The Environmentalist, 21, 4169, 2001 2001 Kluwer Academic Publishers. Manufactured in The Netherlands.

Food and hunger in Sub-Saharan Africa

NORMAN MYERS and JENNIFER KENT Upper Meadow, Old Road, Headington, Oxford OX3 8SZ, UK

Summary. Sub-Saharan Africa is by far and away the most disadvantaged of the worlds three main developing regions. Worse, its situation has mostly been deteriorating for much of the past several decades. Its agriculture is severely under-productive, and per capita food supplies have been steadily dwindling. Its environments and natural-resource base, characterised by water decits, soil erosion, fuelwood shortages, rudimentary agro-practices, and grossly inadequate infrastructure, are generally unfavourable for sustainable agriculture. The population has expanded until it far exceeds carrying capacity, yet its growth rate is the highest in the world. The region also suffers from more disease than any other region. There is widespread and deepening poverty. As a result of these and other problems, and despite major food imports, two-thirds of the people are malnourished, one-quarter of whom endure outright hunger, even semi-starvation. Both these proportions appear set to keep on increasing both relatively and absolutely. Were these problems to persist with their decades-long trends, there could eventually arrive a stage when much larger numbers of people would succumb to terminal malnutrition, precipitating a human tragedy of unprecedented proportions. Fortunately, success stories demonstrate that solutions are available, on the part of both governments concerned and international agencies. Because of ignorance, or rather ignoreance of the potential mortality disaster ahead, however, not nearly enough has been done to address the challenge with the energy and urgency to match its scale. Keywords: Sub-Saharan Africa, poverty, famine, diseases, population growth

Introduction In April 2000, another famine crisis arose in Ethiopia, placing eight million people at risk of starvation (Food and Agriculture Organization, 2000a). This was all the more remarkable in that Ethiopia had been viewed as a semi-success story in the mid-1990s with markedly increased grain harvests. Also, in early 2000 neighboring Sudan featured six million enfamished people, and Somalia three million, while drought in Kenya left nearly three million people facing severe food shortages. This has demonstrated that hunger remains a frequent phenomenon in Sub-Saharan Africa.
For a 46,000-word report on which this article is based, see Myers and Kent (2000). The article reects a research project funded by the Winslow Foundation in Washington, DC, USA.

It is pertinent to review the situation in this article, and to ask whether there is a prospect of improvementor whether a more likely outlook is that the region could eventually face a starvation disaster with mortality on an unprecedented scale. This is not to discount the famines and increased mortality of the mid-1970s, the mid-1980s and parts of the 1990s in areas such as the Sahel, the Horn of Africa, Rwanda, Burundi, Angola and Mozambique. Fortunately these crises were fairly short lived, even though they cost the lives of millions of people. By 2025 the region may not be able to produce food for more than 40 percent of its people (United Nations University, Institute for Natural Resources in Africa, 1999). To cite the World Food Summit in 1996, Sub-Saharan Africas precarious food security could lead to a genuine human tragedy.

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Myers and Kent 250 million people have no access to health services. The death rate from several diseases is proportionately higher than in any other region; the region suffers 90 percent of all malaria deaths worldwide. The region features 67 percent of all HIVinfected people worldwide, and 83 percent of AIDS deaths have occurred here. At least 400 million people are malnourished, over 100 million of whom endure outright hunger if not semi-starvation. The region suffers the highest mortality among under-ve children. It features proportionately more civil strife, military violence and wars than any other region. For details of trends in population growth, food supplies, malnutrition, and economic factors in the region, see Tables 13. This is not to overlook an improvement in some countries during the last few years. Overall, however, there is much evidence that the long-term trends will continue. This is all the more likely insofar as many African governments and international agencies have not been doing enough to reverse these long-term trends. While no starvation episodes of several million have yet overtaken the region (the largest to date was one million in Ethiopia during 1984/85), the implicit response on the part of bodies responsible, viz., governments and international agencies, is that the situation is somehow tolerable. They may protest that this is quite the opposite of what they intend. But if they did not view the situation with a modicum of ignore-ance, they would surely have done more to rectify it. It is not unrealistic to suppose that the region could soon start to experience many more hunger crises, each on a larger scale and overtaking more countries than before. Suppose too that each crisis costs the lives of not just one million people but conceivably several millionsand not just once in two decades but several times a decade, a human debacle of altogether unprecedented proportions is likely to arrive. There is much scope for debate about the prospect of a starvation disaster ahead. Remarkably, not a single government or agency has explicitly addressed the issue head on, even though the

Background Sub-Saharan Africa lags behind the two other developing regions in terms of virtually every criterion, whether socio-economic, environmental or political. Worse, its situation promises to deteriorate further unless exceptional efforts are made to reverse its adverse trends. For sure, its plight has not yet resulted in any marked or persistent increase in the documented numbers of people dying from hunger. But there has been a steady and even a strong trend in several key factors that contribute to hunger crises: declining food production per person; declining food imports in relation to needs; high growth rates for populations, that in many, if not most countries, have already surpassed carrying capacity; increasing malnutrition and diseases; declining stocks of cropland, water and fuelwood per person; increasing soil erosion among other forms of land degradation, including desertication; increasing environmental rundown of several other sorts; spread of absolute poverty; declining aid, trade, and investment; and continuing political instability and civil strife. To illustrate these points: The regions per capita food supplies are lower than for any other region including Southern Asia. A decades-long decline in supplies seems set to continue. The regions aggregate economy, excepting industrialised South Africa, is less than Belgiums with its 10 million people. It enjoys around 1 percent of global trade. 400 million people have incomes of less than $1 per day, and their numbers are growing faster than the population as a whole. Unemployment runs at over 50 percent. Population growth is still as high as 2.5 percent per year, and the average family size is 5.8 children. The region receives less and more erratic rainfall than either of the other two main developing regions. 200 million people live in water-short countries. More than 150 million adults are illiterate and 40 million children are not in primary school. 40 million women have an unmet need for family planning.

Food and hunger in Sub-Saharan Africa

Table 1. Sub-Saharan Africa: population. Population, millions 2000 2025 2050 (projected) 117 64 52 43 35 30 30 23 20 19 16 15 15 479 646 205 115 105 35 60 34 46 48 27 21 23 25 29 773 1053 304 188 182 33 88 39 59 84 32 23 31 35 47 1145 1556 Natural increase, annual % 2.8 2.4 3.2 1.3 2.9 2.1 2.2 2.9 2.4 2.2 2.2 2.6 2.9 2.5 Population doubling time, years 24 29 22 55 24 33 32 24 29 32 32 27 24 27 Total fertility rate/ family size 1960 2000 6.5 6.9 6.0 6.5 6.8 8.0 6.7 6.9 6.9 6.3 7.2 5.8 6.6 6.6 6.0 6.7 7.2 2.9 5.6 4.7 4.6 6.9 4.5 5.6 5.2 5.2 6.0 5.8

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Country Nigeria Ethiopia D.R. Congo South Africa Tanzania Kenya Sudan Uganda Ghana Mozambique Ivory Coast Cameroon Madagascar Total of above Total for region

Married women using modern contraceptives, % 7 3 3 55 16 32 7 8 13 5 7 7 10 13

Sources: Haub and Cornelius, 2000; UNICEF, 2000; United Nations Population Division, 1999. Note: These 13 countries account for three quarters of the regions population.

Table 2. Food supplies. Per-capita daily calorie supply (1995/97) 2990 2750 2620 2570 2380 2170 2140 2020 2000 1980 1820 1820 1780 2185 Annual rate of change of food output (19941998) na 1.5 to 2.0 Over 5.0 3.0 to 4.0 Over 5.0 1 0 to 0 5 2.0 to 2.5 0.0 to 0.5 1.5 to 2.0 3.0 to 4.0 Below 1 0 2.5 to 3.0 Over 5.0 na Food production in relation to population growth na 2 1 1 1 2 2 2 2 1 2 2 1 na Ofcial estimates of population malnourished 19951997, % na 8 11 15 20 28 32 39 40 41 55 51 63 33

Country South Africa Nigeria Ghana Ivory Coast Sudan Uganda Cameroon Madagascar Tanzania Kenya D.R. Congo Ethiopia Mozambique Total for region

Source: Food and Agriculture Organization. 1999ac. Notes: I = production growth greater than population growth; 2 = food production growth less than population growth. (the category 2 countries comprise 364 million people). When Nigeria is excluded from regional supply estimates, this falls to below 2000. A minor fall in calorie supply translates into a much larger percentage of the population being malnourished. Together with analysis of the skewing factor of Nigeria, this goes some way to substantiate this papers estimate that 62%, viz. 400 million people, are malnourished.

