Hidden Hunger: Unhealthy Food Markets in the Developing World

World population is expected to grow by another 2 billion in just 37 years, creating unprecedented demand for food. The UN projects that Asia’s population will grow from 4.2 billion today to 5.9 billion by 2050 and that urban Africa will go from 414 million to more than 1.2 billion by then.[1] To keep up with this growth, FAO forecasts that food production should increase by 70% by 2050. Over the same period, food prices are likely to increase due to a combination of increasing forces.[2] It is not clear that food nutrient density will keep pace with human needs.
Although the share of people in the world who are hungry has fallen from over 30% in 1970 (when world population was 3.7 billion) to 15% today (with world population at 7 billion) — the vast majority of whom are in Africa and Asia — concerns are increasing over the variety and nutritional quality of food. FAO estimates that 30% (2 billion people) suffer from “hidden hunger.”[3] This is a situation in which the intake of calories is sufficient but the amount of vitamins and minerals is not. Some researchers argue that industrial agriculture reduces the nutrient content of crops, thus escalating the risk of hidden hunger. The International Food Policy Research Institute’s Global Hunger Index report notes that many of the unhealthy food conditions in the developing world are related to poor government social policies, income inequalities, inefficient farming, post-traumatic stress following civil wars, and the low status and educational level of women.

Many trends affect the worldwide nutritional picture. Rising affluence in emerging economies gives people access to more-varied diets. In this setting, food companies attempt to conquer new markets, and competition for agricultural land among food and energy producers increases. Food prices, driven by growing demand, climate change, and monopolization, rise, and land-grabbing increasingly threatens the livelihood of many poor people. GMOs and monocultures expand, and rapid urbanization, female participation in the cash economy, and societal changes are shifting culinary traditions. These and other emerging factors increasingly challenge the nutritional qualities of the world’s food, with health, development, and social consequences. While global childhood mortality and undernourishment have dropped, chronic diseases of the adult population are of increasing concern in poor and middle-income countries, causing about 80% of deaths.[4]

The World Bank notes that reliance on staple crops with technological production requirements makes the developing world vulnerable to volatile supply shocks that raise the price of food for the poor.[5] A concentration of power gives the agricultural biotechnology companies a near monopoly over a large part of global food, undermining small farming and farmers’ rights and most probably driving up costs. Although 95% of the world’s farmers live in the developing world, producing the majority of the world’s food, they are the poorest and most vulnerable to hidden hunger. Hidden hunger is an impediment to development, and poverty is a factor in hidden hunger.

As a result of all these long-term, complex challenges, The Millennium Project welcomed the opportunity to conduct an initial two-month study for the Rockefeller Foundation on the issues and prospects for unhealthy food markets in the developing world, with special attention to Asia and Africa. An on-line questionnaire, called a Real-Time Delphi,[6] was designed to collect judgments about developments that could affect the future of food and nutrition in developing countries, their seriousness, potential time frames, and innovative solutions and strategies for addressing those possibilities by encouraging the positive and countering the negative. It also asked questions about the potential effectiveness of funding by foundations of different actions for improving the state of food nutrition. A total of 124 people from 25 countries logged on to the RTD. Of these, 95 people provided 5,426 answers.

Based on the average responses of the panel, all dimensions of the problem of “hidden hunger” are becoming more serious. In order of increasing severity, they are water scarcity, biodiversity deterioration, loss and/or degradation of farmland, agribusiness and food market monopolies, low income-to-food-price ratio, expansion of monoculture, food waste, lack of access to food with adequate micronutrient content, and dietary culture.
The panel was asked to rate a list of potential root causes. In order of importance as rated by the panel, these were low income-to-food-price ratio, lack of access to food with adequate micronutrients content, agribusiness and food market monopolies, biodiversity deterioration, water scarcity, loss of farmland, dietary culture, expansion of monoculture, and food waste.

