine Borghi and Giovanna Gatica Doming uez
( W HO) were responsible for the analyses in Section 2.3 and Annex 2, including on progress towards
global nutrition targets and of the potential impact of the COV ID-19 pandemic on child stunting and
wasting by 2030, with input from Julia Krasevec and Vrinda Mehra (UNICEF).

Support for report production came from Giovanni Carrasco Azzini, Andrew Park (consulting editor) and
Daniela Verona in the FAO Economic and Social Development Stream.

The FAO Meeting Branch and Lang uage Ser vices Branch of Governing Bodies Ser vicing Division (CSG)
carried out the translations, in addition to the contributors mentioned above.

The Publishing Group (OCCP) of the FAO’s Office of Communications provided editorial support, design
and layout, as well as production coordination, for editions in all six official lang uages.

|x|
ACRONYMS AND ABBREVIATIONS
AARR Average annual rate of reduction IDP Internally displaced person
ADER Average dietary energy requirement IFAD International Fund for Agricultural
ASAP Anomaly Hotspots of Development
Agriculture Production ILO International Labour Organization
ASEAN Association of Southeast Asian Nations IMF International Monetary Fund
BMI Body mass index IPC Integrated Food Security Phase
CGE Computable general equilibrium Classification
IQ Intelligence quotient
CH Cadre Harmonisé (harmonized
framework) JME Joint Malnutrition Estimates
CHIRPS Climate Hazards Group Infrared LIFDCs Low-income food-deficit countries
Precipitation with Stations LMICs Low- and middle-income countries
CPI Consumer price index
MDD Minimum Dietary Diversity
CRED Centre for Research on the
MDD-W Minimum Dietary Diversity for Women
Epidemiology of Disasters
MDER Minimum dietary energy requirement
CSA Climate-smart agriculture
MIRAGRODEP Modelling International Relations under
CV Coefficient of variation
Applied General Equilibrium
CV|r CV due to energy requirements
MPP Mountain Partnership Products
CV|y CV due to income
NCD Non-communicable disease
DEC Dietary energy consumption
NoU Number of undernourished
DES Dietary energy supply
PoU Prevalence of undernourishment
ECMWF European Centre for Medium-Range
PPP Purchasing power parity
Weather Forecasts
PPPP Public-private-producer partnership
FAO Food and Agriculture Organization
of the United Nations SD Standard deviation
FBDGs Food-based dietary guidelines SDGs Sustainable Development Goals
FBS Food Balance Sheet SMEs Small and medium-sized enterprises
FIES Food Insecurity Experience Scale UCDP Uppsala Conflict Data Program
FImod+sev Prevalence of moderate or severe UNICEF United Nations Children's Fund
food insecurity USD United States dollar
FIsev Prevalence of severe food insecurity
VCC Virtual call centre
GDP Gross domestic product
WEAI Women’s Empowerment in
GHG Greenhouse gas Agriculture Index
GWP Gallup World Poll WEO World Economic Outlook
HCES Household Consumption and WFP World Food Programme
Expenditure Survey WHA World Health Assembly
HDP Humanitarian-development-peace
WHO World Health Organization
HGSF Home-grown school feeding

| xi |
KEY MESSAGES

è  Well before the COVID-19 pandemic, we were è  While the global prevalence of moderate or severe
already not on track to meet our commitments to food insecurity (measured using the Food Insecurity
end world hunger and malnutrition in all its forms by Experience Scale) has been slowly on the rise since
2030. Now, the pandemic has made this significantly 2014, the estimated increase in 2020 was equal to that
more challenging. This report presents the first global of the previous five years combined. Nearly one in three
assessment of food insecurity and malnutrition for people in the world (2.37 billion) did not have access
2020 and highlights the need for a deeper reflection to adequate food in 2020 – an increase of almost
on how to better address the global food security and 320 million people in just one year.
nutrition situation.
è  Close to 12 percent of the global population was
è  World hunger increased in 2020 under the severely food insecure in 2020, representing 928 million
shadow of the COVID-19 pandemic. After remaining people – 148 million more than in 2019.
virtually unchanged for five years, the prevalence of
undernourishment (PoU) increased 1.5 percentage è  At the global level, the gender gap in the prevalence
points in just one year – reaching a level of around of moderate or severe food insecurity has grown even
9.9 percent, heightening the challenge of achieving the larger in the year of the COVID-19 pandemic, with the
Zero Hunger target by 2030. prevalence of moderate or severe food insecurity being
10 percent higher among women than men in 2020,
è  It is projected that between 720 and 811 compared to 6 percent in 2019.
million people in the world faced hunger in 2020.
Considering the middle of the projected range è  The high cost of healthy diets coupled with persistent
(768 million), around 118 million more people were high levels of income inequality put healthy diets out of
facing hunger in 2020 than in 2019 – or as many as reach for around 3 billion people, especially the poor, in
161 million more, considering the upper bound of every region of the world in 2019. This number is slightly
the range. less than in 2017 and will likely increase in most regions
in 2020 due to the COVID-19 pandemic.
è  More than half of the world’s undernourished are
found in Asia (418 million) and more than one-third è  Shifting to healthy diets that include sustainability
in Africa (282 million). Compared with 2019, about considerations can contribute to reducing health and
46 million more people in Africa, 57 million more in Asia, climate change costs by 2030, because the hidden
and about 14 million more in Latin America and the costs of these diets are lower compared with those of
Caribbean were affected by hunger in 2020. current consumption patterns.

è  New projections confirm that hunger will not be è  Globally, malnutrition in all its forms also remains
eradicated by 2030 unless bold actions are taken to a challenge. Although, it is not yet possible to fully
accelerate progress, especially actions to address account for the impact of the COVID-19 pandemic
inequality in access to food. All other things constant, due to data limitations, in 2020 it is estimated that
around 660 million people may still face hunger in 22.0 percent (149.2 million) of children under 5 years of
2030 in part due to lasting effects of the pandemic on age were affected by stunting, 6.7 percent (45.4 million)
global food security – 30 million more people than in a were suffering from wasting and 5.7 percent
scenario in which the pandemic had not occurred. (38.9 million) were overweight. The actual figures,
particularly for stunting and wasting, are expected to be
higher due to the effects of the pandemic.

| xii |
è  Most children with malnutrition live in Africa and è  The reversal in the PoU trends in 2014 and
Asia. These regions account for more than nine out of continuous increase, especially pronounced in low-
ten of all children with stunting, more than nine out of and middle-income countries from 2017, are largely
ten children with wasting and more than seven out of ten attributed to countries affected by conflict, climate
children who are affected by overweight worldwide. extremes and economic downturns, and to countries
with high income inequality.
è  An estimated 29.9 percent of women aged 15 to
49 years in 2019 around the world are affected by è  Between 2017 and 2019, the PoU increased by
anaemia – now a Sustainable Development Goal (SDG) 4 percent in countries affected by one or more of these
Indicator (2.2.3). However, the data reveal stark regional major drivers while it decreased by 3 percent in countries
differences: more than 30 percent of women in Africa not affected by them. While middle-income countries
and Asia were affected by anaemia, compared with affected by these drivers registered only a 2 percent
only 14.6 percent of women in Northern America and increase in the PoU, the increase for those with high
Europe. Adult obesity is increasing sharply in all regions. income inequality was double – 4 percent.

è  Globally, the world is not on track to achieve è  In the same period, countries affected by multiple
targets for any of the nutrition indicators by 2030. drivers exhibited the highest increases in the PoU,
The current rate of progress on child stunting, exclusive 12 times larger than those in countries affected by only
breastfeeding and low birthweight is insufficient, and a single driver.
progress on child overweight, child wasting, anaemia in
women of reproductive age and adult obesity is stalled è  Drivers that are external (e.g. conflicts or climate
or the situation is worsening. shocks) and internal (e.g. low productivity and inefficient
food supply chains) to food systems are pushing up
è  The COVID-19 pandemic has likely impacted the the cost of nutritious foods which, combined with
prevalence of multiple forms of malnutrition, and could low incomes, are increasing the unaffordability of
have lasting effects beyond 2020, as we are already healthy diets. The percentage of the population who
seeing in 2021. These will be compounded through cannot afford a healthy diet in countries affected by
the intergenerational effects of malnutrition and the multiple drivers in 2019 was 39 percent and 66 percent
resulting impacts on productivity. Exceptional efforts higher, respectively, than in countries affected by
are required to address and overcome the effects of a single driver or no driver at all. Increases in the
the pandemic as part of accelerating progress towards unaffordability of a healthy diet are associated with
achieving SDG Target 2.2. higher levels of food insecurity, especially among
lower-middle-income countries.
è  Conflict, climate variability and extremes, and
economic slowdowns and downturns (now exacerbated è  In 2020, almost all low- and middle-income
by COVID-19 pandemic) are major drivers of food countries were affected by pandemic-induced economic
insecurity and malnutrition that continue to increase in downturns, and the increase in their number of
both frequency and intensity, and are occurring more undernourished was more than five times greater than
frequently in combination. the highest increase in undernourishment in the last
two decades. When those countries were also affected
by other drivers, particularly climate-related disasters,
conflict, or a combination, the largest increase in
undernourishment was seen in Africa, followed by Asia.

| xiii |
KEY MESSAGES

è  Because these major drivers are negatively affecting è  Coherence in the formulation and implementation
food security and nutrition by creating multiple, of policies and investments among food, health, social
compounding impacts throughout our food systems – as protection and environmental systems is also essential
well as through the interaction between these and other to build on synergies towards more efficient and
systems – a food systems lens is therefore essential to effective food systems solutions to deliver affordable
better understand these interactions and identify entry healthy diets, sustainably and inclusively.
points for interventions to address them.
è  Effective and inclusive governance mechanisms and
è  When transformed with greater resilience to major institutions, in addition to access to technology, data
drivers, including conflict, climate variability and and innovation, should serve as important accelerators
extremes, and economic slowdowns and downturns, in the comprehensive portfolios of policies, investments
food systems can provide affordable healthy diets that and legislation aimed at transforming food systems.
are sustainable and inclusive, and become a powerful
driving force towards ending hunger, food insecurity and è  Systems approaches are needed to build coherent
malnutrition in all its forms, for all. portfolios of policies, investments and legislation and
enable win-win solutions while managing trade-offs;
è  Depending on context, there are six pathways to these include territorial approaches, ecosystems
follow towards food systems transformation: integrating approaches, Indigenous Peoples’ food systems
humanitarian, development and peacebuilding policies approaches and interventions that systemically address
in conflict-affected areas; scaling up climate resilience protracted crisis conditions.
across food systems; strengthening resilience of the
most vulnerable to economic adversity; intervening è  While 2020 was an immense challenge for the world,
along the food supply chains to lower the cost of it may also be a warning of unwelcome events to come
nutritious foods; tackling poverty and structural if the world does not commit to more resolute actions to
inequalities, ensuring interventions are pro-poor and change course. The major drivers that lie behind recent
inclusive; and strengthening food environments and food security and nutrition trends each have their own
changing consumer behaviour to promote dietary trajectory or cyclicality, which ensures they will continue
patterns with positive impacts on human health and to occur and could even worsen in the coming years.
the environment.
è  The UN Food Systems Summit 2021 will bring
è  Given that most food systems are affected by more forward a series of concrete actions that people from
than one driver, and also impact on food security and all over the world can take to support a transformation
nutrition outcomes in multiple ways, the formulation of of the world’s food systems. The six transformation
comprehensive portfolios of policies, investments and pathways identified in this report are needed for greater
legislation may be elaborated along several pathways resilience to specifically address the negative impacts
simultaneously. This will allow for maximizing their of the major drivers behind the recent rise in hunger and
combined effects on food systems transformation, slowing progress to reduce malnutrition in all its forms.
exploiting win-win solutions and mitigating undesirable
trade-offs.

| xiv |
EXECUTIVE SUMMARY

Well before the COV ID-19 pandemic, we were After remaining virtually unchanged from 2014
already not on track to ending world hunger and to 2019, the PoU increased from 8.4 percent
malnutrition in all its forms by 2030. Now, the to around 9.9 percent between 2019 and 2020,
pandemic has made this goal significantly more heightening the challenge of achieving the
challenging. This report presents the first global Zero Hunger target in 2030. The 2020 estimate
assessment of food insecurit y and malnutrition ranges from 9.2 to 10.4 percent, depending on the
for 2020 and offers some indication of what assumptions made to ref lect the uncertainties
hunger and malnutrition would look like by around the assessment.
2030, in a scenario further complicated by the
enduring effects of the pandemic. These trends In terms of population, it is estimated that
highlight the need for deeper ref lection on how between 720 and 811 million people in the world
to better address the global food securit y and faced hunger in 2020. Considering the middle
nutrition situation. of the projected range (768 million), 118 million
more people were facing hunger in 2020 than
One of the key questions posed in this year’s in 2019, with estimates ranging from 70 to
report is – How did the world get to this 161 million.
critical point? To answer, the report draws on
the analyses of the past four editions, which The numbers show enduring and troubling
have produced a vast, evidence-based body of regional inequalities. About one in five people
knowledge of the major drivers behind the recent (21 percent of the population) was facing
changes in food security and nutrition. This is hunger in Africa in 2020 – more than double the
updated with new data to feed into a broader proportion of any other region. This represents
analysis of how these drivers interact, allowing an increase of 3 percentage points in one year.
for a holistic view of their combined effects both This is followed by Latin America and the
on each other and on food systems. In turn, this Caribbean (9.1 percent) and Asia (9.0 percent),
informs an in-depth look at how to move from silo with increases of 2.0 and 1.1 percentage points,
solutions to integrated food systems solutions that respectively, between 2019 and 2020.
specifically address the challenges posed by the
major drivers, highlighting also the types of policy Of the total number of undernourished people in
and investment portfolios required to transform 2020 (768 million), more than half (418 million)
food systems for food security, improved nutrition live in Asia and more than one-third (282 million)
and affordable healthy diets for all. in Africa, while Latin America and the Caribbean
accounts for about 8 percent (60 million).
Compared with 2019, 46 million more people
FOOD SECURITY AND NUTRITION in Africa, almost 57 million more in Asia, and
AROUND THE WORLD about 14 million more in Latin America and the
Food security indicators – latest updates Caribbean were affected by hunger in 2020.
and progress towards ending hunger and Moderate or severe food insecurit y (based on
ensuring food security the Food Insecurit y Experience Scale) at the
The number of people in the world affected global level has been slowly on the rise, from
by hunger continued to increase in 2020 22.6 percent in 2014 to 26.6 percent in 2019.
under the shadow of the COV ID-19 pandemic. Then in 2020, the year the COV ID-19 pandemic

| xv |
EXECUTIVE SUMMARY

spread across the globe, it rose nearly as much Nutrition indicators – latest updates and
as in the previous five years combined, to
30.4 percent. Thus, nearly one in three people
progress towards global nutrition targets
in the world did not have access to adequate Due to the physical distancing measures taken
food in 2020 – an increase of 320 million people to contain the spread of the pandemic, data
in just one year, from 2.05 to 2.37 billion. on nutrition outcomes were limited in 2020.
Nearly 40 percent of those people – 11.9 percent Consequently, the latest estimates do not account
of the global population, or almost 928 million for the effects of the COV ID-19 pandemic.
– faced food insecurit y at severe levels. Close to
148 million more people were severely food Globally, 149.2 million (22.0 percent) of children
insecure in 2020 than in 2019. under the age of five years suffered from stunting
(SDG Indicator 2.1.1) in 2020. The prevalence of
The increases in moderate or severe food stunting has decreased from 33.1 percent in 2000
insecurit y from 2019 to 2020 were sharpest in to 26.2 percent in 2012 and further to 22.0 percent
Latin America and the Caribbean (9 percentage in 2020. In 2020, nearly three-quarters of the
points) and Africa (5.4 percentage points), world’s stunted children lived in just two regions:
compared with a 3.1-point increase in Asia. Central and Southern Asia (37 percent) and
Even in Northern America and Europe, where sub-Saharan Africa (37 percent).
the lowest rates of food insecurit y are found, the
prevalence of food insecurit y increased for the In 2020, 45.4 million children under five years
first time since the beginning of Food Insecurit y (6.7 percent) were wasted. Nearly one-quarter
Experience Scale (FIES) data collection in 2014. lived in sub-Saharan Africa and more than half
lived in Southern Asia, the subregion with the
At the global level, the gender gap in the highest prevalence of wasting – above 14 percent.
prevalence of moderate or severe food insecurit y
has grown even larger in the year of the In the same year, around 5.7 percent
COV ID-19 pandemic, with the prevalence (38.9 million) of children under five years
of moderate or severe food insecurit y being were affected by overweight. There has been
10 percent higher among women than men in little change at global level in two decades –
2020, compared with 6 percent in 2019. 5.7 percent in 2020 compared with 5.4 percent in
2000, and trends in some regions and in many
Tracking the cost and the number of people who settings are on the rise.
cannot afford a healthy diet provides valuable
metrics to better understand the link between Adult obesit y continues to rise, with the global
these important determinants of access to prevalence increasing from 11.7 percent in 2012
food and the trends in the multiple forms of to 13.1 percent in 2016. All subregions showed
malnutrition. As a result of the high cost of increasing trends in the prevalence of adult
healthy diets, coupled with persistent high levels obesit y between 2012 and 2016 and are off track
of income inequality, it is estimated that around to meet the 2025 World Health Assembly target
3 billion people were unable to afford a healthy to halt the rise by 2025.
diet in 2019. Most of these people live in Asia
(1.85 billion) and Africa (1.0 billion), although a One in seven live births, or 20.5 million
healthy diet is also out of reach for millions living (14.6 percent) babies globally, suffered from
in Latin America and the Caribbean (113 million) low birthweight in 2015. Low birthweight
and Northern America and Europe (17.3 million). newborns have a higher risk of dying in the first

| xvi |
28 days after birth; those who sur vive are more to allow for an official assessment at global and
likely to suffer from stunted growth and lower regional levels. Results of one such analysis
intelligence quotient (IQ), and face increased indicate that, under a moderate scenario, an
risk of overweight and obesit y and adult-onset additional 11.2 million children under five years
chronic conditions, including diabetes, later of age in low- and middle-income countries would
in life. be affected by wasting from 2020 to 2022 as a
consequence of the pandemic – 6.9 million in 2020
Optimal breastfeeding practices, including alone. Under a more pessimistic scenario, this
exclusive breastfeeding for the first 6 months estimate rises to 16.3 million additional children
of life, are critical for child sur vival and the affected by wasting. For child stunting, the model
promotion of health and brain and motor predicts that 3.4 million additional children will
development. Globally, 44 percent of infants be stunted due to the effects of the pandemic
under 6 months of age were exclusively breastfed in 2022.
in 2019 – up from 37 percent in 2012.

Anaemia in women of reproductive age has

Ending hunger and all forms of
been newly designated as an SDG indicator malnutrition by 2030
(SDG Indicator 2.2.3). Nearly one in three With less than a decade left to reach the end of
(29.9 percent) women of reproductive age the time horizon set for achieving the SDGs,
globally were still affected by anaemia in 2019, this report presents updated assessments of the
and no progress has been made since 2012. likelihood that SDG Targets 2.1 and 2.2 will be
Wide variations exist between regions, with achieved by 2030.
the prevalence in Africa being nearly three
times higher than that of Northern America This year’s projections of the PoU up to 2030
and Europe. were estimated using a structural approach
based on a global dynamic general equilibrium
Countries worldwide are facing many challenges model. Two scenarios were modelled: a scenario
as they strive to ensure that health, food, aimed at capturing the impact of the COV ID-19
education and social protection systems maintain pandemic, and a no-COV ID-19 scenario.
essential nutrition ser vices while simultaneously Both scenarios assume that the trajectories are
responding to the COV ID-19 pandemic. Based on not disrupted by any of the main drivers of food
a sur vey tracking the situation of children insecurit y and that momentous actions needed
during the pandemic, 90 percent of countries to transform food systems for food securit y
(122 of 135) reported a change in the coverage and decrease inequalities in access to food are
of key nutrition ser vices in Aug ust 2020. not implemented.
Overall, essential nutrition ser vices coverage
declined by 40 percent, and nearly half of the Under the COV ID-19 scenario, following a
countries reported a drop of 50 percent or more projected peak of around 768 million (9.9 percent
for at least one nutrition inter vention. of the population) in 2020, global hunger
would decrease to around 710 million in 2021
Although data on nutritional outcomes are (9 percent), and then continue to decrease
missing for 2020, research based on modelled marginally to less than 660 million (7.7 percent)
scenarios can contribute valuable insights to in 2030. However, the evolution from 2020 to
illustrate the impact of the COVID-19 pandemic 2030 is quite different across regions. While a
at least until new empirical data are available substantial reduction is projected for Asia (from

| xvii |
EXECUTIVE SUMMARY

418 million to 300 million people), a significant

increase is forecast for Africa (from more than
MAJOR DRIVERS OF RECENT FOOD
280 million to 300 million people), placing it SECURITY AND NUTRITION TRENDS
on par with Asia by 2030 as the region with the A food systems lens is critical to address
highest number of undernourished people. the drivers of recent food security and
Under the COV ID-19 scenario, about 30 million
nutrition trends
more people may face hunger in 2030 than if the Conf lict, climate variabilit y and extremes, and
pandemic had not occurred, revealing persistent economic slowdowns and downturns (now
effects of the pandemic on global food securit y. exacerbated by the COV ID-19 pandemic) are
Greater inequalit y in access to food is mostly behind recent rises in hunger and slowing
responsible for the obser ved difference. progress in reducing all forms of malnutrition.
Their adverse inf luence is made all the more
Globally, progress is being made for some difficult by high and persistent levels of
forms of malnutrition, but the world is not on inequalit y. In addition, millions of people
track to achieve targets for any of the nutrition around the world suffer from food insecurit y
indicators by 2030. The current rates of progress and different forms of malnutrition because
on child stunting, exclusive breastfeeding and they cannot afford the cost of healthy diets.
low birthweight are insufficient, and progress These major drivers are unique but not mutually
on child overweight, child wasting, anaemia exclusive, as they interact to the detriment of
in women of reproductive age and adult food securit y and nutrition by creating multiple,
obesit y is stalled (no progress) or the situation compounding impacts at many different points
is worsening. within our food systems.

As the economic and other impacts of the For example, conf lict negatively affects almost
COV ID-19 pandemic continue to unfold, the ever y aspect of a food system, from production,
trajector y over the next years is difficult to har vesting, processing and transport to input
foresee. Evidence is still scarce on the actual supply, financing, marketing and consumption.
effects of the pandemic on various forms of Direct impacts can include the destruction
malnutrition, including on the prevalence of of agricultural and livelihood assets and
child stunting, wasting, overweight; adult can severely disrupt and restrict trade and
obesit y; anaemia in women of reproductive age; movements of goods and ser vices, with a
low birthweight; and exclusive breastfeeding. negative effect on the availabilit y and prices of
These effects will be compounded through the food, including nutritious foods.
intergenerational effects of malnutrition and the
resulting impacts on productivit y and, hence, Similarly, climate variabilit y and extremes create
economic recover y. However, it is clear that the multiple and compounding impacts on food
COV ID-19 pandemic has likely impacted the systems. They negatively affect agricultural
prevalence of multiple forms of malnutrition, and productivit y, and also affect food imports
could have lasting effects beyond 2020, as we are as countries tr y to compensate for domestic
already seeing in 2021. Therefore, exceptional production losses. Climate-related disasters
efforts are required to address and overcome the can lead to significant impacts across the
effects of the pandemic as part of accelerating food value chain, with negative consequences
progress towards achieving SDG Target 2.2. on sector growth and on food and non-food
agro-industries.

| xviii |
On the other hand, economic slowdowns and More than half of the low- and middle-income
downturns primarily impact food systems countries experienced an increase in the PoU in
through their negative effects on people’s access correspondence with one or more drivers (conflict,
to food, including the affordabilit y of healthy climate extremes and economic downturns)
diets, as they lead to rises in unemployment and between 2010 and 2018. Moreover, several
declines in wages and incomes. This is the case of these countries faced recurring increases
irrespective of whether they are driven by market in correspondence with these drivers during
swings, trade wars, political unrest, or a global this period.
pandemic, such as COV ID-19.
Analysis shows that the reversal in the PoU trends
The unaffordabilit y of healthy diets is a result in 2014 and the continuous increase, especially
of the effects of other drivers or factors on pronounced from 2017, are largely attributed
people’s income and on the cost of nutritious to low- and middle-income countries affected
foods throughout the food system. As such, it is a by conflict, climate extremes and economic
driver that acts within food systems to negatively downturns, and to countries with high income
affect food securit y and nutrition. inequality. The PoU is higher and has increased
more in countries affected by these drivers.
Povert y and inequalit y are critical underlying
structural factors that amplif y the negative Focusing on the most recent period of increase
impact of the major drivers. Their impacts are felt before the COV ID-19 pandemic, between 2017
throughout food systems and food environments, and 2019, low- and middle-income countries
ultimately affecting the affordabilit y of healthy affected by one or more of the drivers saw an
diets and food securit y and nutrition outcomes. increase in the PoU, while countries not affected
by any driver saw a decrease. In contrast, the
Beyond their direct impacts on food systems, prevalence of child stunting shows a continuing
these major global drivers and underlying declining trend from 2017 to 2019 and an
structural factors weaken food securit y analysis of countries affected by drivers did
and nutrition through interconnected and not reveal any notable patterns, indicating
circular impacts on other systems, including the presence of other stronger drivers behind
environmental and health systems. this trend.

Impact of major drivers on food security There are also important differences in trends
depending on whether a countr y is affected
and nutrition by more than one driver (multiple drivers) and
In the last ten years, the frequency and intensity depending on the countr y income-group and
of conflict, climate variability and extremes, region. Countries affected by multiple drivers
and economic slowdowns and downturns have consistently show the highest increases in
increased and are undermining food security and the PoU, 12 times larger than those countries
nutrition around the world. Of particular concern affected by only a single driver. For all three
are low- and middle-income countries because regions analysed (Africa, Asia, and Latin
the negative impacts on food security and America and the Caribbean), around 36 percent
nutrition are greatest in these countries and they of low- and middle-income countries were
carr y the biggest burden of the world’s population affected by multiple drivers.
who are undernourished, food insecure and
suffer from one or more forms of malnutrition.

| xix |
EXECUTIVE SUMMARY

Low-income countries affected by conf lict and Those countries also show higher levels of
climate extremes show the largest increase in moderate or severe food insecurit y (47 percent)
the PoU, while for middle-income countries, – 12 percent higher than countries affected by a
the largest increase occurs during economic single driver and 38 percent more than countries
downturns. Africa is the only region with PoU not affected by any driver. The unaffordabilit y
increases from 2017 to 2019 associated with all of healthy diets tends to be higher where there
three drivers (conf lict, climate extremes and is conf lict.
economic downturns). Countries affected by
economic downturns in Africa, Asia, and Latin
America and the Caribbean show the highest WHAT NEEDS TO BE DONE TO
increase in the PoU compared with countries TRANSFORM FOOD SYSTEMS FOR FOOD
affected by climate extremes and conf lict,
with the largest increase seen in Africa and
SECURITY, IMPROVED NUTRITION AND
Latin America and the Caribbean. AFFORDABLE HEALTHY DIETS?
Six pathways to address major drivers
In 2020, almost all low- and middle-income
countries were affected by economic downturns.
behind recent food security and
The increase in the number of undernourished nutrition trends
was more than five times greater than the highest There are six possible recommended pathways
increase in undernourishment in the last two through which food systems could be transformed
decades, and the economic downturn was twice to address the major drivers of food insecurity
as severe as any previously recorded in the same and malnutrition and ensure access to affordable
period. When economic downturns occurred healthy diets for all, sustainably and inclusively.
along with other drivers (either climate-related These are: 1) integrating humanitarian,
disasters, conf lict, or a combination of both), the development and peacebuilding policies in
largest increase in the PoU was seen in Africa, conflict-affected areas; 2) scaling up climate
followed by Asia. resilience across food systems; 3) strengthening
the resilience of the most vulnerable to economic
In last year’s edition of this report, it was shown adversity; 4) intervening along the food supply
that the unaffordabilit y of healthy diets in 2017 chains to lower the cost of nutritious foods;
was strongly associated with undernourishment 5) tackling poverty and structural inequalities,
and different forms of malnutrition, including ensuring interventions are pro-poor and inclusive;
child stunting and adult obesit y. These results and 6) strengthening food environments and
are reconfirmed for 2019, and new analysis shows changing consumer behaviour to promote dietary
that high levels of unaffordabilit y in 2019 are patterns with positive impacts on human health
strongly associated with higher levels of both and the environment.
severe and moderate or severe forms of food
insecurit y, as measured by the FIES. As many countries are affected by multiple
drivers, several pathways will apply
Countries affected by multiple drivers exhibit simultaneously, calling for coherence among
the highest percentage of the population who these pathways to ensure efficiency in
cannot afford a healthy diet (68 percent), which implementation. Comprehensive portfolios of
is, on average, 39 percent higher than countries policies, investments and legislation are therefore
affected by a single driver, and 66 percent are central to enabling the transformation of food
higher than countries not affected by any driver. systems through these pathways.

| xx |
Under conditions of conflict, entire food systems policies, investments and legislation from
are often severely disrupted, challenging people’s production to consumption aimed at realizing
access to nutritious foods. Deep economic crises efficiency gains and cutting food losses and
can unfold where the root causes of conflict waste to help achieve these objectives.
situations are linked to competition over natural
resources, including productive land, forest, Empowerment of poor and v ulnerable population
fisheries and water resources. It is imperative groups, often smallholders with limited access
that policies, investments and actions to reduce to resources or those living in remote locations,
immediate food insecurity and malnutrition be as well as the empowerment of women, children
implemented simultaneously with those aimed at and youth, who may otherwise be excluded,
a reduction in the levels of conflict and aligned represents a major lever in transformative change.
with long-term socio-economic development and Measures of empowerment include increased
peacebuilding efforts. access to productive resources, including access
to natural resources, agricultural inputs and
The ways we produce food and use our natural technolog y, financial resources, as well as
resources can help deliver a climate-positive knowledge and education. Other empowerment
future in which people and nature can coexist measures relate to strengthened organizational
and thrive. This is important, not only because skills and, importantly, access to digital
food systems are affected by climate events, but technolog y and communication.
also because food systems themselves impact
on the state of the environment and are a Changing dietar y patterns have had both
driver of climate change. Central to this effort positive and negative impacts on human health
are priorities to protect nature, to sustainably and the environment. Based on the specific
manage existing food production and supply countr y context and prevailing consumption
systems, and to restore and rehabilitate natural patterns, there is a need for policies, laws
environments. These sustainabilit y efforts will and investments to create healthier food
also strengthen resilience to climate shocks to environments and to empower consumers to
ensure food securit y and improved nutrition. pursue dietar y patterns that are nutritious,
healthy and safe and with a lower impact on
Economic and social policies, legislation and the environment.
governance structures should be in place well in
advance of economic slowdowns and downturns
to counteract the effects of adverse economic
Building coherent portfolios of policies
cycles when they do arrive, and to maintain and investments
access to nutritious foods, especially for the most A key challenge that restricts successful
v ulnerable population groups, including women transformation of food systems is that
and children. In the immediate term, these existing national, regional and global policies,
must include social protection mechanisms and strategies, legislation and investments are
primar y healthcare ser vices. compartmentalized into distinct dialog ues.
These challenges can be overcome through
Inter ventions along food supply chains are the formulation and implementation of
needed to increase the availabilit y of safe and cross-sectoral portfolios of policies, investments
nutritious foods and lower their cost, primarily and legislation that comprehensively address the
as a means to increase the affordabilit y of negative food securit y and nutrition effects of
healthy diets. This calls for a coherent set of the multiple drivers impacting on food systems.

| xxi |
EXECUTIVE SUMMARY

These portfolios need to be well targeted and insecurit y and malnutrition. When predictable
provide incentives for all actors to engage and well targeted, social protection can support
constructively in innovative and systemic households to engage in new economic activities,
changes that will lead to transformed food and to capitalize on opportunities created by
systems. Drawing upon best practices and lessons the continued economic dynamism of food
learned from a series of case studies worldwide, systems, thereby bringing about longer-term
this report provides many illustrative examples improvements in access to healthy diets.
of what it takes – in ver y practical and innovative
ways – to transform food systems at local, The effective and efficient implementation of
countr y, regional and global levels to become portfolios of policies and investments requires an
more resilient to the drivers behind rising levels enabling environment of governance mechanisms
of food insecurit y and malnutrition, and to and institutions that facilitate consultation across
improve access to affordable healthy diets.  sectors and key stakeholders. Scaling up the
availabilit y of technologies, data and innovative
The performance of food systems depends solutions is key to accelerating the transformation
on their coherence and interaction with of food systems, while ensuring that possible
several other systems, including especially trade-offs are minimized as a consequence of the
the wider agri-food systems, in addition to transformative process.
environmental, health and social protection
systems. Other systems, such as education The successful transformation of food systems
systems, play a critical role throughout the towards greater affordabilit y of healthy
food system, from providing nutritious school diets for all, sustainably produced and with
meals, the necessar y knowledge and skills improved resilience to identified drivers, calls
in food production to nutrition education for for win-win solutions to be fully exploited.
school-aged children and raising consumer As with all systemic changes, there will be
awareness towards minimizing the negative winners and losers, while the introduction of
impacts of food consumption on human health new technologies, improved access to data and
and the environment. innovations, and the subsequent changes in food
systems performance, will produce both positive
Health systems and their services are vital in and negative spillover effects. Coherence among
ensuring that people are able to consume foods systems, as well as the cross-cutting accelerators,
and utilize the necessary nutrients for their health play a key role in maximizing the benefits
and well-being. Food systems may exert both and minimizing negative consequences
positive and negative impacts on human health of transformation.
through multiple interrelated pathways, which
are influenced by factors arising from within and
outside food systems, including social, economic
CONCLUSION
and environmental determinants of health. With less than a decade to 2030, the world
is not on track to ending world hunger and
Investments in social protection systems malnutrition; and in the case of world hunger,
have ser ved as powerful instruments for we are moving in the wrong direction.
strengthening people’s access to nutritious This report has shown that economic downturns
food, including during the COV ID-19 pandemic. as a consequence of COV ID-19 containment
Importantly, social protection is more than a measures all over the world have contributed to
short-term response to acute situations of food one of the largest increases in world hunger in

| xxii |
decades, which has affected almost all low- and The coherence in policies and actions to
middle-income countries, and can reverse gains transform food systems, and among systems, as
made in nutrition. The COV ID-19 pandemic well as the cross-cutting accelerators play a key
is just the tip of the iceberg, more alarmingly, role in maximizing the benefits and minimizing
the pandemic has exposed the v ulnerabilities negative consequences of transformation
forming in our food systems over recent years through these six pathways. That is why policy
as a result of major drivers such as conf lict, coherence, understood as a situation where
climate variabilit y and extremes, and economic the implementation of policies in one area
slowdowns and downturns. These major drivers does not undermine others (and where policies
are increasingly occurring simultaneously even reinforce each other where feasible),
in countries, with interactions that seriously will be critical to building transformative
undermine food securit y and nutrition. multisectoral portfolios. Systems approaches
are needed for building coherent portfolios
The UN Food Systems Summit 2021 will bring of policies, investments and legislation that
forward a series of concrete actions that people become win-win solutions; these include
from all over the world can take to support a territorial approaches, ecosystems approaches,
transformation of the world’s food systems. Indigenous Peoples’ food systems approaches
This report has identified six transformation and inter ventions that systemically address
pathways that, alone or frequently in protracted crisis conditions. n
combination, depending on context, are needed
for greater resilience to specifically address the
negative impacts of the major drivers behind
the recent rise in hunger and slowing progress
to reduce malnutrition in all its forms, while
ensuring that ever yone can afford a healthy diet.

| xxiii |
INDIA
A fruit vendor weighing
mangoes using a
manual scale during the
COVID-19 pandemic.
©Mnjpkulkarni |
Dreamstime.com
CHAPTER 1
INTRODUCTION

S ince well before the COV ID-19

pandemic, several major drivers have
put the world off track to ending
world hunger and malnutrition in all its forms
by 2030. Now, the COV ID-19 pandemic and
related containment measures have made
has slowed significantly, and adult overweight
and obesit y continue to increase in rich and
poor countries alike.

What have we learned from past editions?

it significantly more challenging to achieve How did the world get to this critical
this goal. But they have also highlighted the point? – is one of the key questions posed
need for deeper ref lection on how to better in this year’s report. In answering it, the
address the major drivers that are resulting in report draws on the analyses of the past
the global food insecurit y and malnutrition four editions, which have produced a vast,
situation we are experiencing right now. evidence-based body of knowledge of the
major drivers behind the recent changes in
In 2014, the long decline in world hunger that food securit y and nutrition. This is updated
had beg un in 2005 came to a halt. The number with new data to feed into a broader analysis
of people experiencing undernourishment of how these drivers interact, allowing
began to slowly increase until, in 2020, the for a holistic view of their combined
world witnessed an unprecedented setback effects both on each other and on food
in its hunger eradication efforts, as the latest systems. The knowledge accumulated from
estimates in this year’s report indicate. these past editions is grounded in evidence.
Moreover, progress in reducing child stunting The development and monitoring of food

|1|
CHAPTER 1 INTRODUCTION

securit y and nutrition indicators have made nutrition in 2020. This year’s report confirms
it possible to make clear diagnoses at global, this evidence, presenting the first global
regional and countr y levels. a Furthermore, assessment of food insecurit y and malnutrition
analysis of these indicators has allowed us for 2020, which makes use of the most recent
to statistically associate major drivers with data collected around the world in this
recent setbacks in ending world hunger challenging year.
and malnutrition in all its forms by 2030.
This has been fundamental in helping us to There are, of course, a myriad of other drivers
understand entr y points for policy to address of food insecurit y and malnutrition; b moreover,
these drivers. drivers can also be outcomes of other drivers. c
This report, however, focuses on the drivers
Three of the major drivers behind the recent outlined in Box 1, and how they interact to
changes in food securit y and nutrition affect food securit y and nutrition. These are
identified in the past four editions are the major drivers behind the recent global rise
conf lict, climate variabilit y and extremes, and in hunger and slowing progress in reducing
economic slowdowns and downturns, which malnutrition in all its forms. Unless they are
are exacerbated by the underlying causes of addressed more boldly, they will continue to
povert y and ver y high and persistent levels drive obser ved trends in food securit y and
of inequalit y (for example in terms of income, nutrition for many years to come.
productive capacit y, assets, technolog y,
education and health) ( Box 1). The selected major drivers as well as the
underlying causes of povert y and inequalit y
In addition, millions of people around are occurring throughout the world in many
the world suffer from food insecurit y and countries, often at the same time, creating
different forms of malnutrition because compounding effects that are analysed in
they cannot afford the cost of healthy diets. this report. The COV ID-19 pandemic and
Unaffordabilit y of healthy diets is the the measures to contain it have of course led
result of myriad factors driving up the cost to an unprecedented economic downturn.
of nutritious food and reducing people’s Moreover, some parts of the world also
incomes. This fourth driver is associated with continue to experience conf lict, while, globally,
increasing food insecurit y and all forms of climate-related events remain an ever-present
malnutrition, including stunting, wasting, threat. Particularly worr ying is that, as we
micronutrient deficiencies, overweight and show in this report, several of the countries
obesit y, and non-communicable diseases most affected by the COV ID-19 pandemic
(NCDs). Last year, this report also presented a were already struggling with high levels of
preliminar y assessment that warned us about undernourishment and different forms of
the potentially unprecedented effects of the malnutrition before the pandemic. »
COV ID-19 pandemic on food securit y and

a  In the 2017 edition of this report, FAO’s traditional indicator of the

extent of hunger, the prevalence of undernourishment (PoU) – also b  Other important drivers of food insecurity and malnutrition are
an indicator for monitoring SDG Target 2.1 – began to be not considered in this report. Many of these are more localized,
complemented by the Prevalence of Severe Food Insecurity, which is affecting specific regions or countries, or occur infrequently or with
estimated based on data collected using the Food Insecurity limited long-term effects on world hunger and malnutrition. These
Experience Scale (FIES). Importantly, as the report began to monitor include food price hikes, locust outbreaks and localized disease
progress not only towards the target of ending hunger (SDG Target outbreaks, among others. Human population growth patterns are
2.1), but also that of ending all forms of malnutrition (SDG Target 2.2), drivers at a broader intergenerational scale. There are also more
indicators for all forms of malnutrition also began to be monitored specific global drivers of malnutrition, for example, poor sanitation,
and analysed. The SDG indicators of malnutrition were health services and childcare feeding practices. But these are more
complemented with indicators that monitor other related targets systematically covered in other global nutrition reports, such as the
endorsed by the World Health Assembly in 2012. Subsequently, the Global Nutrition Report.
2019 edition of this report introduced a second indicator for c  All drivers can also be seen as outcomes of other drivers. For
monitoring SDG Target 2.1: the Prevalence of Moderate or Severe example, economic slowdowns and downturns can be driven by a global
Food Insecurity, also based on the FIES. Another innovation was financial crisis or global health pandemic, and the unaffordability of
made a year later, in the 2020 edition, with the introduction of healthy diets can be driven by income changes and supply and demand
indicators of the cost and unaffordability of healthy diets. factors that affect food prices.

|2|
 THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2021

BOX 1 MAJOR DRIVERS AND UNDERLYING FACTORS CHALLENGING FOOD SECURITY AND NUTRITION IN
THE WORLD: A SYNTHESIS FROM THE PREVIOUS FOUR EDITIONS OF THIS REPORT

CONFLICT (2017 edition) is a major threat to food security and nutrition

CONFLICT
and the leading cause of global food crises. Marked increases in the
number and complexity of conflicts in the last ten years have eroded
gains in food security and nutrition, leading several countries to the brink
of famine. Internal conflicts have surpassed the number of interstate
conflicts, but with a significant rise in internationalized internal conflicts.
©FAO/Cengiz Yar

More than half of the people who are undernourished and almost
80 percent of stunted children live in countries struggling with some form
of conflict, violence or fragility.1,2

CLIMATE VARIABILITY AND EXTREMES (2018 edition) are a key driver

CLIMATE VARIABILITY
AND EXTREMES behind the recent rise in global hunger, one of the leading causes of
severe food crises, and a contributing factor to the alarming levels of
malnutrition seen in recent years. Increasing climate variability and
extremes, linked to climate change, are negatively affecting all dimensions
©FAO/J. Thompson

of food security and nutrition. Hunger is significantly worse in countries

with agri-food systems highly sensitive to rainfall and temperature
variability and extremes, and where a high proportion of the population
depends on agriculture for livelihoods. Alarmingly, countries are
increasingly exposed to multiple types of climate extremes.3,4

ECONOMIC SLOWDOWNS AND DOWNTURNS (2019 edition) are a key

ECONOMIC SLOWDOWNS
AND DOWNTURNS driver behind rises in hunger and food insecurity. They hinder progress
towards elimination of malnutrition in all its forms, irrespective of whether
they are driven by market swings, trade wars, political unrest or a global
©FAO/Giuseppe Bizzarri

pandemic, such as that driven by COVID-19. Most countries where hunger

has increased have experienced these economic slowdown and downturn
episodes. Economic slowdowns and downturns can also result in people
purchasing cheaper, less nutritious foods – contributing to poor nutritional
quality of diets. These episodes are statistically related to rising food
insecurity as well.5,6

The UNAFFORDABILITY OF HEALTHY DIETS (2020 edition of this report)

UNAFFORDABILITY
OF HEALTHY DIETS is associated with increasing food insecurity and all forms of malnutrition,
including stunting, wasting, overweight and obesity. Several factors are
©FAO/Vyacheslav Oseledko

driving the cost of nutritious foods throughout food systems, in the realms
of food production, food supply chains, food environments, as well as
consumer demand and the political economy of food. These, combined
with low incomes, explain why around three billion people cannot afford
even the cheapest healthy diet, one that includes foods from several
groups and has greater diversity within food groups.7,8,9

|3|
 CHAPTER 1 INTRODUCTION

BOX 1 (CONTINUED)

UNDERLYING CAUSES OF POVERTY AND INEQUALITY

POVERTY AND INEQUALITY (2019 and 2020 in particular increases the likelihood of food
editions) are underlying structural causes of insecurity – especially for socially excluded and
food insecurity and malnutrition in all its forms, marginalized groups – and undercuts the positive
which amplify the negative impacts of the global effect of any economic growth on individual food
drivers above. Poverty negatively impacts on security. Structural vulnerabilities, including
the nutrition quality of diets. Unsurprisingly, inequalities related to gender, youth, ethnicity,
healthy diets are unaffordable for the poor in Indigenous Peoples and people with disabilities,
every region of the world.7,8,9 Food insecurity and tend to exacerbate poverty, food insecurity
malnutrition in all its forms are made worse by and malnutrition during periods of economic
high and persistent levels of inequality – in terms slowdowns and downturns, or following conflict
of income, productive assets and basic services and climate-related disasters.5,6 Furthermore,
(e.g. health, education), as well as access to these levels of inequality are being accelerated by
information and technology (e.g. digital divide) the COVID-19 pandemic.7,8,9
and, more generally, wealth. Income inequality

» From synthesis to the way forward drivers are negatively affecting food securit y
and nutrition through their impact on food
The COV ID-19 pandemic was a powerful systems and the circular interconnected
wake-up call that exposed the f leeting nature impacts of these drivers on other systems,
of our progress on food securit y and nutrition. including environmental and health systems,
At the same time, however, it has provided among others.
us with the opportunit y to re-evaluate how
we tackle the major drivers of hunger and Thus, food systems will not become a powerful
malnutrition and refocus our efforts to force contributing to ending hunger and
build forward better. To make the most of malnutrition in all its forms in the world,
this opportunit y, though, requires that we unless they are transformed with strengthened
understand the interconnected nature of these resilience to the major drivers identified in
drivers through a food systems lens and that the four past editions of this report and are
we inform our actions on the evidence that incentivized to provide affordable healthy
emerges from doing so. diets sustainably and inclusively. While the
calls for broader food systems transformation
As we further elaborate in this report, conf lict, for efficiency, resilience, environmental
climate variabilit y and extremes, economic sustainabilit y and inclusivit y are currently
slowdowns and downturns, and povert y and the centre of global attention, this report
inequalit y are external forces acting on food identifies the transformation pathways needed
systems, while the cost and affordabilit y to specifically address the major drivers behind
of diets is an internal force acting within the recent rise in hunger and slowing progress
food systems. These external and internal towards reducing malnutrition in all its forms.

|4|
 THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2021

This year’s report comprises three main systems lens. This is followed by a chapter
chapters. It starts with a description of the that offers an in-depth look at how to
latest updates and trends in food securit y move from silo solutions to integrated food
and nutrition, and offers some indication systems solutions that specifically address
of what hunger would look like by 2030, the challenges posed by the major drivers,
in a scenario further complicated by the highlighting also the t y pes of portfolios of
enduring effects of the COV ID-19 pandemic. policies, investments and legislation required
The next chapter provides a synthesis of to transform food systems for food securit y,
understanding and empirical analysis of improved nutrition and affordable healthy
the major drivers behind these trends, diets for all. The three chapters are followed
alone and in combination, through a food by an overall conclusion. n

|5|
ETHIOPIA
A local woman collects
yield after her crops
have been heavily
affected by invading
locust swarms.
©FAO/Petterik Wiggers
CHAPTER 2
FOOD SECURITY
AND NUTRITION
AROUND THE
WORLD

T his chapter presents the first global

assessment of food insecurit y and
malnutrition for 2020, the year the
COV ID-19 pandemic spread rapidly across the
globe. Prior to the pandemic, progress was
already stalled towards meeting SDG Targets 2.1
security indicators in Section 2.1 and the nutrition
indicators in Section 2.2. First presented in The
State of Food Security and Nutrition in the World
2020, these indicators are systematically updated
and disseminated annually in this report.

and 2.2: ending hunger and ensuring access to Section 2.2 presents the latest available
safe, nutritious and sufficient food for all people evidence on the state of nutrition and progress
all year round; and eradicating all forms of towards the global nutrition targets defined
malnutrition. While the pandemic has caused by the World Health Assembly in 2012 and the
major setbacks, there is much to be learned Sustainable Development Agenda (SDG 2.2).
from the v ulnerabilities and inequalities it laid Updated estimates for four of the nutrition
bare. If taken to heart, these new insights and indicators are provided.
wisdom can help get the world back on track
towards achievement of SDG Targets 2.1 and Section 2.3 looks ahead to 2030 with new
2.2. This global assessment provides a clear projections regarding the state of food securit y
diagnostic to put in place the policies needed. and nutrition in a scenario further complicated by
the COV ID-19 pandemic. Estimates of what the
Section 2.1 presents a comprehensive assessment prevalence of undernourishment may be in 2030
of the state of food security and progress towards are provided, based on a general equilibrium
achieving the hunger and food insecurity model that derives trajectories of food supply,
targets (SDG 2.1). It includes global, regional economic growth, povert y rates and real price
and subregional assessments for 2020 based of food. While projections for the nutrition
on the most recent data collected around the indicators do not take the COV ID-19 pandemic
world. Also included are new estimates of the into account, modelled projections of its potential
cost and affordability of healthy diets, which impact on the prevalence of child undernutrition
provide an important link between the food (stunting and wasting) are presented. n

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CHAPTER 2 FOOD SECURITY AND NUTRITION AROUND THE WORLD

2.1 è  The sharpest increases in moderate or severe food

FOOD SECURITY insecurity in 2020 occurred in Latin America and the

Caribbean and in Africa. In Northern America and

INDICATORS – LATEST Europe, food insecurity increased for the first time since
the beginning of FIES data collection in 2014.

UPDATES AND è  Of the 2.37 billion people facing moderate or

PROGRESS TOWARDS severe food insecurity, half (1.2 billion) are found in
Asia, one-third (799 million) in Africa, and 11 percent

ENDING HUNGER (267 million) in Latin America and the Caribbean.

AND ENSURING FOOD è  Close to 12 percent of the global population was

severely food insecure in 2020, representing 928 million

SECURITY people – 148 million more than in 2019.

è  At the global level, the gender gap in the prevalence

KEY MESSAGES of moderate or severe food insecurity has grown even
larger in the year of the COVID-19 pandemic, with the
è  World hunger increased in 2020 under the prevalence of moderate or severe food insecurity being
shadow of the COVID-19 pandemic. After remaining 10 percent higher among women than men in 2020,
virtually unchanged for five years, the prevalence of compared with 6 percent in 2019.
undernourishment (PoU) increased from 8.4 to around
9.9 percent in just one year, heightening the challenge è  The high cost of healthy diets coupled with
of achieving the Zero Hunger target by 2030. persistent high levels of income inequality put healthy
diets out of reach for around 3 billion people, especially
è  It is projected that between 720 and 811 million the poor, in every region of the world in 2019 – slightly
people in the world faced hunger in 2020. Considering the less than in 2017.
middle of the projected range (768 million), around
118 million more people were facing hunger in 2020 than è  Notably, only Africa and Latin America show an
in 2019 – or as many as 161 million more, considering the increase in the unaffordability of heathy diets between
upper bound of the projected range. 2017 and 2019, but it is likely that increases will be seen
in most regions in 2020 due to the COVID-19 pandemic.
è  Hunger affects 21.0 percent of the population
in Africa, compared with 9.0 percent in Asia and
9.1 percent in Latin America and the Caribbean. Grappling with uncertainty in the face of
In terms of numbers, more than half of the world’s
undernourished are found in Asia (418 million) and more the COVID-19 pandemic
than one-third in Africa (282 million). One thing is certain: 2020 was a year of great
economic and human losses, provoked by
è  Compared with 2019, about 46 million more people the onset of a global pandemic that deprived
in Africa, 57 million more in Asia, and about 14 million millions of people of their health, lives and
more in Latin America and the Caribbean were affected livelihoods throughout the world. However, the
by hunger in 2020. physical distancing measures taken to contain
the spread of the pandemic also resulted in the
è  While the global prevalence of moderate or severe disruption of data collection activities around
food insecurity (measured using the Food Insecurity the world, posing data and methodological
Experience Scale) has been slowly on the rise since challenges for the assessment of the state of
2014, the estimated increase in 2020 was equal to that food securit y in 2020. As a result, the task
of the previous five years combined. Nearly one in three of estimating how many people were thrust
people in the world (2.37 billion) did not have access into hunger and food insecurit y globally is
to adequate food in 2020 – an increase of almost fraught with more uncertaint y this year than in
320 million people in just one year. past years. »

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 THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2021

BOX 2 UPDATES TO THE PREVALENCE OF UNDERNOURISHMENT AND METHODOLOGY

FOR THE 2020 NOWCAST

The PoU series is revised annually prior to the lack of official data or projections of the level and
publication of each new edition of The State of Food inequality in food consumption at country level in 2020,
Security and Nutrition in the World. This is done to take different methods were developed this year to nowcast
into account any new information that FAO has received the 2020 values of DEC and CV|y. The following specific
since the release of the previous edition. As this process data and procedures were used to project these two
usually implies backward revisions of the entire PoU parameters for 2020:
series, readers are warned to refrain from comparing
series across different editions of these reports. „ Current estimates of per capita, average dietary
Readers should always refer to the most current edition energy supply (DES) in 2020, compiled on the basis of
of the report, including for values in past years. the short-run market outlook exercises conducted by
FAO to inform the World Food Situation,15 were used
ROUTINE REVISIONS to nowcast the 2020 value of DEC for each country,
The new data used to conduct the routine revisions/ starting from the last available year in the FBS series.
updates to the PoU series are reflected in new series „ FIES data collected by FAO in 2020 (see section on
of the three underlying parameters that inform the SDG 2.1.2 below) were used to nowcast the values
PoU: the average dietary energy consumption (DEC), of CV|y up to 2020. As in past editions of this report,
the inequality in access to dietary energy (CV) and the FIES data collected by FAO from 2014 to 2019
minimum dietary energy requirement (MDER) (see were used to project the changes in the CV|y from
Annex 1B for details on the methodology). For this 2015 (or from the year of the last food consumption
edition of the report, updated Food Balance Sheet (FBS) survey) up to 2019, based on a smoothed (three-year
series for all countries up to 2018 and for 56 priority moving average) trend in severe food insecurity.
countries up to 2019 were used to revise the series of However, recognizing that reliance on three-year
the parameter referring to the average value of DEC moving averages would very likely underestimate
at country level. More specifically, updated data on the actual change in CV|y from 2019 to 2020, the
production and trade was used, as a result of increased 2020 nowcast was instead based on the change
interaction with national data providers, together with estimated by considering the actual, unsmoothed
new data of stocks coming from external sources such as change in the prevalence of severe food insecurity
specialized commodity institutions. Furthermore, a new from 2019 to 2020. In addition, recognizing that
methodological approach to treat stocks and non-food the COVID-19 pandemic has created additional
industrial utilization was implemented. In the same way, constraints that may have exacerbated an overall
food consumption data from household consumption inequality in the ability of people to access food,
and expenditure surveys from 17 countries and various an additional component was considered in the
years that became available to FAO since last year* were estimates of the total CV of the distribution of dietary
used to revise the parameter referring to inequality in energy consumption in 2020 that is independent
access to dietary energy due to income (CV|y). of both monetary incomes and dietary energy
requirements. In practice, the range of values for
NOWCAST OF THE PoU IN 2020 the nowcast 2020 CV|y is obtained by parametrically
The exceptional nature of the COVID-19 pandemic made varying the contribution of the change in CV to
it particularly challenging to produce reliable estimates the change in PoU estimates from one-third (as
for 2020, a year like no other in recent history. For this modelled in the past), which provides the lower
reason, a range is presented for the value of the 2020 bound, to 100 percent of the observed change in
global PoU. severe food insecurity, which provides the upper
The uniqueness of the 2020 situation makes the bound. Further details and the ranges of the PoU at
time series-based forecasting methods used in past the regional and subregional levels can be found
editions of this report inappropriate. Considering the in Annex 2.

* Afghanistan (2019), Armenia (2018), Bolivia (Plurinational State of) (2014 and 2018), Botswana (2017), Brazil (2018), Burkina Faso (2018), Ethiopia
(2016), Kiribati (2020), Malawi (2017), Mongolia (2016 and 2018), Namibia (2016), Nigeria (2013, 2016 and 2019), Pakistan (2018), Rwanda (2015),
Samoa (2018), Solomon Islands (2013), Uganda (2017).

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 CHAPTER 2 FOOD SECURITY AND NUTRITION AROUND THE WORLD

FIGURE 1 THE NUMBER OF UNDERNOURISHED PEOPLE IN THE WORLD CONTINUED TO RISE IN 2020.
BETWEEN 720 AND 811 MILLION PEOPLE IN THE WORLD FACED HUNGER IN 2020. CONSIDERING THE
MIDDLE OF THE PROJECTED RANGE (768 MILLION), 118 MILLION MORE PEOPLE WERE FACING HUNGER IN
2020 THAN IN 2019 – OR AS MANY AS 161 MILLION, CONSIDERING THE UPPER BOUND OF THE RANGE

1 000
19
900
811.0
17 800
810.7 768.0
720.4 700
15
650.3 600
606.9 615.1
PERCENTAGE

MILLIONS
13
500
12.4%
11 10.4% 400

9.9%
300
9
9.2%
8.3% 8.4% 200
8.3%
7
100

5 0
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020*

Prevalence of undernourishment (percentage, left axis) Number of undernourished (millions, right axis)

NOTES: * Projected values for 2020 in the figure are illustrated by dotted lines. Shaded areas show lower and upper bounds of the estimated range.
SOURCE: FAO.

» In this edition of the report, the nowcast In contrast, the 2020 assessments of the
(prediction of the recent past) for 2020 of prevalence of moderate or severe food insecurit y
the global prevalence of undernourishment based on the Food Insecurit y Experience Scale
(SDG Indicator 2.1.1) is presented as a range to (SDG Indicator 2.1.2), also presented in this
ref lect the added uncertaint y around the hunger section, are informed mainly by sur vey data
estimates induced by the unprecedented shock collected by FAO through the Gallup © World
of the COV ID-19 pandemic. It is important Poll (GWP) in over 140 different countries, and
to note that the 2020 PoU estimates are not conducted mostly via telephone inter views due to
based on data reported by countries for 2020. the restrictions imposed by the pandemic ( Box 3).
Rather, they are derived by nowcasting the
parameters used in the estimation of the PoU,
using the best data available to FAO regarding
SDG Indicator 2.1.1
the food supply and reasonable assumptions on Prevalence of undernourishment (PoU)
the extent of inequalit y in access to food ( Box 2). There is no doubt that the number of people
in the world affected by hunger continued
to increase in 2020 under the shadow of the

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 THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2021

TABLE 1 PREVALENCE OF UNDERNOURISHMENT (PoU) IN THE WORLD, 2005–2020

  Prevalence of undernourishment (%)
2005 2010 2015 2016 2017 2018 2019 2020*
WORLD 12.4 9.2 8.3 8.3 8.1 8.3 8.4 9.9
AFRICA 21.3 18.0 16.9 17.5 17.1 17.8 18.0 21.0
Northern Africa 8.5 7.3 6.1 6.2 6.5 6.4 6.4 7.1
Sub-Saharan Africa 24.6 20.6 19.4 20.1 19.5 20.4 20.6 24.1
Eastern Africa 33.0 28.4 24.8 25.6 24.9 25.9 25.6 28.1
Middle Africa 36.8 28.9 28.7 29.6 28.4 29.4 30.3 31.8
Southern Africa 5.0 6.2 7.5 7.9 7.3 7.6 7.6 10.1
Western Africa 14.2 11.3 11.5 11.9 11.8 12.5 12.9 18.7
ASIA 13.9 9.5 8.3 8.0 7.8 7.8 7.9 9.0
Central Asia 10.6 4.4 2.9 3.2 3.2 3.1 3.0 3.4
Eastern Asia 6.8 <2.5 <2.5 <2.5 <2.5 <2.5 <2.5 <2.5
South-eastern Asia 17.3 11.6 8.3 7.8 7.4 6.9 7.0 7.3
Southern Asia 20.5 15.6 14.1 13.2 13.0 13.1 13.3 15.8
Western Asia 9.0 9.1 14.3 15.0 14.5 14.4 14.4 15.1
Western Asia and
8.8 8.2 10.5 10.9 10.7 10.6 10.7 11.3
Northern Africa
LATIN AMERICA AND
9.3 6.9 5.8 6.8 6.6 6.8 7.1 9.1
THE CARIBBEAN
Caribbean 19.2 15.9 15.2 15.4 15.3 16.1 15.8 16.1
Latin America 8.6 6.2 5.1 6.2 6.0 6.1 6.5 8.6
Central America 8.0 7.4 7.5 8.1 7.9 8.0 8.1 10.6
South America 8.8 5.7 4.2 5.4 5.2 5.4 5.8 7.8
OCEANIA 6.9 5.3 6.1 6.2 6.3 6.2 6.2 6.2
NORTHERN AMERICA
<2.5 <2.5 <2.5 <2.5 <2.5 <2.5 <2.5 <2.5
AND EUROPE
NOTES: * Projected values based on the middle of the projected range. The full ranges of the projected 2020 values can be found in Annex 2.
For country compositions of each regional/subregional aggregate, see Notes on geographic regions in statistical tables inside the back cover.
SOURCE: FAO.

COV ID-19 pandemic. The long decline in faced hunger in 2020. Considering the middle
undernourishment from 2005 to 2014 had already of the projected range (768 million), 118 million
come to a halt, as described in previous editions more people were facing hunger in 2020 than in
of The State of Food Security and Nutrition in the 2019 ( Figure 1), with estimates ranging from 70 to
World. After remaining virtually unchanged from 161 million. The 2020 estimates presented in
2014 to 2019, the PoU increased from 8.4 percent Tables 1 and 2 are based on the middle of the projected
to around 9.9 percent between 2019 and 2020 range. The full ranges can be found in Annex 2.
( Figure 1), heightening the challenge of achieving
the Zero Hunger target by 2030. The 2020 While the COV ID-19 pandemic surely was a
estimate ranges from 9.2 to 10.4 percent, contributing factor, changes obser ved from 2019
depending on the assumptions made to ref lect to 2020 cannot be attributed only to the pandemic
the uncertainties around the assessment ( Box 2). given the many other factors at play, as described
in Chapter 3. Notwithstanding, the increase
In terms of population, it is estimated that in hunger in 2020 is consistent with existing
between 720 and 811 million people in the world evidence of the economic hardships induced by

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CHAPTER 2 FOOD SECURITY AND NUTRITION AROUND THE WORLD

TABLE 2 NUMBER OF UNDERNOURISHED PEOPLE IN THE WORLD, 2005–2020

  Number of undernourished (millions)
2005 2010 2015 2016 2017 2018 2019 2020*
WORLD 810.7 636.8 615.1 619.6 615.0 633.4 650.3 768.0
AFRICA 195.0 187.4 199.7 212.0 212.3 227.1 235.3 281.6
Northern Africa 15.8 14.8 13.6 14.2 15.0 15.1 15.5 17.4
Sub-Saharan Africa 179.2 172.6 186.1 197.8 197.3 212.0 219.8 264.2
Eastern Africa 97.3 96.3 96.5 102.5 102.3 109.6 111.3 125.1
Middle Africa 41.2 38.0 44.3 47.1 46.5 49.7 52.9 57.1
Southern Africa 2.7 3.6 4.7 5.1 4.7 5.0 5.1 6.8
Western Africa 38.0 34.7 40.5 43.2 43.8 47.8 50.6 75.2
ASIA 553.6 400.1 369.9 356.1 352.1 354.6 361.3 418.0
Central Asia 6.2 2.7 2.0 2.2 2.2 2.2 2.2 2.6
Eastern Asia 106.0 n.r. n.r. n.r. n.r. n.r. n.r. n.r.
South-eastern Asia 97.0 69.0 52.7 49.9 48.1 45.3 46.0 48.8
Southern Asia 325.9 267.9 256.9 243.8 243.8 247.6 255.2 305.7
Western Asia 18.5 21.1 37.0 39.3 38.6 38.9 39.8 42.3
Western Asia and
34.4 35.9 50.5 53.6 53.7 54.0 55.3 59.7
Northern Africa
LATIN AMERICA AND
51.9 40.7 36.4 42.9 42.2 43.7 45.9 59.7
THE CARIBBEAN
Caribbean 7.6 6.5 6.5 6.6 6.6 6.9 6.8 7.0
Latin America 44.3 34.2 29.9 36.3 35.7 36.7 39.1 52.7
Central America 11.7 11.7 12.7 13.9 13.7 14.0 14.4 19.0
South America 32.7 22.5 17.2 22.4 22.0 22.7 24.7 33.7
OCEANIA 2.3 1.9 2.4 2.5 2.6 2.6 2.6 2.7
NORTHERN AMERICA
n.r. n.r. n.r. n.r. n.r. n.r. n.r. n.r.
AND EUROPE
NOTES: * Projected values based on the middle of the projected range. The full ranges of the projected 2020 values can be found in Annex 2.
n.r. = not reported, as the prevalence is less than 2.5 percent. Regional totals may differ from the sum of subregions, due to rounding and non-reported
values. For country compositions of each regional/subregional aggregate, see Notes on geographic regions in statistical tables inside the back cover.
SOURCE: FAO.

the COV ID-19 crisis that have likely aggravated coverage, generosit y and duration of the social
inequalities in access to food. The World Bank protection responses varied across regions and
estimates that the COV ID-19 pandemic pushed countries, as did their effectiveness in mitigating
an additional 119 million to 124 million people the impacts of the pandemic on povert y.
into extreme povert y in 2020. 10 Sur veys by With some exceptions, data suggest that coverage
the World Bank and others reveal staggering has been relatively short-lived. On average,
proportions of both urban and rural households responses lasted just over three months, and
that reported a decrease in their income after the roughly 40 percent of programmes consisted of
beginning of the COV ID-19 crisis. 11,12 one-time payments. 13,14

This is despite an unprecedented response The numbers show enduring and troubling
by countries worldwide to implement social regional inequalities. About one in five people
protection measures. However, the speed, (21 percent of the population) was facing

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 THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2021

FIGURE 2 MORE THAN HALF (418 MILLION) OF THE PEOPLE IN THE WORLD AFFECTED BY HUNGER IN 2020
WERE IN ASIA AND MORE THAN ONE-THIRD (282 MILLION) IN AFRICA

LATIN AMERICA
AND THE CARIBBEAN
ASIA 60 million
418 million

NOT UNDERNOURISHED UNDERNOURISHED

7 027 million 768 million
OCEANIA
3 million
AFRICA
282 million

NORTHERN AMERICA
AND EUROPE
n.r.

NOTES: Number of undernourished in millions. Projected values based on the middle of the projected range. The full ranges of the projected 2020 values
can be found in Annex 2. n.r. = not reported, as the prevalence is less than 2.5 percent.
SOURCE: FAO.

hunger in Africa in 2020 – more than double the Looking more closely at subreg ional
proportion of any other region. This represents differences ( Tables 1 and 2), in Africa, the
an increase of 3 percentage points in one year. proportion of the population in Northern
This is followed by Latin America and the A frica affected by hunger in 2020 (7.1 percent)
Caribbean (9.1 percent) and Asia (9.0 percent), is much smaller compared w ith almost all
with increases of 2.0 and 1.1 percentage points, subreg ions of sub-Saharan A frica, except
respectively, between 2019 and 2020 ( Table 1). for Southern A frica (10.1 percent). In the
other subreg ions, the prevalence ranges from
While the regional prevalence estimates reveal 18.7 percent in Western A frica to 31.8 percent
the depth of hunger in each region, translating in Middle A frica. The largest number of
them into numbers of people gives a sense undernourished people live in Eastern A frica –
of where most of the people facing hunger in more than 125 million.
the world live ( Table 2). Of the total number of
undernourished people in 2020 (768 million), In Asia, the PoU in 2020 ranges from below
more than half (418 million) live in Asia and 2.5 percent in Eastern Asia to a high of
more than one-third (282 million) in Africa, 15.8 percent in Southern Asia, which also
while Latin America and the Caribbean accounts has the highest number of undernourished
for about 8 percent (60 million) ( Figure 2). people – nearly 306 million. The prevalence
Compared with 2019, 46 million more people of undernourishment in Western Asia
in Africa, almost 57 million more in Asia, and (15.1 percent) is nearly on par w ith that of
about 14 million more in Latin America and the Southern Asia.
Caribbean were affected by hunger in 2020.

| 13 |
 CHAPTER 2 FOOD SECURITY AND NUTRITION AROUND THE WORLD

FIGURE 3 ALL SUBREGIONS OF AFRICA AND LATIN AMERICA AND THE CARIBBEAN, AND MOST
SUBREGIONS OF ASIA, SHOW INCREASES IN THE PREVALENCE OF UNDERNOURISHMENT FROM 2019 TO
2020, WITH THE SHARPEST INCREASE IN WESTERN AFRICA

LATIN AMERICA
WORLD AND REGIONS AFRICA ASIA* AND THE CARIBBEAN
35

30

25

20
PERCENTAGE

15

10

0
2015 2019 2020** 2015 2019 2020** 2015 2019 2020** 2015 2019 2020**

World Africa Asia Latin America and the Caribbean

Africa Eastern Africa Central Asia Caribbean
Asia Middle Africa Southern Asia Central America
Latin America Northern Africa South-eastern Asia South America
and the Caribbean Southern Africa Western Asia
Western Africa

NOTES: * Eastern Asia is not shown because the PoU has been consistently below 2.5 percent since 2010. ** Projected values based on the middle of the
projected range. The full ranges of the projected 2020 values can be found in Annex 2.
SOURCE: FAO.

In Latin America and the Caribbean, the estimates access by the end of 2020 (see Chapter 3).
point to a PoU of 16.1 percent in the Caribbean, The sharpest increase in undernourishment was
compared with 10.6 in Central America and 7.8 in in Western Africa, of 5.8 percentage points in
South America. just one year, corresponding to 24.6 million more
people. If confirmed, it would be further evidence
As illustrated in Figure 3, all subregions of Africa of the trends noted by FAO and W FP in 2020 for
and Latin America and the Caribbean, and most several countries in this subregion, 16 signalling
subregions of Asia, show increases in the PoU the need for heightened attention as the situation
from 2019 to 2020, likely ref lecting the way the evolves to prevent further deterioration.
COV ID-19 pandemic exacerbated pre-existing
drivers of food insecurit y and impacted food

| 14 |
 THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2021

SDG Indicator 2.1.2 as much as in the previous five years combined,

Prevalence of moderate or severe food to 30.4 percent. Thus, nearly one in three people
insecurity in the population, based on in the world did not have access to adequate food
the FIES in 2020 – an increase of 320 million people in just
one year, from 2.05 to 2.37 billion ( Table 4).
SDG Target 2.1 challenges the world to go
beyond just ending hunger. For optimal health Nearly 40 percent of those people – 11.9 percent
and well-being, it is imperative to ensure of the global population, or almost 928 million –
access for all to safe, nutritious and sufficient faced food insecurit y at severe levels, indicating
food all year round. SDG Indicator 2.1.2 – the they had run out of food and, at worst, gone a day
prevalence of moderate or severe food insecurit y without eating. The increase in the prevalence
in the population, based on the Food Insecurit y of severe food insecurit y from 2019 to 2020 was
Experience Scale (FIES) – has been specifically also equal to the total increase from 2014 to 2019;
chosen to monitor progress towards ensuring close to 148 million more people were severely
access to adequate food for all. food insecure in 2020.

The estimates of the prevalence of food Although severe food insecurit y normally
insecurit y at severe levels only provide a correlates with the PoU, it is worth noting that
supplementar y lens for monitoring hunger the increase in the number of severely food
to complement the PoU. Although obtained insecure people from 2019 to 2020 is somewhat
using ver y different data and methods, greater than the increase in the estimated
they are expected to correlate with the PoU number of undernourished presented in the
across populations. This is because people preceding section, based on the middle range
experiencing severe food insecurit y are estimate in Table 2. This is likely due mainly
unlikely to be able to acquire enough food to the ver y different nature of the indicators.
to continuously fulfil their dietar y energ y As explained, the FIES data were collected
requirements, which is the concept of chronic directly from respondents in sur veys, with data
undernourishment measured by the PoU. 5,7 collection beginning late in 2020 and extending
into early 2021 when the impacts of
The food insecurit y estimates in this report are the COV ID-19 pandemic were already more
based mainly on FIES data collected by FAO apparent. The 2020 PoU estimates, on the
through the GWP ( Box 3). However, a growing other hand, are nowcasts based on data on
number of countries are adopting the FIES as a food availabilit y and access to food that
standard food securit y assessment tool, making may not yet ref lect the full impact of the
FIES data increasingly available from official COV ID-19 pandemic.
national sources. This year, FIES or equivalent
experience-based food securit y data collected The increases in moderate or severe food
by national institutions were used for more insecurit y from 2019 to 2020 were sharpest in
than 40 countries, covering approximately a Latin America and the Caribbean (9 percentage
quarter of the world population (see Annex 1B). points) and Africa (5.4 percentage points),
In addition, this year’s report is informed by FIES compared with a 3.1-point increase in Asia ( Table 3
data collected by FAO in 2020 for a preliminar y and Figure 4). However, Africa still has the highest
assessment of the food insecurit y situation in the prevalence of food insecurit y at both levels of
context of the COV ID-19 pandemic in a group of severit y. Nearly 60 percent of the population
20 countries facing food insecurit y crises 17 ( Box 4). of Africa was affected by moderate or severe
food insecurit y in 2020, and 26 percent faced
Since FAO first started collecting FIES data in severe food insecurit y. In Latin America and
2014, moderate or severe food insecurit y at the the Caribbean, 41 percent of the population was
global level has been slowly on the rise, from moderately or severely food insecure in 2020, and
22.6 percent in 2014 to 26.6 percent in 2019 ( Table 3 14 percent was severely food insecure. The food
and Figure 4). Then in 2020, the year the COV ID-19 insecurit y situation was comparatively better
pandemic spread across the globe, it rose nearly in Asia, where 26 percent of the population was

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CHAPTER 2 FOOD SECURITY AND NUTRITION AROUND THE WORLD

BOX 3 ADAPTING FIES DATA COLLECTION IN THE CONTEXT OF THE COVID-19 PANDEMIC IN 2020

FAO has collected FIES data annually since 2014 In contrast to face-to-face interviewing, using
through the Gallup© World Poll (GWP) in nationally telephone interviews in surveys that are intended
representative samples of the population in over 140 to cover the general population may induce biases
different countries, in the context of the Voices of the that needed to be addressed. Given the use of dual
Hungry project.18 A major difference in the 2020 round sampling frames (both landline and mobile telephone
of GWP data collection is that data were collected numbers) and the potential for the presence of
almost exclusively via telephone, due to restrictions dual-users in households where both landline and
imposed in response to the COVID-19 pandemic that mobile phones are available, additional weights
impeded face-to-face interviews. This represents were constructed (when relevant) to correct for the
an important change with respect to previous years. unequal probability of selection of respondents.
GWP data collection in 2020 targeted only countries The population with access to telephones tends
where telephone coverage (mobile and/or landline) to be wealthier, more educated and mostly urban,
exceeded 70 percent. FAO collected additional FIES which implies selection biases that may lead to
data in a group of 20 countries facing food insecurity underestimating the extent and severity of food
crises (see Box 4). This information complemented insecurity. Thus, to minimize the risk of biased
the coverage of the GWP data and allowed for a more estimates, a weighting procedure based on the
comprehensive assessment in 2020. sample design was formulated and carried out in
For the 2020 round of data collection, a modified multiple stages. A probability weight factor (base
version of the FIES survey module was used, with the weight) was constructed to account for selection
objective of also understanding the additional impact of telephone numbers from each mobile stratum.
that the COVID-19 pandemic might be having on food In a next step, such base weights were further
security. In addition to the standard eight questions, adjusted depending on the sex, age, employment
the extended module included follow-up questions and educational level of the respondent, to
to determine whether the respondent attributed the adjust for non-response and for the difference in
reported food insecurity experience mainly to the the composition of the realized sample vis-à-vis
COVID-19 crisis. A similar module was used for the the intended reference population using mostly
data collection in the countries facing food insecurity country-level population censuses.
crises not covered by the GWP (Box 4).

affected by moderate or severe food insecurit y in Oceania: 12 percent of the population was
in 2020, and 10 percent was facing severe food affected by moderate or severe food insecurit y
insecurit y. Nevertheless, because of the size of in 2020, including 2.6 percent who were facing
its population, Asia still accounts for half the severe levels of food insecurit y. It is interesting to
moderately or severely food insecure people in note a small improvement in food securit y in this
the world ( Figure 5). region in 2020, at both levels of severit y – a trend
that began in 2017 and seems not to have been
Even in Northern America and Europe, where altered by the pandemic.
the lowest rates of food insecurit y are found,
the prevalence of food insecurit y increased for Figure 5 shows that, from a total of 2.37 billion
the first time in 2020 since the beginning of suffering from food insecurit y, half (1.2 billion)
FIES data collection in 2014 ( Table 3). In 2020, are in Asia; one-third (799 million) are in Africa;
8.8 percent of the population of Northern and 11 percent (267 million) are in Latin America
America and Europe was moderately or severely and the Caribbean. The fig ure also illustrates the
food insecure, and 1.4 percent was severely food difference across regions in the distribution of
insecure, compared with 7.7 and 1.0 percent in the population by food-insecurit y severit y level.
2019, respectively. The rates were slightly higher For example, in addition to being the region with »

| 16 |
 THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2021

TABLE 3 PREVALENCE OF FOOD INSECURITY AT SEVERE LEVEL ONLY, AND AT MODERATE OR SEVERE LEVEL,
BASED ON THE FOOD INSECURITY EXPERIENCE SCALE, 2014–2020
Prevalence of severe Prevalence of moderate or severe
food insecurity (%) food insecurity (%)
  2014 2015 2016 2017 2018 2019 2020 2014 2015 2016 2017 2018 2019 2020
WORLD 8.3 8.1 8.3 8.7 9.6 10.1 11.9 22.6 22.8 23.6 24.9 25.9 26.6 30.4
AFRICA 17.7 18.3 19.8 20.5 20.6 21.9 25.9 47.3 48.0 50.9 52.5 52.7 54.2 59.6
Northern Africa 10.2 9.0 10.4 10.6 9.3 8.8 9.5 29.7 26.4 30.0 33.1 31.1 28.9 30.2
Sub-Saharan Africa 19.4 20.4 22.0 22.7 23.2 24.9 29.5 51.4 53.0 55.8 57.0 57.6 59.9 66.2
Eastern Africa 23.7 24.1 25.8 25.3 25.0 26.0 28.7 57.7 58.1 62.2 62.1 61.6 63.4 65.3
Middle Africa n.a. n.a. n.a. n.a. n.a. n.a. 35.8 n.a. n.a. n.a. n.a. n.a. n.a. 70.0
Southern Africa 18.9 18.9 19.0 19.0 19.1 19.2 22.7 43.8 43.9 44.0 44.1 44.2 44.3 49.7
Western Africa 8.6 10.8 12.9 15.3 16.8 19.6 28.8 39.2 42.8 45.5 48.7 50.6 54.2 68.3
ASIA 7.7 7.2 6.9 7.2 8.6 9.0 10.2 19.1 18.8 18.9 20.3 22.2 22.7 25.8
Central Asia 1.6 1.4 2.0 2.8 2.2 2.3 4.7 8.5 9.1 10.0 13.9 13.6 13.2 18.0
Eastern Asia 0.8 0.8 1.5 1.7 1.9 1.3 2.0 6.0 5.9 6.3 10.0 9.6 7.4 7.8
South-eastern Asia 2.4 2.2 2.5 2.9 2.6 2.6 3.3 15.4 15.3 17.0 17.8 17.3 16.8 18.8
Southern Asia 15.9 14.8 13.1 13.3 16.9 18.3 19.9 31.6 30.8 30.1 29.4 34.6 37.6 43.8
Western Asia 8.2 8.5 8.6 9.6 9.2 8.8 8.9 27.5 27.4 26.3 28.2 27.5 27.9 28.3

Western Asia and

9.1 8.8 9.4 10.1 9.2 8.8 9.2 28.5 27.0 28.0 30.5 29.2 28.3 29.2
Northern Africa

LATIN AMERICA AND

7.7 7.5 9.0 10.0 9.6 10.1 14.2 24.9 27.5 31.3 33.2 31.7 31.9 40.9
THE CARIBBEAN

Caribbean n.a. n.a. n.a. n.a. n.a. n.a. 39.2 n.a. n.a. n.a. n.a. n.a. n.a. 71.3
Latin America 5.7 5.6 7.2 8.1 7.6 8.2 12.4 22.0 24.9 28.8 31.0 29.2 29.6 38.7
Central America 6.5 6.7 6.2 6.3 6.9 7.3 11.2 30.2 30.3 27.5 27.9 27.3 28.2 37.5
South America 5.4 5.1 7.6 8.9 7.9 8.6 12.9 18.7 22.7 29.4 32.2 29.9 30.1 39.2
OCEANIA 2.5 2.6 3.3 4.1 3.7 3.8 2.6 11.4 10.0 11.9 14.4 13.1 13.6 12.0

NORTHERN AMERICA
1.4 1.4 1.3 1.2 1.0 1.0 1.4 9.3 9.3 8.7 8.4 7.6 7.7 8.8
AND EUROPE

Europe 1.5 1.6 1.4 1.4 1.0 1.2 1.7 8.7 8.8 8.6 8.3 7.4 7.7 9.3
Eastern Europe 1.4 1.5 1.5 1.1 0.9 1.3 2.2 10.2 11.7 11.7 10.3 9.1 10.4 14.8
Northern Europe 1.8 1.8 1.7 2.2 1.0 0.9 1.2 6.7 6.8 6.6 6.0 5.5 5.1 4.1
Southern Europe 1.8 1.6 1.6 2.0 1.6 1.6 2.3 11.2 9.6 8.8 10.6 9.0 8.7 9.2
Western Europe 1.4 1.4 0.9 0.9 0.8 0.7 0.8 5.7 5.0 4.9 4.6 4.5 4.3 3.9
Northern America 1.0 1.0 1.0 0.8 0.8 0.8 0.8 10.5 10.3 9.0 8.6 8.0 7.6 7.8
NOTES: n.a. = not available, as data are available only for a limited number of countries, representing less than 50 percent of the population in the
region. The estimates for Latin America and the Caribbean from 2014 to 2019 include Caribbean countries whose combined populations represent
only 30 percent of the population of that subregion, while the 2020 estimates include Caribbean countries whose combined populations
represent around 60 percent of the population of the subregion. The countries included in the 2020 estimate for the Caribbean subregion are:
Dominican Republic, Grenada, Haiti, Jamaica, Saint Lucia, and Saint Vincent and the Grenadines.
SOURCE: FAO.

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CHAPTER 2 FOOD SECURITY AND NUTRITION AROUND THE WORLD

TABLE 4 NUMBER OF PEOPLE EXPERIENCING FOOD INSECURITY AT SEVERE LEVEL ONLY, AND AT MODERATE
OR SEVERE LEVEL, BASED ON THE FOOD INSECURITY EXPERIENCE SCALE, 2014–2020
Number of severely food insecure people Number of moderately or severely food insecure people
(millions) (millions)
  2014 2015 2016 2017 2018 2019 2020 2014 2015 2016 2017 2018 2019 2020
WORLD 604.5 598.4 620.2 656.8 731.3 779.9 927.6 1 645.5 1 680.1 1 762.9 1 881.6 1 978.7 2 049.9 2 368.2
AFRICA 203.5 215.9 240.1 254.7 262.9 286.7 346.6 545.0 567.2 617.8 653.3 671.8 708.6 798.8
Northern
22.4 20.2 23.7 24.6 22.0 21.2 23.4 65.1 59.1 68.6 77.0 73.7 69.8 74.5
Africa
Sub-Saharan
181.0 195.7 216.5 230.1 241.0 265.5 323.2 479.8 508.1 549.2 576.3 598.1 638.8 724.4
Africa
Eastern
89.9 94.0 103.2 104.2 105.6 113.0 127.9 218.7 226.3 248.9 255.4 260.5 275.0 290.9
Africa
Middle
n.a. n.a. n.a. n.a. n.a. n.a. 64.3 n.a. n.a. n.a. n.a. n.a. n.a. 125.7
Africa
Southern
11.7 11.9 12.1 12.3 12.6 12.8 15.3 27.2 27.7 28.1 28.6 29.0 29.5 33.5
Africa
Western
29.6 38.0 46.8 56.9 63.9 76.7 115.7 134.0 150.5 164.4 180.7 192.8 212.0 274.3
Africa
ASIA 337.2 319.9 308.0 323.7 394.5 414.7 471.1 840.1 834.6 846.8 918.2 1 014.0 1 043.2 1 198.7
Central Asia 1.1 1.0 1.4 2.0 1.6 1.6 3.5 5.7 6.3 7.0 9.9 9.8 9.6 13.4
Eastern Asia 13.2 12.6 24.6 28.4 31.3 21.7 33.8 98.0 97.1 104.1 166.2 159.5 124.6 130.8
South-eastern
15.2 13.6 16.1 18.5 17.1 16.9 22.1 96.3 96.8 109.1 115.5 113.6 111.0 125.5
Asia
Southern Asia 287.2 270.7 243.3 249.1 319.5 350.3 386.8 570.6 563.8 557.7 551.3 656.5 721.4 849.8
Western Asia 20.7 22.0 22.7 25.7 24.9 24.2 24.9 69.6 70.7 69.0 75.2 74.5 76.7 79.2

Western Asia
and Northern 43.1 42.2 46.4 50.3 46.9 45.4 48.3 134.7 129.8 137.5 152.2 148.2 146.5 153.6
Africa

LATIN
AMERICA
47.6 46.6 56.6 63.6 61.7 65.3 92.8 153.8 171.8 197.0 211.2 203.3 207.0 267.2
AND THE
CARIBBEAN

Caribbean n.a. n.a. n.a. n.a. n.a. n.a. 17.0 n.a. n.a. n.a. n.a. n.a. n.a. 31.0
Latin America 33.1 32.3 42.0 48.3 45.4 49.7 75.8 126.5 145.0 169.2 183.6 174.7 178.8 236.1
Central
10.9 11.3 10.5 10.9 12.1 13.0 20.2 50.3 51.2 47.0 48.3 47.9 50.0 67.4
America
South
22.2 21.0 31.5 37.3 33.3 36.7 55.6 76.2 93.8 122.2 135.3 126.8 128.8 168.7
America
OCEANIA 1.0 1.1 1.3 1.7 1.5 1.6 1.1 4.5 4.0 4.8 5.9 5.5 5.7 5.1

NORTHERN
AMERICA 15.2 15.0 14.1 13.2 10.7 11.6 15.9 102.1 102.5 96.4 93.0 84.2 85.4 98.3
AND EUROPE

Europe 11.4 11.6 10.4 10.4 7.7 8.7 12.8 64.9 65.7 64.2 61.9 55.0 57.4 69.5
Eastern
4.1 4.5 4.3 3.2 2.6 3.8 6.3 29.9 34.4 34.4 30.4 26.8 30.4 43.3
Europe
Northern
1.8 1.9 1.8 2.3 1.1 1.0 1.3 6.9 7.0 6.8 6.3 5.8 5.4 4.4
Europe
Southern
2.8 2.5 2.5 3.1 2.5 2.4 3.6 17.1 14.7 13.5 16.2 13.8 13.3 14.1
Europe
Western
2.8 2.7 1.8 1.8 1.5 1.4 1.6 10.9 9.7 9.5 8.9 8.8 8.4 7.7
Europe
Northern
3.7 3.4 3.8 2.8 3.0 3.0 3.1 37.2 36.8 32.2 31.1 29.1 27.9 28.9
America
NOTES: n.a. = not available, as data are available only for a limited number of countries, representing less than 50 percent of the population in the
region. The estimates for Latin America and the Caribbean from 2014 to 2019 include Caribbean countries whose combined populations represent
only 30 percent of the population of that subregion, while the 2020 estimates include Caribbean countries whose combined populations
represent around 60 percent of the population of the subregion. The countries included in the 2020 estimate for the Caribbean subregion are:
Dominican Republic, Grenada, Haiti, Jamaica, Saint Lucia, and Saint Vincent and the Grenadines.
SOURCE: FAO.

| 18 |
 THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2021

FIGURE 4 MODERATE OR SEVERE FOOD INSECURITY HAS BEEN CLIMBING SLOWLY FOR SIX YEARS AND
NOW AFFECTS MORE THAN 30 PERCENT OF THE WORLD POPULATION
70

59.6
60

54.2
52.7
50.9
50
47.3

33.7 40.9
40
PERCENTAGE

32.3
32.0
31.1
31.3 31.7 31.9
30.4 29.6
30
25.9 26.6 25.8 26.7
24.9
23.6 22.7
22.6 22.2

18.5 19.1 18.9 21.9

20 22.3 22.0
16.3 16.5 15.7
15.3 13.7 17.2
14.3 13.6
25.9 11.5 12.0
20.6 21.9 9.3 8.7 8.8
10 19.8 7.6 7.7
17.7
14.2
11.9 7.9
9.6 10.1 8.6 9.0 10.2 9.0 9.6 10.1 7.5 6.6 7.4
8.3 8.3 7.7 7.7 6.6
6.9

0 1.4 1.3 1.0 1.0 1.4

2014 2016 2018 2019 2020 2014 2016 2018 2019 2020 2014 2016 2018 2019 2020 2014 2016 2018 2019 2020 2014 2016 2018 2019 2020

WORLD AFRICA ASIA LATIN AMERICA NORTHERN AMERICA

AND THE CARIBBEAN AND EUROPE

Severe food insecurity Moderate food insecurity

NOTE: Differences in totals are due to rounding of figures to the nearest decimal point.
SOURCE: FAO.

» the highest overall prevalence of food insecurit y, in those two subregions mirrored the same
Africa is also the region where severe levels trends, increasing sharply in Western Africa from
represent the largest share of the combined 19.6 to 28.8 percent during 2019–2020, but much
total of moderate plus severe food insecurit y – less so in Eastern Africa, from 26 to 28.7 percent.
43 percent, compared with 39 percent in Asia and Moderate increases were seen in Southern Africa,
35 percent in Latin America and the Caribbean. where the prevalence of moderate or severe food
In Northern America and Europe, the proportion insecurit y rose from 44.3 to 49.7 percent, and
of food insecurit y experienced at severe levels is severe food insecurit y increased from 19.2 to
much smaller. 22.7 percent. Much smaller increases of around
1 percentage point were obser ved in Northern
Within the regions, there are important Africa, where 30.2 percent of the population was
differences in food insecurit y at subregional affected by moderate or severe food insecurit y in
level ( Table 3). In Africa, moderate or severe 2020, about one-third of whom were facing severe
food insecurit y increased significantly in the food insecurit y (9.5 percent of the population).
Western subregion, from 54.2 percent in 2019
to 68.3 percent in 2020, surpassing the level In Asia, the largest increases occurred in the
obser ved in Eastern Africa (65.3 percent) where Southern subregion, where moderate or severe
the increase was smaller. Severe food insecurit y food insecurit y jumped from 37.6 percent in

| 19 |
 CHAPTER 2 FOOD SECURITY AND NUTRITION AROUND THE WORLD

FIGURE 5 THE CONCENTRATION AND DISTRIBUTION OF FOOD INSECURITY BY SEVERITY DIFFERS GREATLY
ACROSS THE REGIONS OF THE WORLD

Total population
7 794 million

Total population
4 641 million
NUMBER (MILLIONS) IN 2020

Total population
Total population
1 341 million
1 117 million Total population
654 million

2 368
1 199 799
928 471 347 267
98 16 93
WORLD ASIA AFRICA NORTHERN AMERICA LATIN AMERICA
AND EUROPE AND THE CARIBBEAN

Total population Moderate or severe food insecurity Severe food insecurity

SOURCE: FAO.