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Table 3. Economies of the 13 largest countries. GNP, GNP, GNP growth rate $billion $ per 19971998, % (1998) capita (and per capita) 2880 300 700 300 610 290 390 210 320 100 110 260 210 480 06 11 57 15 67 50 46 32 58 0 8 40 48 11 3 22 1 2 1 7 36 0 9 38 27 19 06 29 3 2 07 16 92 0 4 Population below poverty line (ppp $1 per day), % 24 31 18 50 Na N/a N/a 16 N/a 46 N/a N/a N/a 48 External debt, $billion, and % of GNP (1997) 25 2 28 5 15 6 65 93 16 3 59 72 37 10 1 12 3 41 60 219 19 72 141 49 93 182 57 77 31 131 215 85 135 70 Foreign aid, $ per capita 1990 1997 3 59 51 39 36 38 48 42 21 24 35 76 43 12 2 31 16 36 7 28 31 41 11 4 59 58 33

Country

Income distribution, bottom 60% top 20% 17 6 27 3 33 8 28 9 36 4 32 9 32 7 32 5 64 8 49 3 44 1 50 2 41 7 45 5 46 1 47 7

South Africa 119 0 Nigeria 36 4 Ivory Coast 10 1 Kenya 97 Cameroon 87 Sudan 82 Ghana 72 Tanzania 67 Uganda 67 Ethiopia 61 D.R. Congo 53 Madagascar 38 Mozambique 36 Total for region 304

Sources: United Nations Development Programme, 1999; World Bank 1996b and 1999ac. Note: These 13 countries account for three quarters of the regions population and GNP. Excluding the regions economic leader, South Africa, the remaining 12 countries account for two thirds of population and three-fths of GNP.

risk of such a disaster is surely greater than zero, signicantly so. In light of the potential human tragedy it would entail, the prospect deserves to be considered in appropriate detail.

Sector-by-sector review Food and agriculture During the past 30 years the regions population growth rate, generally 3.0 percent or more, has remained ahead of the growth rate for food production, which, Nigeria and South Africa apart (see below), has generally been no better than 2.0 percent (Food and Agriculture Organization, 1996 and 1999a; 1999b; US Department of Agriculture, 1999) (Tables 1 and 2). So per capita food production in most of the region has declined by an annual average of at least 1.0 percent (United Nations Development Programme, 1998; Food and Agriculture Organization, 1999a; 1999b; Pinstrup-Andersen and Cohen, 1999; Rukuni, 1999). Fortunately some countries in recent years have enjoyed an increase in per capita food production. Whether this is the start of a long-term

advance or a temporary spike in the trend is subject to much uncertainty. Many experts (e.g. World Bank 1998; US Department of Agriculture, 1999; United Nations Development Programme, 1999) agree that food production is unlikely to grow annually at better than 2.3 percent p.a., probably less, until at least the year 2010, while population growth remains at around 2.5 percent p.a. As a result, food output per head is generally expected to drop by about 0.5 percent p.a. for another decade, and possibly by a similar amount during the following decade. While this is only half of the 1.0 percent annual decline since 1970, many people will become more malnourished than ever, and many more people will become malnourished to some degree. Worse, those experiencing severe hunger already could become threatened with outright starvationor, as is more probable, they will become increasingly prone to hunger-related diseases. To close the nutrition gap by 2010 would require an annual growth rate in food production of 3.4 percent (US Department of Agriculture, 1999). On top of all this there are several environmental constraints. Because of unpromising baseline conditions generally and particularly with respect to harsh climate in much of the region (Falkenmark, 1994; Hulme, 1996), it is widely supposed

Food and hunger in Sub-Saharan Africa (e.g. Marsili, 1994; Food and Agriculture Organization, 1997 and Watson et al., 1998) that adverse weather conditions could quickly trigger further onsets of broadscale famine. If this prospect were aggravated by the climatic vicissitudes of global warming (Glantz, 1994; Downing, 1999), there could be marked impact on the large numbers of both those people who will be malnourished, and those who will be semi-starving. An alternative way to assess the future outlook is to consider that twenty countries with total projected populations of almost 430 million are expected to experience up to 25 percent shortfalls in food supplies by 2008. Probably facing still more severe food decits will be another eight countries with total projected populations of 67 million. Fortunately there is a better outlook for four countries with a projected total of 200 million people, which are expected to have adequate food overall by 2008. These countries include Nigeria which, with 18 percent of the regions population, produces 30 percent of its graina distinctly skewing factor for the region-wide average of food supplies. Moreover because of unequal distribution of food in these four countrieswhere the richest one fth will enjoy more than the restthey will still feature large numbers of inadequately fed people (US Department of Agriculture, 1999; World Bank, 1999a). Moreover, food supply is more than food consumption. There are sizeable differences between what derives from the crop eld and what reaches the meal table, due to wastage along the way. Roughly one fth of food grown is wasted (Biswas, 1994; Gardner, 1996). The conclusion must be that the majority of Africans are signicantly malnourishedprobably twice as many as the ofcial and minimalist estimates of 210 million (Alexandratos 1995; Food and Agriculture Organization, 1998). A further conclusion is that large numbers of Africans are malnourished to an extent that leaves them not only chronically hungry, but vulnerable to summary starvation (Myers and Kent, 2000). Food imports are a long way from closing the gap, which is expected to widen still further. Indeed the region will need to import 30 million t of grain by 2020, double the average for the late 1990s, in order to meet minimal needs of a

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population that will have increased by 54 percent, let alone to counter existing levels of malnutrition (Harris, 1996; Poleman, 1997; Brown et al., 1999). Nigeria imported 17 percent of the regions cereals in 1998. Other food-short countries will nd it increasingly difcult to compete in global markets given the large and fast-growing demands on the part of North Africa, Mexico, Iran, India, and especially China (Rosegrant, 1995; Islam 1996; Pinstrup-Andersen et al., 1997; Delgado et al., 1998; US Department of Agriculture, 1999). Food aid provided worldwide in 1998 was only 8 million t, of which less than 3 million t went to Sub-Saharan Africa (Food and Agriculture Organization, 1999b; World Food Programme 1999a). Population It is signicantly due to its unequalled population growth that the region has difculty in feeding itself. Many observers (Sai, 1994; Ehrlich and Ehrlich, 1995; Myers and Kent, 1995; Pimentel et al., 1997; Cleaver and Schreiber, 1994; Brown et al., 1999) regard the present population as too high for the regions physiobiotic carrying capacity and its governments planning capacities. In many instances we should not consider resource shortages, but population longages. The regions population in mid-2000 was growing by 2.5 percent p.a. This contrasted with Latin Americas growth rate of 1.8 percent and developing Asias 1.5 percent. As far ahead as the year 2050, the regions growth rate is expected to be still around 1.1 percent p.a., by contrast with Latin Americas 0.5 percent and Asias 0.4 percent (United Nations Population Division, 1999). The mid-2000 population of 646 million is projected to reach 1053 million by 2025, a 63 percent increase, and 1556 million by 2050, a 141 percent increase over today (Haub and Cornelius, 2000) (Table 1). In 2050 the region will account for almost half of the annual global increase, by contrast with only one fth in 2000. By the time the region reaches zero population growth at some stage in the 22nd century, the population could readily top two billion (United Nations Population Division, 1999). But this is strictly a demographic projection, and takes no account of the regions capacity to support such

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Myers and Kent average is around 16 percent (Bongaarts and Bruce, 1995; Alan Guttmacher Institute, 1997; Rosen and Conly, 1998; Jain, 1999). Were the unmet needs to be met, the demographic consequences would be marked, with some countries achieving a fertility decline of 1718 percent, or an average of 30 percent of the distance to replacement fertility (Westoff and Ochoa, 1996). Fortunately more than 30 countries now have active family planning programmes, but only 13 percent of couples use modern contraception methods (Haub and Cornelius, 2000; United Nations Development Programme, 1999; World Bank, 1999a). What of the population impact of AIDS in a region where one person in 30 is infected with HIV? The most immediate consequence is for life expectancy. In the 29 hardest-hit countries, life expectancy at birth is seven years less than it would have been without AIDS (Lutz et al., 1997; United Nations Population Division, 1999). In large-population countries with high adult HIV rates, life expectancy is expected to plunge, e.g. in Zambia from 66 to 33 years (HIV rate 19 percent), in Zimbabwe from 70 to 40 years (26 percent), in Kenya from 68 to 40 years (12 percent), and in South Africa from 60 to 40 (13 percent) (Caldwell and Caldwell, 1996; US National Research Council, 1996; United Nations Population Division, 1999; Haub and Cornelius, 2000). Countries that could soon experience zero population growth include Zambia, Zimbabwe, Botswana, Namibia and Swaziland. South Africas population is expected to decline from 43 million today to 35 million in 2025 (Haub and Cornelius, 2000). However, AIDS will slow population growth only marginally in the long term. Assuming a moderate spread of AIDS beyond the countries deeply affected already, the regions population growth rate is expected to fall to perhaps 2.0 percent at the height of the pandemic, leaving the regions numbers to keep on expanding apace (United Nations Population Division, 1999). Diseases The region is the most diseased of all three main developing regions. Infectious diseases such as measles, malaria, tuberculosis, pneumonia,

an unprecedented increase. It should reect deteriorating conditions such as spreading poverty, hunger and disease. Note the latent power of demographic momentum, with its premium on urgent and incisive action. Because of the youthful population proleas many as 44 percent of the present population are under the age of 15 (Latin America 33 percent, Asia 32 percent)there are huge numbers of potential parents for the future. Even if African women were to average two children from today, the regions population would still grow for best part of two generations and almost double (cf. United Nations Population Division, 1999). Added to this is the fact that several governments of the region, especially those of the Francophone countries, have no population policies at all. Ten governments view their population situation as satisfactory. These governments include that of D.R. Congo, even though the country has 52 million people already, an average family size of 7.2 children (no decline since 1980), and a population growth rate of 3.2 percent per year (doubling time, just 22 years) (Haub and Cornelius, 2000). If the growth rate of population could be halved and the growth rate of food production could be doubled by 2020, the region would be well on the way to producing enough to feed itself (Kendall and Pimentel, 1994; Cleaver and Schreiber, 1994; Rukuni, 1999). Fortunately there is much scope to reduce population growth by tackling the key factor of unmet need for family planning. This is specially important in that the number of children per reproductive woman has declined very slowly. In 1975 it was as high as 6.7, falling only to 6.5 in 1984 and 5.8 in 2000 (United Nations Population Division, 1999; Haub and Cornelius, 2000). Not all these children were wanted or plannednot by a long way. As many as 29 percent of married women do not want any more children or want to defer their next pregnancy, but they lack the family planning facilities to put their wish into practice. (If unmarried women were included, the need would be all the greater; in Kenya the rate is 47 percent among married teenage women and 74 percent among unmarried teenage women (United Nations Population Fund, 1999).) The 29 percent rate is the highest among all developing regions, where the

