Malnutrition

Malnutrition
The orange ribbon—an awareness ribbon for malnutrition.

Malnutrition is a general term for a medical condition caused by an improper or inadequate diet and nutrition.

According to the World Health Organization, hunger and malnutrition are the single gravest threats to the world's public health and malnutrition is by far the biggest contributor to child mortality, present in half of all cases.

In addition to infant mortality risks, lifelong malnutrition can begin in utero and is typically associated with the mother's stature (associated with her childhood nutritional status), her nutritional status prior to conception, and diarrheal disease, intestinal parasites, and/or respiratory infection status. Multiple studies have shown that nutritional status of adults is substantially influenced by their nutritional experience from conception through early childhood. Even if individuals have had adequate nutrition from childhood on, their health outcomes are still impacted.

Causes of Malnutrition

Sociopolitical

In the late eighteenth and early nineteenth century, the English economist Thomas Malthus noted how increases in food production were likely to occur along a slow arithmetic progression due to the law of diminishing returns while population growth follows much faster, geometric progressions. His theory argued that this lag in productivity caused food shortages, that it would lead to famines worldwide as humans surpassed the carrying capacity of the land, and that it would create checks on socio-cultural systems in the forms of poverty and misery as humans would earn and live off of just enough to subsist and survive. This Malthusian argument has long since been refuted on several grounds but has none the less served as a backdrop for understanding of the causes of malnutrition.

The actual causes of malnutrition can be varied and complex and are difficult to encapsulate in a single theory. Certainly, as Malthus suggests, lack of agricultural productivity combined with increases in population can cause and are often correlated to malnutrition. Over-cultivation, overgrazing, and deforestation lead to desertification or otherwise impoverished soils that can not support crops or cattle for subsistence agriculture but this scenario only accounts for malnutrition in certain, specific instances and does not consider larger social issues such as the influence of political inequality. Further, malnutrition can stem from impacts of natural disasters, from the results of conflict and war, as an impact of the HIV/AIDS pandemic as a consequence of other health issues such as diarrheal disease or chronic illness from lack of education regarding proper nutrition, or from countless other potential factors.

Various scales of analysis also have to be considered in order to determine the sociopolitical causes of malnutrition. For example, the population of a community may be at risk if it lacks health-related services, but on a smaller scale certain households or individuals may be at even higher risk due to differences in income levels, access to land, or levels of education. Also within the household, there may be differences in levels of malnutrition between men and women, and these differences have been shown to vary significantly from one region to another with problem areas showing relative deprivation of women. Children and the elderly tend to be especially susceptible. Approximately 27 percent of children under 5 in developing world are malnourished, and in these developing countries, malnutrition claims about half of the 10 million deaths each year of children under 5.

Often the consequences of malnutrition exacerbate its causes and form a vicious downward spiral. For example, in cases of malnourishment, lack of sufficient nutrients can weaken the immune system and invite infectious disease , and by compromising digestive function, many of these diseases can intensify malnutrition. In communities or areas that lack access to safe drinking water, these additional health risks present a critical problem. Lower energy and impaired function of the brain also represent the downward spiral of malnutrition as victims are less able to perform the tasks they need to in order to acquire food, earn an income, or gain an education.

Since the time of Malthus, various new theories and approaches have developed for understanding the truly complex mechanisms and underlying causes of malnutrition. Most famous among recent theorists is the Indian economist and philosopher Amartya Sen whose breakthrough 1981 book Poverty and Famines: An Essay on Entitlement and Deprivation went beyond the Malthusian argument that lack of food production led to hunger and demonstrated that malnutrition and famine were more related to problems of food distribution A person’s entitlements, according to Sen, are “commodity bundles that a person in society can command using the totality of rights and opportunities that he or she faces,” (p.8) and famine can then be described as a collapse of entitlements for a certain segment of society and the failure of the state to protect those entitlements.

South Asia

According to the Global Hunger Index, South Asia has the highest child malnutrition rate of world's regions. India contributes to about 5.6 million child deaths every year, more than half the world's total. The 2006 report mentioned that "the low status of women in South Asian countries and their lack of nutritional knowledge are important determinants of high prevalence of underweight children in the region" and was concerned that South Asia has "inadequate feeding and caring practices for young children".

Half of children in India are underweight, one of the highest rates in the world and nearly double the rate of Sub-Saharan Africa.

Effects

Mortality due to malnutrition

• 1 person dies every second as a result of hunger - 4000 every hour - 100 000 each day - 36 million each year - 58 % of all deaths (2001-2004 estimates).
• 1 child dies every 5 seconds as a result of hunger - 700 every hour - 16 000 each day - 6 million each year - 60% of all child deaths (2002-2008 estimates).

According to the World Health Organization, hunger is the gravest single threat to the world's public health. According to Jean Ziegler (the United Nations Special Rapporteur on the Right to Food for 2000 to March 2008), mortality due to malnutrition accounted for 58% of the total mortality in 2006: "In the world, approximately 62 millions people, all causes of death combined, die each year. One in twelve people worldwide are malnourished. In 2006, more than 36 millions died of hunger or diseases due to deficiencies in micronutrients". The World Health Organization estimates that one-third of the world is well-fed, one-third is under-fed and one-third is starving.

Hunger and malnutrition have an even bigger impact on children’s health than was previously thought. According to the World Health Organization, malnutrition is by far the biggest contributor to child mortality, present in half of all cases. Underweight births and inter-uterine growth restrictions cause 2.2 million child deaths a year. Poor or non-existent breastfeeding causes another 1.4 million. Other deficiencies, such as lack of vitamin A or zinc, for example, account for 1 million. According to The Lancet, malnutrition in the first two years is irreversible. Malnourished children grow up with worse health and lower educational achievements. Their own children also tend to be smaller. Hunger was previously seen as something that exacerbates the problems of diseases such as measles, pneumonia and diarrhea. But malnutrition actually causes diseases as well, and can be fatal in its own right. This is the impact The Lancet seeks to identify.