2019 to 43.8 percent in 2020. There was already Marked increases in food insecurit y were
a notable increase in this subregion since obser ved in most subregions of Latin America
2017 when the prevalence was 29.4 percent. and the Caribbean. In Central and South America,
Severe food insecurit y also rose in Southern less than 40 percent of the population is facing
Asia in one year, from 18.3 percent to nearly moderate or severe food insecurit y, and levels
19.9 percent. There was a small increase in of severe food insecurit y are 11 and 13 percent,
moderate or severe food insecurit y in Western respectively. However, both subregions registered
Asia, which has the second highest prevalence 9-point increases in moderate or severe food
of food insecurit y in the region – 28.3 percent in insecurit y, and 4-point increases in severe food
2020. A small increase in severe food insecurit y insecurit y, in 2020. In the Caribbean subregion, d
was also obser ved, from 8.8 percent in 2019 to for which estimates are being reported this year
8.9 percent in 2020. Relatively large increases for the first time, the prevalence of moderate or
in food insecurit y were obser ved from 2019 to severe food insecurit y was 71.3 percent in 2020 –
2020 in Central Asia, from 13.2 to 18 percent for nearly three-quarters of the population. Of those,
moderate or severe, and 2.3 to 4.7 percent for more than half faced severe food insecurit y –
severe only. Despite the increase, the subregion is 39 percent of the population.
second only to Eastern Asia in having the lowest
food insecurit y rates in the region, followed by
South-eastern Asia. It is worth noting that the d  Estimates are being reported for the first time for the Caribbean
prevalence of moderate or severe food insecurit y subregion, as FIES data became available in 2020 for enough countries
in Eastern Asia is below the average for Northern to achieve 50 percent of population coverage in the subregion. The
countries included in the 2020 estimate for the Caribbean subregion
America and Europe. are: Dominican Republic, Grenada, Haiti, Jamaica, Saint Lucia, and
Saint Vincent and the Grenadines.

| 20 |
 THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2021

The lowest levels of food insecurit y in Northern COV ID-19 pandemic on employment and
America and Europe – and in the world – are income were included in the same 2020 GWP
found in Northern and Western Europe, where as the FIES module, providing the opportunit y
about 4 percent of the population is affected to explore the relationship between food
by moderate or severe food insecurit y. In fact, insecurity severity and income loss induced by
moderate or severe food insecurit y declined the COVID-19 crisis. Respondents were asked
slightly in these subregions in 2020. In Northern whether, due to the COV ID-19 situation, they
America and Southern Europe, however, had: 1) temporarily stopped working at their
moderate or severe food insecurit y rose slightly job or business; 2) lost their job or business;
from 2019 to 2020, reaching 7.8 and 9.2 percent, 3) worked less hours at their job or business;
respectively. A notable rise in moderate or severe and 4) received less money than usual from
food insecurit y was obser ved in Eastern Europe their employer or business. As expected, results
in the same period, from 10.4 to 14.8 percent. of the analysis e point to a higher likelihood of
Severe food insecurit y has remained low in being food insecure among respondents whose
all subregions, with increases from 2019 to employment and income had been negatively
2020 in all but Northern America. The largest impacted by the COV ID-19 pandemic. Loss of
increases occurred in Eastern Europe (from 1.3 to job or business had the strongest negative
2.2 percent) and Southern Europe (from 1.6 to effect on food securit y status, followed by
2.3 percent). receiving less money and temporar y work
disruptions (32, 20 and 19 percent higher odds
Towards an assessment of the impact of the of being moderately or severely food insecure,
COVID-19 crisis on food security respectively).
In summar y, the estimates based on the FIES
point to a worse food securit y situation in The effect was stronger for moderate or severe
2020 compared with 2019 in most parts of the food insecurit y than it was for severe food
world. There is little doubt that the COV ID-19 insecurit y. Moreover, the higher the income
pandemic contributed to this deterioration of of the respondent, the less food securit y was
people’s access to food. As mentioned in Box 3, a affected by the impacts of the COV ID-19
modified version of the FIES sur vey module was pandemic on employment. These findings
used in the GWP data collection to tr y to assess may ref lect a strong negative impact of the
the impact of the COV ID-19 pandemic on food pandemic on the food securit y of those in the
securit y. On average, approximately 60 percent middle-income range who normally count
of respondents experiencing food insecurit y on stable employment, offering hope of rapid
at moderate or severe level, and 55 percent at improvement in food securit y once people are
severe level, attributed their poor access to food able to resume normal work activities.
mainly to the COV ID-19 pandemic. However, it
is challeng ing to isolate and measure the impact Gender differences in food insecurity
of the pandemic alone on food insecurit y, The individual-referenced questions that
g iven the way it has exacerbated pre-existing constitute the FIES sur vey module also enable a
v ulnerabilities and affected so many aspects comparison between the food insecurit y status
of people’s lives. Therefore, the results should of men and women. Figure 6 shows the prevalence
not be interpreted as referring to the isolated of food insecurit y at different levels of severit y
impact of the COV ID-19 pandemic on food among adult men and women worldwide and
insecurit y, but rather as an indication that in all regions, highlighting the evolution from
people perceive it as being an important factor 2014 to 2020. At the global level, the gender
in their diminished access to food. gap in the prevalence of moderate or severe

Another way to explore the impacts of the e  The analysis was performed through a fixed effect regression model,
COV ID-19 pandemic on food securit y is using food insecurity status as outcome variable and responses to the
to examine the effects on specific drivers four questions about the pandemic’s impact on employment and
income as explanatory variables. Education, employment status,
of food insecurit y, such as loss of income. gender, urban/rural area and world region were considered as controls.
Questions related to the impacts of the See Annex 2 for more details.

| 21 |
 CHAPTER 2 FOOD SECURITY AND NUTRITION AROUND THE WORLD

FIGURE 6 GLOBALLY AND IN EVERY REGION, THE PREVALENCE OF FOOD INSECURITY IS HIGHER AMONG
WOMEN THAN MEN

60

50

40
PERCENTAGE

30

20

10

0
2014 2016 2018 2020 2014 2016 2018 2020 2014 2016 2018 2020 2014 2016 2018 2020 2014 2016 2018 2020

WORLD AFRICA ASIA LATIN AMERICA NORTHERN AMERICA

AND THE CARIBBEAN AND EUROPE

Men − moderate or severe Men − severe Women − moderate or severe Women − severe
food insecurity food insecurity food insecurity food insecurity

NOTE: The shaded area represents the margins of error around the estimates.
SOURCE: FAO.

food insecurit y grew even larger during the the prevalence is also higher among women
year the COV ID-19 pandemic spread across than men. The difference increased from
the world, with the prevalence of moderate or 2019 to 2020, with women being 11 percent
severe food insecurit y being 10 percent higher more food insecure than men in 2020 versus
among women than men in 2020, compared 9 percent more than men in 2019. Thus, the
with 6 percent in 2019. This is mostly due to the widening of the gap between men and women
widening of the gap in Latin America and the at the global level in a year impacted by the
Caribbean (30 percent in 2020 versus 24 percent COV ID-19 pandemic was more pronounced for
in 2019) and Asia (10 percent in 2020 versus moderate or severe food insecurit y. »
4 percent in 2019). For severe food insecurit y,

| 22 |
 BOX 4 USING THE FIES TO GUIDE AND TARGET RESPONSES
THE STATE TOSECURITY
OF FOOD THE COVID-19 PANDEMICIN THE WORLD 2021
AND NUTRITION
AT SUBNATIONAL LEVEL

The full potential of the FIES to generate information first subnational administrative unit (admin-1) level.
to guide policies is realized when applied in large Approximately 200 interviews were conducted in
national surveys that allow more detailed analyses each admin-1 area, resulting in samples ranging
of the food insecurity situation at subnational level. from slightly more than 1 000 to more than 8 300
The surveys described in this box were conducted to across the 20 countries. A stand-alone FIES module
provide food insecurity assessments useful to inform was used with adaptations included to assess the
the planning of responses to the COVID-19 pandemic degree to which the COVID-19 pandemic may have
in 20 countries facing food insecurity crises, in exacerbated food insecurity.19 Post-hoc adjustments
addition to computing SDG Indicator 2.1.2.17 were applied to the sample data to control for the
Between October 2020 and January 2021, FIES potential bias that might have arisen due to the
data were collected in the following 20 countries: relatively low mobile telephone penetration in some
Afghanistan, Burkina Faso, Cameroon, Central of the countries surveyed (see Box 3).
African Republic, Chad, Democratic Republic Results show that there was an increase in the
of the Congo, El Salvador, Ethiopia, Guatemala, prevalence of food insecurity in most countries
Haiti, Iraq, Liberia, Mozambique, Myanmar, Niger, for which previous assessments are available
Nigeria, Sierra Leone, Somalia, South Africa for comparison (Figure A). The increases were, on
and Zimbabwe. The surveys were conducted via average, of about 10 percentage points for moderate
mobile telephone with samples intended to be or severe food insecurity and 5 percentage points for
representative at the national level as well as the severe food insecurity.

FIGURE A FOOD INSECURITY IN 2020 COMPARED WITH 2019 (OR LAST AVAILABLE YEAR)
IN COUNTRIES FACING FOOD INSECURITY CRISES
100

90

80

70

60 Moderate or
PERCENTAGE

severe food
50 insecurity

40
100
30
90
20
80
10 Severe food
70
insecurity
0
60 Moderate or
iti r r r
PERCENTAGE

e c ia lia e ue r ia ad n o la o n pia a q
on Ha b li er ma bw ge ta ng ma as oo do r ic Ir a ma severe food
e pu L ib ba Ni biq Ni
ge Ch nis Co te aF er l va hio Af an
aL e So m a e a in m a Et h My insecurity
50err nR Zim za
Af
gh th Gu rk Ca lS ut
Si ca Mo of Bu E So
A fri b li c
40 r al pu
nt Re
Ce a tic
cr
30 mo
De
20
Statistically significant increase No statistically significant change No assessment for comparison
10 Severe food
SOURCE: FAO. insecurity
0
i li c ia lia r r r
on
e it er bw
e
ge iqu
e r ia ad an go ala so on o ia ca Ir a
q a
Ha ub ma sample Ni at the ge Ch is t on em Fa ro ad iop fri nm
The representativeness
r ra
Le
R ep Lib ofSothe
i m ba
z a mb admin-1
Ni
g h an h e C constitute
u at k i na a powerful
a me
l S alv tool E th to help
u t h A policymakers M ya and
an Z t ur C
Sie enabled
level Mo of the Af of G
programme planners E visualize So which provinces or
rf ic a more detailed assessment li c B
food insecurity lA situation in the countries surveyed. ub regions are most in need and, therefore, should be
ra ep
e nt R
C ic
Maps illustrating the geographical distribution of r at targeted for interventions aimed at guaranteeing the
oc
food insecurity, like the ones below for AfghanistanDem right to adequate food.
and the Democratic Republic of the Congo (Figure B),
Statistically significant increase No statistically significant change No assessment for comparison

| 23 |
CHAPTER 2 FOOD SECURITY AND NUTRITION AROUND THE WORLD

BOX 4 (CONTINUED)

FIGURE B PREVALENCE OF MODERATE OR SEVERE FOOD INSECURITY IN AFGHANISTAN

AND THE DEMOCRATIC REPUBLIC OF THE CONGO BY PROVINCE IN 2020

AFGHANISTAN Jawzjan
Balkh
Kunduz
Takhar
Badakhshan

Samangan
Faryab Baghlan
Sar-e-Pul
Panjsher Nuristan
Badghes Kapisa
Bamyan Parwan Kunarha
Laghman
Kabul
Maydanwardag
Ghor Nangarhar
Hirat Logar
Daykundi
Paktya
Ghazni Khost

Uruzgan
Farah
DEMOCRATIC REPUBLIC
Pakteka
Zabul
OF THE CONGO
Hilmand
Kandahar
Nemroz

Nord-Ubangi Bas-Uélé
Haut-Uélé
Sud-Ubangi

Mongala

Ituri

Tshopo
Équateur

Tshuapa Nord-Kivu

Mai-Ndombe

Sankuru Maniema Sud-Kivu

Kinshasa
Kwilu Kasaï
Kongo Central
Kasaï-Central
Kasaï Lomami
Oriental Tanganyika
Kwango

Haut-Lomami

Prevalence of moderate or severe

food insecurity Lualaba
Haut-Katanga

10–20% 20–30% 30–40%

40–50% 50–60% 60–70%

70–80% 80–90% 90–100%

NOTE: The boundaries and names shown and the designations used on these map(s) do not imply the expression of any opinion whatsoever on the part of
FAO concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers and boundaries.
SOURCE: FAO.

| 24 |
 THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2021

» Historically, women tend to be disproportionally 10 percent of total energ y intake from free sugars
affected by health and economic crises in a (preferably less than 5 percent); consumption of
number of areas, including but not limited to at least 400 g of fruits and vegetables per day;
food securit y and nutrition, health, time burden, and less than 5 g per day of salt (to be iodized).
and productive and economic dimensions. While the exact make-up of a healthy diet varies
The results of this analysis support existing depending on individual characteristics, as well
evidence of the disproportionate impact of the as cultural context, locally available foods and
pandemic on women’s economic opportunities dietary customs, the basic principles of what
and access to nutritious foods. 20 constitutes a healthy diet are the same. 22,23

Affordability of healthy diets: a link Healthy diets can also play an important
between food security and nutritional role in increasing the sustainabilit y of food
systems. As shown in the 2020 edition of this
outcomes report, shifting to healthy diets that include
The cost and affordabilit y of healthy diets are sustainabilit y considerations g can contribute
important determinants of a person’s food to reducing health and climate change costs
choices, and ultimately, of their food securit y, by 2030, because the hidden costs of these
nutrition and health. 7,21 Cost refers to what diets are lower compared with those of current
people have to pay to secure a healthy diet, consumption patterns. The adoption of healthy
while affordabilit y refers to the cost relative diets is projected to lead to a reduction of up to
to a person’s income, minus other required 97 percent in direct and indirect health costs and
expenses. f Tracking the cost and the number of 41– 47 percent in the social costs of greenhouse
people who cannot afford a healthy diet provides gas emissions (GHG) in 2030. 7
valuable metrics to better understand the link
between these important determinants of access Estimates of the cost and affordabilit y of healthy
to food and the trends in the multiple forms diets around the world in 2017, by region and
of malnutrition described in the next section. income group, were first presented in last year’s
More importantly, they can be used to inform a edition of this report. 7 This year, the estimates
wide range of policies and programmes at the were updated to 2019 using the latest available
global, national and subnational levels. data to monitor the progress towards ensuring
affordable, healthy diets for all. While the price
According to WHO, healthy diets protect and income distribution data needed to update
against malnutrition in all its forms, including the estimates to 2020 are not yet available,
non-communicable diseases (NCDs) such as trends in consumer food prices and incomes are
diabetes, heart disease, stroke and cancer. discussed with likely implications for the cost
Healthy diets contain a balanced, diverse and and affordabilit y of healthy diets in 2020 and into
appropriate selection of foods eaten over a period 2021. For a full description of the methodolog y
of time. In addition, a healthy diet ensures that a and data sources, see Annex 2.
person’s needs for macronutrients (proteins, fats
and carbohydrates, including dietary fibre) and Cost of healthy diets
essential micronutrients (vitamins and minerals) As seen in last year’s edition of this report,
are met, specific to their gender, age, physical the cost of a diet increases as the diet qualit y
activity level and physiological state. Healthy diets increases, across all regions and countr y
include less than 30 percent of total energ y intake income groups. That analysis was based on
from fats, with a shift in fat consumption away three reference diets that simulate incremental
from saturated fats to unsaturated fats and the levels of diet qualit y, starting from an “energ y
elimination of industrial trans fats; less than
g  Healthy diets that include sustainability considerations are diets that
are not only optimized for health, but also include environmental
f  In this report, the cost of a diet refers to the sum of the value of all sustainability considerations. Not all healthy diets are sustainable and
the least expensive food items needed to reach a given level of diet not all diets designed for sustainability are always healthy or adequate
quality. The value, in turn, is the price per unit for each food item for all population groups. See the 2020 edition of this report for a full
multiplied by the quantity of the food item. discussion and analysis.7

| 25 |
CHAPTER 2 FOOD SECURITY AND NUTRITION AROUND THE WORLD

sufficient”, to a “nutrient adequate” diet and of a diet relative to income, changes over time
then a “healthy” diet. 8 On average, the cost of a can be the result of changes in the cost of a diet,
healthy diet was 60 percent more than a diet that people’s income, or both. Rising food costs,
just meets requirements for essential nutrients, if not matched by rising income, could result
and almost five times as much as a diet that in more people being unable to afford healthy
just meets the minimum dietar y energ y needs diets. Moreover, wider problems in the economy,
through a starchy staple. such as economic slowdowns and downturns
that lead to increases in unemployment and
Updated results indicate that in 2019, at the declines in wages, could result in more people
global level, the cost of a healthy diet was finding healthy diets unaffordable, irrespective
USD 4.04 per person per day. However, the of price trends.
average cost of the diet and the change in the
cost between 2017 and 2019 varies by region and As a result of the high cost of healthy diets,
countr y income group ( Table 5). coupled with persistent high levels of income
inequality, it is estimated that around 3 billion
The cost of a healthy diet increased by 7.9 percent people were unable to afford a healthy diet in
globally between 2017 and 2019, but differences are 2019 ( Table 5). Most of these people live in Asia
notable across regions ( Table 5). All regions except (1.85 billion) and Africa (1.0 billion), although a
Africa present lower increases than the global healthy diet is also out of reach for millions living
average. Africa had the largest increase in the cost in Latin America and the Caribbean (113.0 million)
of a healthy diet from 2017 to 2019 – 12.9 percent. h and Northern America and Europe (17.3 million).
The second largest increases were in Northern
America and Europe and Latin America and the The total number of people in the world who
Caribbean, which both had an average regional could not afford a healthy diet in 2019 j is
increase of 6.8 percent. Asia registered marginal slightly lower than the 2017 estimate published
increases of 4.1 percent. Among the subregions, in last year’s report by around 21 million. k
Eastern Africa had the highest increase (33 percent) There are, however, important differences
followed by South America (9.2 percent). i across regions, with Latin America and the
Caribbean and Africa registering an increase,
The analysis of the cost of a healthy diet by while Asia, Northern America and Europe and
countr y income group shows that the largest Oceania show a decrease. The highest increase
increases in the cost of a healthy diet occurred in in the number of people who cannot afford a
lower-middle-income and high-income countries healthy diet was seen in Latin America and the
(14.3 and 6.6 percent, respectively). Increases in Caribbean (8.4 percent), which is largely driven
the cost of a healthy diet are much smaller in by increases in South America (14.3 percent). l In
low-income and upper-middle-income countries Africa, the number of people who cannot afford
(5.4 and 5.7 percent, respectively). a healthy diet increased by 5.4 percent between
2017 and 2019, ranging from 2.0 percent in
Affordability of healthy diets prior to the Southern Africa to 6.8 percent in Middle Africa. »
COVID-19 pandemic
Affordabilit y is a key component of food
securit y and nutrition and is a measure of
j  2019 estimates are updated using the 2019 food CPI-inflated cost
economic access to food and healthy diets. and PovcalNet income distributions; see Annex 2 for methodology and
Because affordabilit y is a measure of the cost data sources.
k  After March 2021 PovcalNet updates, sensitivity analysis was
conducted on affordability computed in 2017, using different income
h  This increase is largely due to an increase in the cost of a healthy distributions that showed similar results. The number reported in the
diet in Zimbabwe. The percentage increase for Africa would be 2020 edition of this report for 2017 is 3.02 billion; this number slightly
4.3 percent, excluding Zimbabwe. decreases to 2.97 billion if the updated 2018 income data of PovcalNet
i  The increase in Eastern Africa was largely driven by an increase in are used, while the number is slightly higher (3.05 billion) if instead the
the cost of a healthy diet in Zimbabwe; and for South America, by an 2017 income distribution is used. See background methods paper to
increase in Argentina. The percentage change for Eastern Africa would The State of Food Security and Nutrition in the World 2021 report. 302
be 2.7 percent, excluding Zimbabwe. The percentage change for South l  This increase is largely attributable to Argentina, which had a
America would be 5.2 percent, excluding Argentina. 49 percent increase in the cost of a healthy diet between 2017 and 2019.

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 THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2021

TABLE 5 HEALTHY DIETS WERE STILL UNAFFORDABLE FOR AROUND 3 BILLION PEOPLE IN THE WORLD IN
2019. THE NUMBER OF PEOPLE UNABLE TO AFFORD HEALTHY DIETS INCREASED IN AFRICA AND IN LATIN
AMERICA AND THE CARIBBEAN BETWEEN 2017 AND 2019
People unable to afford
  Cost of a healthy diet in 2019
a healthy diet in 2019

Cost Change between Change between

Total number
(USD per person 2017 and 2019 Percent 2017 and 2019
(millions)
per day) (percent) (percent)

WORLD 4.04 7.9 41.9 3 000.5 -0.7

AFRICA 4.37 12.9 80.2 1 017.0 5.4
Northern Africa 4.35 5.6 60.5 141.8 4.2
Sub-Saharan Africa 4.37 13.7 84.7 875.2 5.6
Eastern Africa 4.88 33.0 85.0 342.2 5.3
Middle Africa 3.81 2.2 87.9 152.0 6.8
Southern Africa 4.07 2.1 61.8 41.2 2.0
Western Africa 4.30 6.8 86.8 339.7 5.9
ASIA 4.13 4.1 44.0 1 852.8 -4.2
Central Asia 3.42 0.9 16.9 5.8 -22.0
Eastern Asia 4.99 6.4 13.5 213.5 -7.4
South-eastern Asia 4.41 4.9 49.5 316.1 -2.9
Southern Asia 4.12 1.2 71.3 1 281.5 -4.2
Western Asia 3.77 5.3 20.3 35.9 8.1
LATIN AMERICA AND THE CARIBBEAN 4.25 6.8 19.3 113.0 8.4
Caribbean 4.49 6.7 48.5 12.9 -1.0
Latin America 4.00 6.8 17.9 100.1 9.7
Central America 3.93 3.1 20.0 32.0 1.2
South America 4.05 9.2 17.1 68.1 14.3
OCEANIA 3.25 6.2 1.8 0.5 -14.9

NORTHERN AMERICA AND EUROPE 3.43 6.8 1.6 17.3 -3.6

COUNTRY INCOME GROUPS          

Low-income 4.06 5.4 87.6 463.0 4.8
Lower-middle-income 4.49 14.3 69.5 1 953.2 -1.4
Upper-middle-income 4.20 5.7 21.1 568.5 -2.0
High-income 3.64 6.6 1.4 15.8 -9.9
NOTES: The table shows the cost and unaffordability of a healthy diet by region and country income group in 2019. The cost of a healthy diet is the
2017 USD cost per person per day (published in last year’s edition of this report), updated using FAOSTAT country-level food consumer price index
(CPI) and purchasing power parity (PPP) in 2019. Unaffordability of a healthy diet is the weighted percentage (%) and the total number (million) of
population in each region and country income group who cannot afford the diet in 2019. For country income groups, the most recent 2019 World
Bank income classification is used for both years 2017 and 2019. This implies that cost and affordability indicators shown by income groups in last
year’s edition of this report differ from this year’s edition as some countries may have changed income status between 2017 and 2019. See Annex 2
for methodology and data sources.
SOURCE: FAO.

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 CHAPTER 2 FOOD SECURITY AND NUTRITION AROUND THE WORLD

» Both Asia and Northern America and Europe, on therefore small increases in the cost of a diet
the other hand, had a decrease in the number of can be significant in countries where the poor
people who cannot afford a healthy diet between make up a large percentage of the population.
2017 and 2019 (4.2 and 3.6 percent, respectively). For example, small increases in the cost of the
All subregions in Asia, except Western Asia, diet in Africa affect a larger proportion of the
show a decrease in the number of people who population – an estimated 80 percent of the
cannot afford a healthy diet, with large decreases population cannot afford a healthy diet.
in Central Asia (22 percent) m and Eastern Asia
(7.4 percent). Western Asia shows an increase The level of income inequalit y in a countr y is
of 8.1 percent. South America experienced the also critical, as income inequalit y shapes the
largest decrease. impact of economic growth and deceleration
on average incomes. As shown in the 2019
The comparison of cost and affordability over time edition of this report, where inequalit y is
points to the important roles of changes in income greater, economic slowdowns and downturns
as well as prices in determining affordability. have a disproportionate effect on low-income
In Asia, the increased cost of a healthy diet populations, since they use large portions of
coincided with higher incomes, so that the their income to buy food. In Latin America
number of people unable to afford a healthy diet and the Caribbean, the combination of ver y
decreased. On the other hand, Africa n was one of high income inequalit y, an economic slowdown
the regions with the smallest increases in the cost and downturn o and a high increase in the cost
of a healthy diet but where the highest increase of a healthy diet had a compounding effect,
was observed in the number of people unable leading to one of the highest increases in the
to afford one, pointing to the role of declining unaffordabilit y of a healthy diet between 2017
incomes. Economic growth and increases in and 2019. In contrast, Asia, with lower levels
income were lower in Africa over this period. of income inequalit y and economic growth
during this same period, was able to offset high
In comparison, the large increase in the cost of increases in the cost of the diet, leading to one of
healthy diets in Latin America and the Caribbean the highest improvements in affordabilit y.
coincided with a growing number of people
who were unable to afford them. This contrasts These findings illustrate that a broader policy
sharply with Northern America and Europe, approach is needed to improve the affordabilit y
which saw a similar increase in the cost of of healthy diets, one which focuses not only on
healthy diets, but with fewer people unable to improving incomes and reducing the costs of
afford them. In the case of Latin America and healthy diets, but also on addressing inequalit y
the Caribbean, the increased cost of the diet was (see Chapters 3 and 4).
compounded by falling incomes, resulting in a
double hit to the unaffordabilit y of healthy diets, Affordability of healthy diets in 2020
whereas in Northern America and Europe, the There is no room for complacency about access
rise in the cost was offset by rising incomes. to affordable healthy diets – especially given the
emergence of the pandemic in 2020 – even in
There are important dynamics at play behind those regions where improvements are obser ved
these obser ved differences related to the context between 2017 and 2019. While it is not possible to
and structural features of a countr y, notably update estimates to 2020 at this time, the number
levels of povert y and income inequalit y. The poor of people who cannot afford a healthy diet is
spend a large proportion of their income on food,

o  Latin America and the Caribbean has the highest level of income
m  This decrease is largely driven by Kyrgyzstan, where the percentage inequality in the world, both in terms of the Gini coefficient and the ratio
of the population who cannot afford a healthy diet decreased from between the income share of the richest and the poorest 20 percent of
60 percent in 2017 to 48 percent in 2019. This was due in part to the the population. See Figure 34 in FAO, IFAD, UNICEF, WFP and WHO
income needed to afford a healthy diet (i.e. accounting for 63 percent of (2019).5 The region also experienced economic slowdowns in 2017 and
income spent on food), which decreased from USD 5.40 to USD 5.23. 2018, and downturns in 2016 and 2019. The annual percentage change
n  Excluding Zimbabwe, the percent increase for Africa would only be in GDP per capita was -1.4 in 2016, 0.8 in 2017, 0.6 in 2018 and
4.3 percent. -0.1 percent in 2019. 319

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 THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2021

likely to have increased due to the compounding Estimates of the cost and affordabilit y of healthy
effects of inf lation in consumer food prices and diets will be updated annually and disseminated
income losses, stemming from the economic in this report, ref lecting the most recent data
impacts of the COV ID-19 pandemic and the as they become available. Once new data for
measures put in place to contain it. 2020 are available, it will be possible to estimate
the overall economic impact of the COV ID-19
By December 2020, global consumer food prices pandemic on the cost and affordabilit y of healthy
were at their highest for any month in the last diets. Regional, subregional, national and even
six years, and they continued to increase into the subnational differences are expected, given
first quarter of 2021. Consumer food prices in the different timing, duration and intensit y of
Latin America and the Caribbean, for example, lockdowns, as well as differential impacts of
increased by 16 percent between Januar y and economic shocks on countries. n
December 2020, with the largest increase in
South America. p

The global economic recession that started in 2.2

2020 has extended into 2021, with record levels of
unemployment, lost livelihoods and rising poverty NUTRITION
levels in many countries around the world (see
Chapter 3). One study using modelled estimates q of INDICATORS – LATEST
changes in income in 63 low- and middle-income
countries (total population of 3.5 billion) points UPDATES AND
to a deeper affordability gap in 2020 due to the
COVID-19 pandemic, putting healthy diets even PROGRESS TOWARDS
further out of reach. 24,25 The analysis suggests
that the pandemic led to an additional 141 million GLOBAL NUTRITION
people being unable to afford a healthy diet in the
countries studied. Strikingly, the number of people
unable to afford even half the cost of a healthy diet
TARGETS
was also estimated to have risen from 43 percent KEY MESSAGES
to 50 percent. Where the affordability gap is this
large, filling nutrient intake gaps among the most è  Globally, malnutrition in all its forms remains a
nutritionally vulnerable during the first 1 000 days challenge. Although it is not yet possible to fully account
of life, from conception to the second birthday, for the impact of the COVID-19 pandemic due to data
should be an urgent priority, because of the severe limitations, in 2020, it is estimated that 22.0 percent
and lasting consequences of undernutrition early (149.2 million) of children under 5 years of age were
in life. affected by stunting, 6.7 percent (45.4 million) were
suffering from wasting and 5.7 percent (38.9 million)
p  Calculated as the annual percentage change in the consumer price were affected by overweight. The actual figures,
index for a country. See FAO (2020). 320 particularly for stunting and wasting, are expected to be
q  The methodology for this study differs significantly from the methods higher due to the effects of the COVID-19 pandemic.
used to estimate the cost and affordability of the diet reported in Table 5
of this report (and therefore are not comparable). While the study uses
the 2017 cost estimates of diets from the 2020 edition of this report, the è  Most children under five years with malnutrition live
updated cost and affordability estimates are modelled estimates, which in Africa and Asia. These regions account for more than
are derived after the authors have applied exogenous changes into
IFPRI’s global computable general equilibrium (CGE) model, nine out of ten of all children with stunting, more than
MIRAGRODEP (Modelling International Relations under Applied General nine out of ten children with wasting and more than
Equilibrium) model enhanced for the AGRODEP modeling consortium – seven out of ten children who are overweight worldwide.
www.agrodep.org/models/library). Such changes are implemented
through a number of parameters to approximate the socio-economic
impacts of the COVID-19 pandemic resulting from health impacts, è  There has been some progress towards increasing
physical distancing, restrictions on (labour) mobility, international the percentage of infants 0–5 months of age who are
transport and the closure of some business activities. In this way, the
authors simulate endogenous impacts on economic growth, incomes, fed exclusively with breastmilk – 44 percent in 2019
employment, consumption, prices, trade and, ultimately, poverty. 25 compared with 37 percent in 2012.

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CHAPTER 2 FOOD SECURITY AND NUTRITION AROUND THE WORLD

è  Anaemia in women aged 15–49 years is now an height and weight were limited this past year
SDG indicator (2.2.3). Globally, 29.9 percent of women due to physical distancing measures to contain
aged 15 to 49 years are affected by anaemia; however, the spread of the pandemic; only four national
the data reveal stark regional differences. In 2019, sur veys with at least some field work in 2020
more than 30 percent of women in Africa and Asia were are ref lected in these updated estimates.
affected by anaemia, compared with only 14.6 percent Nevertheless, some obser ved and modelled
of women in Northern America and Europe. impacts of the COV ID-19 pandemic on nutrition
are discussed at the end of this section.
è  These estimates do not take into account the impact
of the COVID-19 pandemic, given the challenges it One in seven live births, or 20.5 million
posed for data collection in 2020. However, telephone (14.6 percent) babies globally, suffered from
surveys during 2020 showed disruptions in essential low birthweight in 2015. 29 Low birthweight
nutrition interventions and negative impacts on dietary newborns have a higher risk of dying in the
patterns. The modelled impact of economic shocks and first 28 days after birth; those who sur vive
service disruptions show the pandemic’s potential to are more likely to suffer from stunted growth
increase all forms of malnutrition. and lower intelligence quotient (IQ), and face
increased risk of overweight and obesit y and
è  With increased momentum towards the UN Food adult-onset chronic conditions, including
Systems Summit in September 2021 and the Tokyo cardiovascular diseases and diabetes, later in
Nutrition for Growth Summit in December 2021, now is life. 30,31 Data show that little progress has been
the opportunity to secure concrete commitments and made to reduce low birthweight since 2012.
plans towards eliminating all forms of malnutrition over New low birthweight estimates will be released
the second half of the UN Decade of Action on Nutrition in early 2022.
by 2025 and towards the 2030 SDGs.
Optimal breastfeeding practices, including
exclusive breastfeeding for the first 6 months
Global trends of life, are critical for child sur vival and the
This section assesses progress towards the seven promotion of health and of brain and motor
global nutrition targets. These include the six development. Globally, 44 percent of infants
nutrition targets endorsed by the World Health under 6 months of age were exclusively
Assembly ( W H A) in 2012 to be achieved by breastfed in 2019 – up from 37 percent in 2012.
2025, for which 2030 targets 26 were subsequently Oceania (excluding Australia and New Zealand)
proposed ( Table 6). Four out of the six indicators demonstrated the highest levels of exclusive
were also selected to monitor progress towards breastfeeding, at 61.3 percent. More than
SDG Target 2.2, including anaemia in women two in five infants under 6 months in Africa
15 – 49 years which has been newly designated (43.6 percent) and Asia (45.3 percent) were
as an SDG indicator (SDG Indicator 2.2.3). 27 The exclusively breastfed in 2019, compared with
seventh target is to halt the rise in adult obesit y, only one in three infants in Northern America
which is part of the Global Action Plan for the (34.7 percent). This practice, however, varies
Prevention and Control of Noncommunicable considerably among the subregions of Asia and
Diseases adopted by the W H A in 2013. 28 Africa. Three out of five subregions in Asia have
a higher prevalence than the global estimate.
Progress towards each of the seven nutrition Southern Asia has the highest prevalence,
targets is summarized in Figure 7. The latest with 57.2 percent of infants being exclusively
estimates do not account for the effects of the breastfed compared with only 22.0 percent of
COV ID-19 pandemic because data on nutrition infants in Eastern Asia. Similarly, in Africa, the
outcomes were not collected or have not yet prevalence of exclusive breastfeeding is nearly
been fully estimated. The 2020 estimates of twice as high in Eastern Africa (60.7 percent)
childhood stunting, wasting and overweight compared with Southern (33.5 percent) and
presented in this edition are based almost Western Africa (32.3 percent). Though many
entirely on data collected before 2020 as the regions have demonstrated progress, two
collection of household sur vey data on child subregions in particular have demonstrated

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 THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2021

TABLE 6 THE GLOBAL NUTRITION TARGETS ENDORSED BY THE WORLD HEALTH ASSEMBLY AND THEIR
EXTENSION TO 2030
2025 Target 2030 Target
40 percent reduction in the number of 50 percent reduction in the number of
Stunting (SDG)
children under five who are stunted. children under five who are stunted.

50 percent reduction in anaemia in women of 50 percent reduction in anaemia in women of

Anaemia (SDG)
reproductive age. reproductive age.

Low birthweight 30 percent reduction in low birthweight. 30 percent reduction in low birthweight.

Reduce and maintain childhood overweight to

Childhood overweight (SDG) No increase in childhood overweight.
less than 3 percent.

Increase the rate of exclusive breastfeeding in Increase the rate of exclusive breastfeeding in
Breastfeeding
the first six months up to at least 50 percent. the first six months up to at least 70 percent.

Reduce and maintain childhood wasting to Reduce and maintain childhood wasting to
Wasting (SDG)
less than 5 percent. less than 3 percent.

NOTE: Targets were set considering the baseline year 2012.

SOURCES: WHO & UNICEF. 2017. The extension of the 2025 Maternal, Infant and Young Child nutrition targets to 2030. Discussion paper. Geneva,
Switzerland, WHO. (also available at www.who.int/nutrition/global-target-2025/discussion-paper-extension-targets-2030.pdf).

worr ying declines in exclusive breastfeeding stunting prevalence declining by nearly half,

prevalence, with levels decreasing from from 26.1 percent in 2000 to 13.4 percent in
29.7 percent to 25.9 percent in the Caribbean and 2020. Progress on stunting has been slower in
from 28.5 percent to 22.0 percent in Eastern Asia Africa, declining from 41.5 percent in 2000 to
between 2012 and 2019. 30.7 percent in 2020 (only a 26 percent decline in
relative terms); the slower decline in prevalence
Estimates of childhood stunting and overweight, combined with population increases make it the
presented below, have been generated using only region where the number of children with
a new countr y-level model (see Annex 1B for stunting has increased since 2000. Some African
details). However, as mentioned above, the full subregions have shown slower progress.
impact of the COV ID-19 pandemic on child For example, Middle Africa and Southern Africa
malnutrition is still unfolding and is not captured have decreased their stunting prevalence by less
in the 2020 estimates. than 20 percent, in relative terms, since 2000.

Globally, 149.2 million (22.0 percent) children Child wasting (part of SDG Indicator 2.2.2)
under the age of five years suffered from is a life-threatening condition resulting from
stunting (SDG Indicator 2.2.1) in 2020. 32 poor nutrient intake and frequent or prolonged
Stunting (defined as being too short for one’s illnesses. Affected children are dangerously thin,
age) undermines children’s physical growth have weakened immunity and face an increased
and cognitive development and increases their acute risk of death. In 2020, 32 45.4 million children
risk of dying from common infections. It is also under five years (6.7 percent) were wasted.
associated with increased risk of developing Nearly one-quarter lived in sub-Saharan Africa
NCDs later in life. The prevalence of stunting and more than half lived in Southern Asia, the
has decreased from 33.1 percent in 2000 to subregion with the highest prevalence of wasting –
26.2 percent in 2012 and further to 22.0 percent above 14 percent. This form of malnutrition is
in 2020. In 2020, nearly three-quarters of the the most impacted by the COVID-19 pandemic
world’s stunted children lived in just two regions: in the short term, as it is an acute condition
Central and Southern Asia (37 percent) and with potential to manifest quickly in the face of
sub-Saharan Africa (37 percent). Eastern Asia shocks. The pandemic has likely shifted the global
and South-eastern Asia have made the greatest prevalence even further from the global targets.
progress over the past two decades, with As mentioned above, the estimate of 45.4 million »

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 CHAPTER 2 FOOD SECURITY AND NUTRITION AROUND THE WORLD

FIGURE 7 REACHING THE 2025 AND 2030 GLOBAL NUTRITION TARGETS REMAINS A CHALLENGE. IN 2020,
AN ESTIMATED 22 PERCENT OF CHILDREN UNDER 5 YEARS OF AGE WERE AFFECTED BY STUNTING,
6.7 PERCENT BY WASTING AND 5.7 PERCENT BY OVERWEIGHT. NEARLY 30 PERCENT OF WOMEN AGED
15 TO 49 YEARS WERE AFFECTED BY ANAEMIA IN 2019

70.0
70

60

50.0
50
44.0
PERCENTAGE

40
37.0

29.9
28.5
30
26.2
22.0
20
15.0 14.6 15.4 14.3 14.3
12.8 13.1 11.8
10.5 10.5 11.8
10 6.7
5.0 5.6
5.6 5.7
3.0 3.0

0
2012
2015

2025
2030

2012
2019
2025
2030

2012
2020
2025
2030

2020
2025
2030

2012
2020
2025
2030

2012
2019
2025
2030

2012
2016
2025

Low Exclusive Stunting Wasting Overweight Anaemia Obesity

birthweight breastfeeding (under 5 years) (under 5 years) (under 5 years) (women of (adults)
(< 6 months) reproductive age)
2025 targets extended to 2030
2025 WHA Global Nutrition Targets to be aligned with the SDG timeline

NOTES: The potential impact of the COVID-19 pandemic is not reflected in the estimates. Wasting is an acute condition that can change frequently and
rapidly over the course of a calendar year. This makes it difficult to generate reliable trends over time with the input data available – as such, this report
provides only the most recent global and regional estimates.
SOURCES: Data for stunting, wasting and overweight are based on UNICEF, WHO & World Bank. 2021. UNICEF-WHO-World Bank: Joint child malnutrition
estimates - Levels and trends (2021 edition) [online]. https://data.unicef.org/resources/jme-report-2021, www.who.int/data/gho/data/themes/topics/joint-
child-malnutrition-estimates-unicef-who-wb, https://datatopics.worldbank.org/child-malnutrition; data for exclusive breastfeeding are based on UNICEF.
2020. UNICEF Global Database on Infant and Young Child Feeding. In: UNICEF [online]. New York, USA. [Cited 19 April 2021]. data.unicef.org/topic/
nutrition/infant-and-young-child-feeding; data for anaemia are based on WHO. 2021. Global Health Observatory (GHO). In: WHO [online]. Geneva,
Switzerland. [Cited 26 April 2021]. www.who.int/data/gho/data/themes/topics/anaemia_in_women_and_children; data for adult obesity are based on
WHO. 2017. Global Health Observatory (GHO). In: WHO [online]. Geneva, Switzerland. [Cited 2 May 2019]. www.who.int/data/gho/data/indicators/
indicator-details/GHO/prevalence-of-obesity-among-adults-bmi-=-30-(age-standardized-estimate)-(-); data for low birthweight are based on UNICEF &
WHO. 2019. UNICEF-WHO Low Birthweight Estimates: Levels and trends 2000–2015 [online]. [Cited 4 May 2021]. data.unicef.org/resources/low-
birthweight-report-2019

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 THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2021

» children does not include the impact of the pointing to the need for consolidated attention
pandemic given the inability to measure children and action. Similar patterns hold for anaemia in
while physical distancing policies were in place. pregnant women, as well. 36
However, one study based on modelling indicates
that wasting may have affected around 15 percent Adult obesity is a diet-related risk factor for
more children in 2020 than estimated, putting the several NCDs. Adult obesit y continues to rise,
lives of tens of millions of children at risk. 33 with the global prevalence increasing from
11.8 percent in 2012 to 13.1 percent in 2016.
Childhood overweight (part of SDG Indicator 2.2.2) All subregions showed increasing trends in
has immediate impacts on children’s health and the prevalence of adult obesit y between 2012
well-being and increases the risk of diet-related and 2016, and are off track to meet the 2025
NCDs later in life. It has been on the rise in many W H A target. Northern America, Western
countries, boosted by industry-led marketing Asia, and Australia and New Zealand had the
and greater access to highly processed foods, highest levels, at 35.5 percent, 29.8 percent
often high in energ y, fats (particularly saturated and 29.3 percent, respectively, as of 2016.
and trans fats), free sugars and salt, 34 along with Latin America and the Caribbean, and Oceania
inadequate levels of physical activity. For example, excluding Australia and New Zealand, also show
a study in Europe found that over half of levels above 20 percent. Updated adult obesit y
commercial complementary infant foods contained estimates will be released in late 2021.
excessive levels of sugar. 35 In 2020, 5.7 percent
(38.9 million) of children under five years were The regional trends described above are
overweight. 32 There has been little change at the summarized in Figure 8 and subregional trends are
global level in two decades – 5.7 percent in 2020 presented in Table 7 in the next section.
compared with 5.4 percent in 2000 – and trends in
some regions and in many settings are on the rise. As has been touched upon previously in this
While the prevalence of child overweight in Africa report, hundreds of millions of people were
is similar to the global prevalence (5.3 percent already suffering from hunger and malnutrition
in 2020), subregional levels show differences, before the onset of the COV ID-19 pandemic.
reaching 13.0 and 12.1 percent in Northern Africa In the long term, without large-scale coordinated
and Southern Africa, respectively. There have been action, the combined effects of COV ID-19
notable increases in child overweight between infection, as well as corresponding mitigation
2000 and 2020, 32 especially in two regions, Eastern measures and the emerging global recession,
and South-eastern Asia, and Australia and could disrupt the functioning of food systems
New Zealand, where levels have increased from with disastrous consequences for health and
5.2 to 7.7 percent and from 7.7 to 16.9 percent, nutrition. In the following section, we examine
respectively. A reversal in trajectory is needed to some of the evidence of the impacts of the
achieve the 3 percent global target for 2030. COV ID-19 pandemic on nutrition.

New updates from 2019 on anaemia in women

of reproductive age (SDG Indicator 2.2.3) are
Impact of the COVID-19 pandemic
presented in this year’s report. Nearly one in on nutrition
three (29.9 percent) women of reproductive The COV ID-19 pandemic has led to multiple
age globally were still affected by anaemia economic, food and health system shocks that
and no progress has been made since 2012. threaten to reverse the progress made to date in
Wide variations exist between regions, with the tackling all forms of malnutrition. 37 It will likely
prevalence in Africa being nearly three times be some time before empirical data are available
higher than that of Northern America and on a global scale that allow proper assessment of
Europe. The prevalence is particularly high in the impact of the pandemic on nutritional status.
Western Africa, representing 51.8 percent, with However, results of the studies described below
little progress since 2012 (52.9 percent). No region provide insight into how the COV ID-19 pandemic
has shown a significant decline in the prevalence has impacted nutrition-related factors that
of anaemia among women of reproductive age, ultimately inf luence nutrition outcomes. »

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 CHAPTER 2 FOOD SECURITY AND NUTRITION AROUND THE WORLD
FIGURE 8 STUNTING IS THE ONLY INDICATOR SHOWING SUBSTANTIAL IMPROVEMENTS IN MULTIPLE
REGIONS SINCE 2000. TWO INDICATORS – CHILD OVERWEIGHT AND ANAEMIA AMONG WOMEN OF
REPRODUCTIVE AGE – HAVE SEEN NO PROGRESS IN TWO DECADES. ADULT OBESITY IS RISING SHARPLY IN
ALL REGIONS

LOW STUNTING OVERWEIGHT WASTING1,2

BIRTHWEIGHT (under 5 years) (under 5 years) (under 5 years)

45 45 45 45

40 40 40 40

35 35 35 35
PREVALENCE (%)

30 30 30 30

25 25 25 25

20 20 20 20

15 15 15 15

10 10 10 10

5 5 5 5

0 0 0 0
2000 2012 2015 2020 2000 2012 20203 2000 2012 20203 20203

EXCLUSIVE BREASTFEEDING2 ANAEMIA OBESITY

(< 6 months) (women of reproductive age) (adults)

70 45 45

40 40
60
35 35
PREVALENCE (%)

50
30 30
40 25 25

30 20 20

15 15
20
10 10
10
5 5

0 0 0
2000 2012 2019 2020 2000 2012 2019 2020 2000 2012 2016 2020

World Africa Asia4 Latin America and the Caribbean

Northern America, Europe and Oceania excluding Australia and New Zealand
Australia and New Zealand

NOTES: 1 Wasting is an acute condition that can change frequently and rapidly over the course of a calendar year. This makes it difficult to generate
reliable trends over time with the input data available and, as such, this report provides only the most recent global and regional estimates. 2 For wasting
and exclusive breastfeeding, estimates are not shown for regions/years where population coverage was below 50 percent. 3 The collection of household
survey data on child height and weight were limited in 2020 due to the physical distancing measures required to prevent the spread of COVID-19. Only
four national surveys included in the database were carried out (at least partially) in 2020. The estimates on child stunting, wasting and overweight are
therefore based almost entirely on data collected before 2020 and do not take into account the impact of the COVID-19 pandemic. 4 For wasting and low
birthweight, the Asia estimate excludes Japan.
SOURCES: Data for low birthweight are based on UNICEF & WHO. 2019. UNICEF-WHO Low Birthweight Estimates: levels and trends 2000–2015, May
2019. In: UNICEF data [online]. New York, USA, UNICEF [Cited 19 April 2021]. data.unicef.org/resources/unicef-who-low-birthweight-estimates-levels-
and-trends-2000-2015; data for stunting, wasting and overweight are based on UNICEF, WHO & World Bank. 2021. UNICEF-WHO-World Bank: Joint child
malnutrition estimates - Levels and trends (2021 edition) [online]. https://data.unicef.org/resources/jme-report-2021, www.who.int/data/gho/data/themes/
topics/joint-child-malnutrition-estimates-unicef-who-wb, https://datatopics.worldbank.org/child-malnutrition; data for exclusive breastfeeding are based
on UNICEF. 2020. UNICEF Global Database on Infant and Young Child Feeding. In: UNICEF [online]. New York, USA. [Cited 19 April 2021]. data.unicef.
org/topic/nutrition/infant-and-young-child-feeding; data for anaemia are based on WHO. 2021. Global Health Observatory (GHO). In: WHO [online].
Geneva, Switzerland. [Cited 26 April 2021]. www.who.int/data/gho/data/themes/topics/anaemia_in_women_and_children; data for adult obesity are
based on WHO. 2017. Global Health Observatory (GHO). In: WHO [online]. Geneva, Switzerland. [Cited 19 April 2021]. www.who.int/data/gho/data/
indicators/indicator-details/GHO/prevalence-of-obesity-among-adults-bmi-=-30-(age-standardized-estimate)-(-)

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 THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2021

» Changes in food and diet patterns The study revealed sociodemographic

Some data collection efforts have continued inequalities in dietar y qualit y in Brazil: people
during the pandemic through phone and online in the lower wealth quintiles, those who became
sur veys, and through modified in-person sur veys unemployed, people of colour and respondents
employing infection prevention and control from the poorer Northeastern region of the
measures. Many nutrition-related sur veys countr y reported increased consumption of
undertaken in 2020 included questions on coping highly processed food. The findings highlight
strategies adopted by households in the face the need for policies to focus on the promotion
of the COV ID-19 pandemic, shedding light on of healthy diets while providing social protection
changes in dietar y patterns. schemes to support v ulnerable groups during
the COV ID-19 pandemic. Similar patterns
One national survey in Indonesia found that were obser ved across the Latin America and
31 percent of households reported food shortages Caribbean region as well. 41
and 38 percent reported eating less than
usual, compared with 3 percent and 5 percent, Disruption of essential nutrition services
respectively, the previous year. 11 Survey results Countries worldwide are facing many challenges
show that foods consumed by households were as they strive to ensure that health, food,
neither sufficient in amount nor in diversity, education and social protection systems maintain
increasing the risk of nutritional deficiencies essential nutrition ser vices while simultaneously
and irreversible physical and cognitive deficits responding to the COV ID-19 pandemic. Based on
to children, as well as adult underweight, a sur vey tracking the situation of children
overweight and obesity, and of developing NCDs. during the pandemic, 42 90 percent of countries
Another study in Yemen found that the dietary (122 of 135) reported a change in the coverage
diversity of households already consuming poor of key nutrition ser vices in Aug ust 2020 ( Figure 9).
diets had deteriorated between February and April Overall, essential nutrition ser vices coverage
2020, with the share of households consuming declined by 40 percent, and nearly half of the
only three or fewer food groups increasing countries reported a drop of 50 percent or
from 22 to 30 percent during that period. more for at least one nutrition inter vention.
These households reported eating mainly cereals, Nutrition programmes in schools were the most
fats and sugar, instead of nutritious foods. 38 affected, with an overall 60 percent reduction
in ser vice coverage, followed by iron–folic acid
Conditions imposed by the COVID-19 pandemic, supplementation for adolescent girls (45 percent).
such as mobility restrictions, closures or limited In most countries reporting data on school-based
operating hours of food markets, and price nutrition programmes, including school feeding
increases of perishable, often more nutritious and take-home rations (39 of 68 countries with
foods, 39 have all provoked changes in dietary available data), school nutrition programmes
patterns. These conditions, along with reduced were disrupted by as much as 75 –100 percent due
incomes, can induce families to choose cheaper, to COV ID-19 mitigation measures ( Figure 9).
highly processed foods with a longer shelf life
– often of high energ y density and minimal The findings from the sur vey demonstrate that
nutritional value – over fresh and more nutritious the most v ulnerable regions were also the most
foods. Forty-nine percent of survey respondents affected by the COV ID-19 pandemic. Africa and
in Brazil reported that their food habits had Asia, regions that bear the greatest share of all
changed during quarantine and social isolation forms of child malnutrition, also reported the
periods. Among households with children and biggest overall drops in coverage of essential
adolescents under 17 years, this proportion nutrition ser vices of 27 percent and 49 percent,
increased to 58 percent. Almost one-third respectively. Similarly, over 90 percent of all
(31 percent) of households with children increased countries in fragile r situations reported some
their consumption of highly processed foods, level of ser vice disruption compared with
compared with 18 percent of households without
children, highlighting how deteriorations in diet r  Based on World Bank FY19 List of Fragile and Conflict-affected
quality are taking the greatest toll on children. 40 Situations.

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CHAPTER 2 FOOD SECURITY AND NUTRITION AROUND THE WORLD

FIGURE 9 AROUND 90 PERCENT OF COUNTRIES SURVEYED REPORTED CHANGES IN COVERAGE OF KEY

NUTRITION SERVICES DUE TO COVID-19 IN AUGUST 2020. WHILE 80 PERCENT REPORTED DISRUPTIONS IN
COVERAGE, A SMALL PROPORTION WITNESSED IMPROVED COVERAGE

Food subsidies (n=36)

Treatment of child wasting (n=83)

Early detection of wasting (n=103)

Large-scale fortification (n=69)

Nutrition support for pregnant, lactating mothers (n=99)

Iron–folic acid (IFA) supplementation for adolescent girls (n=28)

Nutrition programmes in schools (n=68)

Vitamin A supplementation (n=87)

Home fortification with multiple micronutrient powders (MNPs) (n=55)

Promotion of nutritious diets for children 6–23 months (n=114)

Protection and promotion of breastfeeding (n=118)

0 10 20 30 40 50 60 70 80 90 100

PERCENTAGE

No change <25% drop 25–49% drop 50–74% drop 75–100% drop New/increased coverage

SOURCE: UNICEF. 2020. Tracking the situation of children during COVID-19. In: UNICEF [online]. [Cited 21 May 2021]. https://data.unicef.org/resources/
tracking-the-situation-of-children-during-covid-19-august-2020

75 percent of countries not in fragile situations. of countries (11 percent) even reported increased
Worldwide, countries attempted to adapt coverage of nutrition ser vices during this period.
their programmes to continue to provide key
nutrition inter ventions during the pandemic. The COVID-19 pandemic has not only disrupted
For example, over 70 countries implemented health systems but also impacted the global
measures, such as physical distancing at clinics, community’s ability to monitor nutrition outcomes
to ensure continuation of high-dose vitamin A for children and adults. While in 90 percent of
supplementation for children. A small proportion countries, routine information systems continued

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 THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2021

to function in some capacity, almost half of the infection, resulting in early developmental
countries reported an inability to implement deficits, and may not be as easily reversed. 7
surveys, which are the leading source of data for
the monitoring of global nutrition targets. Three different scenarios were modelled based
on trajectories of economic recovery and service
In addition to key nutrition ser vices being disruptions from the COVID-19 pandemic in 2021
suspended, countries also reported disruptions and 2022: a rapid recovery in 2021 (optimistic), a
to other health ser vices such as mass vaccination scenario with a second wave of infections in 2021
campaigns, with measles campaigns suspended (moderate), and a scenario of persistent disruptions
in 27 countries, putting children with suboptimal and protracted recovery (pessimistic). A global
growth at a higher risk of death from such computable general equilibrium model s linked to
infections. 43,4 4 Moreover, three-quarters of country-specific household survey data was used
countries reported a considerable degree of to predict the effects of the pandemic's disruptions
disruption of ser vices aimed at the prevention or on gross national income (GNI) per capita,
treatment of NCDs. 45 According to a sur vey on household incomes and USD 1.90/day poverty
continuit y of essential health ser vices during the rates between 2020 and 2022 for each scenario.
COV ID-19 pandemic, management of moderate These were then used to predict country-specific
and severe malnutrition was one of the most changes in the prevalence of wasting based on
frequently disrupted ser vices in April 2021 observed historical associations. Estimates of
under reproductive, maternal, newborn, child, poverty and wasting, and assumptions about levels
and adolescent health and nutrition, affecting of disruption of health and nutrition services,
41 percent of reporting countries. 46 were imputed into the Lives Saved Tool (LiST)
to predict changes in stunting. For the analysis
Impact on child malnutrition presented below, the results of this model for
Research based on modelled scenarios can 118 countries were extrapolated to estimate the
contribute valuable insights, at least until new potential impact if all 135 low- and middle-income
empirical data for 2020 and 2021 are available countries experienced similar relative increases in
from a large enough number of countries to malnutrition (see Box 6 in the next section).
allow for an official assessment of the impact
of the COV ID-19 pandemic at the global and For child wasting, under the moderate
regional levels. One such effort by members of scenario, this modelling exercise predicts
the Standing Together for Nutrition Consortium that an additional 11.2 million children under
involved the application of a combination of five years of age in low- and middle-income
modelling tools to estimate the joint effects of countries would be affected by wasting
economic, food and health systems disruptions from 2020 to 2022 as a consequence of
induced by the pandemic on various forms of the pandemic – 6.9 million in 2020 alone.
maternal and child undernutrition in 118 low- For the pessimistic scenario, the estimate of
and middle-income countries. 47 They estimated additional cases increases to 16.3 million.
how many more children may be affected by For child stunting, under the moderate
wasting in 2020, 2021 and 2022 as a consequence scenario, the model predicts that 3.4 million
of the COV ID-19 pandemic. Potential additional more children will be stunted in 2022 due
cases of stunting due to the pandemic were to the impacts of the COV ID-19 pandemic –
estimated only for 2022 compared with 2019, 4.5 million more in the pessimistic scenario.
given the cumulative nature of stunting.
Increases in wasting among young children living Though not included in the above modelling
in communities badly hit by pandemic-related study, concerns have been raised over the
disruptions in health ser vices, food supply chains potential impact of the pandemic on micronutrient
and/or loss of jobs and livelihoods are likely to deficiencies, as well as on overweight and obesity
be seen within a matter of months, and could and the risk of NCDs. The above-mentioned
disappear as soon as circumstances improve.
Child stunting, on the other hand, ref lects more s  See further reference to this model (MIRAGRODEP) in the next
chronic periods of undernutrition or frequent section and in Annex 2. See also IFPRI (2011).55

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CHAPTER 2 FOOD SECURITY AND NUTRITION AROUND THE WORLD

2.3
negative impacts on the affordability of healthy
diets and diet quality increase the likelihood
of micronutrient deficiencies, and along with
decreased physical activity, may exacerbate ENDING HUNGER
overweight and obesity, as well as NCDs, far
beyond the duration of the pandemic. This is AND ALL FORMS
particularly concerning as the scientific evidence
shows that patients with obesity (including young OF MALNUTRITION
adults) hospitalized with COVID-19 experienced
substantially higher rates of severe outcomes. 48 BY 2030
2021 year of nutrition KEY MESSAGES
In summary, malnutrition persists in multiple
forms and the full impact of the COVID-19 è  New projections confirm that hunger will not be
pandemic is still unfolding. Many regions eradicated by 2030 unless bold actions are taken to
and countries are increasingly dealing with accelerate progress, especially actions to address
multiple forms of malnutrition simultaneously. inequality in access to food. The COVID-19 pandemic
This coexistence of undernutrition along has worsened the discouraging trends that already
with overweight and obesity, associated with existed prior to the crisis.
diet-related NCDs, in individuals and within
households and populations, is referred to as the è  Projections that consider the potential impact
“double burden of malnutrition”. 49 For example, of the COVID-19 pandemic suggest that, following a
wasting and overweight in children under 5 years peak of more than 760 million people in 2020, global
can coexist in a population at problematic levels. hunger will decline slowly to fewer than 660 million in
In Oceania (excluding Australia and New Zealand) 2030. Nevertheless, this represents 30 million more
in 2020, wasting prevalence was 9.0 percent people than projected for 2030 had the pandemic not
while overweight prevalence was 8.0 percent. occurred, revealing lasting effects of the pandemic on
Different forms of malnutrition can also interact global food security.
over the life course and across generations.
In order to reach the global targets, malnutrition è  While a substantial reduction in hunger is
must therefore be addressed holistically in policies projected for Asia by 2030 (from 418 million in
and programmes designed at regional and national 2020 to 300 million people), a significant increase
level. 50,51 Identifying opportunities to achieve is forecasted for Africa (from more than 280 to
multiple malnutrition goals and targets with single 300 million people), placing it by 2030 on par
interventions by scaling up so called Double-duty with Asia as the region with the highest number of
Actions will be key to achieve this goal. 52,50 undernourished people.

Various nutrition initiatives and efforts have è  Globally, progress is being made for some forms
culminated in notable progress achieved of malnutrition, but the world is not on track to
globally in exclusive breastfeeding and stunting. achieve targets for any of the nutrition indicators by
However, accelerated actions are needed, not only 2030. The current rate of progress on child stunting,
to maintain progress, but also to make greater exclusive breastfeeding and low birthweight is
strides towards the global nutrition targets insufficient, and progress on child overweight, child
– particularly in the wake of the COV ID-19 wasting, anaemia in women of reproductive age and
pandemic. With increased momentum towards adult obesity is stalled or the situation is worsening.
the UN Food Systems Summit in September 2021
and the Tokyo Nutrition for Growth Summit in è  Despite poor progress at the global level, notable
December 2021, now is the time to make concrete improvements are occurring in some areas, with about
commitments and plans towards eliminating all one-quarter of countries confirmed to be on track to
forms of malnutrition over the second half of the reach the 2030 SDG targets for childhood stunting
UN Decade of Action on Nutrition until 2025 53,54 and wasting and about one in six countries on track to
and towards the 2030 SDGs. n achieve the target on child overweight.

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 THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2021

è  The COVID-19 pandemic has likely impacted the This year’s projections of the elements that
prevalence of multiple forms of malnutrition, and could determine the PoU values up to 2030 were
have lasting effects beyond 2020, as we are already estimated using a structural approach based on
seeing in 2021. These will be compounded through MIR AGRODEP, 55 a dynamic general equilibrium
the intergenerational effects of malnutrition and the model that reproduces the functioning of world
resulting impacts on productivity. Exceptional efforts agricultural and non-agricultural markets,
are required to address and overcome the effects of considers developments in agricultural markets
the pandemic as part of accelerating progress towards and applies them to the economy as a whole
achieving SDG Target 2.2. to generate new equilibrium values of a set of
macroeconomic parameters. The MIR AGRODEP
With ten years left to reach the end of the model was calibrated to the pre-COV ID-19
time horizon set for achieving the SDGs, last situation of the world economy in 2018 and
year’s edition of this report presented a first used to generate projections of macroeconomic
assessment of the likelihood that Targets 2.1 and fundamentals into 2019–2030 under two
2.2 would be achieved. 7 The forecast depicted scenarios: a reference scenario, aimed at
a world that was not on track to achieve Zero capturing the macroeconomic impact of the
Hunger by 2030. Projections also highlighted the COV ID-19 pandemic as ref lected in the latest
tremendous challenges, despite some progress available update of the IMF’s World Economic
on child stunting and low birthweight, to Outlook ( W EO), published in April 2021, hereby
achieving all global nutrition targets by 2030. referred to as the COV ID-19 scenario; and a
This year, with nine years remaining to achieve no-COV ID-19 scenario based on economic
the targets, renewed efforts were made to look growth projections presented in the October
ahead to 2030 in a scenario further complicated 2019 edition of the W EO, the last one before
by the COV ID-19 pandemic. the pandemic.

Towards ending hunger: projections Specifically, trajectories of food supply, economic

growth and real price of food were derived from
to 2030 the COV ID-19 scenario for 171 countries, and of
With respect to SDG Target 2.1, the conclusion povert y rates for 85 countries. These were used,
presented in last year’s report that the target of in turn, to predict the evolution of the DEC for
eradicating hunger would be out of reach was all countries and of the C V for 85 countries.
based on extrapolation of recent trends in the Together with projections of population size
three fundamental variables used to compute and growth rates as provided by the 2019 UN
the prevalence of undernourishment for each World Population Prospects, these were then
country: the total supply of food, the population used to project the future trajectories of the
size and composition (which determine the total three fundamental variables that inform the
dietary energ y requirements) and the degree of PoU (see above). These trajectories were then
inequality in food access within the population. linked to the 2020 nowcasts of the same variables
The simple time-series forecasting methods to generate the projected PoU series from
applied depicted a scenario in which food 2021 to 2030. In the case of the no-COV ID-19
supplies would not keep pace with population scenario, the trajectories of the fundamental
growth, hence reducing the availability of food in variables beginning from 2019 were linked to the
per capita terms, while inequality in food access pre-COV ID-19 situation in 2018 (for details, see
continued to increase. Annex 2). Both scenarios assume the trajectories
are not disrupted by new conf licts, climate
Clearly, a method that projects the future by variabilit y and extreme weather events, and
extrapolating past trends cannot properly account economic downturns, the main drivers of recent
for the consequences that an unprecedented increases in food insecurit y (see Chapter 3).
shock like the COV ID-19 pandemic has had – They also assume that momentous actions needed
and may continue to have – on the drivers of to transform food systems for food securit y and
food insecurit y. Therefore, for this edition of the decrease inequalities in access to food (Chapter 4)
report, a different approach was used. are not implemented.

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 CHAPTER 2 FOOD SECURITY AND NUTRITION AROUND THE WORLD

FIGURE 10 THE COVID-19 SCENARIO PROJECTS A SMALL DECREASE IN GLOBAL HUNGER BETWEEN 2021
AND 2030, WITH WIDE VARIATION IN EVOLUTION ACROSS REGIONS

800 768.0

700
656.8
NUMBER OF UNDERNOURISHED (MILLIONS)

650.3
600 624.1

500

418.0
400
299.3
361.3 299.5
300 281.6
290.8
283.0
200 235.3

100
45.9 59.7 52.2
45.4
0
2015 2019 2020* 2030*

World Africa Asia Latin America and the Caribbean

Projections for the COVID-19 scenario Projections for the no-COVID-19 scenario

NOTES: * Projected values. The 2020 projected values are based on the middle of the projected range. The full ranges can be found in Annex 2.
SOURCE: FAO.

Figure 10 shows the projected series of the undernourished people. Numbers remain
number of undernourished globally and stable in Latin America and the Caribbean, and
at regional level. Under the COV ID-19 marginal in other regions.
scenario, following a projected peak of around
768 million (9.9 percent of the population) in Comparing the COV ID-19 scenario to the
2020, global hunger would decrease to around hy pothetical no-COV ID-19 scenario, we see that
710 million in 2021 (9.0 percent), and then global hunger in 2030 is projected to be above the
continue to decrease marginally to less than level it would have been had the pandemic not
660 million (7.7 percent) in 2030. However, the occurred. About 30 million more people may face
evolution from 2020 to 2030 is quite different hunger in 2030 compared with the no-COV ID-19
across regions. While a substantial reduction scenario, revealing possible persistent effects of
is projected for Asia (from 418 to 300 million the pandemic on global food securit y.
people), a significant increase is forecast for
Africa (from more than 280 to 300 million A closer look at the underlying parameters
people), placing it on par with Asia by 2030 that inform the estimates of the number of
as the region with the highest number of undernourished (see Box 2 and Annex 2) sheds

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 THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2021

light on what is driving this higher projected the COV ID-19 pandemic, does not give weight
number due to the COV ID-19 pandemic in to the more recent trends and does not factor in
2030. We obser ve that while the COV ID-19 future potential change in trends.
scenario indicates that food supplies will return
to levels that would have prevailed under the Globally, progress has been made for some forms
no-COV ID-19 scenario, it also predicts the of malnutrition, but the world is not on track to
pandemic will have a lasting impact on GDP achieve targets for any of the nutrition indicators
growth rates, income inequalit y and povert y by 2030. The current rate of progress on child
rates that will not be fully absorbed by 2030, thus stunting, exclusive breastfeeding and low
inducing higher levels of inequalit y in food access birthweight is insufficient, and progress on child
in the COV ID-19 scenario compared with the overweight, child wasting, anaemia in women of
no-COV ID-19 scenario. This greater inequalit y reproductive age and adult obesit y is stalled (no
in access to food would therefore be mostly progress) or the situation is worsening ( Table 7).
responsible for the obser ved difference.
Progress has been uneven across regions ( Table 7
The structural approach used to inform the and Figure 11). While almost all subregions are
new projections confirms the fundamental either on track or making some strides towards
result anticipated last year: hunger will not be reducing child stunting, too many are still
eradicated by 2030 unless exceptional efforts off track to reach the other global nutrition
are deployed. The prospects were already targets, pointing to the need for accelerated
discouraging before the COV ID-19 pandemic, actions to change course between now and
which has aggravated the situation. Bold actions 2030. The current level of wasting remains well
are needed to accelerate progress – especially above the 5 percent global target for 2025 and
actions to address inequalit y in access to food the 3 percent global target for 2030. While Latin
(see Chapter 4). America and the Caribbean is on track for
wasting, other regions remain off track, with
Towards ending all forms of malnutrition: many children suffering from this life-threatening
projections to 2030 condition. Most regions are showing no progress
or are worsening with respect to the prevalence
With respect to SDG Target 2.2 and the W H A of children under 5 who are overweight.
global nutrition targets, last year’s report also Particularly concerning are the worsening trends
pointed to insufficient progress towards ending seen in Eastern Asia and South-eastern Asia, and
malnutrition in all its forms, even without Australia and New Zealand. The prevalence of
taking the impact of the COV ID-19 pandemic overweight is greater among older age groups,
into account. Like the projections for hunger, and preventive interventions in early childhood
estimates regarding levels of malnutrition in 2030 are critical to reduce the risk of overweight
are characterized by a high level of uncertaint y. and obesity across the life course. 5 Meaningful
Household sur vey data on child height and progress in this area is needed to reduce child
weight were, in most cases, not collected in 2020 overweight to less than 3 percent; such efforts
due to physical distancing measures; moreover, would also likely contribute to stem the alarming
the future of the COV ID-19 pandemic, and its rise in adult obesity, which is worsening in all
impacts over the next decade, are unknown. subregions. No subregion is on track to achieve
For this reason, the same approach applied either the 2025 or 2030 targets on reducing
in the last edition of this report to project anaemia in women of reproductive age, with
the nutritional indicators was used, which is trends stagnating or worsening in all regions
based on the rate of obser ved trends before the except Latin America and the Caribbean.
pandemic. This rate was then compared with Likewise, based on the latest estimates, no
the rate of progress required to achieve the 2030 subregion is on track to reach the 2025 or 2030
targets to provide an assessment of progress global targets for low birthweight.
towards the global nutrition targets (see Box 5
and Annex 2). The limitations of this approach, If current trends continue, the world is
however, are that it does not include the effect of expected to reach the 2025 target for exclusive »

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CHAPTER 2 FOOD SECURITY AND NUTRITION AROUND THE WORLD

TABLE 7 MOST REGIONS HAVE MADE SOME PROGRESS, BUT NOT ENOUGH TO ACHIEVE GLOBAL TARGETS IF
TRENDS (BEFORE COVID-19) CONTINUE; NO SUBREGION IS ON TRACK FOR THE LOW BIRTHWEIGHT TARGET,
AND ADULT OBESITY HAS BEEN WORSENING IN ALL SUBREGIONS
Anaemia in
Child Low Exclusive
Child stunting Child overweight women of Adult obesityc
wastinga birthweighta breastfeedingb
(percent) (percent) reproductive (percent)
(percent) (percent) (percent)
age (percent)
2012

2020

2030

2012

2020

2030

2020

2030

2012

2015

2030

2012

2019

2030

2012

2019

2030

2012

2016

2025
World 26.2 22.0 5.6 5.7 6.7 15.0 14.6 37.0 44.0 28.5 29.9 11.7 13.2

Africa 34.5 30.7 5.0 5.3 6.0 14.1 13.7 35.5 43.6 39.2 38.9 10.4 11.8

Northern Africa 22.7 21.4 12.0 13.0 6.6 12.4 12.2 40.7 42.1 31.9 31.1 22.5 25.4

Sub-Saharan Africa 36.6 32.3 3.8 4.0 5.9 14.4 14.0 34.5 44.0 41.2 40.7 6.9 8.0

Eastern Africa 38.9 32.6 4.0 4.0 5.2 13.8 13.4 48.6 60.7 31.4 31.9 4.3 5.2

Middle Africa 38.0 36.8 4.4 4.8 6.2 12.8 12.5 28.5 n.a. 46.1 43.2 5.5 6.6

Southern Africa 24.3 23.3 12.1 12.1 3.2 14.3 14.2 n.a. 33.5 28.5 30.3 23.2 25.6

Western Africa 34.9 30.9 2.3 2.7 6.9 15.6 15.2 22.1 32.3 52.9 51.8 6.4 7.7

Asia 28.1 21.8 4.9 5.2 8.9 17.8 17.3 39.0 45.3 31.1 32.7 6.0 7.3
Central Asia and
39.2 29.8 3.1 2.7 13.6 26.4 25.5 46.6 56.6 47.5 47.5 4.6 5.7
Southern Asia
Central Asia 15.4 10.0 8.5 5.6 2.3 5.6 5.4 29.2 44.8 28.8 28.1 14.4 16.8

Southern Asia 40.2 30.7 2.9 2.5 14.1 27.2 26.4 47.4 57.2 48.3 48.2 4.2 5.2
Eastern Asia and
16.0 13.4 6.5 7.7 4.1 8.0 8.0 30.4 29.8 18.2 19.5 5.1 6.5
South-eastern Asia
Eastern Asia 7.5 4.9 6.8 7.9 1.7 5.1 5.1 28.5 22.0 15.5 16.1 5.0 6.4
South-eastern
30.5 27.4 5.8 7.5 8.2 12.4 12.3 33.5 47.9 25.0 27.2 5.3 6.7
Asia
Western Asia 17.8 13.9 9.0 8.3 3.5 10.0 9.9 32.3 33.1 31.7 32.5 25.7 28.6
Western Asia and
20.3 17.8 10.5 10.8 5.1 11.2 11.1 37.4 38.7 31.8 31.8 24.2 27.2
Northern Africa
Latin America
12.8 11.3 7.3 7.5 1.3 8.7 8.7 33.4 n.a. 18.2 17.2 21.7 24.1
and the Caribbean
Caribbean 13.2 11.8 6.4 6.6 2.8 10.1 9.9 29.7 25.9 28.7 29.2 21.9 24.8

Central America 17.9 16.6 6.6 6.3 0.9 8.8 8.7 21.6 33.2 15.2 14.6 24.2 26.6

South America 10.2 8.6 7.7 8.2 1.4 8.6 8.6 41.9 n.a. 18.4 17.3 20.8 23.0
Oceania excluding
Australia and  40.3 41.4 7.3 8.0 9.0 10.0 9.9 56.9 61.3 32.9 33.9 20.1 22.4
New Zealand
Australia and New
2.4 2.3 12.9 16.9 n.a. 6.2 6.4 n.a. n.a. 7.6 8.8 28.2 30.7
Zealand
Northern America
4.4 4.0 9.3 8.6 n.a. 7.0 7.0 n.a. n.a. 13.1 14.6 26.7 29.0
and Europe
Europe 5.3 4.5 9.6 8.3 n.a. 6.6 6.5 n.a. n.a. 14.5 16.0 23.4 25.4
Northern America 2.8 3.2 8.8 9.1 0.2 7.9 7.9 25.5 34.7 9.9 11.7 34.1 36.7

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 THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2021

TABLE 7 (CONTINUED)
Child stunting, child overweight, Low birthweight and exclusive Adult obesity
child wasting and anaemia breastfeeding
On track On track On track
Off track – some progress Off track – some progress Off track – worsening
Off track – no progress Off track – no progress or Assessment not possible
worsening
Off track – worsening
Assessment not possible
Assessment not possible

NOTES: Details on the methodology to assess progress can be found in Annex 2; n.a. shown where population coverage is under 50 percent. a Wasting
and low birthweight regional aggregates exclude Japan. b Exclusive breastfeeding: Regional averages are population weighted using the most recent
estimate for each country between 2005 and 2012 (2012 column) and 2014 to 2019 (2019 column), except for China where a 2013 estimate is used for
2019 aggregates; estimates in the 2012 and 2019 columns do not have the same subset of countries. c Adult obesity: There is no official target for adult
obesity for 2030.
SOURCES: UNICEF, WHO & World Bank. 2021. UNICEF-WHO-World Bank: Joint child malnutrition estimates - Levels and trends (2021 edition) [online].
https://data.unicef.org/resources/jme-report-2021, www.who.int/data/gho/data/themes/topics/joint-child-malnutrition-estimates-unicef-who-wb,
https://datatopics.worldbank.org/child-malnutrition; NCD Risk Factor Collaboration (NCD-RisC). 2017. Worldwide trends in body-mass index,
underweight, overweight and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children,
adolescents and adults. The Lancet, 390(10113): 2627–2642; UNICEF & WHO. 2019. UNICEF-WHO Joint Low Birthweight Estimates [online]. [Cited 28
April 2020]. www.unicef.org/reports/UNICEF-WHO-low-birthweight-estimates-2019; www.who.int/nutrition/publications/UNICEF-WHO-lowbirthweight-
estimates-2019; UNICEF. 2020. UNICEF Global Database on Infant and Young Child Feeding. In: UNICEF [online]. New York, USA. [Cited 19 April 2021].
data.unicef.org/topic/nutrition/infant-and-young-child-feeding; data for anaemia are based on WHO. 2021. Global Health Observatory (GHO). In: WHO
[online]. Geneva, Switzerland. [Cited 26 April 2021] www.who.int/data/gho/data/themes/topics/anaemia_in_women_and_children; data for adult obesity
are based on WHO. 2017. Global Health Observatory (GHO). In: WHO [online]. Geneva, Switzerland. [Cited 2 May 2019]. www.who.int/data/gho/data/
indicators/indicator-details/GHO/prevalence-of-obesity-among-adults-bmi-=-30-(age-standardized-estimate)-(-)

BOX 5 ASSESSMENT OF PROGRESS TOWARDS 2030 TARGETS FOR NUTRITION INDICATORS

To determine which progress assessment category experienced to date is calculated using a trendline
to use for each indicator and for each region, two comprising all*** estimates available between 2012
distinct average annual rates of reduction (AARR)* (baseline) and the latest available estimate for that
are calculated: (i) the AARR required for the indicator. For example, for child overweight, the
region to reach the 2030 target and (ii) the actual trendline to assess the actual AARR uses the nine
AARR that the region has experienced to date. annual point estimates from 2012 (baseline) to 2020
The required AARR is calculated using the baseline (the latest available estimate). For a region to be
prevalence for the region in 2012 and the target considered “on track” towards a specific target, the
prevalence as noted in the 2030 Maternal Infant actual AARR must be higher than the required AARR
and Young Child Nutrition targets.** For example, for that target.**** For the “off track” categories, the
for child overweight, the required AARR at the AARR ranges associated with each category (some
global level is the annual rate of change needed progress, no progress, worsening) vary by indicator.
to go from a prevalence of 5.6 percent in 2012 to See Annex 2 for further details.
the targeted 3.0 percent in 2030. The actual AARR

* See technical note on how to calculate AARR (available at: https://data.unicef.org/resources/technical-note-calculate-average-annual-rate-reduction-

aarr-underweight-prevalence). Note that for wasting, AARR based on trend estimates from the UNICEF-WHO-World Bank Joint Malnutrition Estimates are
used even if trends are unpublished.
** The 2030 targets for six of the seven indicators are available from The extension of the 2025 Maternal, Infant and Young Child nutrition targets to
2030. 26 Please note that only a 2025 target is available for adult obesity.
*** Multiple years of data are used to calculate the actual AARRs experienced to date for all indicators except exclusive breastfeeding, for which modelled
estimates are not available and which is calculated using only two estimates: the baseline (2012) and the latest year available (2019).
**** A static threshold for the latest prevalence is also used for some indicators; for example, any country for which the most recent stunting prevalence is
below 3 percent is considered “on track”, even if the AARR is less than the required AARR (see Annex 2).

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 CHAPTER 2 FOOD SECURITY AND NUTRITION AROUND THE WORLD

FIGURE 11 SOME PROGRESS HAS BEEN MADE ON MALNUTRITION, BUT THE PACE MUST BE ACCELERATED,
AND TRENDS IN SOME FORMS OF MALNUTRITION MUST BE REVERSED TO ACHIEVE THE 2025 AND 2030
GLOBAL NUTRITION TARGETS

LOW STUNTING OVERWEIGHT WASTING1,2

BIRTHWEIGHT (under 5 years) (under 5 years) (under 5 years)

20 45 10 10
18 40 9 9
16 35 8 8
PREVALENCE (%)

14 7 7
30
12 6 6
25
10 5 5
20 2025 target
8 4 4
15
6 3 3
10 2030 target
4 2 2
2 5 1 1
0 0 0 0
2012 2015 20254 20304 2012 20203 20254 20304 2012 20203 20254 20304 20203

EXCLUSIVE BREASTFEEDING2 ANAEMIA OBESITY

(< 6 months) (women of reproductive age) (adults)
80 40 40

70 35 35

60 30 30
PREVALENCE (%)

50 25 25

40 20 20

30 15 15

20 10 10

10 5 5

0 0 0
2012 2019 20254 20304 2012 2019 20254 20304 2012 2016 20254 20304

World Africa Asia5 Latin America and the Caribbean Northern America, Europe and
Australia and New Zealand
Oceania excluding Australia and New Zealand Global targets

NOTES: 1 Wasting is an acute condition that can change frequently and rapidly over the course of a calendar year. This makes it difficult to generate
reliable trends over time with the input data available and, as such, this report provides only the most recent global and regional estimates. 2 For wasting
and exclusive breastfeeding, estimates are not shown for regions/years where population coverage was below 50 percent. 3 The collection of household
survey data on child height and weight were limited in 2020 due to the physical distancing measures required to prevent the spread of COVID-19. Only
four national surveys included in the database were carried out (at least partially) in 2020. The estimates on child stunting, wasting and overweight are
therefore based almost entirely on data collected before 2020 and do not take into account the impact of the COVID-19 pandemic. 4 For methods on
projections to 2025 and 2030, see Annex 2. 5 For wasting and low birthweight, the Asia estimate excludes Japan.
SOURCES: Data for low birthweight are based on UNICEF & WHO. 2019. UNICEF-WHO Low Birthweight Estimates: levels and trends 2000–2015, May
2019. In: UNICEF [online]. New York, USA, UNICEF [Cited 19 April 2021]. https://data.unicef.org/resources/unicef-who-low-birthweight-estimates-levels-
and-trends-2000-2015; data for stunting, wasting and overweight are based on UNICEF, WHO & World Bank. 2021. UNICEF-WHO-World Bank: Joint child
malnutrition estimates - Levels and trends (2021 edition) [online]. https://data.unicef.org/resources/jme-report-2021, www.who.int/data/gho/data/themes/
topics/joint-child-malnutrition-estimates-unicef-who-wb, https://datatopics.worldbank.org/child-malnutrition; data for exclusive breastfeeding are based
on UNICEF. 2020. UNICEF Global Database on Infant and Young Child Feeding. In: UNICEF [online]. New York, USA. [Cited 19 April 2021]. data.unicef.
org/topic/nutrition/infant-and-young-child-feeding; data for anaemia are based on WHO. 2021. Global Health Observatory (GHO). In: WHO [online].
Geneva, Switzerland. [Cited 26 April 2021] www.who.int/data/gho/data/themes/topics/anaemia_in_women_and_children; data for adult obesity are
based on WHO. 2017. Global Health Observatory (GHO). In: WHO [online]. Geneva, Switzerland. [Cited 2 May 2019]. www.who.int/data/gho/data/
indicators/indicator-details/GHO/prevalence-of-obesity-among-adults-bmi-=-30-(age-standardized-estimate)-(-)

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 THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2021

» breastfeeding, but not the 2030 target. progress towards the global nutrition targets
Most subregions are making at least some if the trends prior to the pandemic were to
progress towards the 2030 target, except continue to 2030. This section presents a scenario
Eastern Asia and the Caribbean – the only (see Box 6) of how the COV ID-19 pandemic could
subregions experiencing a decline in prevalence. potentially affect the prevalence of child stunting
Central America is nearly on track to reach the and wasting by 2030. While any such projections
2030 target for exclusive breastfeeding, missing are highly speculative, they nevertheless
the target by only one year if current trends illustrate one important point: in a context in
continue. If current rates of progress for exclusive which additional effort, attention and action
breastfeeding are maintained in Central Asia and were already called for prior to the pandemic,
Southern Asia, these subregions will reach the even more will be needed now – in a situation
2030 target. worsened by the COV ID-19 pandemic – to get on
track to reach the 2030 targets.
Most regions are making some progress, but not
enough to achieve the global nutrition targets. Under a no-COV ID-19 scenario, if the A A RR of
Where progress is being made at the regional child stunting before the COV ID-19 pandemic
level, it can often mask the lack of countr y-level were to continue, 23.2 percent of children under
progress. Figure 12 shows the percentage of five years would be expected to be stunted
countries in each region that are on track and in 2022. In comparison, projections from our
off track, with off track countries differentiated COV ID-19 scenario indicate that 23.9 percent
by whether they are making some progress, no of children under five years would be stunted
progress or worsening. For the target to reduce in the year 2022 under the pessimistic scenario
the number of children affected by stunting ( Figure 13A), and 23.7 percent under the moderate
by 50 percent, only 25 percent of countries are scenario. While this represents only a small
confirmed to be on track, and within the Africa increase in prevalence, even this marginal
region, only 9 percent of countries are on track increase would result in 4.5 and 3.4 million
(five countries). For the target to reduce wasting additional stunted children in the year 2022
levels to less than 3 percent, only 28 percent of alone under the pessimistic and moderate
countries seem to be on track based on available scenarios, respectively.
data (57 countries). Particularly concerning
are the trends in Africa and Asia, where more When making projections to 2030, it is important
than half of the countries with data are off to consider the cumulative and chronic nature
track or worsening. Globally, a mere 17 percent of childhood stunting, as once a child is
of countries are confirmed to be on track to stunted, he or she will most likely remain
achieve the target of reducing child overweight stunted in subsequent years. This will result
prevalence to less than 3 percent; no countries in double-counting if the number of additional
are on track in Latin America and the Caribbean stunted children is aggregated ever y year.
and only 2 percent of countries are on track in To avoid this, we assume that 35 percent of
Northern America and Europe, and Australia and the total number of stunted children each year
New Zealand. In 2020, about half of the world’s contributes to the additional stunted population
children under five lived in countries that were in subsequent years. Furthermore, if we assume
not on track to achieve any of the three 2030 that from 2022 to 2030, trends in stunting follow
SDG targets for stunting, wasting or overweight. the pre-COV ID-19 trajector y, an additional 16 to
This analysis provides clear evidence of the need 22 million children in low- and middle-income
to step up efforts to eliminate child malnutrition countries will be stunted between the years 2020
if the targets are to be met by 2030. and 2030 under the moderate and pessimistic
scenarios, respectively, compared with the
Potential additional cases of stunting and wasting scenario without the COV ID-19 pandemic.
due to the COVID-19 pandemic
The projections presented above do not account The projected additional numbers of stunted
for the effect of the COV ID-19 pandemic on children almost certainly underestimate the full
malnutrition. They describe the projected impact of the COV ID-19 pandemic on stunting

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CHAPTER 2 FOOD SECURITY AND NUTRITION AROUND THE WORLD

FIGURE 12 AROUND HALF OF CHILDREN LIVE IN COUNTRIES THAT ARE NOT ON TRACK TO REACH ONE OF
THE 2030 SDG TARGETS FOR CHILD STUNTING, WASTING AND OVERWEIGHT

Progress towards the child malnutrition SDG targets by:

Percentage* of CHILDREN Percentage* of COUNTRIES
GLOBAL GLOBAL REGIONAL
2% 5% Africa
25% n=54
8% 25%
Asia
STUNTING

42% n=48
Latin America and the Caribbean
5% n=37
Oceania***
8% n=15
42%
36% Northern America, Europe and
Australia and New Zealand
n=48

14% Africa
n=54
28%
36% Asia
n=48
WASTING

49% Latin America and the Caribbean

21%
n=37

8% Oceania***
n=15
8% 9% Northern America, Europe and
21% 6% Australia and New Zealand
n=48

6% Africa
25% 17% n=54
Asia
OVERWEIGHT

n=48
27% 42% 9% Latin America and the Caribbean
n=37
Oceania***
17% n=15
Northern America, Europe and
2% 32% Australia and New Zealand
22%
n=48
0 20 40 60 80 100

On track** Off track – some progress** Off track – no progress** Off track – worsening** Assessment not possible**

NOTES: * Percentages may not add up to 100 percent due to rounding. ** See notes on progress assessment categories in Annex 2. *** Oceania excluding
Australia and New Zealand.
SOURCE: UNICEF, WHO & World Bank. 2021. UNICEF-WHO-World Bank: Joint child malnutrition estimates - Levels and trends (2021 edition) [online].
https://data.unicef.org/resources/jme-report-2021, www.who.int/data/gho/data/themes/topics/joint-child-malnutrition-estimates-unicef-who-wb,
https://datatopics.worldbank.org/child-malnutrition

for several reasons. The effects of stunting will in the conditions that contribute to increased
last beyond age 5 throughout the life course and stunting, such as poor nutrition and disruptions
can have intergenerational effects, as stunted in access to health and nutrition ser vices, it is
adults are more likely to earn less income possible that the additional number of children
and stunted mothers are more likely to give who are stunted will increase over time (scenario
birth to children who will be stunted, leading not shown). Furthermore, there will also be
to intergenerational effects of povert y and an intergenerational effect from deteriorating
stunting. Also, if there are persistent effects of maternal nutrition during the COV ID-19
the COV ID-19 pandemic and no improvement pandemic (not shown), leading to more mothers

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 THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2021

BOX 6 METHODOLOGY: ESTIMATES OF POTENTIAL ADDITIONAL CASES OF STUNTING AND WASTING DUE
TO THE COVID-19 PANDEMIC BASED ON A SCENARIO

Given the interest in understanding how the wasting (or stunting) prevalence estimates for low-
COVID-19 pandemic may shape progress towards and middle-income countries from the UNICEF/
2030 global nutrition targets, and the lack of WHO/World Bank Joint Malnutrition Estimates
global data directly measuring malnutrition status (JME) Working Group. This increase in prevalence
during the pandemic in 2020, a crude scenario was due to the COVID-19 pandemic under the moderate
developed to consider potential implications. and pessimistic scenarios was extrapolated to all
As described in Section 2.2, results of one 135 low- and middle-income countries for each of
published modelling exercise covering 118 low- the three years to calculate the projected relative
and middle-income countries estimated how the increase in prevalence and number of children
prevalence of childhood stunting and wasting may stunted and wasted for 2020, 2021 and 2022.
increase between 2020 and 2022 under moderate To generate projections for the prevalence
and pessimistic assumptions.47 These estimates of of stunting and wasting from 2022 to 2030, the
increased wasting and stunting in 118 countries trajectory (AARR) for the pre-COVID-19 scenario was
were extrapolated to all 135 low- and middle-income applied to the 2022 prevalence under each scenario.
countries for 2020–2022. For the projection of The pre-COVID-19 AARR was calculated from all
additional cases between 2020 and 2030 due to data points available from 2012 to 2020 of the
the COVID-19 pandemic in this section, a scenario JME estimates.
where low- and middle-income countries no longer This COVID-19 scenario was created for
experience an increase in stunting and wasting after illustrative purposes to discuss the potential impact
2022, but rather return to the pre-COVID annual of the COVID-19 pandemic on wasting and stunting.
average rate of reduction (AARR), was applied to The real impact of the pandemic on child stunting
hypothesize a potential scenario. and wasting, as well as other forms of malnutrition,
For the three-year period of 2020–2022, the by 2030 is difficult to predict and is influenced by
increase in prevalence of wasting (and stunting) due multiple pathways. There are many unknown factors,
to the COVID-19 pandemic was calculated for the such as the extent and scope of virus mutations;
moderate and pessimistic scenarios of a modelling potential resurgence of the epidemic and associated
exercise of 118 countries.47 First, the additional mitigation practices in various settings; the trajectory
prevalence was estimated by dividing the predicted of economic recovery; the speed at which any
additional cases from the modelling exercise by the disruptions of essential nutrition services and food
projected populations of the UN World Population access will subside; and whether there may be other
Prospects. Then the increased prevalence in wasting shocks and what the lasting effects of those shocks
(or stunting) was derived by calculating the ratio might be. This section presents merely a scenario to
of the additional prevalence compared with the illustrate potential repercussions.

with inadequate nutrition giving birth to a children under 5 would be stunted in 2030 in the
cohort of children who are more likely to be 135 low- and middle-income countries, which is
stunted (and to experience wasting), which would well above 85 million, the 2030 SDG target of a
increase the number of stunted children above 50 percent reduction in the number of children
our current scenario. 56 under five who are stunted. Our COV ID-19
scenario projects 125 to 127 million stunted
Of the seven global nutrition targets, the most children in the year 2030 (20.4 to 20.7 percent),
progress in the past two decades has been which is 5 to 7 million more children than
achieved on child stunting. Still, even before if pre-COV ID trends continued without the
the pandemic, it was projected that 119 million effect of COV ID-19, and 42 million above the

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 CHAPTER 2 FOOD SECURITY AND NUTRITION AROUND THE WORLD

FIGURE 13 CONSERVATIVE ESTIMATES OF THE POTENTIAL IMPACTS OF THE COVID-19 PANDEMIC INDICATE
THAT AN ADDITIONAL 5 TO 7 MILLION CHILDREN MAY BE STUNTED, AND 570 THOUSAND TO 2.8 MILLION
MORE WASTED, IN LOW- AND MIDDLE-INCOME COUNTRIES IN THE YEAR 2030. HOWEVER, THE ESTIMATE
OF ACCUMULATED ADDITIONAL CASES OF WASTING FROM 2020 TO 2030 IS 16 TO 40 MILLION

A) CHILD STUNTING B) CHILD WASTING

30 10

25 8
PERCENTAGE

20 6

15 4
2012 2020 2022 2030 2012 2020 2022 2030

Trend and pre-COVID-19 projections Moderate scenario and projections Pessimistic scenario and projections

NOTES: Wasting is an acute condition that can change frequently and rapidly over the course of a calendar year. This makes it difficult to generate
reliable trends over time with the input data available; this trend is not an official estimate but is shown as a scenario for this exercise.
SOURCES: UNICEF and WHO analysis of potential impact of the COVID-19 pandemic on stunting and wasting, based on extrapolation of increase in
wasting and stunting from a modelling exercise 47 and joint malnutrition estimates of trends and average annual rate of reduction before the COVID-19
pandemic. 32 See Box 6 for more details.