All the factors that might account for micronutrient deficiencies seem to be worsening simultaneously, and those worsening the most were judged to be the most serious. For example, low income-to-food-price ratio was seen to be increasing in severity and a very important root cause compared with other factors; hence it should be given high priority in efforts to counter hidden hunger. Figures 1 and 2 below display the panel’s ratings of both dimensions: causes that are worsening and their apparent seriousness. Because of space constrains, only the most extreme items are identified.

Figure 1. Seriousness versus Worsening of Root Causes of Micronutrient Deficiencies

As for inexpensive low nutritional value foods, the most serious root cause was also seen to be the most worsening one: expansion of fast-food chains and the processed food market, followed closely by corporate marketing and profitability of low-value foods. Interestingly, the items judged to be the more important root causes were also seen as increasing in their severity.

Figure 2. Seriousness versus Worsening of Root Causes of Inexpensive Food

Low Nutritional Value Foods
An open-ended question asked respondents to identify forces that might delay improvements to unhealthy food markets in developing countries. Over 50 comments were received. A more detailed list is in the full report in GFIS. Following is a distillation of those comments:

• Lack of education of farmers; obsolete farming, transportation, and storage
• Agribusiness monopolies of new genetically modified seeds
• Low living standards in rural areas
• Increased application of restrictive food standards that rely on physical characteristics such as color, shape, and size rather than measurable food quality
• Expanded use of GMOs that are less nutritious[7] and that displace local varieties and species
• Improper use of transgenic crops
• Growth in the use of pesticides, hormones, vaccines, and petroleum-based fertilizers
• Soil contamination and degradation
• Expansion of monoculture and reduction of food diversity, particularly among smallholder farmers
• Inequitable access to land (plus land-grabbing)
• Insufficient information in the food industry about the health consequences of the food they produce
• Sugar addiction
• Poverty
• Corruption
• Insufficient attention by the governments to food and nutrition
• High food prices
• Vested interests in subsidy systems
• Commodity prices increasing from a combination of lower supply, increased demand, and suspension of GMO research (which if successful could lead to healthier and less toxic foods)
• Worldwide speculation in food and agricultural commodities
• Blindly following the example of the food industry in industrial countries
• Successful marketing campaigns for fast foods
• Expansion of fast-food chains
• Increasing awareness of unhealthy foods in industrial countries leading the manufacturers of less healthy foods to increase exports and dump their stock in developing nations
• Lack of nutritional knowledge coupled with increased purchasing power creating a larger demand for unhealthy processed foods, which in turn will create price drops in processed foods, making them more available to all in developing countries
• Allowing the production and sale of foods engineered to cause people to overeat (salt-sugar combinations common in fast-food menus)

The panel gave 4,419 numeric answers and entered 1,054 comments and suggestions to address the range of problems and causes associated with unhealthy developing-world food markets, with special attention to Asia and Africa. These are detailed in the full report in GFIS. The following is a distillation of the suggestions, grouped in the categories public policy, economic policy incentives, science and technology, business-oriented, education, farming practices, and general culture-related.

Public Policy

• Introduce national agricultural policies that support local farming over exports for satisfying local needs.
• Create and require an icon for unhealthy foods (like those for poison or radioactivity) for marking beverages, foods, and packaged meals.
• Develop industry standards for minimum nutritional value of foods.
• Legislate that low nutritional foods should have a high price and information on health effects stamped on their packages, as there are for cigarettes.
• Limit advertising of foods that do not meet certain nutritional criteria; this would most strictly apply to fast-food restaurants whose advertising is ubiquitous and misleading in regards to nutritional value.
• Base food aid on healthy and highly nutritious food and measure it not by tons of food but by calories, proteins, and so on per person.
• Manage food aid to avoid undermining the market for local and regional production.
• Fight corruption, which sometimes plays an important role in allowing certain chains to exploit markets in developing countries.
• Regulate low-quality foods such as soft drinks.
• Designate local, provincial, and territorial GE-free zones; ban the introduction of new GE products until approved by thorough research and the public.
• Improve the regulation of food advertising.
• Establish and rigorously enforce government nutrition standards that would limit the amount of sugars, carbohydrates, and salts in foods.
• Outlaw chemical preservatives and additives.
• Establish global organic food quality standards.
• Internationally prohibit or limit the use of agricultural food resources, especially corn, to produce biofuels.
• Develop systems, procedures, and industry standards for certifying food quality and nutrition.
• Ratify and enforce multilateral environmental regulations.
• Agree at the WTO and FAO to pursue innovative strategies of the sorts discussed here.