Food and hunger in Sub-Saharan Africa diarrhoea and AIDS cause more than 70 percent of ill health, and there is a strong linkage to malnutrition through potentiating impacts in both directions (Murray and Lopez, 1996; Daily and Ehrlich, 1996; Pimentel et al., 1998; World Health Organization, 1999). Just as malnutrition greatly predisposes people to diseases, so diseases leave malnourished people all the more vulnerable to the rigours of semi-starvation. To emphasize a key point: people rarely die directly from hunger, rather they succumb to diseases that are strongly facilitated by malnutrition. Moreover, the two processes do not generally work in additive fashion: they are likely to be multiplicative. Malaria kills almost one million people each year (90 percent of all malaria deaths worldwide), and accounts for one in ve of all childhood deaths in the region, whether directly or in combination with other forms of ill health such as respiratory infections, diarrhoea and especially malnutrition (World Health Organization, 1999). During the period 197090 several countries recorded an increase in malaria incidence ranging from four-fold to over 150-fold, an increase which is continuing (World Health Organization, 1996a). Another major scourge in Sub-Saharan Africa is measles. The virus may ultimately cause more child deaths than any other single microbe, due to complications from pneumonia, diarrhoea and especially malnutrition. An African child runs a 1000-fold greater chance of dying from measles than a developed-country child, yet at least every second child remains unimmunized against the disease (World Health Organization, 1999). Other sources of disease include intestinal parasites from contaminated food, water and soil. They result in reduced intake of nutrients, plus loss of nutrients through diarrhoea and dysentery (Shetty and Shetty, 1993). Hookworms can remove up to 30 ccs. of blood from a host in a single day, leaving the person susceptible to other diseases (Hotez and Pritchard, 1995). Although hookworm undermines the health of millions of people throughout Sub-Saharan Africa, almost nothing is spent on its basic epidemiology and on vaccine research. The most widespread and injurious, and the most readily treatable disease, is diarrhoea. This surely ranks as the forgotten malady. Over one million children in Sub-Saharan Africa

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die from diarrhoea each year (Murray and Lopez, 1996; UNICEF, 1998; World Health Organization, 1999). Most of such deaths could be prevented with oral rehydration therapy, a technical name for a salt-and-sugar mixture that replaces nutrients lost through the disease. Although the therapy generally needs to be applied several times a year to counter recurrent bouts, it costs less than 33 US cents per dose when supplied in bulk (World Health Organization, 1999). All diseases together levy such a nutritional toll that 520 percent of food intake is needed to offset maladies (Pimentel and Pimentel, 1996), yet malnutrition makes people much more susceptible to disease, so a vicious circle ensues which is hard to break down. The biggest scourge, AIDS, is already killing two million people p.a. The region is the epicenter of the global HIV/AIDS pandemic, with nearly 70 percent of all HIV cases among 10 percent of the worlds population. Of 34 million HIVinfected people worldwide, 23 million are in the region (United Nations Population Division, 1999). Todays total could well double before the pandemic nally abates. In some areas, as many as one quarter of adults are affected, and women are more heavily hit than in any other region (World Health Organization, 1996a). Already the disease is the leading cause of mortality among adults aged 1539 in Uganda, Zambia, Malawi, Zimbabwe and Botswana; and regionwide it claims more than twice as many childrens lives as do malaria or measles. AIDS deaths p.a. have reached 2 million (worldwide 2.5 million), and by 2015 they are expected to have totalled well over 20 million. Worst of all, HIV is spreading more rapidly than ever in the region, with four million new infections annually, plus infections from mothers to unborn children (Mann and Tarantola, 1998; United Nations Development Programme, 1999; World Health Organization, 1999). The people most affected by HIV/AIDS tend to be those in their most productive and energetic years, being those with above-average education and skills, notably government planners, agronomists, engineers, and teachershence those who most drive national economies. In the worst-hit countries, AIDS sufferers may lose as much as ten years of productive life, and national

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Myers and Kent losses $10 million, for a total of $5.1 billion (World Bank, 1999a) (cf. the nations economy, $36 billion). In the early 1990s soil erosion region-wide caused crop yields to decline by 240 percent, with food losses averaging 10.5 million t p.a. (Fig. 1). If accelerating erosion continues unabated, yields could decline at least twice as much by the year 2020 (Lal, 1995). There are several other forms of land degradation, notably desertication, with all forms together affecting 65 percent of the regions agricultural lands, by contrast with Asias 38 percent and South Americas 45 percent (Oldeman et al., 1990; Gardner, 1996; Bojo, 1996; Scherr and Yadav, 1997). There are widespread shortages of water for agriculture and other purposes (Fig. 2). The region has 10 percent of surface water supplies worldwide, by comparison with South Americas 26 percent and Asias 36 percent (Postel, 1999). Only 20 percent of the regions rainfall feeds into streams, rivers and underground aquifers, compared with 37 percent globally. Half of all the farmers experience unusually low and variable rainfall, and one third live in droughtaffected grainlands (Chievba, 1996; Pingali and Rajaram, 1998). In 1995 droughts in several sectors of the region caused food production to drop to two-thirds of the 1994 level (Rosegrant, 1996). Already more than 200 million people, almost one-third of the total population, live in watershort countries, and by 2010 over twice as many people will likely face severe water constraints on food productiona total that by 2025 could climb to 700 million (Gardner-Outlaw and Engelman, 1997; Falkenmark et al., 1999; Postel, 1999). Water shortages are likely be accentuated by climate change, with rainfall becoming more sparse and erratic, resulting in more frequent and severe droughts (Watson et al., 1998). As a result, it is anticipated there will be major reductions in food production in several parts of the region. Yet no other region is less able than Sub-Saharan Africa, because of its poverty, to adapt to the impacts of climate change. Virtually all good lands have already been mobilized, and fully half of the spare land that could be used to produce food features poor soils or is covered with forests with their many benets

economies could be reduced by 1015 percent in a single decade, with all that implies for government investments in agriculture, health and other sectors that reect food and nutrition (Forsythe, 1996). In addition, governments are shifting medical funds to combat AIDS, so they have to reduce investments in primary health care, safe water and sanitation, agriculture, infrastructure and education. (As it is, the regions health expenditures amount to only around 1.4 percent of GDP.) All this militates against the biggest battle, the campaign to stem malnutrition. Many countries could nd themselves declining into even worse poverty and far more severe food decits than today, with all the indirect consequences this would have for morbidity and mortality. Moreover, the pandemic will mean a reversal in many countries of hard-won trends in infant and child mortality. In Zimbabwe, for instance, child mortality could more than quadruple as early as 2010 (Brown, 1996). Child mortality is one of the main factors spurring high fertility, so family planning campaigns could well be set back by several decades (Caldwell and Caldwell, 1993; World Health Organization, 1995; Bongaarts, 1996). Environments and natural resources The region has some of the most adverse environments anywhere. Being the driest of the three developing regions, it features climatic conditions that are, for the most part, distinctly unfavourable to agriculture. Other problems include soil erosion, fuelwood decits and shrinking per capita croplands. The situation is often made worse by poor land management and rudimentary agriculture, which in turn reect the regions poverty. It is possible for a country to keep on pushing up its food output year by year over the short term, but with costs to the environmental resource base (soils, water, weather/climate, etc.) that eventually levy a toll on the potential for future output (Daily et al., 1998; Pinstrup-Andersen and Pandya-Lorch, 1998). There are also wider costs from environmental depletion: in Nigeria, soil degradation in 1992 was worth $3 billion p.a., water contamination $1 billion, deforestation $750 million, coastal erosion $150 million, gulley erosion $100 million, shery declines $50 million, water hyacinth blockages $50 million, and wildlife

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Figure 1. Topsoil being removed in a dust storm, Bokena Valley, Wollo region of Ethiopia (Photo Courtesy: Mark Edwards/Still Pictures).