SDG target ( Figure 13A). Comprehensive efforts to countries is projected to increase to

address the detrimental impacts of the COV ID-19 8.0 percent in 2020, 7.8 percent in 2021 and
pandemic on maternal and child nutrition are 7.2 percent in 2022 ( Figure 13B), resulting in
crucial to return to the pre-COV ID-19 level of an additional 16 million children affected by
progress, and achieve the 2030 global target for wasting between 2020 and 2022. Under the
childhood stunting. moderate scenario, 11 million additional
children in low- and middle-income countries
With respect to child wasting, under a will suffer from wasting in the three-year
no-COV ID-19 scenario, it is estimated that period. If we assume that after 2022, trends in
6.8 percent of children under 5 years in low- wasting follow a similar pattern to the trend
and middle-income countries were affected before the COV ID-19 pandemic, an additional
by this acute form of undernutrition in 2020. 32 16 to 40 million children will be affected by
If the effect of the COV ID-19 pandemic is wasting between 2020 and 2030, under the
considered, under the pessimistic scenario, the moderate and pessimistic modelled scenarios,
wasting prevalence in low- and middle-income respectively.

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 THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2021

This does not take into account any large future continue to unfold, the trajectory over the next
shocks or emergencies that could cause a spike years is difficult to foresee. Evidence is still scarce
in the number of children affected by wasting. on the actual effects of the COVID-19 pandemic
The application of the pre-COV ID-19 A A RR on various forms of malnutrition, including on the
from 2022–2030 also may not take into account prevalence of child stunting, wasting, overweight,
relevant seasonalities associated with wasting. adult obesity, anaemia in women of reproductive
This is because the A A RR used represents trends age, low birthweight and exclusive breastfeeding.
in sur vey time points that capture a specific These effects will be compounded through the
cross-section of f luctuating wasting caseload intergenerational effects of malnutrition and
and may not be representative of overall trends. the resulting impact on productivity and, hence,
Nevertheless, the immediate effects of the economic recovery. However, it is clear that the
COV ID-19 pandemic are manifested first in the COVID-19 pandemic has likely impacted the
acute condition of child wasting and, if economic prevalence of multiple forms of malnutrition, and
conditions, food access and dietar y patterns do could have lasting effects beyond 2020, as we are
not recover fully, levels of child wasting globally already seeing in 2021. Therefore, exceptional
will be elevated. Moreover, the management of efforts are required to address and overcome the
moderate and severe undernutrition was one of effects of the pandemic as part of accelerating
the most frequently disrupted ser vices. progress towards achieving SDG Target 2.2.

Based on the scenarios accounting for While the simple projected scenarios showing
COV ID-19, it is projected that 6.1 to 6.5 percent a reversal in progress are discouraging, if the
of children under five (37.3 to 39.6 million right policies and actions are put in place now,
children) will be wasted in 2030 under the it is possible to get the world on track towards
moderate and pessimistic scenarios, respectively, zero hunger and malnutrition. In the context
in low- and middle-income countries ( Figure 13B). of declining Overseas Development Assistance
This represents 570 thousand to 2.8 million projections, this would require sufficient and
more children compared with the no-COV ID-19 innovative financing, strong commitment and
scenario, and implies a level of wasting which efficient deliver y to ensure essential nutrition
is twice as high as the global target of 3 percent ser vices are provided to the population in
in 2030. Thus, if the rise in child wasting is need. Just as the v ulnerabilities of food systems
not prevented, and there are disruptions in have been laid bare by the pandemic, so have
caring for these children, child mortalit y will many of the actions needed to strengthen their
increase as well. Clearly, the prevention, care, resilience to the various drivers that have been
management and treatment of child wasting undermining progress. Chapter 3 provides an
requires urgent attention. integrated analysis of these drivers and Chapter 4
lays out pathways for transforming food systems
As the pandemic continues with no clear end that can help get the world back on track towards
in sight, and the economic and other impacts zero hunger and malnutrition. n

| 49 |
UGANDA
Agro-pastoralist women
collect harvest greens
next to their crops near
the Kenyan border.
©FAO/Luis Tato
CHAPTER 3
MAJOR DRIVERS
OF RECENT FOOD
SECURITY AND
NUTRITION TRENDS

è  High income inequality magnifies the negative

KEY MESSAGES impact of these drivers on food insecurity for
middle-income countries. While middle-income
è  In the last ten years, the frequency and intensity countries affected by these drivers show a 2 percent
of conflict, climate variability and extremes, and increase in the PoU between 2017 and 2019, for those
economic slowdowns and downturns have increased countries with high income inequality, the increase is
significantly. The increased occurrence of these major double – 4 percent.
drivers, now exacerbated by the COVID-19 pandemic,
has led to a rise in hunger and has undermined è  Low-income countries affected by these drivers
progress in reducing all forms of malnutrition, show the largest increase in the PoU from 2017 to 2019;
particularly in low- and middle-income countries. the increases in their PoU are 2.5 times greater than
increases in middle-income countries affected by these
è  Economic downturns in 2020, including those drivers during the same period.
resulting from COVID-19 containment measures,
contributed to one of the largest increases in world è  Countries affected by economic downturns in Africa,
hunger in decades, affecting almost all low- and Asia, and Latin America and the Caribbean show the
middle-income countries. When economic downturns highest increase in the PoU compared with countries
occurred along with other drivers, particularly affected by climate extremes and conflict from 2017
climate-related disasters, conflict, or a combination to 2019. Africa is the only region where such a surge is
of both, the largest increases in the PoU occurred in associated with all three major drivers.
Africa, followed by Asia.
è  New evidence suggests that recent increases in
è  Each of these major drivers is unique and, while the unaffordability of healthy diets are associated with
they are external to food systems, they interact to increases in both severe and moderate forms of food
create multiple, compounding impacts at many insecurity, especially in lower-middle-income countries.
different points within food systems, to the detriment
of food security and nutrition. è  Drivers that are external (e.g. conflict and climate
shocks) and internal (e.g. low productivity and inefficient
è  Seventy percent of low- and middle-income food supply chains) to food systems are pushing up
countries are affected by at least one of the drivers the cost of nutritious foods which, combined with low
and 41 percent also have high income inequality (38 of incomes, is increasing the unaffordability of healthy diets.
93 countries), which worsens their impact.
è  Countries affected by multiple drivers exhibited in
è  The majority of undernourished people and stunted 2019 the highest percentage of the population who
children live in countries affected by multiple drivers. cannot afford a healthy diet (68 percent), which is, on
Between 2017 and 2019, in all regions, countries average, 39 and 66 percent higher than that of countries
affected by multiple drivers exhibit the highest affected by a single driver or not affected by any driver,
increases in the PoU – 12 times larger than those in respectively. The unaffordability of healthy diets tends
countries affected by only a single driver. to be higher where there is conflict.

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CHAPTER 3 MAJOR DRIVERS OF RECENT FOOD SECURITY AND NUTRITION TRENDS

3.1 and inclusivit y, are broader as they encompass

A FOOD SYSTEMS both agricultural and food systems and focus on

both food and non-food agricultural products,

LENS IS CRITICAL TO with clear overlaps (see Chapter 4, Figure 29).

While broader agri-food systems transformation

ADDRESS THE MAJOR is of utmost importance, it is beyond the scope of

this report.

DRIVERS OF RECENT Importantly, food systems perform a central role

FOOD SECURITY AND not only in determining the quantit y, qualit y,

diversit y and nutritional content of the foods

NUTRITION TRENDS available for consumption, but also in sustaining

the livelihoods of millions of people around
the world. In addition, food systems have a
As highlighted in the last four editions of major impact on human health (both positive
this report, as well as Chapter 1 (see Box 1), and negative) through a variet y of different
conf lict, climate variabilit y and extremes, and channels, 66 and on the environmental and
economic slowdowns and downturns are ecosystem health of our planet. As such, how
challenging efforts to end hunger and all forms food systems function, the cost and qualit y of
of malnutrition. Their adverse inf luence is made the food they deliver, and the impact they have
all the more difficult by high and persistent levels on the health of people and our planet, directly
of inequalit y. In addition, millions of people and indirectly impacts outcomes of food securit y
around the world suffer from food insecurit y and nutrition. Therefore, any analysis of the
and different forms of malnutrition because they after-mentioned drivers and their impacts must
cannot afford the cost of healthy diets. 7 This is be viewed through a food systems lens, which
because other drivers are pushing up the cost involves considering trade-offs and synergies
of nutritious foods throughout the food system, between these different outcomes.
including low productivit y, inefficient food
supply chains and trade policies, among others, t The previous editions of this report, which
while the income of millions of people cannot analysed in depth each driver separately, taught
keep up. Put simply, unaffordable healthy diets us that these drivers are not mutually exclusive,
can be seen as a driver that is the result of other as they interact to the detriment of food securit y
drivers and low incomes. They are associated and nutrition by creating multiple, compounding
with increasing food insecurit y and all forms impacts at many different points within our
of malnutrition, including stunting, wasting, food systems. We also learned that drivers do
micronutrient deficiencies, overweight and not necessarily move in the same direction,
obesit y, and NCDs. and that there are trade-offs and synergies
associated with the policies enacted in response
Food systems are extensive networks made to these drivers. A food systems lens, therefore,
up of ever ything – and ever ybody – involved becomes essential to better understand how the
in producing, storing, packing, processing, negative impacts of these drivers interact, and
distributing, marketing, consuming and to facilitate the identification of targeted entr y
disposing of food, including the social, points for inter ventions to address the significant
political, economic, legal and environmental challenges presented by the drivers.
systems. 57,58,59,60,61,62,63,23,64,65 Agri-food systems,
a term increasingly used in the context of This perspective also allows for an examination
transforming food systems for sustainabilit y of the synergies and trade-offs between policy
inter ventions and how addressing one driver can
t  Factors driving up the cost of nutritious foods are found in the have positive and negative impacts on different
realms of food production, food supply chains, food environments, as outcomes. For example, an effective response to
well as consumer demand and the political economy of food. The State
of Food Security and Nutrition in the World 2020 provides an in-depth recover from an economic downturn can improve
examination of each of these. both food access and utilization, with either

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 THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2021

FIGURE 14 IMPACTS OF VARIOUS DRIVERS ARE TRANSMITTED THROUGHOUT FOOD SYSTEMS,

UNDERMINING FOOD SECURITY AND NUTRITION

CLIMATE ECONOMIC
POVERTY AND
VARIABILITY AND SLOWDOWNS AND CONFLICT
INEQUALITY
EXTREMES DOWNTURNS
BIO-PHYSICAL AND TECHNOLOGY ECONOMIC AND POLITICAL AND ECONOMIC AND DEMOGRAPHIC
ENVIRONMENTAL AND INNOVATION MARKET DRIVERS INSTITUTIONAL SOCIOCULTURAL DRIVERS
DRIVERS DRIVERS DRIVERS DRIVERS

FOOD SYSTEMS
NUTRITION
SYSTEMS SUPPORTING FOOD SUPPLY CONSUMER DIETS
AND
FOOD PRODUCTION CHAINS BEHAVIOUR HEALTH
• QUANTITY
• QUALITY
• DIVERSITY
• SAFETY BROADER
AFFORDABILITY • ADEQUACY IMPACTS
OF HEALTHY DIETS
FOOD ENVIRONMENTS

POLICY AND GOVERNANCE

FOOD SECURITY: AVAILABILITY - ACCESS - UTILIZATION - STABILITY - AGENCY - SUSTAINABILITY

SOURCE: Adapted from HLPE. 2020. Food security and nutrition: building a global narrative towards 2030. A report by the High Level Panel of Experts on
Food Security and Nutrition of the Committee on World Food Security. Rome.

negative or positive effects on the environment. (availability, access, utilization and stability), as well
A disconnected approach is unable to address as the two additional dimensions of agency and
the interconnected nature of the challenges, sustainability. u These drivers have impacts on
both within food systems and also in the attributes of diets (quantity, quality, diversity, safety
intersection of food systems and other systems, and adequacy) and nutrition and health outcomes
including environmental, health and social (nutrition and health). While Figure 14 includes
protection systems. other drivers in addition to those identified in

Figure 14 presents a food systems diagram to

illustrate how the drivers behind recent food u  While these two new dimensions are proposed by the High Level
security and nutrition trends specifically create Panel of Experts (HLPE) of the Committee on World Food Security
multiple impacts throughout food systems ( food (CFS), they are not formally agreed upon by FAO or other bodies, nor is
there an agreed language on the definition. However, due to their
systems, including food environments), leading to relevance in the context of this report, they are included here. For
impacts on the four dimensions of food security definitions, see Annex 6 Glossary in this report.

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 CHAPTER 3 MAJOR DRIVERS OF RECENT FOOD SECURITY AND NUTRITION TRENDS

this report, such as demographic drivers v and tend to create multiple, compounding impacts on
technolog y and innovation drivers, w these are not food systems that negatively affect food securit y
elaborated upon as these tend to be long-term and nutrition. Because the drivers coexist and
drivers in their effects on food security and interact, this complexit y must be fully understood
nutrition, whereas in this report we focus more on and addressed when designing programme and
the short term. The report specifically focuses on policy responses.
the major drivers (dark blue boxes in Figure 14) that
are behind the recent rise in hunger and slowdown For example, as shown in the 2017 edition of
in progress in reducing all forms of malnutrition. this report, conflict negatively affects almost
The orange text in parenthesis throughout this every aspect of food systems, 1 from production,
section refers to specific element names in Figure 14 harvesting, processing and transport to input
for emphasis and to ease cross-referencing with supply, financing, marketing and consumption.
the figure. Direct impacts can be significant, particularly
in regard to the destruction of agricultural and
The diagram also accounts for circular feedback livelihood assets (such as land, livestock, crops,
loops that can create compounding impacts seed stocks or irrigation infrastructure), the
that occur over time. For example, economic forced or corrupt seizure of natural resources,
downturns that reduce the affordability of and displacement from land, livestock grazing
nutritious foods and increase the consumption areas and fishing grounds. When conflict and
of unhealthy diets not only negatively affect civil insecurity severely disrupt and restrict trade
people’s nutrition and health, but can also and movements of goods and services, there can
(as shown in the 2020 edition of this report) also be a negative effect on the availability of
contribute to broader effects on the environment food, including nutritious foods that constitute
and climate change, through increased a heathy diet, and upward pressure on prices
greenhouse gas (GHG) emissions. of traded goods, which negatively affects food
access and food utilization at the household level.
Rather than one single In Figure 14, conf lict Conflict disrupts the flow of food, funds, labour
impact, drivers tend to create ( political and institutional and other essential items through markets; creates
drivers), climate shortages; and contributes to price hikes, thereby
multiple, compounding variabilit y and damaging market functionality. Conflicts can
impacts on food systems extremes ( bio-physical also erode finances for social protection and
and environmental drivers), healthcare and so damage health and nutrition. 1
economic slowdowns and downturns (economic
and market drivers), and povert y and inequalit y Similarly, the 2018 edition of this report analysed
(economic and sociocultural drivers) are external how climate variability and extremesx create
drivers that act upon food systems (yellow box). multiple and compounding impacts on food
Rather than one single impact, these drivers systems. 3 They negatively affect agricultural
productivit y (crop yields and cropping intensit y),
and also affect food imports as countries tr y
v  Population dynamics and urbanization are expected to result in to compensate for domestic production losses.
growing populations and increasing food demand. These changes are
most evident in sub-Saharan Africa and South Asia. In addition to Medium- and large-scale climate-related
population growth, other factors relative to the different locations – for disasters can lead to significant impacts across
example, ageing in rural areas and changes in high-income countries – the food value chain, with negative consequences
are also important. Other social aspects, such as spatial location or
gender, are also subject to change as a result of internal and on sector growth and on food and non-food
international migration. 321 agro-industries. Food price spikes and volatilit y
w  For example, currently, several technologies in agri-food systems tend to follow climate extremes (often in
contribute to degradation of natural resources. This is due to intensive combination with losses in agricultural income),
production systems focusing on profitability over environmental
aspects. Technical progress, including the emergence of more
“systemic” technologies, digitalization, biotechnologies and other x  While increasing climate variability and extremes can be attributed
innovative approaches, implies opportunities to achieve the dual aim of to climate change, in this chapter we do not focus on the cause of the
producing sufficient food and safeguarding the environment. Research increase, but analyse the occurrence of climate variability and extremes
is ongoing to ensure safety and acceptability, gender-balanced access and their association with food insecurity and malnutrition. See the
and inclusion of low-income countries to avoid technological divides. 321 2018 edition of this report for further details.

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 THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2021

reducing access to food and negatively affecting (e.g. reduced abilit y to invest in the next planning
the quantit y, qualit y and dietar y diversit y of cycle) and because of urban–rural linkages.
food consumed. In addition, more erratic rainfall These impacts can be especially harmful to
and higher temperatures jeopardize the qualit y countries lagging behind in terms of economic
and safet y of food and increase instances of development, as the food and agriculture sectors
crop contamination and outbreaks of pests and account for substantial shares of employment
diseases. y Nutrition is highly susceptible to and output in these countries. The need to
changes in climate and bears a heav y burden as change consumption patterns can lead v ulnerable
a result, as seen in the impaired nutrient qualit y households to shift away from nutritious foods
and dietar y diversit y of foods produced and towards more energ y-dense foods with minimal
consumed, the impacts on water and sanitation, nutritional value, or to cut spending on a range of
and the effects on patterns of health risks and basic ser vices for health and disease prevention.
disease, as well as changes in maternal care, Economic slowdowns and downturns also reduce
child care and breastfeeding. 3 the fiscal space for government to provide
support to the poor.
Economic slowdowns and downturns, in turn,
primarily impact food systems through their The unaffordability of healthy dietsaa is regarded
negative effects on people’s access to food, here as an internal driver resulting from the effect
including the affordabilit y of healthy diets, of other drivers or factors that directly affect
as they lead to rises in unemployment and the cost of nutritious foods throughout the food
declines in wages and incomes. 5 This is the case system. Affordabilit y of a diet is determined
irrespective of whether they are driven by market by the cost of food relative to people’s income.
swings, trade wars, political unrest, or a global As such, this internal driver acts within food
pandemic such as COV ID-19 ( Box 7). As shown systems, and more specifically within food
in the 2019 edition of this report, for countries environments ( food environment, affordability of
dependent on primar y commodit y trade, food healthy diets) to negatively affect food securit y
securit y and nutrition is especially v ulnerable and nutrition ( Figure 14). Food environment refers
when economic slowdowns and downturns are to the physical, economic, sociocultural and
linked to international trade shocks. 5 In all policy conditions that shape access, affordabilit y,
countries, the poor who spend a large share of safet y and food preferences. 58,67,68,69 Clearly, the
their income on food and depend on markets unaffordabilit y of healthy diets can be driven
for a significant portion of their diets, are by income changes (which can in turn be driven
especially v ulnerable to economic slowdowns by conf lict, climate variabilit y and extremes,
and downturns. z With reduced incomes, healthy and economic slowdowns or downturns, among
diets become even more unaffordable, due to the others), as well as determined by supply and
higher relative cost compared with a basic diet. demand factors within the food system that affect
food prices. 7
The impacts of economic slowdowns and
downturns can also be felt particularly hard As shown in the 2020 edition of this report, the
in the food and agriculture sectors, both factors that drive the cost of nutritious foods
because of what happens within the sector are found throughout the food system. On the
food production or supply side, low levels of
productivity, 70,71 high production risks and
y  For example, higher intensity rainfall can create conditions that lead
to mould growth and the subsequent contamination of crops in the field insufficient diversification towards the production
with mycotoxin contamination, while higher temperatures can lead to of more nutritious foods are key drivers of the
pest and fungi development during storage. Climate extremes such as cost of healthy diets, especially in low-income
temperature and humidity alter survival and transmission patterns and
can lead to increased bacterial, viral and pathogenic contamination in countries. In food supply chains, inadequate food
water (for both consumption and for irrigation of crops) and food. See handling and storage, 72 poor road infrastructure 7 »
FAO (2018), 3 p. 74.
z  In a review of studies of dietary diversity that included a measure of
market access and production diversity, five of six studies showed a aa  For the definition of a healthy diet, see Chapter 1, Section 2.1
statistically significant positive relationship between market access and Affordability of healthy diets: a link between food security and
dietary diversity in at least some models. 322 nutritional outcomes.

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 CHAPTER 3 MAJOR DRIVERS OF RECENT FOOD SECURITY AND NUTRITION TRENDS

BOX 7 IMPACT CHANNELS OF THE COVID-19 PANDEMIC ON FOOD SECURITY AND NUTRITION

recent past. People employed in the informal sector

in many countries around the world saw their incomes
significantly reduced or disappear. In high-income
countries, governments provided support to employers
to retain employees, albeit at reduced salaries.
While food supply chains have proven to be more
robust than originally predicted, the pandemic is
eroding people’s ability to purchase food as they lose
their incomes and livelihoods. As a result, not only are
more people unable to afford healthy diets, increasing
their risk of any form of malnutrition, but more people
are going hungry because they lack sufficient quantities
©FAO/Ismail Taxta

of food. In addition, school closures have led to the

suspension of critically important school food and
nutrition programmes. Food assistance programmes
such as food banks and various other initiatives have
experienced a significant and continuous increase
in demand for their services throughout 2020, in
The COVID-19 pandemic and the measures put in both developing and developed countries. This rise
place to counter it have delivered one of the most in demand stems from income loss and subsequent
devastating blows to global food security and nutrition increased unaffordability of foods resulting in many
in recent times, with multiple impacts on food systems more people depending on food assistance to maintain
(Figure 14) and the channels through which food systems a healthy diet and avoid food insecurity.
affect diets, including the affordability of healthy diets This economic downturn translates directly into
(systems supporting food production, food supply chains, increased unaffordability of food and greater food
food environments, consumer behaviour).74 The number insecurity and malnutrition – as people have less
of people suffering from chronic hunger in the world, as income to buy food, let alone more expensive nutritious
measured by the prevalence of undernourishment (PoU), foods required for healthy diets. Migrant workers have
increased by up to 161 million more people in 2020 – been affected by lockdowns, trade disruptions, layoffs
the largest single-year increase in decades (Figure A). and illness,76 although remittances sent to their home
Additionally, by the end of 2020, at least 155 million countries show a smaller decline than previously
people suffered from acute food insecurity* requiring predicted.77 Women have been particularly hard hit
urgent humanitarian assistance in 55 countries/ by the economic and social fallout of the COVID-19
territories (Integrate Food Security Phase Classification/ pandemic. The pandemic has pushed more women
Cadre Harmonisé [IPC/CH] Phase 3 or above).75 Of into extreme poverty than men, with women also
these, economic shocks were a primary driver of acute facing higher job losses, shrinking work hours and
food insecurity in 17 food crisis countries affecting greater care burdens.74 As highlighted in Chapter 2,
40 million people in Crisis or worse (IPC/CH Phase 3 the gender gap has grown even larger in the year of the
or above). By comparison, in 2019, economic shocks pandemic – with the prevalence of moderate or severe
constituted the primary driver in just eight countries food insecurity being 10 percent higher among women
with around 24 million people in Crisis or worse (IPC/CH than men in 2020, compared with 6 percent in 2019.
Phase 3 or above), or equivalent. (see Chapter 2, Figure 6).
The most destructive effects of the COVID-19 But the COVID-19 pandemic is not only having
pandemic on food security and nutrition emanate multiple demand-side effects on access to food; there
from the unprecedented reach and scale of the are also supply-side effects that are negatively affecting
economic downturns caused by the pandemic people’s capacity to access food and healthy diets.
containment measures (economic and market drivers). These include border closures, travel restrictions,
These plunged the world and most countries into quarantines, and market, supply chain and trade
economic recession in 2020, with per capita incomes disruptions. These negative effects restrict people’s
contracting in more countries than at any time in the physical access to sufficient, diverse and nutritious

* Acute food insecurity is a severe form of food insecurity that threatens lives and/or livelihoods, requiring urgent humanitarian assistance. Generally, it
reflects short-term fluctuations, typical of acute crises, which are the main focus of the indicators. On the other hand, chronic food insecurity is food
insecurity that persists over time mainly due to structural causes. This measure has relevance in providing strategic guidance to actions that focus on the
medium- and long-term improvement of the quality and quantity of food consumption for an active and healthy life. See Box 5 in FAO, IFAD, UNICEF, WFP
and WHO (2019) 5 for a discussion of the comparison of different objectives and assessments of acute and chronic food insecurity indicator measures.

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 THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2021

BOX 7 (CONTINUED)

FIGURE A THE COVID-19 PANDEMIC CONTRIBUTED TO THE LARGEST SINGLE-YEAR

INCREASE IN GLOBAL HUNGER IN DECADES
1 000
160
900
ANNUAL CHANGE IN NUMBER OF UNDERNOURISHED (MILLIONS)

140 160.7

120 800

NUMBER OF UNDERNOURISHED (MILLIONS)

100
117.6 700

80
600
60
500
40
70
17.6 21.7 18.3 16.9
20 400
8.2

0
300
-20
200
-40
100
-60

-80 0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020

Annual change in NoU pre-COVID-19 (left axis) Annual change in NoU in 2020, lower bound (left axis)
Number of undernourished people (right axis) Annual change in NoU in 2020, middle point (left axis)
Annual change in NoU in 2020, upper bound (left axis)

NOTES: The blue bars show the annual change in the number of undernourished people (NoU) between 2000 and 2019 (left y-axis). Selected numbers in
correspondence of the blue bars denote the highest annual changes in the NoU. The orange line shows the total number of undernourished people in
2000–2019 (right y-axis). The stacked bar for year 2020 shows the additional number of undernourished people in 2020, which ranges from 70 million
people (lower bound) to 160.7 million people (upper bound).
SOURCE: FAO for NoU and PoU.

sources of food, especially in countries hit hard by the impacts may be less than expected and more evidence
pandemic or already affected by high levels of food is needed, there are some reports of food losses and
insecurity and malnutrition. High-value perishable waste, especially of fruits and vegetables, fish, meat
commodities are going to waste along the chains, as and dairy products.80 Furthermore, travel restrictions
essential workers in food and agriculture are barred are causing severe labour shortages in food and
from crossing borders and food supply chains are agriculture production and processing industries,
being disrupted. Closure of markets, including informal leading to production and supply disruptions.
markets, also exacerbates the unaffordability of Moreover, school closures have led to missed meals
healthy diets. normally provided through school food and nutrition
The adverse effects of the pandemic physical programmes. As a response, some countries have
distancing measures have tended to be more started door-to-door meal delivery service to children.**
immediate and pronounced for highly perishable The COVID-19 pandemic and related containment
fruits and vegetables, for which production and trade measures have exacerbated other drivers, widened
are more labour-intensive as compared with other inequalities, and exposed structural vulnerabilities of
food commodities such as staple foods.78,79,80 While local and global food systems. While the COVID-19

** There are a number of other impacts not highlighted, including observed changes in purchasing patterns in favour of products with longer shelf lives
and often poorer nutrition profiles, which could lead to higher levels of undernutrition, as well as overweight and obesity. Although many negative
consequences have been noted, positive consequences have also been observed such as increased opportunities for online food purchases, home
delivery of meals to the elderly, or setup of community kitchens to serve free meals to vulnerable populations.

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 CHAPTER 3 MAJOR DRIVERS OF RECENT FOOD SECURITY AND NUTRITION TRENDS

BOX 7 (CONTINUED)

pandemic is itself driving a global economic downturn, The global economic recession that started in
it has negatively affected several regions of the world 2020 is extending into 2021 for many countries,
while interacting with conflict or climate variability with regional and international trade impacts,
and extremes, or a combination of both (see analysis record levels of unemployment, lost livelihoods
below and Figures 19 and 24) as well as more localized and rising poverty levels in many countries around
drivers, such as the locust outbreaks in East Africa the world.82,25,10 The uneven pace of recovery
(Kenya and Somalia) and South Asia (India and from the effects of the COVID-19 pandemic and
Pakistan). It has also combined to worsen food containment measures will mean that some
crises in emergency contexts.75 For example, acute countries will continue to face significant food
food insecurity requiring emergency response has security and nutrition challenges related to these
increased in El Salvador, Honduras and Nicaragua in 2021, and possibly beyond, especially in
due to the double impact of hurricanes Eta and Iota contexts where this is combined with conflict and
and the economic effects of the COVID-19 pandemic. climate-related disasters. As shown in Figure 24, in
In the Democratic Republic of the Congo and South 2020, in countries affected by economic downturns
Sudan, the combined effects of conflict and climate combined with climate-related disasters and
variability and extremes, including droughts, cyclones conflict, increases in undernourishment were
or seasonal flooding, have been aggravated by the more than five times greater than in countries only
economic effects of the pandemic.75,81 affected by economic downturns.

» and limited food preser vation capacity lead to broader sense (i.e. multidimensional), including
food losses (especially for highly perishable inequalit y in access to resources (land, water)
foods) 73 and inefficiencies along the food supply and basic ser vices (health, education, etc.).
chain that drive up the cost of nutritious foods. 7 Their impacts are felt throughout food systems
On the demand side, food environments influence and food environments, ultimately affecting the
consumer behaviour; moreover, the preferences affordabilit y of healthy diets and food securit y
of consumers also represent an important factor and nutrition outcomes. The 2019 edition of this
driving the cost and affordability – and the report analysed the nexus between economic
availability – of healthy diets. 7 Rapid rates of growth, povert y, and food securit y and nutrition,
urbanization have resulted in more work-away factoring in inequalit y. Analysis reconfirmed
and eat-away-from-home habits, with a direct that economic slowdowns and downturns are
impact on the demand for easy-to-prepare, highly associated with increases in food insecurit y, but
processed foods or convenience foods that are also showed that not only does income inequalit y
often energ y dense and high in fat, sugar and/or increase the likelihood of food insecurit y, but
salt. Such foods have also become more widely high income inequalit y amplifies the negative
available and affordable, but do not necessarily effect of economic slowdowns or downturns on
contribute to healthy diets. However, consumer individual food securit y. 5,6
demand can also be a positive force: for example,
increased demand can also encourage production Beyond their direct There are circular
of nutritious foods, making it more available at a impacts on food
interconnected impacts of
lower cost. systems, these major
global drivers weaken drivers on other systems,
Inequality and sociocultural Poverty and food securit y and including environmental and
stratification magnify the inequality (economic nutrition through health systems
and market drivers) interconnected and
negative effects of other
and sociocultural circular impacts on other systems, including
drivers stratification and environmental and health systems. For example,
empowerment, as explored in depth in the 2020 edition of this
including gender and power dynamics report, diets of poor qualit y and insufficient
(sociocultural drivers), are important external factors quantit y have broader impacts on human health
( Figure 14) that tend to magnif y the negative and the environment, including increased
effects of other drivers. Importantly, inequalit y morbidit y, mortalit y and the social costs
is related to economic and market drivers in a associated with multiple forms of malnutrition,

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 THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2021

including stunting, wasting, micronutrient marketing policies, can also shape healthier
deficiencies, overweight and obesit y, as food environments.
well as costs associated with environmental
degradation and GHG emissions (broader On the other hand, some economic policies may
impacts: economic, socio-economic, environmental ) result in an economic slowdown, or governance
( Figure 14). may trigger conf lict. For example, protectionar y
trade measures and input subsidy programmes
Current food consumption patterns are a tend to protect and incentivize the domestic
leading cause of morbidit y and disabilit y production of staple foods, such as rice and
– with poor diets accounting for 8 million maize, often to the detriment of more nutritious
premature deaths globally ever y year 83 – which foods, such as fruits and vegetables. 7,8 4,85
require higher spending on healthcare, placing These measures and programmes can also
significant burdens on national healthcare keep the cost of fruits and vegetables above
systems and economies. 59 The 2020 edition the world market rate or restrict farmers to
of this report estimated that if current food just producing the staple crops – both of which
consumption patterns continue, diet-related also reduce consumer access to a diverse diet.
health costs linked to NCDs and their mortalit y Similarly, liberalization of trade and investment
are projected to exceed USD 1.3 trillion per rules can also reshape food systems and thus
year by 2030. 7 At the same time, current food inf luence food securit y and nutrition in both
consumption patterns are leading to significant positive and negative ways – whether by
environmental impacts and associated costs. improving access to diverse, nutritious foods or
The diet-related social costs (i.e. economic costs) by increasing the availabilit y and affordabilit y
of GHG emissions associated with current of foods that are high in fat, sugar or salt.
dietar y patterns is projected to exceed Finally, non-tariff trade measures can help
USD 1.7 trillion per year by 2030. 7 improve food safet y, qualit y standards and
the nutritional value of food, and minimize
These broader impacts – and their repercussions any unintended consequences, but they can
on other systems – are important as they fuel also drive up the costs of trade and hence food
a circular feedback loop impacting drivers that prices, negatively affecting the affordabilit y of
affect the food system, for example in the way healthy diets. 7
diets affect GHG emissions, which are a driver of
climate change that then affects the food systems It is, however, not only about having the right
( bio-physical and environmental drivers) ( Figure 14). policies; governance, legislation and institutions
are key to the implementation of policies and
Governance and policy Other factors that to ensuring they consider the impacts on all
shape how food systems need to be taken into dimensions of food securit y and nutrition (policy
consideration are the coherence) and on all stakeholders, especially the
function and the outcomes policies and governance most v ulnerable. For policies to be enforceable,
they produce, including – including legislation they need to be grounded in legislation. This
both positive and negative and finance – that highlights the importance of an enabling
food security and nutrition shape food systems, legislative environment for food securit y and
outcomes and hence food nutrition. Such a legal framework is composed of
securit y and nutrition complex networks of interlinked legal areas and
outcomes ( policy and governance) ( Figure 14). They can is best construed through a food systems lens to
be a positive force, but also a negative one. ensure consistency and coherence.

For example, food and agricultural policies In particular, it is also ver y important to consider
have the power, either directly or indirectly, institutional deficits and power imbalances.
to positively affect the availabilit y, access to For example, poorer households, even net-food
and cost of nutritious foods. Policy measures, sellers, are exposed to volatilit y in food prices,
including food standards, fiscal, labelling, owing to their weak bargaining position in
reformulation, public procurement and food chains that keeps them from capturing

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CHAPTER 3 MAJOR DRIVERS OF RECENT FOOD SECURITY AND NUTRITION TRENDS

3.2
the benefits from higher prices. 86 The agency
dimension of food securit y is also key to
addressing power asymmetries and reducing
inequalit y, for example, by enhancing the IMPACT OF MAJOR
participation of the rural poor in food systems
transformation and its benefits. Agency goes DRIVERS ON FOOD
beyond access to material resources in that it
includes empowerment – the abilit y of people SECURITY AND
to take actions that help improve their own
well-being, including food securit y and nutrition,
as well as their abilit y to engage in societ y in
NUTRITION
ways that wield inf luence. 58 As highlighted above, conf lict, climate variabilit y
and extremes, and economic slowdowns and
These drivers differ from countr y to countr y downturns can negatively affect food securit y
and even within countries, and in the way they and nutrition through their impacts on our food
interact. They also increase and decrease in systems. As a result, all dimensions of food
intensit y, and may disappear altogether for a securit y and nutrition are likely to be affected,
time. However, what is common across countries including food availabilit y, access, utilization and
is the lack of resilience of food systems to the stabilit y. This is corroborated by the association
negative effects of these drivers and their lack found between the occurrence of these drivers
of capacit y to deliver food securit y and good and the food securit y and nutrition indicators, as
nutrition under these circumstances. we detail in this section.

Analysis shows that this food systems Drivers are increasing in frequency and
v ulnerabilit y is further compromised and made
worse by high and persistent levels of inequalit y
intensity, undermining food security
– in terms of income, productive assets and basic and nutrition
ser vices (e.g. health, education). Income and In the last ten years, the frequency and intensit y
wealth inequalities are closely associated of conf lict, climate variabilit y and extremes,
with access to food and, as a consequence, and economic slowdowns and downturns have
to hunger. If we are to end hunger, food increased and are undermining food securit y
insecurit y and malnutrition in all its forms, food and nutrition around the world. Of particular
systems need to be transformed and inequalit y concern are low- and middle-income countries
reduced in order to strengthen resilience to because the negative impacts on food securit y
the negative effects of these drivers. A food and nutrition are greatest in these countries:
systems approach is necessar y to overcome the they carr y the biggest burden of the world’s
complexit y of this challenge, by gaining an population who are undernourished (13 percent)
understanding of the interrelationships among and children who are stunted (24 percent).
key drivers and their negative impacts to help Further, these countries experience multiple
formulate appropriate solutions. Only then will forms of malnutrition, including child
a global transformation be possible to achieve overweight (6 percent) and adult obesit y
well-functioning, resilient food systems that (18 percent).
deliver affordable healthy diets. n
High-income countries also face the increased
occurrence of some of these major drivers,
notably climate variabilit y and extremes, and
economic slowdowns and downturns. In the
context of these countries, some people will
become food insecure and malnourished as a
result of the drivers, particularly during the
COV ID-19 pandemic. However, the analysis here
focuses on low- and middle-income countries,

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 THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2021

FIGURE 15 LOW- AND MIDDLE-INCOME COUNTRIES FACE INCREASING FREQUENCY

AND INTENSITY OF DRIVERS

A) CONFLICTS (2000–2019)

800 40

PERCENTAGE OF TIME COUNTRIES WERE

700 38
36

EXPOSED TO CONFLICTS
NUMBER OF CONFLICTS

600
34
500 32
400 30
300 28
26
200
24
100 22
0 20
2000–2004 2005–2009 2010–2014 2015–2019

Total number of conflicts Percentage of time countries were exposed to conflict

B) CLIMATE EXTREMES (2000–2020)

PERCENTAGE OF COUNTRIES EXPOSED TO THREE

60 100

PERCENTAGE OF COUNTRIES EXPOSED

90
OR FOUR CLIMATE EXTREMES

50
80

TO CLIMATE EXTREMES
70
40
60
30 50
40
20
30
20
10
10
0 0
2000–2004 2005–2009 2010–2014 2015–2020

Percentage of countries exposed to three or four different types of climate extremes Percentage of countries exposed to climate extremes

C) ECONOMIC DOWNTURNS (2011–2021)

6
90
ANNUAL PER CAPITA GDP GROWTH (%)

Conflict
PERCENTAGE OF COUNTRIES WITH

4 60
where the major drivers exhibit the most
ECONOMIC DOWNTURNS

significant
2 impacts on hunger and malnutrition. The number of countries, as well as the specific 30
countries, experiencing violent conf licts has0
0
There has been a notable and significant remained fairly stable over the last ten years.-30
increase
-2 in the frequency and intensit y of However, there is a marked increase in the
-60
conf lict, climate variabilit y and extremes, and number of conf licts per year and the percentage
-4
economic slowdowns and downturns in the of time countries experienced conf lict ( Figure -90
15A).
last ten
-6 years among low- and middle-income There has also been a resurgence in the number -120
countries ( Figure 15). For our analysis of the latter of violent conf licts, with conf lict-related -150
-8
two drivers, we focus
2011 2012
specifically
2013
on climate2015
2014 2016
deaths
2017
increasing
2018
from
2019
an all-time
2020
low
2021
in
extremes and economic downturns. 2005. The number of conf licts that include
GDP per capita growth: sub-Saharan Africa, Percentage of countries with economic downturns:
Latin America, Western Asia sub-Saharan Africa, Latin America, Western Asia
| 61 |
GDP per capita growth: other subregions Percentage of countries with economic downturns: other subregions
 50

PERCENTAGE OF COUNTRIES EXPOSE

80

PERCENTAGE OF COUNTRIES EX
OR FOUR CLIMATE EXTREM

TO CLIMATE EXTREMES
70
40
60
30 50
40
CHAPTER
20 3 MAJOR DRIVERS OF RECENT FOOD SECURITY AND NUTRITION TRENDS
30
20
10
10
0 0
2000–2004 2005–2009 2010–2014 2015–2020

(CONTINUED)
FIGURE 15 Percentage of countries exposed to three or four different types of climate extremes Percentage of countries exposed to climate extremes

C) ECONOMIC DOWNTURNS (2011–2021)

6
90
ANNUAL PER CAPITA GDP GROWTH (%)

PERCENTAGE OF COUNTRIES WITH

4 60

ECONOMIC DOWNTURNS
2 30

0
0
-30
-2
-60
-4
-90
-6 -120

-8 -150
2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021

GDP per capita growth: sub-Saharan Africa, Percentage of countries with economic downturns:
Latin America, Western Asia sub-Saharan Africa, Latin America, Western Asia
GDP per capita growth: other subregions Percentage of countries with economic downturns: other subregions

NOTES: Figure 15A shows the total number of violent conflicts in the five-year subperiods that were caused by internal or intrastate conflict (blue bars), and
the percentage of time countries were exposed to conflict (yellow line). Globally, 98 countries were affected by conflict during 2000–2019. Figure 15B
shows the percentage of countries where at least one climate extreme (yellow line) occurred, and the percentage of countries exposed to three or four
climate extremes (orange bars). There are 127 low- and middle-income countries with information available on climate extremes. Figure 15C refers to the
occurrence of economic downturns, for years 2011–2019 and 2020–2021, respectively. There are 129 low- and middle-income countries with
information available on GDP per capita growth: 71 countries in sub-Saharan Africa, Latin America and Western Asia, and 58 countries in the other
regions. See Annex 3 for methodology.
SOURCES: Violent conflict data based on the Uppsala University. 2021. Uppsala Conflict Data Program (UCDP). In: UCDP [online]. Uppsala, Sweden.
[Cited 10 June 2021]. ucdp.uu.se; for years 2000–2005 updated drought provided by UCT using data from the European Centre for Medium-Range
Weather Forecasts (ECMWF). 2021. Datasets. In: ECMWF [online]. Reading, United Kingdom. [Cited 10 June 2021].www.ecmwf.int/en/forecasts/datasets
and for years 2006–2020 provided by EU-JRC using data from the European Commission. 2021. Anomaly Hotspots of Agricultural Production (ASAP). In:
ASAP [online]. Brussels. [Cited 10 June 2021]. mars.jrc.ec.europa.eu/asap; updated flood data provided by UCT using Climate Hazards Center of the
University of California - Santa Barbara. 2021. CHIRPS: Rainfall estimates from rain gauge and satellite observations. In: CHIRPS [online]. Santa Barbara,
USA. [Cited 10 June 2021]. www.chc.ucsb.edu/data/chirps; updated heat spell data provided by UCT using data from the European Centre for Medium-
Range Weather Forecasts (ECMWF). 2021. Datasets. In: ECMWF [online]. Reading, United Kingdom. [Cited 10 June 2021]. www.ecmwf.int/en/forecasts/
datasets; updated storm data based on Centre for Research on the Epidemiology of Disasters (CRED). 2021. EM-DAT: the international disasters
database. In: EM-DAT [online]. Brussels. [Cited 10 June 2021]. public.emdat.be; annual per capita GDP based on IMF. 2021. World Economic Outlook
Database - April 2021. In: IMF [online]. Washington, DC. [Cited 10 June 2021]. www.imf.org/en/Publications/WEO/weo-database/2021/April

one-sided, state- and non-state violence have The nature of conf lict is also changing
increased dramatically (by 86 percent since – conf licts are becoming more complex,
2010, and at 145 conf licts as of 2019) ab and now protracted and intractable. Internal conf licts
are at an all-time high. 1 These increases have have surpassed the number of interstate
been accompanied by increasing numbers of conf licts and there is a significant rise in
displaced people. The number of refugees and internationalized internal conf licts (internal
internally displaced persons (IDPs) has increased conf licts that have spread to involve other
significantly with the increase in conf licts, nearly nations). 87,88 Coupled with large outf lows of
doubling from 40 million in 2010 to more than displaced people and the entanglement of
70 million in 2019; this number reached more external international actors, conf licts are
than 80 million in 2020. 87,88 also increasingly a regional problem, with
cross-border armed networks that are all
ab  Data are not updated to 2020 because at the time of writing, the too ready to share resources to further their
Uppsala Conflict Data Program (UCDP) dataset was only updated to 2019.

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 THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2021

common goals. ac Conf licts also tend to have by 39 percentage points for countries in Africa,
multiple layers in many countries, making from 10 percent in 2000 –2004 to 49 percent in
concepts like onset and cessation analytically 2015 –2020. Similarly, the percentage of Asian
difficult to disentangle in practice. Even in countries experiencing multiple t y pes of climate
post-conf lict contexts, violence can simply extremes increased to 57 percent in 2015 –2020,
change its form as settings, actors and drivers up from 11 percent in 2000 –2004. The intensit y
change. 89 Sometimes the factors that lead to a of climate extremes in Latin America and
conf lict may not disappear when the conf lict is the Caribbean also moved from 9 percent in
seemingly over; what is more, conf licts can take 2000 –2004 to 57 percent in 2015 –2020.
on a cyclical nature if underlying causes are not
addressed. ad
Economic downturns
Even before the COV ID-19 pandemic, global
Climate extremes economic reports had highlighted that economic
Countries face increasing climate variabilit y slowdowns, stagnation and outright recessions
and more frequent climate extremes, linked were evident in several economies and already
in part to climate change. 4 The number of leading to increased unemployment and
low- and middle-income countries exposed to declines in income. 5,90,91 The economic growth
climate extremes has steadily been on the rise rate, as measured by the percent variation of
over the past twent y years, from 76 percent real GDP per capita growth from one period
of countries in 2000 –2004 to 98 percent to another, is t y pically used to gauge whether
in 2015 –2020. More strikingly, countries’ an economy is slowing down or contracting.
exposure to climate extremes has significantly In most regions, this rate rebounded after the
magnified in terms of intensit y (three or four sharp 2008 –2009 global economic downturn.
t y pes of climate extremes in a five-year period) But the recover y was uneven and short lived, as
( Figure 15B). The frequency, or number of years a many countries experienced generally declining
countr y is exposed in each subperiod, increased trends in growth since 2011. Since 2014,
by 42 percentage points, from 30 percent in poor and uneven growth has been especially
2000 –2004 to 72 percent in 2015 –2019 (not pronounced in sub-Saharan Africa, Latin
shown in fig ure). In terms of increasing America and Western Asia. The percentage of
intensit y, 52 percent of countries were exposed countries experiencing economic downturns
to three or four t ypes of climate extremes (heat within these regions increased from 25 percent
spell, drought, f lood, or storm) in 2015 –2020, in 2014 to 38 percent in 2019. As a result, these
compared with 11 percent in 2000 –2004. regions experienced a severe reduction in their
In other words, the number has almost GDP per capita growth compared with other
quintupled in the last 20 years (see Annex 3 for regions from 2014 to 2019 ( Figure 15C).
definitions, methodolog y and data sources).
The measures put in place to contain the
The analysis at the regional level confirms the COV ID-19 pandemic delivered a significant
intensit y of climate extremes found at the global economic hit, sending most countries
level. For instance, the occurrence of three or into recession during 2020. For low- and
more t ypes of climate extremes has increased middle-income countries, per capita income
contracted in 117 of 129 countries with
ac  The mapping of conflict events in Africa, across time and by information available on GDP per capita
magnitude, draws a startling picture of their cross-border and regional growth. Specifically, 94 percent of the countries
nature. These include some of the most protracted conflicts, including in sub-Saharan Africa, Latin America and
those in the Horn of Africa, the Great Lakes region and in northern
Cameroon, Chad and northern Nigeria across the Sahel. But there are Western Asia experienced an economic
also examples in other regions, such as in Afghanistan, India and downturn in 2020, and 86 percent in other
Pakistan in Asia. 2 regions ( Figure 15C). The 2020 global recession
ad  For example, in Africa and Asia, actors of violence during conflict proved to be the deepest in decades, despite
and war often reconstitute themselves in post-conflict periods to take
economic and political advantage of fragile and vulnerable the extraordinar y efforts of governments to
environments.1,2 counter the downturn with fiscal and monetar y

| 63 |
 CHAPTER 3 MAJOR DRIVERS OF RECENT FOOD SECURITY AND NUTRITION TRENDS

FIGURE 16 WHILE POVERTY DECLINES AROUND THE WORLD, INCOME INEQUALITY REMAINS HIGH,
WITH AN INCREASE IN 2020 IN LOW- AND MIDDLE-INCOME COUNTRIES

50
AVERAGE POVERTY AND INCOME INEQUALITY (%)

40

30

20

10

0
2001–2005 2006–2010 2011–2016 2017–2018 2020

Average poverty Average inequality (Gini index)

NOTES: The figure shows the average poverty and income inequality by five-year subperiods in low- and middle-income countries. Shaded columns for
year 2020 report IMF projections of the Gini index and poverty, as expressed by the percentage of the population living below USD 1.90 (PPP 2011).
Poverty projections for 2020 are based on the October World Economic Outlook database. Income inequality in 2020 is expressed as a median. Poverty
and inequality are shown for the sample of 133 low- and middle-income countries. See Annex 3 for definitions.
SOURCES: World Bank. 2021. World Development Indicators. In: World Bank [online]. Washington, DC. [Cited 24 April 2020]. datatopics.worldbank.org/
world-development-indicators for poverty and Gini index data between 2001–2018; and IMF. 2020. Fiscal Monitor: policies for the recovery. Washington,
DC. (also available at www.imf.org/en/Publications/FM/Issues/2020/09/30/october-2020-fiscal-monitor) for poverty and the Gini index data in 2020.

policy support. While some countries have seen

their economies begin to recover in 2021, it is
Poverty and inequality
forecasted that many will not. One of the factors Povert y and inequalit y are critical underlying
that will make recover y in 2021 less likely in structural factors that amplif y the negative
some countries is the growing external debt impact of conf lict, climate variabilit y and
burden, which could crowd out investments in extremes, and economic slowdowns and
economic recover y and social protection, as a downturns. While povert y has declined, income
result of which food securit y and nutrition could inequalit y – as measured by the Gini index
worsen. The global economic recession that – has remained high and persistent over the
started in 2020 has extended into 2021, with last 20 years at the global level ( Figure 16).
record levels of unemployment, lost livelihoods As shown in the 2019 edition of this report,
and rising povert y levels in many countries a closer look at countr y level data shows that
around the world. income inequalit y is rising in nearly half the
countries in the world, including many low-

| 64 |
 THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2021

and middle-income countries. 5 As a region, inequalit y. For example, as shown in the 2018
Latin America and the Caribbean shows the edition of this report, climate variabilit y and
most progress in reducing income inequalit y, extremes contribute to greater risk of food
but still exhibits the highest levels of inequalit y insecurit y and malnutrition, but if prolonged
globally. ae For the first time in more than or recurrent they lead to diminished coping
20 years, povert y and income inequalit y at the capacit y, loss of livelihoods, distress migration
global level increased in 2020 as a result of the and destitution. In other words, they not only
COV ID-19 pandemic and the measures put contribute to increased food insecurit y and
in place to contain it ( Figure 16). The number of malnutrition, but can create and sustain povert y,
“new poor” (i.e. in addition to the number of as well as contribute to increased inequalit y. 3af
people who were already poor), resulting from This creates further circular associations,
the pandemic was estimated to be between 119 contributing to increased food insecurit y and
and 124 million in 2020. In 2021, this number malnutrition, as well as current and future
is set to rise to between 143 and 163 million. 10 v ulnerabilit y to climate extremes.
Income inequalit y increased from 38 to
41 percent in 2020. The Dr y Corridor in Central America –
in particular in El Salvador, Guatemala
Nexus between drivers and underlying and Honduras – is highly v ulnerable to
climate-related disaster risks due to its
causes and interconnected circular geographical location, high occurrence of
associations climate extremes, including recurrent droughts,
Although the trends in the occurrence of excessive rains and severe f looding, and
conf lict, climate variabilit y and extremes, institutional and socio-economic weaknesses. 3,4
economic slowdowns and downturns, and People’s livelihoods are ver y climate-sensitive,
underlying causes of povert y and inequalit y are with more than 1 million families relying on
presented separately, in fact, they often interact, subsistence farming. Moreover, levels of povert y,
and tend to create interconnected circular inequalit y, food insecurit y and malnutrition are
associations. For example, as highlighted in the alarming, particularly among rural populations
2017 edition of this report, conf lict can wreak and Indigenous Peoples. The reoccurring and
havoc on economic production and growth, increasing cycles of climate variabilit y and
causing deep economic recessions. In turn, extremes are not only a threat to food securit y
economic recessions that drive up inf lation and nutrition, but often trigger large-scale
and lead to sharp increases in food prices tend human displacement and migration – with those
to exacerbate the risk of political unrest, as left behind being mostly the elderly, women and
witnessed in 2007–2008 when food riots broke children. This exodus creates a breeding ground
out in more than 50 countries. 1 Similarly, for conf lict, and feeds a circular association
increasing climate variabilit y and extremes, of increased povert y, inequalit y and greater
especially severe droughts, tend to jeopardize v ulnerabilit y to climate extremes.
food securit y in terms of food availabilit y and
access, which is found to increase the risk of Disentangling the nexus, and the causal factors
conf lict. 1 between the drivers and underlying factors of
povert y and inequalit y, is often so complex and
There are also interconnected circular challenging that it is not always clear which
associations between conf lict, climate variabilit y comes first and what follows. However, it
and extremes, and economic slowdowns and is possible to obser ve the occurrence of the
downturns – especially if these are severe, drivers simultaneously or over time, and their
prolonged or recurrent – and povert y and associated links with changes in food securit y
and nutrition. »
ae  Nonetheless, this progress in reducing income disparity in Latin
America and the Caribbean does not seem to be reflected in the
distribution of workers’ wages. See Figure 34 in FAO, IFAD, UNICEF,
WFP and WHO (2019) 5 and associated analysis. af  Also see Charles, Kalikoski and Macnaughton (2019).113

| 65 |
 CHAPTER 3 MAJOR DRIVERS OF RECENT FOOD SECURITY AND NUTRITION TRENDS

FIGURE 17 MORE THAN HALF OF LOW- AND MIDDLE-INCOME COUNTRIES EXPERIENCED INCREASING PoU
CHANGE POINTS IN CORRESPONDENCE WITH ONE OR MORE DRIVERS (CONFLICT, CLIMATE EXTREMES,
AND ECONOMIC SLOWDOWNS AND DOWNTURNS) BETWEEN 2010 AND 2018

20
DEMOCRATIC REPUBLIC
OF THE CONGO

YEMEN SAO TOME

AND PRINCIPE
CHAD DOMINICAN
REPUBLIC
GAMBIA SUDAN

15 GABON INDONESIA

MEXICO SOUTH AFRICA

TURKMENISTAN ANGOLA
NUMBER OF COUNTRIES

MAURITANIA BELIZE
VENEZUELA
(BOLIVARIAN
REPUBLIC OF) EGYPT LEBANON
DEMOCRATIC
REPUBLIC
10 CÔTE D’IVOIRE OF THE CONGO KIRIBATI GEORGIA

MALI JORDAN JAMAICA PAKISTAN

RWANDA COSTA RICA GEORGIA INDIA

DEMOCRATIC
REPUBLIC
ECUADOR BELIZE SUDAN OF THE CONGO SRI LANKA
CENTRAL
AFRICAN VENEZUELA BOLIVIA
SIERRA LEONE SOUTH AFRICA REPUBLIC CONGO (BOLIVARIAN (PLURINATIONAL JORDAN
REPUBLIC OF) STATE OF)
5 IRAQ AFGHANISTAN MOZAMBIQUE BOTSWANA UNITED REPUBLIC COLOMBIA PARAGUAY
OF TANZANIA
MALAWI LEBANON CUBA ANGOLA CENTRAL AFRICAN MALI MOROCCO
REPUBLIC
VANUATU GAMBIA BURKINA FASO AFGHANISTAN MADAGASCAR NEPAL BRAZIL

HAITI SURINAME LESOTHO LEBANON THAILAND KENYA LESOTHO NIGERIA

GHANA SOLOMON MADAGASCAR PERU DOMINICA ARMENIA CÔTE D’IVOIRE GAMBIA

ISLANDS
0
2010 2011 2012 2013 2014 2015 2016 2017 2018

Climate extremes Economic slowdowns and downturns

Conflict and climate extremes Conflict and economic slowdowns and downturns
Climate extremes and economic slowdowns and downturns Conflict, climate extremes, and economic slowdowns and downturns

NOTES: The figure shows the number of low- and middle-income countries with an increasing change point in the prevalence of undernourishment (PoU)
occurring in any year between 2010 and 2018, and in correspondence with any one of the three drivers (conflict, climate extremes, or economic
slowdowns and downturns). Of the 110 low- and middle-income countries with available information on the PoU, this analysis excludes one country for
which the PoU was imputed. The figure shows 60 countries (of 109) with 79 increasing PoU change points in correspondence of one or more drivers. See
Annex 3 for methodology.
SOURCES: PoU based on FAO; conflict data based on Uppsala University. 2021. Uppsala Conflict Data Program (UCDP). In: UCDP [online]. Uppsala, Sweden.
[Cited 10 June 2021]. ucdp.uu.se; updated drougth provided by EU-JRC using data from the European Commission. 2021. Anomaly Hotspots of Agricultural
Production (ASAP). In: ASAP [online]. Brussels. [Cited 10 June 2021]. mars.jrc.ec.europa.eu/asap; updated flood provided by UCT using data from Climate
Hazards Center of the University of California - Santa Barbara. 2021. CHIRPS: Rainfall estimates from rain gauge and satellite observations. In: CHIRPS
[online]. Santa Barbara, USA. [Cited 10 June 2021]. www.chc.ucsb.edu/data/chirps; updated heat spells provided by UCT using data from the European
Centre for Medium-Range Weather Forecasts (ECMWF). 2021. Datasets. In: ECMWF [online]. Reading, United Kingdom. [Cited 10 June 2021]. www.ecmwf.
int/en/forecasts/datasets; updated storm data based on Centre for Research on the Epidemiology of Disasters (CRED). 2021. EM-DAT: the international
disasters database. In: EM-DAT [online]. Brussels. [Cited 10 June 2021]. public.emdat.be; annual per capita GDP based on IMF. 2021. World Economic
Outlook Database - April 2021. In: IMF [online]. Washington, DC. [Cited 10 June 2021]. www.imf.org/en/Publications/WEO/weo-database/2021/April

| 66 |
 THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2021

» Increases in undernourishment characterized by increasing undernourishment

occur in correspondence with conflict, after years of reduction or stabilization for
climate extremes and economic downturns 109 low- and middle-income countries with
available information. ah It indicates that
Conf lict, climate extremes and economic among the 109 countries combined, there were
downturns critically challenge food systems – 87 increasing PoU change points during this
either through effects on systems supporting period in 65 low- and middle-income countries.
food production, food supply changes, food Of these, 79 increasing PoU change points in
environments or consumer behaviour, or any 60 countries were in correspondence with one
combination of these – with impacts on food or more drivers (conf lict, climate extremes, and
securit y and nutrition. This is particularly the economic slowdowns and downturns) ( Figure 17).
case where a countr y’s food system is highly This means that more than half of the countries
v ulnerable to the impacts of the drivers and (55 percent) experienced increasing PoU in
the countr y has high levels of povert y and correspondence with at least one of these drivers
inequalit y but does not have sufficient support during 2010 –2018.
in place to counter the fallout.
Around 45 percent, or 27 of the 60 countries,
Although it is difficult to establish a direct experienced an increase in the PoU in
causal relationship considering there is limited correspondence with one driver. Of these
year-on-year variation in estimated PoU countries, most were in correspondence with
values, ag it is possible to examine whether economic slowdowns or downturns (18 countries),
increasing change points in the PoU time series followed by climate extremes (9 countries),
correspond to the occurrence of the drivers. while, interestingly, conflict always occurs in
The identification of an increasing change point combination with other drivers. However, seven
refers to the statistically significant increase in of these countries not only experienced an
the PoU for two consecutive years before and increase in PoU in correspondence with one driver
after the year of the change point (see Annex 3 in a given year, but also experienced increases in
for the methodolog y). A change point analysis other years in correspondence with a combination
was presented in the 2018 edition of this report of drivers. As a result, 52 of the 79 PoU increases
for severe drought and in 2019 for economic occurred in correspondence with a combination
slowdowns and downturns. Here we update the of drivers (in 40 of the 60 countries): 32 change
analysis for the first time to consider conf lict, points in 26 countries with climate extremes and
climate extremes, and economic downturns and economic slowdowns and downturns, 10 change
slowdowns together, which provides further points in nine countries with all three drivers
insights on the possible inf luences of multiple combined, 5 change points in five countries with
driver events in countries that concurrently conflict and climate extremes, and the remaining
experience PoU increases. Because the 5 change points in five countries with conflict and
methodolog y requires two years before and two economic slowdowns and downturns.
years after the year of the point of change, the
latest change point that can be estimated is 2018. As seen from this analysis, there are more
PoU increases (79) than there are countries
The change point analysis of PoU time series (60), which also means that several countries
presented here covers changes between 2010 and experienced more than one increase in the PoU
2018, and within this period identifies the years during the period 2010 –2018. In other words,
several countries faced recurring PoU increases
ag  The PoU is used to monitor progress towards the achievement of during this period. Although most countries
SDG Target 2.1.As this indicator changes slowly over time, direct (44 of 60) experienced PoU increases while at
regression with other indicators is inappropriate. However, the PoU
change point analysis allows the identification of increasing change
points in the prevalence of undernourishment in the years when a ah  Of the 133 low- and middle-income countries analysed in the
subsequent increasing tendency in the PoU time series occurs. chapter, information on PoU is available for 110 countries. Furthermore,
Therefore, it is possible to examine when major drivers, such as conflict, the PoU change point analysis excludes one country for which the
climate extremes and/or economic downturns, occur in correspondence prevalence of undernourishment was imputed. Therefore, the analysis
with increasing change points in the PoU. includes 109 countries.

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 CHAPTER 3 MAJOR DRIVERS OF RECENT FOOD SECURITY AND NUTRITION TRENDS

FIGURE 18 THE 2020 INCREASE IN THE NUMBER OF UNDERNOURISHED WAS MORE THAN FIVE TIMES
GREATER THAN THE HIGHEST INCREASE IN UNDERNOURISHMENT IN THE LAST TWO DECADES, AND
THE ECONOMIC DOWNTURN WAS TWICE AS SEVERE THAN PREVIOUSLY RECORDED IN LOW- AND
MIDDLE-INCOME COUNTRIES

120
109.6 14

100
12

ANNUAL CHANGE IN GDP PER CAPITA (PERCENTAGE POINTS)

NUMBER OF ECONOMIC DOWNTURNS IN SELECTED YEARS
80 10

8
60
ANNUAL CHANGE IN NoU (MILLIONS)

6
40
4
20.7
20 14.4
11.8 2
(28)
(29) 3.1 (29)
0 0
(27) (29)
(30) -2
-20
-24.5
(57) -4
-40
-6

-60 (99)
-8

-80 -10
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020

Annual change in NoU (left axis) Annual change in GDP per capita growth and number
of economic downturns (in parenthesis) (right axis)

NOTES: The blue bars show the annual change in the number of undernourished people (NoU) between 2000 and 2020 (left axis) in low- and
middle-income countries. Selected numbers in correspondence of the blue bars denote the highest annual changes in the NoU. The orange line shows
the annual change in GDP per capita growth in the same period (right axis); the number in parenthesis refers to the total number of countries that
experienced an economic downturn in selected years. The figure analyses the sample of 107 low- and middle-income countries with information available
on NoU and GDP per capita. This sample includes only countries for which official Food Balance Sheets exist. See Annex 4 for definitions.
SOURCES: FAO for PoU data and annual per capita GDP based on IMF. 2021. World Economic Outlook Database - April 2021. In: IMF [online].
Washington, DC. [Cited 10 June 2021]. www.imf.org/en/Publications/WEO/weo-database/2021/April

the same time being affected by one driver or a (Democratic Republic of the Congo, Gambia and
combination of drivers in a single year, several Lebanon) witnessed it for three years.
countries (16) experienced an increase in the
PoU in correspondence with any of the drivers Importantly, reoccurring PoU change points are
for two or three years. In particular, for 13 of seen where different drivers prevail. Only in
the countries, this simultaneous occurrence 4 of the 16 countries with reoccurring increases
is recorded for two years; three countries in the PoU did these changes coincide with

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 THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2021

FIGURE 19 IN 2020, MOST LOW- AND MIDDLE-INCOME COUNTRIES HIT BY ECONOMIC DOWNTURNS
EXHIBIT AN INCREASE IN THE PoU, BUT OFTENTIMES ECONOMIC DOWNTURNS OCCUR SIMULTANEOUSLY
WITH CLIMATE-RELATED DISASTERS AND CLIMATE EXTREMES

20
DOMINICAN REPUBLIC
BOSNIA AND HERZEGOVINA
SERBIA
RWANDA
15 GEORGIA GAMBIA
ANGOLA SIERRA LEONE
NUMBER OF COUNTRIES

BRAZIL BELIZE
NEPAL BENIN
BOLIVIA
(PLURINATIONAL STATE OF) DJIBOUTI TUNISIA
10 UNITED REPUBLIC OF TANZANIA MADAGASCAR MONTENEGRO
SAO TOME AND PRINCIPE MEXICO TOGO
KYRGYZSTAN GUATEMALA ECUADOR
MALAWI UZBEKISTAN NORTH MACEDONIA IRAN
(ISLAMIC
RUSSIAN FEDERATION KENYA BULGARIA REPUBLIC OF)

5 SAMOA PERU PARAGUAY YEMEN INDIA ETHIOPIA

ESWATINI HONDURAS JAMAICA PAKISTAN COLOMBIA VIET NAM
COSTA RICA EL SALVADOR MOROCCO NIGERIA THAILAND CHINA
NAMIBIA MALI SRI LANKA SENEGAL BURKINA FASO LEBANON PHILIPPINES TURKEY
SOUTH AFRICA IRAQ MOZAMBIQUE MAURITANIA UKRAINE JORDAN SUDAN ALGERIA GUYANA

TYPE OF DRIVERS

Economic downturns Economic downturns – conflict (food crisis)

Economic downturns – climate-related disasters Economic downturns – climate extremes
Economic downturns – conflict (food crisis) – climate-related disasters Economic downturns – conflict (food crisis) – climate extremes
Economic downturns – conflict – climate-related disasters Economic downturns – conflict – climate extremes
No downturn

NOTES: Of the 107 low- and middle-income countries with available information on the prevalence of undernourishment (PoU) and GDP per capita, the
figure shows 66 countries with an increase in the PoU from 2019 to 2020 that is higher than the increase from 2017 to 2019. Of the 66 countries, 60 have
an increase in the PoU along with an economic downturn in 2020. For these countries, the PoU increase in 2020 may occur in correspondence with an
economic downturn as well as other drivers: conflict, climate extremes or climate-related disasters. See Annex 5 for definitions and methodology.
SOURCES: PoU based on FAO; see sources of Figure 17 for data on drivers (conflict, climate extremes and economic downturns); data on climate-related
disasters (extreme temperatures, floods, storms) based on Centre for Research on the Epidemiology of Disasters (CRED). 2021. EM-DAT: the international
disasters database. In: EM-DAT [online]. Brussels. [Cited 10 June 2021]. public.emdat.be; conflict as a primary driver of acute food insecurity in countries
in a food crisis situation based on FSIN & Global Network Against Food Crisis. 2021. Global Report on Food Crises 2021. Rome. (also available at
www.fsinplatform.org/sites/default/files/resources/files/GRFC 2021 050521 med.pdf).

the occurrence of the same driver(s), while the Similarly, the Democratic Republic of the
remaining 12 countries experienced different Congo reported increasing change points in
drivers or combinations of drivers. For instance, correspondence with all three drivers in two
Côte d’Ivoire, Lebanon and Lesotho first years (2011 and 2017) and with conf lict and
experienced increasing PoU change points in climate extremes in 2014. Afghanistan also
correspondence with economic slowdowns and experienced increasing PoU change points in
downturns (in 2010, 2014 and 2013, respectively) correspondence with all three drivers in 2011,
and then in combination with climate extremes and with conf lict and economic slowdowns and
(Lebanon in 2018, and the other two in 2017). downturns in 2014.

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CHAPTER 3 MAJOR DRIVERS OF RECENT FOOD SECURITY AND NUTRITION TRENDS

While a PoU change point analysis is usually only, while for the rest of the countries, the
needed to detect statistically significant increases occurred under the inf luence of
inf lection points and increases in the PoU from economic downturns and a combination of
year to year, the sharp and unprecedented rise other drivers.
in the PoU from 2019 to 2020 allows for a more
direct approach. In this case, it is possible to The most frequently occurring combination of
detect an increase in 2020 by comparing the 2019 drivers in 2020 was economic downturns with
to 2020 PoU increase with the increase from climate extremes or climate-related disasters
2017 to 2019 (see Annex 5 for methodolog y). (34 of 60) ( Figure 19). Most striking is that in
This approach is applied to examine the 2020 most (19) of these 34 countries, the climate
increase in the PoU and whether one or more of impacts were severe, qualif ying as medium-
the drivers exerted inf luence at the same time. and/or large-scale climate-related disasters. aj
Climate-related disasters have come to dominate
The annual change in the number of the risk landscape to the point where they now
undernourished people living in low- and account for more than 80 percent of all major
middle-income countries was 110 million from internationally reported disasters. 92,93 There were
2019 to 2020, far exceeding any single year two countries (Iraq and Mali) that had an increase
increase in decades ( Figure 18). This unprecedented in the PoU and were simultaneously affected by
increase in undernourishment was primarily both economic downturns and conflict; both are
driven by the equally exceptional economic food crisis countries with high levels of acute food
downturns that hit most countries around the insecurity requiring emergency humanitarian
world as a result of the COV ID-19 pandemic assistance. Thirteen of the 60 countries
containment measures (see Box 7). Among low- experienced an economic downturn along with
and middle-income countries, GDP per capita conflict and climate extremes or climate-related
growth declined, on average, by 6.7 percentage disasters; seven of these are food crisis countries
points in 2020, which is more than double with high levels of acute food insecurity that also
the severit y of the 2009 global financial crisis experienced climate-related disasters (Burkina
and economic downturn ( Figure 18). ai Economic Faso, Jordan, Lebanon, Nigeria, Pakistan,
downturns in 2020 also occurred in almost Ukraine and Yemen). As will be seen in the
twice as many countries compared with 2009 analysis below, some of the largest increases
(99 countries affected by economic downturns in in the PoU from 2019 and 2020 were seen in
2020, compared with 57 in 2009). countries where economic downturns combined
with climate-related disasters, or with food crisis
Most low- and middle-income countries for countries with conflict as a primary driver.
which there are PoU and GDP per capita data
for 2020 (81 of 107) registered an increase in the Highest levels of food insecurity and
PoU from 2019 to 2020. The magnitude of this
single-year increase in the PoU is higher than
malnutrition seen in countries affected
the increase from the previous two years in most by multiple drivers
countries (66 of 81) ( Figure 19). Only 15 countries The extent to which a driver or factor negatively
with a PoU increase from 2019 to 2020 did not affects people’s food securit y and nutrition
have an increase higher than the one from 2017 depends on their degree of exposure and their
to 2019. v ulnerabilit y to its impact. In the analysis that
follows, countries are categorized based on
Almost all the low- and middle-income countries whether they are “affected” by a driver or factor,
with an increase in PoU in 2020 higher than the i.e. countries affected by conf lict, countries
increase during the previous two years (60 of 66) affected by climate extremes, countries affected
show this increase amid an economic downturn
( Figure 19). Of these, 11 countries show an increase aj  Climate-related disasters are based on the Centre for Research on
in the PoU occurring with economic downturns the Epidemiology of Disasters (EM-DAT)326 datasets of medium- and
large-scale disasters and include disasters caused by droughts, floods,
extreme temperatures and storms. See EM-DAT for definitions and
ai  See trend analysis of economic downturns. sources.

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 THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2021

BOX 8 DEFINITION OF COUNTRIES AFFECTED BY CONFLICT, CLIMATE EXTREMES, ECONOMIC DOWNTURNS

AND WITH HIGH INCOME INEQUALITY

The following definitions are applied to categorize period. Climate-related vulnerability is identified
countries affected by a driver (conflict, climate when at least one of the following conditions occur:
extremes and economic downturns) and with high i) a country shows a high and statistically significant
inequality across 133 low- and middle-income association between cereal production or imports and
countries. Countries can be categorized as affected by at least one climate factor (temperature, precipitation
more than one driver (or factor) if they meet the criteria. and vegetation growth) during the years 2001–2020;
Countries affected by conflict are those experiencing ii) a country is highly dependent on agriculture,
conflict that resulted in a significant loss of human life, measured by 60 percent or more people employed in
i.e. that suffered 500 or more battle deaths for at least the agriculture sector in 2019; iii) a country shows an
one of the four subperiods considered in the analysis increasing PoU change point in correspondence with a
(2000–2004; 2005–2009; 2010–2014; 2015–2019). severe drought warning.
This definition includes both aspects of occurrence of Countries affected by economic downturns are
conflict, as well as vulnerability in terms of a significant those experiencing an economic downturn, coinciding
loss of life. As highlighted above, a longer time period with an increasing PoU change point during any year
is necessary to define countries affected by conflict; between 2010 and 2018. This definition captures both
because of the changing nature of conflict where even the occurrence of an economic downturn, as well as
in post-conflict contexts, violence can simply change vulnerability in terms of a corresponding increase in
its form as settings, actors and drivers change, may undernourishment. Specifically, a PoU change point
not disappear when the conflict is seemingly over characterized by an increasing tendency between t-2
and conflicts structural impacts can be seen in other and t+2 is identified at time t, and it should occur in
locations and years. correspondence with an economic downturn reported at
Countries affected by climate extremes are those time t, or at time t-1.
experiencing a combination of high exposure to Countries with high income inequality are those
climate extremes (i.e. drought, flood, heat spell, storm) countries with a Gini index during 2010–2018
and vulnerability to climate factors. High exposure that is higher than the median value of the income
is defined as when a country experiences three or inequality distribution.
four different typologies of climate extremes during A further breakdown of this analysis considers all
2010–2014 or 2015–2019 (among drought, flood, possible combinations of multiple drivers that can
heat spell, storm), or when any of these extremes affect low- and middle-income countries. Eight mutually
occur for at least seven years in the 2010–2019 exclusive categories of countries are identified.

See Annex 4 for the methodology and the list of countries affected by different combinations of drivers.

by economic downturns and countries with is an increased probability that these climate
high inequalit y. The variables used to define the extremes will result in negative outcomes of food
different categories are provided in  Box 8. insecurity and malnutrition (vulnerability). If both
conditions are met, then a country is categorized
In summar y, two criteria are used for a countr y as a “country affected by climate extremes”.
to be categorized as being affected by a driver: A country can be affected by more than one type
(i) evidence of the occurrence of an event related of driver if it meets the criteria, e.g. a country can
to the driver in a countr y, for example, the be affected by both climate extremes and conflict.
occurrence of a conf lict, a climate extreme, or
an economic downturn; and (ii) evidence of a Although there are many vulnerability factors
v ulnerabilit y to the impacts of such an event, related to each driver, many are problematic to
which refers to conditions that increase the define consistently across countries for a global
probabilit y that the occurrence of the driver event analysis due to the lack of data and comparability.
will negatively affect the countr y’s food securit y In this analysis, a small subset of indicators are
and nutrition situation. selected for the analyses that serve as a proxy
for best measure of, vulnerability related to the
For example, a country affected by climate drivers and their relative importance to food
extremes is a country where there is evidence security and nutrition, and measurability across
of the occurrence of climate extremes over the 133 low- and middle-income countries
agricultural areas (exposure) and where there (LMICs).

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CHAPTER 3 MAJOR DRIVERS OF RECENT FOOD SECURITY AND NUTRITION TRENDS

As seen above, 2020 represents a unique year A salient finding is that most of the hungr y
in that most low- and middle-income countries people live in countries affected by multiple
experienced steep economic downturns. As a drivers: 381.4 million of the 650.3 million
result, for that year there is an unusually high chronically undernourished globally in 2019
number of countries affected by multiple ( Figure 20A).
drivers, with economic downturns combed
with climate extremes and conf lict. For this Child stunting shows a similar pattern. In 2019,
reason, it is important to separate this analysis for countries with available information, the
and first examine the pre-COV ID-19 period. unweighted average prevalence of stunted
children in countries affected by a combination
In the pre-COV ID-19 period, most or of drivers was 6 percentage points higher
70 percent of low- and middle-income countries than in countries affected by one driver
were affected by at least one of the drivers (93 only, and 9 percentage points higher than in
of 133). Of the 133 low- and middle-income countries not affected by any driver (28.5,
countries, only 40 countries are not affected by 22.6 and 19.6 percent, respectively) ( Figure 20B).
any of the three drivers, while most countries Around 130 million, or 90 percent, of the total
are affected by either one driver (52 countries) number of stunted children under the age of
or a combination of drivers (41 countries). five lived in countries affected by one or more
For countries affected by one driver, most are drivers ( Figure 20B). However, the drivers are
affected by climate extremes (38 countries), not the only inf luencing factors determining
followed by conf lict (8 countries) and economic food securit y and nutrition outcomes in these
downturns (6 countries). Climate extremes are countries, and a deeper analysis is therefore
the most common driver affecting countries, called for.
either as a single driver or in combination
with other drivers (75 countries). Conf lict is If we update the analysis to identif y countries
the second most common driver affecting affected by the different drivers including
countries, either as a single driver or in year 2020, of 133 low- and middle-income
combination with other drivers (40 countries), countries, the number of countries not affected
followed by economic downturns (24 countries). by any of the drivers decreases from 40 to only
For countries affected by one or more drivers 14 (compared with 2010 –2019), while most
41 percent also have high income inequalit y of the countries (80 countries) are affected
(38 of 93 countries). by a combination of drivers, and only a few
are affected by one driver (39 countries).
For countries affected by multiple drivers, more Climate extremes continue to be the most
countries are affected by conf lict and climate common driver affecting countries, either
extremes (23 countries), followed by climate as a single driver or in combination with
extremes and economic downturns (9 countries). other drivers (104 countries). Economic
Five countries are affected by all three drivers. downturns, however, either as a single or in
See Annex 4 for a list of countries affected combination, are the second most common
by drivers. driver affecting countries (72 countries),
followed by conf lict (40).
The majorit y of chronically undernourished
people and stunted children live in countries Consequently, in 2020, the number of
affected by multiple drivers ( Figure 20). undernourished people who live in low- and
Moreover, countries affected by multiple drivers middle-income countries affected by multiple
also have a significantly higher prevalence of drivers increases significantly to more
undernourishment and of stunted children. than 585 million people (no fig ure shown).
In 2019, the unweighted average of the PoU Countries affected by multiple drivers also have
in countries affected by multiple drivers a much higher prevalence of undernourishment
(17 percent) was 6 percentage points higher in 2020 (16 percent) compared with countries
than in countries affected by one driver or affected by one driver or not affected by
countries not affected by any driver ( Figure 20A). any driver (10 and 8 percent, respectively). »

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 THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2021
FIGURE 20 THE MAJORITY OF UNDERNOURISHED PEOPLE AND STUNTED CHILDREN LIVE IN COUNTRIES
AFFECTED BY MULTIPLE DRIVERS (2019)

A) PREVALENCE OF UNDERNOURISHMENT (PoU)

450 20

17 18
400
NUMBER OF UNDERNOURISHED (MILLIONS)

PREVALENCE OF UNDERNOURISHMENT (%)

16
350

14
300
11 13 12
11
250
10
200
8
8
150
6

100
4
4
50 2

0 0

NO DRIVER SINGLE DRIVER MULTIPLE DRIVERS

Number of undernourished 2019 (millions) Prevalence of undernourishment 2019 (weighted)

Prevalence of undernourishment 2019 (unweighted)

B) STUNTED CHILDREN UNDER THE AGE OF FIVE

110 35
31.9

30
NUMBER OF STUNTED CHILDREN (MILLIONS)

90

PREVALENCE OF STUNTED CHILDREN (%)

28.5
23.1 25
70
20.4
22.6
20
50 19.6

15

30
10

10
5

-10 0
NO DRIVER SINGLE DRIVER MULTIPLE DRIVERS

Number of stunted children 2019 (millions) Prevalence of stunted children 2019 (weighted)
Prevalence of stunted children 2019 (unweighted)

NOTES: Figure 20A shows the total number (bars) and prevalence of undernourishment (circles), and Figure 20B shows the total number (bars) and
prevalence of stunted children (circles) in 2019, for low- and middle-income countries exposed to no driver, a single driver or multiple drivers. The
analysis in Figure 20A (PoU) is shown for 110 low- and middle-income countries with available information in 2019, with 29 countries affected by no driver,
45 countries by one driver, and 36 countries by multiple drivers. The analysis in Figure 20B (stunting) is shown for 84 low- and middle-income countries
with available information (17 countries affected by no driver, 37 countries by a single driver, and 30 countries by multiple drivers). See Annex 4 for
definitions and methodology of countries affected by multiple drivers.
SOURCES: PoU based on FAO; child stunting data based on UNICEF, WHO & World Bank. 2021. UNICEF-WHO-World Bank: Joint child malnutrition
estimates - Levels and trends (2021 edition) [online]. https://data.unicef.org/resources/jme-report-2021, www.who.int/data/gho/data/themes/topics/joint-
child-malnutrition-estimates-unicef-who-wb, https://datatopics.worldbank.org/child-malnutrition; see sources of Figure 17 for data on drivers (conflict,
climate extremes and economic downturns).

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 CHAPTER 3 MAJOR DRIVERS OF RECENT FOOD SECURITY AND NUTRITION TRENDS

FIGURE 21 HUNGER IS HIGHER AND HAS INCREASED MORE IN COUNTRIES AFFECTED BY CONFLICT,
CLIMATE EXTREMES OR ECONOMIC DOWNTURNS, OR WITH HIGH INEQUALITY

22

20
PREVALENCE OF UNDERNOURISHMENT (%)

18

16

14

12

10
2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020

Affected by conflict Not affected by conflict

Affected by climate extremes Not affected by climate extremes
High income inequality Low income inequality
Affected by economic downturns Not affected by economic downturns

NOTES: The figure shows the prevalence of undernourishment between the years 2010 and 2020 for low- and middle-income countries affected by any of
the three drivers (conflict, climate extremes or economic downturns), and for countries with high income inequality. PoU estimates are unweighted. The
analysis is shown for 110 low- and middle-income countries with available PoU information. See Annex 4 for definitions and methodology of countries
affected by the different drivers.
SOURCES: PoU based on FAO; Gini index of income inequality data based on World Bank. 2021. World Development Indicators. In: World Bank [online].
Washington, DC. [Cited 24 April 2020]. datatopics.worldbank.org/world-development-indicators; see sources of Figure 17 for data on drivers (conflict,
climate extremes and economic downturns).

» Similarly, in 2020 the highest prevalence of Hunger increases the most where there is
stunting occurred in countries affected by
multiple drivers (23 percent), compared with
conflict, climate extremes, economic
downturns and high income inequality
22

countries affected by one driver or not affected

by any driver (18 and 14 percent, respectively). As shown in the previous chapter, world hunger,
20

However, child stunting decreased from as measured by the PoU, reversed course after
24 percent in 2019 to 21 percent in 2020 for low- a long period of decline and began to slowly
18

and middle-income countries. increase in 2014. Given the reversal in the

downward trend and the recent increases in
16

undernourishment, even before the COV ID-19

pandemic, it is important to examine trends more
14

closely in low- and middle-income countries

affected by conf lict, climate extremes and
12

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10
10

11

12

13

14

15

16

17

18

19

20
20

20

20

20

20

20

20

20

20

20

20
 THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2021

economic downturns, as well as differences for increase in the PoU of 4 percent, while countries
countries with high income inequalit y. not affected by any driver show a decreaseof
3 percent. Overall, between 2017 and 2019,
This analysis shows that the reversal in the countries affected by multiple drivers exhibit the
PoU trends in 2014 and the continuous increase highest increases in the PoU (6 percent), which is
(especially pronounced from 2017) is largely 12 times larger than those in countries affected
attributed to low- and middle-income countries by only a single driver (0.5 percent).
affected by conf lict, climate extremes and
economic downturns, and to countries with high Considering all low- and middle-income
income inequalit y ( Figure 21). The PoU is higher countries, 24 of the countries affected by
and has increased more in countries affected by economic downturns show the largest increase in
these drivers. PoU (1.5 percentage points), while 36 countries
affected by multiple drivers show the second
Of the 110 low- and middle-income countries largest increase (1.0 percentage point) ( Figure 22).
with available information, the largest increase This compares with a 0.1 percentage point
in the PoU is obser ved in countries affected by increase for the 45 countries affected by a single
economic downturns. The group of countries driver, and a 0.3 percentage point reduction for
affected by economic downturns have had the 29 countries not affected by any driver.
increases in the PoU that started as early as
2010, surpassing countries affected by other A further breakdown of this analysis considers
drivers to have the highest PoU ( Figure 21). all possible combinations of multiple drivers that
can affect low- and middle-income countries.
Countries affected by conf lict exhibit a small Given 110 countries with available information
but increasing trend in their PoU from 16 to on undernourishment, eight mutually exclusive
16.9 percent between 2017 and 2019. Though not groups are created. Figure A4.1 shows countries
shown in Figure 21, the PoU is even higher and grouped by the eight categories denoting
with greater increases in countries where conf lict different combinations of drivers and Table A4.1
is compounded by protracted crisis. During the provides the countr y list. The largest increases
years 2010 –2019, countries in protracted crises in the PoU (not shown in fig ure) are seen by the
reported the highest PoU at an average level of nine countries affected by both climate extremes
30 percent, with an increase of 1.5 percentage and economic downturns, with a 2.1 percentage
points between 2017 and 2019 (from 28.7 to point increase during 2017–2019, followed by
30.2 percent). the five countries affected by all three drivers,
which feature an increase of 2 percentage
It is strikingly clear from Figure 21 that 2020 points (Afghanistan, Central African Republic,
represents a clear departure from previous years, Democratic Republic of the Congo, Nigeria and
as surges in the PoU are seen across all low- and Yemen). Countries experiencing the combination
middle-income countries. As seen earlier, the of conf lict and climate extremes (18 countries) or
economic downturns resulting from the COVID-19 conf lict and economic downturns (4 countries),
pandemic and its containment measures delivered feature a 0.4 and a 0.5 percentage point increase
the hardest blow in decades to world hunger, in the PoU, respectively.
contributing to a sharp and significant increase in
undernourishment in a single year. Between 2017 and 2019, low-income countries
affected by the drivers show the largest increase
There are also important differences in trends in the PoU (from 30.8 to 32.4 percent), which is
depending on whether a countr y is affected 2.5 times higher than to the increase reported by
by more than one driver (multiple drivers) and middle-income countries affected by the drivers
depending on the countr y income group ( Figure 22). over the same period (from 8.9 to 9.1 percent)
Focusing on the most recent period of increase ( Figure 22). Specifically, there is a 1.6 percentage
before the COV ID-19 pandemic, between 2017 point PoU increase in low-income countries,
and 2019, low- and middle-income countries which is higher than the 0.2 percentage point
affected by one or more of the drivers show an PoU increase for middle-income-countries (no

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 CHAPTER 3 MAJOR DRIVERS OF RECENT FOOD SECURITY AND NUTRITION TRENDS

FIGURE 22 LOW-INCOME COUNTRIES AFFECTED BY CONFLICT AND CLIMATE EXTREMES SHOW THE
LARGEST INCREASE IN THE PoU, WHILE FOR MIDDLE-INCOME COUNTRIES, THE LARGEST INCREASE
OCCURS DURING ECONOMIC DOWNTURNS
DIFFERENCE IN THE PoU FROM 2017 TO 2019 (PERCENTAGE POINTS)

2.5

2.0

1.5

1.0

0.5

0.0

-0.5

-1.0
Low-income Lower-middle-income Upper-middle-income Middle-income
countries countries countries countries

WORLD BANK INCOME GROUP ALL COUNTRIES

Affected by conflict Affected by climate extremes Affected by economic downturns High income inequality
No driver Single driver Multiple drivers

NOTES: The figure shows the difference in the PoU, measured in percentage points, from 2017 to 2019 for low- and middle-income countries affected by
conflict, climate extremes and economic downturns, and for countries with high income inequality. The figure also shows the difference in the PoU by
different combinations of drivers (no driver, single, multiple drivers). The analysis is shown by country income group for a sample of 110 low- and middle-
income countries with available PoU information. See Annex 4 for definitions and methodology.
SOURCES: PoU based on FAO; Gini index of income inequality data based on World Bank. 2021. World Development Indicators. In: World Bank
[online]. Washington, DC. [Cited 24 April 2020]. datatopics.worldbank.org/world-development-indicators; see sources of Figure 17 for data on drivers
(conflict, climate extremes and economic downturns).

increase for lower-middle-income countries by conf lict is higher also compared with
and 0.4 for upper-middle-income countries). low-income countries not affected by conf lict (no
Low-income countries also feature high increase in the PoU).
increases across all three drivers, as well as when
affected by a single driver or multiple drivers. In contrast with low-income countries, increases
Low-income countries affected by conf lict (11 in the PoU among middle-income countries
countries) and climate extremes (14 countries) during this period are primarily seen for
feature increases that are, respectively, 2.3 and countries affected by economic downturns
1.4 percentage points, which are higher compared and multiple drivers ( Figure 22). Middle-income
with middle-income countries affected by these countries affected by economic downturns (16
drivers ( Figure 22). Furthermore, the 2.3 percentage countries) feature a 1.7 percentage point increase
point increase in low-income countries affected in the PoU, compared with middle-income

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 THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2021

countries not affected by economic downturns Regional differences in drivers and

(74), which show a 0.3 percentage point impacts on food security and nutrition
reduction. Of these, 8 lower-middle-income
countries had a 1.9 percentage point increase, A regional analysis shows differences in trends
and 8 upper-middle-income countries had a related to the different drivers. The analysis in
1.4 percentage point increase. this section focuses on low- and middle-income
countries in Africa, Asia, and Latin America and
High income inequalit y is also a factor in the the Caribbean. These are the three regions of the
PoU increases during this period, especially world where most of the undernourished people
in middle-income countries. Middle-income and stunted children are located and where there
countries with high income inequalit y are sufficient data for analysis. We first analyse
(39 countries) have a higher increase in the the period 2017–2019, followed by a focused look
PoU than middle-income-countries without at 2020.
high income inequalit y. Specifically, the
former had a 0.3 percentage point increase, In the period 2017–2019, for all three reg ions
and the latter a 0.3 percentage point reduction. analysed, around 78 percent of low- and
Furthermore, considering middle-income middle-income countries are affected by at
countries affected by one or more drivers, they least one of the three drivers (conf lict, climate
show a 2 percent increase in the PoU between extremes and economic downturns) ( Figure 23).
2017 and 2019, while those with the additional Of these countries, 45 percent (33 of 74 countries)
burden of high income inequalit y had a double also have high income inequalit y, which
increase in the PoU (4 percent). worsens the impact of these drivers. There is a
0.6 percentage point increase in the PoU between
In contrast to recent trends in the prevalence 2017 and 2019 for countries affected by drivers
of undernourishment, the prevalence of child with high income inequalit y (not shown in the
stunting shows a continuing declining trend fig ure), compared with a slight decrease in the
from 2017 to 2019. However, an analysis of PoU for countries affected by drivers but with
child stunting for countries affected by conf lict, low income inequalit y. Of the 44 countries from
climate extremes and economic downturns, these reg ions that have high income inequalit y,
as well as differences for countries with 26 are located in Africa, 5 in Asia, and 13 in
high income inequalit y, did not reveal any Latin America and the Caribbean. ak
notable patterns, indicating the presence of
other stronger drivers behind these trends. Countries affected by economic downturns in
Similarly, while there is an increase in adult Africa, Asia, and Latin America and the Caribbean
obesit y from 2012 to 2016 that is obser ved across show the highest PoU increase from 2017 to 2019,
low- and middle-income countries, the analysis compared with countries affected by climate
indicates that this increasing trend is driven extremes or conflict ( Figure 23). The largest increase
by structural factors related to the economic is seen in Africa and Latin America and the
development of a countr y and associated Caribbean (2 percentage points). Africa is the only
changes in food environments, rather than by region where a surge in PoU is associated with all
contingencies related to the drivers. In fact, three major drivers. Of the 24 countries affected by
the increase in adult obesit y is correlated with economic downturns, 11 are in Africa (27 percent
countr y income level and with the nutrition of countries), 6 in Asia (19 percent of countries) and
transition that often accompanies economic 5 in Latin America and the Caribbean (22 percent
development. Indeed, middle-income countries of countries). There are also countries outside these
feature a statistically significant higher increase regions affected by economic downturns but not
than low-income countries (1.9 compared with shown in the figure: two in Oceania.
1.4 percentage points), with the highest increase
reported by upper-middle-income countries ak  There are also low- and middle-income countries in two other
(2.1 percentage points). regions, but these are not included in the analysis due to limited number
of countries and data on drivers for these countries. There are three
countries outside the three regions analysed with high income inequality,
of which two are in North America and Europe, and one in Oceania.