Economic Policy Incentives

• Tax inexpensive low nutritional foods and use the money raised to subsidize (and thus reduce the price) of healthy foods.
• Penalize or restrict speculative activities in food markets.
• Effectively end agribusiness and food market monopolies.
• Subsidize healthy, nutritionally balanced food production.
• Introduce national and international regulations and standards for nutritional value, food production, processing, logistics and supply chains.
• Establish standards, labeling, and independent monitoring that are endorsed by 50% of value chain actors.
• Empower consumer organizations.
• Penalize false corporate marketing on what is “healthy,” such as low-fat but filled with sugar, or vitamins added but full of hydrogenated fats.
• Require all health insurance policies to include healthy eating and living/lifestyle incentives that reward healthy life choices and penalize poor-quality or unhealthy lifestyles.

Science and Technology

• Research how to make otherwise toxic plants non-toxic and existing food crops more nutritious in order to increase net supplies (about half of vegetable matter contains toxins).
• Develop technologies such as GMOs with improved micronutrients, greening the desert, and use of ICT.
• Increase investment in agricultural S&T to help developing countries improve their technical level in agricultural cultivation, aquaculture, etc.
• Conduct independent research on GE foods and GE crops and their long-term effects on people and the environment.
• Develop inexpensive body sensors connected to smartphones to monitor body needs.
• Develop urban agriculture that does not require soil (hydroponics).
• Develop the Codex Alimentarius.
• Invent crops that grow well in hard conditions, such as water scarcity and increasing soil salinity.

Business-Oriented

• Create an international version of the National Grocers Association with the mission of improving the quality of food markets in poor countries, hopefully sponsored by large respected multinational companies such as Google, Apple, Amazon, etc.
• Commission the private sector to prepare health campaign ads with added benefits if targets are met—for example, commission McDonald’s to market healthy foods, and if their burger demands drop by 10%, with salads increasing by a certain percent, then an added financial bonus would be applied.
• Include chain restaurants in a global committee or body that regulates chain restaurants’ menus.
• Get retailers in the developing world to create industry-wide norms for minimum nutritional content of food products they will carry.
• Encourage large-scale food marketers to introduce food standards, with some independent body to evaluate and validate them.
• Sell low-cost candy with iron and protein additions with UNICEF price subsidies to prevent kwashiorkor, which can limit brain development.
• Fortify adult food with nutrients.
• Use inverse health value pricing, taxing foods in proportion to their unhealthiness index (if low nutritional food is more expensive than fruits, vegetables, poultry, we will see a major difference).
• Improve food packaging, storage, and transport.
• Improve the level of technological innovation in the food industry chain.
• Improve local production and market systems.
• Convince food markets that sustainable development and green solutions are also good business.
• Provide effective protection of agricultural production and food security.
• Support companies’ efforts at “sustainable local food supply,” such as the program of Walmart and the Walmart Foundation, which in several countries try to sustainably source foods from small-scale producers as well as larger ones.[8]
• Create/expand a dynamic network of angel investors for innovation.