(Alexandratos, 1995). Moreover many of these lands lack enough water for sustainable agriculture (Ingram and Frisvold, 1994). In any case, much land with agricultural potential is unevenly distributed: two-fths of it are in D.R. Congo, Nigeria and Sudan alone (United Nations Environment Programme, 1999). Due to population growth, even allowing for a moderate expansion of croplands, the per capita expanse has been shrinking markedly in most countries, and is projected to decline drastically by 2025. In Nigeria, the country with the largest population, the amount in 1960 was 0.68 ha, in 1990 it had contracted to 0.34 ha, and it is projected to be only 0.14 ha in 2025 (Engelman and LeRoy, 1995). The latter gure is no more than the equivalent of ve tennis courts. An expanse of 0.07 ha is enough in principle for just one individual to survive off a largely vegetarian diet, without using modern intensive agronomic inputs and with no signicant environmental constraints such as water

shortages. Even with near-perfect planning, with equable climate and with average-fertility soils, a typical African farmer today needs at least 0.1 ha to feed one individual (Engleman and LeRoy, 1995; World Resources Institute, 1998; Brown et al., 1999). Forest cover is shrinking almost everywhere, sometimes at rates as high as 2 percent p.a. Together with its derivative charcoal, fuelwood provides most of the energy needs of the region. There are major fuelwood decits in at least 20 countries (Fig. 3). In 1990 fuelwood supplies in Ethiopia were enough to support only 37 million people, while the population totalled 51 million; today the gap is expected to have widened to 36 out of 64 million. A lengthy list of other countries reveal similar and growing gaps (Pearce et al., 1996). As many as 400 million people in 1993, more than two-thirds of the regions populace, found it was often as difcult to heat the supper bowl as to ll it (Cleaver and Schreiber, 1994).

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Figure 2. Africa has a widespread water shortage. Digging a well in Burkina Faso, West Africa involves a further man at the bottom of the well (Photo Courtesy: Mark Edwards/Still Pictures).

This had a vital linkage to malnutrition; semicooked food is not so nutritious and it contains more pathogens. Projections for food production in Sub-Saharan Africa, inadequate as they are for overall nutritional needs, take no account of environmental degradation. What if soil erosion over the past several decades has reduced the future potential of farmlands, even though the threat has been temporarily held at bay by increasing amounts of fertiliser? What if cropland per person has been shrinking due to population growth until the amount becomes too small for even subsistence purposes (given meagre agro-technologies and rural support services)? What if soil erosion and per capita cropland shrinkage occur at the same time and place, in a manner that causes each to reinforce the other in synergistic fashion? What

if, too, the situation is compounded yet again by water shortages and fuelwood decits? What, above all, when global warming starts to bite? Economics and poverty The region is the most impoverished of the developing world, with two-thirds of the 50 poorest countries in the world (World Bank, 1999a). Worse, and by contrast with the other two developing regions, its people have mostly been growing poorer for much of the past several decades. Todays per capita GNP is around $500, whereas the developing worlds average is $1260. Its aggregate economies total around $300 billion, by contrast with Belgiums $259 billion for 10 million people. If South Africas GNP of $119 billion is discounted, the regional GNP declines to

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Figure 3. These women in Kalsaka village, Burkina Faso, walk for an hour to an area where they can nd fuelwood. There are major fuelwood decits throughout much of Africa (Photo Courtesy: Mark Edwards/Still Pictures).

$185 billion, hardly greater than that of London (Table 3). Worst of all, the region is getting left further behind. The regional economy has slipped to less than 1 percent of the global economy, it accounts for only 0.8 percent of the worlds private direct investment and around 1 percent of global trade, with all three shares declining (World Bank, 1999a; 1999b; 1999c). Globalization is overlooking Sub-Saharan Africa. Another way to put perspective on these gures is to note that the worlds seven largest corporations have annual sales larger than the GNP of the regions leading economy, South Africa with $119 billion. The regions 20 smallest economies are together worth less than General Motors annual sales of $164 billion. The regions aggregate economy is less than the assets of the worlds 15 richest individuals (United Nations Development Programme, 1999). Almost two-thirds of the population, 400 million people, live in absolute poverty with

incomes of $1 or less per day (the share of population rises in nine countries to over 60 percent; even in the richest country, South Africa, it is 24 percent) (African Development Bank, 1998; Speth, 1999). This means that many people, governments too, cannot afford to buy food. Malnourishment is not just a problem of food shortages, it is a problem of poverty as well. The impoverished total has more than doubled since 1987 (Pinstrup-Andersen, 1995; United Nations Development Programme, 1998; World Bank, 1999a). During the two decades 197595, the regions per capita GNP fell by 20 percent or an average of 1.0 percent p.a. (World Bank, 1997; United Nations Development Programme, 1998). During the more recent period 199197 it declined by an annual average of only 0.2 percent, followed by a partial recovery in 199598 (often due to better rains supporting agriculture), with per capita GNP growth of around 2.0 percent p.a. or more in several countries, though with dips in still more

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Myers and Kent there has been some marginal relief during 1999. In recent years there has been an increasingly important role for private direct investment, but the regions share amounts to only $5 billion out of $400 billion for all developing countries (Messer et al., 1998; World Bank, 1999b). Poverty is a more important cause of hunger than civil strife. War leads to acute (temporary) rather than chronic food shortages and this factor tends to divert attention from underlying problems, notably the sheer lack of economic development (World Bank, 1997). Civil disorders and military activities The food and nutrition prospect in Sub-Saharan Africa is undermined by the many civil disorders and military activities that afict the region. During the period 197090, violent conicts led to reduced food production and increased malnutrition. The reverse also applied: food shortages and hunger were often among the root causes of violent conicts, while hunger is often used as a weapon. Several such conicts were implicated in the famines of the 1980s and 1990s (Marchione, 1996; Messer et al., 1998; PinstrupAndersen and Cohen, 1999). Sub-Saharan Africa has featured in more violent conicts and outright wars than any other region. In 1996 the region featured 12 out of 34 conicts worldwide. Some of these conicts had been underway for a long time. The Angola war lasted 197594, the one in Ethiopia 197492, in Mozambique 198192, and in Liberia 1985 93. In Somalia hostilities have been running for 10 years, and in Sudan for 15 years. Conversely and a hopeful portent for the futuremore than half of the 19 peace agreements achieved around the world during 198996 were in the region (Tilford, 1998; Renner, 1999). In addition, there have been more than 70 violent overthrows of governments. The new regimes, having gained power by force, tend to maintain themselves by more force. In fact greater violence is directed by governments at their own people than at neighbouring countries, and it is primarily for purposes of domestic oppression that political leaders engage in extravagant spending on arms and other military activities.

countries (World Bank, 1999b), followed by further fall-offs in several other countries during the rst part of 1999. During the decade 19982007 per capita GNP may well continue to grow, though not by more than 1.0 percent p.a. or less than $50 for the decade (Paarlberg, 1997; Speth, 1999; World Bank, 1999b). The situation is worst in rural areas with 71 percent of the population, these being strategically important people insofar as they are food-producing farmers (Donovan, 1996; Cleaver, 1997; World Bank, 1999a). There are various prognoses of what needs to be done to tackle poverty. One analysis (United Nations Development Programme, 1999) asserts that even if GNP growth were to continue at the best recent rate of around 4.0 percent, the region would still need at least a decade merely to recover to its 1980 level. A second analysis calculates that in order to achieve an acceptable annual reduction in the numbers of poorest people, GNP growth would have to average 67 percent p.a., accompanied by an agricultural growth rate of 45 percent p.a. (which would not only help to relieve poverty but to reduce malnutrition) (Cleaver, 1997; see also Ndulu et al., 1996; World Bank, 1999a). These two prognoses are heavily optimistic given the record of the past two decades. Furthermore, the future is less promising than it might be thanks to the present jobs famine, exacerbated by the emergent phenomenon of jobless development. If the unemployment rate is to be reduced below 10 percent by 2020, jobs will need to be created at a rate of 3.4 percent p.a., equivalent to an increase of 380 million new jobs by 2020. Yet during the next 20 years there will be 16 million people entering the labour force annually (India with 37 percent more people will add only 10 million p.a.). During the next 50 years, Nigerias labour force is projected to triple and Ethiopias quadruple (International Labour Organization, 1999). There is mixed economic support from outside the region. Foreign aid in 1997 totalled $16 billion (worth $26 per capita, down from $40 in 1990). It amounted to 5 percent of the regions collective GNP, down from 11 percent in 1990 (Dollar, 1998; World Bank, 1999a; Devarajan et al., 1999; United Nations Development Programme, 1999). More than offsetting foreign aid is the debt burden; during 19801997 it increased eight times, though

Food and hunger in Sub-Saharan Africa Military expenditures have long been rising, albeit falling off somewhat in recent years. During the period 196092, the proportion of the regions collective GNP devoted to military activities rose from 0.7 percent to 3.9 percent. In constant 1994 dollars, the region spent in 1984 a total of $4.1 billion (3.3 percent of GNP), mounting in 1987 to $4.8 billion (3.5 percent), and in 1992 to a peak of $6.1 billion (3.9 percent), before declining in 1994 to $3.4 billion (2.2 percent) (Ul Haq, 1995; Gallick, 1996; Renner, 1999). The proportions have generally been much greater than for the other two developing regions. Certain countries have spent way above the average. In 1991 Ethiopia spent $15 per person on military activities when its per capita GNP was a mere $120; Sudans gures were $23 and $400, and Mozambiques $10 and $80 (United Nations Development Programme, 1998). At the time of the early 2000 famine in Ethiopia, the government was spending $1 million per day on its war with Eritrea. During the rst half of 2000, the Zimbabwe government, which is unable to feed more than half its citizens properly, spent $78 million to support its favoured side in D.R. Congos civil war. When one dollar is spent on soldiers and tanks, it cannot be spent on clinics and schools, let alone on growing food. In many countries, military expenditures have surpassed those for education and health combined (Colletta et al., 1996; Sivard, 1996). Somalia has been spending ve times as much; Ethiopia two to three times as much; and even Tanzania, a relatively peaceful country, more than twice as much. The ratio of soldiers to teachers in Somalia is 5.9 and in Ethiopia 4.2 (United Nations Development Programme, 1998). There are other forms of the humanitarian toll. Military turmoil has undermined anti-malaria programmes in many countries. It has grossly disrupted agricultural activities, whether in elds or markets. It has destroyed rural infrastructure wholesale. Perhaps most important of all, it has forced millions of people to abandon their farmlands. In 1994, the region featured 8 million of the worlds 25 million refugees who had crossed international borders, plus 18 million internally displaced persons or 60 percent of the global total (Minear and Weiss, 1993; United Nations