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 CHAPTER 3 MAJOR DRIVERS OF RECENT FOOD SECURITY AND NUTRITION TRENDS

FIGURE 23 LATIN AMERICA AND THE CARIBBEAN FEATURE THE HIGHEST INCREASE IN THE PoU FROM
MULTIPLE DRIVERS, WHILE AFRICA IS THE ONLY REGION WHERE THE PoU INCREASED UNDER THE
INFLUENCE OF ALL THREE DRIVERS FROM 2017 TO 2019

2.5 100
93 94
DIFFERENCE IN THE PoU FROM 2017 TO 2019 (PERCENTAGE POINTS)

PERCENTAGE OF COUNTRIES AFFECTED BY AT LEAST ONE DRIVER

85 90
2.0
78
80

1.5 70

60
1.0

50

0.5
40

0.0 30

20
-0.5
10

-1.0 0
AFRICA ASIA LATIN AMERICA ALL COUNTRIES
AND THE CARIBBEAN

Affected by conflict Affected by climate extremes Affected by economic downturns Percentage of countries affected
No driver Single driver Multiple drivers by at least one driver

NOTES: In the figure, the left axis shows the difference in the PoU, measured in percentage points, from 2017 to 2019 for all low- and middle-income
countries affected by conflict, climate extremes and economic downturns, and for each selected region (bars). The right axis shows the percentage of
countries that were exposed to at least one driver in each region compared with all countries in the region (circles). The analysis is shown for a sample of
110 low- and middle-income countries with available PoU information. See Annexes 3 and 4 for definitions and methodology.
SOURCES: PoU based on FAO; see sources of Figure 17 for data on drivers (conflict, climate extremes and economic downturns).

Climate extremes are an important driver 2017–2019 ( Figure 23). In contrast, the one countr y
in Africa, with countries affected by climate affected by conf lict in Latin America and the
extremes in this region showing a 1.2 percentage Caribbean (Colombia) shows no increase in
point PoU increase from 2017 to 2019, whereas the PoU.
Asia reports a 0.4 percentage point reduction
( Figure 23). There are 21 countries in Africa affected Africa is the only region with PoU increases
by climate extremes (51 percent of countries) and from 2017 to 2019 associated with all three
24 countries in Asia (77 percent of countries). drivers (conf lict, climate extremes and economic
downturns) ( Figure 23). Moreover, countries
Countries affected by conf lict in Africa show a affected by conf lict and climate extremes
1.7 percentage point increase in the PoU during in Africa show a higher increase in the PoU

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 THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2021

FIGURE 24 IN 2020, AFRICA, ASIA, AND LATIN AMERICA AND THE CARIBBEAN WITNESSED SIGNIFICANT
INCREASES IN THE PoU WHILE BEING HIT BY ECONOMIC DOWNTURNS COMBINED WITH CLIMATE-RELATED
DISASTERS, CONFLICT, OR A COMBINATION OF BOTH

6.0 60
DIFFERENCE IN PoU FROM 2019 TO 2020

49 49

NUMBER OF COUNTRIES AFFECTED

5.0 50
(PERCENTAGE POINTS)

BY A SPECIFIC DRIVER
4.0 35 40

3.0 30

2.0 20
9
1.0 7 7 10

0.0 0

-1.0 -10
Economic downturns Economic downturns Economic downturns Economic downturns Economic downturns, Countries not affected
and multiple drivers and climate-related and conflict (food crisis) climate-related disasters by economic downturns
disasters and conflict (food crisis)
AFFECTED BY
MULTIPLE DRIVERS AFFECTED BY COMBINATION OF DRIVERS

World Africa Asia Latin America and the Caribbean Number of countries

NOTES: In the figure, the left axis shows the difference in the PoU, measured in percentage points, from 2019 to 2020 in each selected region, and for all
low- and middle-income countries affected by economic downturns, and by specific combinations of economic downturns with other drivers (bars). The
right axis shows the number of low- and middle-income countries that were exposed to each combination of drivers (circles). The analysis is shown for a
sample of 107 low- and middle-income countries with available information on PoU and GDP per capita growth in 2020. See Annex 5 for definitions and
methodology.
SOURCES: PoU based on FAO; conflict data based on Uppsala University. 2021. Uppsala Conflict Data Program (UCDP). In: UCDP [online]. Uppsala,
Sweden. [Cited 10 June 2021]. ucdp.uu.se; climate-related disasters (extreme temperatures, flooding, storms) data based on Centre for Research on the
Epidemiology of Disasters (CRED). 2021. EM-DAT: the international disasters database. In: EM-DAT [online]. Brussels. [Cited 10 June 2021]. public.
emdat.be; annual per capita GDP based on IMF. 2021. World Economic Outlook Database - April 2021. In: IMF [online]. Washington, DC. [Cited 10 June
2021]. www.imf.org/en/Publications/WEO/weo-database/2021/April; conflict as a primary driver of acute food insecurity in countries in a food crisis
situation based on FSIN & Global Network Against Food Crisis. 2021. Global Report on Food Crises 2021. Rome. (also available at www.fsinplatform.org/
sites/default/files/resources/files/GRFC 2021 050521 med.pdf).

compared with countries affected by the same a 0.6 percentage point reduction in Asia, and a
drivers in Asia and Latin America and the 0.2 percentage point increase in Latin America
Caribbean. Interesting differences in the change and the Caribbean.
in the PoU from 2017 to 2019 are found within
the regions. African countries affected by The highest increase in the PoU, a 2.1 percentage
conf lict and economic downturns show higher point increase, is obser ved in countries affected
increases in the PoU than African countries not by multiple drivers in Latin America and the
affected by the same drivers (the latter show Caribbean ( Figure 23). Africa also registered
a small increase around 0.3 – 0.4 percentage ver y high increases in the PoU for countries
point). Similarly, countries affected by economic affected by multiple drivers (1.9 percentage point
downturns in Asia and Latin America and the increase). The most frequent combination of
Caribbean have higher PoU increases than drivers in Africa is conf lict and climate extremes
countries not affected by this driver, which show (five countries). In Latin America and the

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CHAPTER 3 MAJOR DRIVERS OF RECENT FOOD SECURITY AND NUTRITION TRENDS

Caribbean, four countries are affected by multiple There are many countries (49 of the 107 countries)
drivers: three by climate extremes and economic with an increase in the PoU in 2020 that were
downturns, and one by conf lict and climate affected only by the single driver of economic
extremes (Colombia). downturns, but the PoU increase on average,
was much smaller than the increase in countries
Countries affected by multiple drivers (one or affected by economic downturns combined with
more of the drivers) consistently show among the other drivers ( Figure 24). On average at the world
highest PoU increases during 2017–2019. In this level, the increase was 1.1 percentage point lower,
period, for all three regions analysed (Africa, and 1.5 percentage points lower for both Africa
Asia, and Latin America and the Caribbean), and Asia.
around 36 percent of low- and middle-income
countries were affected by multiple drivers, of Economic downturns combined with
which 15 are in Africa, 15 in Asia and 4 in Latin climate-related disasters affected 35 countries
America and the Caribbean. Countries affected and led to significant increases in the PoU in
by multiple drivers show a 1.9 percentage point all three regions ( Figure 24). The largest increase
increase in Africa and a 2.1 percentage point is seen in Latin America and the Caribbean
increase in Latin America and the Caribbean, (2.1 percentage points), followed by Africa
and no increase in Asia ( Figure 23). On the other (1.6 percentage points) and Asia (1 percentage
hand, while almost half the countries affected point). Of the 35 countries, 9 are in Africa (9 of
by drivers experience multiple drivers in Asia, 41 African countries), 12 are in Asia (12 of 30
during this period, it is only countries affected Asian countries) and 8 are in Latin America and
by economic downturns that show an increase in the Caribbean (8 of 21 countries in that region).
the PoU.
In 2020, countries affected by conf lict combined
In 2020, all low- and middle-income countries with other drivers had a high PoU increase.
with available information were affected by Countries in Africa affected by all three drivers
economic downturns, with the exception of of economic downturns, climate-related
nine countries (Bangladesh, China, Eg ypt, disasters and conf lict show the highest
Ethiopia, Guyana, Iran, Myanmar, Turkey and increase in the PoU (5.2 percentage points),
Viet Nam). Guyana, for instance, grew at a while countries in Asia affected by economic
rate of 43.5 percent in 2020, having completed downturns and conf lict show the second highest
an extraordinar y year of oil production. increase (3.1 percentage points).
Similarly, Iran’s GDP grew by 8 percentage
points in 2020, due to favourable oil revenues in Increasing unaffordability of healthy diets
the second half of the year.
is strongly associated with severe and
Figure 24 shows PoU increases for economic moderate forms of food insecurity
downturns and various combinations with other FAO has beg un to systematically monitor the
drivers in 2020. When economic downturns occur cost and affordabilit y of healthy diets around
along with other drivers (either climate-related the world in this report. The new 2019 estimates
disasters, conflict, or a combination of both), presented in Chapter 2 provide an important
the largest PoU increase is seen in Africa opportunit y to better understand how these are
(5.2 percentage points), followed by Asia related to food insecurit y, and how changes over
(3.1 percentage points). Of the 49 countries time affect food insecurit y and the different
affected by multiple drivers, 16 are in Africa forms of malnutrition.
(16 of 41 African countries), 18 are in Asia (18 of
30 Asian countries), 8 are in Latin America and In last year’s edition of this report, it was
the Caribbean (8 of 21 countries in Latin America shown that the unaffordabilit y of healthy
and the Caribbean), and the remaining 7 countries diets in 2017 was strongly associated with
in North America and Europe and Oceania. Of the undernourishment and different forms of
7, 3 countries are in North America and Europe malnutrition, including child stunting and
(3 of 9) and 4 countries in Oceania (4 of 6). adult obesit y. These results are reconfirmed »

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 THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2021
FIGURE 25 THE UNAFFORDABILITY OF HEALTHY DIETS IN 2019 IS STRONGLY ASSOCIATED WITH HIGHER
LEVELS OF BOTH SEVERE AND MODERATE OR SEVERE FOOD INSECURITY

R-squared=0.4332
4
PREVALENCE OF SEVERE FOOD INSECURITY (LOG)

-2

-4
-2 0 2 4 6

UNAFFORDABILITY OF HEALTHY DIET (LOG)

Low-income countries Lower-middle-income countries Upper-middle-income countries Quadratic fit

R-squared=0.4738
PREVALENCE OF MODERATE OR SEVERE FOOD INSECURITY (LOG)

1
-2 0 2 4 6

UNAFFORDABILITY OF HEALTHY DIET (LOG)

Low-income countries Lower-middle-income countries Upper-middle-income countries Quadratic fit

NOTES: The figure shows simple regression analyses by country income group between the prevalence of severe food insecurity and the unaffordability
of a healthy diet (top), and between the prevalence of moderate or severe food insecurity and the unaffordability of a healthy diet (bottom). The
unaffordability of a healthy diet (horizontal axis) identifies the percentage of the population in a country that cannot afford a healthy diet in 2019. Higher
values on the horizontal axis reflect higher levels of food insecurity on the vertical axes. All variables are expressed in logarithms. The R-squared denotes
the percent of the variance in the variable on the vertical axes explained by unaffordability of the healthy diet. The analysis is shown for 86 low- and
middle-income countries with available information on both unaffordability and food insecurity. See Annex 2 for definitions and methodology.
SOURCES: FAO for severe food insecurity and moderate or severe food insecurity indicators based on the FIES, and for unaffordability of healthy diets.

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 CHAPTER 3 MAJOR DRIVERS OF RECENT FOOD SECURITY AND NUTRITION TRENDS

FIGURE 26 IN 2019, COUNTRIES AFFECTED BY MULTIPLE DRIVERS AND COUNTRIES AFFECTED BY

CONFLICT (ALONE OR COMBINED WITH OTHER DRIVERS) EXHIBITED AMONG THE HIGHEST PERCENTAGE
OF THE POPULATION WHO CANNOT AFFORD A HEALTHY DIET AND ARE MODERATELY OR SEVERELY
FOOD INSECURE
PERCENTAGE OF THE POPULATION WHO CANNOT AFFORD A HEALTHY DIET

100 94
PREVALENCE OF MODERATE OR SEVERE FOOD INSECURITY (%)

90
82
80 74 72
70
59
60

50 44 44
41
40

30

20

10

0
Economic Climate Conflict Conflict - climate Climate extremes - Conflict - economic All three
downturns extremes extremes economic downturns downturns

NO DRIVER AFFECTED BY SINGLE DRIVER AFFECTED BY MULTIPLE DRIVERS

Prevalence of moderate or severe food insecurity (%) Percentage of the population who cannot afford a healthy diet

NOTES: The figure shows the percentage of the population who cannot afford a healthy diet (blue diamonds) and the percentage of the population with
moderate or severe food insecurity (orange bars). Both indicators are shown for the year 2019 and for all possible combinations of drivers. The analysis is
shown for 100 low- and middle-income countries with available information on unaffordability of a healthy diet, and for 88 countries with available
information on moderate or severe food insecurity. See Annexes 2 and 4 for definitions and methodology.
SOURCES: FAO for moderate or severe food insecurity indicator based on the FIES, and for unaffordability of healthy diets. See sources of Figure 17 for
data on drivers (conflict, climate extremes and economic downturns).

» this year by an analysis of estimates for 2019, who are moderately or severely food insecure,
which shows that high levels of unaffordabilit y and whether or not these populations live in
of healthy diets are strongly correlated with countries affected by drivers reveals interesting
high levels of both severe and moderate or patterns ( Figure 26). In countries affected by one
severe food insecurit y, as measured by the FIES or more drivers, on average, the percentage of
( Figure 25). As expected, the lower the income the population who are moderately or severely
of the countr y, the higher the levels of both food insecure is almost 10 percentage points
unaffordabilit y of healthy diets and severe and higher (44 percent) than that of countries not
moderate or severe forms of food insecurit y. affected by any driver (34 percent). Moreover,
a larger percentage of the population cannot
Looking at the intersection between the afford a healthy diet (57 percent) compared
percentage of the population that cannot afford with the percentage in countries not affected
a healthy diet, the percentage of the population by any driver (41 percent). Countries affected

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 THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2021

by multiple drivers exhibit the highest levels diet between 2017 and 2019. However, severe
of unaffordabilit y (68 percent), which is, on food insecurit y and moderate or severe food
average, 39 percent higher than countries insecurit y, as measured using the FIES, do not
affected by a single driver and 66 percent show such variabilit y in such a short period of
higher than countries not affected by any time, so this analysis uses their levels for 2019,
driver. Those countries also show higher rather than their 2017–2019 change. al
levels of moderate or severe food insecurit y
(47 percent), 12 percent higher than countries The analysis shows (not presented graphically
affected by a single driver (42 percent) and here) that there is a positive correlation between
38 percent more than countries not affected by the 2017–2019 change in the number of people
any driver (34 percent).  who cannot afford a healthy diet, for both
moderate or severe food insecurit y, and severe
Countries affected by conf lict have among food insecurit y in 2019. While the former variable
the highest levels of moderate or severe food may not explain much of the variabilit y in the
insecurit y and unaffordabilit y of healthy FIES-based indicators given a low coefficient of
diets in 2019, irrespective of whether they determination (R-squared of around 0.06), the
are affected by conf lict alone, or by conf lict correlation is statistically significant.
in combination with other drivers. The only
exception is countries affected by conf lict in Thus, countries where the unaffordability of a
combination with climate extremes, which healthy diet increased between 2017 and 2019 also
have a lower level of moderate or severe food show higher levels of food insecurity (both severe
insecurit y than countries affected by climate and moderate or severe). Further descriptive
extremes combined with economic downturns statistics and tests of significance suggest that
( Figure 26). The few countries that were affected this positive association is attributable mainly to
by all three drivers of conf lict, climate extremes lower-middle-income countries.
and economic downturns show the highest
levels of unaffordabilit y (94 percent of their FAO has only beg un to systematically monitor
population) and moderate or severe food the cost and affordabilit y of healthy diets.
insecurit y (69 percent of their population). Therefore, it is expected that, as more data
points over time become available, the capacit y
Importantly, we now have the first to analyse and better understand how changes
opportunit y to extend the analysis and look in the cost and affordabilit y of healthy diets
at the relationship between the change in the affect food insecurit y and the different forms
unaffordabilit y of healthy diets, comparing of malnutrition will significantly improve.
2017 and 2019 data, and the levels of food Furthermore, a systematic price collection of
insecurit y as measured by the two FIES-based the key food items that form healthy diets will
indicators. Even though, at the global level, allow to build a healthy food basket populated
the total number of people who cannot afford with countr y-relevant food items that can be
a healthy diet in 2019 is slightly lower than the compared across countries while capturing local
2017 estimate published in last year’s report, in realities at the same time. n
several reg ions, the number actually increased
(see Chapter 2, Table 5). Latin A merica and
the Caribbean reg istered the largest increase
(8.4 percent), with even higher subreg ional
increases for Latin A merica (9.7 percent) and
South A merica (14.3 percent). High increases al  An analysis was attempted to correlate the variation in the
were also reg istered in A frica (5.4 percent), unaffordability of healthy diets from 2017 to 2019, and the variation in
the levels of food insecurity as measured by the FIES-based indicators
notably in Middle A frica (6.8 percent) and in the same period. However, due to the lack of variation in the data of
Western A frica (5.9 percent). There is sufficient the latter, the results did not turn out to be statistically significant.
variabilit y with both increases and decreases Although variation may be higher for specific subregions or countries, at
the global level, both FIES-based indicators changed on average only by
across countries with respect to the total around 1 percentage point from 2017 to 2019, compared with a
number of people who cannot afford a healthy 3.6 percentage point change in the unaffordability variable.

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AFGHANISTAN
Vendors carry onions to
sell at a market in Herat.
©FAO/Farshad Usyan
CHAPTER 4
WHAT NEEDS TO BE DONE TO
TRANSFORM FOOD SYSTEMS FOR
FOOD SECURITY, IMPROVED
NUTRITION AND AFFORDABLE
HEALTHY DIETS?

KEY MESSAGES

è  When transformed with greater resilience to major è  Comprehensive policies aimed at both the food and
drivers, food systems can provide affordable healthy natural environments, reinforced by regulations and
diets that are sustainable and inclusive, and become legislation, can result in behavioural changes along the
a powerful driving force towards ending hunger, food food supply chain and among consumers, thus shifting
insecurity and malnutrition in all its forms. dietary patterns to the benefit of human health and
the environment.
è  In conflict-affected areas, maintaining
conflict-sensitive food systems functions to the è  Coherence in the formulation and implementation of
extent possible, while aligning actions for immediate policies and investments among agri-food, health, social
humanitarian assistance to protect lives and livelihoods, protection and environmental systems is essential to build
long-term development and sustaining peace, is key to on synergies towards more efficient and effective food
building resilience of the most vulnerable in these areas. systems solutions to deliver affordable healthy diets for all.

è  Innovative mechanisms to reduce climate-related è  Effective and inclusive governance mechanisms and
risks, widespread adoption of climate-smart and institutions, in addition to access to technology, data
environmentally sound production techniques, and the and innovation, should serve as important accelerators
conservation and rehabilitation of natural environments in the comprehensive portfolios of policies, investments
will strengthen the resilience of food systems against and legislation aimed at transforming food systems to
increased climate variability and extremes. increase the affordability of healthy diets.

è  The economic fallout from the COVID-19 pandemic è  Given that food systems are affected by more than
has demonstrated that during economic slowdowns one driver, and also impact on food security and nutrition
and downturns, it is critical to keep food supply chains outcomes in multiple ways, comprehensive portfolios
operational, while providing adequate support to the of context-specific policies, investments and legislation
livelihoods of the most vulnerable, ensuring continued should be formulated to maximize their combined effects
production and access to nutritious foods, including on food systems transformation, while recognizing that
through enhanced social protection programmes. financial resources are limited.

è  The persistence of socio-economic inequalities è  Systems approaches that contribute to win-win

amplifies the need for systemic changes in food systems solutions and help manage trade-offs are needed to build
to provide vulnerable and historically marginalized coherent portfolios of policies, investments and legislation;
populations with greater access to productive these include territorial approaches, ecosystems
resources, technology, data and innovation to empower approaches, Indigenous Peoples’ food systems approaches
them to become agents of change towards more and coordinated policy actions under protracted crisis
sustainable food systems. conditions, complementing peacebuilding efforts.

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CHAPTER 4 WHAT NEEDS TO BE DONE TO TRANSFORM FOOD SYSTEMS

Global calls for action towards food with greater resilience to the identified drivers,
systems transformation and incentives are put in place for food systems to
provide affordable healthy diets sustainably and
Over the past several decades, food systems inclusively, they can become a powerful driving
have delivered a wide variet y of foods needed to force towards ending hunger, food insecurity and
feed a fast-growing and more urbanized world malnutrition in all its forms – and put us on track
population. But many of these food systems have towards achieving SDG 2, while also triggering
not succeeded in providing safe and nutritious important synergies for other SDGs.
foods to nourish the entire world’s population
adequately, as nearly three billion people This transformation of food systems demands
could not even afford a healthy diet before the innovative systemic changes supported by an
onset of the COV ID-19 pandemic. Moreover, a enabling environment of institutions, policies,
growing proportion of the world’s population laws, reg ulations and investments with
now consumes diets containing highly processed coherent and complementar y objectives, across
energ y-dense foods and beverages high in fats, sectors. 86,95 In addition, incremental transitions
sugars and/or salt. 94 at small scale and structural changes to
institutions, legislation and standards at larger
The inability of food systems to provide scale are needed – in coordinated and integrated
households with adequate access to nutritious ways – to achieve the desired transformation. 96
foods that contribute to healthy diets – especially Importantly, coordinated action by all key
in the aftermath of containment measures players in public and private sectors, academia,
aimed at stemming the still ongoing COVID-19 civil societ y and international institutions is
pandemic – has amplified the call for a essential, as is recognized by the aforementioned
transformation of food systems 7 to make healthy global events. The challenges associated with
diets available and affordable to all. The urgent achieving such changes are immense, and
need for this transformation has become central require significant mobilization of financial
to a global debate aimed at addressing some of the resources, while ensuring the identification of
greatest challenges to sustainable development, win-win solutions and managing trade-offs.
specifically the challenge of ending hunger, food
insecurity and malnutrition in all its forms by
2030. Three global summits to be held during the
Best practices help illustrate
course of 2021 will address issues central to this transformative changes needed
debate, including the UN Food Systems Summit Drawing upon best practices an and lessons
in New York (and the Pre-Summit held in Rome), learned from a series of case studies worldwide, 97
the 26th UN Climate Change Conference of this chapter provides policy g uidance for actors
the Parties (COP26) in Glasgow, and the Tokyo at the local, countr y, regional and global levels
Nutrition for Growth Summit. to transform food systems to be more resilient to
the major drivers behind recent increases in food
As already shown in Chapter 3, a number of insecurit y and malnutrition, while improving
major drivers, through their impact on food access to affordable healthy diets for all through
systems, have had increasingly negative effects on environmentally sustainable approaches.
food security and nutrition outcomes worldwide. It highlights the importance of understanding
Major drivers include conflict, climate variability specific contexts in addition to the needs of
and extremes, and economic slowdowns and v ulnerable population groups, including women,
downturns, whose impacts are intensified children and youth, Indigenous Peoples, and
by poverty and inequality. In spite of these people living in conf lict-affected countries and in
challenges, if food systems are transformed am remote areas.

am  In the context of this report, food systems transformation happens an  A “best practice” can be defined as a practice that has proven to
when profound and purposeful departures from business as usual are work well, has produced good results through a sound evaluation, and is
introduced into any of the food system components, 3 resulting in therefore recommended as a model to be scaled up. It is a successful
greater resilience to drivers of food insecurity and malnutrition, and in experience, which has been tested, validated and repeated, and thus
greater affordability of healthy diets. deserves to be shared so that a greater number of people can adopt it.

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 THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2021

4.1
As there are no one-size-fits-all solutions,
countr y-level experiences provide illustrative
examples of what it takes – in ver y practical and
innovative ways – to transform food systems. SIX PATHWAYS TO
In particular, coherence of policy measures and
investments between food systems and closely ADDRESS MAJOR
related systems, such as agri-food, health,
environmental and social protection systems, DRIVERS BEHIND
are considered. The examples demonstrate how
transformative measures, especially inclusive RECENT FOOD
governance mechanisms, technolog y, data and
innovation (in addition to legislation, standards SECURITY AND
and other measures), can lead to successful
transformation of food systems. NUTRITION TRENDS
Well over 100 contributions were received A key challenge that restricts successful
in response to a global “call for best practices transformation of food systems is that
in transforming food systems for affordable existing national, regional and global policies,
healthy diets and addressing major drivers of strategies, investments and legislation are
food insecurity and malnutrition”98 issued for compartmentalized into distinct dialog ues:
this report, supplemented by a questionnaire for example, separate discussions on priorities
circulated among partner agencies. Examples of for political stabilit y or economic recover y,
best practices and the lessons drawn from disaster risk reduction and climate resilience,
them are detailed in the sections below. trade and development in food and agriculture
The contributions demonstrate how major sectors, or restoring health systems and ensuring
drivers of food insecurit y and malnutrition adequate social protection. 1,3,5,7 Too often, there
can be addressed and which key policy actions is insufficient recognition – or lack of action,
are needed along one or more of six identified where there has been recognition – of important
pathways. In all cases, the importance of relationships and complementarities among
ensuring better integration of various policy these dialog ues and their relevance to key
platforms, and of measures and actions across functions of the food systems, such as ensuring
and within sectors is highlighted, with emphasis the sufficient production and supply of nutritious
on sectors covering natural resources, food, foods and the affordabilit y of healthy diets.
agriculture, health, social welfare, education,
marketing, trade and investment. n Even though it is easier said than done,
these challenges can only be overcome
through the formulation and implementation
of cross-sectoral portfolios of policies and
investments that comprehensively address the
major drivers whose widespread effects on
food systems are resulting in negative food
securit y and nutrition outcomes (as presented
and analysed in Chapter 3). These portfolios
need to be well targeted and provide incentives
for all actors to change behaviour and to
engage constructively in innovative and
systemic changes that will lead to transformed
food systems.

The sections below discuss six possible pathways

( Figure 27) along which food systems can be
transformed to address the major drivers of

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CHAPTER 4 WHAT NEEDS TO BE DONE TO TRANSFORM FOOD SYSTEMS

FIGURE 27 POSSIBLE PATHWAYS TOWARDS FOOD SYSTEMS TRANSFORMATION TO ADDRESS MAJOR

DRIVERS OF FOOD INSECURITY, MALNUTRITION AND UNAFFORDABILITY OF HEALTHY DIETS

One or more possible pathways towards transformation of food systems:

1
Integrating humanitarian, development and peacebuilding policies in
conflict-affected areas

COUNTRY CONTEXT
Major drivers of food
insecurity and malnutrition: 2 Scaling up climate resilience across food systems
 conflict Transformation of
food systems for
 climate variability food security,
and extremes
 economic slowdowns
3 Strengthening resilience of the most vulnerable to economic adversity improved nutrition
and access to
and downturns affordable healthy
 unaffordability of diets for all
4
Intervening along the food supply chains to lower the
healthy diets cost of nutritious foods
 underlying poverty
and inequality

5
Tackling poverty and structural inequalities,
ensuring interventions are pro-poor and inclusive

6
Strengthening food environments and changing consumer behaviour to promote
dietary patterns with positive impacts on human health and the environment

SOURCES: FAO, IFAD, UNICEF, WFP & WHO. 2017. The State of Food Security and Nutrition in the World 2017. Building resilience for peace and food
security. Rome, FAO; FAO, IFAD, UNICEF, WFP & WHO. 2018. The State of Food Security and Nutrition in the World 2018. Building climate resilience for
food security and nutrition. Rome, FAO; FAO, IFAD, UNICEF, WFP & WHO. 2019. The State of Food Security and Nutrition in the World 2019. Safeguarding
against economic slowdowns and downturns. Rome, FAO; FAO, IFAD, UNICEF, WFP & WHO. 2020. The State of Food Security and Nutrition in the World
2020. Transforming food systems for affordable healthy diets. Rome, FAO.

food insecurit y and malnutrition identified combination of drivers impacts most on the
and reviewed in previous chapters – and as identified food system and on related food
summarized in Box 1. Ever y one of the pathways securit y and nutrition outcomes. The pathways
builds on key recommendations from the may also complement and reinforce each other.
previous four editions of this report (2017–2020)
and corresponds to one or more of the major Drawing upon illustrative examples from
drivers discussed and analysed in Chapter 3. country case studies, in addition to policy
recommendations from the scientific community
These transformation pathways form a basis and previous editions of this report, the remainder
for formulating a coherent set of policy of this chapter reviews practical steps for
and investment portfolios to enable the building the recommended portfolios of policies
transformation of food systems (see also Figures 28 and investments along the six transformation
and 29). The relevant set of pathways is derived pathways. Figure 28 illustrates the recommended
from a context-specific situation analysis steps in the entire process towards food systems
(see below) that determines which driver or transformations that address the major drivers of

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 THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2021

FIGURE 28 STEPS TOWARDS FOOD SYSTEMS TRANSFORMATION FOR MORE AFFORDABLE HEALTHY DIETS

FOOD SYSTEMS TRANSFORMATION

Situation analysis: Ensure coherence with other Scale up and re-evaluate

Identify win-win
food systems performance, systems: agri-food, food systems performance
opportunities and
food security and nutrition environmental, health, social and food security and
trade-offs
situation protection and others nutrition situation

Formulate
6 possible pathways towards
portfolios of Transformation of
transformation
policies, food systems for
1 2 3 4 5 6 investments and food security,
legislation for improved nutrition
food systems and access
transformation to affordable
Identify actions to Identify
Implementation: healthy diets
address drivers accelerators to
monitoring and
along alternative support and speed
Major drivers drivers impacting on evaluation,
pathways up transformative
food systems (driving recent food accountability
(best practices) processes
security and nutrition trends)

SITUATION ANALYSIS BUILDING PORTFOLIOS IMPLEMENTATION

SOURCE: FAO.

food insecurity, malnutrition and unaffordability decide where in the food system systemic
of healthy diets for all. Broadly speaking, the changes are needed to achieve desired outcomes.
process requires (i) an in-depth context-specific Furthermore, through a multi-stakeholder
situation analysis; (ii) the formulation of coherent consultation, the relevant policy, investment and
cross-sectoral portfolios of policies, investments governance environments in the country are
and legislation, and including accelerators that identified, taking into account the most relevant
spur the transformative processes; and (iii) institutions and any political economy issues. 7
the implementation of these portfolios with All of the above will help identify which pathways
adequate monitoring and evaluation, as well as towards food systems transformation are most
accountability mechanisms in place. appropriate within a given context.

The situation analysis covers a context-specific and For each applicable pathway, recommended
comprehensive assessment of which major drivers policy options and best practices are then
impact negatively on food systems and result in reviewed to illustrate the t y pe of actions that
poor food security and nutrition outcomes, based could be taken and to inform the formulation
on available data and information as provided of policy and investment portfolios – and
annually in this report (and in other key references associated accelerators – for food systems
at global, national and local levels). 99,100,101,102,103,104 transformation. This part of the process is
Depending on which drivers of food insecurity illustrated in the section below. The disastrous
and malnutrition are present, stakeholders impact of the ongoing COV ID-19 pandemic on

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CHAPTER 4 WHAT NEEDS TO BE DONE TO TRANSFORM FOOD SYSTEMS

human health and economies worldwide, and food environment and consumer behaviour,
the importance of social protection systems generally apply to challenges faced by most
to help ensure adequate access to nutritious food systems. 7
foods for the most v ulnerable, demonstrate the
interconnectedness of, especially, the agri-food, 1. Integrating humanitarian, development and
health, environmental and social protection peacebuilding policies in conflict-affected areas
systems. Ensuring coherence among these and It is important to recall that the majorit y of
other relevant systems is a sine qua non condition the chronically food insecure and many of the
to facilitate the transformative processes. malnourished live in countries affected by
This and other key building blocks of policy and insecurit y and conf lict. Therefore, it is imperative
investment portfolios ( Figure 29) are discussed in that conf lict-sensitive policies, investments and
more detail in Section 4.2. actions to reduce immediate food insecurit y and
malnutrition be implemented simultaneously
Examples of best practices along six with those aimed at a reduction in the levels
pathways towards food systems of conf lict, and aligned with long-term
socio-economic development and peacebuilding
transformation efforts. 1 Under conditions of violent conf lict,
Upon completion of an in-depth context-specific entire food systems are often severely disrupted,
situation analysis of major drivers and their challenging people’s access to nutritious foods.
impact on food systems and on food insecurit y Emergency food assistance programmes,
and malnutrition in all its forms, the chosen emergency support to ensure clean water, qualit y
pathways indicate which transformative measures health ser vices and sanitation, and inter ventions
to consider. Illustrative examples of best practices to maintain livelihoods are among the t y pical
and important policy measures in each of these crisis response and social protection mechanisms
transformation pathways are provided below. ao implemented to ensure minimum levels of food
securit y and nutrition.
As many countries are affected by the major
drivers, which also interact (elaborated in In Yemen, conf lict is the main driver of
Chapter 3), several pathways will apply severe food insecurit y and malnutrition,
simultaneously, calling for coherence among requiring a large-scale humanitarian response.
them to ensure efficiency in implementation. Acute malnutrition has reached record levels,
Similarly, many of the best practices and affecting half the children under five years
policy measures discussed in this section of age. 105 Among the major causes are a high
are supportive of more than one pathway. prevalence of communicable diseases due to
For example, best practices in building poor water qualit y. Near the capital Sana’a, a
resilience to climate variabilit y and extremes breakdown of a major wastewater treatment
(pathway 2) may also provide increased levels plant in 2017 resulted in contaminated
of resilience in countries affected by economic water being used for vegetable production,
slowdowns and downturns (pathway 3) or causing cholera outbreaks and a scarcit y
conf lict (pathway 1). Furthermore, given of fresh vegetables in peri-urban areas.
persistent and high levels of income inequalit y Through an emergency inter vention in
in most LMICs, in particular, best practices and 2018 –2019, cost-effective small-scale water
policy measures elaborated under pathway 5 treatment plants were built and water-efficient
apply to many countries. Similarly, the best drip irrigation systems installed covering 60 ha
practices and policy measures discussed of irrigated land for vegetable production.
under pathway 6, which focuses on the The inter vention produced multiple benefits,
including clean water provision, availabilit y
ao  For each pathway, key policy areas and associated goals are of uncontaminated vegetables, and restored
summarized (Tables 8–13). Importantly, key policy recommendations livelihoods. 97,106 This example highlights the
provided are not exhaustive. Rather, for a more in-depth discussion of importance of ensuring local food systems
recommended policies and actions needed to comprehensively address
the major drivers behind recent food security and nutrition trends, the provide minimum levels of access to safe and
four most recent editions of this report (2017–2020) should be consulted. nutritious foods, also in conf lict-affected areas.

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 THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2021

In conflict-affected areas, peacebuilding efforts households were provided with seeds and tools
are of paramount importance in achieving for home gardening, and pastoralists were given
long-term food security and improved nutrition. support for livestock, which improved animal
Furthermore, resilience-building programmes, as health and milk production. The programme has
well as social protection mechanisms, should be put increased access to food by households under
in place without delay; otherwise, individuals and emergency conditions, improved the qualit y
households may engage in increasingly destructive and diversit y of their diets, and enhanced
and irreversible coping strategies (such as selling the nutrition knowledge of the programme’s
productive assets) that threaten future livelihoods participants through nutrition and food
as well as their food security and nutrition.1 safet y education.
Conflict-affected countries have been particularly
hard hit during the COVID-19 pandemic. In a context of escalating conflict, displacement,
For example, due to movement restrictions, it has climate shocks and commodity price fluctuations
often been difficult to reach refugees and internally in the Central Sahel (Burkina Faso, Mali and
displaced persons (IDPs) with humanitarian Niger), a multi-pronged food systems approach
assistance and other forms of support needed to has been implemented, where food production,
ensure sufficient access to nutritious foods. transformation, logistics, retail and consumption
are aligned with the objectives of responding
Deep economic crises can unfold where the to the food security and nutrition crises, while
structural causes of conf lict situations are linked also strengthening systems to better respond to,
to competition over natural resources, including manage and prevent future crises. At the food
productive land, forest, fisheries and water production level, farmers are supported with
resources. Policies supported by institutional productive assets, training in climate-smart
and legal reforms, where needed, should address agriculture practices and improved market access.
these causes and aim to mitigate – and if At the food processing level, the capacities of
possible, prevent – their impact on food systems, women’s groups and local agribusinesses are
food securit y and nutrition, and the economy strengthened to produce fortified blended foods
at large. Especially in the context of protracted and fortified staples to improve the nutritional
crisis situations, with possible periods of low quality of food available on the market. And at the
(but persistent) levels of conf lict and prolonged food environment level, to prevent malnutrition,
periods of displacement, it is critical to maintain access to nutritious foods and protection against
food and agricultural production, sustain food price fluctuations is provided through a food
supply chains and ensure people’s access to voucher system for locally available nutritious
nutritious foods and healthy diets. 5 foods that are otherwise not affordable.
In addition, nutritionally vulnerable women
The above scenario applies in Somalia, where and children are supported with programmes
people have experienced a three-decade-long to prevent acute malnutrition. Hence, multiple
protracted crisis with periods of severe food entry points are used to ensure linkages among
insecurit y and malnutrition (and including food, health and social protection systems, and to
famine in 2011), in addition to frequent extreme develop the capacity of governments to improve
climate events (mainly droughts and f loods). food quality and safety, and to systematically
In recent years, appropriate action has been taken analyse food price data for decision-making.
as, for example, in response to drought-induced In this way, short-term emergency needs are met,
large-scale food insecurit y and malnutrition and the resilience of individuals, households and
that affected up to 6 million people during communities strengthened. 109
2017–2019, including acute malnutrition among
900 000 children. 107 A nutrition-sensitive “Cash+” Prior to the recent violent and deadly conflict
programme was implemented in 2018 that with Israel, Palestine had already endured a
combined unconditional long-term cash transfers fragile security situation for decades, affecting
with livelihood support to build resilience to food security and nutrition. Restrictions on the
future shocks, while maintaining productive movement of people and goods, as well as limited
capacit y and food supply chains. 108 Agricultural access to natural resources and international

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CHAPTER 4 WHAT NEEDS TO BE DONE TO TRANSFORM FOOD SYSTEMS

TABLE 8 KEY POLICY AREAS AND GOALS FOR INTEGRATING HUMANITARIAN, DEVELOPMENT
AND PEACEBUILDING EFFORTS IN CONFLICT-AFFECTED AREAS
Policy area Goals
Peacebuilding efforts linked } Ensure that conflict-sensitive policies and actions at a minimum do no harm.
to livelihood support } Reduce/avoid conflict over access to and use of natural resources, while
maintaining productive capacity.
} Prevent destructive coping mechanisms (sale of assets).
} Meet immediate food security and nutrition needs.
Nutrition-sensitive social protection and } Livelihood support and social protection measures to ensure food security and
food production and supply programmes nutrition and a robust recovery.
Maintaining key functions of food } Re-engage smallholders, both during and in the aftermath of conflicts, to ensure a
supply chains rapid stabilization of food supply for own consumption and commercialization.
Community-based approaches in } Foster trust and social cohesion for reduced uncertainties, reinforced positive
post-conflict policies aspirations and improved well-being.
SOURCE: FAO, IFAD, UNICEF, WFP & WHO. 2017. The State of Food Security and Nutrition in the World 2017. Building resilience for peace and food
security. Rome, FAO.

markets, had placed a heav y burden on local food 2. Scaling up climate resilience across food systems
systems and people’s livelihoods. In spite of the The ways we produce food and use our natural
difficult circumstances, there have been efforts resources can help deliver a climate-positive
to strengthen the resilience of food systems future in which people and nature can coexist
within the context of periodic conflict, as well and thrive. 110 This is important, not only because
as social, environmental and economic shocks. food systems are affected by environmental
Some food systems have been transformed into degradation and climate events, but also
more resource-efficient and diversified market-led because food systems themselves impact on
systems through improved agricultural knowledge, the state of the environment and are a major
strengthened post-production and market driver of climate change. Central to this effort
capacities, increased value chain services and are priorities to protect nature, to sustainably
empowered producer cooperatives. Results (prior manage existing food production and supply
to the recent conflict) show a 12 percent systems, and to restore and rehabilitate natural
improvement in land productivity, 10 percent environments. 111,112
improvement in marketing values, 15 percent
reduction in production costs and an overall Solutions require increased partnerships and
10 percent increase in profitability among the multi-year, large-scale funding in support
agribusinesses run by small- and medium-scale of (among others): integrated disaster risk
farmers supported by the project. 97 Production of reduction and management programmes; climate
high-value crops, compliant with international change adaptation policies; and practices that
quality and safety standards, and strengthened are short-, medium- and long-term in scope 3
linkages between small-scale producers (and to mitigate the impact of climate variabilit y
their cooperatives) and other value chain actors, and extremes, including on persistent povert y
including distributors and marketers, have raised and inequalit y. 113 Adopting climate-sensitive
export revenues, in addition to nutritious and safe approaches in food and agricultural investments
foods being made available on local markets. can reduce food securit y risks associated with
climate extremes, build long-term resilience
Drawing upon key policy recommendations from and strengthen coping mechanisms along food
the 2017 edition of this report, complemented supply chains. 114
by more recent evidence, Table 8 provides a short
list of the most important policy measures to The implementation of climate resilience
be considered for integrating humanitarian, policies and programmes requires adapting
development and peacebuilding efforts in and refitting tools and inter ventions such as
conf lict-affected areas. risk monitoring and early warning systems,

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 THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2021

emergency preparedness and response, in Mexico, the CADENA Programme has scaled
v ulnerabilit y reduction and resilience-building up smallholder access to agricultural insurance
measures, shock-responsive social protection through a subsidized public–private insurance
mechanisms, risk transfers (including climate scheme, which promotes the engagement of the
risk insurance) and forecast-based financing, in private insurance sector in small-scale agriculture
addition to strong risk governance structures in in providing insurance coverage related to a wide
the environment–food–health system nexus. 3 variety of climate-related risks. 116
To ensure their enforceabilit y, such tools may
need to be grounded in legislation. Climate risk A proven approach to building climate resilience
and food insecurit y are deeply intertwined is climate-smart agriculture (CSA), which
in rural areas of the developing world, which builds resilience in multiple ways through
has led to the development of various asset climate-sensitive and socio-economically
insurance schemes targeted specifically at poor beneficial approaches that have demonstrated
and v ulnerable households. The challenges triple wins in food systems transformation: CSA
of making micro-insurance markets work approaches sustainably increase agricultural
are multiple; nevertheless, available analysis productivity and improve incomes, build
suggests the potential gains to solving these resilience to the impacts of climate change and
challenges are substantial. 115 reduce GHG emissions. 117

In Zambia, new initiatives aimed at raising In Lao People’s Democratic Republic, diversified
climate resilience include the introduction and climate-resilient agricultural practices
of agricultural insurance for v ulnerable introduced in 2016 through farmer field schools
households. Households that adopt conser vation and farmer nutrition schools resulted in positive
agriculture techniques are provided with impacts on soil conservation, biodiversity, and
access to agricultural insurance, which in turn income and nutritional outcomes. In particular,
allows for investment in riskier projects with community-based approaches with a strong focus
potentially higher revenues. Under this approach, on women’s empowerment resulted in increased
agricultural insurance is not only important for purchasing power and higher dietary diversity
building climate resilience but could also lead to among women and children, in addition to
poverty reduction and increased food security positive impacts on children’s health. 97
and improved nutrition. Elsewhere, different
types of agricultural insurance schemes aimed In Ethiopia, during 2015–2020, a CSA project
specifically at poor and v ulnerable smallholder focused on supporting women resulted in
households have been developed. increased crop revenue while reducing the
risk of food deficits that many participants
Implementing insurance schemes against disaster had experienced before the implementation of
risk in agriculture is a costly endeavour that the project. Other examples worldwide have
faces several challenges and constraints (e.g. demonstrated that the adoption of sustainable
infrastructural, reg ulator y and socio-economic). agricultural practices raises productivity
Nevertheless, integrating agricultural insurance and enhances food systems resilience, while
schemes as a component of broader social helping to reduce poverty, food insecurity and
protection programmes can lead to increased malnutrition. 3
smallholder resilience and reduced rural poverty,
while also reducing the cost of existing social Access to water is essential for smallholders
protection mechanisms and strengthening the to build climate resilience while also working
planning capacities of public agencies, when it towards more equitable and sustainable
comes to mitigating and transferring the risk of livelihoods. It is estimated that 77 percent of
natural disasters. This has been demonstrated small-scale farms across LMICs are located
by a number of successful agricultural insurance in water-scarce regions, while only 37 percent
schemes implemented in recent years, such as have access to irrigation. 118 In arid areas of the
the Index-based Livestock Insurance (IBLI) Sahel region, climate change has exacerbated
programme in Ethiopia and Kenya.115 Likewise, irreg ular rainfall and other climate extremes,

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CHAPTER 4 WHAT NEEDS TO BE DONE TO TRANSFORM FOOD SYSTEMS

such as repeated droughts and f loods. The territorial management and knowledge
The consequences have been devastating for systems of Indigenous Peoples are useful for
the poorest rural households, who have seen improving climate resilience, as these systems
their v ulnerabilit y worsen as they struggle to have enabled them to generate food in some
cope with these shocks. Efficient, sustainable of the most hostile environments and fragile
and fair management of water resources is more ecosystems in the world. 112,123,124 In Guatemala,
than ever a priorit y to improve the resilience the Maya Ch'orti' Indigenous Peoples living in
of v ulnerable communities and raise their the Dr y Corridor (Corredor Seco) have subsisted
levels of food securit y and nutrition. 119 Many on farming in a dr y environment for years, but
studies have documented how investments in increasing drought fuelled by climate change
water-har vesting techniques and irrigation has led to increasing rates of food insecurit y
infrastructure result in win-win solutions as and malnutrition. A reforestation and water
the increased water-use efficiency also rises management project is now bringing renewed
crop yields. 118 impetus to the use and conser vation of endemic
vegetal and animal species that are well adapted
In Kiribati, the combination of climate change, to the dr y environment. The Maya Ch'orti' have
limited access to clean water, and unreliable benefited from this support, which has led to a
imported food supplies have contributed to reduction of stunting by 51 percent following
growing malnutrition and unhealthy diets. improved food consumption and diet qualit y. 98
A community development project began in 2014
to provide rainwater-har vesting infrastructures In Colombia, the Tikuna, Cocama and Yagua
and training related to household food production Indigenous Peoples living in the Tarapoto Lakes
(home gardening and poultr y). As a result, complex maintained sophisticated food systems
households reported an 80 percent reduction of for hundreds of years that were adapted to a
cases of diarrhoea and dysenter y and a 90 percent unique forest and aquatic flooding-ecosystem,
improvement in terms of access to clean water. 120 which later became a Ramsar Convention ap
Amazon protected area. 112 But with the rapid
Land is another crucial natural resource to build growth of food markets in urban areas, increased
resilience to climate extremes. Many v ulnerable demand for fish and wild animals provoked
producers face degradation in the qualit y of their new extractive fishing and hunting methods.
land, which is increasingly linked to povert y and These unsustainable fishing practices, such
food insecurit y, and higher levels of v ulnerabilit y as the replacement of traditional traps with
to climate change. A vast majorit y of people metal and nylon wires, led to the depletion of
living on degraded agricultural land live in fish and game stocks. Calling upon traditional
LMICs. 121 In Ethiopia, a 2015 –2020 landscape indigenous knowledge and governance systems,
restoration project not only helped raise farm a community-based fishing agreement was
productivit y through soil and water conser vation, drawn up and complemented by an educational
but also successfully linked farmers to markets, programme for indigenous youth to re-establish
thereby raising their income-generating sustainable fishing practices. The agreement,
potential. Households reported improvements in based on collective rights, regulates the use of
food securit y, average household income grew fishing tools, includes temporary bans on certain
significantly and minimum dietar y diversit y species and establishes fishing standards. 112,125
scores increased. 98 In India, a 2012–2016 land Today, healthy fish populations provide essential
restoration and crop intensification project used protein within a thriving indigenous food system
traditional water storage systems (haveli) in counting over 153 different foods – largely wild
combination with infrastructure investment and and semi-wild foods. 126,127,128
technolog y transfers, with positive effects on
degraded and rainfed lands: crop yields increased The utilization of traditional varieties and wild
by 10 to 70 percent, and average household edible species from local food systems to increase
incomes grew by 170 percent. 97,122 This approach
also enabled groundwater recharges, resulting in ap  The Ramsar Convention refers to The Ramsar Convention on
improvements in water-use sustainabilit y. Wetlands of International Importance Especially as Waterfowl Habitat.

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 THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2021

TABLE 9 KEY POLICY AREAS AND GOALS FOR SCALING UP CLIMATE RESILIENCE ACROSS FOOD SYSTEMS
Policy area Goals
Reducing climate-related risk and } Increase resilience to climate events along the entire food supply chain to fewer
adapting to climate change disruptions in food production and supply.
} Protect smallholders against climate events that could affect their livelihoods,
including through climate risk insurance.
} Create an enabling environment for promoting sustainable investments in
agriculture.
Establishing climate risk monitoring and } Reduce impact of different hazards, including climate extremes, in both food
early warning systems systems and livelihoods.
Improving access to, and management } Sustainable increase in agricultural productivity (with positive effects on natural
of, natural productive resources resources and the environment), including through climate-smart agricultural
practices.
SOURCE: FAO, IFAD, UNICEF, WFP & WHO. 2018. The State of Food Security and Nutrition in the World 2018. Building climate resilience for food
security and nutrition. Rome, FAO.

climate resilience has also been applied in Brazil, the importance of building resilience in the
Kenya, Sri Lanka and Turkey. 97 The approach face of economic adversity. 13 Critically, the need
seeks out potential improvements along food for economic and social policies, institutions,
value chains, building farmers’ capacit y to legislation and other measures to be in place
produce traditional crops and species in adequate well in advance of economic slowdowns and
quantit y and qualit y, while raising consumer downturns became evident, as these measures
awareness and demand for these products. are designed to counteract the effects of adverse
This initiative also builds on linkages with other economic cycles when they do arrive, especially
programmes: in Brazil, local products have been for the most vulnerable population groups,
included in the public procurement system, and and to maintain access to nutritious foods and
in the meals that are part of the school feeding healthy diets. In the immediate term, such
programmes. In Kenya, traditional products policies, laws and investments must include social
have been included in farm-to-school networks protection mechanisms and primary healthcare
that provide school meals, while in Sri Lanka, services, while supporting household income and
32 market outlets are now selling products made livelihoods through social assistance or active
from traditional food crops. 129 labour market policies.

Countr y examples of best practices presented Social protection programmes have been
above illustrate some of the innovative measures central to government policy responses to the
towards building climate resilience that have consequences of the COV ID-19 pandemic on
evolved in recent years. Key policy areas and people’s incomes and livelihoods. By May 2021,
goals for scaling up climate resilience across food more than 200 countries and territories in the
systems are presented in Table 9. The 2018 edition world had implemented at least one social
of this report contains an in-depth discussion of protection initiative, comprised mostly of cash
policy areas and measures aimed at strengthened and in-kind transfers, waived or postponed
resilience to climate variabilit y and extremes. financial obligations and labour reg ulations.
Together, these measures have benefited just
3. Strengthening resilience of the most vulnerable over 1.5 billion people worldwide. 13 Importantly,
to economic adversity largely due to financial constraints, many
In 2020, as world GDP contracted by an estimated COV ID-19-related social protection responses
3.3 percent during the COVID-19 pandemic, 130 had low coverage, provided small transfers
counteractive measures, including stepped-up and could be maintained only for a limited
social assistance, employment and social insurance period of time. Cash transfer programmes,
programmes, and large-scale emergency measures for example, were implemented on average for
to protect economies worldwide, demonstrated only four months. In Timor-Leste, one of the

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CHAPTER 4 WHAT NEEDS TO BE DONE TO TRANSFORM FOOD SYSTEMS

poorest countries in the world, a universal on their meals as schools closed to stem the
cash transfer was established in June 2020, spread of the COV ID-19 disease. To date, 27
followed by a subsidy for three months directed countries have not re-opened schools, seven
at self-employed and informal workers, 13 which of which have important school food and
helped buffer the income shock of measures nutrition programmes.
taken during the pandemic on the population. 131
In several countries, in an effort to further
In Panama, an inter-ministerial programme institutionalize school feeding programmes,
aimed at providing support to families affected innovative approaches include home-grown
by the COV ID-19 pandemic has delivered in-kind school feeding (HGSF) and school gardens
food transfers to some of the most v ulnerable that improve the nutritional status of school
populations. Procured directly from food children while also promoting access to an
producers nationwide, the programme provides increased supply of affordable nutritious foods.
diverse and nutritious foods including animal Other benefits of these initiatives include raising
source foods, fruits, vegetables, leg umes, roots awareness of the importance of healthy diets and
and tubers. In Jamaica, rural livelihoods were shifting households’ food demand towards more
supported by reinforcing the Government’s nutritious foods. Arg uments in favour of HGSF
public procurement mechanism during 2020, with as a transformative measure to strengthen food
a focus on female-headed farming households. systems are presented in Box 9.
In addition, in-kind transfers consisting of
locally grown fresh foods were delivered to the In Ethiopia, a further innovative social protection
programme’s beneficiaries, supporting both scheme provides digital access to monthly food
household incomes and food intake. vouchers, tailored to household size for an amount
based on the cost of a nutritious diet. In rural
Elsewhere, in Brazil, the mandator y closure of areas, mothers with children under two years
schools due to the pandemic put the continued of age are provided vouchers for the purchase
implementation of a nationwide school feeding of fresh fruits, vegetables and eggs. These are
programme targeting millions of beneficiaries redeemed with local retailers, who themselves
at risk. The programme was rapidly modified have received training to improve the quality and
to enable in-kind food transfers to be safety of their food supply. As a complementary
delivered directly to children’s homes instead. action, changes in social behaviour are
Even under much more difficult circumstances, encouraged through community counselling and
food kits include at least 30 percent locally media campaigns to promote improved dietary
procured fresh foods, as established by Brazil’s diversity and care practices and to raise demand
school feeding law. 97 for fresh fruits and vegetables. An external
evaluation revealed that the voucher programme
Before the COV ID-19 pandemic, school feeding has increased the profits of rural food retailers by
programmes reached 388 million children as much as 40 percent and shortened food supply
worldwide, representing one of the largest chains, while also having a positive impact on the
social protection mechanisms. Between 2013 dietary diversity of mothers and their children. 97
and 2020, the number of children receiving
meals through school feeding grew by 9 percent In Kyrgyzstan, an ongoing “Cash Plus” approach
globally and by 36 percent in low-income aims to strengthen the impact of the national
countries. This growth ref lects a widespread cash transfer programme. Positive results at
institutionalization of these programmes, as household level include increased and more
80 percent of countries have integrated school diversified food production for own consumption
feeding into their policies (up from 42 percent in and stepped-up engagement in income-generating
2013) with 90 percent of their funding coming activities. Seventy-four percent of households
from national budgets. 132 The importance increased agricultural productivity, and
of school food and nutrition programmes 90 percent of beneficiaries improved dietary
has been underscored during 2020 –2021, as diversity and nutritional outcomes, for both
millions of children globally have missed out mothers and their children. 98 »

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 THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2021

BOX 9 HOME-GROWN SCHOOL FEEDING AS A LEVER FOR FOOD SYSTEMS TRANSFORMATION

School feeding programmes, coupled with nutrition triggered local demand for traditional African leafy
education and other nutrition interventions, support vegetables (ALVs), leading to improved nutritional
access to school and learning opportunities, while also practices and creating jobs through local public
providing school children with food and other services procurement, while enhancing territorial biodiversity.
that contribute to better health and nutrition. They also The numerous benefits include improved capacity
improve children’s learning abilities for a better of smallholders to access new and steady markets,
future.133 The programmes are particularly beneficial in and increased awareness and interest among youth
LMICs, where many children suffer from micronutrient in sustainable agriculture and environmental issues.
deficiencies. The school meals are often the only Moreover, the resilience of local agricultural systems
nutritious meals the children eat;134 moreover, they has been reinforced while crop diversification has been
provide an incentive to attend school. enhanced; thousands of students have received school
When linked to smallholder agriculture, school meals enriched with ALVs that improve their nutrition
feeding programmes and other healthy public food and health.
procurement and service policies135 can promote In Ethiopia, the HGSF approach has served as a
additional social, economic and environmental benefits. lever for food systems transformation, specifically
Moreover, they can become an entry point for food in addressing existing bottlenecks in procurement
systems transformation, especially if they are scaled and along supply chains.138 The solutions to these
up. The home-grown school feeding (HGSF) model bottlenecks include (i) conducive public procurement
is designed to provide children in schools with safe, regulatory frameworks and (ii) improving the
diverse and nutritious food, partially food sourced inclusivity and efficiency of local supply chains,
locally from smallholders.136 In integrating education, using a multisector and multidimensional approach.
agriculture, social protection and public procurement Specifically, in reforming its HGSF programme,
objectives, these programmes provide both educational Ethiopia has been able to address challenges faced
and food security and nutrition gains for children, by smallholders in accessing schools and other formal
as well as livelihood gains for smallholders and their markets. Smallholders now have greater access to new
communities. In addition, by changing procurement market opportunities and to increased and more stable
practices and creating a demand for healthy diets sources of income. The programme has also directly
through sustainable food systems, HGSF can incentivize impacted the lives of vulnerable children and their
those involved in the supply chain to support a families, providing daily school meals and contributing
transition towards more sustainable food production to their nutrition, health and education.
and consumption patterns. School feeding programmes The tremendous potential of HGSF programmes
can create 1 700 jobs for every 100 000 children fed.132 to enable food systems transformation has become
Kenya and Ethiopia have embraced HGSF more evident as a result of COVID-19-induced
approaches, illustrating the importance of a economic shocks and crises in the education sector,
multisectoral approach for successful implementation. which has seen more than 199 countries closing
In Kenya’s Busia County, challenges related to schools and cutting off school feeding supply chains,
poverty, food insecurity and malnutrition, as well as affecting an estimated 370 million children.132 Based
biodiversity loss, were addressed through a HGSF on the Kenyan and Ethiopian experiences, which
approach conceptualized by a Biodiversity for Food demonstrate the potential for positive change, there
and Nutrition (BFN) project. The combined goal is an urgent need to review existing school food
was to improve student nutrition while promoting and nutrition practices to build more resilient rural
biodiversity conservation, the empowerment of local livelihoods and ensure that vulnerable children,
farmers and the development of inclusive value smallholder farmers and others dependent on
chains.137 Implemented since 2012, the initiative has well-functioning food systems are better protected.

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TABLE 10 KEY POLICY AREAS AND GOALS FOR STRENGTHENING RESILIENCE OF THE MOST VULNERABLE TO
ECONOMIC ADVERSITY
Policy area Goals
Strengthening agri-food productivity and } Improve income opportunities for smallholders and other actors of the food supply
market linkages along the food supply chain.
chain
Curbing rises in food prices and excessive } Reduce the vulnerability of poor households and net food buyers in accessing food.
price volatility and/or mitigating their } Avoid undesirable coping strategies during periods of extreme food price
effects fluctuations.
Boosting job creation and expanding } Minimize short-term impacts of economic shocks among vulnerable households
social protection schemes through nutrition-sensitive social protection programmes.
} Stabilize incomes and food consumption.
SOURCE: FAO, IFAD, UNICEF, WFP & WHO. 2019. The State of Food Security and Nutrition in the World 2019. Safeguarding against economic
slowdowns and downturns. Rome, FAO.

» As countries move beyond the COV ID-19 4. Intervening along food supply chains to lower the
pandemic, it is vital that adequate levels of cost of nutritious foods
public spending on health and social protection Inter ventions along food supply chains are
systems be maintained. Any cuts would likely needed to increase the availabilit y of safe and
increase hardship among already disadvantaged nutritious foods and lower their cost, primarily
groups, weaken performance, increase the risk as a means to increase the affordabilit y of
of negative health and nutrition outcomes, add healthy diets. This pathway calls for a coherent
to fiscal pressures and undermine development set of policies and investments from production
gains. 139,140 In the medium term, these to consumption aimed at realizing efficiency
policies should be institutionalized as part of gains and cutting food losses and waste to help
national social protection systems, together achieve these objectives. 7 Incentives should,
with increasing access to social ser vices. 5 In among others, stimulate diversification of
addition, other innovative measures towards production in the food and agriculture sectors
building economic resilience should be towards nutritious foods, including fruits,
implemented, such as stepping up access to vegetables, leg umes and seeds, as well as
agricultural insurance for food producers, many animal source foods and biofortified crops,
of whom are v ulnerable to both climate-related in addition to investments in innovation,
and economic shocks. 141 Such insurance research and extension to raise productivit y.
schemes (as discussed under pathway 2) can Elsewhere in the supply chain, the nutritional
help reduce povert y, especially when combined qualit y of food products and beverages can
with social protection schemes. 142 be improved by post-har vest fortification
of staple foods in line with international
Countr y examples under this third pathway g uidelines. 143,14 4,145,146 Food manufacturers and
have highlighted the importance of a number retailers can also reformulate their products to
of innovative social protection mechanisms eliminate industrially produced trans-fatt y acids
aimed in particular at strengthening resilience and reduce levels of saturated fat, sugars and/or
of the most v ulnerable populations to economic salt (see also pathway 6).
slowdowns and downturns, as also experienced
during the COV ID-19 pandemic. There are many Fortification and biofortification have been
other longer-term policy measures that need to used as a cost-effective measure to reduce
be considered to strengthen economic resilience micronutrient deficiencies while increasing the
as discussed in detail in the 2019 edition of this availability – and lowering the cost – of nutritious
report. Several key policy areas and goals are foods. The fortification of staple foods has been
presented in Table 10. 5 an effective strateg y to supply micronutrients to
entire populations (such as universal iodization
of salt, and iron and folic acid fortification of

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wheat or maize flour). In Peru, the fortification of enhancing their role in promoting healthy
rice with 9 vitamins and minerals has been scaled diets with sustainabilit y considerations.
up, where it has been included in the school Support components include building
feeding programme and other social protection capacities to ensure food qualit y and safet y,
programmes. Considering that micronutrient improving access to financial resources and
deficiencies and anaemia are widespread in the strengthening market linkages. Similarly, in
population across socioeconomic groups, the Myanmar, SMEs at the food production level
countr y approved the national rice fortification have received support to diversif y their
law in 2021. products through direct transfers, increased
access to new technologies and training in
In Zimbabwe, in the context of a programme sustainable production techniques. More than
promoting conser vation agriculture for increasing half of the programme’s participants have
climate resilience and agricultural productivit y, seen their incomes increase by 50 percent,
farmers participating in the programme and their expansion of production to include
adopted biofortified varieties of different crops. fresh vegetables has significantly increased the
The increases in productivit y after the adoption supply of nutritious foods in local markets. 151
of climate resilient techniques also improved In Sao Tome and Principe, a recent five-year
the availabilit y of micronutrients among development project facilitated the marketing
participating households. Finally, in Rwanda, of organic, high qualit y cacao, coffee and
iron-biofortified beans have been introduced pepper by developing farmer cooperatives and
and rapidly adopted by farmers. By the end of family plantations to increase sales to domestic
2018, it was estimated that 20 percent of beans and export markets through public-private
produced in the countr y were iron-biofortified, partnerships. Results from the impact
and 15 percent of the population was consuming assessment of these programmes demonstrated
these. Reg ular consumption of fortified beans positive and significant impacts on agricultural
can provide up to 80 percent of daily iron needs. incomes (by 46 percent) and on increased levels
Iron-biofortified varieties have also produced of dietar y diversit y (5 percent). 152
yields with iron levels that are 20 percent above
those of other varieties, turning them into an Rapid rates of urbanization worldwide are
attractive alternative for farmers. 97 placing tremendous pressure on ever longer
food supply chains to deliver nutritious
Small and medium-sized enterprises (SMEs) play a foods safely and sustainably to ever more
central role in maintaining local community-based congested metropolitan areas. In many urban
food systems, and can help ensure an adequate and peri-urban areas, povert y and inequalit y
supply of safe and nutritious foods. Their role in prevent the most v ulnerable from accessing
achieving food security and good nutrition has sufficient nutritious foods, while changing
been increasingly recognized. 147 For example, food environments and consumption patterns
SMEs engaged in food processing in Africa have led to rising levels of overweight, obesit y
procure 95 percent of their food supplies from and diet-related NCDs. Various processes
smallholders, demonstrating their importance in linked to urbanization pose challenges but also
the development and transformation of the whole present opportunities to create food systems
food system. 148 And while the economic impact of that are more inclusive in providing greater
lockdowns during the COVID-19 pandemic has access to nutritious foods to all, while also
hit many SMEs particularly hard, 149 given the way being environmentally sustainable. 153 In this
SMEs are embedded in local communities, they context, appropriate urban food policies and
also play a key role in building forward from crisis efficient rural–urban linkages are critical for
conditions and ensuring sufficient access to safe the transformation of food systems for greater
and nutritious foods. affordabilit y of healthy diets in peri-urban
and urban settings ( Box 10). 154 Small- and
In Kenya, SMEs involved in the fruit and medium-sized cities can play a key role in
vegetable supply chains have received strengthening rural–urban linkages because
government support 150 with the objective of of their proximit y to surrounding rural areas

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BOX 10 THE QUITO AGRI-FOOD PACT: FACILITATING THE TRANSFORMATION OF THE CITY’S FOOD SYSTEMS

Similar to many cities in the world, inequitable income “AGRUPAR” has supported the creation of more than
distribution in Quito, Ecuador, is preventing the most 4 400 urban gardens (84 percent of which are led by
vulnerable populations from accessing adequate women) to increase the availability of nutritious foods
nutritious foods. Households of the poorest income not only for own consumption, but also to be sold
decile consume foods that contain 20 percent more in the city through significantly shorter food supply
carbohydrates and 50 percent less animal protein chains – thus lowering their cost. Forty-three percent
than the richest income bracket.153 The challenges of of the produce from urban gardens is sold in local
Quito’s food system include dependence on long food food markets, improving access to fresh and
supply chains from production to consumption, as nutritious foods, particularly in the most vulnerable
well as vulnerability because of natural and man-made zones of the city. The network of urban gardens has
hazards, insufficient risk reduction measures and played a significant role in improving the resilience
limited supply routes. Moreover, the availability and of Quito’s food system, as also demonstrated by
quality of food varies significantly across the city.158 the success of the gardens in continuing to supply
In 2015, to address these challenges, the main nutritious foods even during the worst period of the
stakeholders concerned with Quito’s food system, COVID-19 pandemic.
including public institutions, the private sector, civil Urban policies formulated and implemented
society organizations and development agencies, through the engagement of all key stakeholders, as
established the Quito Agri-food Pact. The pact in the case of Quito, represent an excellent model
provided a policy coordination space that, jointly with of how to build coherent and integrated portfolios
the municipality, then developed the Quito Agri-food of policies to enable the transformation of urban
Strategy to identify the main challenges facing the food systems. The territorial approach and the
city.159 A key challenge was the insufficient availability development of appropriate governance mechanisms,
of fresh and nutritious foods in some of the most among other important elements, can be replicated
vulnerable neighbourhoods. or adapted to similar contexts elsewhere to
The promotion of urban agriculture represents effectively provide healthy diets to all through
an important part of the strategy. The project sustainable food systems.

(referred to as a “functional territor y”) and has been creating urban gardens in informal
in addressing key social, economic and settlements and schools in Rio de Janeiro.
environmental challenges. 155 Appropriate policy The food produced has been for own consumption
action can play a major role in supporting such by the engaged households, with surpluses
functional territories to improve livelihoods donated or sold to the neighbouring community,
and strengthen the resilience of people and of thus improving access to nutritious foods and
agri-food systems. Development of food systems generating income for urban dwellers. As in many
in these functional territories furthermore holds other places, maintaining the supply of nutritious
potential for sustainably reducing povert y, foods in urban areas has become a great challenge
food insecurit y and malnutrition, as food under the COVID-19 pandemic. In Ecuador,
systems respond to the growth of cities and the linkages between some areas of the city of Quito
concurrent transformation of diets, which itself with a high prevalence of COVID-19 cases and
is dependent on rural-urban linkages. 156 farmers from the surrounding province have been
strengthened through neighbourhood cultural
Urban agriculture is likely to deliver positive societies that have established a marketing and
impacts on both dietary diversity and household distribution network, receiving food baskets from
incomes. 157 In Brazil, a longstanding project farmers and then distributing them to buyers

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TABLE 11 KEY POLICY AREAS AND GOALS FOR INTERVENING ALONG FOOD SUPPLY CHAINS TO LOWER THE
COST OF NUTRITIOUS FOODS
Policy area Goals
Increasing investments for a more } Increase the supply of safe and nutritious foods, lowering their cost.
productive and diverse agriculture sector
Increasing the efficiency of food } Improve functioning of value chains to realize efficiency gains in storage, processing
value chains and marketing of food, thus lowering the cost of nutritious foods.
} Reduce food loss and waste through a coherent set of policies and investments in
food production, harvesting, handling, packaging, storage, transportation,
processing and marketing.
Creating an environment that promotes } Adjust fiscal and other policies to influence relative prices of nutritious foods and of
nutritious foods along the supply chain foods high in fats, sugars and/or salt.
Enacting mandatory food fortification in } Increase supply of fortified foods as part of a programme to address micronutrient
line with international guidelines deficiencies.
Promoting biofortification in line with } Increase production of foods with higher micronutrient content to address
international guidelines and regulations micronutrient deficiencies.
SOURCE: FAO, IFAD, UNICEF, WFP & WHO. 2020. The State of Food Security and Nutrition in the World 2020. Transforming food systems for
affordable healthy diets. Rome, FAO.

directly at their homes. These baskets include The COV ID-19 pandemic has aggravated
fresh fruits and vegetables produced organically, this situation, exacerbating inequalities and
so urban dwellers have access to nutritious foods negatively impacting on the lives and well-being
and farmers face a shorter marketing chain, which of the rural poor, in particular. 160 If implemented
allows them to sell their products at a lower successfully, this fifth pathway can reduce
cost. These practices have continued following extreme povert y and structural inequalities
the pandemic lockdowns, creating new and through accelerated food systems transformation
innovative linkages between urban dwellers and that is both pro-poor and inclusive.
rural food producers. 97
In rural areas in particular, the transformation
The countr y cases under this fourth pathway of agri-food systems presents an opportunit y
highlight some of the key areas where there are to some of the poorest smallholders who are
opportunities for inter ventions along the food not well integrated into food value chains.
supply chain to lower the cost of nutritious foods, In South-eastern Asia, rural povert y among
which are listed in Table 11. Additional policy smallholders is exacerbated by the lack of
recommendations aimed at lowering the cost of access to productive resources and poor
nutritious foods are discussed in more detail in market integration, further compounded by
the 2020 edition of this report. climate-related and economic shocks, as well as
periodic plant and animal disease outbreaks. 97 In
5. Tackling poverty and structural inequalities, this region, the integration of poor smallholders
ensuring interventions are pro-poor and inclusive into food value chains has been facilitated
Persistent and high levels of inequalit y seriously through public-private-producer partnerships
limit people’s chances to overcome hunger, food (PPPPs) that provide opportunities to overcome
insecurit y and malnutrition in all its forms. povert y and structural inequalities, especially
Policies, investments and laws that address where reinforced by improved governance
underlying structural inequalities faced by mechanisms and multi-stakeholder platforms. 97
v ulnerable population groups in both rural and
urban areas are needed, while also increasing In Indonesia, in 2017, the total production and
their access to productive resources and new value of cocoa had fallen by 70 percent from its
technologies. About 80 percent of the extreme peak in 2009, hitting smallholders’ incomes and
poor live in rural areas, where povert y rates livelihoods particularly hard. Since 2014, in an
are three times higher than in urban areas. effort to reduce the number of cocoa farmers

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living below the poverty line and empower them Another initiative concerned with improving
to engage in a more efficient and resilient cocoa livelihoods of people living in remote areas is the
supply chain, a multi-stakeholder “whole of Mountain Partnership Products (MPP) Initiative
value chain” approach was introduced. The PPPP that aims at strengthening the resilience of
approach engaging 150 000 smallholders included, mountain peoples, their economies and their
among others, increased access to financing ecosystems in eight countries. 97 In providing
and productivity-enhancing technologies, the access to a certification and labelling scheme
introduction of traceability systems, product based on environmentally and ethically sound
certification to capture premium prices, improved approaches, the MPP Initiative promotes short
primary processing, nutrition education and value chains, while ensuring transparency
the establishment of farmer organizations. and trust between producers and consumers,
Over a five-year period, cocoa yields increased by fair compensation for the primar y producers,
73 percent, while empowered smallholders saw conser vation of agrobiodiversit y and preser vation
their incomes increase by more than 200 percent. 97 of ancient techniques implemented in several
countries. In Bolivia, for example, women
In Viet Nam, about 500 000 mostly poor producing certified honey from a local bee variet y
smallholder farmers earn their livelihoods from were able to strengthen their linkages with local
coffee production. In mid-2020, coffee prices had markets, while preser ving cultural traditions and
plummeted by 48 percent from a peak in late local biodiversit y.
2016, before recovering but remaining volatile.
To help reduce smallholder v ulnerabilit y to both In Nepal, during 2011–2018, an agriculture
economic and climate-related shocks, provincial project covering some of the most remote hilly
and district-level coffee boards were established and mountainous areas of Karnali province
to assist smallholders with improved technologies adopted a whole value chain approach, to bridge
and good environmental practices in coffee information and access gaps between producers
production. The improved practices allowed the and markets. Targeted actions sought to make
coffee to be certified for a premium on producer the new value chains more inclusive by breaking
prices, while also strengthening the resilience down the barriers that t y pically hold back
of coffee growers not only to climate shocks, participation of under-represented groups such as
but also to likely future economic shocks. 97 women and ethnic minorities. Results show that
the project was successful in increasing annual
In Morocco, over the past decade, a cross-sectoral income by 32 percent among its target groups,
territorial approach has been implemented to with crop and livestock income increasing by
address regional inequalities within the country.161 47 percent and 44 percent, respectively. 162 Results
A major investment programme has transformed show that project participants experienced lower
a large geographic area of 5.2 million people, levels of food insecurit y (by 9 percent) and a
covering 16 provinces in the remote oases and higher food consumption score (by 4 percent).
argan tree zones. The programme focused on
transforming the agri-food value chains of date The Nepal example alludes to a strong and
palm and argan trees, two high-value crops. common theme across many of the best
The population previously experienced relatively practice case studies reviewed: the importance
high levels of poverty, illiteracy and malnutrition, of empowerment, in one way or another,
associated with harsh living conditions and of poor and v ulnerable population groups,
vulnerability due to various natural and often smallholders with limited access to
environmental threats (desertification, soil erosion, resources or those living in remote locations,
water scarcity, extreme weather conditions). 97 as a major lever in transformative change.
Over a ten-year period, the cross-sectoral Measures of empowerment var y widely, but
territorial investment programme resulted in a include in particular the need for increased
41 percent increase in regional per capita GDP, access to productive resources (access to natural
a 33 percent increase in farmer incomes and a resources, agricultural inputs and technolog y,
50 percent reduction in poverty rates, among many financial resources, as well as knowledge and
other positive development indicators. education). Other empowerment measures

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 THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2021

relate to strengthened organizational skills innovation potential. 171 Young entrepreneurs

(increased engagement in producer groups engaged in agri-food systems have been
and cooperatives), certification programmes particularly hard hit by the COV ID-19 pandemic,
(e.g. for locally produced organic products), exacerbating existing challenges that young
and importantly, access to digital technolog y people face when engaging in agri-food systems,
and communication. notably because of limited access to productive
resources, finance and markets. 172 Generally, a
The effects of the COVID-19 pandemic have lack of economic dynamism and employment
furthermore exposed structural inequalities, opportunities in rural areas leads young people
as women’s productive and income-generating to migrate out of necessit y. 173 Hence, within
capacities have been impacted disproportionately, broader efforts to boost responsible investments,
because of reduced economic opportunities and specific action is needed to increase youth
access to nutritious foods, while at the same time access to productive resources, finance, markets
having to increase their workloads. Hence, policy and connectivit y, as well as decision-making.
responses should consider women’s roles in Social norms that might prevent young
agri-food systems and ensure that their multiple rural people from taking advantage of new
needs – as guardians of household food security, opportunities, especially v ulnerable groups, such
food producers, farm managers, processors, as young women and indigenous youth, also need
traders, wage workers and entrepreneurs – are to be addressed. 174
adequately addressed. 163 Beyond merely “levelling
the playing field”, policies and interventions Additional evidence of how the empowerment
that help strengthen women’s roles in food of both women and youth could accelerate
systems and their decision-making capacity food systems transformation for improved food
can be a powerful source of food systems securit y and nutrition is presented in  Box 11.
transformation. 164 The potential of addressing
gender gaps to increase productivity has been Community-based approaches are key to building
well established, 165 while there is growing relationships and strengthening social cohesion,
evidence that empowering women also results improving aspirations, confidence and trust, all of
in improved nutritional outcomes for their which are critical in tackling structural inequalities
children. 166 Innovations that support women’s and in ensuring that policies, legislation and
productive capacity either directly or indirectly interventions are pro-poor and inclusive, and
by freeing up women’s time are especially deliver equitable services. In Burundi, the Caisse de
empowering, such as making drinking water more Resilience (CdR) is an integrated community-based
easily accessible, and enabling women to engage and participatory approach that combines
in productive activities, such as growing fruits technical, financial and social dimensions in a
and vegetables for household consumption. 119 mutually reinforcing way. Under this approach,
small groups of rural households receive
Youth represent a tremendous opportunit y training in sustainable agricultural practices
for transformative change in food systems, through farmer field schools, while a savings
especially in less developed countries, where and loans fund managed by communities
more than 80 percent of the youth live. 167 Youth themselves enhances their financial capacities.
(aged 15 –24 years) make up about 16 percent This community-based participatory approach has
(1.2 billion) of the world’s population, 168 and as resulted in increases in agricultural production of
potential young entrepreneurs, they represent 30 to 60 percent, as well as increases in household
the future agents of change. Yet, the youth of income by some 40 to 52 percent. 97
today face greater constraints when compared
with adults in accessing decent jobs, 169 productive While recognizing the need to combat povert y
resources, social capital and governance in both rural and urban settings, illustrative
mechanisms that shape food systems. 170 countr y examples provided under this fifth
Strengthening their skills and agency through pathway highlight the importance of tackling
training, positive role models and mentorship structural inequalities (as also illustrated
is central to untap their entrepreneurship and in Chapter 3), while ensuring inter ventions »

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BOX 11 ACCELERATING FOOD SYSTEMS TRANSFORMATION BY EMPOWERING WOMEN AND YOUTH

Women’s empowerment often leads to improved nutrition livelihoods for adolescents programme in Uganda showed
because of positive effects on child and maternal how vocational and life-skills training could significantly
health. In Ghana, women’s empowerment is strongly increase the likelihood of adolescent girls of legal working
associated with diet quality, and women’s aggregate age engaging in safe income-generating activities (by
empowerment and participation in credit decisions is 48 percent), while reducing both teenage pregnancy
positively and significantly correlated with the indicator (by 34 percent) and the likelihood of entering into early
estimating Minimum Dietary Diversity for Women marriage or cohabitation (by 62 percent).180 Especially
(MDD-W). A study in Nepal measuring outcomes against for younger youth below 18, employment-focused
three of ten indicators of the Women’s Empowerment in interventions need to avoid drawing children into child
Agriculture Index (WEAI) found significant associations labour situations, and thus need to target only youth of
between women’s empowerment and improved child legal working age (14–15 years old in most countries)
nutrition.175 Moreover, a study using the WEAI in six and engage them only in safe tasks. In Senegal, a
countries in Africa and Asia to help identify which comprehensive approach to diversified agricultural
dimensions of women’s empowerment are related to production improved market access of mostly vulnerable
household, women, and child-level dietary and nutrition small-scale producers, women and underemployed youth
outcomes has found that several indicators are positively by strengthening their access to markets and ensuring
associated with the Household Dietary Diversity Score access to finance. Smallholders managed to diversify
(HDDS). The study also found that some trade-offs exist their production to include poultry rearing and vegetable
between increased participation of women in agriculture production, in addition to groundnuts. Incomes from crop
on the one hand, and women’s workload and their own production increased by 48 percent, and total income
nutrition conditions on the other.176 increased by 11 percent among the project’s target
In Tajikistan, a livestock and pasture development groups.97 In Zambia, a market system approach was used
project addressed the effects of over-grazing and to create opportunities for rural youth in agribusiness.
climate change on degraded pastoral land, with During 2014–2019, more than 14 600 enterprises were
emphasis on supporting women-headed households. supported, creating an additional 5 367 additional jobs
Among these households, livestock income increased of which more than 40 percent specifically for youth.181
by 47 percent and livestock ownership by 77 percent. The approach aimed at inspiring companies working in
In addition, women who benefited from the project agri-food value chains to coordinate more effectively,
realized significantly higher economic decision-making while developing and refining business models that are
power. An unintended positive impact was on children’s more youth-inclusive.
school attendance, which increased by 6 percent thanks In Guatemala, rural youth were empowered through
to less time spent on water harvesting and livestock community-based social enterprises, promoting
rearing, as well as increased household income.177 In their role as agents of territorial and food system
Indonesia, a coastal community development project development. Following intensive training, young
promoted sustainable fishery and aquaculture production participants from migration-prone rural areas were able
practices by providing production inputs and establishing to assess local markets and community assets, mobilize
processing facilities and market linkages. Women, who both youth and adults in their rural areas and lead
are primarily engaged in fish processing and marketing,178 the design of community-based and environmentally
saw their empowerment increased by 27 percent, friendly business plans. Over one-third of the young
while fish productivity increased by 78 percent and participants managed to gather small-scale local
post-harvest losses reduced by 5 percent. Diets of target agribusiness into community clusters with at least
groups became more diverse (by 6 percent) with higher 25 young and adult members. After one year, more than
consumption of seafood, dairy and fruits.179 half of those clusters had been successfully registered
Young people can similarly benefit from interventions as cooperatives or producer associations, with youth
that remove some of the age-specific constraints to gaining credibility and self-confidence as changemakers,
their ability to productively engage in agriculture and with several of them managing to sell directly to schools
food systems. Evidence from an empowerment and under the national school feeding programme.182

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TABLE 12 KEY POLICY AREAS AND GOALS FOR TACKLING STRUCTURAL INEQUALITIES, ENSURING
INTERVENTIONS ARE PRO-POOR AND INCLUSIVE
Policy area Goals
Empowering vulnerable and historically } Reduce inequality within households, with positive effects on food security and
marginalized populations nutrition outcomes of women, children and youth.
Reducing gender inequalities in food } Increase productive capacity of men and women by ensuring equitable access to
security and nutrition and supporting productive resources.
women’s economic activities in food } Implement financial services support mechanisms targeting women’s economic
value chains activities as producers, processors, traders and entrepreneurs.
Enacting reforms with a gender lens to } Improve access to key agricultural productive assets.
enable more equal distribution of } Increase access of vulnerable populations to essential services, primary healthcare
resources and access to social services and expanded social protection mechanisms.
} Improve income distribution within countries.
SOURCE: FAO, IFAD, UNICEF, WFP & WHO. 2019. The State of Food Security and Nutrition in the World 2019. Safeguarding against economic
slowdowns and downturns. Rome, FAO.

» are not only pro-poor and inclusive, but also The promotion and increased availability of
empower women and youth as a means of highly processed foods has led to increased
accelerating transformative change in food consumption of unhealthy diets affecting all ages.
systems. Key policy areas and goals in this Promotion of breastmilk substitutes dissuades
regard are presented in Table 12. Additional policy mothers from breastfeeding and weakens the
recommendations supportive of this pathway can ability of healthcare workers to fully support
be found in the 2019 edition of this report. lactating mothers. Large food companies target
much of their marketing to youth, and small-scale
6. Strengthening food environments and changing local production of foods of high energ y density
consumer behaviour to promote dietary patterns and minimal nutritional value is also expanding
with positive impacts on human health and the rapidly. As a result of these food environment
environment changes, childhood overweight and obesity are
Access to nutritious foods and healthy diets rising as fast or faster than underweight is falling
is not only a matter of cost and affordability. in ever y region of the developing world. 183
Many elements of the food environment determine
dietary patterns, while culture, language, culinary Early adolescents are seeing the largest increases
practices, knowledge and consumption patterns, in the incidence of overweight, but it should be
food preferences, beliefs and values all relate to noted that it is an issue that has its roots in early
the way food is sourced, generated, produced and childhood and even during the gestational period.
consumed. Dietary patterns have been changing The promotion and marketing of foods can influence
and have had both positive and negative impacts food preferences and consumption, even in ways
on human health and the environment. 58 Hidden that consumers may not be aware of. 68 This has been
costs to human health and to the environment recognized as one of the main drivers that explain
that characterize most food systems today today’s dietary patterns, with children especially
are ignored. Given that they are mostly not showing a susceptibility to this influence. 184,185
measured either, they also go unaddressed and Restrictions on food marketing to children should
are unaccounted for in food prices, ultimately be implemented as part of a comprehensive package
jeopardizing the sustainability of food systems. of measures to create healthy food environments
Therefore, based on the specific country context that enable dietary choices for optimal nutrition
and prevailing consumption patterns, there is a and good health. International guidelines can
need for policies, laws and investments to create provide clear recommendations on the marketing
healthier food environments and to empower of breastmilk substitutes, complementary foods,
consumers to pursue dietary patterns that are and foods and beverages for older children. 186,187,188
nutritious, healthy and safe and with a lower Highlights of best practices from several countries
impact on the environment. 7 are presented in Box 12. »

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BOX 12 PROTECTING CHILDREN FROM THE HARMFUL IMPACTS OF FOOD MARKETING

Protecting children of all ages from the harmful impacts Indian marketing legislation has been proposed as a
of food marketing is an essential food system action, a factor.209 Exclusive breastfeeding in India increased
moral imperative and a human rights obligation.198,199,200 from 46 percent in 1992 to 55 percent in 2015.210
It can be done through a combination of legislation Following implementation of Chile’s law of food
on marketing of breastmilk substitutes, foods for labelling and advertising, pre-school children’s and
infants and young children, and marketing to which adolescents’ exposure to advertising for restricted
children are exposed in general. Notwithstanding the foods dropped,211 and sales of these foods in school
existence of global rules on food marketing,186,201,202 food kiosks dramatically declined.212 Purchases of foods
no country has yet implemented comprehensive best and beverages high in salt, sugar, energy or saturated
practice legislation to protect children from birth to fat,207 which are required to carry front-of-pack warning
18 years from the harmful impact of food marketing. labels, fell by 24 percent following introduction of the
Nevertheless, a number of countries have implemented regulation.213
elements of best practice, including India,203 The barriers that countries face in implementing
Brazil,204,205 the Philippines,206 Chile207 and Turkey208 as food marketing laws include opposition from powerful
summarized below. vested interests, as well as difficulties in addressing
Because the determinants of malnutrition are so cross-border marketing and monitoring digital
multi-factorial, it is very challenging to unpick the marketing. International guidance is available to support
nutritional impact of any single policy measure, but countries in implementing comprehensive measures to
data from India and Chile point to how well the laws protect children of all ages.186,187,214 Marketing measures
are working. In India, sales of infant formula remained should be considered as part of a comprehensive
steady between 2002 and 2008, while sales in China, portfolio of policies to reduce all forms of malnutrition
in comparison, more than tripled; the more robust and to support healthy diets.

ELEMENTS OF BEST PRACTICE TO PROTECT CHILDREN FROM THE HARMFUL IMPACT OF FOOD MARKETING
Element of best practice Country examples
Legislation covering Infants and young children: Brazil: Legislation covers any complementary foods for young
all relevant foods complementary foods covered. children up to 36 months.
Marketing of foods to children: Chile: The law defines “high” levels for calories, saturated fat, total
robust, transparent nutrition sugars and sodium in foods and beverages.
criteria used to define foods high Turkey: Nutrient criteria are closely aligned with WHO European
in fats, sugars and/or salt (HFSS). regional nutrient profile model used to define HFSS foods.
Protection for all Infants and young children: Philippines: The law extends to products marketed or labelled as
children from birth covers children up to 36 months. being suitable for infants and children up to 36 months.
to 18 years
Marketing of foods to children: Turkey: Broadcast regulations are intended to protect all children up
covers children up to 18 years. to 18 years.
All forms of Infants and young children: Philippines: Prohibition of advertising, provision of samples or gifts,
marketing are covers children up to 36 months. point-of-sale promotions, with robust provisions to keep industry at
regulated (media arm’s length from health workers/facilities, and strict rules on
channels and product labelling, as well as the use of cartoons.
promotional
techniques) Marketing of foods to children: Chile: Wide scope covering: television advertising; use of cartoons
covers children up to 18 years. and toys; sale and promotion of food in schools (including
sponsorship or educational resources); product labelling.
Robust monitoring Infants and young children. India: A monitoring mechanism, in place from the outset, authorizes
and enforcement, consumer organizations to report violations, which the authorities
with meaningful are obliged to investigate.
sanctions
Marketing of foods to children. Turkey: Baseline study conducted in 2017 (WHO and Ministry of
Health) to monitor digital food marketing to children.
Chile: Enforcement is well coordinated by the Ministry of Health, and
implemented by regional health authorities.
SOURCE: UNICEF/WHO.