Education

• Develop large-scale public programs designed to change behavior (like anti-cigarette or AIDS education programs).
• Launch systematic large-scale public campaigns to advocate healthy foods and dietary behaviors.
• Educate people and decisionmakers about the importance of nutrition and the dangers of micronutrient deficiencies.
• Use media to educate the public about the effects of consuming fast food and to promote healthy alternatives.
• Increase the demand for healthy foods.
• Incorporate nutrition information into school curricula, especially at very young ages, and make nutrition an elective course in universities.
• Train more food and agricultural scientists who will work in their own countries.
• Make education mandatory for food developers and owners of the food industry.
• Develop mobile applications for interactive consulting on agronomy for small-scale farmers that will extend appropriate professional technical advisory services tied to accessible and dynamic local, regional, and global knowledge management systems.

Farming Practices

• Fund research and testing plots that highlight the benefits of an integrated food production system.
• Increase organic agriculture and political support for practices that support its principles.
• Establish efficient operation of an international bank for new genetically modified seeds.
• Stop land-grabbing and give land titles to small farmers.
• Expand seawater agriculture.
• Emphasize healthy forests.
• On a massive scale, reintroduce proper livestock land management practices that will enhance water retention and soil productivity that will reverse massive swaths of soil and productivity degradation in all affected areas.[9]

General Culture-related

• Work with “good” witchdoctors to make it an “in thing” to mix protein foods with starch foods in a bowl as children’s food, separate from the large bowls for the adults.[10]
• Hold contests or chef competitions (or competitions among schools) for the best-tasting food recipes.
• Encourage top African and Asian music stars to make nutrition “cool” and/or sponsor contests to produce songs like Eat for Success, Power Foods, Nutrition Rocks, Sexy Foods, and Eat Smart Be Smart.
• Increase female participation in food-related decisions.
• Promote a food gardening culture (especially urban farming).
• Encourage indigenous agriculture and culinary traditions.
• Reduce population growth.
• Identify African practices that were positive 20–30 years ago and that have potential to be replicated and scaled up.
• Provide nutrition supplements to undernourished pregnant and nursing mothers to reduce long-term stunting and malnutrition in their offspring.

The respondents gave many reasons for their ratings and made additional suggestions.

Halfway into this one-month online study, the suggestions for addressing the problems related to hidden hunger were reviewed and distilled to a list of 16. In cooperation with the Rockefeller Foundation staff, 5 were selected for additional review by the international panel. Participants were asked to return to the questionnaire and answer three questions about each of these strategies; the questions were about potential effectiveness, the likelihood that foundation support would help implement the strategy, and other actions that could be helpful to the strategy.

The five strategies considered were:

• Tax unhealthy foods and use the money raised by this means to subsidize (and thus drop the price) of healthy foods.
• Regulate low-quality food such as soft drinks.
• Use McDonald’s “Happy Meal” strategy (child-appealing and friendly gifts) but focus on the parents to encourage the purchase of nutritious meals—happy meals that feature nutritious and good-tasting foods, advertising, the star system (for example, what is Schwarzenegger eating today?).
• Commission the private sector to prepare health campaign ads with added benefits if targets are met—for example, commission McDonald’s to market healthy foods, and if their burger demands drop by 10%, with salads increasing by a certain percent, then an added financial bonus would be applied.
• Support multiple cropping systems (including intercropping) based on traditional local farming and variable sowing dates adapted to the changing climate, for increasing crop and biological diversity, enabling farmers to develop higher-yielding, more-productive varieties of crops with improved nutrition characteristics.

Figure 3 plots the strategies by potential effectiveness and the help that funding could provide. The strategy that stands out as superior in both categories is “support multiple cropping systems based on traditional local farming.”

Figure 3. Strategies effectiveness vs. how effective funding could be.

The results of this study can be useful for identifying evolving patterns, their potential impacts, and strategies for addressing the situation, as well as for setting priorities for potential funding. They can also be useful for exploring alternative futures for research, technological development, and innovations, as well as policies for improving healthy food production, processing, marketing, and consumption preferences.

——————————————————————–