53

High Commissioner for Refugees, 1995; Messer et al., 1998; Oxfam, 1999). In the whole of 1999 outside donors spent only $0.11 on each of these refugees and displacees, by contrast with $1.60 spent every day on each refugee eeing from Kosovo (Oxfam, 1999). Money could be better spent on helping people to live rather than to kill each other. (In Zimbabwe, where 26 percent of the adult population is HIV-positive, the government has been spending $78 million on the civil war in D. R. Congo, while spending only $1 million on the prevention of AIDS.) Were basic health and education to be assured, people would be less susceptible to diseases with their potentiating impacts on malnutrition; and by being more educated people could do a more productive job with farming and other agricultural activities such as marketing and distribution. Relatively small expenditures on preventative medicine (research, vaccines, etc.) would go far to combat the many diseases that afict the region. Equally important, extra money available for socio-economic growth generally would relieve poverty and offer more people the funds to purchase food. Most significant of all, much more could be accomplished with more money spent directly on food production (Marchione, 1996; Messer and Uvin, 1996; Pinstrup-Andersen and Cohen, 1999). The close relationship between conict and food production has been prominent in many parts of the region throughout the past three decades. Some 12 countries experiencing extensive and prolonged conict during 19701993 produced a mean of 15 percent less food per capita in war years than in peace time. By contrast, from 1980 onwards peace would have added between 2.5 and 5.8 percent to the regions annual per capita food production. During the 1990s war has reduced growth rates of per capita food production by between 3.9 and 5.3 percent (Colletta et al., 1996; Messer et al., 1998; Pinstrup-Andersen and Cohen, 1999). Malnutrition and hunger Sub-Saharan Africa suffers proportionately more malnutrition than any other region. This hidden hunger is the root cause of much if not most ill health and excessive mortality. It also

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Myers and Kent to consume their bodies as their system eats up their muscles: it is outright starvation. But people do not often die of outright starvation. The cause of death in a malnourished person is usually an infectious disease. Another key factor is that per capita food supplies are substantially higher than actual consumption for the majority of people, due mainly to disproportionate consumption by the top 20 percent of people with their larger incomes. Nor does consumption always equate with nutrition. To cite but one problem, diarrhoea can overtake children as often as every month and thus undercut the nutritional value of food consumed. The regions malnutrition has steadily worsened. During 1979/81 it ofcially affected 130 million people or 35 percent of the total population, by 1990/92 196 million or 40 percent, and by 1994/96 210 million or 39 percent (Food and Agriculture Organization, 1999b; 1999c; for similar, but divergent, estimates, see Sharma et al., 1996; Bender and Smith, 1997; Alberts, 1998; Jolly, 1997; de Haen et al., 1999; Rukuni, 1999). But these are cautious and minimalist estimates. Only the one-fth of the population enjoying the highest income, totalling 130 million people today, receives the basic nutritional requirement of 2100 calories per day. The other four-fths, some 517 million people, experience some degree of malnutrition. Because the second quintile are only just below the cut-off level of 2100 calories per day, in order to be conservative, it is possible to discount most of them, and suppose that the people who are signicantly malnourished total 400 million. That this is a reasonable estimate is conrmed by a detailed recent calculation by the US Department of Agriculture (1999), postulating 361 million malnourished in 1998 and 516 million in 2008, which through intrapolation implies 392 million in 2000. Moreover the poorest one-fth, comprising 130 million people, has been receiving only 74 percent of nutritional needs, a nutrition level that is expected to decline by 2008 to 70 percent (US Department of Agriculture, 1999). These people are viewed here as so severely malnourished that they are chronically hungry. Their situation leaves them vulnerable to pandemic diseases as well as summary starvation (Myers and Kent, 2000). To be conservative again, their total today is put at 100 million. Especially hard hit by malnutrition are women and children. Malnutrition contributes to at least

reduces worker productivity and cognitive capacity (Dasgupta, 1993; Dreze et al., 1995). The average household now consumes 20 percent less food than 25 years ago. Per capita food supplies region-wide amounted in 1965 to 2100 calories per day, the minimum for basic nutrition. They declined by 1985 to 2050 calories and by 1991 to 2040 calories, before rising by 1998, thanks largely to (temporarily?) better rainfall, to 2220 calories (Food and Agriculture Organization 1999b; 2000b). But note the skewing factor of Nigeria which enjoys a per capita supply of 2750 calories per day, well above the regional average (Food and Agriculture Organization, 1999b). If Nigeria is excluded from the regional calculation, the per capita calorie supply falls from 2220 to below 2000 (Food and Agriculture Organization, 1999a; 1999b; US Department of Agriculture, 1999; United Nations Development Programme, 1999; Myers and Kent, 2000). (South Africa enjoys a per capita calorie supply of almost 3000 per day, but it is not included in the Food and Agriculture Organizations regional estimates). Because of unequal distribution of food within Nigeria, it still features many malnourished people, with almost two out of ve children underfed. A minimum daily intake of 2100 calories should provide sufcient food energy for reasonable physical activity (Food and Agriculture Organization, 1992; World Health Organization, 1996b). Below that level, malnutrition sets in, whereupon it disables and it can kill. Much depends too on a persons activity. A subsistence farmer with heavy labour may need 3500 calories per day (US National Research Council, 1989; James and Schoeld, 1990). Conversely a woman with her smaller body size needs fewer calories than a manthough a pregnant woman needs an additional 300 calories a day, and her lactation will require an extra 500 calories a day. A child may get by with 1000 calories (World Health Organization, 1996b; Bender and Smith, 1997; Poleman, 1997). Worse than standard malnutrition is undernutrition, or outright hunger. This means that food intake is less than 80 percent of recommended calories per day, or 1700 calories. It is not enough to sustain even low levels of activity: it is close to starvation. If it falls to 1500 per day, sufferers start

Food and hunger in Sub-Saharan Africa half and perhaps two-thirds of all mortality among under-ve children (World Health Organization, 1997; UNICEF, 1998; US Agency for International Development, 1999). Moreover, the great majority of these childhood deaths is associated with mild to moderate, rather than severe, malnutrition, largely because the rst is three times more prevalent than the rst (Jolly, 1997; World Health Organization, 1999). Thus even a marginal amount of malnutrition can lead to mortality. The malnutrition straw does not have to be heavy to break the pre-school childs back (Haddad, 1995). All in all, at least 1.5 million children die from malnutrition and related diseases each year, or over 4000 per day (equivalent to a jumbojet-ful every second hour (Murray and Lopez, 1996; UNICEF, 1998; US Agency for International Development, 1999). Overall assessment These seven reviews show that the region is subject to a host of problems, each of which reduces food consumption and fosters malnutrition. This much is obvious. Less obvious though more important is the way in which these problems interact, often with compounded impact. In the Horn of Africa during the early 1990s, violent conict resulted in mortality rates from malnutrition and disease more than 20 times greater than usual (Webb and von Braun, 1994; Hansch, 1995). During the 198284 famines, several countries were aficted by both drought and civil war: Chad, Sudan, Ethiopia, Somalia, Angola and Mozambique (Hansch, 1995). A still more signicant cause of hunger and eventual starvation can lie with poverty. War leads to acute (temporary) rather than chronic food shortages, whereas poverty persists when the war ends. People can be malnourished even in a country with plenty of food. Similarly important are linkages among resource supplies, notably those between croplands, forests and water stocks, all being resources that are coming into increasingly short supply and that are inclined to interact. When a country is short of croplands, its agriculture suffers; and if that same country is short of water too, its agriculture suffers again though not in additive fashion, rather through multiplicative effects. Put one problem together

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with another problem and the outcome may not be a double problem but a super problem. The same applies only more so with regard to soil erosion and fuelwood decits when they impose their compounding impacts on cropland and water shortages. Such synergized interactions are likely to become an ever-more frequent phenomenon in Sub-Saharan Africa. The biggest threat is not only that the regions problems will become more numerous and more potent, but that they will often reinforce each others effects. Now for the most important point of all. When problems interact together to generate a compounded impactor when several compounded impacts arise at once, generating their own supersynergized effectsthere can emerge what is technically known as a discontinuity. This is sudden and pronounced departure from a trend, hence its rather less technical and more comprehensible name of non-linearity. In Sub-Saharan Africa, the most obvious discontinuity arises when people no longer keep on growing hungrier but they start to die, as illustrated notably by the mass starvation deaths during the Ethiopia famine of 198485. There have been many such instances of mass mortality in the Sahel, Somalia, Sudan, Angola and Mozambique, to cite but the best known cases. In practice it is not possible to separate out the various contributions of food shortages, chronic malnutrition, pandemic diseases, absolute poverty, violent conicts, etc. The interacting mixture cannot be untangled and evaluated even qualitatively, let alone quantitatively. There is scant empirical evidence of the pressure point stage when coping measures are exhausted. This does not mean, however, that the prospect of more discontinuities should be ignored simply because the analytic complexities cannot be resolved. The foreseeable future could well feature increasing numbers of discontinuities in the form of greater starvation crises and mass mortality. Intersectoral linkages The above points up the particular importance of intersectoral linkages. Consider too the many interactions in the diseases sector. The failure to implement disease-prevention measures is viewed