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BOX 13 NUTRITION POLICY MEASURES TO ENHANCE BENEFITS AND MINIMIZE RISKS OF TRADE

Trade can improve the availability and diversity Moreover, these standards have been adopted and
of nutritious foods, but it can also increase the implemented without allowing domestic production
availability, accessibility and affordability of highly of fatty meats to increase to compensate for the
processed foods that are high in fat, sugar and/ drop in imports.220,221
or salt.217,218 In response, national policymakers
have implemented different measures to ensure Enhancing the benefits of increased trade:
coherence between trade and nutrition policies, Fiscal policies in Fiji
utilizing available mechanisms under trade Fiscal policies such as taxes, subsidies and changes
agreements to implement measures to protect in import tariffs (customs duties), can be used
public health, in line with the Framework for Action to minimize the risk and/or enhance the benefits
recommendation from the Second International of increased trade. One example of an approach
Conference on Nutrition (ICN2).219 to enhance the benefits of trade is the Fijian
Government’s removal of customs duties on imported
Minimizing trade-related risks: vegetables in 2013.222 As in other Pacific Island
Ghana’s use of food standards countries, globalization and increased international
Ghana experienced a dramatic increase in imports trade have influenced the nutrition transition in
of meat products as a result of trade liberalization in Fiji, which has contributed to elevated levels of
the late 1980s and early 1990s. The Ghana Health overweight and obesity in the country (adult obesity
Service raised particular concerns about rising was 30 percent in 2016)210 and the high burden
consumption of one particular product – namely, of NCDs.
imported turkey tails (known as tsofi locally), which Based on advocacy work by the Ministry of
have a very high fat content (up to 40 percent). Health with support from the Consumer Council of
In response to these concerns, the Ministries of Fiji and the academic sector, a new customs policy
Health, Trade and Agriculture collaborated to was introduced to improve access to vegetables in
set standards for the maximum amount of fat in Fiji.223 In 2012, customs duty was decreased from
carcasses and cuts of meat, including an upper limit 32 percent to 5 percent on vegetables not grown
of 15 percent for poultry, which were applicable or produced in Fiji; then in 2013 an excise tax of
to meats regardless of origin (i.e. applied to both 10 percent on all imported vegetables was eliminated,
domestic and imported products). while revenue losses were offset by increasing duty on
The overall effect of these standards has been less nutritious foods.223
to reduce the availability of turkey tails in the The volume of imported vegetables, which are not
Ghanaian food supply for over 20 years. Import data grown in Fiji, including leeks, capsicums, cauliflowers
show that imports of unspecified turkey cuts, which and celery, increased substantially between 2010
includes tails, declined following introduction and 2014. Imports of carrots – a vegetable, which
of the standards in the 1990s. At times, due to is grown in Fiji – also increased, but not to the same
fluctuation in imports, the measure has been extent.222 Further research is needed to explore how
reinforced by enhanced publicity and high-profile this greater availability of vegetables translates to
enforcement action, bringing imports down again. vegetable consumption in the diet of Fijians.223

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 CHAPTER 4 WHAT NEEDS TO BE DONE TO TRANSFORM FOOD SYSTEMS

TABLE 13 KEY POLICY AREAS AND GOALS FOR STRENGTHENING FOOD ENVIRONMENTS AND CHANGING
CONSUMER BEHAVIOUR TO PROMOTE DIETARY PATTERNS WITH POSITIVE IMPACTS ON HUMAN HEALTH AND
THE ENVIRONMENT
Policy area Goals
Implementing healthy public food } Ensure that food sold or served in schools, hospitals and other public institutions
procurement and service policies contributes to healthy diets.
Improving trade standards with a } Enhance the role of trade for increasing the availability and affordability of healthy
nutrition-oriented focus diets.
Taxation of energy-dense foods high in } Lower consumption of food with negative impact on human health.
fats, sugars and/or salt and subsidizing } Ensure nutritious foods are more affordable than energy-dense foods.
nutritious foods
Enacting legislation on food marketing } Protect all people, and in particular children from birth to 18 years, from harmful
impacts of food marketing.
Enacting labelling rules, including } Help consumers to shift their preference towards nutritious foods, in using
interpretive front-of-pack nutrition interpretive nutrition labels on the front, as well as nutrition information panels on
labelling the back of food packaging.
Regulating industrially produced trans } Eliminate industrially produced trans fats from the food supply chain.
fats
Reformulating food products and } Reduce levels of salt/sodium, sugars, calories and/or saturated fat in highly
beverages processed food.
SOURCE: FAO, IFAD, UNICEF, WFP & WHO. 2020. The State of Food Security and Nutrition in the World 2020. Transforming food systems for
affordable healthy diets. Rome, FAO.

» Reg ulator y approaches can be used to improve sweetened beverages within all school premises;
the nutritional qualit y of widely available restrictions on marketing for high-calorie,
processed foods that enable dietar y patterns with low-nutrient foods and high-caffeine foods
more positive impacts on health. Since 2004, directed at children and food qualit y certification
Argentina has implemented successive policies for children’s foods. 191,192,193,194
to reduce industrial trans fats in the food supply,
including voluntar y reformulation in cooperation Efforts to encourage the consumption of
with the food industr y, mandator y trans-fat nutritious foods and avoid negative impact
labelling and, ultimately, mandator y limits for on human health include the reformulation
levels in foods. 189 By 2015, 93 percent of foods of foods, 195 which targets the main sources
were reported to be compliant. 190 Multisectoral of food that are of concern to human health,
cooperation between relevant government such as saturated fat or trans fats, sugars
ministries and research institutes, consumer and/or salt. In Kuwait, the Food and Nutrition
groups, academia and the food industr y provided Administration identified locally produced bread
technical support to the process. as a key source of salt in the population’s diet
and approached the government-owned f lour
In the Republic of Korea, “green food zones” mills and bakeries, which produce most of the
were established in 2009–2010, prohibiting the countr y’s bread, about progressively reducing
sale of foods of high energ y densit y and minimal the levels of salt. 196 Within two months, the salt
nutritional value, including fast foods, within content of f lat white bread had been reduced
200 metres of selected schools. By 2017, “green by 10 percent, and within the year, a 20 percent
food zones” were established around more than reduction of salt content had been achieved. 197
90 percent of all schools. This was part of a
wider package of reg ulator y measures introduced Many countries have seen their food systems
to protect the nutrition of children and young transform rapidly as a result of globalization. 7
people, including, among others: introduction Over the past several decades, increasing levels
of traffic-light nutrition labelling and menu of international trade in food and agricultural
labelling in chain restaurants; a ban on sales of products have played a key role in ensuring

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 THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2021

a sufficient supply of staple foods, while also 4.2

maintaining dietar y diversit y in the provision
of nutritious foods, in particular where the BUILDING COHERENT
availabilit y of fresh fruits and vegetables may
drop significantly for part of the year. Yet, trade PORTFOLIOS OF
policies, including protectionar y trade measures,
may affect the availabilit y and cost of nutritious POLICIES AND
foods on local markets, as well as the supply and
price of energ y-dense foods. Similarly, while
non-tariff trade measures can help improve food
INVESTMENTS
safet y, qualit y standards and the nutritional Key elements of portfolios of policies
value of food, they can also drive up the costs of and investments
trade and hence food prices, negatively affecting As elaborated above and illustrated in Figure 28,
affordabilit y of healthy diets. the formulation of comprehensive portfolios
of policies and investments starts with a
In Peru, for example, the US-Peru free trade context-specific situation analysis to obtain an
agreement eliminated a 25 percent tariff on in-depth understanding of the countr y context,
soft drinks from the United States of America, including the nature and intensit y of major
which resulted in increased investment f lows, drivers impacting upon food systems and the
followed by an increase of 122 percent in soft prevailing food securit y and nutrition situation,
drink production in the countr y (including juices, in addition to the identification of relevant
bottled water and energ y drinks). 215 An initial actors, institutions and governance mechanisms.
rise in sugar consumption from sugar-sweetened The situation analysis will enable countries to
beverages eventually stagnated at elevated assess which combination of pathways towards
levels. As part of a comprehensive approach to the transformation of food systems is most
NCD prevention in Peru, especially given rising relevant, given the way in which the major
prevalence of overweight and obesit y, the countr y drivers of food insecurit y and malnutrition have
has raised taxes on sugar-sweetened beverages. 216 affected them, and which policy measures and
Since 2019, a tiered system of taxation – with investments are most appropriate to form part of
higher tax rates on drinks with higher levels of the portfolio ( Figure 29, left-hand side).
sugar – has been in place. As well as the expected
impact on consumer purchases, especially when Given the cross-sectoral nature of inter ventions
combined with the front-of-pack warning label needed to transform food systems and achieve
required on beverages high in sugar, this t ype of food securit y and improved nutrition (as
tax can act as a powerful driver for industr y to illustrated in the examples presented in the
reformulate products to reduce the sugar content. previous section), coherence with policies and
investments between agri-food, environmental,
A number of nutrition policy measures can health, social protection and other systems
enhance benefits and minimize risks of increased such as education, energ y, trade and finance is
trade and investment in global food systems essential for effective transformative change
( Box 13). ( Figure 29, right-hand side). Coherence is needed
not only for effective formulation, but also for the
Table 13 summarizes the key policy areas, including efficient and accelerated implementation of the
related laws and reg ulations to strengthen food portfolios, all of which call for multi-stakeholder
environments and changing consumer behaviour governance mechanisms and supportive
to promote dietar y patterns with positive institutions. Importantly, apart from access to
impacts on human health and the environment. productive and financial resources, systemic
Additional policy recommendations related to transformative change requires development
this pathway can be found in the 2020 edition of and generation of (and access to) appropriate
this report. n technolog y, data and innovation, referred to as
accelerators to spur the transformative processes
( Figure 29, right-hand side).

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FIGURE 29 KEY ELEMENTS OF A PORTFOLIO OF POLICIES AND INVESTMENTS

COMBINATION OF TRANSFORMATION
PORTFOLIO of POLICIES, COHERENT POLICIES AND
PATHWAYS (TPs) DEPENDING ON DRIVERS
INVESTMENTS ACROSS SYSTEMS
(supported by an in-depth INVESTMENTS and LEGISLATION
context-specific situation analysis ) to transform food systems with
resilience to drivers AGRI-FOOD SYSTEMS
humanitarian-development-
TP1 peace nexus ,
ENVIRONMENTAL SYSTEMS

TP2 scale up climate resilience

HEALTH SYSTEMS

SOCIAL PROTECTION SYSTEMS

TP3 strengthen economic resilience
OTHER RELEVANT SYSTEMS
lower the cost of nutritious
TP4 foods along food supply chains

TP5 address poverty and inequality

ACCELERATORS
 Governance and institutions
shift to sustainable  Technology, data and innovation
TP6 consumption patterns

SOURCE: FAO.

Following the in-depth discussion of best the food system, from providing the necessar y
practices and policy measures along the six knowledge and skills in food production to
possible pathways towards the transformation nutrition education for school-aged children and
of food systems in the previous section, the raising consumer awareness for better informed
remainder of this chapter reviews the importance choices towards minimizing the negative impacts
of coherence across relevant systems, as well as of food consumption on human health and the
the role of accelerators. A number of existing environment. Energ y systems are essential to
systems approaches that represent useful the functioning of food systems, as they provide
frameworks for building coherent portfolios and the energ y for food production, transportation,
facilitating multisectoral investments and action food processing, storage and consumption. In the
to achieve food securit y and improved levels of specific context of food systems transformation,
nutrition are also brief ly discussed. energ y systems are critical in ensuring increased
productivit y and in reducing food losses and
waste. Increased energ y efficiencies may help
Coherence of food system policies and lower the cost of safe and nutritious foods.
investments with other systems
The overall performance of food systems depends Given the important interrelationships among
on their coherence and interaction with several systems, food systems emerge as a potential
other systems, including especially the wider common space for advancing co-benefits for a
agri-food systems, in addition to environmental, range of policy goals efficiently and effectively. 57
health and social protection systems. Hence, apart from the identification of policy and
Other systems play a critical role throughout investment portfolios to transform food systems

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 THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2021

FIGURE 30 ENSURING COHERENCE AND COMPLEMENTARITY AMONG AGRI-FOOD*, ENVIRONMENTAL,

HEALTH, SOCIAL PROTECTION AND OTHER** SYSTEMS FOR FOOD SYSTEMS TRANSFORMATION FOR FOOD
SECURITY, IMPROVED NUTRITION AND AFFORDABLE HEALTHY DIETS FOR ALL

ENVIRONMENTAL AGRI-FOOD
SYSTEMS SYSTEMS

FOOD SYSTEMS
Food systems
transformation for food
security, improved
nutrition and affordable
healthy diets for all
SOCIAL HEALTH
PROTECTION SYSTEMS
SYSTEMS

OTHER
SYSTEMS

NOTES: * Agri-food systems include fisheries and forestry systems. ** Other systems include additional systems that are critical to food systems
transformation, including among others: education, energy, legal, social, economic, finance, trade and marketing systems.
SOURCE: FAO.

themselves, policy coherence is needed, not only fisheries and forestr y, as well as food
across the different transformation pathways storage, aggregation, post-har vest handling,
described above, but also with other systems that transportation, processing, distribution,
underpin the long-term sustainabilit y of these marketing, disposal and consumption. 224
food systems, as shown graphically in Figure 30. Agri-food systems interact with non-food supply
chains through the purchase of agricultural
Agri-food systems comprise both agricultural and inputs and by providing intermediate inputs to
food systems and encompass the entire range the production of non-food commodities, such
of actors and their interlinked value-adding as maize for biofuel production or cotton for
activities. This includes the primar y production textiles. As stated in Chapter 3, while broader
of food and non-food products in agriculture, agri-food systems transformation is of utmost

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CHAPTER 4 WHAT NEEDS TO BE DONE TO TRANSFORM FOOD SYSTEMS

importance, it is covered extensively in the 40 percent of global agricultural land could be

forthcoming publication on The State of Food and restored without reducing production, if inputs
Agriculture in the World 2021, 224 and is beyond the used and crop distribution were optimized
scope of this report. while respecting biodiversit y hotspots. 225
„ Sustainably managing existing food production
Nevertheless, in the context of building and supply systems renews ecosystems’
portfolios of policies and investments towards abilit y to provide healthy soil and clean
the transformation of food systems, ensuring water, and also supports biodiversit y. This is
coherence among those policies and investments accomplished by increasing efficiency while
specifically aimed at food systems on the one reducing external inputs, favouring the circular
hand, and those in the broader agri-food systems use of resources, and supporting multiple
domain on the other, is important for a number ecosystem ser vices (e.g. through rotations
of reasons – not least given the importance that diminish the need for chemical fertilizers
of agri-food systems in providing income while promoting soil health and carbon
and employment for millions of households. absorption). A rich menu of options exist
Clearly, both agri-food systems as well as food (ranging from regenerative practices based on
systems (forming an integral part of agri-food intercropping and short rotations to precision
systems) are affected by the same drivers agriculture and innovations for sustainable
outlined in Chapter 3, and inf luenced and agriculture), to be adopted and tailored to the
shaped by the same social, economic and natural local context.
environments in which their production systems „ Restoring and rehabilitating natural
are embedded. environments: Nature-positive production can
contribute to restoring the one-third of global
Environmental systems interact with food systems land considered degraded, by either rewilding
primarily at the production level in providing it or by restoring its agricultural productivit y
the necessar y environmental conditions and (and therefore helping to avoid additional
nutrients in the agriculture, fisheries and land conversion for agriculture), while also
forestr y sectors for food to be produced. contributing to preser ving the qualit y of all
Food and agricultural production systems, on land resources.
the other hand, impact on the environment in
multiple ways, including through their impact on Health systems and their ser vices are vital
biodiversit y, soil and water qualit y, animal and in ensuring that people are able to consume
plant health, greenhouse gas emissions, toxicit y, foods and utilize the necessar y nutrients for
as well as food loss and waste. Hence, there their health and well-being. Food systems may
is an increased recognition of the need for exert both positive and negative impacts on
nature-positive production and supply models human health through multiple interrelated
which “produce more with less” to ensure pathways, which are inf luenced by factors
sufficient nutritious food supplies for a growing arising from within and outside food systems,
world population over the coming decades. including social, economic and environmental
Nature-positive production involves actions determinants of health. Closer examination of
aimed at the three interrelated goals of protecting the food–health nexus indicates that unhealthy
nature, sustainably managing existing food diets are among the key risk factors driving the
production and supply systems, and restoring and global burden of disease; moreover, the negative
rehabilitating natural environments: 111 health impacts associated with poor qualit y diets
are significant. According to the Global Burden
„ Protecting nature: Given how inefficient of Disease initiative, 20 percent of premature
current systems are, it is possible to deaths worldwide are associated with a poor
maintain production levels, while halting qualit y diet. 226 Poor qualit y diets include those
the encroachment on natural ecosystems and diets with too high a content of foods high in
protecting marginal agricultural areas rich in fats, sugars and/or salt of minimal nutritional
biodiversit y, such as peatlands and mangroves. value and too low levels of protein qualit y.
A recent global estimate suggests that up to Adequate breastfeeding and child feeding for

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 THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2021

infants and young children are important to drowning and physical injuries) that affect the
ensure good qualit y diets. With current food health of, among others, farmers, agricultural
consumption patterns, diet-related health costs workers, fisherfolk, those working within the
linked to mortalit y and NCDs are projected to food processing and retail sectors, and other food
exceed USD 1.3 trillion per year by 2030. 7 chain workers. 139

Food systems impact human health and well-being Policies, laws, reg ulations and investments in
in several ways, including through: unhealthy health systems form part of the food–health
diets and food insecurity; zoonotic pathogens nexus. Universal health coverage is essential
(originating from both farmed and wild animals) to ensure healthy lives and to promote human
and antimicrobial resistance (AMR); unsafe and well-being. Universal coverage implies that all
adulterated foods; environmental contamination people can use the health ser vices they need
and degradation; and occupational hazards. 139 and that these ser vices are of sufficient qualit y
Illnesses may occur from the ingestion of foods and do not expose people to financial hardship.
containing various pathogens and toxicants; Inputs from health systems can support and
there are also risks with the consumption of reinforce food systems transformation, for
altered and novel foods. Globally, an estimated example, through the provision of essential
33 million healthy life years are lost due to the nutrition actions in universal health coverage, 230
consumption of unsafe food. 227 Malnutrition in including among others:
all its forms increases susceptibility to foodborne
diseases, zoonosis, physical injuries and mental „ Nutrition counselling during pregnancy and
health issues and vice versa, while healthy diets support to breastfeeding and complementar y
and healthy food systems help protect against feeding, alongside food system measures
these susceptibilities. With specific reference to reg ulate the marketing and promotion of
to zoonotic diseases, the multisectoral and breastmilk substitutes and foods for infants
multidisciplinary One Health approach builds and young children.
national mechanisms to address health threats at „ Early detection and support for the
the human-animal-environment interface. 228,229 management or treatment of different forms
of malnutrition, which is critical in informing
Many of the public health policy goals rely on the food systems transformation, as well as social
effective functioning of food systems to deliver protection needs in crisis situations.
safe and nutritious foods in a sustainable way „ The use of micronutrient supplements for
(as also ref lected in the SDGs). For example, v ulnerable groups can be an appropriate
the nutritional qualit y of foods produced and interim measure until food systems are
supplied affects dietar y goals and diet-related transformed to provide greater dietar y
health goals. At the same time, the ways in which diversit y and ensure ever yone has access to
food is grown, distributed and consumed also affordable healthy diets at all times.
affect environmental goals, while employment
and income generation in agriculture affect Additional health system actions can be reinforced
economic goals for producers and farmers, through nutrition-responsive social protection
including strategies aimed at the reduction of systems, including social transfers, maternity leave
rural povert y and income inequalit y. protection and breastfeeding support policies.
In the context of the COVID-19 pandemic, it has
Povert y and inequalit y make these food been particularly critical to strengthen the health
system-related health impacts more likely and system response for nutritional care, as already
increase their severit y. There can be serious strained healthcare systems are being forced to
health consequences from different forms of divert resources from essential nutrition-related
environmental contamination – including from services. 37,46,66,231 The inextricable linkages
heav y metal contamination, fertilizers, pesticides, between food systems and health systems
air pollution and smog, GHG emissions and highlighted above demonstrate the importance
microplastic pollution. Similarly, there are many of coherence among food and health systems
occupational hazards (e.g. the use of pesticides, policies, laws, regulations and investments.

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Food environment policies that foster food effect on increasing the qualit y of diets and the
system changes towards healthy diets are also affordabilit y of nutritious foods depends on
important. As illustrated in pathway 6 above, several factors, including effective targeting,
relevant policies are needed to create healthy adequate transfer amounts and modalities,
food environments by using standards and and effectively integ rating nutrition-specific
legislation to improve the nutritional qualit y of components. 235,236,237
food products and beverages; use fiscal policies
to inf luence relative prices of nutritious foods Social protection programmes can be effective
and foods high in fats, sugars and/or salt; limit in overcoming drivers of food insecurit y and
harmful food marketing; require packaged malnutrition in all its forms and in improving
foods to carr y nutrition labels that help people the affordabilit y of healthy diets in two
to choose healthier diets; and ensure that foods principal ways:
contributing to healthy diets are ser ved in
schools, hospitals, care homes and other public „ Supporting household incomes and livelihoods
institutions, as well as food aid programmes. for the poorest and most v ulnerable groups.
In addition, policies that encourage changes in Measures include boosting job creation and
consumer behaviour to encourage healthier and implementing labour market policies, such as
more sustainable food consumption and food public works programmes that can be used as
waste reduction are needed. 7 short-term measures to support purchasing
power in times of crisis and for developing
Social protection systems represent a set of assets that bring future returns to livelihoods;
policies and programmes, often grounded in social assistance initiatives, such as cash
enforceable legislation, that address economic, transfer programmes that provide support
environmental and social v ulnerabilities to to meet the most immediate needs and that
povert y, food insecurit y and malnutrition enable households to invest in their productive
by protecting and promoting livelihoods, in activities; 235 and increasing universal access to
particular through the reduction of financial healthcare, education and social ser vices that
and social barriers to accessing food and other could safeg uard against setbacks to families,
essential needs. 7,232 The impacts of a sudden nations and regions. 5
loss of income and employment for hundreds „ Improving access and affordability of healthy
of millions across continents has stretched the diets through school food and nutrition
capacit y of social welfare and social protection programmes (among others) especially
systems to the limit, resulting in deeper designed to improve dietar y diversit y, while
inequalities and increased povert y levels. 233 also encouraging the purchase of fresh food
Millions of children have been out of school from local producers. In-kind transfers,
for more than a year, losing out not only on especially in places where food markets are
education, but also daily school meals that not functioning well, could increase access to
make up an important proportion of their daily nutritious foods, in addition to food subsidies,
nutrient requirements. 234 especially those focused on nutritious foods
and targeted at the most v ulnerable. 7
Nutrition-sensitive social protection prog rammes
are particularly effective in supporting poor Large-scale investments in social protection
people and those liv ing under crisis conditions systems have ser ved as powerful instruments for
who do not have basic access to sufficient strengthening people’s access to nutritious food,
nutritious food to consume healthy diets nor particularly for v ulnerable groups in both urban
to essential complementar y nutrition, health and rural settings. And while it is recognized
and sanitation ser v ices. However, social that the capacit y of LMICs to finance such
protection policies and prog rammes do investments has been limited, with the right
not always lead to g reater affordabilit y of investments, laws, reg ulations and policies in
healthy diets. Coherent investments in food, place, social protection, health systems and food
ag riculture and social protection are crucial systems can work together to improve coverage of
for eradicating hunger and povert y, but their a population’s health and nutritional needs. 37

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 THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2021

Importantly, given the impact of measures innovative solutions to build resilience to food
to stem the COV ID-19 pandemic, such insecurit y and malnutrition drivers. These two
complementar y policies and investments should broad categories of accelerators of food systems
ensure that public funds are used to keep transformation – effective governance and
local and national food markets functioning, institutions, and access to technolog y, data and
strengthen health responses for nutritional innovations – are discussed below.
care, and empower women and caretakers who
make household decisions, especially about Governance and institutions
food choices. Actions to protect food workers The importance of effective governance and
and close gaps in food distribution are critical institutions to the implementation of coherent
to reach the most v ulnerable. 37 Importantly, and complementar y food systems policies has
social protection is more than a short-term been increasingly recognized, especially after
response to acute situations of food insecurit y the food price crisis of 2007–2008. 245 There are
and malnutrition. It is when reliable and many existing mechanisms at global, regional,
well targeted, social protection can support national and local levels, all of which aim to
households to engage in new economic activities, ensure adequate consultation and collaboration
and to capitalize on opportunities created by across sectors and among key actors. aq
the continued economic dynamism of food International coordination mechanisms facilitate,
systems, thereby bringing about longer-term among others, the setting of standards (such
improvements in access to healthy diets, in as harmonized sanitar y and phytosanitar y
addition to stimulating the development of local reg ulations) and other trade-related measures
economies. 238,239,240 to enhance regional and international trade.
At national levels, the most effective governance
mechanisms for the coordination of multisectoral
The role of accelerators in food systems actions across systems are best located at a
transformation super-ministerial level in close consultation
The effective and efficient implementation with sector-specific ministries and institutions.
of portfolios of policies and investments Importantly, these governance mechanisms
requires an enabling environment of should facilitate engagement of key actors from
governance mechanisms and institutions that public and private sectors and from civil societ y.
facilitate consultation across sectors and key
stakeholders. 241 At the same time, scaling In 2016, more than three-quarters of countries
up the availabilit y of technologies, data and reported having multisectoral mechanisms
innovative solutions is key to accelerating the to coordinate nutrition work – most
transformative processes. 242 Food systems commonly involving health, agriculture and
transformations are often attributed mainly education. 246 Such coordination mechanisms
to technological innovations, overlooking the may need to be further expanded to ensure a
importance of social and political conditions whole-of-government approach and for increased
in enabling its implementation. 243 Importantly, policy coherence. Case studies have identified
a wide range of institutional, policy and strengths and weaknesses in current governance
socio-cultural innovations are needed to mechanisms: a 2017 diagnostic study on food
enable the deployment and adoption of new systems governance in South Africa reviewed
technologies and innovations for systemic what forms of institutional arrangements
transformation of food systems. 24 4 are most appropriate. It found that the

Lessons drawn from countr y-level best

practices towards food systems transformation aq  At global level, relevant mechanisms for advancing food security,
improved nutrition and healthy diets include the follow-up to the Second
confirm the relevance of accelerators linked to International Conference on Nutrition (ICN2), held in 2014; the UN
institutional, policy and socio-cultural factors Decade of Action on Nutrition (2016–2025); and the UN Food Systems
with high transformative potential, combined Summit and the Tokyo Nutrition for Growth Summit (N4G), both to be
held in 2021. Furthermore, the multi-partner global Committee on World
with the implementation of new technologies, Food Security (CFS) develops and endorses policy recommendations
the extended use of data and the promotion of and guidance on a wide range of food security and nutrition topics.

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existence of three governance mechanisms systems for reliable and timely data to inform
created various challenges as the dominance policy development.
of single government bodies in programme
implementation limited f lexibilit y in policy The Association of Southeast Asian Nations
responses and lacked stakeholder participation. 247 (ASEA N) has made wide use of multi-stakeholder
platforms (MSPs) in seeking transformative
In Mexico, an inter-sectoral governance change, including to strengthen food value
mechanism was established in 2020 with multiple chains at countr y and subnational levels, as well
objectives to address povert y, inequalit y, as addressing issues of regional concern (such
environmental challenges, food insecurit y as implications of the COV ID-19 pandemic),
and malnutrition through the sustainable in addition to exploring opportunities to
transformation of food systems. The mechanism strengthen smallholder engagement in food
involving 18 thematic working groups covering value chains through digitization. In six of the
a wide range of public sector institutions, civil ASEA N member nations, public-private-producer
societ y and UN agencies concerning health, partnerships (PPPPs) are being supported by
food and the environment. Over a short period countr y networks and a regional network,
of time, the body has successfully promoted the composed of more than 520 organizations
introduction of the front-of-package nutritional across the region, representing the public sector,
labelling, as well as an agreement to phase out multinational corporations, local agribusinesses,
glyphosate and genetically modified corn for civil societ y, farmer associations, and academic
human consumption. The still pending formal and research institutions. 248
recognition of this inter-sectoral approach
towards the transformation of food systems in Technology, data and innovation
Mexico remains a constraint, as it prevents the Technolog y, data and innovation – at food
institutions engaged from raising the necessar y production levels, throughout the food value
investment and undermines further progress chain, and in the consumer environment
towards food securit y and improved nutrition. 97 – represent an essential set of accelerators
to speed up transformative change in food
Political dialog ue and advocacy are essential systems. Technological innovations over the past
to generate political commitment and broad centur y have been responsible for fundamental
support for food systems transformation. improvements in food production, processing and
While policymaking remains the role of distribution, leading to important improvements
government, a key condition for transformative in human well-being. The challenges currently
change is to create an enabling environment faced by all actors in introducing systemic
that allows different actors in public and private changes towards healthier, more equitable,
sectors and within civil societ y to interact, while resilient and sustainable food systems call for
setting up transparent rules of engagement, urgent technological and innovative changes. 249
including identif ying and managing conf licts The list of available technologies at all stages of
of interest. Within food systems, interaction is the value chain that can increase the availabilit y
needed among smallholders and agribusinesses; of nutritious foods is immense, and ranges
among food suppliers, marketing agencies from improved vegetable seed varieties to
and consumers; and among reg ulators and hydroponics to vertical farming in urban areas.
those who must comply with the reg ulations. Meanwhile, there are numerous new technologies
Multi-stakeholder mechanisms that engage in across the food system with transformational
the formulation and implementation of policies potential that are ready to be adopted. 24 4
and investments, and that provide robust
safeg uards against possible abuse and conf licts of Beyond the data and analytical capacity needed
interest, have proven to be effective consultative for an in-depth situation analysis to inform
platforms. Effective governance should also priority actions in the transformation of food
include built-in accountabilit y mechanisms systems referred to above, there is also a need
and strengthened oversight, monitoring and for improved data, analysis and decision-making
evaluation, including multisectoral information tools in the implementation of policy and

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investment portfolios for the accelerated inputs such as fertilizers and feed, and in
transformation of food systems. New means are selling their har vested products. There were
being explored to fully exploit the ongoing data significant drops in prices of all perishable
revolution to help transform food and agricultural products such as milk, vegetables and fish.
systems worldwide through evidence-based, With breaks in the supply chains and increasing
countr y-led and countr y-owned initiatives. concerns over health risks faced by their
Sophisticated tools are available, including members and farm workers, farmer organizations
advanced geo-spatial modelling and analytics facilitated the setting up of virtual call centres
to identif y opportunities to raise incomes and ( VCCs). VCCs facilitate local coordination and
reduce v ulnerabilities of rural populations, who communication to support farmers in continuing
constitute the vast majority of the world’s poor. 250 to sell their commodities, buying essential inputs
and ser vices, and sharing best practices during
Innovations along the food value chain. the pandemic. The VCC innovation has improved
Measures taken to contain the COV ID-19 efficiency and productivit y through cooperation
pandemic have had an unprecedented impact and technolog y, and also increased smallholder
on food value chains. Both the food supply and incomes. This has strengthened direct linkages
demand side have faced important challenges: between food producers and traders, while
linkages between farmers, intermediaries, benefitting local communities through increased
wholesalers, processors and retailers have been economic activit y. 97
more difficult, due to lockdown measures, while
consumers have had to endure not only physical New and promising technologies can effectively
challenges in accessing food (with the closure of reinforce food systems’ resilience to the
retail stores and mandator y stay-at-home orders), drivers of food insecurit y and malnutrition,
but also drastic reductions in their economic at the same time that these are transformed
access to food. Economic recessions have to provide healthy diets with sustainabilit y
triggered record losses in income, employment considerations. For example, solar powered
and livelihoods worldwide, hitting in particular irrigation systems are climate-friendly, reliable
the most v ulnerable populations the hardest. 251 and affordable if adequately managed. In the
Near East and North Africa, a regional initiative
Nevertheless, and contrar y to some initial has given special focus to the use of solar energ y
assumptions, most food supply chains have for agricultural irrigation and sustainable
shown to be resilient and have continued development. The system has reduced the
functioning, as innovations were introduced negative environmental impacts of agriculture,
and speedy decisions were taken to protect food decreasing soil pollution from diesel spillovers
supply chains as an “essential ser vice” during and greenhouse gas emissions. 253
the pandemic. 252 And, while these measures
have been applied more widely to modern and In Benin, the use of biofertilizer and isotopic
vertically integrated supply chains rather than techniques has led to a four-fold increase in
to traditional (i.e. much shorter) food supply soybean production between 2009 and 2019,
chains, measures taken during the COV ID-19 raising smallholder incomes and the availabilit y
pandemic have accelerated changes in food of healthy soya-based foods, while leading to
supply chains worldwide. Many innovations and significant increases in soil fertilit y as well as
new technologies have spread rapidly, including export earnings. In Argentina, Mediterranean
an unprecedented expansion of digitization, to fruit f lies had repeatedly damaged valuable
maintain food supply chains during the periods cash crops (cherries, pears and apples) for
of lockdown and constrained transportation and large-, medium- and small-scale producers of
distribution systems. 251 the Patagonia and Mendoza regions, leading
to substantial production losses and reduced
In Bangladesh, COV ID-19 lockdowns put revenues. Furthermore, frequent use of pesticides
tremendous pressure on farmers, as the f low of had caused health concerns for both producers
agricultural products and inputs was heavily and consumers. The introduction of the Sterile
disrupted. Farmers faced challenges in procuring Insect Technique (SIT) to control the fruit f lies

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led to the suppression and eradication of the building transformative multisectoral portfolios.
fruit f ly, which subsequently led to substantial Below, examples of systems approaches
increases in production and international trade in demonstrate how win-win solutions can help
the fruit sector – i.e. greater economic resilience speed up the t ype of transformative processes
and increased revenues for Argentinian farmers with greater efficiency that this report is calling
and traders. 97 for, while at the same time managing necessar y
trade-offs towards more sustainable and
The field of innovation is not only related inclusive food systems transformation.
to scientific or engineering advances.
For example, the high amount of investment
required for food systems transformation
Examples of systems approaches for
will require new and innovative financing building coherent portfolios
mechanisms, in addition to enabling legal Territorial approaches
and reg ulator y frameworks, while innovative As highlighted under several of the pathways
components in social protection programmes reviewed in this report, territorial approaches
can increase their effectiveness and improve can facilitate comprehensive and systemic
their sustainabilit y and positive effects in approaches towards the transformation of
facilitating the access to healthy diets for the food systems. In policy development and the
most v ulnerable. 249 The COV ID-19 pandemic implementation of transformative action,
has put a tremendous pressure on these areas, territorial approaches advocate for cross-sectoral
which have called for innovative solutions: and multi-level governance mechanisms,
in some sub-Saharan countries, including as well as coherence across different spatial
Malawi, Nigeria and Togo, satellite images have levels, while focusing on linkages and
been used, combined with other methods, in opportunities between systems in a given
the selection of new beneficiaries entitled to territor y. 255 As such, territorial approaches lend
stepped-up cash transfer programmes following themselves to realizing efficiency gains, while
increased support needed as a consequence of managing trade-offs in policy implementation.
the COV ID-19 pandemic. 13 Hence, with the benefit of involving all relevant
actors in a given space, territorial approaches
Capitalizing on win-win solutions represent ideal frameworks for responding to
and managing trade-offs the particular context, as well as the dynamic
The successful transformation of food systems and evolving nature of drivers impacting on
towards greater affordabilit y of healthy diets food systems and allow policymakers to design
for all, sustainably produced and with improved coherent and more effective multisectoral
resilience to identified drivers, calls for win-win policy portfolios.
solutions to be fully exploited, and for trade-offs
to be carefully managed. As with all systemic This approach has been implemented in
changes, there will be winners and losers, Colombia, where a 50-year conf lict had left
while the introduction of new technologies and rural areas and populations in povert y and
innovations, and the subsequent changes in with limited institutional capacit y. Since the
food systems performance, will produce both 2016 Peace Ag reement, territorial development
positive and negative spillover effects. 249 The plans have been implemented in 16 territories.
above-mentioned coherence among systems, as These consist of investment plans g rouped
well as the cross-cutting accelerators, play a key into eight pillars, including land tenure,
role in maximizing the benefits and minimizing infrastructure, health and education ser v ices,
negative consequences of transformation housing, water and sanitation, among others. 256
for food securit y, improved nutrition and The Great Green Wall project in the Sahel
affordable healthy diets: that is why policy represents another territorial approach: an
coherence, understood as a situation where ambitious 11-countr y project that seeks to
the implementation of policies in one area transform the lives of 100 million people by
do not undermine others (and even reinforce focusing on the ag ro-ecolog ical potential of
each other where feasible), 254 is needed in landscape restoration, while also producing

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food, increasing food securit y, creating jobs resilience at all levels (productive, social,
and promoting peace in a politically frag ile climatic and environmental). To be successful
reg ion. 257 In a context of climate change across livelihoods and food systems and
and desertification, the project creates to address food insecurit y and all forms of
opportunities for increasing biodiversit y and malnutrition, climate resilience policies and
reversing land deg radation in ways that create programmes should be built around climate
“g reen jobs”. Focusing on enhancing the risk assessments, science and interdisciplinar y
abilit y of small-scale producers to cope with cross-sectoral knowledge, in addition to
climate change, the project also invests in “blended” humanitarian, development and
improved access to markets and streng thened peace approaches that are participator y and
value chains, expanding the use of solar inclusive as well as driven by the needs of
energ y, and capitalizing on ag roforestr y and climate-v ulnerable groups. 3
communit y-led efforts to achieve food securit y
and improved nutrition. 258 Ecosystem approaches
In regard to coherence among food and
As introduced under pathway 4 above, territorial environmental systems, the transformation and
approaches to food systems transformation “greening” of food systems can be a powerful
also apply to urban and peri-urban settings. tool to build resilience to climate and economic
With over half of the world’s population now shocks simultaneously. The IMF has estimated
liv ing in urban settings, 259 municipal authorities that green multipliers are several orders of
responsible for cities and urban places can magnitude larger than non-green ones. 261 When
play an important role in transforming food portfolios of policies and investments for the
systems to improve food securit y and nutrition greening of food systems are designed and
and to help raise the affordabilit y of healthy implemented in such a way as to be an engine of
diets. Cit y authorities can, for example, use economic recover y, they can create viable jobs
their reg ulator y and planning powers to and sustainable livelihoods, address inequalit y,
shape the food env ironment (e.g. zoning of and promote food securit y and nutrition.
fast food outlets, calorie labelling, advertising Hence, strengthening climate resilience of food
restrictions, or taxation of beverages with a systems is not only good for sustainabilit y
high sugar content). 194 One example is the and reducing the carbon footprint – it is also
Milan Urban Food Policy Pact, an international good for ending hunger and malnutrition in
ag reement among cities to “develop sustainable all its forms. Similarly, developing or updating
food systems that are inclusive, resilient, safe national food-based dietar y g uidelines (FBDGs)
and diverse, that prov ide healthy and affordable through the full integration of environmental
food to all people in a human-rights based sustainabilit y elements in each of the g uideline’s
framework, that minimize waste and conser ve recommendations, according to national contexts
biodiversit y while adapting to and mitigating and using these FBDGs to g uide agriculture
impacts of climate change.” The pact has been and food policies, is one way help to drive the
signed by 211 cities worldwide with the aim of greening of food systems. 23
fostering cit y-to-cit y cooperation and exchange
of best practices. 260 The potential for boosting the provision
of ecosystem ser vices, while increasing
Coherent policy portfolios also have to productivit y, food securit y and resilience, has
address increased exposure and v ulnerabilit y been illustrated by a number of integrated
of livelihoods, particularly of disadvantaged watershed management inter ventions. In Kenya,
population groups. Without proper planning, an innovative Water Fund supports farmers
climate variabilit y and extremes will affect in the Upper Tana River Basin in adopting
v ulnerabilit y to future extreme events. 3 Any sustainable land and water management
rise in climate extremes can exacerbate the practices. In addition to strengthening
v ulnerabilit y of disadvantaged population smallholder resilience to the impacts of climate
groups, with adverse long-term developmental variabilit y and extremes, the Water Fund has
effects if no action is taken to increase helped raise productivit y and profitabilit y of

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coffee and other value chains. The integrated Urgent policy recommendation to support
approach of the Water Fund has furthermore Iraq on a sustainable path to recover y
improved the qualit y of drinking water for the include: the scaling up of social protection
capital Nairobi, while raising the countr y’s mechanisms; ensuring basic ser vices for the
hydropower output. Hence, this investment poor; protecting jobs, SMEs, and v ulnerable
has contributed to water and energ y systems workers in the informal economy, 265 as well
directly and to food, health and social as cross-cutting reforms for private sector-led
protection systems indirectly. 262 diversification and growth by creating
sustainable job opportunities. 266 Along these
In Mexico, a community-based forest lines, a multisectoral and multi-partner food
management project has been designed to address systems and value chain programme involving
and overcome problems linked to deforestation the Ministries of Planning, Agriculture, Water
and forest degradation in rural communities of Resources, Trade, Education and Migration, aims
marginalized forest areas in Campeche, Chiapas to support the return of millions of formerly
and Oaxaca. The project shows successful internally displaced people (IDP) and host
results in regard to environmental benefits. communities by providing employment to help
Project beneficiaries report being more resilient them rebuild their livelihoods. The cross-sectoral
to shocks (8 percent higher than comparison programme (2020 –2024) is a component of a
group), particularly to climatic shocks, and also UN-led humanitarian-development-peace (HDP)
less affected by drought (16 percent lower). nexus programme and supports: (i) an enabling
Moreover, incomes from off-farm activities have environment through policy engagement and
increased significantly (by 22 percent). On a more legislation changes, facilitating trade and
general level, total assets have also increased improving working conditions; (ii) building
(15 percent), particularly productive assets capacit y of public and private ser vice providers;
(41 percent), reflecting investments in business (iii) supporting smallholders to adopt sustainable
enterprises and improvements in the domain of practices; (iv) strengthening agri-food SMEs by
economic mobility. 263 providing technical and financial support; and
(v) promoting agribusiness development and
Coordinated policy action under protracted network linkages. The comprehensive portfolio
crisis conditions of policies and investments will strengthen the
As highlighted under the first pathway, in management of Iraq’s natural resources, support
conf lict-affected countries, it is imperative that fair and sustainable employment opportunities,
policies, investments and actions to reduce build human capital and strengthen private
immediate food insecurit y and malnutrition sector growth towards long-term recover y and
are implemented simultaneously with those development in Iraq.
aimed at a reduction in the levels of conf lict,
and are aligned with long-term socio-economic In Palestine, more than 1.7 million people
development and peacebuilding efforts. In Iraq, were food insecure in 2018 – about one-third
a three decade-old protracted crisis has had of the population. 267 This estimate rose to
devastating effects on agri-food systems, more than 2 million following the outbreak
causing large population displacements, of the COV ID-19 pandemic in 2020, 268 and
destruction of agricultural infrastructure, loss before the recent outbreak of violent conf lict
of livelihood assets and the severe disruption with Israel. Apart from causing a health crisis,
of food value chains. Low productivit y the pandemic aggravated the humanitarian
compounded by the impact of climate situation, while lockdowns impacted
change has raised challenges in the food and negatively on socio-economic development
agriculture sectors, which are major sources of in Palestine. In response to the crisis,
employment in both rural and urban areas. 97 emergency policy measures were put in place
During 2020, largely due to repercussions of the to maintain agri-food systems, with additional
COV ID-19 pandemic, povert y levels rose from measures to mitigate the effect of the crisis
20 percent (2017–2018) to as much as 35 percent on v ulnerable groups while protecting and
in central governorates. 264 promoting their livelihoods. 269

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After decades of humanitarian response, the protection systems. 273,278 Their food systems are
above measures reflect stepped-up efforts over founded on a holistic and systemic view that
the past five years to strengthen a HDP nexus encompasses spiritualit y, life and culture, with
approach. 270 In this context, in late 2020, the biotic and abiotic components in the ecosystem,
Palestinian cabinet endorsed its first National as well as the interconnections between them.
Food and Nutrition Security Policy (NFNSP, These food systems involve the totalit y of
2019–2030), 271 complemented by a National human capacit y for the sustainable production,
Investment Plan for Food and Nutrition generation, utilization, access, availabilit y,
Security and Sustainable Agriculture (NIP, stabilit y and management of foods that are
2020 –2022). 268,272 In spite of the protracted crisis, nutritious and fulfilling. 279
the NFNSP and NIP – formulated by the Ministry
of Agriculture, in cooperation with, among others, Indigenous Peoples’ food systems provide
the Ministries of Health, Social Development, best practices on sustainabilit y, incorporating
Education and Higher Education, the Palestinian seasonalit y, a broad food base, resilience, food
Water and Environmental Authorities, and the generation, self-governance, management of
Central Bureau of Statistics – jointly aim at collective rights and ecosystems management.
consolidating policy frameworks and coordinating These practices could be applied elsewhere to
and prioritizing interventions by different create healthier, more sustainable food systems.
actors. The renewed policy approach rests on In the United States of America, where Indigenous
strengthening the link between agricultural Peoples are twice as likely to be food insecure
development, social protection and economic than non-indigenous, 280 the Oneida Nation
empowerment to simultaneously address the most in Wisconsin is confronting food insecurit y
urgent as well as structural development needs and malnutrition among its people, including
of the Palestinian people. Regrettably, given the high levels of diabetes and obesit y resulting
most recent outbreak of violent conflict between from excessive consumption of processed
Israel and Palestine, current efforts are inevitably foods. An integrated communit y food systems
focused on peacebuilding, which remains the approach has been set up to revitalize their
most important priority in the near future. beliefs, cosmogony and governance, and a local
food systems’ governance coalition has been
Indigenous Peoples’ food systems established to restore their lands and waters
A good example of holistic and interconnected to sustainably produce nutritious foods for
systems, providing nutritious and varied their people. Their farm-to-school programme
foods within healthy environments while has been nationally recognized as a successful
preser ving biodiversit y, are the food systems way of including nutritious foods in children’s
of Indigenous Peoples. 273,274 In recent decades, school menus that are both local and culturally
these sustainable and resilient food systems appropriate. Furthermore, their intercultural and
– which have managed to generate food integrated approach to food within governance,
and medicines for hundreds of years – have policy, investment and communit y leadership
been negatively affected by climate change, has strengthened the food environment for the
extractive industries, expansion of commercial Oneida Nation, improved public health and
agriculture and persistent marginalization, reinforced intergenerational commitment to
resulting in displacement, violence, structural sustain their food systems. 97
povert y and inequalit y. 112,275,276,277 The ongoing
COV ID-19 pandemic has exacerbated their Living in more than 90 countries across seven
food insecurit y, particularly in urban and socio-cultural regions, Indigenous Peoples
peri-urban areas and in communities that rely represent 6.2 percent of the world population
more on market access to food. (476 million). While one in five of the world’s
extreme poor belong to Indigenous Peoples, their
In spite of these challenges, Indigenous economic povert y is in sharp contrast with the
Peoples have demonstrated that integrated cultural and ecological richness of their societies:
approaches that go beyond food are fundamental they speak 4 000 out of the 6 700 lang uages
to improving food environments and social remaining worldwide, and while their land and »

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BOX 14 INDIGENOUS PEOPLES’ SYSTEMIC APPROACHES PROVIDE EXTENSIVE KNOWLEDGE FOR THE
SUSTAINABLE AND INCLUSIVE TRANSFORMATION OF FOOD SYSTEMS

Indigenous Peoples´ systemic approach to food, through extensive consultation with First Nations,
nutrition, health, environment and biodiversity, Métis Nations and Inuit. 288 In Bolivia, intercultural
demonstrates how environmental, agri-food, health health assistance programmes have been developed,
and social protection systems can build cross-sectoral, combining traditional Indigenous medicine with
coherent and sustainable approaches to food western medicine at the community level.
systems. Their experiences can inform policies to „ Intercultural institutions for inclusive governance
transform other food systems towards sustainability. can support access to safe and nutritious foods for
Key messages include: all by combining Indigenous Peoples’ institutions,
customary self-regulation and governance systems
„ Systemic, inclusive approaches to food systems with formal institutions. In New Zealand, the
strengthen the links between the environment, Government has started a programme to incorporate
health and food production. This includes a indigenous customary law, mediation, and conflict
biocentric approach that uses new metrics to resolution to reduce the imprisonment of Maori
measure system performance to complement current People. In India, the rights of Adivasi or Indigenous
indicators. Internationally, the One Health approach Peoples to forest, land and territorial management
recognizes the interdependence between food, are enshrined within the 2006 Forest Rights Act.
health and the environment, including biodiversity. 228 In Indonesia, the Constitutional Ruling recognizes
„ Diversification of the food base. Indigenous Peoples’ the rights of Hutan Adat or Indigenous Peoples over
food systems can serve as an example of how forest lands. 289
to expand current food bases in acknowledging „ Developing co-responsible, circular food systems
biodiversity, enabling diverse agri-food systems, through reciprocity, solidarity and safety nets that
building resilience and ensuring positive human health influence corporate responsibility beyond the life
benefits from diversified diets.283 The Tikuna, Cocama of a given product. Circularity and co-responsibility
and Yagua Peoples in Colombia as well as Khasi, Botia within food systems can ensure that externalities
and Anwal Peoples in India sustain food systems are absorbed in the prices and ensure that the
counting well beyond 100 edibles consisting of wild, current waste generated by the food systems
semi-domesticated and domesticated species.112 And is moved away from inorganic waste residues
the Tzeltal women in Mexico conserve the biological towards organic ones and thus reincorporated
richness of maize, validating sustainable practices into the system as an input. In New Zealand, the
and doubling the productivity of their seeds. Government’s Waste Minimisation Fund supports
„ Blending technology and innovation with Indigenous food rescue initiatives, such as Para Kore and
Peoples’ traditional knowledge systems for Kai Ika to repurpose and redirect food waste to
new adapted solutions. In Panama, Indigenous families and community groups in the local region,
communities help to monitor illegal logging using promoting food security and diverting organic waste
drone, cell phone and computer technologies, from landfills.
supported by Indigenous elders, who are able to „ Highlighting the importance of dedicated policies to
share their knowledge, such as mental mappings of address collective rights and mobile livelihoods for
their territory to decide about the most appropriate food security. Indigenous Peoples´ food systems
actions to take. 284 In India, an agro-ecological combine individual and collective rights to lands
programme based on the traditional knowledge of and resources. Similarly, mobile, semi-mobile and
Indigenous Peoples has promoted the use of finger nomadic livelihoods are essential for maintaining
millet to address the impact of climate change on both food generation and food production activities
food production. Through this programme, millet within these food systems. In Mali, the importance
yields almost tripled in comparison to other forms of of nomadism and mobile livelihoods is recognized in
millet cultivation. 285,286,287 national legislation. Moreover, scientists and policy
„ Interculturality in policy discussions, decision-making practitioners are starting to realize the relevance of
and implementation. Examples here include mobile livelihoods in biodiversity conservation and
Canada´s new Food Policy, which was formulated territorial management.112

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 THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2021

» territories encompass around 25 percent of the Indigenous Peoples can make towards the
Earth’s surface, these contain 80 percent of the transformation of food systems, their voices
remaining terrestrial biodiversit y and see lower are still marginalized in policy discussions and
rates of deforestation. decision-making processes. 281 To help rectif y
this, the Global-Hub on Indigenous Peoples’
Given their global presence and their wealth Food Systems brings together Indigenous
of knowledge, Indigenous Peoples are key and non-Indigenous experts, scientists and
partners to contribute to global debates around researchers to co-create knowledge and evidence
sustainable and resilient food systems. Their food that can inf luence policy. 282 Drawing upon
systems are diverse and nutritious, help to experiences of Indigenous Peoples worldwide,
preser ve biodiversit y and have demonstrated to Box 14 provides g uidance on best practices towards
be resilient and adaptive to shocks. Despite the systemic approaches for the sustainable and
growing contributions on sustainabilit y that inclusive transformation of food systems. n

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GUATEMALA
A woman applying good
practices of handling
healthy food preparation.
©FAO/Luis Gustavo
Sánchez Días
CHAPTER 5
CONCLUSION

H aving monitored for five years the

progress made towards ending
hunger and all forms of malnutrition
in the framework of SDG 2, and examined the
major drivers behind that progress, this year,
The State of Food Security and Nutrition in the World
– an increase of almost 320 million people in
just one year. Related to this, the high cost of
healthy diets coupled with persistent high levels
of income inequalit y put healthy diets out of
reach for around 3 billion people in 2019 across
all regions. This number will likely increase
completes a pentalog y of editions that closes on in 2020, affecting most regions, due to the
both a negative and positive note. COV ID-19 pandemic.

The negative note is obvious. Chapter 2 of this Moreover, the goal of ending all forms of
report makes it clear that, with less than a malnutrition remains a challenge. Although data
decade to 2030, we are not on track to ending limitations have prevented this report from fully
world hunger and malnutrition – in fact, we are accounting for the impact of the pandemic, it is
moving in the wrong direction. The picture is estimated that 22.0 percent of children in 2020
bleak. After remaining virtually unchanged for were affected by stunting, 6.7 percent were
five years, the prevalence of undernourishment suffering from wasting and 5.7 percent were
increased from 8.4 percent in 2019 to around overweight. An estimated 29.9 percent of women
9.9 percent in 2020, meaning that between aged 15 to 49 years in 2019 around the world
720 and 811 million people in the world faced were affected by anaemia, and adult obesit y is
hunger in 2020 – as many as 161 million more increasing sharply in all regions. The current
people than in 2019. Beyond hunger, the outlook rate of global progress towards targets for these
is also discouraging. For the global prevalence nutrition indicators is insufficient or is even
of moderate or severe food insecurit y, the stalled or worsening.
estimated increase in 2020 was equal to that of
the previous five years combined. Thus, nearly As indicated in Chapter 3, driving these
one in three people in the world (2.37 billion) unwelcome trends are the increasing frequency
did not have access to adequate food in 2020 and intensit y of conf lict, climate variabilit y

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CHAPTER 5 CONCLUSION

and extremes, economic slowdowns and systems. This creates interconnected circular
downturns, and high levels of inequalit y. associations, contributing to increased food
Economic downturns in 2020, which were insecurit y and malnutrition and leading to
mainly a consequence of COV ID-19 containment current and future v ulnerabilit y. These major
measures all over the world, have contributed to drivers each have their own trajector y or
one of the largest increases in world hunger in cyclicalit y that ensures they will continue to
decades, which has affected almost all low- and occur and could even worsen in the coming
middle-income countries, and can reverse gains years; therefore, bolder and scaled-up actions are
made in nutrition. But the downturns resulting needed to build resilience to their negative effects
from the COV ID-19 pandemic were just a small on food securit y and nutrition.
part of a much bigger problem: more alarmingly,
the pandemic has exposed the v ulnerabilities On a more positive note, there is a solution going
forming in our food systems over recent years forward, and Chapter 4 of this report has pointed
as a result of major drivers such as conf lict, us to it. Given that the major drivers negatively
climate variabilit y and extremes, and economic affect food security and nutrition through their
slowdowns and downturns. These major drivers impacts on food systems, the solution lies in
are increasingly occurring simultaneously the transformation of these systems, and in fact
in countries, with interactions that seriously there is already momentum to do so. The world
undermine food securit y and nutrition. It has has noted that food systems are central to the
been shown that the majorit y of children who are goal of eradicating hunger and malnutrition in
hungr y and stunted live in countries affected by a all its forms and ensuring that everyone can
combination of these drivers. Moreover, increases afford a healthy diet. The UN Food Systems
in hunger in 2020 were even larger in countries Summit 2021 will bring forward a series of
where economic downturns were combined with concrete actions that people from all over the
climate-related disasters or conf lict, or both. world can take to support a transformation of the
world’s food systems. To that end, this report has
It is also important to consider that millions identified six pathways that, alone or frequently
of people are food insecure and malnourished in combination, specifically address the negative
in all its forms because they cannot afford a impacts of the major drivers behind the recent
healthy diet. The aforementioned drivers and rise in hunger and slowing progress to reduce
high levels of inequalit y, as well as other factors malnutrition in all its forms. These include:
driving up the cost of nutritious foods – in the (i) integrating humanitarian, development
realms of food production, food supply chains and peacebuilding policies in conflict-affected
and food environments, as well as consumer areas; (ii) scaling up climate resilience across
demand and the political economy of food food systems; (iii) strengthening resilience of
– are behind this significant deficiency in the most vulnerable to economic adversity;
our food systems. Evidence already suggests (iv) intervening along the food supply chains to
that countries where the unaffordabilit y of a lower the cost of nutritious foods; (v) tackling
healthy diet increased between 2017 and 2019 poverty and structural inequalities, ensuring
also show higher levels of severe as well as interventions are pro-poor and inclusive; and
moderate or severe food insecurit y, especially (vi) strengthening food environments and
lower-middle-income countries. changing consumer behaviour to promote dietary
patterns with positive impacts on human health
While the COV ID-19 pandemic and its impacts and the environment.
have been an immense challenge for the world,
they may also be a warning call of unwelcome The complex challenges to food securit y and
events to come if we do not commit to more nutrition call for greater synerg y and coherence
resolute actions to change course. As the report in policy formulation and implementation across
has shown, the major drivers threatening food sectors, supported by more strategic investments
securit y and nutrition are also interconnected from both the public and private sectors, which
with, and have circular impacts on, other is key to avoid undesirable trade-offs. This also
systems, including environmental and health means that silo solutions are no longer an option.

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 THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2021

What are required are integrated portfolios of this report (Chapter 2), having food securit y
policies, investments and legislation, built along estimates based on the Food Experience Scale
the particular transformation pathways needed at disaggregated geographical level has allowed
in each context, that can specifically address food policymakers and programme planners to
securit y and nutrition challenges head on. visualize which provinces or regions are most in
need of inter ventions to g uarantee the right to
The persistence of socio-economic inequalities adequate food. Moreover, more and better data
and povert y is a major issue – one that any allow for carr ying out situation analyses covering
process of food systems transformation context-specific and comprehensive assessments
cannot afford to ignore. This amplifies the of which key drivers are impacting negatively on
need to provide v ulnerable and historically food systems and resulting in poor food securit y
marginalized populations with greater access to and nutrition outcomes (as noted in Chapter 4).
productive resources, technolog y and innovation
to empower them to become agents of change Policy coherence – understood as a situation
towards more equitable and sustainable food where the implementation of policies in one area
systems. The successful transformation of do not undermine others and even reinforce
food systems towards greater affordabilit y of each other where feasible – across systems, as
healthy diets for all, sustainably produced and well as cross-cutting accelerators, play a key
with improved resilience to the major drivers role in maximizing the benefits and minimizing
identified, calls for win-win solutions to be the negative consequences of transformation.
fully exploited, and for trade-offs to be carefully These conditions will be critical to building
managed. Hence, it is not enough to address the transformative multisectoral portfolios of
factors driving up the cost of nutritious foods; policies, investments and legislation that
the inequalities and low incomes faced by many become win-win solutions and help manage
v ulnerable people also need to become a thing trade-offs. Systems approaches are also needed,
of the past. such as territorial approaches, ecosystems
approaches, Indigenous Peoples’ food systems
As with all systemic changes, the actions and inter ventions that systemically address
taken along the six transformation pathways protracted crisis conditions.
proposed in this report will result in winners
and losers. The introduction of new technologies This report recognizes the urgency for the
and innovations will ser ve as important broader food systems transformation that is
accelerators in the comprehensive portfolios needed and is currently at the centre of global
of policies, investments and legislation aimed attention. At the same time, it makes the case
at transforming food systems to increase the that, for getting back on track towards meeting
affordabilit y of healthy diets. However, adequate SDG Target 2.1, ensuring access to safe,
governance will need to be in place to ensure nutritious and sufficient food for all people all
no one is left behind in the access to these year round, and SDG Target 2.2, eradicating
accelerations and potential inequalities and all forms of malnutrition, we must focus on the
divides are prevented. Timely availabilit y of data transformation pathways and policy coherence
and information at both national and subnational that help most in addressing the major drivers
levels will also be critical to monitor progress behind the recent rise in hunger and slowing
towards targets and to target inter ventions progress towards reducing all forms
where they are needed most. As presented in of malnutrition. n

| 127 |
KYRGYZSTAN
A scene of cooking
chak-chak – a dessert.
©FAO/Mirbek Kadraliev
ANNEXES

ANNEX 1A ANNEX 4
Statistical tables to Chapter 2 130 Country group definitions and lists of
countries affected by drivers in Chapter 3 181
ANNEX 1B
Methodological notes for the food security ANNEX 5
and nutrition indicators 156 Country group definitions for the analysis
of food insecurity and drivers in 2020 186
ANNEX 2
Methodologies Chapter 2 170 ANNEX 6
Glossary 188
ANNEX 3
Country exposure to the drivers and PoU
change point analysis in Chapter 3 179

| 129 |
 ANNEX 1A
STATISTICAL TABLES TO CHAPTER 2

TABLE A1.1 PROGRESS TOWARDS THE SUSTAINABLE DEVELOPMENT GOALS (SDGs) AND GLOBAL NUTRITION TARGETS: PREVALENCE OF UNDERNOURISHMENT,
MODERATE OR SEVERE FOOD INSECURITY, SELECTED FORMS OF MALNUTRITION, EXCLUSIVE BREASTFEEDING AND LOW BIRTHWEIGHT
UNDERNOURISHMENT

0–5 MONTHS OF AGE

REPRODUCTIVE AGE
ADULT POPULATION

LOW BIRTHWEIGHT
CHILDREN (UNDER

CHILDREN (UNDER

CHILDREN (UNDER

ANAEMIA AMONG
5 YEARS OF AGE)

5 YEARS OF AGE)

5 YEARS OF AGE)

AMONG INFANTS
POPULATION1, 2, 3
PREVALENCE OF

PREVALENCE OF

PREVALENCE OF

PREVALENCE OF

PREVALENCE OF

PREVALENCE OF

PREVALENCE OF
BREASTFEEDING
POPULATION1, 2, 3
PREVALENCE OF

OVERWEIGHT IN
PREVALENCE OF

PREVALENCE OF
OBESITY IN THE

(18 YEARS AND

MODERATE OR
SEVERE FOOD
SEVERE FOOD
POPULATION1

IN THE TOTAL
IN THE TOTAL
IN THE TOTAL

STUNTING IN
INSECURITY
INSECURITY

WASTING IN

WOMEN OF

EXCLUSIVE
REGIONS/
SUBREGIONS/

(15–49)
OLDER)
COUNTRIES
| 130 |

2004–06 2018–204 2014–16 2018–20 2014–16 2018–20 20205 2012 20206 2012 20206 2012 2016 2012 2019 20127 20198 2012 2015
(%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%)
WORLD 12.3 8.9 8.2 10.5 23.0 27.6 6.7 26.2 22.0 5.6 5.7 11.8 13.1 28.5 29.9 37.0 44.0 15.0 14.6
Least developed
28.5 22.0 20.5 22.3 49.9 53.8 7.3 38.9 33.7 3.2 3.4 4.9 6.0 39.1 39.4 45.7 55.2 16.2 15.6
countries
Landlocked
developing 26.8 17.5 16.4 19.7 44.5 51.3 5.6 36.2 30.2 4.3 3.9 8.3 9.4 32.0 32.9 45.4 54.5 14.3 13.9
countries
Small island
18.2 15.2 n.a. n.a. n.a. n.a. 5.6 21.1 20.6 6.3 6.6 18.8 20.9 28.2 29.2 36.8 38.6 11.2 11.1
developing states
Low-income
32.5 28.9 23.3 26.2 54.6 59.6 6.9 39.6 34.6 3.9 3.7 6.3 7.3 38.5 38.8 42.5 54.4 14.5 14.1
economies
Lower-middle-
18.5 13.0 12.7 16.5 31.5 39.0 9.9 36.3 29.1 4.0 4.0 6.5 7.6 43.8 43.7 39.8 50.1 21.3 20.5
income economies
Upper-middle-
8.0 3.4 3.4 4.7 14.1 17.3 2.1 12.8 10.8 8.1 8.8 11.5 13.1 18.6 19.6 31.1 29.6 7.8 7.7
income economies
High-income
<2.5 <2.5 1.7 1.6 8.6 7.6 0.4a 3.7a 3.4a 7.3a 7.8a 22.3 24.3 13.2 14.4 n.a. n.a. 7.6 7.6
economies
Low-income food-
23.3 18.0 16.8 20.4 35.8 43.8 10.6 38.6 30.7 3.2 3.1 4.3 5.2 n.a. n.a. 43.7 55.7 20.9 20.1
deficit countries
 TABLE A1.1 (CONTINUED)

UNDERNOURISHMENT

0–5 MONTHS OF AGE

REPRODUCTIVE AGE
ADULT POPULATION

LOW BIRTHWEIGHT
CHILDREN (UNDER

CHILDREN (UNDER

CHILDREN (UNDER

ANAEMIA AMONG
5 YEARS OF AGE)

5 YEARS OF AGE)

5 YEARS OF AGE)

AMONG INFANTS
POPULATION1, 2, 3
PREVALENCE OF

PREVALENCE OF

PREVALENCE OF

PREVALENCE OF

PREVALENCE OF

PREVALENCE OF

PREVALENCE OF
BREASTFEEDING
POPULATION1, 2, 3
PREVALENCE OF

OVERWEIGHT IN
PREVALENCE OF

PREVALENCE OF
OBESITY IN THE

(18 YEARS AND

MODERATE OR
SEVERE FOOD
SEVERE FOOD
POPULATION1

IN THE TOTAL
IN THE TOTAL
IN THE TOTAL

STUNTING IN
INSECURITY
INSECURITY

WASTING IN

WOMEN OF

EXCLUSIVE
REGIONS/
SUBREGIONS/

(15–49)
OLDER)
COUNTRIES

2004–06 2018–204 2014–16 2018–20 2014–16 2018–20 20205 2012 20206 2012 20206 2012 2016 2012 2019 20127 20198 2012 2015
(%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%)
AFRICA 21.6 19.0 18.6 22.8 48.8 55.5 6.0 34.5 30.7 5.0 5.3 11.5 12.8 39.2 38.9 35.5 43.6 14.1 13.7
Northern Africa 8.3 6.6 9.9 9.2 28.7 30.0 6.6 22.7 21.4 12.0 13.0 23.0 25.2 31.9 31.1 40.7 42.1 12.4 12.2
Algeria 6.7 <2.5 13.0 6.9 22.9 17.6 2.7 12.6 9.3 13.5 12.9 24.7 27.4 32.9 33.3 25.4 n.a. 7.3 7.3
Egypt 6.4 5.4 8.4b 6.7 27.8b 27.8 9.5 22.5 22.3 15.8 17.8 29.3 32.0 31.0 28.3 52.8 39.5 n.a. n.a.
Libya n.a. n.a. 11.2 18.6 29.1 37.4 10.2 29.3 43.5 25.6 25.4 30.0 32.5 28.6 29.9 n.a. n.a. n.a. n.a.
Morocco 5.5 4.2 28.0 c,d
2.6 16.4 12.9 11.8 11.3 23.4 26.1 29.8 29.9 27.8 35.0 17.5 17.3
Sudan 18.9 12.3 13.4 c,d
16.8 c,d
41.4 c,d
49.4 c,d
16.3 36.0 33.7 2.5 2.7 <0.1 <0.1 36.8 36.5 41.0 54.6 n.a. n.a.
| 131 |

Tunisia 4.3 3.0 9.1 10.7 18.2 25.1 2.1 9.1 8.6 10.9 16.5 24.6 26.9 30.4 32.1 8.5 13.5 7.5 7.5
Northern Africa
6.1 5.4 9.1 7.5 26.0 25.9 n.a. n.a. n.a. n.a. n.a. 26.8 29.5 n.a. n.a. 40.6 37.1 11.5 11.4
(excluding Sudan)
Sub-Saharan Africa 25.0 21.8 20.6 25.9 53.4 61.3 5.9 36.6 32.3 3.8 4.0 8.0 9.2 41.2 40.7 34.5 44.0 14.4 14.0
Eastern Africa 34.2 26.6 24.6 26.6 59.3 63.5 5.2 38.9 32.6 4.0 4.0 5.3 6.4 31.4 31.9 48.6 60.7 13.8 13.4
Burundi n.a. n.a. 4.8 56.8 57.6 2.3 3.1 4.4 5.4 31.1 38.5 69.3 71.9 15.5 15.1
Comoros n.a. n.a. n.a. n.a. n.a. n.a. n.a. 32.3 22.6 10.9 9.6 6.7 7.8 32.8 33.8 11.4 n.a. 24.2 23.7
Djibouti 31.3 16.2 n.a. n.a. n.a. n.a. n.a. 31.7 34.0 7.2 7.2 12.3 13.5 31.0 32.3 12.4 n.a. n.a. n.a.
Eritrea n.a. n.a. n.a. n.a. n.a. n.a. n.a. 50.1 49.1 1.7 2.1 4.1 5.0 36.2 37.0 68.7 n.a. n.a. n.a.
Ethiopia 37.1 16.2 14.5 16.4 56.2 56.3 7.2 42.8 35.3 2.5 2.6 3.6 4.5 22.4 23.9 52.0 58.8 n.a. n.a.
Kenya 28.5 24.8 17.3 c,d
25.7 c.d
53.0 c,d
68.5 c,d
4.2 27.8 19.4 4.6 4.5 5.9 7.1 28.4 28.7 31.9 61.4 11.7 11.5
Madagascar 33.4 43.2 n.a. n.a. n.a. n.a. 6.4 47.9 40.2 1.8 1.5 4.3 5.3 37.5 37.8 41.9 50.6 17.5 17.1
Malawi 22.5 17.3 51.8 c,d
51.4 c,d
81.9 c,d
81.8 c,d
0.6 43.8 37.0 5.7 4.7 4.8 5.8 30.6 31.4 70.8 59.4 14.9 14.5
Mauritius 5.1 6.2 5.2 8.3 13.0 24.2 n.a. 9.0f 8.7f 7.4f 7.6f 9.6 10.8 19.2 23.5 n.a. n.a. 17.0 17.1
Mozambique 33.3 31.2 40.7 40.5 68.4 71.1 4.4 42.9 37.8 5.7 6.0 6.1 7.2 48.8 47.9 40.0 n.a. 14.1 13.8
Rwanda 35.3 35.2 1.1 40.5 32.6 5.7 5.2 4.7 5.8 18.3 17.2 83.8 86.9 8.2 7.9
Seychelles n.a. n.a. 3.2 c
3.3 c
14.3 c
14.7 c
n.a. 8.0 7.4 9.6 9.8 12.4 14.0 23.5 25.1 n.a. n.a. 11.0 11.7
 TABLE A1.1 (CONTINUED)

UNDERNOURISHMENT

0–5 MONTHS OF AGE

REPRODUCTIVE AGE
ADULT POPULATION

LOW BIRTHWEIGHT
CHILDREN (UNDER

CHILDREN (UNDER

CHILDREN (UNDER

ANAEMIA AMONG
5 YEARS OF AGE)

5 YEARS OF AGE)

5 YEARS OF AGE)

AMONG INFANTS
POPULATION1, 2, 3
PREVALENCE OF

PREVALENCE OF

PREVALENCE OF

PREVALENCE OF

PREVALENCE OF

PREVALENCE OF

PREVALENCE OF
BREASTFEEDING
POPULATION1, 2, 3
PREVALENCE OF

OVERWEIGHT IN
PREVALENCE OF

PREVALENCE OF
OBESITY IN THE

(18 YEARS AND

MODERATE OR
SEVERE FOOD
SEVERE FOOD
POPULATION1

IN THE TOTAL
IN THE TOTAL
IN THE TOTAL

STUNTING IN
INSECURITY
INSECURITY

WASTING IN

WOMEN OF

EXCLUSIVE
REGIONS/
SUBREGIONS/

(15–49)
OLDER)
COUNTRIES

2004–06 2018–204 2014–16 2018–20 2014–16 2018–20 20205 2012 20206 2012 20206 2012 2016 2012 2019 20127 20198 2012 2015
(%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%)
Somalia 58.2 59.5 n.a. 43.0h n.a. 79.1h n.a. 31.1 27.4 3.1 2.9 7.0 8.3 44.0 43.1 5.3 n.a. n.a. n.a.
South Sudan – n.a. 65.4 c
62.0 c
85.1 c
84.8 c
n.a. 32.1 30.6 6.4 5.7 <0.1 <0.1 34.7 35.6 44.5 n.a. n.a. n.a.
Uganda n.a. n.a. 17.5c,d 21.7c,d 58.0c,d 69.2c,d 3.5 34.1 27.9 3.9 4.0 4.3 5.3 31.3 32.8 62.3 65.5 n.a. n.a.
United Republic of
31.6 25.1 23.8c,d 24.7c,d 55.0c,d 56.4c,d 3.5 38.3 32.0 4.7 5.5 6.9 8.4 40.3 38.9 48.7 57.8 10.7 10.5
Tanzania
Zambia n.a. n.a. 21.8c,d 23.2c,d 48.8c,d 51.4c,d 4.2 41.3 32.3 6.2 5.7 6.8 8.1 30.5 31.5 59.9 69.9 11.9 11.6
Zimbabwe n.a. n.a. 35.5 32.1 64.7 69.8 2.9 31.4 23.0 4.7 3.6 14.3 15.5 30.0 28.9 31.3 41.9 12.8 12.6
| 132 |

Middle Africa 36.7 30.5 n.a. 35.6 n.a. 69.5 6.2 38.0 36.8 4.4 4.8 6.7 7.9 46.1 43.2 28.5 n.a. 12.8 12.5
Angola 52.2 17.3 21.0 26.9c 66.5 73.5c 4.9 32.4 37.7 2.9 3.5 6.8 8.2 45.9 44.5 n.a. 37.4 12.0 15.3
Cameroon 15.9 5.3 n.a. 26.7 n.a. 55.8 4.3 32.5 27.2 6.9 9.6 9.8 11.4 41.2 40.6 19.9 39.4 9.6 12.0
Central African
39.6 48.2 n.a. 61.8 n.a. 81.3 5.2 41.4 40.1 3.5 2.6 6.4 7.5 47.9 46.8 33.0 28.8 11.5 14.5
Republic
Chad 37.8 31.7 13.9 38.7 35.0 2.4 3.4 5.1 6.1 49.2 45.4 3.2 0.1 n.a. n.a.
Congo 34.0 37.7 42.6 51.7 82.0 88.3 8.2 23.4 18.9 5.1 5.1 8.3 9.6 53.1 48.8 20.2 32.9 9.4 11.6
Democratic
Republic of the 38.4 41.7 n.a. 38.5 n.a. 69.2 6.4 42.8 40.8 4.6 4.2 5.6 6.7 46.4 42.4 36.4 n.a. 8.7 10.8
Congo
Equatorial Guinea n.a. n.a. n.a. n.a. n.a. n.a. n.a. 25.5 19.7 8.8 9.3 6.8 8.0 47.4 44.5 7.4 n.a. n.a. n.a.
Gabon 14.3 15.7 n.a. n.a. n.a. n.a. n.a. 17.2 14.4 6.5 7.4 13.5 15.0 55.3 52.4 5.1 n.a. 11.4 14.2
Sao Tome and
9.0 11.9 n.a. n.a. n.a. n.a. 4.1 18.3 11.8 2.7 4.0 10.7 12.4 45.7 44.2 50.3 71.7 5.1 6.6
Principe
Southern Africa 5.1 8.4 18.9 20.3 43.9 46.1 3.2 24.3 23.3 12.1 12.1 25.0 27.1 28.5 30.3 n.a. 33.5 14.3 14.2
Botswana 25.2 29.3 19.6 c,d
22.2 c,d
45.9 c,d
50.8 c,d
n.a. 24.4 22.8 10.6 11.0 17.5 18.9 31.3 32.5 20.3 30.0 15.9 15.6
Eswatini 9.2 11.6 29.4 30.8 62.6 64.1 2.0 29.2 22.6 10.6 9.7 14.9 16.5 30.0 30.7 43.8 63.8 10.5 10.3
Lesotho 13.7 23.5 n.a. 27.0 c
n.a. 49.7 c
2.1 37.7 32.1 7.0 7.2 14.9 16.6 28.3 27.9 52.9 59.0 14.8 14.6
Namibia 18.2 19.8 28.9c,d 32.1c,d 53.2c,d 57.6c,d n.a. 24.1 18.4 4.3 5.0 15.1 17.2 24.7 25.2 22.1 n.a. 15.7 15.5
 TABLE A1.1 (CONTINUED)

UNDERNOURISHMENT

0–5 MONTHS OF AGE

REPRODUCTIVE AGE
ADULT POPULATION

LOW BIRTHWEIGHT
CHILDREN (UNDER

CHILDREN (UNDER

CHILDREN (UNDER

ANAEMIA AMONG
5 YEARS OF AGE)

5 YEARS OF AGE)

5 YEARS OF AGE)

AMONG INFANTS
POPULATION1, 2, 3
PREVALENCE OF

PREVALENCE OF

PREVALENCE OF

PREVALENCE OF

PREVALENCE OF

PREVALENCE OF

PREVALENCE OF
BREASTFEEDING
POPULATION1, 2, 3
PREVALENCE OF

OVERWEIGHT IN
PREVALENCE OF

PREVALENCE OF
OBESITY IN THE

(18 YEARS AND

MODERATE OR
SEVERE FOOD
SEVERE FOOD
POPULATION1

IN THE TOTAL
IN THE TOTAL
IN THE TOTAL

STUNTING IN
INSECURITY
INSECURITY

WASTING IN

WOMEN OF

EXCLUSIVE
REGIONS/
SUBREGIONS/

(15–49)
OLDER)
COUNTRIES

2004–06 2018–204 2014–16 2018–20 2014–16 2018–20 20205 2012 20206 2012 20206 2012 2016 2012 2019 20127 20198 2012 2015
(%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%)
South Africa 3.4 6.5 18.0 19.3 42.9 44.9 3.4 23.6 23.2 12.8 12.9 26.1 28.3 28.6 30.5 n.a. 31.6 14.3 14.2
Western Africa 14.1 14.8 10.8 21.8 42.5 57.8 6.9 34.9 30.9 2.3 2.7 7.4 8.9 52.9 51.8 22.1 32.3 15.6 15.2
Benin 12.0 7.6 n.a. n.a. n.a. n.a. 5.0 33.8 31.3 1.6 2.2 8.2 9.6 55.5 55.2 32.5 41.4 17.2 16.9
Burkina Faso 17.5 14.4 10.0c,d 15.4c,d 41.8c,d 47.9c,d 8.1 33.9 25.5 1.7 2.6 4.5 5.6 53.3 52.5 38.2 55.8 13.5 13.1
Cabo Verde 11.0 15.4 n.a. 7.6 c
n.a. 35.1 c
n.a. 12.2 f
9.7 f
n.a. n.a. 10.3 11.8 26.9 24.3 59.6 n.a. n.a. n.a.
Côte d'Ivoire 20.2 14.9 6.1 29.3 17.8 2.5 2.8 8.7 10.3 52.2 50.9 11.8 23.1 15.8 15.5
Gambia 21.7 13.6 23.6 25.7 52.7 56.0 5.1 22.4 16.1 1.9 2.3 8.7 10.3 56.4 49.5 33.1 53.3 17.2 16.8
| 133 |

Ghana 11.2 6.1 7.6c,d 8.6c,d 49.3c,d 50.2c,d 6.8 22.2 14.2 2.2 2.9 9.4 10.9 44.2 35.4 45.7 42.9 14.5 14.2
Guinea n.a. n.a. 44.3 49.7 72.5 74.1 9.2 33.8 29.4 4.1 5.7 6.4 7.7 50.9 48.0 20.4 33.4 n.a. n.a.
Guinea-Bissau n.a. n.a. n.a. n.a. n.a. n.a. 7.8 29.7 28.0 2.7 3.4 7.9 9.5 49.9 48.1 38.3 52.5 21.8 21.1
Liberia 35.8 38.9 n.a. 37.3 n.a. 80.6 3.4 35.6 28.0 3.2 4.7 8.6 9.9 43.6 42.6 27.8 n.a. n.a. n.a.
Mali 13.3 10.4 9.3 30.9 25.7 1.6 2.1 7.2 8.6 58.2 59.0 20.2 40.2 n.a. n.a.
Mauritania 9.4 9.1 4.6 c,d
6.5 c,d
26.3 c,d
39.8 c,d
11.5 27.0 24.2 1.9 2.7 11.0 12.7 45.1 43.3 26.7 40.3 n.a. n.a.
Niger n.a. n.a. 9.8 48.3 46.7 0.9 1.9 4.5 5.5 49.1 49.5 23.3 n.a. n.a. n.a.
Nigeria 7.1 14.6 6.6 c,d
21.4 c,d
36.5 c,d
57.7 c,d
6.5 38.0 35.3 2.5 2.7 7.4 8.9 54.9 55.1 14.7 25.2 n.a. n.a.
Senegal 17.2 7.5 14.5 13.6c 39.3 40.9c 8.1 19.8 17.2 1.5 2.1 7.6 8.8 55.9 52.7 37.5 42.1 18.9 18.5
Sierra Leone 46.7 26.2 30.4c,d 31.8c,d 78.4c,d 83.9c,d 5.4 35.4 26.8 3.4 4.7 7.4 8.7 47.9 48.4 31.2 54.1 14.9 14.4
Togo 27.7 20.4 5.7 27.4 23.8 1.7 2.4 7.1 8.4 47.4 45.7 62.1 64.3 16.3 16.1
Sub-Saharan Africa
24.8 21.4 20.3 25.6 53.0 60.8 n.a. n.a. n.a. n.a. n.a. 7.7 8.9 n.a. n.a. 34.8 44.3 14.4 14.0
(including Sudan)
ASIA* 13.7 8.2 7.3 9.3 19.0 23.6 8.9 28.1 21.8 4.9 5.2 6.1 7.3 31.1 32.7 39.0 45.3 17.8 17.3
Central Asia 10.8 3.2 1.7 3.1 9.2 15.0 2.3 15.4 10.0 8.5 5.6 15.6 17.7 28.8 28.1 29.2 44.8 5.6 5.4

Kazakhstan 7.3 <2.5 n.a. <0.5c,d n.a. 2.3c,d 3.1 11.1 6.7 11.5 8.8 19.0 21.0 27.3 28.7 31.8 37.8 6.1 5.4
Kyrgyzstan 9.0 7.2 n.a. 1.1 c,d
n.a. 7.0 c,d
2.0 16.0 11.4 7.6 5.8 14.4 16.6 34.1 35.8 56.0 45.6 5.6 5.5
 TABLE A1.1 (CONTINUED)

UNDERNOURISHMENT

0–5 MONTHS OF AGE

REPRODUCTIVE AGE
ADULT POPULATION

LOW BIRTHWEIGHT
CHILDREN (UNDER

CHILDREN (UNDER

CHILDREN (UNDER

ANAEMIA AMONG
5 YEARS OF AGE)

5 YEARS OF AGE)

5 YEARS OF AGE)

AMONG INFANTS
POPULATION1, 2, 3
PREVALENCE OF

PREVALENCE OF

PREVALENCE OF

PREVALENCE OF

PREVALENCE OF

PREVALENCE OF

PREVALENCE OF
BREASTFEEDING
POPULATION1, 2, 3
PREVALENCE OF

OVERWEIGHT IN
PREVALENCE OF

PREVALENCE OF
OBESITY IN THE

(18 YEARS AND

MODERATE OR
SEVERE FOOD
SEVERE FOOD
POPULATION1

IN THE TOTAL
IN THE TOTAL
IN THE TOTAL

STUNTING IN
INSECURITY
INSECURITY

WASTING IN

WOMEN OF

EXCLUSIVE
REGIONS/
SUBREGIONS/

(15–49)
OLDER)
COUNTRIES

2004–06 2018–204 2014–16 2018–20 2014–16 2018–20 20205 2012 20206 2012 20206 2012 2016 2012 2019 20127 20198 2012 2015
(%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%)
Tajikistan n.a. n.a. 5.6 26.5 15.3 5.6 3.5 12.2 14.2 31.0 35.2 32.6 35.8 5.7 5.6
Turkmenistan 4.2 4.1 n.a. n.a. n.a. n.a. 4.1 13.0 7.6 5.0 3.8 16.3 18.6 25.3 26.6 10.9 58.3 5.0 4.9
Uzbekistan 14.7 <2.5 1.9 4.0 11.2 19.7 1.8 14.2 9.9 8.6 5.0 14.4 16.6 28.7 24.8 23.8 49.5 5.3 5.3
Eastern Asia* 6.9 <2.5 1.0 1.7 6.1 8.3 1.7 7.5 4.9 6.8 7.9 4.9 6.0 15.5 16.1 28.5 22.0 5.1 5.1
China 7.0 <2.5 1.9 7.4 4.7 7.2 8.3 5.0 6.2 14.8 15.5 27.6 20.8 5.0 5.0
China, mainland 7.1 <2.5 n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a.
Taiwan Province
4.3 3.3 n.a. n.a. n.a. n.a. n.a. n.a. n.a. 27.0 28.4 n.a. n.a. n.a. n.a.
| 134 |

of China
China, Hong Kong
<2.5 <2.5 n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a.
SAR
China, Macao SAR 16.0 4.3 n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a.
Democratic
People's Republic 33.8 42.4 n.a. n.a. n.a. n.a. 2.5 26.1 18.2 1.3 1.9 5.9 6.8 31.7 33.9 68.9 71.4 n.a. n.a.
of Korea
Japan <2.5 <2.5 <0.5 0.7 2.6 3.4 n.a. 6.6 5.5 2.0 2.4 3.6 4.3 19.7 19.0 n.a. n.a. 9.6 9.5
Mongolia 29.6 4.3 3.4 4.9 21.0 26.2 0.9 12.6 7.1 10.2 10.1 17.9 20.6 14.3 14.5 65.7 50.2 5.5 5.4
Republic of Korea <2.5 <2.5 <0.5c 0.6 4.8c 5.1 n.a. 2.2 2.2 7.7 8.8 4.1 4.7 13.7 13.5 n.a. n.a. 5.4 5.8
Eastern Asia
(excluding China, 5.6 6.2 0.5 0.8 3.9 4.6 n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. 8.5 8.4
mainland)
South-eastern Asia 17.1 7.1 2.4 2.8 15.9 17.6 8.2 30.5 27.4 5.8 7.5 5.4 6.7 25.0 27.2 33.5 47.9 12.4 12.3
Brunei Darussalam <2.5 <2.5 n.a. n.a. n.a. n.a. n.a. 17.5 12.7 8.4 9.3 12.1 14.1 14.8 16.7 n.a. n.a. 12.1 10.8
Cambodia 17.0 6.2 16.9 13.4 48.9 44.8 9.7 34.4 29.9 2.1 2.1 3.1 3.9 46.1 47.1 72.8 65.2 12.6 12.1
Indonesia 19.2 6.5 0.7c,d 0.7c,d 6.0c,d 6.2c,d 10.2 34.5 31.8 8.2 11.1 5.5 6.9 27.0 31.2 40.9 50.7 10.2 10.0
Lao People's
22.4 5.3 n.a. 8.9 n.a. 29.4 9.0 40.7 30.2 2.3 3.0 4.1 5.3 36.3 39.5 39.7 44.4 17.7 17.3
Democratic Republic
Malaysia 3.2 3.2 7.8 7.5 17.4 18.7 9.7 18.3 20.9 6.0 6.1 13.1 15.6 30.1 32.0 n.a. 40.3 11.3 11.3
 TABLE A1.1 (CONTINUED)

UNDERNOURISHMENT

0–5 MONTHS OF AGE

REPRODUCTIVE AGE
ADULT POPULATION

LOW BIRTHWEIGHT
CHILDREN (UNDER

CHILDREN (UNDER

CHILDREN (UNDER

ANAEMIA AMONG
5 YEARS OF AGE)

5 YEARS OF AGE)

5 YEARS OF AGE)

AMONG INFANTS
POPULATION1, 2, 3
PREVALENCE OF

PREVALENCE OF

PREVALENCE OF

PREVALENCE OF

PREVALENCE OF

PREVALENCE OF

PREVALENCE OF
BREASTFEEDING
POPULATION1, 2, 3
PREVALENCE OF

OVERWEIGHT IN
PREVALENCE OF

PREVALENCE OF
OBESITY IN THE

(18 YEARS AND

MODERATE OR
SEVERE FOOD
SEVERE FOOD
POPULATION1

IN THE TOTAL
IN THE TOTAL
IN THE TOTAL

STUNTING IN
INSECURITY
INSECURITY

WASTING IN

WOMEN OF

EXCLUSIVE
REGIONS/
SUBREGIONS/

(15–49)
OLDER)
COUNTRIES

2004–06 2018–204 2014–16 2018–20 2014–16 2018–20 20205 2012 20206 2012 20206 2012 2016 2012 2019 20127 20198 2012 2015
(%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%)
Myanmar 27.8 7.6 n.a. 1.9 n.a. 22.2 6.7 31.9 25.2 2.2 1.5 4.6 5.8 39.4 42.1 23.6 51.2 12.5 12.3
Philippines 14.9 9.4 3.2c,d 4c,d 41.2c,d 42.7c,d 5.6 32.2 28.7 3.4 4.2 5.4 6.4 16.9 12.3 33.0 n.a. 20.4 20.1
Singapore n.a. n.a. 1.0 0.9 2.8 4.5 n.a. 3.2 2.8 4.0 4.8 5.6 6.1 11.5 13.0 n.a. n.a. 9.7 9.6
Thailand 11.9 8.2 4.2 8.5 15.1 29.8 7.7 13.9 12.3 8.7 9.2 7.9 10.0 22.1 24.0 12.3 23.0 10.8 10.5
Timor-Leste 32.2 22.6 n.a. n.a. n.a. n.a. n.a. 52.8 48.8 3.0 2.6 2.9 3.8 26.8 29.9 50.8 50.2 n.a. n.a.
Viet Nam 15.5 6.7 <0.5 0.5 c,d
6.3 6.5 c,d
5.8 25.9 22.3 4.2 6.0 1.6 2.1 17.0 20.6 17.0 n.a. 8.4 8.2

Southern Asia 19.9 14.1 14.6 18.4 30.9 38.7 14.1 40.2 30.7 2.9 2.5 4.5 5.4 48.3 48.2 47.4 57.2 27.2 26.4
| 135 |

Afghanistan 36.1 25.6 14.8 19.8 c,d

45.1 63.1 c,d
5.1 44.7 35.1 5.3 3.9 4.4 5.5 37.5 42.6 n.a. 57.5 n.a. n.a.
Bangladesh 14.2 9.7 13.3 10.5 32.2 31.9 9.8 38.1 30.2 1.7 2.1 2.8 3.6 35.7 36.7 64.1 65.0 29.0 27.8
Bhutan n.a. n.a. n.a. n.a. n.a. n.a. n.a. 30.2 22.4 6.1 5.2 5.2 6.4 39.8 38.6 48.7 53.2 11.9 11.7
India 21.6 15.3 17.3 41.7 30.9 2.4 1.9 3.1 3.9 53.2 53.0 46.4 58.0 n.a. n.a.
Iran (Islamic
5.2 5.5 9.5 8.7 48.0 42.5 n.a. 6.1 6.3 8.4f 9.4f 23.3 25.8 22.8 24.1 53.1 n.a. n.a. n.a.
Republic of)
Maldives n.a. n.a. n.a. n.a. n.a. n.a. 9.1 17.2 14.2 5.8 4.6 6.7 8.6 45.6 52.2 45.3 63.0 12.0 11.7
Nepal 16.8 4.8 10.4 12.0 29.5 36.4 12.0 40.3 30.4 1.4 1.8 3.3 4.1 35.9 35.7 69.6 65.2 22.6 21.8
Pakistan 17.6 12.9 7.1 43.4 36.7 4.6 3.4 7.1 8.6 42.7 41.3 37.0 47.5 n.a. n.a.
Sri Lanka 14.7 6.8 15.1 16.8 16.0 1.2 1.3 4.1 5.2 33.5 34.6 75.8 82.0 16.6 15.9
Southern Asia
15.4 11.0 12.4 13.4 38.6 39.8 n.a. n.a. n.a. n.a. n.a. 8.2 9.5 n.a. n.a. 49.9 55.3 n.a. n.a.
(excluding India)
Western Asia 8.9 14.6 8.5 9.0 27.1 27.9 3.5 17.8 13.9 9.0 8.3 27.2 29.8 31.7 32.5 32.3 33.1 10.0 9.9
Armenia 12.3 3.4 1.2 1.1 c,d
17.1 12.7 c,d
4.4 14.0 9.1 14.8 10.8 18.3 20.2 17.6 17.3 34.1 44.5 8.0 9.0
Azerbaijan 4.8 <2.5 <0.5 <0.5 5.9 8.9 n.a. 17.2 16.3 11.1 9.4 17.7 19.9 34.7 35.1 10.8 n.a. 7.0 7.3
Bahrain n.a. n.a. n.a. 6.3 f
5.1 f
5.6 f
6.4 f
27.6 29.8 36.3 35.4 n.a. n.a. 10.2 11.9
Cyprus 7.6 <2.5 n.a. n.a. n.a. n.a. n.a. 20.4 21.8 12.0 13.6 n.a. n.a. n.a. n.a.
 TABLE A1.1 (CONTINUED)

UNDERNOURISHMENT

0–5 MONTHS OF AGE

REPRODUCTIVE AGE
ADULT POPULATION

LOW BIRTHWEIGHT
CHILDREN (UNDER

CHILDREN (UNDER

CHILDREN (UNDER

ANAEMIA AMONG
5 YEARS OF AGE)