Children are not only affected by the consequences of malnourishment, but the societies they live in suffer as well. Both severe and moderate cases of malnutrition have a significant impact on the outcomes children face for the remainder of their lives and are also a cause of severe illnesses leading to growth retardation both physical and mental, and possibly death. The risk of death is not limited to only those who suffer from severe forms of malnutrition, though the risk of death is higher among severely malnourished children. Considering the elevated risks of mortality among children that are associated with moderate forms of malnutrition, combined with a high prevalence worldwide, it would seem more appropriate to distinguish that the deaths of children as a result of malnourishment is attributable to moderate, rather than severe conditions of malnutrition. Another factor that largely keeps malnutrition from being properly treated is a lack of education in many developing countries. This lack of education allows cultures of superstitions to persist. For example, in some cases in China, breast-feeding started at a very late stage. As such, there is an increasing wide effort to implement an access for education about proper feeding methods.

Biological effects

An extended period of malnutrition can result in starvation or deficiency diseases such as scurvy. Malnutrition increases the risk of infection and infectious disease; for example, it is a major risk factor in the onset of active tuberculosis.

Malnutrition appears to increase activity and movement in many animals - for example an experiment on spiders showed increased activity and predation in starved spiders, resulting in larger weight gain. This pattern is seen in many animals, including humans while sleeping. It even occurs in rats with their cerebral cortex or stomachs completely removed. Increased activity on hamster wheels occurred when rats were deprived not only of food, but also water or B vitamins such as thiamine This response may increase the animal's chance of finding food, though it has also been speculated the emigration response relieves pressure on the home population.

Responses to malnutrition

Societal responses to malnutrition vary depending upon which factor one subscribes to as the primary cause of hunger and malnutrition. While most responses are targeted to address undernutrition, there are several that also respond to overnutrition.

If the principal cause of malnutrition is that humans have populated the earth (or a specific geographic region) beyond its carrying capacity, then a restricted population size is the solution. This is an argument that is espoused by people of both liberal and conservative persuasions. In the late 1700’s, Thomas Malthus originally argued that nothing could be done as only natural disasters could check population growth, but he later included the possibility of voluntary limits through “moral restraint.”1 More recently, Robert Chapman suggests that an intervention through government policies is a necessary ingredient of curtailing global population growth. Garret Hardin takes an anti-immigration, isolationist approach arguing that “…all sovereign states must accept the responsibility of solving their population problems in their own territories.” Hardin also asserts that immigration acts as a sort of pressure release valve which allows countries to continue to ignore solving their population problems.

Others, Amartya Sen among them, argue that other social and economic factors, such as declining wages, unemployment, rising food prices, and poor food-distribution systems, rather than population numbers per se, lead to malnutrition and in severe cases famine. For Sen, “no matter how a famine is caused, methods of breaking it call for a large supply of food in the public distribution system. This applies not only to organizing rationing and control, but also to undertaking work programmes and other methods of increasing purchasing power for those hit by shifts in exchange entitlements in a general inflationary situation.”

One suggested policy framework to resolve access issues is termed food sovereignty, the right of peoples to define their own food, agriculture, livestock, and fisheries systems in contrast to having food largely subjected to international market forces. Food First is one of the primary think tanks working to build support for food sovereignty.

One policy adopted in recent decades to alleviate world malnutrition is direct humanitarian aid in the form of food. For the rich donor countries, this is a way to reduce domestic excess supply created by domestic agricultural subsidies, stabilizing farm prices in rich countries, even if the cost of supplying the food to its final beneficiaries is high. Food aid may be provided for short-term emergencies (natural disasters or human-made like war) or in the form of a long-term program for an extended period. For recipient countries, emergency food aid is welcome, though aid in cash may also be welcome because the food may often be purchased locally in zones not affected by the emergency, thus benefitting local farmers. Long-term foreign food aid has been criticized as discouraging local production and distorting markets.

Neoliberals advocate for an increasing role of the free market. The World Bank itself claims to be part of the solution to malnutrition, asserting that the best way for countries to succeed in breaking the cycle of poverty and malnutrition is to build export-led economies that will give them the financial means to buy foodstuffs on the world market.

There are several different technical approaches in combating under-nutrition including nutritional education and medical nutrition which consists of micro-nutrient supplementation, immunizations and food fortifications. Nutritional education is a preventative measure that focuses on raising awareness on what foods are necessary for the body to gain the nutrients needed to function. In recent years many foods, such as Spirulina and peanut butter, have been developed or refined for mass-production in hopes of combating malnutrition and its effects. Foodstuffs are usually selected that allow the supplementing of the required daily 2000kcal, as well as the requirements in proteïn and other micro-nutrients. These allow the curing of protein-energy malnutrition. See IIMSAM and Plumpy'nut for more on these efforts.

Climate Change and Malnutrition

With 95% of all malnourished peoples living in the relatively stable climate region of the sub-tropics and tropics, climate change is of great importance to food security in these regions. According to the latest IPCC reports, temperature increases in these regions are "very likely." Even small changes in temperatures can lead to increased frequency of extreme weather conditions. Many of these have great impact on agricultural production and hence nutrition. For example, the 1998-2001 central Asian drought brought about an 80% livestock loss and 50% reduction in wheat and barley crops in Iran. Similar figures were present in other nations. An increase in extreme weather such as drought in regions such as Sub-Saharan would have even greater consequences in terms of malnutrition. Even without an increase of extreme weather events, a simple increase in temperature reduces the productiveness of many crop species, also decreasing food security in these regions.