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Myers and Kent eight persons or 12 percent of the local population; most of these deaths derived from the general economic breakdown hanging over from the mid-1990s civil wars, and only 3.0 percent of the population (a decidedly minimalist estimate) are thought to have died from hunger and starvation together with starvation-related diseases (though economic breakdown itself would have been a prime source of food shortages). A fourth example concerns Angola with over 400000 people hungry in mid-1999, and 200 deaths every day related to severe malnutrition; this meant that each month saw the demise of over 6000 or 1.5 percent of the people in question (Oxfam, 1999). The deaths in these four examples thus amounted to 1.4, 2.8, 3.0 and 1.5 percent of local populations. Still more to the point, recall that only people in the top income quintile receive more than the adequate food intake of 2100 food calories per day, while the bottom quintile, 130 million people, receive less than 75 percent of the 2100 minimum, i.e. 1550 calories (US Department of Agriculture, 1999). If this latter intake falls still further, such people could readily be pushed across a threshold into terminal starvation or die from malnutrition-related diseases. This serves to conrm the earlier calculation that over 100 million people are so severely malnourished that they are on the verge of starvation (clearly a cautious and conservative estimate). Compare these empirical data with a theoretical and more expansive calculation. The crucial point is that 400 million people are malnourished today, at least 100 million of them severely malnourished. During the coming decade there will probably be a projected decline in per capita food production, which in turn will often be a good deal less than actual consumption and nutrition. Suppose that the 100 million people increase in proportion to the projected rise in the numbers of malnourished people (from 400 million to 516 million, a 30 percent increase), and hence total 130 million by 2010. Suppose too that by 2010 some 5 percent of these 130 million nd themselves deprived of only a small part of their food intake due to the projected decline in food consumption. (This 5 percent estimate, while higher than the 1.4 to 3.0 percent in the four instances cited above, is realistic as witness the paragraph below on mortality among under-ve children.)

as a highly signicant factor with respect to malaria, diarrhoea and nine other major diseases, while malaria is considered a highly signicant consequence of several other factors, e.g. malnutrition, lack of clean water and sanitation, poor or non-existent health services, and lack of vaccines (World Health Organization, 1997). Malnutrition is implicated in ve diseases (World Health Organization, 1999). Bearing in mind the potent phenomenon of synergized linkages, consider some interactions among the various sectors reviewed earlier Table 4. Note in particular the many linked linkages or multi-pronged linkages. Whereas each of the ten driver sectors in Table 4 affects several other sectors, it can often be the case that several driver sectors are operating at once. On top of the intersectoral linkages are subsectoral factors. A notable one is the skewedness of income. The bottom 60 percent of the regions people enjoy only around 30 percent of national incomes (World Bank, 1999c). This means that the people in question are unduly impoverished, and little able to purchase food or agro-inputs, or to pay for health, education and many other basic needs. There are many other instances of such subsectoral factors that further multiply and strengthen the linkages listed. Potential mass mortality ahead? How many of the 100 million people who are now on the verge of starvation will nd themselves with even less to eator simply too little to eat? Equally to the point, how many of the other 300 million malnourished people are likely to experience still worse malnutrition until they join the 100 million? This is the most fundamental and difcult question of all. Some limited insight can be gained by looking at four specic instances cited earlier. The 1973 drought in the Sahel left 7 million people acutely dependent on food handouts; at least 100000 people died of hunger or related diseases, that total being 1.4 percent of the food-short people. Secondly, during the Ethiopia famine of 198485 well over 1 million people died of starvation, comprising 2.8 percent of the countrys population. Thirdly, in late 1998 several areas of Burundi, Rwanda and eastern D.R. Congo suffered a mortality rate of almost one in

Food and hunger in Sub-Saharan Africa

Table 4. Intersectoral linkages. Food shortages impact on: malnutrition and hunger land degradation via unsustainable farming practices water decits via unsustainable demand in dry areas diseases via potentiating effects of malnutrition Cropland shortages impact on: food production, hence on malnutrition and disease forests through clearing of forestlands for agriculture Forest shortages impact on: fuelwood supplies, hence on disease and malnutrition womens education, hence fertility too, through time spent on seeking fuelwood from distant stocks agriculture through the food-growing opportunity costs of women seeking fuelwood from distant stocks watershed functions via upland erosion Water shortages impact on: cropland productivity via lack of soil moisture diseases via lack of safe water and sanitation womens education, hence fertility too, via time spent on seeking water from distant sources agriculture through the food-growing opportunity costs of women seeking water from distant sources Population impacts on: cropland supplies via sheer pressure of growing numbers land degradation via demands beyond carrying capacity food consumption via demand to feed growing human numbers malnutrition via insufcient food for growing numbers poverty via unsustainable economic demands from over-rapid growth in human numbers fuelwood shortages via excessive consumption water shortages via excessive demand

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other resource shortages via population longages disease via infections in over-crowded communities violent conicts via shortages of land and other resources Disease impacts on: population via incentives for large families to compensate for child mortality malnutrition via potentiating effects economic development in general and agriculture in particular, via reduced worker productivity Malnutrition impacts on: farm production via physical incapacity disease via potentiating effects poverty via reduced productivity economic development via retardation of childrens physical and mental capacities Poverty impacts on: malnutrition via shortage of means to purchase food disease via lack of health care food production via shortages of agro-inputs and knowhow of modern farming forests via over-exploitation of fuelwood stocks Violent conict impacts on: farmland degradation via military activities food production via abandoned farmlands malnutrition via disruption of food supplies disease via run-down of health services economic development generally and poverty in particular via funds diverted from development Economic development impacts on: all of the abovejust as all of the above impact on economic development

These 5 percent will rank as people so malnourished that they experience outright hunger and nally starve. The 5 percent proportion will mean that 6.5 million of the 130 million could die in 2010. Recall the single biggest mass mortality to date, viz. the one million people who died in the 198485 famine in the single country of Ethiopia. Consider the prospect from still another standpoint. Some 44 million under-ve children, 41 percent of 108 million such children in the region today, are so malnourished that they are unusually susceptible to starvation and hunger-related diseases. Some 4.4 million, or 4.1 percent, of under-ves die from all causes each year. Between half and two-thirds of all child deaths can be attributed, whether directly or indirectly, to malnutrition, hence these deaths total between 2.2 million and 2.9 million of the 4.4 million per year. If there are 126 million under-ves by 2010

(increasing by a projected average of 1.7 percent per year, so 17 percent more than the 108 million children in 1999), and if the malnourished proportion remains at 41 percent, this means an additional 8 million malnourished children, making a total of 52 million. If the mortality rate for the under-ves remains at 4.1 percent, this will result in 5.2 million deaths per year. If half of them die from malnutrition, this will amount to 2.6 million deaths; and if two-thirds, then 3.4 million. But child malnutrition is expected to increase by 15 percent by 2010, placing an additional 8 million at risk and raising the total of malnourished under-ves from 52 million to 60 million. In turn this means that malnutrition deaths among children would total between 3 million and 4 million in 2010. Note that the 3 million gure represents 5 percent of the 60 million children at risk. It thus rein-

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Myers and Kent combination of pervasive poverty, land degradation, regular droughts, failing agriculture, disease pandemics, outbreaks of violence, etc. Collectively these problems nally reach a critical mass and cross over a break point. A long-standing process abruptly changes course (a discontinuity), as it switches from a malnutrition level that is somehow tolerable in normal times but becomes intolerable under new circumstances. Yet the steady build-up to the sudden switch can be exceedingly difcult to perceive ahead of time. What covert trends of this sort are underway today, unusually serious but usually disregarded until some threshold effect precipitates a long a-building debacle? It is not possible to hazard an estimate of how many people could ultimately be overtaken by the crisis-to-catastrophe processes. Sufce it say that the 6.5 million total of people dying as early as 2010 could well prove to be an under-estimate, even a severe under-estimate. By 2020 the situation could have deteriorated to an extent that precipitates an even larger disaster. The deepest uncertainty lies with the question of when a starvation catastrophe might start to overtake the region. Plainly a catastrophe is unlikely to arrive next year; and equally plainly according to this article, it will surely ensue at some stage within the foreseeable futureunless the region and the outside world determine to tackle the source problems in far more timely and energetic fashion than to date, and thus engage in anticipatory measures of scope and scale to match the problems. Whether the rst onset of major mortality occurs by the year 2010 or is deferred until a later stage is not so important as the question of what should be done to pre-empt the prospect. Were ameliorative or even preventive measures to be implemented, there would be clear benet in as much lead time as possiblein which case, a catastrophe that does not build up nal momentum until a later date would allow more manoeuvring time to reduce the ultimate scale of the catastrophe. All this hinges on a decided switch in response from governments and development agencies both within the region and outside. Whether rightly or wrongly, this article has presupposed there will not be sufcient response until too late to avert a catastrophe of some degree. This may sound unduly pessimistic. But leaders both within the region and the wider world have watched