5 YEARS OF AGE)

5 YEARS OF AGE)

AMONG INFANTS
POPULATION1, 2, 3
PREVALENCE OF

PREVALENCE OF

PREVALENCE OF

PREVALENCE OF

PREVALENCE OF

PREVALENCE OF

PREVALENCE OF
BREASTFEEDING
POPULATION1, 2, 3
PREVALENCE OF

OVERWEIGHT IN
PREVALENCE OF

PREVALENCE OF
OBESITY IN THE

(18 YEARS AND

MODERATE OR
SEVERE FOOD
SEVERE FOOD
POPULATION1

IN THE TOTAL
IN THE TOTAL
IN THE TOTAL

STUNTING IN
INSECURITY
INSECURITY

WASTING IN

WOMEN OF

EXCLUSIVE
REGIONS/
SUBREGIONS/

(15–49)
OLDER)
COUNTRIES

2004–06 2018–204 2014–16 2018–20 2014–16 2018–20 20205 2012 20206 2012 20206 2012 2016 2012 2019 20127 20198 2012 2015
(%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%)
Georgia 4.1 8.7 7.0 9.5 31.8 39.7 0.6 9.2 5.7 13.7 7.6 19.3 21.7 26.9 27.5 54.8 20.4 4.8 6.1
Iraq 23.8 37.5 3.0 19.2 11.6 9.2 9.0 28.0 30.4 29.8 28.6 19.4 25.8 n.a. n.a.
Israel <2.5 <2.5 1.3c,d 1.9c,d 11.0c,d 13.7c,d n.a. n.a. n.a. n.a. n.a. 24.8 26.1 11.5 12.9 n.a. n.a. 8.0 7.8
Jordan 5.5 9.5 n.a. 7.9 7.3 5.7 7.1 33.1 35.5 30.5 37.7 22.7 25.4 13.9 13.8
Kuwait <2.5 <2.5 4.9 4.9 12.6 12.2 2.5 4.8 6.0 7.9 7.1 35.6 37.9 21.1 23.7 n.a. n.a. 9.9 9.9
Lebanon 10.9 9.3 n.a. 12.9 10.4 19.8 19.7 29.7 32.0 25.4 28.3 n.a. n.a. 9.3 9.2
Oman 9.6 8.2 n.a. n.a. n.a. n.a. 9.3 11.3 12.2 3.0 4.8 24.3 27.0 29.0 29.1 n.a. 23.2 10.6 10.5
| 136 |

Palestine n.a. n.a. n.a. 4.4c n.a. 26.3c 1.3 10.3 7.8 8.1 8.5 n.a. n.a. 30.5 31.0 28.7 38.1 8.5 n.a.
Qatar n.a. n.a. n.a. n.a. n.a. n.a. n.a. 6.0 f
4.6 f
13.1 f
13.9 f
32.4 35.1 27.1 28.1 29.3 n.a. 7.5 7.3
Saudi Arabia 4.8 3.9 n.a. 5.5 3.9 6.2 7.6 32.8 35.4 25.8 27.5 n.a. n.a. n.a. n.a.
Syrian Arab
n.a. n.a. n.a. n.a. n.a. n.a. n.a. 27.6 29.6 19.2 18.2 25.1 27.8 31.7 32.8 42.6 n.a. n.a. n.a.
Republic
Turkey <2.5 <2.5 1.7 n.a.g n.a.g n.a.g n.a.g 29.5 32.1 n.a. n.a. 41.6 40.7 11.6 11.4
United Arab
8.8 3.7 n.a. n.a. n.a. n.a. n.a. 29.0 31.7 24.0 24.3 n.a. n.a. 12.7 12.7
Emirates
Yemen 27.8 45.4 n.a. n.a. n.a. n.a. n.a. 47.4 37.2 2.9 2.7 14.6 17.1 61.5 61.5 n.a. n.a. n.a. n.a.
Central Asia and
19.6 13.7 14.1 17.8 30.1 37.8 13.6 39.2 29.8 3.1 2.7 4.9 5.9 47.5 47.5 46.6 56.6 26.4 25.5
Southern Asia
Eastern Asia and
9.6 2.8 1.4 2.0 8.8 10.9 4.1 16.0 13.4 6.5 7.7 5.0 6.2 18.2 19.5 30.4 29.8 8.1 8.0
South-eastern Asia*
Western Asia and
8.6 10.9 9.1 9.1 27.8 28.9 5.1 20.3 17.8 10.5 10.8 25.3 27.7 31.8 31.8 37.4 38.7 11.2 11.1
Northern Africa
LATIN AMERICA
AND THE 9.3 7.7 8.1 11.3 27.9 34.8 1.3 12.8 11.3 7.3 7.5 22.2 24.2 18.2 17.2 33.4 n.a. 8.7 8.7
CARIBBEAN
Caribbean 19.2 16.0 n.a. 37.6 n.a. 67.5 2.8 13.2 11.8 6.4 6.6 22.0 24.7 28.7 29.2 29.7 25.9 10.1 9.9
 TABLE A1.1 (CONTINUED)

UNDERNOURISHMENT

0–5 MONTHS OF AGE

REPRODUCTIVE AGE
ADULT POPULATION

LOW BIRTHWEIGHT
CHILDREN (UNDER

CHILDREN (UNDER

CHILDREN (UNDER

ANAEMIA AMONG
5 YEARS OF AGE)

5 YEARS OF AGE)

5 YEARS OF AGE)

AMONG INFANTS
POPULATION1, 2, 3
PREVALENCE OF

PREVALENCE OF

PREVALENCE OF

PREVALENCE OF

PREVALENCE OF

PREVALENCE OF

PREVALENCE OF
BREASTFEEDING
POPULATION1, 2, 3
PREVALENCE OF

OVERWEIGHT IN
PREVALENCE OF

PREVALENCE OF
OBESITY IN THE

(18 YEARS AND

MODERATE OR
SEVERE FOOD
SEVERE FOOD
POPULATION1

IN THE TOTAL
IN THE TOTAL
IN THE TOTAL

STUNTING IN
INSECURITY
INSECURITY

WASTING IN

WOMEN OF

EXCLUSIVE
REGIONS/
SUBREGIONS/

(15–49)
OLDER)
COUNTRIES

2004–06 2018–204 2014–16 2018–20 2014–16 2018–20 20205 2012 20206 2012 20206 2012 2016 2012 2019 20127 20198 2012 2015
(%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%)
Antigua and
n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. 17.1 18.9 16.7 17.2 n.a. n.a. 9.1 9.1
Barbuda
Bahamas n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. 29.5 31.6 13.3 14.5 n.a. n.a. 13.2 13.1
Barbados 6.1 4.1 n.a. n.a. n.a. n.a. n.a. 7.6 6.6 10.8 11.4 20.9 23.1 16.9 17.0 19.7 n.a. n.a. n.a.
Cuba <2.5 <2.5 n.a. n.a. n.a. n.a. 2.0 7.1 7.0 9.2 10.0 22.6 24.6 20.2 19.3 48.6 32.8 5.2 5.3
Dominica 5.4 5.6 n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. 25.6 27.9 20.1 20.8 n.a. n.a. n.a. n.a.
Dominican Republic 19.2 8.3 n.a. 8.0 5.9 7.8 7.6 24.5 27.6 28.0 26.4 8.0 4.6 11.4 11.3
| 137 |

Grenada n.a. n.a. n.a. n.a. n.a. n.a. n.a. 19.1 21.3 18.9 19.2 n.a. n.a. n.a. n.a.
Haiti 55.0 46.8 3.7 23.9 20.4 3.6 3.7 19.4 22.7 47.6 47.7 39.3 39.9 n.a. n.a.
Jamaica 7.4 7.7 3.3 6.8 8.5 7.2 6.8 22.3 24.7 19.5 19.9 23.8 n.a. 14.7 14.6
Puerto Rico n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. 18.4 18.8 n.a. n.a. n.a. n.a.
Saint Kitts and
n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. 20.4 22.9 16.0 15.4 n.a. n.a. n.a. n.a.
Nevis
Saint Lucia n.a. n.a. 4.5c n.a. 22.2c n.a. n.a. 2.7 2.8 6.5 6.9 17.4 19.7 14.1 14.3 3.5 n.a. n.a. n.a.
Saint Vincent and
7.9 5.6 n.a. n.a. n.a. n.a. n.a. 21.2 23.7 17.3 17.0 n.a. n.a. n.a. n.a.
the Grenadines
Trinidad and Tobago 11.1 6.7 n.a. n.a. n.a. n.a. n.a. 8.5 8.7 9.5 11.0 16.3 18.6 17.8 17.7 21.5 n.a. 12.5 12.4
Central America 7.9 8.9 6.4 8.5 29.3 31.0 0.9 17.9 16.6 6.6 6.3 25.1 27.3 15.2 14.6 21.6 33.2 8.8 8.7
Belize 5.7 5.9 n.a. n.a. n.a. n.a. 1.8 17.5 13.3 9.0 8.0 22.0 24.1 21.2 20.5 14.7 33.2 8.7 8.6
Costa Rica 4.4 3.1 1.8c,d 2.6c,d 12.2c,d 15.3c,d 1.8 7.0 8.6 8.3 8.1 22.9 25.7 12.3 13.7 32.5 n.a. 7.3 7.5
El Salvador 9.1 8.5 13.8 13.8 42.2 47.1 2.1 16.0 11.2 6.0 6.6 22.2 24.6 9.9 10.6 31.4 46.7 10.4 10.3
Guatemala 18.9 16.8 16.1 19.2 42.7 49.7 0.8 47.5 42.8 5.4 5.1 18.9 21.2 11.0 7.4 49.6 53.2 11.2 11.0
Honduras 22.3 13.5 14.2c,d 14.6c,d 41.6c,d 45.6c,d n.a. 22.7 19.9 5.0 5.7 19.0 21.4 16.6 18.0 30.7 n.a. 11.0 10.9
Mexico 4.4 7.2 3.6c 5.8c,d 25.6c 26.1c,d 1.4 12.7 12.1 6.7 6.3 26.8 28.9 15.9 15.3 14.4 28.6 8.0 7.9
Nicaragua 23.3 19.3 n.a. 17.4 14.1 7.2 7.5 21.5 23.7 13.3 15.7 31.7 n.a. 10.8 10.7
 TABLE A1.1 (CONTINUED)

UNDERNOURISHMENT

0–5 MONTHS OF AGE

REPRODUCTIVE AGE
ADULT POPULATION

LOW BIRTHWEIGHT
CHILDREN (UNDER

CHILDREN (UNDER

CHILDREN (UNDER

ANAEMIA AMONG
5 YEARS OF AGE)

5 YEARS OF AGE)

5 YEARS OF AGE)

AMONG INFANTS
POPULATION1, 2, 3
PREVALENCE OF

PREVALENCE OF

PREVALENCE OF

PREVALENCE OF

PREVALENCE OF

PREVALENCE OF

PREVALENCE OF
BREASTFEEDING
POPULATION1, 2, 3
PREVALENCE OF

OVERWEIGHT IN
PREVALENCE OF

PREVALENCE OF
OBESITY IN THE

(18 YEARS AND

MODERATE OR
SEVERE FOOD
SEVERE FOOD
POPULATION1

IN THE TOTAL
IN THE TOTAL
IN THE TOTAL

STUNTING IN
INSECURITY
INSECURITY

WASTING IN

WOMEN OF

EXCLUSIVE
REGIONS/
SUBREGIONS/

(15–49)
OLDER)
COUNTRIES

2004–06 2018–204 2014–16 2018–20 2014–16 2018–20 20205 2012 20206 2012 20206 2012 2016 2012 2019 20127 20198 2012 2015
(%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%)
Panama 21.6 7.5 n.a. 20.0 14.7 10.1 10.8 20.6 22.7 22.1 21.2 n.a. n.a. 10.2 10.1

South America 8.8 6.3 6.0 9.8 23.6 33.1 1.4a 10.2 8.6a 7.7 8.2a 21.1 23.0 18.4 17.3 41.9 n.a. 8.6 8.6

Argentina 3.7 3.9 5.8 12.6 19.2 35.8 1.6 7.8 7.8 12.4 12.9 26.3 28.3 12.7 11.9 32.0 n.a. 7.1 7.3
Bolivia (Plurinational
26.8 12.6 2.0 20.3 12.7 9.0 8.8 18.3 20.2 28.6 24.4 64.3 55.7 7.3 7.2
State of)
Brazil 6.5 <2.5 1.9 3.5 18.3 23.5 n.a. 6.3 6.1 6.9 7.3 20.1 22.1 18.3 16.1 38.6 n.a. 8.4 8.4
Chile 3.1 3.4 2.9c,d 4.3c,d 10.8c,d 17.9c,d 0.3 1.9 1.6 10.4 9.8 26.1 28.0 7.9 8.7 n.a. n.a. 6.0 6.2
| 138 |

Colombia 11.2 8.8 1.6 12.9 11.5 5.2 5.8 20.4 22.3 22.1 21.2 n.a. 36.7 10.0 10.0
Ecuador 22.4 12.4 6.0 c,d
11.6 c,d
20.7 c,d
32.7 c,d
3.7 24.1 23.1 7.3 9.8 18.1 19.9 17.3 17.2 n.a. n.a. 11.3 11.2
Guyana 7.1 5.2 n.a. n.a. n.a. n.a. 6.4 14.4 9.0 5.9 6.6 17.9 20.2 34.4 31.7 31.3 21.1 15.8 15.6
Paraguay 9.5 9.2 1.0 9.6 4.6 10.1 12.0 18.2 20.3 22.2 23.0 24.4 29.6 8.2 8.1
Peru 18.8 8.7 13.5 19.2 37.2 47.8 0.4 18.8 10.8 8.7 8.0 18.1 19.7 20.6 20.6 67.4 66.4 9.5 9.4
Suriname 9.7 8.7 n.a. n.a. n.a. n.a. 5.5 8.7 8.0 3.8 4.0 24.4 26.4 20.3 21.0 2.8 n.a. 14.9 14.7
Uruguay 3.9 <2.5 6.8 6.7 21.6 23.5 1.4 8.9 6.5 9.8 10.3 26.0 27.9 13.2 15.0 n.a. n.a. 7.9 7.6
Venezuela (Bolivarian
8.4 27.4 n.a. 12.5 10.6 6.4 6.7 24.0 25.6 20.9 24.2 n.a. n.a. 8.6 9.1
Republic of)
OCEANIA 6.7 6.2 2.8 3.4 11.1 12.9 n.a. n.a. n.a. n.a. n.a. 25.8 28.1 14.4 16.0 n.a. n.a. 7.8 7.9
Australia and New
<2.5 <2.5 2.8 3.4 10.6 12.6 n.a. 2.4 2.3a 12.9 16.9 27.0 29.3 7.6 8.8 n.a. n.a. 6.2 6.4
Zealand
Australia <2.5 <2.5 2.8 3.3 10.8 12.3 n.a. 2.1 2.1 14.2 18.5 26.7 29.0 7.4 8.5 n.a. n.a. 6.3 6.5
New Zealand <2.5 <2.5 2.8 3.9 10.0 14.0 n.a. n.a. n.a. n.a. n.a. 28.4 30.8 8.8 10.4 n.a. n.a. 5.9 5.7
Oceania excluding
Australia and New 20.9 20.0 n.a. n.a. n.a. n.a. 9.0 40.3 41.4 7.3 8.0 21.3 23.6 32.9 33.9 56.9 61.3 10.0 9.9
Zealand
Melanesia 23.2 21.7 n.a. n.a. n.a. n.a. n.a. 42.7 43.6 7.4 8.2 20.1 22.3 33.3 34.2 56.9 61.1 10.1 9.9
 TABLE A1.1 (CONTINUED)

UNDERNOURISHMENT

0–5 MONTHS OF AGE

REPRODUCTIVE AGE
ADULT POPULATION

LOW BIRTHWEIGHT
CHILDREN (UNDER

CHILDREN (UNDER

CHILDREN (UNDER

ANAEMIA AMONG
5 YEARS OF AGE)

5 YEARS OF AGE)

5 YEARS OF AGE)

AMONG INFANTS
POPULATION1, 2, 3
PREVALENCE OF

PREVALENCE OF

PREVALENCE OF

PREVALENCE OF

PREVALENCE OF

PREVALENCE OF

PREVALENCE OF
BREASTFEEDING
POPULATION1, 2, 3
PREVALENCE OF

OVERWEIGHT IN
PREVALENCE OF

PREVALENCE OF
OBESITY IN THE

(18 YEARS AND

MODERATE OR
SEVERE FOOD
SEVERE FOOD
POPULATION1

IN THE TOTAL
IN THE TOTAL
IN THE TOTAL

STUNTING IN
INSECURITY
INSECURITY

WASTING IN

WOMEN OF

EXCLUSIVE
REGIONS/
SUBREGIONS/

(15–49)
OLDER)
COUNTRIES

2004–06 2018–204 2014–16 2018–20 2014–16 2018–20 20205 2012 20206 2012 20206 2012 2016 2012 2019 20127 20198 2012 2015
(%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%)
Fiji 3.7 5.6 n.a. 2.0c n.a. 14.3c n.a. 8.5 7.5 4.8 5.2 27.7 30.2 31.5 32.0 n.a. n.a. n.a. n.a.
New Caledonia 9.6 6.9 n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a.
Papua New Guinea 27.4 24.6 n.a. n.a. n.a. n.a. n.a. 47.2 48.4 8.1 8.9 19.0 21.3 33.4 34.4 56.1 59.7 n.a. n.a.
Solomon Islands 12.5 16.5 n.a. n.a. n.a. n.a. 8.5 31.9 29.3 3.5 4.0 19.9 22.5 38.4 37.7 73.7 76.2 n.a. n.a.
Vanuatu 6.3 9.3 n.a. 2.4 c
n.a. 23.3 c
n.a. 27.3 28.7 4.8 4.9 22.6 25.2 24.1 28.5 39.5 n.a. 11.0 10.9
Micronesia n.a. n.a. n.a. n.a. n.a. n.a. n.a. 16.5 15.2 4.5 4.8 43.2 45.9 27.9 29.1 66.4 n.a. 9.4 9.3
Kiribati 5.3 4.1 n.a. 7.9 c
n.a. 40.9 c
3.5 15.8 14.9 2.4 2.4 43.5 46.0 31.8 32.6 66.4 n.a. n.a. n.a.
| 139 |

Marshall Islands n.a. n.a. n.a. n.a. n.a. n.a. 3.5 36.2 32.2 4.1 4.2 50.7 52.9 29.7 30.6 27.3 43.1 n.a. n.a.
Micronesia
n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. 42.9 45.8 22.7 25.0 n.a. n.a. n.a. n.a.
(Federated States of)
Nauru n.a. n.a. n.a. n.a. n.a. n.a. n.a. 20.3 15.0 3.1 3.7 59.6 61.0 29.5 29.6 67.2 n.a. n.a. n.a.
Palau n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. 53.1 55.3 27.3 28.5 n.a. n.a. n.a. n.a.
Polynesia 3.6 4.1 n.a. n.a. n.a. n.a. n.a. 7.5 6.7 8.3 8.4 44.9 47.6 25.6 27.4 51.6 70.3 8.1 8.1
American Samoa n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a.
Cook Islands n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. 53.8 55.9 25.8 27.1 n.a. n.a. 3.5 3.5
French Polynesia 3.8 3.8 n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a.
Niue n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. 46.8 50.0 25.9 27.3 n.a. n.a. n.a. n.a.
Samoa 3.4 4.6 n.a. 3.4 c
n.a. 23.6 c
3.1 5.7 6.8 6.7 7.1 44.7 47.3 24.5 26.8 51.3 70.3 n.a. n.a.
Tokelau (Associate
n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a.
Member)
Tonga n.a. n.a. n.a. 6.0c n.a. 23.2c 1.1 6.7 2.6 13.2 12.6 45.4 48.2 27.2 28.5 52.2 n.a. n.a. n.a.
Tuvalu n.a. n.a. n.a. n.a. n.a. n.a. n.a. 10.0 9.7 6.2 6.4 48.6 51.6 26.0 27.5 34.7 n.a. n.a. n.a.
NORTHERN
AMERICA AND <2.5 <2.5 1.3 1.1 9.1 8.0 n.a. 4.4a 4.0a 9.3a 8.6a 25.0 26.9 13.1 14.6 n.a. n.a. 7.0 7.0
EUROPE
Northern America** <2.5 <2.5 1.0 0.8 9.9 7.8 0.2 2.8 3.2 8.8 9.1 32.9 35.5 9.9 11.7 25.5 34.7 7.9 7.9
 TABLE A1.1 (CONTINUED)

UNDERNOURISHMENT

0–5 MONTHS OF AGE

REPRODUCTIVE AGE
ADULT POPULATION

LOW BIRTHWEIGHT
CHILDREN (UNDER

CHILDREN (UNDER

CHILDREN (UNDER

ANAEMIA AMONG
5 YEARS OF AGE)

5 YEARS OF AGE)

5 YEARS OF AGE)

AMONG INFANTS
POPULATION1, 2, 3
PREVALENCE OF

PREVALENCE OF

PREVALENCE OF

PREVALENCE OF

PREVALENCE OF

PREVALENCE OF

PREVALENCE OF
BREASTFEEDING
POPULATION1, 2, 3
PREVALENCE OF

OVERWEIGHT IN
PREVALENCE OF

PREVALENCE OF
OBESITY IN THE

(18 YEARS AND

MODERATE OR
SEVERE FOOD
SEVERE FOOD
POPULATION1

IN THE TOTAL
IN THE TOTAL
IN THE TOTAL

STUNTING IN
INSECURITY
INSECURITY

WASTING IN

WOMEN OF

EXCLUSIVE
REGIONS/
SUBREGIONS/

(15–49)
OLDER)
COUNTRIES

2004–06 2018–204 2014–16 2018–20 2014–16 2018–20 20205 2012 20206 2012 20206 2012 2016 2012 2019 20127 20198 2012 2015
(%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%)
Bermuda n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a.
Canada <2.5 <2.5 0.6c 0.9c 5.0c 5.8c n.a. n.a. n.a. 11.2 11.8 27.1 29.4 8.8 10.4 n.a. n.a. 6.2 6.4
Greenland n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a.
United States of
<2.5 <2.5 1.1c 0.8c 10.5c 8.0c 0.1 2.7 3.2 8.6 8.8 33.6 36.2 10.0 11.8 25.5 34.7 8.1 8.0
America
Europe <2.5 <2.5 1.5 1.3 8.7 8.1 n.a. 5.3a 4.5a 9.6a 8.3a 21.4 22.9 14.5 16.0 n.a. n.a. 6.6 6.5
Eastern Europe <2.5 <2.5 1.5 1.5 11.2 11.4 n.a. 7.9a 6.6a 13.5a 9.9a 22.0 23.4 19.2 20.5 n.a. n.a. 6.2 6.1
| 140 |

Belarus <2.5 <2.5 n.a. 4.0 3.9 9.2 6.8 23.0 24.5 19.1 20.6 19.0 n.a. 4.9 5.1
Bulgaria 4.9 3.0 1.9 2.4 14.9 13.2 6.3 7.5 6.4 8.2 5.7 23.2 25.0 22.5 23.6 n.a. n.a. 9.4 9.6
Czechia <2.5 <2.5 0.7 0.8 5.8 4.2 n.a. 2.4 2.5 5.9 6.6 24.5 26.0 20.0 21.1 n.a. n.a. 7.9 7.8
Hungary <2.5 <2.5 1.4 1.4 11.3 8.6 n.a. n.a. n.a. n.a. n.a. 24.5 26.4 19.6 19.7 n.a. n.a. 8.6 8.8
Poland <2.5 <2.5 1.8 <0.5 8.9 5.8 n.a. 2.3 2.3 5.9 6.7 21.5 23.1 n.a. n.a. n.a. n.a. 5.7 5.9
Republic of
n.a. n.a. 1.6 4.5 19.3 27.2 n.a. 7.1 4.9 6.2 4.3 17.5 18.9 26.0 26.1 36.4 n.a. 5.0 5.0
Moldova
Romania <2.5 <2.5 5.6 3.4 19.3 13.9 n.a. 10.6 9.7 9.5 6.7 20.7 22.5 22.1 22.7 n.a. n.a. 8.3 8.2
Russian Federation <2.5 <2.5 0.7 <0.5c 8.2 6.0c n.a. n.a. n.a. n.a. n.a. 21.9 23.1 20.0 21.1 n.a. n.a. 6.0 5.8
Slovakia 5.5 4.0 1.1 1.1 6.2 6.0 n.a. n.a. n.a. n.a. n.a. 19.1 20.5 22.3 23.5 n.a. n.a. 8.0 7.6
Ukraine <2.5 <2.5 2.0 2.5 n.a. 19.1 15.9 25.7 17.0 22.7 24.1 14.4 17.7 19.7 n.a. 5.4 5.6
Northern Europe <2.5 <2.5 1.8 1.1 6.7 4.9 n.a. 3.4 a
2.9 a
7.5 a
8.3 a
23.7 25.8 10.6 12.0 n.a. n.a. 6.1 6.0
Denmark <2.5 <2.5 1.0 1.1 5.9 5.0 n.a. n.a. n.a. n.a. n.a. 18.1 19.7 11.5 12.2 n.a. n.a. 5.3 5.3
Estonia <2.5 <2.5 0.9 0.8 9.5 7.9 1.5 1.3 1.2 5.1 5.7 20.1 21.2 20.7 21.7 n.a. n.a. 4.4 4.3
Finland <2.5 <2.5 2.4 1.9 9.3 8.0 n.a. n.a. n.a. n.a. n.a. 20.7 22.2 9.7 10.9 n.a. n.a. 4.2 4.1
Iceland <2.5 <2.5 1.7 1.5 6.4 6.6 n.a. n.a. n.a. n.a. n.a. 20.3 21.9 9.4 10.3 n.a. n.a. 3.9 4.2
Ireland <2.5 <2.5 3.4 4.3 8.9 8.3 n.a. n.a. n.a. n.a. n.a. 22.8 25.3 10.9 12.1 n.a. n.a. 5.3 5.9
Latvia <2.5 <2.5 0.6 0.7 9.9 10.2 n.a. n.a. n.a. n.a. n.a. 22.4 23.6 20.9 21.6 n.a. n.a. 4.5 4.5
 TABLE A1.1 (CONTINUED)

UNDERNOURISHMENT

0–5 MONTHS OF AGE

REPRODUCTIVE AGE
ADULT POPULATION

LOW BIRTHWEIGHT
CHILDREN (UNDER

CHILDREN (UNDER

CHILDREN (UNDER

ANAEMIA AMONG
5 YEARS OF AGE)

5 YEARS OF AGE)

5 YEARS OF AGE)

AMONG INFANTS
POPULATION1, 2, 3
PREVALENCE OF

PREVALENCE OF

PREVALENCE OF

PREVALENCE OF

PREVALENCE OF

PREVALENCE OF

PREVALENCE OF
BREASTFEEDING
POPULATION1, 2, 3
PREVALENCE OF

OVERWEIGHT IN
PREVALENCE OF

PREVALENCE OF
OBESITY IN THE

(18 YEARS AND

MODERATE OR
SEVERE FOOD
SEVERE FOOD
POPULATION1

IN THE TOTAL
IN THE TOTAL
IN THE TOTAL

STUNTING IN
INSECURITY
INSECURITY

WASTING IN

WOMEN OF

EXCLUSIVE
REGIONS/
SUBREGIONS/

(15–49)
OLDER)
COUNTRIES

2004–06 2018–204 2014–16 2018–20 2014–16 2018–20 20205 2012 20206 2012 20206 2012 2016 2012 2019 20127 20198 2012 2015
(%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%)
Lithuania <2.5 <2.5 2.5 1.7 15.3 11.3 n.a. n.a. n.a. n.a. n.a. 25.0 26.3 18.8 19.9 n.a. n.a. 4.5 4.5
Norway <2.5 <2.5 1.1 1.0 4.8 4.1 n.a. n.a. n.a. n.a. n.a. 21.3 23.1 10.7 12.0 n.a. n.a. 4.7 4.5
Sweden <2.5 <2.5 0.8 1.2 4.5 5.3 n.a. n.a. n.a. n.a. n.a. 19.0 20.6 11.7 13.6 n.a. n.a. 3.8 2.4
United Kingdom of
Great Britain and <2.5 <2.5 1.9 0.7 6.3 3.9 n.a. n.a. n.a. n.a. n.a. 25.4 27.8 9.4 11.1 n.a. n.a. 6.9 7.0
Northern Ireland
Southern Europe <2.5 <2.5 1.7 1.9 9.9 9.0 n.a. 4.5a 4.0a 8.1a 8.0a 20.4 21.8 13.5 15.1 n.a. n.a. 7.2 7.3
Albania 8.9 3.9 10.0 8.8 38.8 33.8 1.6 17.6 9.6 21.7 14.6 19.3 21.7 21.6 24.8 37.1 36.5 4.6 4.6
| 141 |

Andorra n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. 24.8 25.6 10.6 12.1 n.a. n.a. 7.5 7.4
Bosnia and
<2.5 <2.5 1.5 2.0 9.6 10.0 n.a. 9.3 9.1 18.9 12.8 16.3 17.9 23.8 24.4 18.2 n.a. 3.4 3.4
Herzegovina
Croatia <2.5 <2.5 0.6 1.3 6.5 11.0 n.a. n.a. n.a. n.a. n.a. 22.5 24.4 20.4 21.0 n.a. n.a. 4.8 5.1
Greece <2.5 <2.5 2.6 1.7 c,e
15.8 8.6 c,e
n.a. 2.1 2.2 14.2 13.9 23.2 24.9 12.8 15.1 n.a. n.a. 8.7 8.7
Italy <2.5 <2.5 1.2 1.2 8.6 6.7 n.a. n.a. n.a. n.a. n.a. 18.7 19.9 11.8 13.6 n.a. n.a. 7.0 7.0
Malta <2.5 <2.5 1.5 0.9 5.9 4.3 n.a. n.a. n.a. n.a. n.a. 27.5 28.9 12.3 13.7 n.a. n.a. 7.0 6.3
Montenegro 5.5 <2.5 2.1 2.8 12.6 13.5 2.2 8.2 8.1 15.3 10.2 21.6 23.3 16.1 17.2 19.3 n.a. 5.2 5.5
North Macedonia 5.0 2.7 3.6 5.0 15.1 17.7 3.4 5.8 4.1 13.4 10.0 20.8 22.4 17.2 19.3 23.0 n.a. 8.8 9.1
Portugal <2.5 <2.5 4.1 3.2 14.7 11.5 0.6 3.8 3.3 7.6 8.5 19.0 20.8 12.0 13.2 n.a. n.a. 8.5 8.9
Serbia <2.5 3.9 1.7 2.6 11.4 12.0 2.6 6.2 5.3 15.5 10.8 20.0 21.5 21.8 22.8 13.4 12.8 4.6 4.5
Slovenia <2.5 <2.5 0.9 <0.5 12.3 8.2 n.a. n.a. n.a. n.a. n.a. 18.8 20.2 20.2 21.8 n.a. n.a. 6.2 6.1
Spain <2.5 <2.5 1.1 1.8 7.1 8.8 n.a. n.a. n.a. n.a. n.a. 22.4 23.8 12.0 13.4 n.a. n.a. 8.2 8.3
Western Europe <2.5 <2.5 1.3 0.8 5.2 4.2 n.a. 2.6 a
2.3 a
5.4 a
6.0 a
20.1 21.7 9.6 11.6 n.a. n.a. 7.0 6.9
Austria <2.5 <2.5 1.1 0.9 5.5 3.0 n.a. n.a. n.a. n.a. n.a. 18.4 20.1 11.5 13.0 n.a. n.a. 6.9 6.5
Belgium <2.5 <2.5 n.a. 1.1 n.a. 3.7 0.4 2.7 2.3 4.5 5.1 20.7 22.1 11.3 13.6 n.a. n.a. 6.9 7.3
France <2.5 <2.5 1.6 0.7 6.8 5.8 n.a. n.a. n.a. n.a. n.a. 20.1 21.6 8.8 10.6 n.a. n.a. 7.4 7.4
 TABLE A1.1 (CONTINUED)

UNDERNOURISHMENT

0–5 MONTHS OF AGE

REPRODUCTIVE AGE
ADULT POPULATION

LOW BIRTHWEIGHT
CHILDREN (UNDER

CHILDREN (UNDER

CHILDREN (UNDER

ANAEMIA AMONG
5 YEARS OF AGE)

5 YEARS OF AGE)

5 YEARS OF AGE)

AMONG INFANTS
POPULATION1, 2, 3
PREVALENCE OF

PREVALENCE OF

PREVALENCE OF

PREVALENCE OF

PREVALENCE OF

PREVALENCE OF

PREVALENCE OF
BREASTFEEDING
POPULATION1, 2, 3
PREVALENCE OF

OVERWEIGHT IN
PREVALENCE OF

PREVALENCE OF
OBESITY IN THE

(18 YEARS AND

MODERATE OR
SEVERE FOOD
SEVERE FOOD
POPULATION1

IN THE TOTAL
IN THE TOTAL
IN THE TOTAL

STUNTING IN
INSECURITY
INSECURITY

WASTING IN

WOMEN OF

EXCLUSIVE
REGIONS/
SUBREGIONS/

(15–49)
OLDER)
COUNTRIES

2004–06 2018–204 2014–16 2018–20 2014–16 2018–20 20205 2012 20206 2012 20206 2012 2016 2012 2019 20127 20198 2012 2015
(%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%)
Germany <2.5 <2.5 1.0 0.7 4.1 3.4 0.3 1.5 1.6 3.7 4.1 20.7 22.3 9.6 11.7 n.a. n.a. 6.8 6.6
Luxembourg <2.5 <2.5 1.8 0.8 4.7 3.1 n.a. n.a. n.a. n.a. n.a. 20.9 22.6 9.0 10.2 n.a. n.a. 6.8 6.5
Netherlands <2.5 <2.5 1.5 1.4 5.7 4.7 n.a. 1.5 1.6 4.1 5.0 18.6 20.4 10.9 12.8 n.a. n.a. 6.2 6.2
Switzerland <2.5 <2.5 1.5 <0.5 4.8 2.0 n.a. n.a. n.a. n.a. n.a. 18.0 19.5 9.6 11.3 n.a. n.a. 6.5 6.5

NOTES: 4
The estimates for the year 2020 are the middle of with the exception of China where the latest data are for reporting indicators of food security. Note that
1
Regional estimates were included when more than the projected range. from the year 2013. the two estimates are not directly comparable due to
50 percent of population was covered. To reduce 5
For regional estimates, values correspond to the * Wasting under 5 years of age and low birthweight different definitions of "severe food insecurity".
the margin of error, estimates are presented as model predicted estimates for the year 2020. For regional aggregates exclude Japan. c
Based on official national data.
| 142 |

three-year averages. countries, the latest data available from 2014 to ** The Northern America wasting estimates are d
For years when official national data are not
2
FAO estimates of the percentage of people in the 2020 are used. derived applying mixed-effect models with available, the estimates are projected using FAO
total population living in households where at least 6
The collection of household survey data on child subregions as fixed effects; data were available only data. See Annex 1B for further details.
one adult has been found to be food insecure. height and weight were limited in 2020 due to the for the United States of America, preventing the e
Based on official national data collected in 2019
3
Country-level results are presented only for those physical distancing measures required to prevent the estimation of standard errors (and confidence and 2020 through EU-SILC.
countries for which estimates are based on official spread of COVID-19. Only four national surveys intervals). Further details on the methodology are f
Most recent input data are from before 2000,
national data (see note c) or as provisional estimates, included in the database were carried out (at least described in De Onis, M., Blössner, M., Borghi, E., interpret with caution.
based on FAO data collected through the Gallup © partially) in 2020. The estimates on child stunting, Frongillo, E.A. & Morris, R. 2004. Estimates of global g
Pending review.
World Poll, for countries whose national relevant wasting and overweight are therefore based almost prevalence of childhood underweight in 1990 and h
2020 estimate only.
authorities expressed no objection to their entirely on data collected before 2020 and do not 2015. Journal of the American Medical Association, <2.5 = prevalence of undernourishment less than
publication. Note that consent to publication does take into account the impact of the COVID-19 291(21): 2600–2606. Model selection is based on 2.5 percent; <0.5 = prevalence of severe food
not necessarily imply validation of the estimate by pandemic. best fit. insecurity less than 0.5 percent.
the national authorities involved and that the 7
Regional estimates are included when more than a
Consecutive low population coverage; interpret n.a. = data not available.
estimate is subject to revision as soon as suitable 50 percent of population is covered. For countries, with caution.
data from official national sources are available. the latest data available from 2005 to 2012 are used. b
The Central Agency for Public Mobilization &
Global, regional and subregional aggregates are 8
Regional estimates are included when more than Statistics (CAPMAS) reports an estimate of severe
based on data collected in approximately 50 percent of population is covered. For countries, food insecurity of 1.3 percent for 2015, based on
150 countries. the latest data available from 2014 to 2019 are used HIECS data, using the WFP consolidated approach
 TABLE A1.2 PROGRESS TOWARDS THE SUSTAINABLE DEVELOPMENT GOALS (SDGs) AND GLOBAL NUTRITION TARGETS: NUMBER OF PEOPLE WHO ARE AFFECTED BY
UNDERNOURISHMENT, MODERATE OR SEVERE FOOD INSECURITY AND SELECTED FORMS OF MALNUTRITION; NUMBER OF INFANTS EXCLUSIVELY BREASTFED AND
NUMBER OF BABIES BORN WITH LOW BIRTHWEIGHT

NUMBER OF ADULTS

REPRODUCTIVE AGE

NUMBER OF BABIES
WHO ARE STUNTED
UNDERNOURISHED

CHILDREN (UNDER

CHILDREN (UNDER

CHILDREN (UNDER

(15–49) AFFECTED
OLDER) WHO ARE
MODERATELY OR

5 YEARS OF AGE)

5 YEARS OF AGE)

5 YEARS OF AGE)

MONTHS OF AGE
SEVERELY FOOD
SEVERELY FOOD

(18 YEARS AND

BIRTHWEIGHT
AFFECTED BY

OVERWEIGHT

EXCLUSIVELY
INFANTS 0–5
BY ANAEMIA
NUMBER OF

NUMBER OF

NUMBER OF

NUMBER OF

NUMBER OF

NUMBER OF
NUMBER OF
NUMBER OF

BREASTFED
PEOPLE 1, 2, 3
PEOPLE 1, 2, 3

WOMEN OF
REGIONS/

INSECURE

WITH LOW
INSECURE

WHO ARE
WASTING
PEOPLE 1
SUBREGIONS/

OBESE
COUNTRIES

2004–06 2018–204 2014–16 2018–20 2014–16 2018–20 20205 2012 20206 2012 20206 2012 2016 2012 2019 20127 20198 2012 2015
(millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions)

WORLD 804.0 683.9 607.7 813.0 1 696.1 2 132.3 45.4 173.7 149.2 37.0 38.9 574.3 675.7 519.5 570.8 49.9 59.8 20.9 20.5
Least developed
212.1 227.0 192.7 230.2 469.5 556.2 10.9 51.8 50.2 4.2 5.0 22.5 30.8 83.6 101.4 12.7 16.9 4.9 4.9
countries
Landlocked
developing 100.3 91.4 77.5 102.7 210.9 267.2 4.2 24.4 22.7 2.9 2.9 19.3 24.5 34.3 42.4 6.4 8.3 2.2 2.2
countries
Small island
10.7 10.4 n.a. n.a. n.a. n.a. 0.3 1.3 1.3 0.4 0.4 8.1 9.5 4.6 4.9 0.4 0.5 0.1 0.1
| 143 |

developing states
Low-income
150.6 193.6 151.9 188.1 354.0 427.0 7.3 36.7 36.5 3.6 3.9 17.6 22.9 50.3 6.2 8.3 11.8 2.8 3.3
economies
Lower-middle-
434.5 379.4 334.1 465.1 842.4 1 108.6 30.1 108.2 88.5 11.9 12.1 105.4 133.5 294.1 32.6 24.0 30.9 12.9 13.0
income economies
Upper-middle-
206.5 99.8 101.6 140.3 398.7 504.7 4.3 25.7 21.6 16.3 17.5 232.4 277.2 138.8 14.4 12.9 11.8 3.2 3.2
income economies
High-income
n.r. n.r. 19.8 19.0 99.9 90.7 0.2a 2.5a 2.2a 5.0a 5.1a 206.6 231.4 36.3 3.9 n.a. n.a. 1.0 1.0
economies
Low-income food-
481.9 472.2 412.2 533.7 881.3 1 146.5 <0.1 108.8 89.0 8.9 8.9 59.9 79.6 n.a. n.a. 24.8 33.0 14.9 14.5
deficit countries
AFRICA 198.4 248.0 219.8 298.7 576.7 726.4 12.1 60.2 61.4 8.7 10.6 65.5 81.5 103.1 122.7 13.1 17.7 5.6 5.7
Northern Africa 15.5 16.0 22.1 22.2 64.3 72.6 1.9 5.8 6.2 3.1 3.8 30.2 35.7 17.6 18.9 2.3 2.4 0.7 0.7
Algeria 2.2 n.r. 5.2 3.0 9.1 7.6 0.1 0.5 0.5 0.6 0.6 6.2 7.4 3.4 3.6 0.2 n.a. <0.1 <0.1
Egypt 4.9 5.4 7.8 b
6.8 25.7 b
27.9 1.1 2.4 2.8 1.7 2.3 15.6 18.4 6.9 7.0 1.3 1.0 n.a. n.a.
Libya n.a. n.a. 0.7 1.3 1.9 2.5 0.1 0.2 0.3 0.2 0.2 1.2 1.4 0.5 0.6 n.a. n.a. n.a. n.a.
Morocco 1.7 1.5 10.2c,d 0.1 0.5 0.4 0.4 0.4 5.2 6.2 2.7 2.9 0.2 0.2 0.1 0.1
Sudan 5.8 5.3 5.2c,d 7.2c,d 16.1c,d 21.2c,d 1.0 2.0 2.1 0.1 0.2 <0.1 <0.1 3.1 3.8 0.5 0.7 n.a. n.a.
Tunisia 0.4 0.3 1.0 1.2 2.0 2.9 <0.1 0.1 0.1 0.1 0.2 1.9 2.2 0.9 1.0 <0.1 <0.1 <0.1 <0.1
 TABLE A1.2 (CONTINUED)

NUMBER OF ADULTS

REPRODUCTIVE AGE

NUMBER OF BABIES
WHO ARE STUNTED
UNDERNOURISHED

CHILDREN (UNDER

CHILDREN (UNDER

CHILDREN (UNDER

(15–49) AFFECTED
OLDER) WHO ARE
MODERATELY OR

5 YEARS OF AGE)

5 YEARS OF AGE)

5 YEARS OF AGE)

MONTHS OF AGE
SEVERELY FOOD
SEVERELY FOOD

(18 YEARS AND

BIRTHWEIGHT
AFFECTED BY

OVERWEIGHT

EXCLUSIVELY
INFANTS 0–5
BY ANAEMIA
NUMBER OF

NUMBER OF

NUMBER OF

NUMBER OF

NUMBER OF

NUMBER OF
NUMBER OF
NUMBER OF

BREASTFED
PEOPLE 1, 2, 3
PEOPLE 1, 2, 3

WOMEN OF
REGIONS/

INSECURE

WITH LOW
INSECURE

WHO ARE
WASTING
PEOPLE 1
SUBREGIONS/

OBESE
COUNTRIES

2004–06 2018–204 2014–16 2018–20 2014–16 2018–20 20205 2012 20206 2012 20206 2012 2016 2012 2019 20127 20198 2012 2015
(millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions)
Northern Africa
9.6 10.7 16.9 15.0 48.2 51.5 n.a. n.a. n.a. n.a. n.a. 30.2 35.7 n.a. n.a. 1.8 1.6 0.5 0.5
(excluding Sudan)
Sub-Saharan Africa 182.8 232.0 197.7 276.6 512.4 653.8 10.1 54.3 55.2 5.6 6.8 35.3 45.9 85.4 103.8 10.9 15.3 4.9 5.0
Eastern Africa 101.0 115.3 95.7 115.5 231.3 275.5 3.5 23.4 22.1 2.4 2.7 9.3 12.7 26.5 33.8 6.1 8.4 1.9 1.9
Burundi n.a. n.a. 0.1 1.0 1.2 <0.1 0.1 0.2 0.3 0.7 1.0 0.3 0.3 <0.1 <0.1
Comoros n.a. n.a. n.a. n.a. n.a. n.a. n.a. <0.1 <0.1 <0.1 <0.1 <0.1 <0.1 0.1 0.1 <0.1 n.a. <0.1 <0.1
Djibouti 0.2 0.2 n.a. n.a. n.a. n.a. n.a. <0.1 <0.1 <0.1 <0.1 0.1 0.1 0.1 0.1 <0.1 n.a. n.a. n.a.
Eritrea n.a. n.a. n.a. n.a. n.a. n.a. n.a. 0.3 0.2 <0.1 <0.1 0.1 0.1 0.3 0.3 0.1 n.a. n.a. n.a.
| 144 |

Ethiopia 28.3 18.2 14.7 18.4 56.7 63.2 1.2 6.3 5.9 0.4 0.4 1.6 2.4 4.8 6.6 1.6 2.0 n.a. n.a.
Kenya 10.4 13.0 8.3 c,d
13.5 c,d
25.4 c,d
36.0 c,d
0.3 2.0 1.4 0.3 0.3 1.3 1.8 3.1 3.9 0.5 0.9 0.2 0.2
Madagascar 6.1 11.7 n.a. n.a. n.a. n.a. 0.3 1.7 1.7 0.1 0.1 0.5 0.7 2.0 2.5 0.3 0.4 0.1 0.1
Malawi 2.8 3.2 8.7c,d 9.6c,d 13.7c,d 15.2c,d <0.1 1.2 1.1 0.2 0.1 0.3 0.5 1.1 1.4 0.4 0.4 <0.1 <0.1
Mauritius <0.1 <0.1 <0.1 0.1 0.2 0.3 n.a. <0.1f <0.1f <0.1f <0.1f 0.1 0.1 0.1 0.1 n.a. n.a. <0.1 <0.1
Mozambique 6.8 9.5 11.0 12.3 18.5 21.6 0.2 1.9 1.9 0.2 0.3 0.7 1.0 2.9 3.5 0.4 n.a. 0.1 0.2
Rwanda 3.1 4.4 <0.1 0.7 0.6 0.1 0.1 0.3 0.4 0.5 0.5 0.3 0.3 <0.1 <0.1
Seychelles n.a. n.a. <0.1c <0.1c <0.1c <0.1c n.a. <0.1 <0.1 <0.1 <0.1 <0.1 <0.1 <0.1 0.0 n.a. n.a. <0.1 <0.1
Somalia 6.1 9.2 n.a. 6.8h n.a. 12.6h n.a. 0.7 0.8 0.1 0.1 0.4 0.5 1.2 1.5 <0.1 n.a. n.a. n.a.
South Sudan -- n.a. 7.0 c
6.9 c
9.1 c
9.4 c
n.a. 0.5 0.5 0.1 0.1 <0.1 <0.1 0.8 0.9 0.2 n.a. n.a. n.a.
Uganda n.a. n.a. 6.7 c,d
9.6 c,d
22.2 c,d
30.6 c,d
0.2 2.2 2.2 0.3 0.3 0.7 1.0 2.5 3.4 0.9 1.0 n.a. n.a.
United Republic of
12.1 14.5 12.3c,d 14.3c,d 28.3c,d 32.7c,d 0.3 3.2 3.1 0.4 0.5 1.6 2.2 4.4 5.3 0.8 1.2 0.2 0.2
Tanzania
Zambia n.a. n.a. 3.5c,d 4.1c,d 7.7c,d 9.2c,d 0.1 1.1 1.0 0.2 0.2 0.5 0.6 1.0 1.4 0.3 0.4 <0.1 <0.1
Zimbabwe n.a. n.a. 4.9 4.7 8.9 10.2 0.1 0.7 0.5 0.1 0.1 1.0 1.1 1.0 1.1 0.1 0.2 <0.1 <0.1
 TABLE A1.2 (CONTINUED)

NUMBER OF ADULTS

REPRODUCTIVE AGE

NUMBER OF BABIES
WHO ARE STUNTED
UNDERNOURISHED

CHILDREN (UNDER

CHILDREN (UNDER

CHILDREN (UNDER

(15–49) AFFECTED
OLDER) WHO ARE
MODERATELY OR

5 YEARS OF AGE)

5 YEARS OF AGE)

5 YEARS OF AGE)

MONTHS OF AGE
SEVERELY FOOD
SEVERELY FOOD

(18 YEARS AND

BIRTHWEIGHT
AFFECTED BY

OVERWEIGHT

EXCLUSIVELY
INFANTS 0–5
BY ANAEMIA
NUMBER OF

NUMBER OF

NUMBER OF

NUMBER OF

NUMBER OF

NUMBER OF
NUMBER OF
NUMBER OF

BREASTFED
PEOPLE 1, 2, 3
PEOPLE 1, 2, 3

WOMEN OF
REGIONS/

INSECURE

WITH LOW
INSECURE

WHO ARE
WASTING
PEOPLE 1
SUBREGIONS/

OBESE
COUNTRIES

2004–06 2018–204 2014–16 2018–20 2014–16 2018–20 20205 2012 20206 2012 20206 2012 2016 2012 2019 20127 20198 2012 2015
(millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions)

Middle Africa 41.2 53.2 n.a. 62.1 n.a. 121.2 1.9 9.8 11.3 1.1 1.5 4.5 6.0 14.6 17.2 1.6 n.a. 0.8 0.8
Angola 10.1 5.5 5.9 8.6c 18.5 23.4c 0.3 1.6 2.2 0.1 0.2 0.8 1.1 2.6 3.3 n.a. 0.4 0.2 0.2
Cameroon 2.8 1.4 n.a. 6.9 n.a. 14.4 0.2 1.2 1.1 0.3 0.4 1.0 1.4 2.1 2.5 0.2 0.3 <0.1 0.1
Central African
1.6 2.3 n.a. 2.9 n.a. 3.9 <0.1 0.3 0.3 <0.1 <0.1 0.1 0.2 0.5 0.5 0.1 <0.1 <0.1 <0.1
Republic
Chad 3.8 5.1 0.4 1.0 1.0 0.1 0.1 0.3 0.4 1.4 1.6 <0.1 <0.1 n.a. n.a.
Congo 1.2 2.0 2.1 2.8 4.0 4.7 0.1 0.2 0.1 <0.1 <0.1 0.2 0.2 0.6 0.6 <0.1 0.1 <0.1 <0.1
Democratic
| 145 |

Republic of the 21.1 36.2 n.a. 33.4 n.a. 60.1 1.0 5.5 6.5 0.6 0.7 1.8 2.5 7.1 8.2 1.0 n.a. 0.3 0.4
Congo
Equatorial Guinea n.a. n.a. n.a. n.a. n.a. n.a. n.a. <0.1 <0.1 <0.1 <0.1 <0.1 0.1 0.1 0.1 <0.1 n.a. n.a. n.a.
Gabon 0.2 0.3 n.a. n.a. n.a. n.a. n.a. <0.1 <0.1 <0.1 <0.1 0.1 0.2 0.2 0.3 <0.1 n.a. <0.1 <0.1
Sao Tome and
<0.1 <0.1 n.a. n.a. n.a. n.a. <0.1 <0.1 <0.1 <0.1 <0.1 <0.1 <0.1 <0.1 0.0 <0.1 <0.1 <0.1 <0.1
Principe
Southern Africa 2.8 5.6 11.9 13.5 27.7 30.7 0.2 1.6 1.6 0.8 0.8 9.6 11.2 4.7 5.5 n.a. 0.4 0.2 0.2
Botswana 0.5 0.7 0.4c,d 0.5c,d 1.0c,d 1.2c,d n.a. 0.1 0.1 <0.1 <0.1 0.2 0.2 0.2 0.2 <0.1 <0.1 <0.1 <0.1
Eswatini <0.1 0.1 0.3 0.4 0.7 0.7 <0.1 <0.1 <0.1 <0.1 <0.1 0.1 0.1 0.1 0.1 <0.1 <0.1 <0.1 <0.1
Lesotho 0.3 0.5 n.a. 0.6 c
n.a. 1.1 c
<0.1 0.1 0.1 <0.1 <0.1 0.2 0.2 0.1 0.2 <0.1 <0.1 <0.1 <0.1
Namibia 0.4 0.5 0.7 c,d
0.8 c,d
1.2 c,d
1.4 c,d
n.a. 0.1 0.1 <0.1 <0.1 0.2 0.2 0.1 0.2 <0.1 n.a. <0.1 <0.1
South Africa 1.6 3.8 10.0 11.3 23.7 26.3 0.2 1.4 1.3 0.7 0.7 9.0 10.4 4.2 4.8 n.a. 0.4 0.2 0.2
Western Africa 37.9 57.8 38.1 85.5 149.7 226.4 4.5 19.5 20.2 1.3 1.8 11.9 15.9 39.6 47.3 2.6 4.3 2.0 2.1
Benin 1.0 0.9 n.a. n.a. n.a. n.a. 0.1 0.6 0.6 <0.1 <0.1 0.4 0.5 1.3 1.5 0.1 0.2 <0.1 <0.1
Burkina Faso 2.4 2.9 1.8 c,d
3.1 c,d
7.6 c,d
9.7 c,d
0.3 1.0 0.9 0.1 0.1 0.4 0.5 2.0 2.5 0.2 0.4 <0.1 <0.1
Cabo Verde <0.1 <0.1 n.a. <0.1c n.a. 0.2c n.a. <0.1f <0.1f n.a. n.a. <0.1 <0.1 <0.1 0.0 <0.1 n.a. n.a. n.a.
Côte d'Ivoire 3.7 3.8 0.2 1.0 0.7 0.1 0.1 0.9 1.2 2.6 3.2 0.1 0.2 0.1 0.1
 TABLE A1.2 (CONTINUED)

NUMBER OF ADULTS

REPRODUCTIVE AGE

NUMBER OF BABIES
WHO ARE STUNTED
UNDERNOURISHED

CHILDREN (UNDER

CHILDREN (UNDER

CHILDREN (UNDER

(15–49) AFFECTED
OLDER) WHO ARE
MODERATELY OR

5 YEARS OF AGE)

5 YEARS OF AGE)

5 YEARS OF AGE)

MONTHS OF AGE
SEVERELY FOOD
SEVERELY FOOD

(18 YEARS AND

BIRTHWEIGHT
AFFECTED BY

OVERWEIGHT

EXCLUSIVELY
INFANTS 0–5
BY ANAEMIA
NUMBER OF

NUMBER OF

NUMBER OF

NUMBER OF

NUMBER OF

NUMBER OF
NUMBER OF
NUMBER OF

BREASTFED
PEOPLE 1, 2, 3
PEOPLE 1, 2, 3

WOMEN OF
REGIONS/

INSECURE

WITH LOW
INSECURE

WHO ARE
WASTING
PEOPLE 1
SUBREGIONS/

OBESE
COUNTRIES

2004–06 2018–204 2014–16 2018–20 2014–16 2018–20 20205 2012 20206 2012 20206 2012 2016 2012 2019 20127 20198 2012 2015
(millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions)

Gambia 0.3 0.3 0.5 0.6 1.1 1.3 <0.1 0.1 0.1 <0.1 <0.1 0.1 0.1 0.3 0.3 <0.1 <0.1 <0.1 <0.1
Ghana 2.5 1.8 2.1c,d 2.6c,d 13.7c,d 15.3c,d 0.3 0.8 0.6 0.1 0.1 1.3 1.7 2.9 2.7 0.4 0.4 0.1 0.1
Guinea n.a. n.a. 5.1 6.3 8.3 9.5 0.2 0.6 0.6 0.1 0.1 0.3 0.4 1.3 1.5 0.1 0.1 n.a. n.a.
Guinea-Bissau n.a. n.a. n.a. n.a. n.a. n.a. <0.1 0.1 0.1 <0.1 <0.1 0.1 0.1 0.2 0.2 <0.1 <0.1 <0.1 <0.1
Liberia 1.2 1.9 n.a. 1.8 n.a. 4.0 <0.1 0.2 0.2 <0.1 <0.1 0.2 0.2 0.4 0.5 <0.1 n.a. n.a. n.a.
Mali 1.7 2.0 0.3 1.0 0.9 <0.1 0.1 0.5 0.7 2.0 2.6 0.1 0.3 n.a. n.a.
Mauritania 0.3 0.4 0.2c,d 0.3c,d 1.1c,d 1.8c,d 0.1 0.2 0.2 <0.1 <0.1 0.2 0.3 0.4 0.5 <0.1 0.1 n.a. n.a.
| 146 |

Niger n.a. n.a. 0.5 1.8 2.2 <0.1 0.1 0.3 0.5 1.8 2.4 0.2 n.a. n.a. n.a.
Nigeria 9.9 29.4 11.9 c,d
43.0 c,d
66.1 c,d
116.0 c,d
2.2 11.1 12.0 0.7 0.9 6.1 8.2 20.9 25.5 0.9 1.8 n.a. n.a.
Senegal 1.9 1.2 2.1 2.2c 5.7 6.7c 0.2 0.5 0.5 <0.1 0.1 0.5 0.7 1.8 2.1 0.2 0.2 <0.1 0.1
Sierra Leone 2.6 2.0 2.2c,d 2.5c,d 5.6c,d 6.6c,d 0.1 0.4 0.3 <0.1 0.1 0.3 0.3 0.8 0.9 0.1 0.1 <0.1 <0.1
Togo 1.6 1.7 0.1 0.3 0.3 <0.1 <0.1 0.2 0.3 0.8 0.9 0.1 0.2 <0.1 <0.1
Sub-Saharan Africa
188.7 237.3 203.0 283.7 528.5 674.9 n.a. n.a. n.a. n.a. n.a. 35.3 45.9 n.a. n.a. 11.3 16.1 5.1 5.2
(including Sudan)
ASIA* 543.6 378.0 321.7 426.8 840.5 1.085.3 31.9 103.6 79.0 18.2 18.7 181.7 231.3 351.9 380.7 28.9 32.7 13.3 12.8
Central Asia 6.3 2.3 1.1 2.3 6.3 10.9 0.2 1.1 0.8 0.6 0.5 6.6 8.1 5.2 5.3 0.5 0.7 <0.1 <0.1

Kazakhstan 1.1 n.r. n.a. <0.1c,d n.a. 0.4c,d 0.1 0.2 0.1 0.2 0.2 2.2 2.6 1.3 1.3 0.1 0.1 <0.1 <0.1
Kyrgyzstan 0.5 0.5 n.a. <0.1c,d n.a. 0.4c,d <0.1 0.1 0.1 0.1 <0.1 0.5 0.6 0.5 0.6 0.1 0.1 <0.1 <0.1
Tajikistan n.a. n.a. 0.1 0.3 0.2 0.1 <0.1 0.6 0.7 0.6 0.8 0.1 0.1 <0.1 <0.1
Turkmenistan 0.2 0.2 n.a. n.a. n.a. n.a. <0.1 0.1 0.1 <0.1 <0.1 0.6 0.7 0.4 0.4 <0.1 0.1 <0.1 <0.1
Uzbekistan 3.9 n.r. 0.6 1.3 3.5 6.5 0.1 0.5 0.3 0.3 0.2 2.8 3.5 2.4 2.2 0.2 0.3 <0.1 <0.1
Eastern Asia* 107.4 n.r. 16.8 28.9 99.7 138.3 1.5 7.4 4.6 6.7 7.4 61.1 77.5 67.1 64.4 5.6 4.0 0.9 0.9
China 95.4 n.r. 1.6 6.4 3.9 6.2 6.9 53.8 68.7 56.1 54.0 4.9 3.4 0.9 0.8
China, mainland 94.3 n.r. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a.
 TABLE A1.2 (CONTINUED)

NUMBER OF ADULTS

REPRODUCTIVE AGE

NUMBER OF BABIES
WHO ARE STUNTED
UNDERNOURISHED

CHILDREN (UNDER

CHILDREN (UNDER

CHILDREN (UNDER

(15–49) AFFECTED
OLDER) WHO ARE
MODERATELY OR

5 YEARS OF AGE)

5 YEARS OF AGE)

5 YEARS OF AGE)

MONTHS OF AGE
SEVERELY FOOD
SEVERELY FOOD

(18 YEARS AND

BIRTHWEIGHT
AFFECTED BY

OVERWEIGHT

EXCLUSIVELY
INFANTS 0–5
BY ANAEMIA
NUMBER OF

NUMBER OF

NUMBER OF

NUMBER OF

NUMBER OF

NUMBER OF
NUMBER OF
NUMBER OF

BREASTFED
PEOPLE 1, 2, 3
PEOPLE 1, 2, 3

WOMEN OF
REGIONS/

INSECURE

WITH LOW
INSECURE

WHO ARE
WASTING
PEOPLE 1
SUBREGIONS/

OBESE
COUNTRIES

2004–06 2018–204 2014–16 2018–20 2014–16 2018–20 20205 2012 20206 2012 20206 2012 2016 2012 2019 20127 20198 2012 2015
(millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions)
Taiwan Province of
1.0 0.8 n.a. n.a. n.a. n.a. n.a. n.a. n.a. 1.7 1.7 n.a. n.a. n.a. n.a.
China
China, Hong Kong
n.r. n.r. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a.
SAR
China, Macao SAR <0.1 <0.1 n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a.
Democratic
People's Republic 8.1 10.9 n.a. n.a. n.a. n.a. <0.1 0.4 0.3 <0.1 <0.1 1.1 1.3 2.1 2.2 0.2 0.3 n.a. n.a.
of Korea
Japan n.r. n.r. 0.5 0.8 3.3 4.3 n.a. 0.4 0.3 0.1 0.1 3.9 4.6 5.3 4.8 n.a. n.a. 0.1 0.1
| 147 |

Mongolia 0.7 0.1 0.1 0.2 0.6 0.8 <0.1 <0.1 <0.1 <0.1 <0.1 0.3 0.4 0.1 0.1 <0.1 <0.1 <0.1 <0.1
Republic of Korea n.r. n.r. 0.2 c
0.3 2.4 c
2.6 n.a. 0.1 <0.1 0.2 0.2 1.7 2.0 1.8 1.6 n.a. n.a. <0.1 <0.1
Eastern Asia
(excluding China, 11.9 13.3 1.2 1.9 9.3 11.0 n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. 0.2 0.2
mainland)
South-eastern Asia 95.8 46.7 15.0 18.7 100.7 116.7 4.6 17.2 15.3 3.3 4.2 22.2 29.5 41.7 47.4 3.8 5.2 1.5 1.4
Brunei Darussalam n.r. n.r. n.a. n.a. n.a. n.a. n.a. <0.1 <0.1 <0.1 <0.1 <0.1 <0.1 <0.1 0.0 n.a. n.a. <0.1 <0.1
Cambodia 2.3 1.0 2.6 2.2 7.6 7.4 0.2 0.6 0.5 <0.1 <0.1 0.3 0.4 1.9 2.1 0.3 0.2 <0.1 <0.1
Indonesia 43.5 17.6 1.8 c,d
1.9 c,d
15.5 c,d
16.8 c,d
2.5 8.1 7.5 1.9 2.6 9.1 12.2 18.3 22.3 2.0 2.3 0.5 0.5
Lao People's
1.3 0.4 n.a. 0.6 n.a. 2.1 0.1 0.3 0.2 <0.1 <0.1 0.2 0.2 0.6 0.8 0.1 0.1 <0.1 <0.1
Democratic Republic
Malaysia 0.8 1.0 2.4 2.4 5.3 6.0 0.3 0.4 0.5 0.1 0.2 2.6 3.3 2.4 2.8 n.a. 0.2 <0.1 <0.1
Myanmar 13.6 4.1 n.a. 1.0 n.a. 12.0 0.3 1.5 1.1 0.1 0.1 1.5 2.1 5.7 6.3 0.2 0.5 0.1 0.1
Philippines 12.9 10.1 3.3 c,d
4.3 c,d
42.1 c,d
46.1 c,d
0.6 3.6 3.0 0.4 0.4 3.2 4.1 4.2 3.5 0.8 n.a. 0.5 0.5
Singapore n.a. n.a. <0.1 <0.1 0.2 0.3 n.a. <0.1 <0.1 <0.1 <0.1 0.2 0.3 0.2 0.2 n.a. n.a. <0.1 <0.1
Thailand 7.8 5.7 2.9 5.9 10.4 20.8 0.3 0.6 0.4 0.3 0.3 4.1 5.4 4.1 4.2 0.1 0.2 <0.1 <0.1
Timor-Leste 0.3 0.3 n.a. n.a. n.a. n.a. n.a. 0.1 0.1 <0.1 <0.1 <0.1 <0.1 0.1 0.1 <0.1 <0.1 n.a. n.a.
Viet Nam 13.0 6.5 0.4 0.5 c,d
5.8 6.2 c,d
0.4 1.9 1.8 0.3 0.5 1.0 1.4 4.3 5.3 0.3 n.a. 0.1 0.1
 TABLE A1.2 (CONTINUED)

NUMBER OF ADULTS

REPRODUCTIVE AGE

NUMBER OF BABIES
WHO ARE STUNTED
UNDERNOURISHED

CHILDREN (UNDER

CHILDREN (UNDER

CHILDREN (UNDER

(15–49) AFFECTED
OLDER) WHO ARE
MODERATELY OR

5 YEARS OF AGE)

5 YEARS OF AGE)

5 YEARS OF AGE)

MONTHS OF AGE
SEVERELY FOOD
SEVERELY FOOD

(18 YEARS AND

BIRTHWEIGHT
AFFECTED BY

OVERWEIGHT

EXCLUSIVELY
INFANTS 0–5
BY ANAEMIA
NUMBER OF

NUMBER OF

NUMBER OF

NUMBER OF

NUMBER OF

NUMBER OF
NUMBER OF
NUMBER OF

BREASTFED
PEOPLE 1, 2, 3
PEOPLE 1, 2, 3

WOMEN OF
REGIONS/

INSECURE

WITH LOW
INSECURE

WHO ARE
WASTING
PEOPLE 1
SUBREGIONS/

OBESE
COUNTRIES

2004–06 2018–204 2014–16 2018–20 2014–16 2018–20 20205 2012 20206 2012 20206 2012 2016 2012 2019 20127 20198 2012 2015
(millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions)

Southern Asia 315.9 269.5 267.0 352.2 564.0 742.6 25.0 73.0 54.3 5.3 4.5 49.7 65.4 218.4 241.0 17.0 20.7 10.3 9.8

Afghanistan 9.2 9.7 5.1 7.5 c,d

15.5 24 c,d
0.3 2.4 2.0 0.3 0.2 0.6 0.9 2.5 3.8 n.a. 0.7 n.a. n.a.
Bangladesh 19.7 15.9 20.7 17.1 50.4 52.0 1.4 5.7 4.3 0.3 0.3 2.7 3.7 14.9 16.8 1.9 1.9 0.9 0.9
Bhutan n.a. n.a. n.a. n.a. n.a. n.a. n.a. <0.1 <0.1 <0.1 <0.1 <0.1 <0.1 0.1 0.1 <0.1 <0.1 <0.1 <0.1
India 247.8 208.6 20.1 52.3 36.1 3.0 2.2 25.2 34.3 171.5 187.3 11.2 13.9 n.a. n.a.
Iran (Islamic
3.6 4.6 7.5 7.2 37.7 35.2 n.a. 0.4 0.5 0.5f 0.7f 12.6 14.8 5.1 5.5 0.7 n.a. n.a. n.a.
Republic of)
| 148 |

Maldives n.a. n.a. n.a. n.a. n.a. n.a. <0.1 <0.1 <0.1 <0.1 <0.1 <0.1 <0.1 <0.1 0.1 <0.1 <0.1 <0.1 <0.1
Nepal 4.3 1.4 2.8 3.4 8.0 10.4 0.3 1.2 0.8 <0.1 <0.1 0.5 0.7 2.6 3.2 0.4 0.4 0.1 0.1
Pakistan 28.2 27.9 1.9 10.7 10.3 1.2 1.0 7.5 10.2 19.8 22.4 1.9 2.7 n.a. n.a.
Sri Lanka 2.9 1.4 0.3 0.3 0.3 <0.1 <0.1 0.6 0.8 1.8 1.8 0.3 0.3 <0.1 <0.1
Southern Asia
68.1 60.9 64.2 73.9 199.6 219.5 n.a. n.a. n.a. n.a. n.a. 24.5 31.1 n.a. n.a. 5.7 6.8 n.a. n.a.
(excluding India)
Western Asia 18.3 40.3 21.8 24.7 69.7 76.8 1.0 4.7 3.7 2.4 2.2 42.4 51.4 19.6 22.5 1.8 1.8 0.6 0.6
Armenia 0.4 0.1 <0.1 <0.1c,d 0.5 0.4c,d <0.1 <0.1 <0.1 <0.1 <0.1 0.4 0.5 0.1 0.1 <0.1 <0.1 <0.1 <0.1
Azerbaijan 0.4 n.r. <0.1 <0.1 0.6 0.9 n.a. 0.1 0.1 0.1 0.1 1.2 1.4 0.9 0.9 <0.1 n.a. <0.1 <0.1
Bahrain n.a. n.a. n.a. <0.1 f
<0.1 f
<0.1 f
<0.1 f
0.3 0.3 0.1 0.1 n.a. n.a. <0.1 <0.1
Cyprus <0.1 n.r. n.a. n.a. n.a. n.a. n.a. 0.2 0.2 <0.1 0.0 n.a. n.a. n.a. n.a.
Georgia 0.2 0.3 0.3 0.4 1.3 1.6 <0.1 <0.1 <0.1 <0.1 <0.1 0.6 0.7 0.3 0.2 <0.1 <0.1 <0.1 <0.1
Iraq 6.4 14.7 0.2 0.9 0.6 0.4 0.5 4.7 6.1 2.3 2.8 0.2 0.3 n.a. n.a.
Israel n.r. n.r. 0.1 c,d
0.2 c,d
0.9 c,d
1.2 c,d
n.a. n.a. n.a. n.a. n.a. 1.3 1.4 0.2 0.3 n.a. n.a. <0.1 <0.1
Jordan 0.3 1.0 n.a. 0.1 0.1 0.1 0.1 1.5 2.0 0.6 1.0 0.1 0.1 <0.1 <0.1
Kuwait n.r. n.r. 0.2 0.2 0.5 0.5 <0.1 <0.1 <0.1 <0.1 <0.1 0.9 1.1 0.2 0.2 n.a. n.a. <0.1 <0.1
Lebanon 0.5 0.6 n.a. 0.1 0.1 0.1 0.1 1.1 1.5 0.4 0.5 n.a. n.a. <0.1 <0.1
 TABLE A1.2 (CONTINUED)

NUMBER OF ADULTS

REPRODUCTIVE AGE

NUMBER OF BABIES
WHO ARE STUNTED
UNDERNOURISHED

CHILDREN (UNDER

CHILDREN (UNDER

CHILDREN (UNDER

(15–49) AFFECTED
OLDER) WHO ARE
MODERATELY OR

5 YEARS OF AGE)

5 YEARS OF AGE)

5 YEARS OF AGE)

MONTHS OF AGE
SEVERELY FOOD
SEVERELY FOOD

(18 YEARS AND

BIRTHWEIGHT
AFFECTED BY

OVERWEIGHT

EXCLUSIVELY
INFANTS 0–5
BY ANAEMIA
NUMBER OF

NUMBER OF

NUMBER OF

NUMBER OF

NUMBER OF

NUMBER OF
NUMBER OF
NUMBER OF

BREASTFED
PEOPLE 1, 2, 3
PEOPLE 1, 2, 3

WOMEN OF
REGIONS/

INSECURE

WITH LOW
INSECURE

WHO ARE
WASTING
PEOPLE 1
SUBREGIONS/

OBESE
COUNTRIES

2004–06 2018–204 2014–16 2018–20 2014–16 2018–20 20205 2012 20206 2012 20206 2012 2016 2012 2019 20127 20198 2012 2015
(millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions)

Oman 0.2 0.4 n.a. n.a. n.a. n.a. <0.1 <0.1 0.1 <0.1 <0.1 0.6 0.9 0.2 0.3 n.a. <0.1 <0.1 <0.1
Palestine n.a. n.a. n.a. 0.2c n.a. 1.3c <0.1 0.1 0.1 0.1 0.1 n.a. n.a. 0.3 0.4 <0.1 0.1 <0.1 <0.1
Qatar n.a. n.a. n.a. n.a. n.a. n.a. n.a. <0.1f <0.1f <0.1f <0.1f 0.6 0.8 0.1 0.1 <0.1 n.a. <0.1 <0.1
Saudi Arabia 1.1 1.3 n.a. 0.2 0.1 0.2 0.2 6.4 8.1 1.9 2.3 n.a. n.a. n.a. n.a.
Syrian Arab
n.a. n.a. n.a. n.a. n.a. n.a. n.a. 0.7 0.6 0.5 0.3 3.0 3.0 1.7 1.5 0.2 n.a. n.a. n.a.
Republic
Turkey n.r. n.r. 0.1 n.a.g n.a.g n.a.g n.a.g 15.1 17.8 n.a. n.a. 0.6 0.5 0.2 0.1
United Arab
| 149 |

0.4 0.4 n.a. n.a. n.a. n.a. n.a. 2.2 2.5 0.4 0.5 n.a. n.a. <0.1 <0.1
Emirates
Yemen 5.6 13.2 n.a. n.a. n.a. n.a. n.a. 1.8 1.5 0.1 0.1 1.8 2.5 3.7 4.6 n.a. n.a. n.a. n.a.
Central Asia and
322.2 271.8 268.2 354.4 570.3 753.5 25.2 74.1 55.1 5.9 4.9 56.4 73.5 223.5 246.3 17.4 21.4 10.4 9.9
Southern Asia
Eastern Asia and
203.2 65.8 31.7 47.6 200.4 255.0 6.0 24.6 20.1 9.9 11.6 83.3 107.0 108.8 111.9 9.5 8.7 2.5 2.5
South-eastern Asia*
Western Asia and
33.8 56.3 43.9 46.9 134.0 149.4 2.9 10.5 10.0 5.5 6.0 72.6 87.0 37.2 41.4 4.1 4.2 1.3 1.3
Northern Africa
LATIN AMERICA
AND THE 51.8 49.8 50.3 73.3 174.2 225.8 0.7 6.7 5.8 3.9 3.9 90.8 106.0 29.6 29.6 3.5 n.a. 0.9 0.9
CARIBBEAN
Caribbean 7.6 6.9 n.a. 16.3 n.a. 29.2 0.1 0.5 0.4 0.2 0.2 6.3 7.3 3.0 3.1 0.2 0.2 <0.1 <0.1
Antigua and
n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. <0.1 <0.1 <0.1 0.0 n.a. n.a. <0.1 <0.1
Barbuda
Bahamas n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. 0.1 0.1 <0.1 0.0 n.a. n.a. <0.1 <0.1
Barbados <0.1 <0.1 n.a. n.a. n.a. n.a. n.a. <0.1 <0.1 <0.1 <0.1 <0.1 0.1 <0.1 0.0 <0.1 n.a. n.a. n.a.
Cuba n.r. n.r. n.a. n.a. n.a. n.a. <0.1 <0.1 <0.1 0.1 0.1 2.0 2.2 0.6 0.5 0.1 <0.1 <0.1 <0.1
Dominica <0.1 <0.1 n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. <0.1 0.0 n.a. n.a. n.a. n.a.
Dominican Republic 1.7 0.9 n.a. 0.1 0.1 0.1 0.1 1.6 1.9 0.7 0.7 <0.1 <0.1 <0.1 <0.1
 TABLE A1.2 (CONTINUED)

NUMBER OF ADULTS

REPRODUCTIVE AGE

NUMBER OF BABIES
WHO ARE STUNTED
UNDERNOURISHED

CHILDREN (UNDER

CHILDREN (UNDER

CHILDREN (UNDER

(15–49) AFFECTED
OLDER) WHO ARE
MODERATELY OR

5 YEARS OF AGE)

5 YEARS OF AGE)

5 YEARS OF AGE)

MONTHS OF AGE
SEVERELY FOOD
SEVERELY FOOD

(18 YEARS AND

BIRTHWEIGHT
AFFECTED BY

OVERWEIGHT

EXCLUSIVELY
INFANTS 0–5
BY ANAEMIA
NUMBER OF

NUMBER OF

NUMBER OF

NUMBER OF

NUMBER OF

NUMBER OF
NUMBER OF
NUMBER OF

BREASTFED
PEOPLE 1, 2, 3
PEOPLE 1, 2, 3

WOMEN OF
REGIONS/

INSECURE

WITH LOW
INSECURE

WHO ARE
WASTING
PEOPLE 1
SUBREGIONS/

OBESE
COUNTRIES

2004–06 2018–204 2014–16 2018–20 2014–16 2018–20 20205 2012 20206 2012 20206 2012 2016 2012 2019 20127 20198 2012 2015
(millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions)

Grenada n.a. n.a. n.a. n.a. n.a. n.a. n.a. <0.1 <0.1 <0.1 0.0 n.a. n.a. n.a. n.a.
Haiti 5.1 5.3 <0.1 0.3 0.3 <0.1 <0.1 1.2 1.5 1.3 1.4 0.1 0.1 n.a. n.a.
Jamaica 0.2 0.2 <0.1 <0.1 <0.1 <0.1 <0.1 0.4 0.5 0.1 0.2 <0.1 n.a. <0.1 <0.1
Puerto Rico n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. 0.2 0.1 n.a. n.a. n.a. n.a.
Saint Kitts and
n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. <0.1 0.0 n.a. n.a. n.a. n.a.
Nevis
Saint Lucia n.a. n.a. <0.1c n.a. <0.1c n.a. n.a. <0.1 <0.1 <0.1 <0.1 <0.1 <0.1 <0.1 0.0 <0.1 n.a. n.a. n.a.
Saint Vincent and
| 150 |

<0.1 <0.1 n.a. n.a. n.a. n.a. n.a. <0.1 <0.1 <0.1 0.0 n.a. n.a. n.a. n.a.
the Grenadines
Trinidad and Tobago 0.1 <0.1 n.a. n.a. n.a. n.a. n.a. <0.1 <0.1 <0.1 <0.1 0.2 0.2 0.1 0.1 <0.1 n.a. <0.1 <0.1
Central America 11.6 15.8 10.9 15.1 49.5 55.1 0.1 2.9 2.7 1.1 1.0 26.1 30.8 6.7 7.0 0.7 1.1 0.3 0.3
Belize <0.1 <0.1 n.a. n.a. n.a. n.a. <0.1 <0.1 <0.1 <0.1 <0.1 <0.1 0.1 <0.1 0.0 <0.1 <0.1 <0.1 <0.1
Costa Rica 0.2 0.2 <0.1c,d 0.1c,d 0.6c,d 0.8c,d <0.1 <0.1 <0.1 <0.1 <0.1 0.8 0.9 0.2 0.2 <0.1 n.a. <0.1 <0.1
El Salvador 0.6 0.5 0.9 0.9 2.7 3.0 <0.1 0.1 0.1 <0.1 <0.1 0.9 1.0 0.2 0.2 <0.1 0.1 <0.1 <0.1
Guatemala 2.5 2.9 2.6 3.4 6.9 8.7 <0.1 0.9 0.9 0.1 0.1 1.6 2.0 0.4 0.3 0.2 0.2 <0.1 <0.1
Honduras 1.7 1.3 1.3 c,d
1.4 c,d
3.8 c,d
4.4 c,d
n.a. 0.2 0.2 0.1 0.1 0.9 1.2 0.4 0.5 0.1 n.a. <0.1 <0.1
Mexico 4.7 9.2 4.4c 7.4c,d 31.2c 33.2c,d 0.2 1.4 1.3 0.8 0.7 20.6 24.0 5.1 5.3 0.3 0.6 0.2 0.2
Nicaragua 1.3 1.3 n.a. 0.1 0.1 <0.1 <0.1 0.8 0.9 0.2 0.3 <0.1 n.a. <0.1 <0.1
Panama 0.7 0.3 n.a. 0.1 0.1 <0.1 <0.1 0.5 0.6 0.2 0.2 n.a. n.a. <0.1 <0.1

South America 32.6 27.0 24.9 41.9 97.4 141.4 0.4 a

3.4 2.8 a
2.6 2.6 a
58.4 67.9 19.9 19.5 2.8 n.a. 0.6 0.6

Argentina 1.4 1.7 2.5 5.7 8.3 16.0 0.1 0.3 0.3 0.5 0.5 7.6 8.6 1.3 1.3 0.2 n.a. <0.1 <0.1
Bolivia (Plurinational
2.5 1.5 <0.1 0.2 0.2 0.1 0.1 1.1 1.4 0.7 0.7 0.2 0.1 <0.1 <0.1
State of)
Brazil 12.1 n.r. 3.9 7.5 37.5 49.6 n.a. 0.9 0.9 1.0 1.1 28.4 33.3 10.1 9.2 1.1 n.a. 0.3 0.2
Chile 0.5 0.6 0.5c,d 0.8c,d 1.9c,d 3.4c,d <0.1 <0.1 <0.1 0.1 0.1 3.4 3.8 0.4 0.4 n.a. n.a. <0.1 <0.1
 TABLE A1.2 (CONTINUED)

NUMBER OF ADULTS

REPRODUCTIVE AGE

NUMBER OF BABIES
WHO ARE STUNTED
UNDERNOURISHED

CHILDREN (UNDER

CHILDREN (UNDER

CHILDREN (UNDER

(15–49) AFFECTED
OLDER) WHO ARE
MODERATELY OR

5 YEARS OF AGE)

5 YEARS OF AGE)

5 YEARS OF AGE)

MONTHS OF AGE
SEVERELY FOOD
SEVERELY FOOD

(18 YEARS AND

BIRTHWEIGHT
AFFECTED BY

OVERWEIGHT

EXCLUSIVELY
INFANTS 0–5
BY ANAEMIA
NUMBER OF

NUMBER OF

NUMBER OF

NUMBER OF

NUMBER OF

NUMBER OF
NUMBER OF
NUMBER OF

BREASTFED
PEOPLE 1, 2, 3
PEOPLE 1, 2, 3

WOMEN OF
REGIONS/

INSECURE

WITH LOW
INSECURE

WHO ARE
WASTING
PEOPLE 1
SUBREGIONS/

OBESE
COUNTRIES

2004–06 2018–204 2014–16 2018–20 2014–16 2018–20 20205 2012 20206 2012 20206 2012 2016 2012 2019 20127 20198 2012 2015
(millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions)

Colombia 4.8 4.4 0.1 0.5 0.4 0.2 0.2 6.4 7.6 2.8 2.9 n.a. 0.3 <0.1 <0.1
Ecuador 3.1 2.2 1.0c,d 2.0c,d 3.4c,d 5.7c,d 0.1 0.4 0.4 0.1 0.2 1.8 2.2 0.7 0.8 n.a. n.a. <0.1 <0.1
Guyana <0.1 <0.1 n.a. n.a. n.a. n.a. <0.1 <0.1 <0.1 <0.1 <0.1 0.1 0.1 0.1 0.1 <0.1 <0.1 <0.1 <0.1
Paraguay 0.6 0.7 <0.1 0.1 <0.1 0.1 0.1 0.7 0.9 0.4 0.4 <0.1 <0.1 <0.1 <0.1
Peru 5.2 2.8 4.1 6.2 11.3 15.5 <0.1 0.6 0.3 0.3 0.2 3.5 4.1 1.6 1.8 0.4 0.4 <0.1 <0.1
Suriname <0.1 <0.1 n.a. n.a. n.a. n.a. <0.1 <0.1 <0.1 <0.1 <0.1 0.1 0.1 <0.1 0.0 <0.1 n.a. <0.1 <0.1
Uruguay 0.1 n.r. 0.2 0.2 0.7 0.8 <0.1 <0.1 <0.1 <0.1 <0.1 0.6 0.7 0.1 0.1 n.a. n.a. <0.1 <0.1
| 151 |

Venezuela (Bolivarian
2.2 7.8 n.a. 0.4 0.2 0.2 0.2 4.6 5.1 1.6 1.8 n.a. n.a. <0.1 <0.1
Republic of)
OCEANIA 2.3 2.6 1.1 1.4 4.4 5.4 n.a. n.a. n.a. n.a. n.a. 7.0 8.1 1.3 1.6 n.a. n.a. <0.1 <0.1
Australia and New
n.r. n.r. 0.8 1.0 3.0 3.8 n.a. <0.1 <0.1a 0.2 0.3 5.7 6.5 0.5 0.6 n.a. n.a. <0.1 <0.1
Zealand
Australia n.r. n.r. 0.7 0.8 2.6 3.1 n.a. <0.1 <0.1 0.2 0.3 4.7 5.4 0.4 0.5 n.a. n.a. <0.1 <0.1
New Zealand n.r. n.r. 0.1 0.2 0.5 0.7 n.a. n.a. n.a. n.a. n.a. 1.0 1.1 0.1 0.1 n.a. n.a. <0.1 <0.1
Oceania excluding
Australia and New 2.0 2.4 n.a. n.a. n.a. n.a. 0.1 0.6 0.6 0.1 0.1 1.3 1.6 0.8 1.0 0.2 0.2 <0.1 <0.1
Zealand
Melanesia 1.9 2.4 n.a. n.a. n.a. n.a. n.a. 0.5 0.6 0.1 0.1 1.1 1.3 0.8 0.9 0.1 0.2 <0.1 <0.1
Fiji <0.1 <0.1 n.a. <0.1 c
n.a. 0.1 c
n.a. <0.1 <0.1 <0.1 <0.1 0.2 0.2 0.1 0.1 n.a. n.a. n.a. n.a.
New Caledonia <0.1 <0.1 n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a.
Papua New Guinea 1.8 2.2 n.a. n.a. n.a. n.a. n.a. 0.5 0.5 0.1 0.1 0.8 1.0 0.6 0.8 0.1 0.1 n.a. n.a.
Solomon Islands <0.1 0.1 n.a. n.a. n.a. n.a. <0.1 <0.1 <0.1 <0.1 <0.1 0.1 0.1 0.1 0.1 <0.1 <0.1 n.a. n.a.
Vanuatu <0.1 <0.1 n.a. <0.1 c
n.a. <0.1 c
n.a. <0.1 <0.1 <0.1 <0.1 <0.1 <0.1 <0.1 0.0 <0.1 n.a. <0.1 <0.1
Micronesia n.a. n.a. n.a. n.a. n.a. n.a. n.a. <0.1 <0.1 <0.1 <0.1 0.1 0.1 <0.1 0.0 <0.1 n.a. <0.1 <0.1
Kiribati <0.1 <0.1 n.a. <0.1 c
n.a. <0.1 c
<0.1 <0.1 <0.1 <0.1 <0.1 <0.1 <0.1 <0.1 0.0 <0.1 n.a. n.a. n.a.
 TABLE A1.2 (CONTINUED)

NUMBER OF ADULTS

REPRODUCTIVE AGE

NUMBER OF BABIES
WHO ARE STUNTED
UNDERNOURISHED

CHILDREN (UNDER

CHILDREN (UNDER

CHILDREN (UNDER

(15–49) AFFECTED
OLDER) WHO ARE
MODERATELY OR

5 YEARS OF AGE)

5 YEARS OF AGE)

5 YEARS OF AGE)

MONTHS OF AGE
SEVERELY FOOD
SEVERELY FOOD

(18 YEARS AND

BIRTHWEIGHT
AFFECTED BY

OVERWEIGHT

EXCLUSIVELY
INFANTS 0–5
BY ANAEMIA
NUMBER OF

NUMBER OF

NUMBER OF

NUMBER OF

NUMBER OF

NUMBER OF
NUMBER OF
NUMBER OF

BREASTFED
PEOPLE 1, 2, 3
PEOPLE 1, 2, 3

WOMEN OF
REGIONS/

INSECURE

WITH LOW
INSECURE

WHO ARE
WASTING
PEOPLE 1
SUBREGIONS/

OBESE
COUNTRIES

2004–06 2018–204 2014–16 2018–20 2014–16 2018–20 20205 2012 20206 2012 20206 2012 2016 2012 2019 20127 20198 2012 2015
(millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions)

Marshall Islands n.a. n.a. n.a. n.a. n.a. n.a. <0.1 <0.1 <0.1 <0.1 <0.1 n.a. n.a. <0.1 0.0 <0.1 <0.1 n.a. n.a.
Micronesia
n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. <0.1 <0.1 <0.1 0.0 n.a. n.a. n.a. n.a.
(Federated States of)
Nauru n.a. n.a. n.a. n.a. n.a. n.a. n.a. <0.1 <0.1 <0.1 <0.1 n.a. n.a. <0.1 0.0 <0.1 n.a. n.a. n.a.
Palau n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. <0.1 0.0 n.a. n.a. n.a. n.a.
Polynesia n.a. n.a. n.a. n.a. n.a. n.a. n.a. <0.1 <0.1 <0.1 <0.1 0.2 0.2 <0.1 0.0 <0.1 <0.1 <0.1 <0.1
American Samoa n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a.
Cook Islands n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. <0.1 0.0 n.a. n.a. <0.1 <0.1
| 152 |

French Polynesia <0.1 <0.1 n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a.
Niue n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. <0.1 0.0 n.a. n.a. n.a. n.a.
Samoa <0.1 <0.1 n.a. <0.1 c
n.a. <0.1 c
<0.1 <0.1 <0.1 <0.1 <0.1 <0.1 0.1 n.a. n.a. <0.1 <0.1 n.a. n.a.
Tokelau (Associate
n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a.
Member)
Tonga n.a. n.a. n.a. <0.1c n.a. <0.1c <0.1 <0.1 <0.1 <0.1 <0.1 <0.1 <0.1 <0.1 0.0 <0.1 n.a. n.a. n.a.
Tuvalu n.a. n.a. n.a. n.a. n.a. n.a. n.a. <0.1 <0.1 <0.1 <0.1 n.a. n.a. <0.1 0.0 <0.1 n.a. n.a. n.a.
NORTHERN
AMERICA AND n.r. n.r. 14.8 12.7 100.3 89.3 n.a. 2.8a 2.4a 5.9a 5.2a 216.2 237.2 33.7 36.2 n.a. n.a. 0.9 0.9
EUROPE
Northern America** n.r. n.r. 3.6 3.0 35.4 28.6 <0.1 0.6 0.7 2.0 2.0 87.8 98.7 8.1 9.8 1.1 1.5 0.3 0.3
Bermuda n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a.
Canada n.r. n.r. 0.2 c
0.3 c
1.8 c
2.2 c
n.a. n.a. n.a. 0.2 0.2 7.6 8.6 0.7 0.9 n.a. n.a. <0.1 <0.1
Greenland n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a.
United States of
n.r. n.r. 3.4c 2.7c 33.6c 26.5c <0.1 0.6 0.6 1.8 1.7 80.2 90.1 7.4 8.9 1.0 1.4 0.3 0.3
America
 TABLE A1.2 (CONTINUED)

NUMBER OF ADULTS

REPRODUCTIVE AGE

NUMBER OF BABIES
WHO ARE STUNTED
UNDERNOURISHED

CHILDREN (UNDER

CHILDREN (UNDER

CHILDREN (UNDER

(15–49) AFFECTED
OLDER) WHO ARE
MODERATELY OR

5 YEARS OF AGE)

5 YEARS OF AGE)

5 YEARS OF AGE)

MONTHS OF AGE
SEVERELY FOOD
SEVERELY FOOD

(18 YEARS AND

BIRTHWEIGHT
AFFECTED BY

OVERWEIGHT

EXCLUSIVELY
INFANTS 0–5
BY ANAEMIA
NUMBER OF

NUMBER OF

NUMBER OF

NUMBER OF

NUMBER OF

NUMBER OF
NUMBER OF
NUMBER OF

BREASTFED
PEOPLE 1, 2, 3
PEOPLE 1, 2, 3

WOMEN OF
REGIONS/

INSECURE

WITH LOW
INSECURE

WHO ARE
WASTING
PEOPLE 1
SUBREGIONS/

OBESE
COUNTRIES

2004–06 2018–204 2014–16 2018–20 2014–16 2018–20 20205 2012 20206 2012 20206 2012 2016 2012 2019 20127 20198 2012 2015
(millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions)

Europe n.r. n.r. 11.1 9.7 64.9 60.7 n.a. 2.1a 1.8a 3.9a 3.2a 128.4 138.4 25.5 26.5 n.a. n.a. 0.5 0.5
Eastern Europe n.r. n.r. 4.3 4.3 32.9 33.5 n.a. 1.3 a
1.1 a
2.3 a
1.6 a
53.0 55.8 14.1 14.0 n.a. n.a. 0.2 0.2
Belarus n.r. n.r. n.a. <0.1 <0.1 0.1 <0.1 1.8 1.9 0.5 0.4 <0.1 n.a. <0.1 <0.1
Bulgaria 0.4 0.2 0.1 0.2 1.1 0.9 <0.1 <0.1 <0.1 <0.1 <0.1 1.4 1.5 0.4 0.4 n.a. n.a. <0.1 <0.1
Czechia n.r. n.r. <0.1 <0.1 0.6 0.4 n.a. <0.1 <0.1 <0.1 <0.1 2.1 2.3 0.5 0.5 n.a. n.a. <0.1 <0.1
Hungary n.r. n.r. 0.1 0.1 1.1 0.8 n.a. n.a. n.a. n.a. n.a. 2.0 2.1 0.5 0.4 n.a. n.a. <0.1 <0.1
Poland n.r. n.r. 0.7 0.2 3.4 2.2 n.a. <0.1 <0.1 0.1 0.1 6.7 7.2 n.a. n.a. n.a. n.a. <0.1 <0.1
| 153 |

Republic of
n.a. n.a. <0.1 0.2 0.8 1.1 n.a. <0.1 <0.1 <0.1 <0.1 0.6 0.6 0.3 0.3 <0.1 n.a. <0.1 <0.1
Moldova
Romania n.r. n.r. 1.1 0.6 3.8 2.7 n.a. 0.1 0.1 0.1 0.1 3.4 3.6 1.1 1.0 n.a. n.a. <0.1 <0.1
Russian Federation n.r. n.r. 1.0 0.4 c
11.9 8.8 c
n.a. n.a. n.a. n.a. n.a. 25.7 26.9 7.3 7.2 n.a. n.a. 0.1 0.1
Slovakia 0.3 0.2 <0.1 <0.1 0.3 0.3 n.a. n.a. n.a. n.a. n.a. 0.8 0.9 0.3 0.3 n.a. n.a. <0.1 <0.1
Ukraine n.r. n.r. 0.9 1.1 n.a. 0.5 0.3 0.7 0.4 8.5 8.8 1.6 1.8 0.1 n.a. <0.1 <0.1
Northern Europe n.r. n.r. 1.8 1.1 6.9 5.2 n.a. 0.2 a
0.2a 0.5 a
0.5 a
19.0 21.2 2.5 2.8 n.a. n.a. <0.1 <0.1
Denmark n.r. n.r. <0.1 <0.1 0.3 0.3 n.a. n.a. n.a. n.a. n.a. 0.8 0.9 0.1 0.2 n.a. n.a. <0.1 <0.1
Estonia n.r. n.r. <0.1 <0.1 0.1 0.1 <0.1 <0.1 <0.1 <0.1 <0.1 0.2 0.2 0.1 0.1 n.a. n.a. <0.1 <0.1
Finland n.r. n.r. 0.1 0.1 0.5 0.4 n.a. n.a. n.a. n.a. n.a. 0.9 1.0 0.1 0.1 n.a. n.a. <0.1 <0.1
Iceland n.r. n.r. <0.1 <0.1 <0.1 <0.1 n.a. n.a. n.a. n.a. n.a. <0.1 0.1 <0.1 0.0 n.a. n.a. <0.1 <0.1
Ireland n.r. n.r. 0.2 0.2 0.4 0.4 n.a. n.a. n.a. n.a. n.a. 0.8 0.9 0.1 0.1 n.a. n.a. <0.1 <0.1
Latvia n.r. n.r. <0.1 <0.1 0.2 0.2 n.a. n.a. n.a. n.a. n.a. 0.4 0.4 0.1 0.1 n.a. n.a. <0.1 <0.1
Lithuania n.r. n.r. <0.1 <0.1 0.4 0.3 n.a. n.a. n.a. n.a. n.a. 0.6 0.6 0.1 0.1 n.a. n.a. <0.1 <0.1
Norway n.r. n.r. <0.1 <0.1 0.2 0.2 n.a. n.a. n.a. n.a. n.a. 0.8 1.0 0.1 0.1 n.a. n.a. <0.1 <0.1
Sweden n.r. n.r. <0.1 0.1 0.4 0.5 n.a. n.a. n.a. n.a. n.a. 1.4 1.6 0.3 0.3 n.a. n.a. <0.1 <0.1
United Kingdom of
Great Britain and n.r. n.r. 1.2 0.5 4.1 2.6 n.a. n.a. n.a. n.a. n.a. 12.9 14.6 1.4 1.7 n.a. n.a. <0.1 <0.1
Northern Ireland
 TABLE A1.2 (CONTINUED)

NUMBER OF ADULTS

REPRODUCTIVE AGE

NUMBER OF BABIES
WHO ARE STUNTED
UNDERNOURISHED

CHILDREN (UNDER

CHILDREN (UNDER

CHILDREN (UNDER

(15–49) AFFECTED
OLDER) WHO ARE
MODERATELY OR

5 YEARS OF AGE)

5 YEARS OF AGE)

5 YEARS OF AGE)

MONTHS OF AGE
SEVERELY FOOD
SEVERELY FOOD

(18 YEARS AND

BIRTHWEIGHT
AFFECTED BY

OVERWEIGHT

EXCLUSIVELY
INFANTS 0–5
BY ANAEMIA
NUMBER OF

NUMBER OF

NUMBER OF

NUMBER OF

NUMBER OF

NUMBER OF
NUMBER OF
NUMBER OF

BREASTFED
PEOPLE 1, 2, 3
PEOPLE 1, 2, 3

WOMEN OF
REGIONS/

INSECURE

WITH LOW
INSECURE

WHO ARE
WASTING
PEOPLE 1
SUBREGIONS/

OBESE
COUNTRIES

2004–06 2018–204 2014–16 2018–20 2014–16 2018–20 20205 2012 20206 2012 20206 2012 2016 2012 2019 20127 20198 2012 2015
(millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions) (millions)

Southern Europe n.r. n.r. 2.6 2.8 15.1 13.7 n.a. 0.3a 0.3a 0.6a 0.5a 25.6 27.5 4.8 5.0 n.a. n.a. 0.1 <0.1
Albania 0.3 0.1 0.3 0.3 1.1 1.0 <0.1 <0.1 <0.1 <0.1 <0.1 0.4 0.5 0.2 0.2 <0.1 <0.1 <0.1 <0.1
Andorra n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. <0.1 0.0 n.a. n.a. n.a. n.a.
Bosnia and
n.r. n.r. <0.1 <0.1 0.3 0.3 n.a. <0.1 <0.1 <0.1 <0.1 0.5 0.5 0.2 0.2 <0.1 n.a. <0.1 <0.1
Herzegovina
Croatia n.r. n.r. <0.1 <0.1 0.3 0.5 n.a. n.a. n.a. n.a. n.a. 0.8 0.8 0.2 0.2 n.a. n.a. <0.1 <0.1
Greece n.r. n.r. 0.3 0.2c,e 1.7 0.9c,e n.a. <0.1 <0.1 0.1 0.1 2.1 2.2 0.3 0.3 n.a. n.a. <0.1 <0.1
Italy n.r. n.r. 0.7 0.7 5.2 4.0 n.a. n.a. n.a. n.a. n.a. 9.3 10.1 1.6 1.7 n.a. n.a. <0.1 <0.1
| 154 |

Malta n.r. n.r. <0.1 <0.1 <0.1 <0.1 n.a. n.a. n.a. n.a. n.a. 0.1 0.1 <0.1 0.0 n.a. n.a. <0.1 <0.1
Montenegro <0.1 n.r. <0.1 <0.1 <0.1 <0.1 <0.1 <0.1 <0.1 <0.1 <0.1 0.1 0.1 <0.1 0.0 <0.1 n.a. <0.1 <0.1
North Macedonia 0.1 <0.1 <0.1 0.1 0.3 0.4 <0.1 <0.1 <0.1 <0.1 <0.1 0.3 0.4 0.1 0.1 <0.1 n.a. <0.1 <0.1
Portugal n.r. n.r. 0.4 0.3 1.5 1.2 <0.1 <0.1 <0.1 <0.1 <0.1 1.6 1.8 0.3 0.3 n.a. n.a. <0.1 <0.1
Serbia n.r. 0.3 0.2 0.2 1.0 1.1 <0.1 <0.1 <0.1 0.1 <0.1 1.4 1.5 0.5 0.5 <0.1 <0.1 <0.1 <0.1
Slovenia n.r. n.r. <0.1 <0.1 0.3 0.2 n.a. n.a. n.a. n.a. n.a. 0.3 0.3 0.1 0.1 n.a. n.a. <0.1 <0.1
Spain n.r. n.r. 0.5 0.9 3.3 4.1 n.a. n.a. n.a. n.a. n.a. 8.7 9.1 1.4 1.4 n.a. n.a. <0.1 <0.1
Western Europe n.r. n.r. 2.4 1.5 10.0 8.3 n.a. 0.3a 0.2a 0.5a 0.6a 30.8 33.9 4.1 4.8 n.a. n.a. 0.1 0.1
Austria n.r. n.r. <0.1 <0.1 0.5 0.3 n.a. n.a. n.a. n.a. n.a. 1.3 1.5 0.2 0.3 n.a. n.a. <0.1 <0.1
Belgium n.r. n.r. n.a. 0.1 n.a. 0.4 <0.1 <0.1 <0.1 <0.1 <0.1 1.8 2.0 0.3 0.3 n.a. n.a. <0.1 <0.1
France n.r. n.r. 1.0 0.4 4.4 3.7 n.a. n.a. n.a. n.a. n.a. 10.0 10.9 1.2 1.5 n.a. n.a. <0.1 <0.1
Germany n.r. n.r. 0.8 0.6 3.3 2.9 <0.1 <0.1 0.1 0.1 0.2 14.0 15.3 1.7 2.0 n.a. n.a. <0.1 <0.1
Luxembourg n.r. n.r. <0.1 <0.1 <0.1 <0.1 n.a. n.a. n.a. n.a. n.a. 0.1 0.1 <0.1 0.0 n.a. n.a. <0.1 <0.1
Netherlands n.r. n.r. 0.3 0.2 1.0 0.8 n.a. <0.1 <0.1 <0.1 <0.1 2.5 2.8 0.4 0.5 n.a. n.a. <0.1 <0.1
Switzerland n.r. n.r. 0.1 <0.1 0.4 0.2 n.a. n.a. n.a. n.a. n.a. 1.2 1.3 0.2 0.2 n.a. n.a. <0.1 <0.1
 TABLE A1.2 (CONTINUED)

NOTES: 4
The estimates for the year 2020 are the middle of with the exception of China where the latest data are for reporting indicators of food security. Note that
1
Regional estimates were included when more than the projected range. from the year 2013. the two estimates are not directly comparable due to
50 percent of population was covered. To reduce 5
For regional estimates, values correspond to the * Wasting under 5 years of age and low birthweight different definitions of "severe food insecurity".
the margin of error, estimates are presented as model predicted estimates for the year 2020. For regional aggregates exclude Japan. c
Based on official national data.
three-year averages. countries, the latest data available from 2014 to ** The Northern America wasting estimates are d
For years when official national data are not
2
FAO estimates of the number of people living in 2020 are used. derived applying mixed-effect models with available, the estimates are projected using FAO
households where at least one adult has been found 6
The collection of household survey data on child subregions as fixed effects; data were available only data. See Annex 1B for further details.
to be food insecure. height and weight were limited in 2020 due to the for the United States of America, preventing the e
Based on official national data collected in 2019
3
Country-level results are presented only for those physical distancing measures required to prevent the estimation of standard errors (and confidence and 2020 through EU-SILC.
countries for which estimates are based on official spread of COVID-19. Only four national surveys intervals). Further details on the methodology are f
Most recent input data are from before 2000,
national data (see note c) or as provisional estimates, included in the database were carried out (at least described in De Onis, M., Blössner, M., Borghi, E., interpret with caution.
based on FAO data collected through the Gallup © partially) in 2020. The estimates on child stunting, Frongillo, E.A. & Morris, R. 2004. Estimates of global g
Pending review.
World Poll, for countries whose national relevant wasting and overweight are therefore based almost prevalence of childhood underweight in 1990 and h
2020 estimate only.
authorities expressed no objection to their entirely on data collected before 2020 and do not 2015. Journal of the American Medical Association, <0.1 = less than 100 000 people.
publication. Note that consent to publication does take into account the impact of the COVID-19 291(21): 2600–2606. Model selection is based on n.a. = data not available.
not necessarily imply validation of the estimate by pandemic. best fit. n.r. = data not reported as the prevalence is less
the national authorities involved and that the 7
Regional estimates are included when more than a
Consecutive low population coverage; interpret than 2.5 percent.
estimate is subject to revision as soon as suitable 50 percent of population is covered. For countries, with caution.
data from official national sources are available. the latest data available from 2005 to 2012 are used. b
The Central Agency for Public Mobilization &
Global, regional and subregional aggregates are 8
Regional estimates are included when more than Statistics (CAPMAS) reports an estimate of severe
based on data collected in approximately 50 percent of population is covered. For countries, food insecurity of 1.3 percent for 2015, based on
150 countries. the latest data available from 2014 to 2019 are used HIECS data, using the WFP consolidated approach
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ANNEX 1B
METHODOLOGICAL
NOTES FOR THE
FOOD SECURITY
AND NUTRITION
INDICATORS

UNDERNOURISHMENT where θ is a vector of parameters that

Definition: Undernourishment is defined as the characterizes the pdf. The distribution is
condition of an individual whose habitual food assumed to be lognormal, and thus fully
consumption is insufficient to provide, on characterized by only two parameters: the mean
average, the amount of dietar y energ y required to dietar y energ y consumption (DEC), and its
maintain a normal, active and healthy life. coefficient of variation (C V ).

How it is reported: The indicator is reported as a Data source: Different data sources are used to
prevalence and is denominated as “prevalence estimate the different parameters of the model.
of undernourishment” (PoU), which is an
estimate of the percentage of individuals in Minimum dietary energy requirement (MDER): Human
the total population that are in a condition energ y requirements for an individual in a given
of undernourishment. National estimates are sex/age class are determined on the basis of
reported as three-year moving averages, to normative requirements for basic metabolic rate
control for the low reliabilit y of some of the (BMR) per kilogram of body mass, multiplied by
underlying parameters, such as the year-to-year the ideal weights that a healthy person of that
variation in food commodit y stocks, one of the sex/age class may have, given his or her height,
components of the annual FAO Food Balance and then multiplied by a coefficient of physical
Sheets for which complete, reliable information activit y level (PAL) to take into account physical
is ver y scarce. Regional and global aggregates, activit y. ar Given that both healthy BMIs and PALs
on the other hand, are reported as annual var y among active and healthy individuals of the
estimates, on account of the fact that possible same sex and age, a range of energ y requirements
estimation errors are expected not to be applies to each sex and age group of the
correlated across countries. population. The MDER for the average individual
in the population, which is the parameter used
Methodology: To compute an estimate of the in the PoU formula, is obtained as the weighted
prevalence of undernourishment in a population, average of the lower bounds of the energ y
the probabilit y distribution of habitual dietar y requirement ranges for each sex and age group,
energ y intake levels (expressed in kcal per using the shares of the population in each sex
person per day) for the average individual is and age group as weights.
modelled as a parametric probabilit y densit y
function (pdf ), f(x). 290,291 The indicator is Information on the population structure by
obtained as the cumulative probabilit y that the sex and age is available for most countries
habitual dietar y energ y intake (x) is below the in the world and for each year from the UN
minimum dietar y energ y requirements (MDER) Department of Economic and Social Affairs
(i.e. the lowest limit of the range of energ y (DESA) Population Prospects, revised ever y two
requirements for the population’s representative years. This edition of The State of Food Security
average individual) as in the formula below:

PoU = ∫x< MDER f(x| θ )dx, ar  A person is considered healthy if his or her body mass index (BMI)
indicates neither underweight nor overweight. Human energy
requirement norms per kilogram of body mass are given in FAO and
WHO (2004). 328

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 THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2021

and Nutrition in the World uses the 2019 revision outlook exercises conducted by FAO to inform the
of the World Population Prospects. 168 World Food Situation, 330 are used to nowcast the
2020 value of DEC for each countr y, starting from
Information on the median height in each sex and the last available year in the FBS series.
age group for a given country is derived from a
recent demographic and health survey (DHS) or Coefficient of variation (CV): When reliable data
from other surveys that collect anthropometry on food consumption are available from
data on children and adults. Even if such surveys aforementioned nationally representative
do not refer to the same year for which the PoU is household sur veys, the C V due to income (C V|y)
estimated, the impact of possible small intervening that describes the distribution of average daily
changes in median heights over the years on PoU dietar y energ y requirement in the population
estimates is expected to be negligible. can be estimated directly. Since the last edition
of this report, 21 new sur veys from the following
Dietary energy consumption (DEC): Ideally, data on 17 countries have been processed to update the
food consumption should come from nationally C V|y: Afghanistan, Armenia, Bolivia, Botswana,
representative household sur veys (such as Brazil, Burkina Faso, Ethiopia, Kiribati, Malawi,
Living Standard Measurement Sur veys or Mongolia, Namibia, Nigeria, Pakistan, Rwanda,
Household Incomes and Expenditure Sur veys). Samoa, Solomon Islands and Uganda. That makes
However, only ver y few countries conduct such for a total of 101 sur veys from 54 countries for
sur veys on an annual basis. Thus, in FAO’s PoU which C V|y is based on national sur veys.
estimates for global monitoring, DEC values
are estimated from the dietar y energ y supply When no suitable survey data are available,
(DES) reported in the Food Balance Sheets (FBS), FIES data collected by FAO since 2014 are used
compiled by FAO for most countries in the world to project the changes in the CV|y from 2015
(see FAO, 2021). 329 (or from the year of the last food consumption
survey) up to 2019, based on a smoothed
Since the last edition of this report, the new FBS (three-year moving average) trend in severe food
domain on FAOSTAT has been updated up to insecurity. For the nowcast of CV|y for 2020, see
2018. At the time of this report, the FBS series Annex 2. Since 2014, FIES data provide evidence
were updated for the following 56 countries with on recent changes in the extent of severe food
the largest number of undernourished people insecurity that might closely reflect changes in
or total population, bringing them up to date the PoU. To the extent that such changes in PoU
through 2019: Afghanistan, Algeria, Angola, are not explained by changes in average food
Bangladesh, Bolivia (Plurinational State of ), supplies, they can thus be used to infer the likely
Burkina Faso, Cambodia, Cameroon, Central changes in the CV|y that might have occurred in
African Republic, Chad, China (mainland), the most recent year. Analysis of the combined
Colombia, Congo, Côte d’Ivoire, Democratic set of historic PoU estimates reveals that, on
People’s Republic of Korea, Democratic Republic average, and once differences in DEC and MDER
of the Congo, Ecuador, Eswatini, Ethiopia, have been controlled for, the CV|y explains about
Guatemala, Haiti, Honduras, India, Indonesia, one-third of the differences in PoU across time
Iran (Islamic Republic of ), Iraq, Kenya, and space. For each country for which FIES data
Lao People’s Democratic Republic, Liberia, are available, the CV|y is estimated by the amount
Madagascar, Malawi, Mali, Mexico, Mongolia, that would generate one-third of a percentage
Mozambique, Myanmar, Nepal, Nigeria, point change in the PoU for each observed
Pakistan, Papua New Guinea, Peru, Philippines, percentage point change in the prevalence of
Rwanda, Senegal, Sierra Leone, Somalia, South severe food insecurity. For all other countries, the
Africa, Sri Lanka, Sudan, Thailand, Togo, United CV|y is kept constant at the estimated 2017 value.
Republic of Tanzania, Uzbekistan, Venezuela
(Bolivarian Republic of ), Viet Nam and Yemen. In the FAO PoU parametric approach, the CV
due to body weight and lifestyle, a.k.a. CV due to
Estimates for the per capita average DES in 2020, requirement (CV|r), represents the variability of
compiled on the basis of the short-run market the distribution of dietary energ y requirements of

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ANNEX 1B

a hypothetical average individual representative the precision of the PoU estimates is generally
of a healthy population, which is also equal to low. While it is not possible to formally compute
the CV of the distribution of dietary energ y margins of error around PoU estimates, these are
intakes of a hypothetical average individual if the expected to likely exceed 5 percent in most cases.
population is perfectly nourished. The distribution For this reason, FAO does not consider PoU
of dietary energ y requirements of a hypothetical estimates that result to be lower than 2.5 percent
average individual can be assumed to be normal, as sufficiently reliable to be reported.
thus its variability can be estimated if at least
two percentiles and their values are known. As a References:
result, given that we are interested in deriving FAO. 1996. Methodolog y for assessing food
the theoretical distribution of dietary energ y inadequacy in developing countries. In FAO.
requirements for healthy hypothetical average The Sixth World Food Survey, pp. 114–143. Rome.
individuals to estimate the CV|r, the MDER and FAO. 2003. Proceedings: Measurement and
the average dietary energ y requirement (ADER) Assessment of Food Deprivation and Undernutrition:
can be used to approximate the 1st percentile International Scientific Symposium. Rome.
and the 50th percentile of the distribution of FAO. 2014. Advances in hunger measurement:
energ y requirements of the hypothetical average traditional FAO methods and recent innovations.
individual as they are built on the same principles FAO Statistics Division Working Paper
of a weighted average from sex-age-physiological No. 14– 04. Rome.
status groups. 331, 332 Therefore, the value of CV|r Naiken, L. 2002. Keynote paper: FAO methodology
is derived as the inverse cumulative standard for estimating the prevalence of undernourishment.
normal distribution of the difference between Paper presented at the Measurement and
the MDER and the ADER. Similar to the MDER, Assessment of Food Deprivation and
the ADER is estimated using the average of the Undernutrition International Scientific
minimum and the maximum values of the PAL Symposium, Rome, 26 –28 June 2002. Rome, FAO.
category “Active or moderately active lifestyle”. Wanner, N., Cafiero, C., Troubat, N. & Conforti,
P. 2014. Refinements to the FAO methodology for
The total C V is then obtained as the geometric estimating the prevalence of undernourishment
mean of the C V|y and the C V|r: indicator. Rome, FAO.

FOOD INSECURITY AS MEASURED

𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶 = �(𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶|𝑦𝑦𝑦𝑦)2 + (𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶|𝑟𝑟𝑟𝑟)2 BY THE FOOD INSECURITY EXPERIENCE
SCALE (FIES)
Challenges and limitations: While formally the state Definition: Food insecurit y as measured by this
of being undernourished or not is a condition indicator refers to limited access to food, at the
that applies to individuals, given exp�𝑎𝑎𝑎𝑎 the−data 𝑃𝑃𝑃𝑃𝑗𝑗𝑗𝑗 � usually level of individuals or households, due to lack of
𝑖𝑖𝑖𝑖
𝑃𝑃𝑃𝑃𝑟𝑟𝑟𝑟𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃�𝑋𝑋𝑋𝑋
available = Yes�
on a𝑖𝑖𝑖𝑖,𝑗𝑗𝑗𝑗large = it is impossible to
scale, money or other resources. The severit y of food
reliably identif y which individuals 1 + exp�𝑎𝑎𝑎𝑎 in 𝑖𝑖𝑖𝑖a−certain 𝑃𝑃𝑃𝑃𝑗𝑗𝑗𝑗 � insecurit y is measured using data collected with
group are actually undernourished. Through the the Food Insecurit y Experience Scale sur vey
statistical model described above, the indicator module (FIES-SM), a set of eight questions
can only be computed with reference to a asking to self-report conditions and experiences
population or a group of individuals for t y pically associated with limited access to
which a representative sample is available. food. For purposes of annual SDG monitoring,
The prevalence of undernourishment
𝐹𝐹𝐹𝐹𝐼𝐼𝐼𝐼𝐿𝐿𝐿𝐿 = ∑𝑝𝑝𝑝𝑝𝑖𝑖𝑖𝑖,𝐿𝐿𝐿𝐿 𝑤𝑤𝑤𝑤𝑖𝑖𝑖𝑖 is thus an the questions are asked with reference to the
estimate of the percentage of individuals in that 12 months preceding the sur vey.
group that are in such condition and cannot be
further disaggregated. Using sophisticated statistical techniques based
on the Rasch measurement model, the information
Due to the probabilistic FI𝐿𝐿𝐿𝐿,𝑐𝑐𝑐𝑐 ×of𝑁𝑁𝑁𝑁𝑐𝑐𝑐𝑐the inference
∑𝑐𝑐𝑐𝑐nature obtained in a survey is validated for internal
FI𝐿𝐿𝐿𝐿,𝑟𝑟𝑟𝑟of =uncertaint y associated with
and the margins consistency and converted into a quantitative
estimates of each of the parameters
∑𝑐𝑐𝑐𝑐 𝑁𝑁𝑁𝑁𝑐𝑐𝑐𝑐 in the model, measure along a scale of severity, ranging from

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𝑀𝑀𝑀𝑀𝑀𝑀𝑀𝑀𝑀𝑀𝑀𝑀𝑀𝑀𝑀𝑀
 THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2021

low to high. Based on their responses to the larger samples of 9 350 individuals in India
FIES-SM items, the individuals or households (where a combination of CAPI and CATI was
interviewed in a nationally representative survey implemented) and 5 500 in mainland China.
of the population are assigned a probability of In 2020, additional oversampling was applied in
being in one of three classes: food secure or only 5 countries: Bangladesh (3 000), Eg y pt (2 000),
marginally insecure, moderately food insecure Russian Federation (4 000), Turkey (2 000) and
and severely food insecure as defined by two Viet Nam (2 000).
globally set thresholds. Based on FIES data
collected over three years from 2014 to 2016, FAO Additionally to the GWP, in 2020 FAO collected
has established the FIES reference scale, which is data in 20 countries through Geopoll ® with the
used as the global standard for experience-based specific objective of assessing food insecurit y
food-insecurity measures, and to set the two during the COV ID-19 pandemic. The countries
reference thresholds of severity. covered were: Afghanistan, Burkina Faso,
Cameroon, Central African Republic, Chad,
SDG Indicator 2.1.2 is obtained as the cumulated Democratic Republic of the Congo, El Salvador,
probabilit y to be in the two classes of moderate Ethiopia, Guatemala, Haiti, Iraq, Liberia,
and severe food insecurit y. A separate indicator Mozambique, Myanmar, Niger, Nigeria, Sierra
(FI sev ) is computed by considering only the severe Leone, Somalia, South Africa and Zimbabwe.
food-insecurit y class. For all these countries, the 2020 assessment was
based on Geopoll data.
How it is reported: In this report, FAO provides
estimates of food insecurit y at two different For Afghanistan, Angola, Armenia, Botswana,
levels of severit y: moderate or severe food Burkina Faso, Cabo Verde, Canada, Chile, Costa
insecurit y (FI mod+sev ) and severe food insecurit y Rica, Ecuador, Fiji, Ghana, Greece, Grenada,
(FI sev ). For each of these two levels, two estimates Honduras, Indonesia, Israel, Kazakhstan,
are reported: Kenya, Kiribati, Kyrg yzstan, Lesotho, Malawi,
Mauritania, Mexico, Morocco, Namibia, Niger,
„ the prevalence (%) of individuals in the Nigeria, Palestine, Philippines, Republic of Korea,
population living in households where at least Russian Federation, Saint Lucia, Samoa, Senegal,
one adult was found to be food insecure; Seychelles, Sierra Leone, South Sudan, Sudan,
„ the estimated number of individuals in the Tonga, Uganda, United Republic of Tanzania,
population living in households where at least United States of America, Vanuatu, Viet Nam
one adult was found to be food insecure. and Zambia, national government survey data
were used to calculate the prevalence estimates
Data source: Since 2014, the eight-question FIES of food insecurity by applying FAO’s statistical
sur vey module has been applied in nationally methods to adjust national results to the same
representative samples of the adult population global reference standard, covering approximately
(defined as aged 15 or older) in more than a quarter of the world population. Countries are
140 countries included in the Gallup © World considered for the year/years when national
Poll (GWP), covering 90 percent of the world data are available, informing the regional and
population. In 2020, inter views were conducted subregional aggregates assuming a constant
by telephone given the high risk of communit y trend in the period 2014–2020, or integrating the
transmission from conducting face-to-face data remaining years with GWP or Geopoll data in
collection during the COV ID-19 pandemic. case they were compatible. Exceptions to this rule
By evaluating Dual Frame coverage (i.e. are: Armenia, Botswana, Burkina Faso, Chile,
the proportion of the adult population that is Costa Rica, Ecuador, Ghana, Honduras, Indonesia,
covered by a combination of landline and mobile Israel, Malawi, Namibia, Niger, Nigeria, Sierra
phones), countries with a minimum of 70 percent Leone, Uganda and Zambia. In these cases, the
coverage were included as part of the 2020 following procedure was followed:
World Poll though Computer Assisted Telephone
Inter viewing (CATI). In most countries, „ Use national data collected in one year to
samples include about 1 000 individuals, with inform the corresponding year.

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ANNEX 1B

„ For the remaining years, apply the smoothed As only individuals aged 15 or more are
trend coming from the data collected by sampled in the GWP, the prevalence estimates
FAO through the Gallup © World Poll to the directly produced from these data refer to the
national data to describe evolution over population 15 years and older. To arrive at the
time. Smoothed trend is computed by taking prevalence and number of individuals (of all ages)
the mean of the rates of change between in the population, an estimate is required of
consecutive three-year averages. the number of people living in the households
where at least one adult is estimated to be food
The motivation behind this procedure was insecure. This involves a multistep procedure
the strong evidence found in support of the detailed in Annex II of the Voices of the Hungry
trend suggested by data collected by FAO (for Technical Report (see link in the “References”
instance, evolution of povert y, extreme povert y, section, below).
employment, food inf lation, among others),
allowing to provide a more updated description Regional and global aggregates of food insecurit y
of the trend in the period 2014–2020. at moderate or severe, and severe levels, FI Lr, are
computed as:
In Indonesia, Kazakhstan, Kyrg yzstan, Mauritania,
Nicaragua, Paraguay, Rwanda, Seychelles, Sudan ∑ c FI L,c × N c
FI L,r =
and United Republic of Tanzania, due to lack of ∑ c Nc
data in 2020, the corresponding subregional trend
between 2019 and 2020 was used to inform 2020. where r indicates the region, FI L,𝑐 is the value
of FI at level L estimated for countr y c in the
Methodology: The data were validated and used region and N c is the corresponding population
to construct a scale of food-insecurit y severit y size. When no estimate of FI L is available for
using the Rasch model, which postulates that the a countr y, it is assumed to be equal to the
probabilit y of obser ving an affirmative answer by population-weighted average of the estimated
respondent i to question j is a logistic function of values of the remaining countries in the same
the distance, on an underlying scale of severit y, region. A regional aggregate is produced only if
between the position of the respondent, 𝑎 𝑖 , and the countries for which an estimate is available
that of the item, 𝑏𝑗. cover at least 50 rather than 80 percent of the
region’s population.
exp(a i – b j)
Prob(X i,j = Yes) = Universal thresholds are defined on the FIES
1 + exp(a i – b j)
global standard scale (a set of item parameter
values based on results from all countries covered
By applying the Rasch model to the FIES data, it by the GWP in 2014–2016) and converted into
is possible to estimate the probabilit y of being corresponding values on local scales. The process
food insecure (𝑝 i,L) at each level of severit y of of calibrating each country’s scale against the FIES
food insecurit y L (moderate or severe, or severe), global standard can be referred to as equating,
for each respondent i, with 0 < 𝑝 i,L < 1. and permits the production of internationally
comparable measures of food-insecurity severity
The prevalence of food insecurity at each level of for individual respondents, as well as comparable
severit y (FI L) in the population is computed as national prevalence rates.
the weighted sum of the probabilit y of being food
insecure for all respondents (i) in a sample: The problem stems from the fact that, when
defined as a latent trait, the severity of food
FI L = ∑p i,L w i insecurity has no absolute reference against
which it could be evaluated. The Rasch model
where 𝑤 𝑖 are post-stratification weights enables identification of the relative position
that indicate the proportion of indiv iduals that the various items occupy on a scale that is
or households in the national population denominated in logit units, but whose “zero”
represented by each record in the sample. is arbitrarily set, usually to correspond to the

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 THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2021

mean estimated severity. This implies that the STUNTING, WASTING AND OVERWEIGHT
zero of the scale changes in each application.
To produce comparable measures over time and
IN CHILDREN UNDER 5 YEARS OF AGE
across different populations requires establishing Definition of stunting (children under 5 years of age):
a common scale to use as a reference, and finding Height/length (cm) for age (months) < -2 SD
the formula needed to convert measures across of the W HO Child Growth Standards median.
different scales. As it is the case for converting Low height-for-age is an indicator that ref lects
measures of temperature across difference the cumulative effects of undernutrition and
measuring scales (such as Celsius and Fahrenheit), infections since and even before birth. It may be
this requires the identification of a number of the result of long-term nutritional deprivation,
“anchoring” points. In the FIES methodolog y, recurrent infections and lack of water and
these anchoring points are the severity levels sanitation infrastructures.
associated with the items whose relative position
on the scale of severity can be considered equal How it is reported: The percentage of children
to that of the corresponding items on the global aged 0 –59 months who are below -2 SD from
reference scale. The “mapping” of the measures the median height-for-age of the W HO Child
from one scale to the other is then obtained by Growth Standards.
finding the formula that equates the mean and the
standard deviations (SD) of the common items’ Definition of wasting: Weight (kg) for height/
severity levels. length (cm) < -2 SD of the W HO Child Growth
Standards median. Low weight-for-height is an
Challenges and limitations: When food-insecurit y indicator of acute weight loss or a failure to gain
prevalence estimates are based on FIES data weight and can be consequence of insufficient
collected in the GWP, with national sample sizes food intake and/or an incidence of infectious
of about 1 000 in most countries, confidence diseases, especially diarrhoea.
inter vals rarely exceed 20 percent of the
measured prevalence (that is, prevalence rates of How it is reported: The percentage of children aged
50 percent would have margins of error of up to 0 –59 months who are below -2 SD from the
plus or minus 5 percent). Confidence inter vals median weight-for-height of the W HO Child
are likely to be much smaller, however, when Growth Standards.
national prevalence rates are estimated using
larger samples and for estimates referring to Definition of overweight: Weight (kg) for height/
aggregates of several countries. To reduce the length (cm) > +2 SD of the W HO Child Growth
impact of year-to-year sampling variabilit y, Standards median. This indicator ref lects
countr y-level estimates are presented as excessive weight gain for height generally
three-year averages, computed as averages of all due to energ y intakes exceeding children’s
available years in the considered triennia. energ y requirements.

References: How it is reported: The percentage of children aged

Gallup. 2020. Gallup Keeps Listening to the 0 –59 months who are above +2 SD from the
World Amid the Pandemic. In: Gallup [online]. median weight-for-height of the W HO Child
[Cited 25 May 2021]. https://news.gallup.com/ Growth Standards.
opinion/gallup/316016/gallup-keeps-listening-wo
rld-amid-pandemic.aspx Data source: UNICEF, W HO & World Bank.
FAO. 2016. Methods for estimating comparable rates 2021. UNICEF-W HO-World Bank: Joint child
of food insecurity experienced by adults throughout malnutrition estimates - Levels and trends
the world. Rome. (also available at w w w.fao. (2021 edition) [online]. https://data.unicef.org/
org/3/a-i4830e.pdf ). resources/jme-report-2021, w w w.who.int/data/
FAO. 2018. Voices of the Hungr y. In: FAO gho/data/themes/topics/joint-child-malnutrit
[online]. Rome. [Cited 28 April 2020]. w w w.fao. ion-estimates-unicef-who-wb, https://datatopics.
org/in-action/voices-of-the-hungr y worldbank.org/child-malnutrition

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ANNEX 1B

Methodology: For stunting and overweight, the JME country

dataset is used to generate country-modelled
Country-level estimates estimates which serve as the official JME estimates
The UNICEF/WHO-World Bank Group Joint Child (i.e. the stunting prevalence from a household
Malnutrition Estimates (JME) country dataset survey for a given country in a given year is not
The UNICEF/W HO-World Bank Group JME reported as the prevalence for that country in that
dataset of countr y estimates requires the year; rather, it feeds into the modelled estimates
collection of national data sources that contain described in the next section below).
information on child malnutrition – specifically,
data on the height, weight and age of children Country-level model for stunting and
under 5, which can be used to generate national overweight estimates
level prevalence estimates for stunting, wasting The technical details of the statistical models are
and overweight. These national-level data sources provided elsewhere. 333 Briefly, for both stunting
are mainly comprised of household sur veys (e.g. and overweight, prevalence was modelled at logit
Multiple Indicator Cluster Sur veys, Demographic (log-odds) scale using a penalized longitudinal
and Health Sur veys). Some administrative data mixed-model with a heterogeneous error term.
sources (e.g. from sur veillance systems) are also The quality of the models was quantified with
included where population coverage is high. model-fit criteria that balance the complexity
As of the latest review closure on 31 Januar y of the model with the closeness of the fit to
2021, the primar y source dataset contained the observed data. The proposed method has
997 data sources from 157 countries and important characteristics, including non-linear
territories, with nearly 80 percent of children time trends, regional trends, country-specific
living in countries with at least one data point trends, covariate data and a heterogeneous
within the past five years on stunting, wasting error term. All countries with data contribute to
and overweight. This suggests that the global estimates of the overall time trend and the impact
estimates are highly representative of the of covariate data on prevalence. For overweight,
majorit y of children across the globe for the most the covariate data consisted of linear and quadratic
recent period. The dataset contains the point socio-demographic index (SDI), as and data source
estimate (and where available, the standard type. The same covariates were used for stunting,
error), the 95 percent confidence bounds and the plus an additional covariate of the average health
unweighted sample size. Where microdata are system access over the previous five years.
available, the JME uses estimates that have been
recalculated to adhere to the global standard Annual countr y-level modelled estimates from
definition. Where microdata are not available, 2000 to 2020 at on stunting and overweight
reported estimates are used, except in cases were disseminated by the JME in 2021 for
where adjustments are required to standardize 155 countries with at least one data point
for: (i) use of an alternate growth reference (e.g. from a household sur vey) included in
from the 2006 W HO Growth Standards; (ii) age the JME countr y dataset described above.
ranges that do not include the full 0 –59-month Modelled countr y estimates were also produced
age group; and (iii) data sources that were only for an additional 49 countries, used solely for
nationally representative for populations residing
in rural areas. Further details related to data as  SDI is a summary measure that identifies where countries or other
source compilation, re-analysis of microdata, and geographic areas sit on the spectrum of development. Expressed on a
scale of 0 to 1, SDI is a composite average of the rankings of the income
data source review are described elsewhere. 333 per capita, average educational attainment, and fertility rates of all
areas in the Global Burden of Disease study.
The JME country dataset serves different purposes at  The collection of household survey data on child height and weight
for different indicators. For wasting, the JME were limited in 2020 due to the physical distancing measures required
to prevent the spread of COVID-19. Only four national surveys included
country dataset serves as the country estimates in the JME database were carried out (at least partially) in 2020. The
themselves (i.e. the wasting prevalence in the JME estimates on child stunting, wasting and overweight are therefore
JME country dataset from a household survey based almost entirely on data collected before 2020 and do not take
into account the impact of the COVID-19 pandemic. However, one of the
for a country in a given year is the wasting covariates used in the country stunting and overweight models takes the
prevalence reported for that country in that year). impact of COVID-19 partially into account.

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 THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2021

generation of regional and global aggregates. related diseases that can affect nutrition status).
Modelled estimates for these 49 countries are not Given that countr y sur veys can be collected
shown because they did not have any household during any season, the prevalence estimate from
sur veys in the JME countr y dataset or because any sur vey may be at a high or low; or it may fall
the modelled estimates remained pending final somewhere in between if data collection spanned
review at the time of publication. The results across several seasons. Thus, the prevalence
for the 204 countries can be used to calculate of wasting captures the situation of wasting at
estimates and uncertaint y inter vals for any a specific point in time and not over an entire
group of countries aggregated. The uncertaint y year. Variations in seasons across sur veys make
inter vals are important in monitoring trends, it difficult to draw inferences on trends. The lack
especially for countries with sparse data and of methods to account for seasonalit y and
where primar y data sources present large incident cases of wasting are the main reasons
primar y data source sampling errors. When only why the JME does not present annual trends for
sparse data are available in the most recent this form of malnutrition.
period, the inclusion of a sur vey can affect a
substantial change in the predicted trajector y. Generation of regional and global estimates
For this reason, uncertaint y inter vals are needed Different methods were applied to generate
to enhance trend interpretabilit y in terms of regional and global estimates for stunting
the caution level employed. The uncertaint y and overweight compared to wasting, as
inter vals for the new JME method have been described below. In short, results from the new
tested and validated with various data t ypes. countr y-level model were used to generate
the regional and global estimates for stunting
Regional and global estimates and overweight, while the JME subregional
Regional and global wasting estimates are multi-level model was used to generate the
only presented for the most recent year, 2020, global and regional estimates for wasting.
unlike stunting and overweight estimates for
which an annual time series is available from Stunting and overweight
2000 to 2020. au This is because the JME are Global and regional estimates for all years from
based on national-level countr y prevalence 2000 to 2020 av were derived as the respective
data, which come from cross-sectional sur veys countr y averages weighted by the countries’
(i.e. a snapshot at one point in time) that are under-five population from The United Nations
collected infrequently (ever y three to five years) World Population Prospects, 2019 Revision,
in most countries. Since stunting and overweight using model-based estimates for 204 countries.
are relatively stable over the course of a calendar This includes 155 countries with national data
year, it is reasonable to track changes in these sources (e.g. household sur veys) included in the
two conditions over time with these data, JME countr y dataset described above. It also
whereas wasting is an acute condition that can includes 49 countries with modelled estimates
change frequently and rapidly. An individual generated for development of regional and global
child can be affected by wasting more than aggregates, but for which countr y modelled
once in a calendar year (i.e. can recover but estimates are not shown because they did not
then become wasted again in the same year), have any household sur veys in the JME countr y
and the risk of wasting in many contexts can be dataset or because the modelled estimates
driven by seasonal variations, which can result remained pending final review at the time of
in seasonal spikes in prevalence. For example, publication. Confidence inter vals were generated
wasting prevalence, in some contexts, may based on bootstrapping methodolog y.
double between the post-har vest season (often
associated with higher food availabilit y and Wasting
weather patterns that are less likely to cause The wasting prevalence data from national data
disease) and the pre-har vest season (often sources described in the above section about the
associated with food shortages, heav y rains and JME countr y dataset were used to generate the

au  See footnote at. av  See footnote at.

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ANNEX 1B

regional and global estimates for the year 2020 aw UNICEF, W HO & World Bank. 2021.
using the JME subregional multi-level model, UNICEF-W HO-World Bank: Joint child malnutrition
applying population weights for children under estimates - Levels and trends (2021 edition)
5 years of age from the United Nations World [online]. https://data.unicef.org/resources/
Population Prospects, 2019 Revision. jme-report-2021, w w w.who.int/data/gho/data/
themes/topics/joint-child-malnutrition-estima
Challenges and limitations: The recommended tes-unicef-who-wb, https://datatopics.worldbank.
periodicit y for countries to report on stunting, org/child-malnutrition
overweight and wasting is ever y three to five UNICEF, W HO & World Bank. 2021. Technical
years; however, for some countries, data are notes from the background document for
available less frequently. While ever y effort has country consultations on the 2021 edition of the
been made to maximize the comparabilit y of UNICEF-W HO-World Bank Joint Malnutrition
statistics across countries and over time, countr y Estimates. SDG Indicators 2.2.1 on stunting, 2.2.2a
data may differ in terms of data collection on wasting and 2.2.2b on overweight. New York,
methods, population coverage and estimation USA, UNICEF. (also available at data.unicef.org/
methods used. Sur vey estimates come with resources/jme-2021-countr y-consultations).
levels of uncertaint y due to both sampling errors W HO. 2014. Comprehensive Implementation Plan
and non-sampling errors (technical measurement on maternal, infant and young child nutrition.
errors, recording errors, etc.). Neither of the Geneva, Switzerland. w w w.who.int/nutrition/
two sources of error has been fully taken into publications/CIP_document/en
account for deriving estimates at countr y or W HO. 2019. Nutrition Landscape Information
regional and global levels. System (NLIS) country profile indicators:
interpretation guide. Geneva, Switzerland.
For the prevalence of wasting, as sur veys are (also available at w w w.who.int/publications/i/
generally carried out during a specific period item/9789241516952).
of the year, the estimates can be affected by
seasonalit y. Seasonal factors related to wasting
include food availabilit y (e.g. pre-har vest periods) EXCLUSIVE BREASTFEEDING
and disease (rainy season and diarrhoea, malaria, Definition: Exclusive breastfeeding for infants
etc.), while natural disasters and conf licts can <6 months of age is defined as receiving only
also show real shifts in trends that would need to breastmilk and no additional food or drink,
be treated differently than a seasonal variation. not even water. Exclusive breastfeeding is a
Hence, countr y year estimates for wasting cornerstone of child sur vival and is the best food
may not necessarily be comparable over time. for newborns, as breastmilk shapes the baby’s
Consequently, only estimates from the most microbiome, strengthens the immune system and
recent year (2020 ax) are provided. reduces the risk of developing chronic diseases.

References: Breastfeeding also benefits mothers by preventing

de Onis, M., Blössner, M., Borghi, E., Morris, postpartum haemorrhage and promoting uterine
R. & Frongillo, E.A. 2004. Methodolog y for involution, decreasing risk of iron-deficiency
estimating regional and global trends of child anaemia, reducing the risk of various types of
malnutrition. International Journal of Epidemiology, cancer and providing psychological benefits.
33(6): 1260–1270. https://doi.org/10.1093/ije/dyh202
GBD 2019 Risk Factors Collaborators. How it is reported: Percentage of infants aged
2020. Global burden of 87 risk factors in 204 0 –5 months who are fed exclusively on breastmilk
countries and territories, 1990 –2019: a systematic with no additional food or drink, not even water,
analysis for the Global Burden of Disease Study in the 24 hours preceding the sur vey. 294
2019. The Lancet, 396(10258): 1223 –1249.
https://doi.org/10.1016/s0140-6736(20)30752-2 Data source: UNICEF. 2020. Infant and young child
feeding. In: UNICEF [online]. New York, USA.
aw  See footnote at. [Cited 19 April 2021] . data.unicef.org/topic/
ax  See footnote at. nutrition/infant-and-young-child-feeding

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 THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2021

Methodology: References:
UNICEF. 2020. Infant and young child
Infants 0 –5 months of age who received only feeding: exclusive breastfeeding. In: UNICEF
breastmilk during the previous day Data: Monitoring the Situation of Children and
Women [online]. New York, USA. [Cited 19
Infants 0 –5 months of age April 2021]. data.unicef.org/topic/nutrition/
infant-and-young-child-feeding
This indicator includes breastfeeding by a wet W HO. 2014. Comprehensive Implementation Plan
nurse and feeding expressed breastmilk. on maternal, infant and young child nutrition.
Geneva, Switzerland. w w w.who.int/nutrition/
The indicator is based on a recall of the previous publications/CIP_document/en
day’s feeding to a cross-section of infants 0 –5 W HO. 2019. Nutrition Landscape Information
months of age. System (NLIS) country profile indicators:
interpretation guide. Geneva, Switzerland.
In 2012, the regional and global exclusive (also available at w w w.who.int/publications/i/
breastfeeding estimates were generated using item/9789241516952).
the most recent estimate available for each W HO and UNICEF. 2021. Indicators for assessing
countr y between 2005 and 2012. Similarly, 2019 infant and young child feeding practices: definitions
estimates were developed using the most recent and measurement methods.
estimate available for each countr y between 2014
and 2019. Global and regional estimates were
calculated as weighted averages of the prevalence LOW BIRTHWEIGHT
of exclusive breastfeeding in each countr y, Definition: Low birthweight is defined as a weight
using the total number of births from the World at birth of less than 2 500 g (less than 5.51 lbs),
Population Prospects, 2019 revision (2012 for the regardless of gestational age. A newborn’s weight
baseline and 2019 for the current) as weights. at birth is an important marker of maternal and
Estimates are presented only where the available foetal health and nutrition. 297
data are representative of at least 50 percent of
corresponding regions’ total number of births, How it is reported: The percentage of newborns
unless otherwise noted. weighing less than 2 500 g (less than 5.51 lbs)
at birth.
Challenges and limitations: While a high proportion of
countries collect data for exclusive breastfeeding, Data source: UNICEF & W HO.
data are lacking in high-income countries in 2019. UNICEF-W HO joint low birthweight
particular. The recommended periodicit y of estimates. In: United Nations Children’s
reporting on exclusive breastfeeding is ever y Fund [online]. New York, USA and Geneva,
three to five years. However, for some countries, Switzerland. [Cited 28 April 2020]. w w w.unicef.
data are reported less frequently, meaning org/reports/UNICEF-W HO-low-birthweight-esti
changes in feeding patterns are often not mates-2019, w w w.who.int/nutrition/publications/
detected for several years after the change occurs. UNICEF-W HO-lowbirthweight-estimates-2019

Regional and global averages may be affected Methodology: Nationally representative estimates of
depending on which countries had data available low birthweight prevalence can be derived from
for the periods considered in this report. a range of sources, broadly defined as national
administrative data or representative household
Using the previous day’s feeding as a basis may surveys. National administrative data are those
cause the proportion of exclusively breastfed coming from national systems including Civil
infants to be overestimated, as some infants Registration and Vital Statistics (CRVS) systems,
who may have been given other liquids or foods national Health Management Information Systems
irreg ularly may not have received these on the (HMIS) and birth registries. National household
day before the sur vey. surveys which contain information about
birthweight as well as key related indicators

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ANNEX 1B

including maternal perception of size at birth ≥1 low birthweight data point from any source
(MICS, DHS) are also an important source of low meeting inclusion criteria are fitted into a
birthweight data especially in contexts where model using covariates to generate annual low
many births are unweighted and/or data heaping birthweight estimates, as well as uncertaint y
is a problem. Prior to entry into the country ranges, using a bootstrap approach. The model
dataset, country data are reviewed for coverage includes natural log of neonatal mortalit y
and quality and adjusted where the source is rate; the proportion of children underweight
a household survey. Administrative data are (weight-for-age z score below -2 SD from
categorized as (i) high coverage, if representing median weight for age of reference population);
≥90 percent of live births; (ii) medium coverage, data t y pe (higher qualit y administrative, lower
if representing between 80 and 90 percent of live qualit y administrative, household sur vey); UN
births; or (iii) not included, if covering <80 percent region (e.g. Southern Asia, Caribbean); and
of live births. To be included in the dataset, survey a countr y-specific random effect. These low
data need to have: birthweight estimates may var y substantially
from estimates reported by countries in
i. a birthweight in the dataset for at minimum administrative and sur vey reports, especially
30 percent of the sample; given that the household sur vey estimates
ii. a minimum of 200 birthweights in the dataset; are adjusted for missing birthweights and
iii. no indication of severe data heaping – this heaping, while sur vey reports often present a
means that: a) ≤55 percent of all birthweights low birthweight estimate just for the children
can fall on the three most frequent with a birthweight and with no adjustment for
birthweights (i.e. if 3 000 g, 3 500 g and 2 500 data heaping.
g were the three most frequent birthweights, „ No estimate: countries for which low birthweight
when added together, they have to make input data were not available and/or did not
up ≤55 percent of all birthweights in the meet inclusion criteria are indicated in the
dataset); b) ≤10 percent of all birthweights are database as “no estimate”. A total of 54 countries
≥4 500 g; c) ≤5 percent of birthweights fall on in the current country database were reported
tail ends of 500 g and 5 000 g; and as having “no estimate”. Despite not presenting
iv. undergone an adjustment for missing an estimate for these individual 54 countries,
birthweights and heaping. 295 annual low birthweight estimates were derived
for them using the hierarchical regression
Modelling methods were applied to the accepted methods detailed above but used only to input
(and for household sur vey data, accepted and into regional and global estimates.
adjusted) countr y data to generate annual
countr y estimates from 2000 to 2015, with Modelled annual countr y estimates are used
methods var ying by availabilit y and t ype of input to generate regional and global estimates from
data as follows: 2000 –2015. Global estimates are derived by
summing the estimated number of live births
„ b-spline: data for countries with ≥8 data points weighing less than 2 500 g for 195 ay countries
from higher coverage administrative sources with an estimate in the United Nations regional
≥1 point prior to 2005 and ≥1 point more grouping for each year, and then dividing by all
recent than 2010 are smoothed with b-spline live births in each year in those 195 countries.
regression to generate annual low birthweight Regional estimates are similarly derived,
estimates. A b-spline regression model based on countries in each regional grouping.
was used to predict the standard error and To obtain the global and regional level estimates
calculate 95 percent confidence inter vals for of uncertaint y, 1 000 low birthweight point
the countr y-level low birthweight estimates.
These low birthweight estimates follow ver y ay  While the world comprises 202 countries (as per the full set of
closely those included in the countries’ own countries in the regional grouping with the largest set of countries – i.e.
administrative reports. the UNICEF regional grouping), seven countries did not have low
birthweight input data or covariate data. It was therefore not possible to
„ Hierarchical regression: data for countries not generate any estimates for these seven countries and they are not
meeting requirements for b-spline but with included in the regional and global estimates.

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 THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2021

estimates were made for each countr y for each 2019. National, regional, and worldwide
year using either b-spline (by randomly sampling estimates of low birthweight in 2015, with trends
from a normal distribution plotted using the from 2000: a systematic analysis. The Lancet
calculated standard error) or hierarchical Global Health, 7(7): e849–e860.
regression approach (using a bootstrap approach).
The countr y low birthweight estimates for each
of the 1 000 samples were summed at worldwide ADULT OBESITY
or regional level and the 2.5th and 97.5th centiles Definition: BMI ≥ 30.0 kg/m 2 . The body mass index
of the resulting distributions were used as the (BMI) is the ratio of weight-to-height commonly
confidence inter vals. used to classif y the nutritional status of adults.
It is calculated as the body weight in kilograms
Challenges and limitations: A major limitation divided by the square of the body height in
of monitoring low birthweight globally is metres (kg/m 2). Obesit y includes individuals with
the lack of birthweight data for many of the BMI equal to or higher than 30 kg/m 2 .
world’s children. There is a notable bias among
the unweighted, with those born to poorer, How it is reported: Percentage of population
less-educated, rural mothers being less likely to over 18 years of age with BMI ≥ 30.0 kg/m 2
have a recorded birthweight when compared to standardized by age and weighted by sex. 210
their richer, urban counterparts with more highly
educated mothers. 296 As the characteristics of Data source: WHO. 2020. Global Health
the unweighted are risk factors for having a low Obser vator y (GHO) data repositor y. In: World
birthweight, estimates that do not well represent Health Organization [online]. Geneva, Switzerland.
these children may be lower than the true value. [Cited 28 April 2020]. apps.who.int/gho/
Furthermore, poor qualit y of available data data/node.main.A900A?lang=en (1 698
with regard to excessive heaping on multiples of population-based studies with more than
500 g or 100 g exists in the majorit y of available 19.2 million participants aged 18 years or older,
data from LMICs 296 and can further bias low measured in 186 countries 298).
birthweight estimates. The methods applied to
adjust for missing birthweights and heaping for Methodology: A Bayesian hierarchical model was
sur vey estimates in the current database 295 are applied to selected population-based studies
meant to address the problem; however, there that had measured height and weight in adults
were a total of 54 countries for which it was aged 18 years and older to estimate trends from
not possible to generate a reliable birthweight 1975 to 2014 in mean BMI and in the prevalence
estimate. In addition, the confidence limits of BMI categories (underweight, overweight
of the regional and global estimates may be and obesit y). The model incorporated nonlinear
artificially small given that about half of the time trends and age patterns; national versus
modelled countries had a countr y-specific subnational and communit y representativeness;
effect generated at random for each bootstrap and whether data covered both rural and urban
prediction, some of which were positive and areas versus only one of them. The model
others negative, making the relative uncertaint y also included covariates that help predict
at the regional and global level tend to be less BMI, including national income, proportion of
than that at the individual countr y level. population living in urban areas, mean number
of years of education and summar y measures
References: of availabilit y of different food t y pes for
Blanc, A. & Wardlaw, T. 2005. Monitoring low human consumption.
birth weight: An evaluation of international
estimates and an updated estimation procedure. Challenges and limitations: Some countries had few
Bulletin World Health Organization, 83(3): 178 –185. data sources and only 42 percent of included
Blencowe, H., Krasevec, J., de Onis, M., sources reported data for people older than
Black, R.E., An, X., Stevens, G.A., Borghi, E., 70 years.
Hayashi, C., Estevez, D., Cegolon, L., Shiekh,
S., Ponce Hardy, V., Lawn, J.E. & Cousens, S.

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ANNEX 1B

References: W HO regional and countr y offices, United

NCD Risk Factor Collaboration (NCD-RisC). Nations organizations, ministries of health,
2016. Trends in adult body-mass index in 200 research and academic institutions, and
countries from 1975 to 2014: a pooled analysis of non-governmental organizations. In addition,
1698 population-based measurement studies with anonymized individual-level data are obtained
19.2 million participants. The Lancet, 387(10026): from multi-countr y sur veys, including
1377–1396. demographic and health sur veys, multiple
W HO. 2019. Nutrition Landscape Information indicator cluster sur veys, reproductive health
System (NLIS) country profile indicators: sur veys and malaria indicator sur veys.
interpretation guide. Geneva, Switzerland.
(also available at w w w.who.int/publications/i/ The 2021 edition of anaemia estimates in
item/9789241516952). women of reproductive age, by pregnancy
status, included 489 data sources spanning
1995 –2020. Adjustments of data on blood
ANAEMIA IN WOMEN OF haemoglobin concentrations for altitude and
REPRODUCTIVE AGE smoking were carried out whenever possible.
Definition: Percentage of women aged 15−49 years Biologically implausible haemoglobin values
with a haemoglobin concentration less than (<25 g/L or >200 g/L) were excluded. A Bayesian
120 g/L for non-pregnant women and lactating hierarchical mixture model was used to estimate
women, and less than 110 g/L for pregnant haemoglobin distributions and systematically
women, adjusted for altitude and smoking. address missing data, non-linear time trends,
and representativeness of data sources.
How it is reported: Percentage of women of Brief ly, the model calculates estimates for
reproductive age (15 to 49 years old) with each countr y and year, informed by data from
haemoglobin concentration below 110 g/L that countr y and year themselves, if available,
for pregnant women and below 120 g/L for and by data from other years in the same
non-pregnant women. countr y and in other countries with data for
similar time periods, especially countries in
Data source: the same region. The model borrows data, to a
W HO. 2021. Vitamin and Mineral Nutrition greater extent, when data are non-existent or
Information System ( V MNIS). In: W HO [online]. weakly informative, and to a lesser extent for
Geneva, Switzerland. [Cited 25 May 2021]. data-rich countries and regions. The resulting
w w w.who.int/teams/nutrition-food-safet y/ estimates are also informed by covariates that
databases/vitamin-and-mineral-nutrition-inform help predict blood haemoglobin concentrations
ation-system (e.g. socio-demographic index, meat supply
W HO. 2021. Global anaemia estimates, Edition [kcal/capita], mean BMI for women and log
2021. In: Global Health Observatory (GHO) of under-five mortalit y for children). 299 The
data repository [online]. Geneva, Switzerland. uncertaint y ranges (credibilit y inter vals) ref lect
[Cited 25 May 2021]. w w w.who.int/data/ the major sources of uncertaint y, including
gho/data/indicators/indicator-details/ sampling error, non-sampling error due to issues
GHO/prevalence-of-anaemia-in-wo in sample design/measurement, and uncertaint y
men-of-reproductive-age-(-) from making estimates for countries and years
without data.
Methodology: The preferable source of data is
population-based sur veys. Data were taken Challenges and limitations: Despite a high proportion
from the Micronutrients Database of the of countries having nationally representative
W HO Vitamin and Mineral Information sur vey data available for anaemia, there is still a
System ( V MNIS). This database compiles and lack of reporting on this indicator, especially in
summarizes data on the micronutrient status high-income countries. As a result, the estimates
of populations from various other sources, may not capture the full variation across
including data collected from the scientific countries and regions, thus tending to “shrink”
literature and through collaborators, including towards global means when data are sparse.

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 THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2021

References: Geneva, Switzerland. [Cited 10 May 2021]. w w w.

Stevens, G.A., Finucane, M.M., De-Regil, who.int/data/nutrition/nlis/countr y-profile
L.M., Paciorek, C.J., Flaxman, S.R., Branca, W HO. 2021. Vitamin and Mineral Nutrition
F., Peña-Rosas, J.P., Bhutta, Z.A. & Ezzati, M. Information System ( V MNIS). In: W HO [online].
2013. Global, regional, and national trends in Geneva, Switzerland. [Cited 10 May 2021].
haemoglobin concentration and prevalence of w w w.who.int/teams/nutrition-food-safet y/
total and severe anaemia in children and pregnant databases/vitamin-and-mineral-nutrition-inform
and non-pregnant women for 1995–2011: ation-system
a systematic analysis of population-representative W HO. 2021. W HO Global Anaemia estimates,
data. The Lancet Global Health, 1(1): e16 –e25. 2021 Edition. In: The Global Health Observatory |
W HO. 2014. Comprehensive Implementation Plan W HO [online]. Geneva, Switzerland.
on maternal, infant and young child nutrition. [Cited 10 May 2021]. w w w.who.int/data/gho/
Geneva, Switzerland. data/themes/topics/anaemia_in_women_and_
W HO. 2021. Nutrition Landscape Information children n
System (NLiS) Countr y Profile. In: W HO [online].

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ANNEX 2
METHODOLOGIES
CHAPTER 2

A. Methodology for 2020 PoU nowcasts Adjustments in the proportion of change in FIsev
As in previous editions of this report, due to that is attributed to CV|y
lack of detailed information on the most recent Another parameter that needed attention to
values of each of the elements that contribute nowcast the 2020 value of PoU is the percentage
to computing the PoU and NoU (see Annex 1B), of change in FI sev that is attributed to C V|y.
estimates referring to the most recent year are Normally, this has been assumed to be
nowcasted; in other words, they are predictions equal to one-third, based on an econometric
of the ver y recent past. analysis of past values of PoU, DEC and C V|y.
The exceptional nature of 2020 calls into
However, 2020 was unique in many respects question this reg ularit y. As virtually no national
due to the COV ID-19 pandemic, which imposed HCES were collected in 2020, there will never
unprecedented restrictions on people’s abilit y be an empirical basis to determine how to
to work and move. This demanded special properly modif y it. The solution was to conduct
considerations when nowcasting the values of the a sensitivit y analysis changing the percentage
PoU, especially with respect to estimating the of change in FI sev that is attributed to C V|y from
likely change in the C V and to modelling the way a minimum of one-third to a maximum of one.
in which inequalit y in access to food contributes The result is a range of possible values of C V|y,
to rates of undernourishment. Both aspects and hence of PoU, in 2020. For completeness,
required special treatment. Table A2.1 presents the lower and upper bounds
of the PoU in 2020 at global, regional and
Estimating changes in FIsev from 2019 to 2020 subregional levels.
While it was possible to nowcast the values
of DEC in 2020 using the traditional approach B. Methodology for the analysis of the
based on information provided by the Markets
and Trade Division of FAO, used to inform
impact on food security of income loss
FAO Agricultural Outlooks, it was necessar y induced by the COVID-19 pandemic
to modif y this traditional approach used The objective of this analysis, presented in
to nowcast the C V. Normally, changes in Section 2.1, was to estimate the impact on
C V|y (the component of the C V associated food insecurit y, measured with the FIES,
with differences in households’ economic of income loss induced by the COV ID-19
conditions) are derived from differences in pandemic. This was possible because the
three-year averages of the prevalence of severe following questions related to the impacts of the
food insecurit y based on the FIES (FI sev ) that COV ID-19 pandemic on employment and income
are not explained by changes in food supplies. were included in the same 2020 Gallup © World
Use of the three-year average addressed the Poll as the FIES module:
need to control for possible excess sampling
variabilit y in countr y-level estimates of „ Have you experienced each of the following as
the FI sev (which, for most countries, is a result of the COV ID-19 situation?
based on relatively small samples of FIES 1. Temporarily stopped working at your job or
data) and is consistent with an assumption business: Yes/No
that C V|y follows a relatively stable trend. 2. Lost your job or business: Yes/No
The exceptional nature of 2020 makes it 3. Worked less hours at your job or business:
difficult to maintain this last assumption. Yes/No
Because of that, in nowcasting the 2020 value 4. Received less money than usual from your
of C V|y, the change between the 2017–19 employer or business: Yes/No
average and the 2020 annual value of FI sev
was used.

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 THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2021

TABLE A2.1 RANGES OF PoU AND NoU NOWCASTED IN 2020

  PoU 2020 (percentage) NoU 2020 (millions)

Lower bound Upper bound Lower bound Upper bound

WORLD 9.2 10.4 720.4 811.0
AFRICA 19.8 21.8 265.3 292.4
Northern Africa 6.9 7.3 17.0 17.9
Sub-Saharan Africa 22.7 25.1 248.3 274.6
Eastern Africa 27.1 29.1 120.5 129.6
Middle Africa 31.5 32.1 56.6 57.7
Southern Africa 9.2 11.1 6.2 7.5
Western Africa 16.2 19.9 65.0 79.8
ASIA 8.5 9.5 393.1 443.2
Central Asia 3.2 3.7 2.4 2.8
Eastern Asia < 2.5 < 2.5 n.r. n.r.
South-eastern Asia 7.1 7.5 47.6 50.1
Southern Asia 14.6 16.9 282.9 328.7
Western Asia 15.0 15.3 41.9 42.7
Western Asia and Northern Africa 11.2 11.5 58.8 60.5
LATIN AMERICA AND THE CARIBBEAN 8.2 10.1 53.8 66.1
Caribbean 15.6 16.5 6.8 7.2
Latin America 7.7 9.7 47.0 58.9
Central America 9.5 11.7 17.1 21.0
South America 6.9 8.8 29.8 38.0
OCEANIA 6.2 6.2 2.7 2.7
NORTHERN AMERICA AND EUROPE < 2.5 < 2.5 n.r. n.r.
NOTES: n.r. = not reported, as the prevalence is less than 2.5 percent. For NoU, regional totals may differ from the sum of subregions, due to
rounding and non-reported values. For country compositions of each regional/subregional aggregate, see Notes on geographic regions in statistical
tables inside the back cover.
SOURCE: FAO.

Respondents were adult men and women „ Food insecurit y status at moderate or severe
15 years or older. Respondents who replied “I level: dichotomous variable being 1 if the
don’t know/Refused/Not applicable or no job” to globally adjusted probabilit y of being food
each of the questions above were excluded from insecure at moderate or severe level was
the analysis. Thus, one may assume the results greater than 0.5, otherwise 0;
refer only to the population that was employed „ Food insecurit y status at severe level:
(working or own business) at the time the dichotomous variable being 1 if the globally
COV ID-19 pandemic began. adjusted probabilit y of being food insecure at
severe level was greater than 0.5, otherwise 0.
A set of random effect logistic regression models
was applied. As outcome (dependent) variables, The two food insecurit y variables were included
the respondents’ food insecurit y status at in separate regression models to study the
moderate or severe level, and severe level only, differential impact of the COV ID-19 crisis on
were used as follows: different levels of food insecurit y.

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 ANNEX 2

As explanator y (independent) variables, C. Methodology for the cost and

responses to each of the questions 1 to 4
(temporarily stopped working; lost job; worked
affordability of healthy diets
less hours; received less money) were included in In Table 5, the cost and affordabilit y of a healthy
a separate regression model. Moreover, education, diet and the change of these indicators from
employment status, gender, urban/rural area 2017 to 2019 are reported by region, subregion
and world region were considered as controls. and countr y income groups, following the latest
Interaction terms between variables 1 to 4 and World Bank classification of income for 2019.
income and employment were also included, as In FAO, IFAD, UNICEF, W FP and W HO (2020), 7
well as countr y random effects. results were presented using the income
classification for 2017. Therefore, as some
The econometric model implemented in the countries changed their income status between
analysis is described in the following equation: these two years, the composition of countries
by income groups may also have changed.
exp [𝒑𝒑𝒑𝒑𝒊𝒊𝒊𝒊𝒍𝒍𝒍𝒍 ]
(1) (1) 𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃(𝑌𝑌𝑌𝑌𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖 = 1|𝜷𝜷𝜷𝜷𝒍𝒍𝒍𝒍 , 𝒃𝒃𝒃𝒃𝒊𝒊𝒊𝒊𝒊𝒊𝒊𝒊𝒍𝒍𝒍𝒍 , 𝑿𝑿𝑿𝑿𝒊𝒊𝒊𝒊 ) =
1+exp [𝒑𝒑𝒑𝒑𝒊𝒊𝒊𝒊𝒍𝒍𝒍𝒍 ] exp [𝒑𝒑𝒑𝒑 ]
(1) 𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃(𝑌𝑌𝑌𝑌𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖 The
= 1|𝜷𝜷𝜷𝜷𝒍𝒍𝒍𝒍 , 𝒃𝒃𝒃𝒃𝒊𝒊𝒊𝒊𝒊𝒊𝒊𝒊𝒍𝒍𝒍𝒍 ,cost
𝒊𝒊𝒊𝒊𝒍𝒍𝒍𝒍
of a healthy diet
𝑿𝑿𝑿𝑿𝒊𝒊𝒊𝒊 ) =
exp [𝒑𝒑𝒑𝒑𝒊𝒊𝒊𝒊𝒍𝒍𝒍𝒍 ] 1+exp [𝒑𝒑𝒑𝒑𝒊𝒊𝒊𝒊𝒍𝒍𝒍𝒍 ]
(1) where: 𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃(𝑌𝑌𝑌𝑌𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖 = 1|𝜷𝜷𝜷𝜷𝒍𝒍𝒍𝒍 , 𝒃𝒃𝒃𝒃𝒊𝒊𝒊𝒊𝒊𝒊𝒊𝒊𝒍𝒍𝒍𝒍 , 𝑿𝑿𝑿𝑿𝒊𝒊𝒊𝒊 ) = A healthy diet provides not only adequate
1+exp [𝒑𝒑𝒑𝒑𝒊𝒊𝒊𝒊𝒍𝒍𝒍𝒍 ]
+ 𝒃𝒃𝒃𝒃𝒊𝒊𝒊𝒊𝒊𝒊𝒊𝒊𝒍𝒍𝒍𝒍𝒊𝒊𝒊𝒊 ) + 𝛽𝛽𝛽𝛽1𝑖𝑖𝑖𝑖𝑙𝑙𝑙𝑙 𝑃𝑃𝑃𝑃𝑖𝑖𝑖𝑖 + 𝛽𝛽𝛽𝛽2𝑖𝑖𝑖𝑖𝑙𝑙𝑙𝑙 𝑐𝑐𝑐𝑐𝑖𝑖𝑖𝑖 + 𝜷𝜷𝜷𝜷𝟑𝟑𝟑𝟑𝒍𝒍𝒍𝒍𝒊𝒊𝒊𝒊 𝑿𝑿𝑿𝑿𝑖𝑖𝑖𝑖 +𝛽𝛽𝛽𝛽4𝑖𝑖𝑖𝑖𝑙𝑙𝑙𝑙 𝒁𝒁𝒁𝒁𝑖𝑖𝑖𝑖 ∗ 𝑐𝑐𝑐𝑐𝑖𝑖𝑖𝑖 calories but also adequate levels of all essential
„ 𝒑𝒑𝒑𝒑𝒊𝒊𝒊𝒊𝒍𝒍𝒍𝒍𝒊𝒊𝒊𝒊 = (𝛽𝛽𝛽𝛽0𝑖𝑖𝑖𝑖𝑙𝑙𝑙𝑙 + 𝒃𝒃𝒃𝒃𝒊𝒊𝒊𝒊𝒊𝒊𝒊𝒊𝒍𝒍𝒍𝒍𝒊𝒊𝒊𝒊 ) + 𝛽𝛽𝛽𝛽1𝑖𝑖𝑖𝑖𝑙𝑙𝑙𝑙 𝑃𝑃𝑃𝑃𝑖𝑖𝑖𝑖 + 𝛽𝛽𝛽𝛽2𝑖𝑖𝑖𝑖𝑙𝑙𝑙𝑙 𝑐𝑐𝑐𝑐𝑖𝑖𝑖𝑖 + 𝜷𝜷𝜷𝜷𝟑𝟑𝟑𝟑𝒍𝒍𝒍𝒍𝒊𝒊𝒊𝒊 𝑿𝑿𝑿𝑿𝑖𝑖𝑖𝑖 +𝛽𝛽𝛽𝛽4𝑖𝑖𝑖𝑖𝑙𝑙𝑙𝑙 𝒁𝒁𝒁𝒁𝑖𝑖𝑖𝑖 ∗nutrients
𝑐𝑐𝑐𝑐𝑖𝑖𝑖𝑖 and of each food group needed for
𝛽𝛽𝛽𝛽1𝑖𝑖𝑖𝑖𝑙𝑙𝑙𝑙 𝑃𝑃𝑃𝑃𝑖𝑖𝑖𝑖 + 𝛽𝛽𝛽𝛽2𝑖𝑖𝑖𝑖𝑙𝑙𝑙𝑙 𝑐𝑐𝑐𝑐𝑖𝑖𝑖𝑖 + 𝜷𝜷𝜷𝜷𝟑𝟑𝟑𝟑𝒍𝒍𝒍𝒍𝒊𝒊𝒊𝒊 𝑿𝑿𝑿𝑿𝑖𝑖𝑖𝑖 +𝜷𝜷𝜷𝜷𝟒𝟒𝟒𝟒𝒍𝒍𝒍𝒍𝒊𝒊𝒊𝒊 𝒁𝒁𝒁𝒁𝑖𝑖𝑖𝑖 ∗ 𝑐𝑐𝑐𝑐𝑖𝑖𝑖𝑖 is the linear predictor a healthy and active life (see Section 2.1).
𝛽𝛽𝛽𝛽1𝑖𝑖𝑖𝑖𝑙𝑙𝑙𝑙 , 𝛽𝛽𝛽𝛽2𝑖𝑖𝑖𝑖𝑙𝑙𝑙𝑙 , 𝜷𝜷𝜷𝜷𝟑𝟑𝟑𝟑𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍 ,„
𝛽𝛽𝛽𝛽4𝑖𝑖𝑖𝑖 )
i 𝑙𝑙𝑙𝑙indicates the respondent, l the level of food The cost of a healthy diet is defined as the
𝜷𝜷𝜷𝜷𝒍𝒍𝒍𝒍𝒊𝒊𝒊𝒊 = (𝛽𝛽𝛽𝛽0𝑖𝑖𝑖𝑖y𝑙𝑙𝑙𝑙(l, 𝛽𝛽𝛽𝛽=1𝑖𝑖𝑖𝑖𝑙𝑙𝑙𝑙moderate
insecurit , 𝛽𝛽𝛽𝛽2𝑖𝑖𝑖𝑖𝑙𝑙𝑙𝑙 , 𝜷𝜷𝜷𝜷𝟑𝟑𝟑𝟑𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍or
, 𝛽𝛽𝛽𝛽4𝑖𝑖𝑖𝑖 𝑙𝑙𝑙𝑙 )
severe, or severe minimum cost of foods, using the least
𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍 , 𝜷𝜷𝜷𝜷𝟒𝟒𝟒𝟒𝒍𝒍𝒍𝒍𝒊𝒊𝒊𝒊 ) only), c the COV ID-19 employment variables expensive available items in each countr y, that
(c = temporarily stopped working, or lost job, meet a set of dietar y recommendations based
exp [𝒑𝒑𝒑𝒑𝒊𝒊𝒊𝒊𝒍𝒍𝒍𝒍 ]
𝒃𝒃𝒃𝒃𝒊𝒊𝒊𝒊𝒊𝒊𝒊𝒊worked
or 𝒍𝒍𝒍𝒍𝒊𝒊𝒊𝒊 less hours or received less (1) 𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃(𝑌𝑌𝑌𝑌
money),𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖 = 1|𝜷𝜷𝜷𝜷𝒍𝒍𝒍𝒍 , 𝒃𝒃𝒃𝒃 , 𝑿𝑿𝑿𝑿𝒊𝒊𝒊𝒊 )national
on𝒊𝒊𝒊𝒊𝒊𝒊𝒊𝒊𝒍𝒍𝒍𝒍ten = Food Based Dietar y Guidelines
1+exp [𝒑𝒑𝒑𝒑𝒊𝒊𝒊𝒊𝒍𝒍𝒍𝒍 ]
c i the value of the COV ID-19 employment (FBDGs). The FBDGs explicitly recommend
𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐶𝐶𝐶𝐶𝑡𝑡𝑡𝑡 = [𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷_𝐾𝐾𝐾𝐾𝑐𝑐𝑐𝑐𝐾𝐾𝐾𝐾𝑙𝑙𝑙𝑙
variables𝑡𝑡𝑡𝑡 for + 𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷
individual 2018 − 𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷_𝐾𝐾𝐾𝐾𝑐𝑐𝑐𝑐𝐾𝐾𝐾𝐾𝑙𝑙𝑙𝑙
i and r i the2018 region ] × (1of− 𝑊𝑊𝑊𝑊𝑊𝑊𝑊𝑊𝐷𝐷𝐷𝐷𝑊𝑊𝑊𝑊𝐷𝐷𝐷𝐷𝑡𝑡𝑡𝑡food ) quantities for each food group and provide
𝒑𝒑𝒑𝒑𝒊𝒊𝒊𝒊𝒍𝒍𝒍𝒍𝒊𝒊𝒊𝒊 world
the = (𝛽𝛽𝛽𝛽0𝑖𝑖𝑖𝑖(according 𝑙𝑙𝑙𝑙 + 𝒃𝒃𝒃𝒃𝒊𝒊𝒊𝒊𝒊𝒊𝒊𝒊𝒍𝒍𝒍𝒍𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐶𝐶𝐶𝐶
𝒊𝒊𝒊𝒊 ) +to 𝑡𝑡𝑡𝑡𝛽𝛽𝛽𝛽=
the
1𝑖𝑖𝑖𝑖
[ 𝑖𝑖𝑖𝑖M49
𝑙𝑙𝑙𝑙 𝑃𝑃𝑃𝑃𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷_𝐾𝐾𝐾𝐾𝑐𝑐𝑐𝑐𝐾𝐾𝐾𝐾𝑙𝑙𝑙𝑙
+ 𝛽𝛽𝛽𝛽2𝑖𝑖𝑖𝑖classification)
𝑙𝑙𝑙𝑙 𝑐𝑐𝑐𝑐𝑖𝑖𝑖𝑖 + 𝑡𝑡𝑡𝑡 + 𝜷𝜷𝜷𝜷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷 𝑖𝑖𝑖𝑖 +𝜷𝜷𝜷𝜷−
𝟑𝟑𝟑𝟑𝒍𝒍𝒍𝒍𝒊𝒊𝒊𝒊 𝑿𝑿𝑿𝑿2018 𝟒𝟒𝟒𝟒𝒍𝒍𝒍𝒍𝒊𝒊𝒊𝒊 𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷_𝐾𝐾𝐾𝐾𝑐𝑐𝑐𝑐𝐾𝐾𝐾𝐾𝑙𝑙𝑙𝑙
𝒁𝒁𝒁𝒁𝑖𝑖𝑖𝑖a∗wide 𝑐𝑐𝑐𝑐𝑖𝑖𝑖𝑖 regional 2018 ] × (representation.
1 − 𝑊𝑊𝑊𝑊𝑊𝑊𝑊𝑊𝐷𝐷𝐷𝐷𝑊𝑊𝑊𝑊𝐷𝐷𝐷𝐷𝑡𝑡𝑡𝑡 ) A healthy diet
= [𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷_𝐾𝐾𝐾𝐾𝑐𝑐𝑐𝑐𝐾𝐾𝐾𝐾𝑙𝑙𝑙𝑙„ +
𝑡𝑡𝑡𝑡 Y il is the 𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷 −
2018dichotomous food 𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷_𝐾𝐾𝐾𝐾𝑐𝑐𝑐𝑐𝐾𝐾𝐾𝐾𝑙𝑙𝑙𝑙 ] ×
2018 insecurit y status ( 1 − 𝑊𝑊𝑊𝑊𝑊𝑊𝑊𝑊𝐷𝐷𝐷𝐷𝑊𝑊𝑊𝑊𝐷𝐷𝐷𝐷 )
𝑡𝑡𝑡𝑡 as also includes a more diverse intake of foods
2 2 described above from several different food groups. Although it
𝑦𝑦𝑦𝑦 + 𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝑟𝑟𝑟𝑟 � „ 𝜷𝜷𝜷𝜷𝒍𝒍𝒍𝒍𝒊𝒊𝒊𝒊 = (𝛽𝛽𝛽𝛽0𝑖𝑖𝑖𝑖𝑙𝑙𝑙𝑙 , 𝛽𝛽𝛽𝛽21𝑖𝑖𝑖𝑖𝑙𝑙𝑙𝑙 , 𝛽𝛽𝛽𝛽2𝑖𝑖𝑖𝑖𝑙𝑙𝑙𝑙 ,2𝜷𝜷𝜷𝜷𝟑𝟑𝟑𝟑𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍 , 𝜷𝜷𝜷𝜷𝟒𝟒𝟒𝟒𝒍𝒍𝒍𝒍𝒊𝒊𝒊𝒊 ) denotes is not selected based on nutrient content but
𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶 = ��𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶 + 𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝑟𝑟𝑟𝑟 �
the vector of𝑦𝑦𝑦𝑦fixed effects corresponding to is determined by FBDGs, this diet meets on
intercept, region of the world, COV ID-19 average 95 percent of nutrient needs, so it
𝒃𝒃𝒃𝒃𝑡𝑡𝑡𝑡 𝒊𝒊𝒊𝒊+
𝛼𝛼𝛼𝛼 + 𝛽𝛽𝛽𝛽1 𝐺𝐺𝐺𝐺𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷_𝑣𝑣𝑣𝑣𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃_𝑝𝑝𝑝𝑝𝑐𝑐𝑐𝑐employment 𝒊𝒊𝒊𝒊𝒍𝒍𝒍𝒍𝒊𝒊𝒊𝒊𝛽𝛽𝛽𝛽2 𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔_𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑖𝑖𝑖𝑖𝑒𝑒𝑒𝑒
variables 𝑡𝑡𝑡𝑡 + 𝛽𝛽𝛽𝛽3 𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑔𝑔𝑔𝑔
and 𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑃𝑃𝑃𝑃_𝑅𝑅𝑅𝑅𝑒𝑒𝑒𝑒𝑒𝑒𝑒𝑒𝑒𝑒𝑒𝑒_𝐹𝐹𝐹𝐹𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑑𝑑𝑑𝑑
a set of 𝑡𝑡𝑡𝑡 + 𝛽𝛽𝛽𝛽4 𝑥𝑥𝑥𝑥190_𝑊𝑊𝑊𝑊𝐴𝐴𝐴𝐴𝐴𝐴𝐴𝐴𝑡𝑡𝑡𝑡 + 𝛽𝛽𝛽𝛽5can 𝑐𝑐𝑐𝑐𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑡𝑡𝑡𝑡therefore
+ 𝛽𝛽𝛽𝛽6 𝑝𝑝𝑝𝑝𝑃𝑃𝑃𝑃𝑝𝑝𝑝𝑝𝑡𝑡𝑡𝑡 almost always be considered as
socio-economic � 𝑡𝑡𝑡𝑡 = 𝛼𝛼𝛼𝛼 +characteristics
𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶 𝛽𝛽𝛽𝛽1 𝐺𝐺𝐺𝐺𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷_𝑣𝑣𝑣𝑣𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃_𝑝𝑝𝑝𝑝𝑐𝑐𝑐𝑐𝑡𝑡𝑡𝑡 +for 𝛽𝛽𝛽𝛽2 𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔 𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔_𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑖𝑖𝑖𝑖𝑒𝑒𝑒𝑒𝑡𝑡𝑡𝑡 + 𝛽𝛽𝛽𝛽3 𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑃𝑃𝑃𝑃_𝑅𝑅𝑅𝑅𝑒𝑒𝑒𝑒𝑒𝑒𝑒𝑒𝑒𝑒𝑒𝑒_𝐹𝐹𝐹𝐹𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑑𝑑𝑑𝑑
individual nutrient adequate. 𝑡𝑡𝑡𝑡 + 𝛽𝛽𝛽𝛽4 𝑥𝑥𝑥𝑥190_𝑊𝑊𝑊𝑊𝐴𝐴𝐴𝐴𝐴𝐴𝐴𝐴
This 𝑡𝑡𝑡𝑡diet, + 𝛽𝛽𝛽𝛽5 𝑐𝑐𝑐𝑐𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃
however, 𝑡𝑡𝑡𝑡 + 𝛽𝛽𝛽𝛽6 𝑝𝑝𝑝𝑝𝑃𝑃𝑃𝑃𝑝𝑝𝑝𝑝
is𝑡𝑡𝑡𝑡 not
𝑣𝑣𝑣𝑣𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃_𝑝𝑝𝑝𝑝𝑐𝑐𝑐𝑐𝑡𝑡𝑡𝑡 + 𝛽𝛽𝛽𝛽2 𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔_𝑔𝑔𝑔𝑔i𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑖𝑖𝑖𝑖𝑒𝑒𝑒𝑒
(X i , i.e. 𝑡𝑡𝑡𝑡 + 𝛽𝛽𝛽𝛽 𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑔𝑔𝑔𝑔
education,
3 𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑃𝑃𝑃𝑃_𝑅𝑅𝑅𝑅𝑒𝑒𝑒𝑒𝑒𝑒𝑒𝑒𝑒𝑒𝑒𝑒_𝐹𝐹𝐹𝐹𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑑𝑑𝑑𝑑
employment 𝑡𝑡𝑡𝑡 + 𝛽𝛽𝛽𝛽4 𝑥𝑥𝑥𝑥190_𝑊𝑊𝑊𝑊𝐴𝐴𝐴𝐴𝐴𝐴𝐴𝐴
status,𝑡𝑡𝑡𝑡 urban/ + 𝛽𝛽𝛽𝛽 5 𝑐𝑐𝑐𝑐𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃
𝑡𝑡𝑡𝑡 + 𝛽𝛽𝛽𝛽6 𝑝𝑝𝑝𝑝𝑃𝑃𝑃𝑃𝑝𝑝𝑝𝑝
specifically
𝑡𝑡𝑡𝑡 optimized to include environmental
𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝑡𝑡𝑡𝑡rural = 𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶 �area 𝑡𝑡𝑡𝑡 + and �𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶 gender), 𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐶𝐶𝐶𝐶−
2019 𝑡𝑡𝑡𝑡 the= �[𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷_𝐾𝐾𝐾𝐾𝑐𝑐𝑐𝑐𝐾𝐾𝐾𝐾𝑙𝑙𝑙𝑙
𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶 2019 �, ∀𝑡𝑡𝑡𝑡 𝑡𝑡𝑡𝑡=+between
interaction 𝑊𝑊𝑊𝑊,𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷
… , 2030 2018 − 𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷_𝐾𝐾𝐾𝐾𝑐𝑐𝑐𝑐𝐾𝐾𝐾𝐾𝑙𝑙𝑙𝑙sustainabilit 2018 ]y×considerations.
(1 − 𝑊𝑊𝑊𝑊𝑊𝑊𝑊𝑊𝐷𝐷𝐷𝐷𝑊𝑊𝑊𝑊𝐷𝐷𝐷𝐷𝑡𝑡𝑡𝑡 )
c i and Z it (a subset of X i , i.e. 𝑡𝑡𝑡𝑡income and 𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶 = �
𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶 𝑡𝑡𝑡𝑡 + �𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶 2019 − �
𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶 2019 �, ∀𝑡𝑡𝑡𝑡 = 𝑊𝑊𝑊𝑊, … , 2030
𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝑡𝑡𝑡𝑡 = 𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶 � 𝑡𝑡𝑡𝑡 +employment �𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶2019 − 𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶 �
status) 2019 �, ∀𝑡𝑡𝑡𝑡 = 𝑊𝑊𝑊𝑊, … , 2030 The availabilit y and prices of items in each
„ bi0lc is the vector 2 of countr 2 y-specific random food group needed for a healthy diet were
𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶 = ��𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝑦𝑦𝑦𝑦 + 𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝑟𝑟𝑟𝑟 �
effects corresponding to intercept obtained from the World Bank’s International
Comparison Program (ICP) as national averages
Results were presented by computing exp( β2lc ) as for 2017. Item definitions are internationally
an estimate � of
𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶 𝑡𝑡𝑡𝑡 =the 𝛼𝛼𝛼𝛼 +odds-ratio𝛽𝛽𝛽𝛽1 𝐺𝐺𝐺𝐺𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷_𝑣𝑣𝑣𝑣𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃_𝑝𝑝𝑝𝑝𝑐𝑐𝑐𝑐 + 𝛽𝛽𝛽𝛽2 probabilit
of𝑡𝑡𝑡𝑡 the 𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔_𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑖𝑖𝑖𝑖𝑒𝑒𝑒𝑒y𝑡𝑡𝑡𝑡 + 𝛽𝛽𝛽𝛽3 𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑃𝑃𝑃𝑃_𝑅𝑅𝑅𝑅𝑒𝑒𝑒𝑒𝑒𝑒𝑒𝑒𝑒𝑒𝑒𝑒_𝐹𝐹𝐹𝐹𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑑𝑑𝑑𝑑
standardized, 𝑡𝑡𝑡𝑡 + 𝛽𝛽𝛽𝛽4allowing
𝑥𝑥𝑥𝑥190_𝑊𝑊𝑊𝑊𝐴𝐴𝐴𝐴𝐴𝐴𝐴𝐴𝑡𝑡𝑡𝑡classification
+ 𝛽𝛽𝛽𝛽5 𝑐𝑐𝑐𝑐𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑡𝑡𝑡𝑡 + 𝛽𝛽𝛽𝛽6 𝑝𝑝𝑝𝑝𝑃𝑃𝑃𝑃𝑝𝑝𝑝𝑝
by 𝑡𝑡𝑡𝑡food
of being food insecure. The larger the odds ratio group and calculation of the least-costs to
compared to 1, the higher the probabilit y of being reach FBDG requirements in each countr y,
food insecure compared to𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶 the𝑡𝑡𝑡𝑡probabilit � 𝑡𝑡𝑡𝑡 +y �𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶
= 𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶 of not2019 − 𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶 � 2019 �, ∀𝑡𝑡𝑡𝑡 = an
representing 𝑊𝑊𝑊𝑊, …average
, 2030 across markets and
being food insecure due to the “yes” answer to throughout the year. 300 For a detailed description
a given question about income loss because of of the healthy diet and related methodolog y, see
COV ID-19 compared to “no”. FAO, IFAD, UNICEF, W FP and W HO (2020). 7

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 THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2021

Affordability of a healthy diet non-alcoholic beverages are used to update the

In this report, to determine affordabilit y, cost of a healthy diet in 2019 for all countries
the cost of a healthy diet is compared with except Central African Republic and Guyana,
countr y-specific income distributions that for which the general CPI is used. The costs of a
are derived from the World Bank PovcalNet healthy diet in 2019 are estimated by using each
database. 301 The resulting measures of countr y’s 2017 actual cost multiplied by its ratio
affordabilit y include the percentage and between food CPIs:
number of people who cannot afford a healthy
diet in a given countr y, in 2019. A healthy Estimated 2019 Diet Cost = Actual 2017
diet is considered unaffordable when its cost Diet Cost × (f )CPI2019 / (f )CPI2017
exceeds 63 percent of the income in a countr y.
The 63 percent accounts for a portion of income Applying the (food) CPIs, the cost of the healthy
that can be credibly reser ved for food, based diet is first estimated in local currency units.
on obser vations that the poorest segment of To compare the cost across countries and political
the population in low-income countries spend, entities, the cost is converted into international
on average, 63 percent of their income on food dollars using the W DI purchasing power parit y
( World Bank Global Consumption Database). 301az (PPP) private consumption conversion factors
for 2019. For a detailed description of the
Based on this threshold and comparing the cost methodolog y, see Yan et al. (forthcoming). 302
of the diet with countr y income distributions,
we obtain the percentage of the population The cost of the healthy diet was computed for
for whom the cost of the diet is unaffordable. 170 countries in 2017. This cost information
These proportions are then multiplied by the was updated for 2019 for all countries except for
2019 population in each countr y using the World Palestine, that has inconsistent PPP conversion
Development Indicators ( W DI) 292 of the World factors, and Taiwan Province of China that has
Bank, to obtain the number of people who cannot no information on CPIs nor on PPPs. Of the
afford a specific diet in a given countr y. For a remaining 168 countries, there are 18 countries
detailed description of the affordabilit y indicators with missing 2019 PPP data, and 2 countries with
and related methodolog y, see Annex 3 of FAO, missing 2019 CPIs data. For the 18 countries, PPP
IFAD, UNICEF, W FP and W HO (2020). 7 imputations were applied using an Autoregressive
Integrated Moving Average Model with
Updating the cost of a healthy diet Explanator y Variable (A RIM A X) approach, which
The ICP is currently the only source of retail allows for one external covariate to be chosen
food price data for internationally standardized between the per capita GDP and the per capita
items, as part of the World Bank’s larger effort to household consumption expenditure. To apply
compute purchasing power parit y exchange rates this methodolog y, the completeness of the series
across all countries of the world. However, these of both covariates has been ensured by applying
data are only available once ever y three to five the Holt-Winter smoothing methodolog y to
years, which does not allow for yearly global fill the gaps, when needed. Thus, the A RIM A X
monitoring of diet costs to g uide programmes model selects the covariate and the parameters
and policies. In the absence of updated food price that minimize the Bayesian Information Criterion
data, in this report, the method of updating the (BIC). Finally, the model estimates the best
cost indicator between ICP publication years specification and computes the predicted values.
relies on Consumer Price Indices (CPIs) published
by FAO. This dataset tracks change in monthly For two additional countries with missing
general and food CPIs at the national level with information on CPIs (Bermuda, and Turks and
reference to a base year of 2015. The annual Caicos Islands), cost imputations were applied
CPIs are computed as simple averages of the 12 using the average diet cost in the subregion (s) of
monthly CPIs within a year. In particular, Food the countr y (i) with missing information:
Consumer Price Indices (CPIs) data for food and
Imputed 2018 Diet Cost = (2017 Diet Cost i /
az  For methodology see Herforth et al. [2020]. 8 Avg 2017 Diet Cost s) × Avg 2018 Diet Cost s

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ANNEX 2

Imputed 2019 Diet Cost = Imputed 2018 Diet D. Methodology for projections
Cost i / Avg 2018 Diet Cost s) × Avg 2019 Diet Cost s of PoU to 2030
To project PoU values to 2030, we project the
Subregional cost averages in 2017 and 2018 were three fundamental variables that enter in the
computed excluding from the computations the PoU formula (DEC, C V and MDER) separately,
countr y with missing cost information. based on different inputs, depending on the
scenario considered.
A limitation of this method is that changes in
the cost of a healthy diet between 2017 and The main source of information is the output
2019 depend on (food) CPIs and do not ref lect of the MIR AGRODEP recursive, dynamic CGE
commodit y-specific changes in food prices, model, which provides series of projected values,
nor any differential changes in the price of at countr y level, for:
different food groups, due to the lack of new
item-level food price data for more nutritious „ real per capita GDP (GDP_Vol_pc)
food items. FAO is exploring how to expand „ Income Gini coefficient (gini_income)
the coverage of the FAO Food Price Monitoring „ An index of real food price (Prices_Real_Food)
and Analysis (FPM A) dataset to include a set of „ Extreme povert y headcount rate (that is, the
countr y-appropriate sentinel foods in non-staple percentage of the population with real daily
food groups, such as fruits and vegetables, to income below USD 1.9) (x190_ ALL)
allow more frequent and robust monitoring of „ Daily per capita food consumption (DES_Kcal)
the cost of a healthy diet.
The MIR AGRODEP model was calibrated to
Updating the affordability of a healthy diet the pre-COV ID situation of the world economy
In this report, affordabilit y was updated for year in 2018, and used to generate projections of
2019. Through continuous updates based on macroeconomic fundamentals into 2019–2030
incoming national sur veys and data imputations, under two scenarios: a reference scenario, aimed
the income distributions for the 2017, 2018 and at capturing the impact of COV ID as ref lected
2019 reference years have been updated in the in the latest available update of the IMF World
PovcalNet database and are now available for Economic Outlook ( W EO) published in April
almost all countries (except for India whose 2021, and a no-COV ID scenario, based on the
most recent income distribution is for 2017). October 2019 edition of W EO, which is the
The percent of people who cannot afford a last one before the pandemic. A more detailed
healthy diet in 2019 was computed using the description of the MIR AGRODEP model, as well
CPI-inf lated cost of the diet described above, as the assumptions used to build the reference
as well as the corresponding reference year scenario and the no-COV ID scenario, can be
of the 2019 income distributions available in found in Laborde and Torero (forthcoming). 303
PovcalNet. These proportions were multiplied
by each countr y’s population in 2019 using the In addition, we use the median variant
W DI of the World Bank, to obtain the number projections of total population (both sexes),
of people who cannot afford the healthy diet in its composition by gender and age, and the
this year. crude birth rate as provided by the 2019 World
Population Prospects.
This affordabilit y indicator is computed for
143 countries for 2017. This information was Projections of DEC
updated for all countries for year 2019, except To project the series of DEC we use the
for Palestine. For this countr y, the affordabilit y following formula:
indicator for 2019 was calculated using cost
information for 2017 and population fig ures DEC t = [DES_ Kcal t+ DES 2018 – DES_ Kcal 2018 ]
for 2019. ba × (1 – WASTE t )

ba  For a detailed description of the methodology see Yan et al. In other words, we take the model projected
(forthcoming). 302 series of DES_Kcal and adjust its level so that the

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 THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2021

TABLE A2.2 REGRESSION COEFFICIENTS FROM THREE MODELS ESTIMATED ON HISTORIC CVy VALUES
(2000–2019)
Regression model coefficients (standard error in parentheses)

Regressors Variable used to project Pooled OLS Robust regression Random effect
Real GDP per capita GDP_vol_pc * -0.0366 (0.0790) -0.0358 (0.0742) -0.0689 (0.0662)
Income Gini coefficient Gini_income * 0.1095 (0.0748) 0.1650 (0.0703) 0.1266 (0.0816)
Real Food CPI Prices_Real_Food * 0.1359 (0.0710) 0.0686 (0.0667) 0.1598 (0.0698)
Poverty headcount X190_ALL * 0.2622 (0.1288) 0.2794 (0.1210) 0.2654 (0.1475)
Crude birth rate cbr ** 0.3806 (0.1281) 0.3301 (0.1204) 0.4029 (0.1491)
Total population pop ** -0.2002 (0.0735) (1) -0.1696 (0.0690) -0.2070 (0.1161)
𝒊𝒊𝒊𝒊𝒍𝒍𝒍𝒍 exp [𝒑𝒑𝒑𝒑 ]
𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃(𝑌𝑌𝑌𝑌
𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖 = 1|𝜷𝜷𝜷𝜷𝒍𝒍𝒍𝒍 , 𝒃𝒃𝒃𝒃𝒊𝒊𝒊𝒊𝒊𝒊𝒊𝒊𝒍𝒍𝒍𝒍 , 𝑿𝑿𝑿𝑿𝒊𝒊𝒊𝒊 ) = 1+exp [𝒑𝒑𝒑𝒑𝒊𝒊𝒊𝒊𝒍𝒍𝒍𝒍 ]
Constant 0.0000 (0.0694) -0.1110 (0.0652) 0.0533 (0.0976)
N * from MIRAGRODEP 112 112 112
𝒑𝒑𝒑𝒑𝒊𝒊𝒊𝒊𝒍𝒍𝒍𝒍𝒊𝒊𝒊𝒊 = (𝛽𝛽𝛽𝛽0𝑖𝑖𝑖𝑖𝑙𝑙𝑙𝑙 + 𝒃𝒃𝒃𝒃𝒊𝒊𝒊𝒊𝒊𝒊𝒊𝒊𝒍𝒍𝒍𝒍𝒊𝒊𝒊𝒊 ) + 𝛽𝛽𝛽𝛽1𝑖𝑖𝑖𝑖𝑙𝑙𝑙𝑙 𝑃𝑃𝑃𝑃𝑖𝑖𝑖𝑖 + 𝛽𝛽𝛽𝛽2𝑖𝑖𝑖𝑖𝑙𝑙𝑙𝑙 𝑐𝑐𝑐𝑐𝑖𝑖𝑖𝑖 + 𝜷𝜷𝜷𝜷𝟑𝟑𝟑𝟑𝒍𝒍𝒍𝒍𝒊𝒊𝒊𝒊 𝑿𝑿𝑿𝑿𝑖𝑖𝑖𝑖 +𝛽𝛽𝛽𝛽4𝑖𝑖𝑖𝑖𝑙𝑙𝑙𝑙 𝒁𝒁𝒁𝒁𝑖𝑖𝑖𝑖 ∗ 𝑐𝑐𝑐𝑐𝑖𝑖𝑖𝑖
r 2
** from WPP 0.4893 0.4943 0.4883
r adjusted
2
0.4601 0.4654
r between
2 𝜷𝜷𝜷𝜷𝒍𝒍𝒍𝒍𝒊𝒊𝒊𝒊 = (𝛽𝛽𝛽𝛽0𝑖𝑖𝑖𝑖𝑙𝑙𝑙𝑙 , 𝛽𝛽𝛽𝛽1𝑖𝑖𝑖𝑖𝑙𝑙𝑙𝑙 , 𝛽𝛽𝛽𝛽2𝑖𝑖𝑖𝑖𝑙𝑙𝑙𝑙 , 𝜷𝜷𝜷𝜷𝟑𝟑𝟑𝟑𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍 , 𝛽𝛽𝛽𝛽4𝑖𝑖𝑖𝑖𝑙𝑙𝑙𝑙 ) 0.562
SOURCE: FAO.