forces the earlier estimate earlier that 5 percent of the 130 million people (children of all ages and adults alike) receiving less than 1500 calories per day could well die in 2010. Even more important, it implies that it is probably an underestimate to postulate that 6.5 million people (children and adults alike) will die from malnutrition in 2010. The calculations thus far reect a simple extrapolation of recent trends, which constitute an exceptional crisis already. Now consider some circumstances that could transform the trend crisis into an unprecedented catastrophe. One likely factor is the combination of declining per capita food supplies and the regional population increase of 16 million people per year. Add in long-term soil erosion, steadily undermining cropland fertility. Add in declining food imports in relation to needs. Add in declining aid and rising debt, together with trade terms at near historic lows, all of which accentuate the spread of absolute poverty. Add in more violent conicts that degrade croplands and disrupt food transportation, fertiliser supplies, marketing networks, anti-malaria projects, etc. Add in several other adverse factors documented above, notably the potentially profound disruptions of global warming (for extended detail, see Myers and Kent, 2000). It becomes clear that all manner of increasing problems could make a difcult situation eventually tip over the edge from crisis into catastrophe. This evaluation is preliminary and approximate, even exploratory. The authors believe that (a) it is realistic, with extensive while less than conclusive evidence in support, and (b) it is warranted, notwithstanding its limitations, in order to gain a grasp of what is an entirely possible prospect for the region, with all the humanitarian implications at stake. There is still another pivotal perspective, that of perception. Like the concept of an epidemic, famine and starvation are generally acknowledged as such only when a dramatic change occurs from one stage to another. More often, however, they are not a discrete event but stem from a continuous process that has been quietly building up until it erupts into catastrophe. While the former, viz. the sudden emergency, arises intermittently in Sub-Saharan Africa, the latter, viz. the creeping crisis, is far more frequent, resulting from a

Food and hunger in Sub-Saharan Africa the regions people become poorer and hungrier for most of three decades, and they have not done nearly enough to achieve a turn-around. To repeat: it is uncertain for present purposes when the catastrophe nally arrives, and how quickly it manifests itself in its full scope. But what is not uncertain is that if decades-long trends persist, there will ultimately be a human tragedy of altogether unprecedented scale in Sub-Saharan Africa. Policy responses: the scope for action There is much evidence that the region knows how to get things right, and has done it on various occasions. Twenty years ago two-thirds of Ghanaians were malnourished, today only onetenth (Poleman, 1997). Ethiopia has doubled its production of certain staple grains since 1990 (Fig. 4), though in 1998 there was a falloff and it needed food aid for six million people due to inadequate rainfall and renewed war, followed in early 2000 by food aid needed for eight million people (Food and Agriculture Organization, 1998; 2000a). Nigeria has greatly increased its maize harvest and expanded the average yield of cassava threefold (US Department of Agriculture, 1999). Mozambique has stepped up its agricultural output by half now that its long civil war is at an end, though at least half its people are still malnourished, and the country is still susceptible to natural disasters such as the oods of early 2000. Uganda has doubled or even tripled its production of several major staples. During the half decade 199498, Kenya increased its average annual food output by 3.0 percent or more, Ethiopia 2.6 percent, Nigeria 1.7 percent, and South Africa and Tanzania between 1.5 and 2.0 percent (Cleaver, 1997; US Department of Agriculture, 1999). In the population eld, Kenya has slashed its fertility rate from 8.0 children per reproductive woman in 1960 to 4.7 children today, and it has cut its population growth rate from over 4 percent in 1980 to to 2.1 percent today. Zimbabwes fertility rate is 4.0 and South Africas 2.9, by contrast with the regional average of 5.8. South Africas modern contraceptive prevalence rate is 55 percent and Zimbabwes 50 percentgures that compare well with some of the more advanced developing countries such as Indonesia with 55 percent,

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and ahead of Pakistan and Bolivia with 48 percent. With respect to HIV/AIDS as well as family planning, Senegal has expanded its distribution rate for condoms from 800000 in 1987 to over 7 million in 1997, while Uganda has cut the rate of new HIV infections (United Nations Development Programme, 1999). In the diseases eld, a campaign against guinea worm shows what can be done. The Carter Center in Atlanta, in conjunction with United Nations agencies, has helped to eliminate the disease from 3.5 million people; in Nigeria the total has declined from 653000 in 1989 to 18000 in 1995. Region-wide the number of cases has decreased by more than 95 percent since the eradication campaign started in 1986, and it was hoped that the disease may be all but eliminated by late 2000 provided that the campaign is not hampered by war and other civil upheavals (World Health Organization, 1999). In the economics eld, countries as disparate as Ivory Coast, Ghana, Nigeria, Namibia, Botswana and South Africa have undertaken structural adjustments and related reforms sufcient to place them on a rm track toward sustainable economic advancement. Altogether ten strong performers achieved average annual growth in per capita GDP of 7 percent during 199597. Others, notably Angola, Ethiopia and Uganda, managed per capita GDP growth of more than 2 percent during 199597. The front runner has been Botswana, which during 199098 achieved an average annual growth of over 11 percent (Richardson, 1996; World Bank, 1998; Messer et al., 1998). Despite these success stories, all countries in the region have a long way to go before they reduce malnutrition to what is viewed by governments and international agencies as an acceptable level, generally taken to be roughly 10 percent (by contrast with the 33 percent ofcially estimated for the region by the Food and Agriculture Organization and the 62 percent postulated in this article). A level of 10 percent would still leave 65 million people malnourished, surely an unacceptable total. Recall nonetheless that the World Food Summit in 1996 proposed that a major breakthrough would be to cut malnutrition worldwide by half to only 400 million people by 2015, a large share of them being in Sub-Saharan Africa.

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Myers and Kent

Figure 4. Rudimentary agriculture on sloping terrain fosters soil erosion (Photo Courtesy: Mark Edwards/Still Pictures).

Nonetheless the success stories offer hope. For future purposes, what specically should the regions governments and citizens undertake? Food and agriculture The many measures that reduce incentives for farmers to produce more food should be reversed. Governments have been inclined to favour industry over agriculture, and cities over countrysides. Within agriculture, moreover, they have favoured commercial farmers who grow cash crops for export rather than subsistence farmers who grow food for local consumption. Particularly adverse policies have included articially low prices for agricultural outputs, subsidies for food imports, export quotas for farm products, and other restrictive practices that have resulted in a plundering of agriculture (Shiff and Valdes, 1995). Just as harmful, though indirectly so, have been macroeconomic policies that have long contributed to

the stagnation or even the decline of agriculture, via high ination, negative interest rates, budget decits of 1020 percent of GDP, and overvalued exchange rates (Paarlberg, 1999; Poleman, 1997; Abdulai and Delgado, 1995; Gardner, 1996; Tweeten and McClellan, 1997). Worst of all, governments nancial support for agriculture has amounted to only about 10 percent of budgetary spending, even though agriculture often contributes 30 percent or more to GDP (Abdulai and Delgado, 1995; Donovan, 1996). Each additional $1 of income from agriculture adds almost $2 to the overall economy (Pardey et al., 1995; Pinstrup-Andersen et al., 1995). Agriculture promotes economic growth through its many forward and backward linkages to nonagriculture sectors. Specially signicant are the consumption linkages that arise when increases in agricultural income lead to increases in household consumer demand for non-agricultural goods, especially labour-intensive goods and services. Various authors give details of how agriculture

Food and hunger in Sub-Saharan Africa contributes to economic growth generally, and thus warrants much greater support from governments (Abdulai and Hazell, 1995; Alexandratos, 1995; Gardner, 1996; Hazell, 1996; Sharma et al., 1996; de Haen et al., 1999.) To be specic, there is need to increase farmers productivity so as to achieve a sustained 4.0 percent rate of food production, twice as much as today. This could be accomplished through greater policy attention to scientic research, agronomic inputs such as fertilizer, incentives for smallholders, marketing networks, extension services, and credit systems (especially for women farmers) (Pinstrup-Andersen, 1995; Abdulai and Delgado, 1995; Teklu, 1995). In addition, there is need for a host of further supplementary measures. These include: greater participation by farmers, NGOs and the private sector in policy, programming and project planning; stronger links between agroresearch and farmers; more focus on land tenure and agrarian reform; fostering womens participation in rural activities; better environmental management; expanded credit facilities through cooperative-owned banks which mobilize individuals savings; and upgraded rural infrastructure, notably marketing roads (Elz, 1987; Jayne et al., 1994; Johnson, 1996; Staatz et al., 1993). Population The huge unmet need for family planning must be tackledand within a context of improved health and education for females and with enhanced social status for women generally. The technologies are all available at little cost. Were these needs to be met, the demographic consequences could be marked, with some countries achieving a fertility decline of 18 percent, or an average of 30 percent of the distance to replacement fertility. Many investments will generate further dividends, through for example the health and education of females. A 10-percent increase in female literacy reduces child mortality by 20 percent (Meier, 1996; World Bank, 1999b). Note the scope for political leadership, as epitomised by Zimbabwe. Its exceptional record has beneted strongly from the promotional activities of just a few politicians. The countrys modern contraception prevalence rate has risen from