𝒃𝒃𝒃𝒃𝒊𝒊𝒊𝒊𝒊𝒊𝒊𝒊𝒍𝒍𝒍𝒍𝒊𝒊𝒊𝒊
exp [𝒑𝒑𝒑𝒑𝒊𝒊𝒊𝒊𝒍𝒍𝒍𝒍 ]
(1) 𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃(𝑌𝑌𝑌𝑌 = 1|𝜷𝜷𝜷𝜷 , 𝒃𝒃𝒃𝒃 𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖 , 𝑿𝑿𝑿𝑿 ) =
𝒍𝒍𝒍𝒍 𝒊𝒊𝒊𝒊𝒊𝒊𝒊𝒊𝒍𝒍𝒍𝒍
value for 2018 matches the actual value. (This is 𝒊𝒊𝒊𝒊 1+exp To [𝒑𝒑𝒑𝒑𝒊𝒊𝒊𝒊𝒍𝒍𝒍𝒍 ] estimate the coefficients used in the above
𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐶𝐶𝐶𝐶𝑡𝑡𝑡𝑡 = [𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷_𝐾𝐾𝐾𝐾𝑐𝑐𝑐𝑐𝐾𝐾𝐾𝐾𝑙𝑙𝑙𝑙 + 𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷2018 − 𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷_𝐾𝐾𝐾𝐾𝑐𝑐𝑐𝑐𝐾𝐾𝐾𝐾𝑙𝑙𝑙𝑙2018 ] × (1 − 𝑊𝑊𝑊𝑊𝑊𝑊𝑊𝑊𝐷𝐷𝐷𝐷𝑊𝑊𝑊𝑊𝐷𝐷𝐷𝐷𝑡𝑡𝑡𝑡 )
necessar y as the MIR AGRODEP model has been formula, we 𝑡𝑡𝑡𝑡considered alternative models,
calibrated
𝒑𝒑𝒑𝒑 𝒊𝒊𝒊𝒊𝒍𝒍𝒍𝒍𝒊𝒊𝒊𝒊 = (𝛽𝛽𝛽𝛽0𝑖𝑖𝑖𝑖𝑙𝑙𝑙𝑙 +to 𝒃𝒃𝒃𝒃𝒊𝒊𝒊𝒊𝒊𝒊𝒊𝒊the
𝒍𝒍𝒍𝒍𝒊𝒊𝒊𝒊 ) +2018𝛽𝛽𝛽𝛽1𝑖𝑖𝑖𝑖𝑙𝑙𝑙𝑙 𝑃𝑃𝑃𝑃𝑖𝑖𝑖𝑖 values
+ 𝛽𝛽𝛽𝛽2𝑖𝑖𝑖𝑖𝑙𝑙𝑙𝑙 𝑐𝑐𝑐𝑐𝑖𝑖𝑖𝑖 of
+ 𝜷𝜷𝜷𝜷an old
𝟑𝟑𝟑𝟑𝒍𝒍𝒍𝒍𝒊𝒊𝒊𝒊 𝑿𝑿𝑿𝑿 𝑖𝑖𝑖𝑖 +𝛽𝛽𝛽𝛽FBS series.)
4𝑖𝑖𝑖𝑖𝑙𝑙𝑙𝑙 𝒁𝒁𝒁𝒁𝑖𝑖𝑖𝑖 ∗ 𝑐𝑐𝑐𝑐𝑖𝑖𝑖𝑖 as summarized in Table A2.2, which yield ver y
similar predictions.
Projections of MDER
𝜷𝜷𝜷𝜷𝒍𝒍𝒍𝒍𝒊𝒊𝒊𝒊 = (𝛽𝛽𝛽𝛽0𝑖𝑖𝑖𝑖𝑙𝑙𝑙𝑙 , 𝛽𝛽𝛽𝛽1𝑖𝑖𝑖𝑖𝑙𝑙𝑙𝑙 , 𝛽𝛽𝛽𝛽2𝑖𝑖𝑖𝑖𝑙𝑙𝑙𝑙 , 𝜷𝜷𝜷𝜷𝟑𝟑𝟑𝟑𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍 , 𝛽𝛽𝛽𝛽4𝑖𝑖𝑖𝑖𝑙𝑙𝑙𝑙 )
𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶 = ��𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶 2
𝑦𝑦𝑦𝑦 + 𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶 2
𝑟𝑟𝑟𝑟 �
To project the MDER, we simply compute it based The series of CVy values predicted by the formula
on the data on the composition of the population separately for each country for the years 2021–2030
𝒃𝒃𝒃𝒃by
𝒊𝒊𝒊𝒊𝒊𝒊𝒊𝒊𝒍𝒍𝒍𝒍𝒊𝒊𝒊𝒊sex and age as projected by the 2019 WPP is then
� 𝑡𝑡𝑡𝑡 = 𝛼𝛼𝛼𝛼 + 𝛽𝛽𝛽𝛽1 𝐺𝐺𝐺𝐺𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷_𝑣𝑣𝑣𝑣𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃_𝑝𝑝𝑝𝑝𝑐𝑐𝑐𝑐 calibrated to the observed 2019 historic
𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶 𝑡𝑡𝑡𝑡 + 𝛽𝛽𝛽𝛽2 𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔_𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑖𝑖𝑖𝑖𝑒𝑒𝑒𝑒𝑡𝑡𝑡𝑡 + 𝛽𝛽𝛽𝛽3 𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑃𝑃𝑃𝑃_𝑅𝑅𝑅𝑅𝑒𝑒𝑒𝑒𝑒𝑒𝑒𝑒𝑒𝑒𝑒𝑒_𝐹𝐹𝐹𝐹𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑑𝑑𝑑𝑑𝑡𝑡𝑡𝑡 + 𝛽𝛽𝛽𝛽4 𝑥𝑥𝑥𝑥190_𝑊𝑊𝑊𝑊𝐴𝐴𝐴𝐴𝐴𝐴𝐴𝐴𝑡𝑡𝑡𝑡 + 𝛽𝛽𝛽𝛽5 𝑐𝑐𝑐𝑐𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑡𝑡𝑡𝑡 + 𝛽𝛽𝛽𝛽6
(medium variant). data, exp [𝒑𝒑𝒑𝒑𝒊𝒊𝒊𝒊𝒍𝒍𝒍𝒍 ] to what is done for the DES:
(1) 𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃(𝑌𝑌𝑌𝑌 = 1|𝜷𝜷𝜷𝜷 , 𝒃𝒃𝒃𝒃 , 𝑿𝑿𝑿𝑿
𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖 𝒍𝒍𝒍𝒍 𝒊𝒊𝒊𝒊𝒊𝒊𝒊𝒊𝒍𝒍𝒍𝒍 𝒊𝒊𝒊𝒊 ) =similarly
exp [𝒑𝒑𝒑𝒑 ] 1+exp [𝒑𝒑𝒑𝒑𝒊𝒊𝒊𝒊𝒍𝒍𝒍𝒍 ]
(1) 𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃(𝑌𝑌𝑌𝑌𝑖𝑖𝑖𝑖𝑖𝑖𝑖𝑖 = 1|𝜷𝜷𝜷𝜷𝒍𝒍𝒍𝒍 , 𝒃𝒃𝒃𝒃𝒊𝒊𝒊𝒊𝒊𝒊𝒊𝒊𝒍𝒍𝒍𝒍 , 𝑿𝑿𝑿𝑿𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐶𝐶𝐶𝐶 𝒊𝒊𝒊𝒊𝒍𝒍𝒍𝒍
= [𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷_𝐾𝐾𝐾𝐾𝑐𝑐𝑐𝑐𝐾𝐾𝐾𝐾𝑙𝑙𝑙𝑙
𝒊𝒊𝒊𝒊 ) =𝑡𝑡𝑡𝑡 1+exp [𝒑𝒑𝒑𝒑 ] 𝑡𝑡𝑡𝑡
+ 𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷2018 − 𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷_𝐾𝐾𝐾𝐾𝑐𝑐𝑐𝑐𝐾𝐾𝐾𝐾𝑙𝑙𝑙𝑙2018 ] × (1 − 𝑊𝑊𝑊𝑊𝑊𝑊𝑊𝑊𝐷𝐷𝐷𝐷𝑊𝑊𝑊𝑊𝐷𝐷𝐷𝐷𝑡𝑡𝑡𝑡 )
Projections of the CV 𝒊𝒊𝒊𝒊𝒍𝒍𝒍𝒍 � 𝑡𝑡𝑡𝑡 + �𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶2019 − 𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶
𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝑡𝑡𝑡𝑡 = 𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶 � 2019 �, ∀𝑡𝑡𝑡𝑡 = 𝑊𝑊𝑊𝑊, … , 2030
𝒊𝒊𝒊𝒊 = (𝛽𝛽𝛽𝛽0𝑖𝑖𝑖𝑖𝑙𝑙𝑙𝑙 + 𝒃𝒃𝒃𝒃𝒊𝒊𝒊𝒊𝒊𝒊𝒊𝒊𝒍𝒍𝒍𝒍𝒊𝒊𝒊𝒊 ) + 𝛽𝛽𝛽𝛽1𝑖𝑖𝑖𝑖𝑙𝑙𝑙𝑙 𝑃𝑃𝑃𝑃𝑖𝑖𝑖𝑖 + 𝛽𝛽𝛽𝛽2𝑖𝑖𝑖𝑖𝑙𝑙𝑙𝑙 𝑐𝑐𝑐𝑐𝑖𝑖𝑖𝑖 + 𝜷𝜷𝜷𝜷𝟑𝟑𝟑𝟑𝒍𝒍𝒍𝒍𝒊𝒊𝒊𝒊 𝑿𝑿𝑿𝑿𝑖𝑖𝑖𝑖 +𝛽𝛽𝛽𝛽4𝑖𝑖𝑖𝑖𝑙𝑙𝑙𝑙 𝒁𝒁𝒁𝒁𝑖𝑖𝑖𝑖 ∗ 𝑐𝑐𝑐𝑐𝑖𝑖𝑖𝑖
𝒑𝒑𝒑𝒑𝒊𝒊𝒊𝒊𝒍𝒍𝒍𝒍As always, the total C V is computed as
= ��𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝑦𝑦𝑦𝑦2 + 𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝑟𝑟𝑟𝑟2 � where the two components with T = 2021 for the reference scenario, and
𝑖𝑖𝑖𝑖𝑙𝑙𝑙𝑙 𝑐𝑐𝑐𝑐𝑖𝑖𝑖𝑖 + 𝜷𝜷𝜷𝜷𝟑𝟑𝟑𝟑𝒍𝒍𝒍𝒍𝒊𝒊𝒊𝒊 𝑿𝑿𝑿𝑿𝑖𝑖𝑖𝑖 +𝛽𝛽𝛽𝛽4𝑖𝑖𝑖𝑖𝑙𝑙𝑙𝑙 𝒁𝒁𝒁𝒁𝑖𝑖𝑖𝑖 ∗ 𝑐𝑐𝑐𝑐
𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶
𝑖𝑖𝑖𝑖
refer to variabilit y due to differences across T = 2020 for the no-COV ID one.
𝜷𝜷𝜷𝜷𝒍𝒍𝒍𝒍households, based on their income level, and
𝒊𝒊𝒊𝒊 = (𝛽𝛽𝛽𝛽0𝑖𝑖𝑖𝑖𝑙𝑙𝑙𝑙 , 𝛽𝛽𝛽𝛽1𝑖𝑖𝑖𝑖𝑙𝑙𝑙𝑙 , 𝛽𝛽𝛽𝛽2𝑖𝑖𝑖𝑖𝑙𝑙𝑙𝑙 , 𝜷𝜷𝜷𝜷𝟑𝟑𝟑𝟑𝒍𝒍𝒍𝒍𝒍𝒍𝒍𝒍 , 𝛽𝛽𝛽𝛽4𝑖𝑖𝑖𝑖𝑙𝑙𝑙𝑙 )
E. Methodology for assessment of
� 𝑡𝑡𝑡𝑡 = 𝛼𝛼𝛼𝛼 + 𝛽𝛽𝛽𝛽1 𝐺𝐺𝐺𝐺𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷_𝑣𝑣𝑣𝑣𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃_𝑝𝑝𝑝𝑝𝑐𝑐𝑐𝑐𝑡𝑡𝑡𝑡 + 𝛽𝛽𝛽𝛽2 𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔_𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑖𝑖𝑖𝑖𝑒𝑒𝑒𝑒𝑡𝑡𝑡𝑡 + 𝛽𝛽𝛽𝛽3 𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑃𝑃𝑃𝑃_𝑅𝑅𝑅𝑅𝑒𝑒𝑒𝑒𝑒𝑒𝑒𝑒𝑒𝑒𝑒𝑒_𝐹𝐹𝐹𝐹𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑑𝑑𝑑𝑑𝑡𝑡𝑡𝑡 + 𝛽𝛽𝛽𝛽4 𝑥𝑥𝑥𝑥190_𝑊𝑊𝑊𝑊𝐴𝐴𝐴𝐴𝐴𝐴𝐴𝐴𝑡𝑡𝑡𝑡 + 𝛽𝛽𝛽𝛽5 𝑐𝑐𝑐𝑐𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑡𝑡𝑡𝑡 + 𝛽𝛽𝛽𝛽6 𝑝𝑝𝑝𝑝𝑃𝑃𝑃𝑃𝑝𝑝𝑝𝑝𝑡𝑡𝑡𝑡
variabilit
𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶 y across individuals based on differences
in sex, age, body mass and physical activit y level.
progress against nutrition targets at the
𝒃𝒃𝒃𝒃𝒊𝒊𝒊𝒊𝒊𝒊𝒊𝒊𝒍𝒍𝒍𝒍𝒊𝒊𝒊𝒊
C Vr is simply computed based on WPP
� 𝑡𝑡𝑡𝑡 + �𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶2019 − 𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶
𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝑡𝑡𝑡𝑡 = 𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶 � 2019 �, ∀𝑡𝑡𝑡𝑡 = 𝑊𝑊𝑊𝑊, … , 2030
regional and global level
population projected data (similarly to what we These methodological notes pertain to results
do for the MDER), 𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐶𝐶𝐶𝐶while𝑡𝑡𝑡𝑡 = [ C Vy is computed
𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷_𝐾𝐾𝐾𝐾𝑐𝑐𝑐𝑐𝐾𝐾𝐾𝐾𝑙𝑙𝑙𝑙 𝑡𝑡𝑡𝑡 + 𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷 using
2018 − presented
𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷_𝐾𝐾𝐾𝐾𝑐𝑐𝑐𝑐𝐾𝐾𝐾𝐾𝑙𝑙𝑙𝑙 2018 ] × in (1 Table 7, Figures
− 𝑊𝑊𝑊𝑊𝑊𝑊𝑊𝑊𝐷𝐷𝐷𝐷𝑊𝑊𝑊𝑊𝐷𝐷𝐷𝐷 𝑡𝑡𝑡𝑡 ) 10 and 11 in Section 2.3
a linear combination
𝐾𝐾𝐾𝐾𝑐𝑐𝑐𝑐𝐾𝐾𝐾𝐾𝑙𝑙𝑙𝑙𝑡𝑡𝑡𝑡 + 𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷2018 − 𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷_𝐾𝐾𝐾𝐾𝑐𝑐𝑐𝑐𝐾𝐾𝐾𝐾𝑙𝑙𝑙𝑙2018 × 1 − 𝑊𝑊𝑊𝑊𝑊𝑊𝑊𝑊𝐷𝐷𝐷𝐷𝑊𝑊𝑊𝑊𝐷𝐷𝐷𝐷𝑡𝑡𝑡𝑡 ] of (relevant macroeconomic ) of the report.
and demographic variables, based on the
estimated coefficients from a multiple regression For Table 7, progress was assessed against the
𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶
of = ��𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝑦𝑦𝑦𝑦2C Vy,
historic + 𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶 and
2
𝑟𝑟𝑟𝑟 �fed with the projections from 2030 nutrition targets established by UNICEF/
the MIR AGRODEP model and WPP. W HO 26 and an adapted version of rules from the
W HO-UNICEF Technical Expert Advisor y Group
on Nutrition
� 𝑡𝑡𝑡𝑡 = 𝛼𝛼𝛼𝛼 + 𝛽𝛽𝛽𝛽1 𝐺𝐺𝐺𝐺𝐷𝐷𝐷𝐷𝐷𝐷𝐷𝐷_𝑣𝑣𝑣𝑣𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃_𝑝𝑝𝑝𝑝𝑐𝑐𝑐𝑐𝑡𝑡𝑡𝑡 + 𝛽𝛽𝛽𝛽2 𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔_𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑖𝑖𝑖𝑖𝑒𝑒𝑒𝑒𝑡𝑡𝑡𝑡 + 𝛽𝛽𝛽𝛽3 𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑃𝑃𝑃𝑃_𝑅𝑅𝑅𝑅𝑒𝑒𝑒𝑒𝑒𝑒𝑒𝑒𝑒𝑒𝑒𝑒_𝐹𝐹𝐹𝐹𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑑𝑑𝑑𝑑
𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶 Monitoring
𝑡𝑡𝑡𝑡 + 𝛽𝛽𝛽𝛽4 𝑥𝑥𝑥𝑥190_𝑊𝑊𝑊𝑊𝐴𝐴𝐴𝐴𝐴𝐴𝐴𝐴 𝑡𝑡𝑡𝑡 + 𝛽𝛽𝛽𝛽5 𝑐𝑐𝑐𝑐𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑡𝑡𝑡𝑡 for
304
+ 𝛽𝛽𝛽𝛽6all indicators
𝑝𝑝𝑝𝑝𝑃𝑃𝑃𝑃𝑝𝑝𝑝𝑝𝑡𝑡𝑡𝑡

2 𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔 𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔_𝑔𝑔𝑔𝑔 𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑖𝑖𝑖𝑖𝑒𝑒𝑒𝑒𝑡𝑡𝑡𝑡 + 𝛽𝛽𝛽𝛽3 𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑔𝑔𝑔𝑔 𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑔𝑃𝑃𝑃𝑃_𝑅𝑅𝑅𝑅𝑒𝑒𝑒𝑒𝑒𝑒𝑒𝑒𝑒𝑒𝑒𝑒_𝐹𝐹𝐹𝐹𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑑𝑑𝑑𝑑 𝑡𝑡𝑡𝑡 + 𝛽𝛽𝛽𝛽

4 𝑥𝑥𝑥𝑥190_𝑊𝑊𝑊𝑊𝐴𝐴𝐴𝐴𝐴𝐴𝐴𝐴 𝑡𝑡𝑡𝑡 + 𝛽𝛽𝛽𝛽5 𝑐𝑐𝑐𝑐𝑃𝑃𝑃𝑃𝑃𝑃𝑃𝑃
𝑡𝑡𝑡𝑡 + 𝛽𝛽𝛽𝛽6 𝑝𝑝𝑝𝑝𝑃𝑃𝑃𝑃𝑝𝑝𝑝𝑝𝑡𝑡𝑡𝑡
except adult obesit y, where 2030 targets or
progress assessment rules have not been
� 𝑡𝑡𝑡𝑡 + �𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶2019 − 𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶
𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝑡𝑡𝑡𝑡 = 𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶 � 2019 �, ∀𝑡𝑡𝑡𝑡 = 𝑊𝑊𝑊𝑊, … , 2030
� �
𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝑡𝑡𝑡𝑡 + �𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶2019 − 𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶2019 �, ∀𝑡𝑡𝑡𝑡 = 𝑊𝑊𝑊𝑊, … , 2030 | 175 |
ANNEX 2

established. For adult obesit y, the 2025 target of variation in the progress to date to use the
“no increase between baseline (2012) and 2025” two categories for these indicators. For adult
was used. obesit y, since the target is “no increase”,
for which the required A A RR is ≥ 0, it is not
To determine which progress assessment categor y possible to have a categor y of “off track – some
to use for each indicator and each region, first, progress” (yellow) or “off track – no progress”
two distinct annual rates of reduction (A A R R) bb (light red) and therefore only “off track –
were calculated: (i) the A A RR required for the worsening” (dark red) is used.
region to reach the 2030 target; and (ii) the actual „ Assessment not possible: For the five indicators
A A R R that the region has experienced to date. based on countr y-modelled data (child
The value of the actual A A RR experienced to stunting, child overweight, low birthweight,
date was then used to determine which progress anaemia and adult obesit y), an assessment is
assessment categor y the region is assigned, while possible for all regions because a modelled
also considering the required A A RR. See Table A2.3 estimate exists for all countries, meaning there
for A A RR ranges and prevalence thresholds are enough data to generate representative
applied for each categor y and for each indicator, estimates for all regions and for all years.
brief ly: For indicators where countr y-modelled
estimates are not available, namely child
„ On track: regions with an actual AARR wasting and exclusive breastfeeding,
that is greater than the required AARR are assessment is not possible for regions where
categorized as being “on track” (green) to population coverage is < 50 percent (see notes
achieve the target. A static threshold for the 16 and 17 to Table A2.3).
latest prevalence, as noted for each indicator
in Table A2.3, is also used to categorize regions The years of data used to calculate the actual
as being “on track”; for example, any region A A RR experienced to date at the regional level
for which the most recent (2020) overweight var y by indicator, as specified in the footnotes
prevalence is below 3 percent is considered “on for Table A2.3. The actual A A RRs for each region
track”, even if its actual A A RR is less than its are calculated using a trendline comprised of
required A A R R. all estimates available between 2012 (baseline)
„ Off track: regions with an actual AARR and the latest estimate for each indicator,
that is less than the required AARR and for except for exclusive breastfeeding for which
which the latest prevalence is above the “on modelled estimates are not available and which is
track” static threshold noted in Table A2.3 are calculated using only two estimates: the baseline
considered “off track”. The “off track” categor y (2012) and the latest year available (2019).
is broken down into different sub-categories The required A A RR is calculated using the
depending on the indicator. For the four baseline prevalence for the region in 2012 and the
indicators of child stunting, child overweight, target prevalence as noted in the 2030 Maternal
child wasting, and anaemia among women, Infant and Young Child Nutrition targets 26 (e.g.
there are three off track sub-categories: “off for child overweight, the required is A A RR is
track – some progress” (yellow), “off track 3.41 percent per year at the global level, which
– no progress” (light red) and “off track – is the annual rate of change needed to go from
worsening” (dark red). For low birthweight the 2012 baseline prevalence of 5.6 percent to the
and exclusive breastfeeding, the categories of targeted 3.0 percent in 2030).
“off track – no progress” (light red) and “off
track – worsening” (dark red) are combined For Figure 10, the actual A A RRs calculated for each
into one categor y of “off track – no progress indicator and for each region for Table 7 were used
or worsening” which is represented with an in the formula below to generate a projected
orange colour because there is insufficient estimate for 2030 if the current trend from the
actual A A RR were to continue. A dotted line was
then drawn between the latest estimate (end of
bb  See technical note on how to calculate AARR at: https://data.
unicef.org/resources/technical-note-calculate-average-annual-rate- the solid line in the graph) and the projected
reduction-aarr-underweight-prevalence 2030 estimate.

| 176 |
 TABLE A2.3 RULES FOR PROGRESS ASSESSMENT AGAINST THE GLOBAL NUTRITION TARGETS
Exclusive Anaemia
Stunting Overweight Wasting Low breastfeeding1,2 (women of Obesity1
Indicator (< 5 years) (< 5 years) (< 5 years) birthweight1 (< 6 months) reproductive age) (adults)
2030 target Reduce the number of Reduce and maintain Reduce and maintain Reduce low Reduce non-exclusive Reduce anaemia 2025 target: No increase
children under 5 who are childhood overweight to childhood wasting to less birthweight breastfeeding among women of in adult obesity
stunted by 50% less than 3% than 3% prevalence by prevalence (< 6 reproductive age by prevalence between
30% months) to 30% 50% 2012 and 2025
On track AARR > required3 AARR > required5 AARR > required5 AARR > AARR > required9 AARR > AARR ≥ required
or prevalence < 3%4 or prevalence < 3%6 or prevalence < 3%6 required (i.e. or prevalence < required (i.e. (i.e. ≥ 0)12 or
1.96)7 or 30%10 3.78)11 or prevalence < 5%8
prevalence < prevalence
5%8 <5%8
Off track – AARR < required, AARR < required, AARR < required, AARR < 1.96 AARR < required, AARR < 3.78 AARR < 0.0
some progress but > 0.5 but > 1.5 but > 2.0 but > 0.5 but > 0.8 but > 0.5
Off track – -0.5 ≤ AARR < 0.5 -1.5 ≤ AARR < 1.5 -2.0 ≤ AARR < 2.0 AARR < 0.5 AARR < 0.8 -0.5 ≤ AARR <
no progress 0.5
Off track – AARR < -0.5 AARR < -1.5 AARR < -2.0 AARR < -0.5
worsening

THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2021

Assessment For regions: For regions: For regions: For regions: For regions: For regions: For regions:
not possible assessment is assessment is assessment not assessment is assessment not assessment is assessment is
possible for all possible for all possible when possible for possible when possible for all possible for all
regions13 regions13 regional population all regions13 regional regions13 regions13
| 177 |

For countries: For countries: coverage < 50%15 For countries: population For countries: For countries: not
assessment not assessment not For countries: not coverage < 50%17 not applicable applicable
possible when data possible when data assessment not applicable For countries: not
are insufficient14 are insufficient14 possible when data applicable
are insufficient 16

NOTES: 4. Regions where the stunting prevalence point 2012 (baseline year) and 2030. Actual AARR is stunting, overweight, low birthweight, anaemia 16. Progress assessment against the child
1. For low birthweight and exclusive estimate or lower 95 percent confidence interval calculated using only two estimates for the years among women of reproductive age, and adult wasting target is not conducted for countries
breastfeeding the categories of “off track – no for the year 2020 is < 3 percent are considered of 2012 and 2019, where the regional averages obesity are based on country-level models which which do not have at least two data points (e.g.
progress” (light red) and “off track – worsening” on track. are population weighted using the most recent provide annual estimates for all countries for household surveys) between 2005 and 2020, with
(dark red) are combined into one category of “off 5. The required AARR is based on the required estimate for each country between 2005 and generation of regional and global estimates at least one point being more recent than 2012.
track – no progress or worsening” which is change in overweight or wasting prevalence to 2012 for the 2012 estimate, and between 2014 to (i.e. annual estimates are even available for 17. Progress assessment is not possible for
represented with an orange colour, because there reduce from the baseline (2012) prevalence to 2019 for the 2019 estimate (except for China, countries without any household survey data, exclusive breastfeeding where the population
is insufficient variation in current progress to split 3 percent by 2030. Actual AARR is calculated using where a 2013 estimate is used for 2019 even in cases where country-modelled estimates coverage of country survey data for the region is
these categories for these indicators. For adult all years of data between 2012 and 2020. Note that aggregates). are not released to the public and used only for < 50 percent for the 2012 and/or the 2019
obesity, since the target is “no increase” for for wasting, unpublished trend estimates from the 10. Regions where the non-exclusive breastfeeding generation of global and regional estimates), estimate. For 2012, population coverage is
which the required AARR is ≥ 0, it is not possible JME are used to generate the actual AARR. prevalence point estimate for the year 2019 is thus making progress assessment possible for calculated by dividing the sum of the population
to have a category of “off track – some progress” 6. Regions where the overweight or wasting < 30 percent (i.e. where exclusive breastfeeding all regions. of children under 5 for countries with at least one
(yellow) or “off track – no progress” (light red) prevalence point estimate for the year 2020 is is ≥ 70 percent) are considered on track. 14. Progress assessment against the child data point from household surveys between 2005
and therefore only “off track – worsening” (dark < 3 percent are considered on track. 11. The required AARR is based on the change stunting and child overweight targets is not and 2012 by the total population of children
red) is used. 7. The required AARR is based on the change required to reduce the prevalence of anaemia conducted for countries which did not have any under 5 for all countries in the region. For 2019,
2. For exclusive breastfeeding, the actual target required to reduce the low birthweight prevalence among women of reproductive age by 50 percent input data (e.g. household survey data) to use in population coverage is calculated by dividing the
is to increase the prevalence of exclusive by 30 percent between 2012 (baseline year) and between 2012 (baseline year) and 2030. The the country model which were more recent than sum of the population of children under 5 for
breastfeeding (< 6 months) to 70 percent by 2030. The same AARR of 1.96 is required for all same AARR of 3.78 is required for all regions the year 2000, or for which modelled estimates countries with at least one data point from
2030; however, it has been revised here to reflect regions since the target requires a relative since the target requires a relative change remain pending final review. household surveys between 2014 and 2019
the prevalence of non-exclusive breastfeeding so change (reduction by 30 percent) in the baseline (halving) of the baseline value. Actual AARR is 15. Progress assessment is not possible for (except for China, where an estimate from a 2013
that the concept of the AARR can be applied as it value. Actual AARR is calculated using all years of calculated using all years of data between 2012 wasting for regions where population coverage is survey is used) by the total population of children
is for the other six targets. data between 2012 and 2015. and 2019. < 50 percent. Population coverage is calculated under 5 for all countries in the region.
3. The required AARR is based on the change in 8. Regions where the low birthweight prevalence 12. The required AARR is based on experiencing by dividing the sum of the population of children SOURCE: This table was made using information
stunting prevalence corresponding to a 50 point estimate for the year 2015, the anaemia “no increase” between 2012 (baseline year) and under 5 for countries with at least one data point from: (i) WHO & UNICEF. 2017. Methodology for
percent reduction in the number of children prevalence point estimate for the year 2019 or the 2030, which is an AARR of 0. Therefore, any from household surveys between 1990 and 2020 monitoring progress towards the global nutrition
affected by stunting between 2012 and 2030, adult obesity prevalence point estimate for the region with a trend that has shown any increase by the total population of children under 5 for all targets for 2025 – technical report; and (ii) WHO
considering the population growth estimated by year 2016 is < 5 percent, are considered on track. between 2012 and 2016 is labelled as “off track – countries in the region. Since wasting estimates & UNICEF. 2017. The extension of the 2025
the United Nations World Population Prospects. 9. The required AARR is based on the required worsening”. Actual AARR is calculated using all are generated with a subregional model, even one Maternal, Infant and Young Child nutrition targets
Actual AARR is calculated using all years of data change to decrease the non-exclusive years of data between 2012 and 2016. year of data between 1990 and 2020 counts to 2030. Geneva, Switzerland and New York,
between 2012 and 2020. breastfeeding prevalence to 30 percent between 13. The global databases for the five indicators of towards the regional population coverage. USA, WHO and UNICEF.
ANNEX 2

Projected estimate in 2030 if current trends which progress assessment is not possible.
continue = j * (1-a ^(2030 –2012)) At the countr y level, progress assessment
against the stunting and overweight targets
where: is not conducted for countries which did not
J = Baseline (2012) prevalence estimate have any input data (e.g. household sur vey
a = Actual A A RR data) to use in the countr y model post-2000, or
for which modelled estimates remain pending
For Figure 11, progress assessment at the countr y final review. For wasting, since a countr y-level
level is reported for child stunting, child model is not available, the calculation of the
overweight and child wasting. The methods A A RR is done using all available countr y data
applied for the countr y assessments for these (e.g. from household sur veys) between 2005
indicators largely follow those applied for the and 2020 in the 2021 JME countr y dataset
regional assessments in Table 7, described in the for countries with at least two data points, of
previous paragraphs and in Table A2.3. For the two which at least one was more recent than 2012.
indicators for which countr y modelled estimates Therefore, assessment against the wasting
are available, namely child stunting and child target is not possible for countries that do not
overweight, the only variation between the have at least two data points between 2005 and
assessment methods at the regional and countr y 2020, with at least one point being more recent
levels relate to designation of countries for than 2012. n

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ANNEX 3
COUNTRY EXPOSURE
TO THE DRIVERS AND
PoU CHANGE POINT
ANALYSIS IN CHAPTER 3

A. Occurrence of the three drivers is based on the Centre for Research on the
Occurrence of conflict Epidemiolog y of Disasters (EM-DAT). 326
Refers to the total number of violent conf licts
– caused by internal or intrastate conf licts – in Methodology: The four t y pologies of climate
each of the five subperiods (from 2000 to 2019), extremes have been updated from The State of
while the frequency is denoted by the percentage Food Security and Nutrition in the World 2018 3
of time, i.e. the number of years in each five-year (see Annex 2 for additional details) to cover most
subperiod when a countr y experienced a violent recent years. See Holleman et al. (2020). 4
conf lict ( Figure 15A).
Occurrence of economic downturns
Data sources: The Uppsala Conf lict Data Program Refers to the percentage of countries reporting
(UCDP) dataset 305 on the number of violent conflicts. a negative per capita GDP growth between two
successive years (annual % change) during the
Methodology: Information on conf licts has been period 2011–2021, with sub-Saharan Africa, Latin
updated from The State of Food Security and America and Western Asian countries being
Nutrition in the World 20171 (see Annex 2 for disproportionately affected ( Figure 15C).
additional details) to cover most recent years.
See Holleman et al. (2017). 2 Data sources: IMF World Economic Outlook
( W EO) time series (April 2021) 327 on per capita
Occurrence of climate extremes annual GDP.
Exposure to climate extremes refers to the
percentage of countries that experienced at least
one typolog y of climate extremes (drought, flood,
B. PoU change point analysis
heat spell, storm) in each subperiod from 2000 of the three drivers
to 2020 that includes three subperiods of five Increasing change points in the prevalence of
years: 2000–2004; 2005–2009; 2010–2014; and one undernourishment are identified for low- and
subperiod of six years: 2015–2020. High exposure middle-income countries when a subsequent
refers to countries that reported three or four increasing tendency in the PoU time series
different types of climate extremes during a given occurs. Specifically, the condition to identif y
subperiod ( Figure 15B). Frequency is denoted by the an increasing change point at time t, is an
percentage of time, i.e. the number of years in each increasing PoU trend from t-2 up to t+2. A PoU
subperiod when a country experienced at least one time series in years 2008 –2020 is used to identif y
typolog y of climate extremes. increasing change points in PoU between 2010
and 2018. The PoU time series has been revised
Data sources: Drought information is based on the in 2020. In particular, a discontinuit y in the
European Centre for Medium-Range Weather methodolog y used to estimate the dietar y energ y
Forecasts (ECMWF) 323 for years 2001–2005 (ER A5), consumption (DEC) has been introduced during
and on the Anomaly Hotspots of Agriculture years 2009–2010 in the revised version of the PoU
Production (ASAP) 324 for years 2006–2020. series, instead of years 2013 –2014 used in the
Flood information is based on the Climate Hazards previous version. This has implied a shift in the
Group Infrared Precipitation with Stations identification of years when an increasing PoU
(CHIRPS). 325 Heat spell information is based on change point occurred in the current analysis,
the European Centre for Medium-Range Weather compared to the analysis conducted in The State
Forecasts (ECMWF) 323 (ER A5). Storm information of Food Security and Nutrition in the World 2018. 3

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ANNEX 3

„ An increasing PoU change point associated „ An increasing PoU change point associated
with conf lict is identified for any year between with economic slowdowns and downturns is
2010 and 2018 when a countr y experiences identified when an economic slowdown or
an increasing PoU change point along with a downturn is reported in one of the two years
conf lict in at least one of the two subperiods before the occurrence of the PoU change point,
(2010 –2014 or 2015 –2019) while suffering for instance during 2015 –2016 or 2016 –2017 if
from 500 or more battle deaths during that the PoU change point occurs in 2017 ( Figure 17).
subperiod ( Figure 17).
„ An increasing PoU change point associated Methodology: The PoU change point analysis
with climate extremes is identified in the has been updated from The State of Food Security
year when a countr y reports an increasing and Nutrition in the World 2018 (see Annex 3 for
change point along with the occurrence of at additional details) 3 to cover most recent years.
least one of these extremes: i) a severe ASAP See Holleman et al. (2020). 4 n
drought warning of the most severe rank
(from 1 to 4); ii) a heat spell; iii) a f lood;
iv) a storm ( Figure 17).

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ANNEX 4
COUNTRY GROUP
DEFINITIONS AND
LISTS OF COUNTRIES
AFFECTED BY DRIVERS
IN CHAPTER 3

The analysis of Chapter 3 is focused on 133 low- and

B. Definition of countries affected by
middle-income countries and territories for which drivers (years 2010–2019)
relevant information on the key drivers of food Countries affected by conflict
insecurity is available. Following the latest World Refers to low- and middle-income countries and
Bank classification of income, of the 133 countries, territories affected by conf lict for at least one
29 are low-income, 50 are lower-middle-income and subperiod of five consecutive years and having
54 are upper-middle-income. Of the 133 countries, suffered 500 or more battle deaths during that
110 low- and middle-income countries have subperiod. The timeframe spans from 2000 to
information on the prevalence of undernourishment 2019, with four periods of five years: 2000 –2004;
for years 2010–2019. 2005 –2009; 2010 –2014; 2015 –2019. Of the
133 low- and middle-income countries, there are
40 low- and middle-income countries that meet
A. Definition of country groups these criteria.
Protracted crisis
The 2020 edition of this report defines protracted Data sources: The Uppsala Conf lict Data
crisis situations as “characterized by recurrent Program (UCDP) dataset 305 on the number of
natural disasters and/ or conflict, longevity of food violent conf licts.
crises, breakdown of livelihoods and insufficient
institutional capacity to react to the crises.” There Methodology: Information on conf licts has been
are three criteria used to define a country with updated from The State of Food Security and
a protracted crisis situation: (i) longevity of the Nutrition in the World 20171 (see Annex 2 for
crisis; (ii) humanitarian aid flow to the country; additional details) to cover most recent years.
and (iii) the country’s economic and food security See Holleman et al. (2017). 2
status. Specifically, the list of countries with a
protracted crisis situation includes those that meet Countries affected by climate extremes
the following three criteria: Refers to low- and middle-income countries
that experience a combination of high exposure
1. The countr y is a low-income food-deficit to climate extremes (i.e. drought, flood, heat
countr y (LIFDC), as defined by FAO in 2018. spell, storm) and v ulnerability to climate factors.
2. The countr y has faced a shock – either natural High exposure is defined when a countr y
or human-induced – for four consecutive years experiences three or four different typologies of
between 2016 and 2019, or for eight of ten climate extremes during the two subperiods of
years between 2010 and 2019, and is reported 2010 –2014 or 2015 –2019 or, alternatively, when
in the list of countries requiring external extremes occur for at least 7 years in 2010 –2019.
assistance for food. 306 Climate-related v ulnerability is identified when at
3. The countr y received more than 10 percent of least one of the following conditions occurs: i) a
total official development assistance (ODA) in countr y shows a high and statistically significant
the form of humanitarian assistance between association between cereal production or imports
2009 and 2017. 307 and at least one climate factor (temperature,
precipitation and vegetation growth) during years
For 2020, there are 22 countries that meet the 2001–2020; ii) a countr y is highly dependent on
above three criteria. agriculture, measured by 60 percent or more

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ANNEX 4

people employed in the agriculture sector in distribution, given information available

2019; iii) a countr y shows an increasing PoU during years 2010 –2018. Of the 133 low- and
change point in correspondence with a severe middle-income countries, there are 54 low- and
ASAP drought warning. Of the 133 low- and middle-income countries that meet these criteria.
middle-income countries, there are 75 low- and
middle-income countries that meet these criteria. Data sources: World Development Indicators of the
World Bank. 292
Data sources: Drought information is based
on the Anomaly Hotspots of Agriculture C. Definition of countries affected by
Production (ASAP). 324 Flood information is
based on the Climate Hazards Group Infrared
multiple drivers (years 2010–2019)
Precipitation with Stations (CHIRPS). 325 Heat Countries affected by multiple drivers are those
spell information is based on the European experiencing a combination of two or more drivers
Centre for Medium-Range Weather Forecasts during years 2010 –2019. Of the 133 low- and
(ECM W F) 323 (ER A5). Storm information is based middle-income countries, 41 are affected by the
on the Centre for Research on the Epidemiolog y following combinations of multiple drivers: conflict
of Disasters (EM-DAT). 326 and climate extremes (23 countries), conflict
and economic downturns (4 countries), climate
Methodology: Information on countries affected extremes and economic downturns (9 countries),
by climate extremes has been updated from The and all three drivers (5 countries).
State of Food Security and Nutrition in the World
2018 3 (see Annex 2 for definition of exposure and For the analysis in Chapter 3, however,
v ulnerabilit y to climate extremes) to cover most there are 110 countries (of the 133) with
recent years. See Holleman et al. (2020). 4 available information on the prevalence of
undernourishment, of which 36 countries are
Countries affected by economic downturns affected by multiple drivers. For the three regions
Refers to low- and middle-income countries analysed in Figure 23 (Africa, Asia, and Latin America
that experience an economic downturn in one and the Caribbean), around 36 percent (34 of 95)
of the two years before the occurrence of an of low- and middle-income countries affected by
increasing PoU change point, and during the drivers suffered from multiple drivers.
period 2010 –2018. Specifically, a PoU change
point characterized by an increasing tendency Furthermore, given the 110 countries, eight
between t-2 and t+2 is identified at time t, and it mutually exclusive groups denoting countries
should occur in correspondence with an economic affected by different drivers are created. These are
downturn reported at time t, or at time t-1. Of the ordered by severit y of PoU:
133 low- and middle-income countries, there are
24 low- and middle-income countries that meet 1. Conf lict, climate extremes and economic
these criteria. downturns (5)
2. Climate extremes and economic downturns (9)
Data sources: IMF World Economic Outlook 3. Conf lict (5)
( W EO) time series (April 2021) 327 on per capita 4. Economic downturns (6)
annual GDP. 5. Conf lict and climate extremes (18)
6. Conf lict and economic downturns (4)
Methodology: For the PoU change point analysis, 7. None of the three drivers (29)
see The State of Food Security and Nutrition in the 8. Climate extremes (34)
World 2018 (see Annex 3 for additional details) 3
and Holleman et al. (2017). 2 Figure A4.1 shows countries grouped by the eight
categories denoting different combinations of
Countries with high income inequality drivers and Table A4.1 provides the countr y list.
Refers to low- and middle-income countries Since the association between multiple drivers
that report a Gini index that is higher than and undernourishment is the key objective of
the median value of the income inequalit y Chapter 3, Figure A4.1 and Table A4.1 report information
for the 110 countries with available PoU. n
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 THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2021

FIGURE A4.1 COUNTRIES BY COMBINATION OF DRIVERS

COMBINATIONS OF DRIVERS
No data Conflict Conflict – Economic downturns
Climate extremes Conflict – Climate extremes Economic downturns
Climate extremes – Economic downturns Conflict – Climate extremes – Economic downturns None

NOTES: Of the 110 low- and middle-income countries, the figure shows eight mutually exclusive categories of low- and middle-income countries affected
by different combinations of drivers (conflict, climate extremes and economic downturns). The final boundary between the Republic of the Sudan and the
Republic of South Sudan has not been yet determined. The final status of the Abyei area, Jammu and Kashmir, and the Malvinas Islands have not yet been
determined. The boundaries shown on this map do not imply the expression of any opinion whatsoever on the part of FAO concerning the legal status of
any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers and boundaries. Dashed lines on maps represent
approximate border lines for which there may not yet be full agreement.
SOURCES: Violent conflict data based on Uppsala University. 2021. Uppsala Conflict Data Program (UCDP). In: UCDP [online]. Uppsala, Sweden. [Cited
10 June 2021]. ucdp.uu.se; for years 2000–2005 updated drought provided by EU-JRC using data from the European Commission. 2021. Anomaly
Hotspots of Agricultural Production (ASAP). In: ASAP [online]. Brussels. [Cited 10 June 2021]. mars.jrc.ec.europa.eu/asap; updated flood data provided
by UCT using Climate Hazards Center of the University of California – Santa Barbara. 2021. CHIRPS: Rainfall estimates from rain gauge and satellite
observations. In: CHIRPS [online]. Santa Barbara, USA. [Cited 10 June 2021]. www.chc.ucsb.edu/data/chirps; updated heat spell data provided by UCT
using data from the European Centre for Medium-Range Weather Forecasts (ECMWF). 2021. Datasets. In: ECMWF [online]. Reading, United Kingdom.
[Cited 10 June 2021]. www.ecmwf.int/en/forecasts/datasets; updated storm data based on Centre for Research on the Epidemiology of Disasters (CRED).
2021. EM-DAT: the international disasters database. In: EM-DAT [online]. Brussels. [Cited 10 June 2021]. public.emdat.be; annual per capita GDP based
on IMF. 2021. World Economic Outlook Database - April 2021. In: IMF [online]. Washington, DC. [Cited 10 June 2021]. www.imf.org/en/Publications/WEO/
weo-database/2021/April

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ANNEX 4

TABLE A4.1 LIST OF COUNTRIES BY COMBINATION OF DRIVERS

A. Countries affected by no B. Countries affected by C. Countries affected by D. Countries affected by
driver (N=29) conflict (N=5) climate extremes (N=34) economic downturns (N=6)
Low-income Low-income Low-income Lower-middle-income
Democratic People’s Republic
Burkina Faso Liberia Congo*
of Korea
Sierra Leone Mali Malawi* Kiribati
Togo* Lower-middle-income Mozambique* Vanuatu
Lower-middle-income Algeria Lower-middle-income Upper-middle-income
Benin* Cameroon* Bangladesh Dominica
Bolivia (Plurinational State of)* Upper-middle-income Cambodia Ecuador*
Cabo Verde* Iraq El Salvador Jordan
Comoros* Ghana*  
Djibouti*   Kenya*  
Eswatini*   Kyrgyzstan  
Lao People’s Democratic
Honduras*    
Republic
Papua New Guinea   Mauritania  
Sao Tome and Principe*   Mongolia  
Solomon Islands   Morocco*  
Timor-Leste   Nicaragua*  
Tunisia   Senegal*  
Upper-middle-income   United Republic of Tanzania*  
Azerbaijan   Viet Nam  
Belarus   Upper-middle-income  
Bosnia and Herzegovina   Albania  
Bulgaria*   Argentina  
Fiji   Armenia  
Gabon   Botswana*  
Guyana   Brazil*  
Kazakhstan   China  
Malaysia*   Costa Rica*  
Namibia*   Cuba  
North Macedonia   Dominican Republic*  
Samoa*   Guatemala*  
St. Vincent and the Grenadines   Jamaica  
Suriname   Mexico*  
    Montenegro*  
    Paraguay*  
    Peru*  
    Serbia  
    Turkmenistan  

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 THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2021

TABLE A4.1 (CONTINUED)

E. Countries affected by F. Countries affected by G. Countries affected by H. Countries affected by
conflict and climate extremes conflict and economic climate extremes and conflict, climate extremes and
(N=18) downturns (N=4) economic downturns (N=9) economic downturns (N=5)
Low-income Low-income Low-income Low-income
Chad* Sudan Gambia Afghanistan
Ethiopia Lower-middle-income Haiti* Central African Republic
Democratic Republic
Rwanda* Angola* Madagascar*
of the Congo*
Somalia Côte d’Ivoire* Lower-middle-income Yemen
Lower-middle-income Nepal Lesotho* Lower-middle-income
Egypt Upper-middle-income Nigeria
India Belize  
Myanmar   Iran (Islamic Republic of)*  
Pakistan   Lebanon  
Philippines*   South Africa*  
Venezuela (Bolivarian
Sri Lanka*    
Republic of)
Ukraine    
Uzbekistan    
Upper-middle-income      
Colombia*      
Georgia      
Indonesia      
Russian Federation      
Thailand      
Turkey*      

NOTES: The table shows the list of 110 low- and middle-income countries with information on PoU that are affected by different combinations of
drivers (conflict, climate extremes and economic downturns). Countries highlighted in yellow denote low-income food-deficit countries (LIFDCs), while
the asterisk denotes countries with high income inequality.
SOURCES: World Bank. 2021. World Development Indicators. In: World Bank [online]. Washington, DC. [Cited 24 April 2020]. datatopics.worldbank.
org/world-development-indicators for poverty and Gini index data; see sources of Figure A4.1 for drivers (conflict, climate extremes, economic
downturns).

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ANNEX 5
COUNTRY GROUP
DEFINITIONS FOR THE
ANALYSIS OF FOOD
INSECURITY AND
DRIVERS IN 2020

Given the exceptional situation related to 2. Countries in a food crisis situation where
the COV ID-19 pandemic in 2020, Chapter 3 conflict is the main driver of acute food
presents a separate analysis of the drivers of insecurity. There are 23 countries and
food insecurit y in 2019–2020 along with more territories with conflict/insecurity as the main
specific definitions. driver in 2020: Afghanistan, Bangladesh,
Burkina Faso, Cameroon, Central African
A. Countries with a high increase in food Republic, Chad, Democratic Republic of the
insecurity from 2019 to 2020 Congo, Eg ypt (Syrian refugees), Iraq, Jordan
(Syrian refugees), Lebanon (Syrian refugees),
Defined as low- and middle-income countries Libya, Mali, Niger, Nigeria, Pakistan, Palestine,
that report an increase in the prevalence of South Sudan, Syrian Arab Republic, Turkey
undernourishment from 2019 to 2020 that is higher (Syrian refugees), Uganda, Ukraine, Yemen.
than the increase experienced in the two previous
years, from 2017 to 2019. Of the 107 countries In Figure 19, countries affected by conflict are
with information available on PoU in 2019–2020, identified using one of the two criteria; in Figure 24,
66 countries report a higher increase in PoU in they are identified using only the second criterion.
2019–2020 compared to 2017–2019 ( Figure 19).
Data sources: The Uppsala Conf lict Data Program
B. Countries affected by economic (UCDP) dataset 305 on the number of violent
downturns conf licts. Global Report on Food Crises (2021) 75 for
the countries where conf lict is the main driver of
Defined as low- and middle-income countries food insecurit y.
that report a negative GDP per capita growth in
year 2020. D. Countries affected by climate extremes
Data sources: IMF World Economic Outlook
or climate-related disasters
( W EO) time series (April 2021) 327 on per capita Refers to low- and middle-income countries and
annual GDP. territories that meet one of two criteria:

C. Countries affected by conflict 1. Countries exposed to at least one t y polog y of

climate extremes (drought, f lood, heat spell) in
Refers to low- and middle-income countries and year 2020.
territories that meet one of two criteria: 2. Countries that experience any of the following
climate-related disasters in 2020: extreme
1. Countries affected by conf lict for at least one temperatures, f loods and storms, based on the
subperiod of five consecutive years and having EM-DAT datasets of medium- and large-scale
suffered 500 or more battle deaths during that disasters. Exposure to climate-related disasters
subperiod. We consider the two most recent is defined when in a given countr y/year one
periods of five year to define countries affected of the three disasters has produced at least
by conf lict in 2020: 2010 –2014 and 2015 –2019. one of the following effects: i) deaths of ten or
more people; ii) 100 or more people affected/

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 THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2021

injured/homeless; iii) declaration by the a breakdown of countries affected by different

countr y of a state of emergency or an appeal combinations of drivers. Of the 66 countries,
for international assistance. 8 countr y groups are affected by different
combinations of drivers, and one group is not
Data source: For year 2020, drought information is affected by drivers. These are:
based on the Anomaly Hotspots of Agriculture
Production (ASAP); 324 f lood information is 1. Economic downturns (11)
based on the Climate Hazards Group Infrared 2. Economic downturns and climate-related
Precipitation with Stations (CHIRPS); 325 heat disasters (19)
spell information is based on the European 3. Economic downturns, conf lict (food crisis) and
Centre for Medium-Range Weather Forecasts climate-related disasters (5)
(ECM W F) 323 (ER A5). Information on 4. Economic downturns, conf lict and
climate-related disasters (extreme temperatures, climate-related disasters (5)
f loods and storms) is based on the Centre for 5. Economic downturns and conf lict
Research on the Epidemiolog y of Disasters (food crisis) (2)
(EM-DAT). 326 6. Economic downturns and climate extremes (15)
7. Economic downturns, conf lict (food crisis) and
Methodology: Information on countries affected climate extremes (2)
by climate extremes has been updated from The 8. Economic downturns, conf lict and climate
State of Food Security and Nutrition in the World extremes (1)
2018 3 (see Annex 2 for definition of exposure and 9. No economic downturns (6)
v ulnerabilit y to climate extremes) to cover most
recent years. See Holleman et al. (2020). 4 Countries affected by economic downturns
combined with more extreme forms of
climate extremes (climate-related disasters)
E. Definition of countries affected by and/or conf lict (food crisis) show the highest
multiple drivers in 2020 increases in PoU between 2019 and 2020.
Due to the extraordinar y nature of the economic Of the 107 countries, there were 49 countries
recession related to the COV ID-19 pandemic, that meet this criteria in 2020. Figure 24 presents
there were economic downturns in most of increases in PoU between 2019 and 2020 for five
the countries in the world in 2020. Of the countr y groups:
107 countries with available information on
PoU and GDP per capita growth in 2019 and 1. Economic downturns (49)
2020, 66 countries experienced an increase in 2. Economic downturns and conf lict
PoU from 2019 to 2020 that was higher than (food crisis) (7)
the PoU increase from 2017 to 2019. Of these, 3. Economic downturns and climate-related
60 are affected by one or more combination of disasters (35)
drivers, including more severe forms of climate 4. All three drivers - economic downturns,
extremes (climate-related disasters) and conf lict climate-related disasters and conf lict
(food crisis countries where conf lict is the main (food crisis) (7)
driver of acute food insecurit y). Figure 19 presents 5. Countries without economic downturns (9). n

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ANNEX 6
GLOSSARY

Acute food insecurity obser ved values of the variable. For simplicit y,
Food insecurit y found in a specified area at both extreme weather events and extreme
a specific point in time and of a severit y that climate events are referred to collectively as
threatens lives or livelihoods, or both, regardless “climate extremes”. 310
of the causes, context or duration. Has relevance
in providing strategic g uidance to actions that Climate resilience
focus on short-term objectives to prevent, An approach to building and/or strengthening
mitigate or decrease severe food insecurit y. 308 resilience (see resilience definition below) that
addresses current or expected climate variabilit y
Affordability and changing average climate conditions.
Affordabilit y refers to the abilit y of people to buy
foods in their local environment. In this report, Climate shocks
cost refers to what people have to pay to secure Climate shocks include not only those
a healthy diet, while affordabilit y refers to the disturbances in the usual pattern of rainfall
cost relative to a person’s income, minus other and temperatures but also complex events like
required expenses. droughts and f loods. Equivalent to the concept
of a natural hazard or stress, they are exogenous
Animal source foods events that can have a negative impact on
All t ypes of meat, poultr y, fish, eggs, milk, food and nutrition securit y, depending on the
cheese and yoghurt, and other dair y products. v ulnerabilit y of an individual, a household, a
communit y, or systems to the shock. 311,312,313,314
Chronic food insecurity
Food insecurit y that persists over time Climate variability
mainly due to structural causes. Can include Refers to variations in the mean state and other
seasonal food insecurit y found in periods with statistics (standard deviations, the occurrence
non-exceptional conditions. Has relevance in of extremes, etc.) of the climate on all spatial
providing strategic g uidance to actions that focus and temporal scales beyond that of individual
on the medium- and long-term improvement of weather events. Variabilit y may be due to natural
the qualit y and quantit y of food consumption for internal processes within the climate system
an active and healthy life. 308 (internal variabilit y), or to variations in natural
or anthropogenic external forcing (external
Climate variabilit y). 309
Climate in a narrow sense is usually defined as
the average weather, or more rigorously, as the Conflict
statistical description in terms of the mean and Conf lict as used in this report is defined as
variabilit y of relevant quantities over a period struggles between interdependent groups that
of time ranging from months to thousands or have either actual or perceived incompatibilities
millions of years. 309 with respect to needs, values, goals, resources
or intentions. This definition includes (but is
Climate change broader than) armed conf lict – that is, organized
Climate change refers to a change in the state of collective violent confrontations between at
the climate that can be identified (e.g. by using least two groups, either state or non-state actors.
statistical tests) by changes in the mean and/or the This report focuses on conf licts that threaten or
variability of its properties, and that persists for entail violence or destruction, including where
an extended period, typically decades or longer. 309 fragilit y raises the risk of damaging conf licts and
where protracted crises persist.
Climate extreme (extreme weather or climate event)
The occurrence of a value of a weather or climate Diet quality
variable above (or below) a threshold value Comprised of four key aspects: variet y and/
near the upper (or lower) ends of the range of or diversit y (within and across food groups),

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 THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2021

adequacy (sufficiency of nutrients or food groups production, or conf lict that disrupts trade and
compared to requirements), moderation (foods production, are examples of supply-side shocks.
and nutrients that should be consumed with
restraint) and overall balance (composition of Economic slowdown
macronutrient intake). Exposure to food safet y Refers to economic activit y that is growing
hazards is another important qualit y aspect. at a slower pace compared with the previous
period. An economic slowdown occurs when
Dietary energy requirements real GDP growth declines from one period of
The amount of dietar y energ y required by an time to another but it is still positive. In the
individual to maintain body functions, health analyses and fig ures presented in this report, an
and normal activit y. Dietar y energ y requirements economic slowdown is identified using the year
are dependent upon age, sex, body size and level as the period of reference, although it is usually
of physical activit y. Additional energ y is required measured in quarters of a year.
to support optimal growth and development in
children and in women during pregnancy, and Energy-dense foods
for milk production during lactation, consistent Food with a high content of calories (energ y)
with the good health of mother and child. with respect to its mass or volume.

Drought Exposure
A period of abnormally dr y weather lasting The presence of people; livelihoods; species or
long enough to cause a serious hydrological ecosystems; environmental functions, ser vices
imbalance. 309 and resources; infrastructure; or economic, social
or cultural assets in places and settings that
Early warning system (EWS) could be adversely affected. 309
The set of capacities needed to generate and
disseminate timely and meaningful warning Extreme poverty
information so that individuals, communities and Refers to the percentage of the population living
organizations threatened by a hazard can prepare on less than USD 1.90 a day (2011 PPP prices) in
prompt and appropriate action to reduce the a countr y in a given year.
possibilit y of harm or loss. 309,310,315
Extreme weather or climate event
Economic downturn The occurrence of a value of a weather or
Refers to a period of decline in economic activit y climate variable above (or below) a threshold
or negative growth as measured by the growth value near the upper (or lower) ends of the
rate in real GDP. It is a synonym for economic range of obser ved values of the variable.
recession, a temporar y or short-term downturn Many weather and climate extremes are the
in economic growth, usually occurring over at result of natural climate variability, and natural
least two consecutive quarters of decline. In the decadal or multi-decadal variations in the
analyses and fig ures presented in this report, an climate provide the backdrop for anthropogenic
economic downturn is identified using the year climate changes. Even if there were no
as a period of reference. anthropogenic changes in climate, a wide
variet y of natural weather and climate extremes
Economic shock would still occur.
An unexpected or unpredictable event that
is external to the specific economy and can Flood
either harm or boost it. A global financial crisis The overf lowing of the normal confines
causing bank lending or credit to fall, or an of a stream or other body of water, or the
economic downturn in a major trading partner accumulation of water over areas not normally
of a countr y ref lect demand-side shocks that submerged. Floods include river (f luvial)
can have multiple effects on spending and f loods, f lash f loods, urban f loods, pluvial
investment. A steep rise in oil and gas prices, f loods, sewer f loods, coastal f loods and glacial
natural disasters that result in sharp falls in lake outburst f loods. 309

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ANNEX 6

Food Insecurity Experience Scale (FIES) stability is the condition in which the whole
An experience-based food securit y scale used to system is stable, thus ensuring that households
produce a measure of access to food at different are food secure at all times. Stability issues
levels of severit y that can be compared across can refer to short-term instability (which can
contexts. It relies on data obtained by asking lead to acute food insecurity) or medium- to
people, directly in sur veys, about the occurrence long-term instability (which can lead to chronic
of conditions and behaviours that are known to food insecurity). Climatic, economic, social and
ref lect constrained access to food. political factors can all be a source of instability.

Food security The report also refers to two additional

A situation that exists when all people, at all dimensions of food securit y that are proposed
times, have physical, social and economic access by the High Level Panel of Experts (HLPE) of
to sufficient, safe and nutritious food that the Committee on World Food Securit y (CFS);
meets their dietar y needs and food preferences however, they are not formally agreed upon by
for an active and healthy life. Based on this FAO or others, and there is not a negotiated
definition, four food securit y dimensions can agreed lang uage. However, due to their relevance
be identified: food availabilit y, economic and in the context of this report, they are included
physical access to food, food utilization and here. These two additional dimensions of food
stabilit y over time. The concept of food securit y securit y are reinforced in conceptual and legal
is evolving to recognize the centralit y of agency understandings of the right to food, and are
and sustainabilit y. See below for the definition of currently referred to and defined as follows:
these two additional elements.
e. Agency refers to the capacit y of individuals
Food security dimensions or groups to make their own decisions about
In this report, food securit y dimensions refer to what foods they eat; what foods they produce;
the four traditional dimensions of food securit y: how that food is produced, processed and
distributed within food systems; and their
a. Availabilit y – This dimension addresses abilit y to engage in processes that shape food
whether or not food is actually or potentially system policies and governance. 58
physically present, including aspects of f. Sustainabilit y refers to the long-term abilit y
production, food reser ves, markets and of food systems to provide food securit y and
transportation, and wild foods. nutrition in a way that does not compromise
b. Access – If food is actually or potentially the economic, social and environmental bases
physically present, the next question is that generate food securit y and nutrition for
whether or not households and individuals future generations. 58
have sufficient physical and economic access to
that food. Food systems
c. Utilization – If food is available and Food systems encompass the entire range
households have adequate access to it, the of actors and their interlinked value-adding
next question is whether or not households activities involved in the production, aggregation,
are maximizing the consumption of adequate processing, distribution, consumption and
nutrition and energ y. Sufficient energ y disposal of food products. They comprise all food
and nutrient intake by individuals is the products that originate from crop and livestock
result of good care and feeding practices, production, forestry, fisheries and aquaculture, as
food preparation, dietar y diversit y and well as the broader economic, societal and natural
intra-household distribution of food, environments in which these diverse production
clean water, sanitation and healthcare. systems are embedded. Agri-food systems, a term
Combined with good biological utilization of increasingly used in the context of transforming
food consumed, this determines the nutritional food systems for sustainability and inclusivity, are
status of individuals. broader as they encompass both agricultural and
d. Stability – If the dimensions of availability, food systems and focus on both food and non-food
access and utilization are sufficiently met, agricultural products, with clear overlaps.

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 THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2021

Fragility elements are also important: 1) infants should be

Fragilit y is defined as the combination of breastfed exclusively during the first 6 months of
exposure to risk and insufficient coping life; 2) infants should be breastfed continuously
capacities of the state, system and/or until 2 years of age and beyond; 3) from 6 months
communities to manage, absorb or mitigate those of age, breastmilk should be complemented with
risks. The new OECD fragilit y framework is a variet y of adequate, safe and nutrient-dense
built on five dimensions of fragilit y – economic, foods. Salt and sugars should not be added to
environmental, political, societal and securit y complementar y foods.
– and measures each through the accumulation
and combination of risks and capacit y. See OECD Heat spell
(2016). 89 A period of abnormally and uncomfortably hot
weather. 309
Hazard
A process, phenomenon or human activit y that Hidden costs
may cause loss of life, injur y or other health In this report, “hidden costs” of diets relate
impacts, propert y damage, social and economic to costs to human health and/or to the
disruption or environmental degradation. 316 environment associated with food production
Natural hazard is synonymous with “climate and consumption that are not accounted for in
shock” in this report. food prices and the cost of a diet. In the case of
human health, these hidden costs are usually
Healthcare “paid for” by the people who must live with
The organized provision of medical care to the consequences of eating foods that harm
individuals or a communit y. This includes human health, such as energ y-dense foods
ser vices provided to individuals or communities high in fats, sugars and/or salt that could lead
by health ser vice providers for the purpose to coronar y heart disease and/or diabetes.
of promoting, maintaining, monitoring or These hidden costs also include costs to health
restoring health. systems in treating non-communicable diseases
as a result of poor eating habits. In the case of
Healthy diet the environment, these hidden costs affect the
A balanced, diverse and appropriate selection of world as a whole and relate to the environmental
foods eaten over a period of time. A healthy diet impacts associated with food production and
protects against malnutrition in all its forms as consumption. These environmental impacts relate
well as NCDs, and ensures that the needs for to land, energ y and water use of food production
macronutrients (proteins, fats and carbohydrates and consumption, as well as impacts related
including dietar y fibres) and essential to climate change in terms of greenhouse gas
micronutrients (vitamins, minerals and trace (GHG) emissions and loss of food biodiversit y.
elements) are met specific to a person’s gender, See FAO, IFAD, UNICEF, W FP and W HO (2020). 7
age, physical activit y level and physiological
state. For diets to be healthy: 1) daily needs Hunger
of energ y and micronutrients should be met, Hunger is an uncomfortable or painful physical
but energ y intake should not exceed needs; 2) sensation caused by insufficient consumption of
consumption of fruits and vegetables should be at dietar y energ y. In this report, the term hunger
least 400 g per day; 3) intake of fats should be no is synonymous with chronic undernourishment
more than 30 percent of total energ y intake, with and is measured by the prevalence of
a shift in fat consumption away from saturated undernourishment (PoU).
fats to unsaturated fats and the elimination of
industrial trans fats; 4) intake of free sugars Macronutrients
should be less than 10 percent of total energ y Macronutrients are needed in larger quantities (in
intake or, preferably, no more than 5 percent; gram range) and are the major source of energ y
5) intake of salt should be less than 5 g per day. and bulk (volume) in our diets. They include
A healthy diet for infants and young children carbohydrates, protein and fats. They are a main
is similar to that for adults, but the following source of dietar y energ y, which is measured in

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ANNEX 6

calories. Getting sufficient energ y is essential Nutritional status

for ever yone in order to maintain body growth, The physiological state of an individual that
development and good health. Carbohydrates, results from the relationship between nutrient
protein and fats, in addition to providing energ y, intake and requirements and the body’s abilit y to
each have ver y specific functions in the body and digest, absorb and use these nutrients.
must be supplied in sufficient amounts to carr y
out those functions. Nutritious foods
Refers to those foods that tend to be high in
Malnutrition essential nutrients such as micronutrients, as well
An abnormal physiological condition caused as proteins, unrefined fibre-rich carbohydrates
by inadequate, unbalanced or excessive intake and/or unsaturated fats. They are low in sodium,
of macronutrients and/or micronutrients. free sugars, saturated fats and trans fats.
Malnutrition includes undernutrition (child
stunting and wasting, and vitamin and mineral Overweight and obesity
deficiencies) as well as overweight and obesit y. Defined as body weight that is above normal for
height as a result of an excessive accumulation
Micronutrients of fat. It is usually a manifestation of expending
Micronutrients include vitamins and minerals less energ y than is consumed. In adults,
and are required in ver y small (micro) but overweight is defined as a BMI of 25 kg/m 2 or
specific amounts. Vitamins and minerals in foods more, and obesit y as a BMI of 30 kg/m 2 or more.
are necessar y for the body to grow, develop and In children under five years of age, overweight
function properly, and are essential for our health is defined as weight-for-height greater than
and well-being. Our bodies require a number of 2 standard deviations above the W HO Child
different vitamins and minerals, each of which Growth Standards median, and obesit y as
has a specific function in the body and must be weight-for-height greater than 3 standard
supplied in different, sufficient amounts. deviations above the W HO Child Growth
Standards median.
Moderate food insecurity
Refers to the level of severit y of food insecurit y, Prevalence of undernourishment
based on the Food Insecurit y Experience Scale, An estimate of the proportion of the population
at which people face uncertainties about their that lacks enough dietar y energ y for a healthy,
abilit y to obtain food and have been forced to active life. It is FAO’s traditional indicator used to
reduce, at times during the year, the qualit y and/ monitor hunger at the global and regional level,
or quantit y of food they consume due to lack of as well as SDG Indicator 2.1.1.
money or other resources. It thus refers to a lack
of consistent access to food, which diminishes Resilience
dietar y qualit y, disrupts normal eating patterns, Resilience is the abilit y of individuals,
and can have negative consequences for nutrition, households, communities, cities, institutions,
health and well-being. systems and societies to prevent, resist, absorb,
adapt, respond and recover positively, efficiently
Nutrition transition and effectively when faced with a wide range of
As incomes rise and populations become more risks, while maintaining an acceptable level of
urban, diets high in complex carbohydrates and functioning and without compromising long-term
fibre give way to more energ y-dense diets high prospects for sustainable development, peace and
in fats, sugars and/or salt. These global dietar y securit y, human rights and well-being for all. 317
trends are accompanied by a demographic
transition with a shift towards increased life Risk
expectancy and reduced fertilit y rates. At the The probabilit y or likelihood of occurrence
same time, disease patterns move away from of hazardous events or trends multiplied by
infectious and nutrient-deficiency diseases the impacts if these events or trends occur.
towards higher rates of childhood obesit y, Risk to food insecurit y is the probabilit y of food
coronar y heart disease and some t ypes of cancer. insecurit y resulting from interactions between a

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 THE STATE OF FOOD SECURITY AND NUTRITION IN THE WORLD 2021

natural or human-induced hazard/shock/stress consumed as a result of repeated instances

and v ulnerable conditions. of disease. It includes being under weight for
one’s age, too short for one’s age (stunted),
Severe food insecurity dangerously thin for one’s height (suffering from
The level of severit y of food insecurit y at which wasting) and deficient in v itamins and minerals
people have likely run out of food, experienced (micronutrient deficiency).
hunger and, at the most extreme, gone for
days without eating, putting their health and Vulnerability
well-being at grave risk, based on the Food Refers to the conditions determined by physical,
Insecurit y Experience Scale. social, economic and environmental factors or
processes that increase the susceptibilit y of
Staple food an individual, communit y, assets or systems
A staple food is one that is eaten reg ularly, and in to the impacts of hazards. 316 Vulnerabilit y to
such quantities as to constitute the dominant part food insecurit y is the range of conditions that
of the diet and supply a major proportion of total increases the susceptibilit y of a household to
dietar y energ y. the impact on food securit y in case of a shock
or hazard.
Stunting
Low height-for-age, ref lecting a past episode or Wasting
episodes of sustained undernutrition. In children Low weight-for-height, generally the result
under five years of age, stunting is defined as of weight loss associated with a recent period
height-for-age less than -2 standard deviations of inadequate dietar y energ y intake and/or
below the W HO Child Growth Standards median. disease. In children under five years of age,
wasting is defined as weight-for-height less than
Undernourishment -2 standard deviations below the W HO Child
Undernourishment is defined as the condition in Growth Standards median.
which an individual’s habitual food consumption
is insufficient to provide the amount of dietar y Weather
energ y required to maintain a normal, active, Weather describes conditions of the atmosphere
healthy life. For the purposes of this report, over a short period of time (minutes to days),
hunger is defined as being synonymous with whereas climate is how the atmosphere
chronic undernourishment. behaves over relatively longer periods of time
(the long-term average of weather over time).
Undernutrition The difference between weather and climate
The outcome of poor nutritional intake in is a measure of time (see above definitions for
terms of quantit y and/or qualit y, and/or poor climate, climate change, climate variabilit y and
absorption and/or poor biolog ical use of nutrients climate extremes). 318 n

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NOTES
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NOTES ON GEOGRAPHIC REGIONS IN STATISTICAL TABLES
IN CHAPTER  2 AND ANNEXES 1 AND 2
Countries revise their official statistics Montserrat; Saint Barthélemy; San Marino. However, anaemia,
regularly for past periods as well as for Saint Martin (French Part); child stunting, overweight and low
the latest reporting period. The same Sint Maarten (Dutch part); and birthweight estimates include
holds for statistics presented in this Turks and Caicos Islands. San Marino.
report. Whenever this happens, Adult obesity, child wasting, low „ Western Europe: With respect to the
estimates are revised accordingly. birthweight and exclusive M49 classification, it excludes
Therefore, users are advised to refer to breastfeeding exclude Puerto Rico Liechtenstein and Monaco.
changes in estimates over time only and the United States Virgin However, child stunting,
within the same edition of The State of Islands. overweight, anaemia and low
Food Security and Nutrition in the World „ South America: With respect to the M49 birthweight estimates include
and refrain from comparing data classification, it excludes Bouvet Monaco.
published in editions for different years. Island, Falkland Islands (Malv inas),
French Guyana, and South Georgia Other groupings
Geographic regions and the South Sandwich Islands.
Least Developed Countries, Land
This publication follows the „ Australia and New Zealand: With respect to
Locked Developing Countries and
composition of geographic regions as the M49 classification, it excludes
Small Island Developing States
presented by the Statistics Division of Christmas Island, Cocos (Keeling)
groupings include the countries as
the United Nations Secretariat Islands, Heard and McDonald
presented by the Statistics Div ision of
primarily for use in its publications and Islands, and Norfolk Island.
the United Nations (https://unstats.
databases (https://unstats.un.org/unsd/ „ Melanesia: With respect to the M49 un.org/unsd/methodolog y/m49).
methodolog y/m49). The assignment of classification, anaemia, child
countries or areas to specific groupings wasting, stunting and overweight, Small Island Developing States: Estimates for
is for statistical convenience and does low birthweight and exclusive child stunting, wasting and
not imply any assumption regarding breastfeeding estimates exclude overweight, adult obesity, exclusive
political or other affiliation of New Caledonia. breastfeeding and low birthweight
countries or territories by the United „ Micronesia: With respect to the M49 exclude French Polynesia, Ang uilla,
Nations. Please refer to the list below classification, adult obesity, Aruba, Bonaire, Sint Eustatius and
for the country composition of each anaemia, child wasting, low Saba, British Virgin Islands, Curaçao,
region in Annexes 1 and 2 tables as birthweight and exclusive Montserrat, New Caledonia, Sint
well as in Tables 1–4 in Section 2.1. breastfeeding estimates exclude Maarten (Dutch part). In addition,
Guam, Northern Mariana Islands estimates for child wasting, adult
Countries, areas and territories for
and US Minor Outlying Islands. obesity, exclusive breastfeeding and
which there were insufficient or
Aggregates for child stunting and low birthweight also exclude
unreliable data for conducting the
overweight exclude only US Minor American Samoa and Puerto Rico.
assessment are not reported and not
Outlying Islands.
included in the aggregates. High-income, upper-middle-income,
Specifically: „ Polynesia: With respect to the M49
lower-middle-income and low-income countries
classification, it excludes Pitcairn
„ Northern Africa: In addition to the include the countries as presented
Islands, and Wallis and Futuna
countries listed in the table, PoU by the World Bank classification
Islands. Adult obesit y, child
and food insecurity based on the for the 2020 –2021 fiscal year
wasting, low birthweight and
FIES include an estimate for (https://datahelpdesk.worldbank.
exclusive breastfeeding estimates
Western Sahara. Child wasting, org/knowledgebase/articles/906519).
exclude American Samoa, French
stunting and overweight, low Polynesia and Tokelau (Associate Low-income food-deficit countries (2018):
birthweight, adult obesity, exclusive Member). Aggregates for child Afghanistan, Bangladesh, Benin,
breastfeeding and anaemia stunting and overweight exclude Burkina Faso, Burundi, Cameroon,
estimates exclude Western Sahara. only French Polynesia. Central African Republic, Chad,
„ Eastern Africa: With respect to the M49 „ Northern America: With respect to the Comoros, Congo, Côte d’Ivoire,
classification, it excludes British M49 classification, it excludes Saint Democratic People’s Republic of Korea,
Indian Ocean Territor y, French Pierre and Miquelon. Adult obesit y, the Democratic Republic of the Congo,
Southern and Antarctic Territories, anaemia, low birthweight and Djibouti, Eritrea, Ethiopia, the
Mayotte, and Réunion. exclusive breastfeeding aggregates Gambia, Ghana, Guinea,
„ Western Africa: With respect to the also exclude Bermuda and Guinea-Bissau, Haiti, India, Kenya,
M49 classification, it excludes Greenland. Aggregates for wasting Kyrg yzstan, Lesotho, Liberia,
Saint Helena. are based only on data for the Madagascar, Malawi, Mali,
„ Asia and Eastern Asia: With respect to the United States of America. Mauritania, Mozambique, Nepal,
M49 classification, low birthweight „ Northern Europe: With respect to the Nicaragua, the Niger, Rwanda, Sao
and child wasting aggregates M49 classification, it excludes Tome and Principe, Senegal, Sierra
exclude Japan. Å land Islands, Channel Islands, Leone, Solomon Islands, Somalia,
„ Caribbean: With respect to the M49 Faroe Islands (Associate Member), South Sudan, the Sudan, the Syrian
classification, it excludes Anguilla; Isle of Man, and Svalbard and Arab Republic, Tajikistan, Togo,
Aruba; Bonaire, Sint Eustatius and Jan Mayen Islands. Uganda, the United Republic of
Saba; British Virgin Islands; „ Southern Europe: With respect to the Tanzania, Uzbekistan, Viet Nam,
Cayman Islands; Curaçao; M49 classification, it excludes Yemen and Zimbabwe.
Guadeloupe; Martinique; Gibraltar, Holy See, and
Composition of geographic regions

AFRICA
Northern Africa: A lgeria, Eg y pt, Libya, Morocco, Sudan, Tunisia and Western Sahara.
Sub-Saharan Africa
Eastern Africa: Burundi, Comoros, Djibouti, Eritrea, Ethiopia, Kenya, Madagascar, Malawi, Mauritius, Mozambique,
Rwanda, Seychelles, Somalia, South Sudan, Uganda, United Republic of Tanzania, Zambia and Zimbabwe.
Middle Africa: Angola, Cameroon, Central African Republic, Chad, Congo, Democratic Republic of the Congo,
Equatorial Guinea, Gabon, and Sao Tome and Principe.
Southern Africa: Botswana, Eswatini, Lesotho, Namibia and South Africa.
Western Africa: Benin, Burkina Faso, Cabo Verde, Côte d’Ivoire, Gambia, Ghana, Guinea, Guinea-Bissau, Liberia, Mali,
Mauritania, Niger, Nigeria, Senegal, Sierra Leone and Togo.

ASIA
Central Asia: Kazakhstan, Ky rg yzstan, Tajikistan, Turkmenistan and Uzbekistan.
Eastern Asia: China, Democratic People’s Republic of Korea, Japan, Mongolia and Republic of Korea.
South-eastern Asia: Brunei Darussalam, Cambodia, Indonesia, Lao People’s Democratic Republic, Malaysia, Myanmar,
Philippines, Singapore, Thailand, Timor-Leste and Viet Nam.
Southern Asia: Afghanistan, Bangladesh, Bhutan, India, Iran (Islamic Republic of ), Maldives, Nepal, Pakistan
and Sri Lanka.
Western Asia: A rmenia, A zerbaijan, Bahrain, Cy prus, Georgia, Iraq, Israel, Jordan, Kuwait, Lebanon, Oman, Palestine,
Qatar, Saudi A rabia, Sy rian A rab Republic, Turkey, United A rab Emirates and Yemen.

LATIN AMERICA AND THE CARIBBEAN

Caribbean: Antig ua and Barbuda, Bahamas, Barbados, Cuba, Dominica, Dominican Republic, Grenada, Haiti, Jamaica,
Puerto Rico, Saint Kitts and Nev is, Saint Lucia, Saint Vincent and the Grenadines, and Trinidad and Tobago.
Latin America
Central America: Belize, Costa Rica, El Salvador, Guatemala, Honduras, Mexico, Nicarag ua and Panama.
South America: A rgentina, Boliv ia (Plurinational State of ), Brazil, Chile, Colombia, Ecuador, Guyana, Parag uay, Peru,
Suriname, Urug uay and Venezuela (Bolivarian Republic of ).

OCEANIA
Australia and New Zealand: Australia and New Zealand.
Oceania excluding Australia and New Zealand
Melanesia: Fiji, New Caledonia, Papua New Guinea, Solomon Islands and Vanuatu.
Micronesia: Kiribati, Marshall Islands, Micronesia (Federated States of ), Nauru and Palau.
Polynesia: American Samoa, Cook Islands, French Polynesia, Niue, Samoa, Tokelau, Tonga and Tuvalu.

NORTHERN AMERICA AND EUROPE

Northern America: Bermuda, Canada, Greenland and United States of America.
Europe
Eastern Europe: Belarus, Bulgaria, Czechia, Hungar y, Poland, Republic of Moldova, Romania, Russian Federation,
Slovakia and Ukraine.
Northern Europe: Denmark, Estonia, Finland, Iceland, Ireland, Lat v ia, Lithuania, Norway, Sweden, and
United Kingdom of Great Britain and Northern Ireland.
Southern Europe: A lbania, Andorra, Bosnia and Herzegov ina, Croatia, Greece, Italy, Malta, Montenegro,
North Macedonia, Portugal, Serbia, Slovenia and Spain.
Western Europe: Austria, Belgium, France, Germany, Luxembourg, Netherlands and Switzerland.
 THE STATE OF
FOOD SECURITY
AND NUTRITION
IN THE WORLD
TRANSFORMING FOOD SYSTEMS
FOR FOOD SECURITY, IMPROVED NUTRITION
AND AFFORDABLE HEALTHY DIETS FOR ALL
In recent years, several major drivers have put the world off track to ending world hunger and
malnutrition in all its forms by 2030. The challenges have only grown with the COVID-19 pandemic
and related containment measures. This report presents the first global assessment of food
insecurity and malnutrition for 2020 and offers some indication of what hunger might look like by
2030, in a scenario further complicated by the enduring effects of the COVID-19 pandemic. It also
includes new estimates of the cost and affordability of healthy diets, which provide an important
link between the food security and nutrition indicators and the analysis of their trends. Altogether,
the report highlights the need for a deeper reflection on how to better address the global food
security and nutrition situation.

To understand how hunger and malnutrition have reached these critical levels, this report draws on
the analyses of the past four editions, which have produced a vast, evidence-based body of
knowledge of the major drivers behind the recent changes in food security and nutrition. These
drivers, which are increasing in frequency and intensity, include conflicts, climate variability and
extremes, and economic slowdowns and downturns – all exacerbated by the underlying causes of
poverty and very high and persistent levels of inequality. In addition, millions of people around the
world suffer from food insecurity and different forms of malnutrition because they cannot afford
the cost of healthy diets. From a synthesized understanding of this knowledge, updates and
additional analyses are generated to create a holistic view of the combined effects of these drivers,
both on each other and on food systems, and how they negatively affect food security and nutrition
around the world.

In turn, the evidence informs an in-depth look at how to move from silo solutions to integrated food
systems solutions. In this regard, the report proposes transformative pathways that specifically
address the challenges posed by the major drivers, also highlighting the types of policy and
investment portfolios required to transform food systems for food security, improved nutrition and
affordable healthy diets for all. The report observes that, while the pandemic has caused major
setbacks, there is much to be learned from the vulnerabilities and inequalities it laid bare. If taken
to heart, these new insights and wisdom can help get the world back on track towards the goal of
ending hunger, food insecurity and malnutrition in all its forms. To that end, this global report
provides a clear diagnostic to put in place the policies needed.