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17 percent at independence to todays 50 percent. Similar progress has been achieved in Kenya through the long-term support of President Daniel arap Moi. Much too could be achieved through measures to encourage family planning motivation among those parents who still want large numbers of children. This stems in part from the persistently high mortality rate for children due to the great killer diseases such as malaria and diarrhoea. As long as parents see many of their children dying, they will feel inclined to have as many children as they can in order to mobilise a kind of insurance. There is huge scope to reduce child mortality. Diseases Malaria could be reduced through modest outlays of research funding. Worldwide spending on a malaria vaccine in 1997 was $60 million per year, down from $84 million in 1983. Todays outlay is equal to under $60 per malaria death, whereas expenditures for research on diseases such as AIDS, cancer and asthma are 100100000 times higher. In Sub-Saharan Africa malaria accounts for almost 10 percent of the disease burden overall (worldwide, 2.1 percent), yet it attracts only 0.1 percent of research spending. For just $11 per child p.a., one in four child deaths could be prevented through insecticide-treated bed nets (World Health Organization, 1999). As it is, many African families spend up to $65, or an average of one-fth of their cash incomes, on antimalaria drugs, mosquito coils and insect repellents each year, with limited success (Wirth and Cattani, 1997; World Health Organization, 1997). Meantime a single bout of the disease for an adult costs an average of 10 working days, and the economic burden of malaria now costs the region $2 billion per year, up from $790 million in 1987 (World Health Organization, 1999). Many of the regions diseases are both preventable and treatable at low cost. There are vaccines against measles, polio, diptheria, tetanus, whooping cough, tuberculosis and yellow fever. Measles immunisation costs only $0.25 for a single vaccine dose. More widespread use of these vaccines could prevent 1.6 million child deaths a year worldwide, yet barely half of the regions

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Myers and Kent funds (Piuf, 1999). The region has 10 times as many new AIDS cases each year as the United States but a budget 5.5 times less (Bellamy, 1999). To supply an individual with one years condoms costs just $14 (World Health Organization, 1999). By contrast, the hardest hit countries will lose 1015 percent of GDP to AIDS deaths in a single decade (Forsythe, 1996). Some 16000 people worldwide contract the HIV virus each day. On that same day an equal number of children, most of them in Sub-Saharan Africa, die from traditional illnesses such as diarrhoea, pneumonia, measles and malaria. Yet a World Conference on Diarrhoea would not receive a fraction of the attention as the regular AIDS conferences. Environments and natural resources Governments and citizens should recognize that drought need not mean famine. The rst is inevitable, the second is notas witness the Greater Horn of Africa Initiative, whereby ten governments, together with development agencies, are working to establish early warning systems for tens of millions of at-risk people. The purpose is to identify food crisis areas, to pre-position food stocks, and to support regional crisis management (Atwood, 1995; World Food Programme, 1999b). A similar success story is at work in Southern Africa. In 1991/92 the worst drought in several decades devastated the subregions agriculture, caused more than a 50 percent drop in food harvests, and induced unprecedented imports of 10 million t of grain to relieve starvation among 80 million people. Fortunately famine was averted through an early warning system, together with regional co-ordination and international support. Hardly anybody died of hunger. In Botswana, a semi-desert country, the government built an anti-famine capacity with a permanent safety net for the poorest people; the country avoided famine despite four droughts in ve years. All this has been in marked contrast to what might well have happened if the droughts had occurred in the Sahel where there are few anticipatory measures (Smith et al., 1995; Meinzen-Dick and Rosegrant, 1997; Thamae, 1997).

children are immunised by their rst birthday. To manufacture all these vaccines together costs less than $1 each, though distribution would push up the cost somewhat (World Health Organization, 1999). Were the United States to pay its arrears to the United Nations, that would go some way to helping the World Health Organization to expand its immunisation efforts. A disease that cannot be countered through immunisation is diarrhoea. Fortunately it can be readily resisted through a simple therapy known as oral rehydration with small sachets of salts. Although the therapy generally needs to be applied several times a year to counter recurrent bouts, it costs less than 33 cents per dose when supplied in bulk (World Health Organization, 1999). The prime way to reduce diarrhoea, however, is through improved water supply and sanitation. This could slash diarrhoea mortality by 65 percent (World Health Organization, 1995; Esrey, 1996), and it could be accomplished at triing costtriing, that is, for outside donors but still viewed as too expensive for most of the regions governments. Only 60 percent of Africans enjoy access to basic health services, compared with Southern Asias 78 percent (UNICEF, 1998; United Nations Development Programme, 1999). Government spending on health often averages just 1.4 percent of GDP, less than $10 per person per year. Many doctors have to moonlight to supplement salaries of a mere $3 per day. The disease burden could be reduced by 30 percent through the investment of an additional 1 percent of GDP (World Bank, 1992). Not so readily tackled is HIV/AIDS, except by much more widespread use of condoms. The region has virtually no access to the new generation of protease inhibitors that have radically cut the AIDS death toll in the United States and Europe. The World Bank (1999a) estimates that treatment of all AIDS cases in Sub-Saharan Africa would cost $10 billion a year for drugs alone, or more than 30 times the amount spent annually by international donors for AIDS programmes in all developing countries combined. As it is, foreign aid to support anti-AIDS campaigns in SubSaharan Africa amounted in 1997 to no more than $150 million, equivalent to the annual budget of a small hospital in Europe. The regions governments contributed $15 million from their meagre

Food and hunger in Sub-Saharan Africa In terms of environmental safeguards overall, some 30-plus countries of the region have developed policies and programmes for better management of their environments and natural resources. Regrettably they have generally not worked out, due to lack of community management based on local self-help initiatives. Such measures are being attempted in certain countries (Cleaver and Schreiber, 1994; Veit et al., 1995; Burman, 1995; Binns, 1995; Veit, 1998). Economics and poverty Governments should recognise how far their policies have undermined the regions economies. Prominent among these are: huge scal decits; poor pricing and trade policies, especially in agriculture; and over-valued exchange rates that discriminate against agricultural exports. In addition, the region has endured problems that stem from beyond its borders: persistent upsets in the global economy; declines in commodity prices; increasing protectionism; steep shifts in international interest rates; soaring fuel prices; terms-of-trade shocks; falling foreign aid; mounting external debt; and meagre private investment. Most important of all have been the many government interventions in economies, leading to a plethora of bureaucratic controls. These have been more numerous and deleterious than in any other developing region. Entire economic sectors have fallen under the control of political lites with their corrupt practices. Such activities have exacted the inevitable penalties: reduced private incentives; inefcient parastatal institutions; dictated prices; proliferant administrative controls; and worst of all, an erosion of productivity, pragmatism and entrepreneurial energyall of which have translated into sluggish economic growth. These constraints were cited by McNamara (1991), and many persist today, albeit with some reform in some countries (Fischer et al., 1998; International Monetary Fund, 1999; World Bank, 1999a). To correct these meta- and mega-problems, there is need for several prime policy responses: control of government expenditures; cutting scal decits; limits on monetary expansion; realistic trade and pricing policies, also exchange rates, in

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order to encourage production and exports; and reform of public enterprises and marketing boards (International Monetary Fund, 1999). Corrective measures should concentrate on the over-riding problem of poverty. The main sources of poverty are easy to list: jobs famine; inadequate land and capital; minimal access by the poor to even small-scale credit; meagre rural development in the most deprived areas; poor access to markets; low levels of human capital (education, health, etc.); environmental degradation with reduced productivity of natural resources; and lack of participation by the poor in development programmes. This implies that a policy attack should be directed at factors of basic human well-being: clean water and sanitation, housing, health, primary school education, jobs, and food of sufcient quantity and quality. All these essentials can be provided through a rigorous rejigging of government budgets, together with a parallel reordering of priorities by donor agencies. Were the outside world to play its full part, the effort would become far less difcult. Note that greater GNP growth will not, in itself, reduce poverty. It is the pattern of growth that must benet the poor, whether directly through increased employment and incomes, or indirectly through improved social services. In turn, the distribution of growth is critical in determining which groups benet from more jobs and other income-earning opportunities. Hence there is need to target certain pivotal growth sectors, especially agriculture, and certain communities, notably those in remote rural areas and urban slums (World Bank, 1995; 1999a). So much for what needs to be done. What has actually been accomplished? Answer: quite a lot. Structural reforms have been implemented in many countries. Domestic price controls have been liberalised if not abolished in several countries. Inefcient public monopolies have been dismantled. Many state enterprises have been privatised. Non-tariff barriers have been eliminated in most countries, and import duties reduced in several. Exchange rates have been freed and unied in many countries. Most governments have eliminated direct controls on bank credit and have established market-determined interest rates. Controls over government spending have been tightened markedly.

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Myers and Kent production, increase social equity (especially distribution of food), improve health facilities, and reduce poverty (World Bank, 1993; Scrimshaw, 1994; Jolly, 1997). These policies work best when hand in hand with each other, often generating a synergised success. There are few magic bullet options for policy initiatives to counter malnutrition, except for example measures to tackle iodine deciency and other micro-nutrient shortfalls. In many countries, however, much policy leverage would be available through a national food and nutrition policy in order to boost sectors such as agriculture, public health and education. This needs to be addressed through strategies to raise nutritional questions higher on political agendas, with enhanced partnerships between governments, the private sector, NGOs and donor agencies. Specially helpful would be a political commitment to establish food and nutrition security as a basic human right. On top of these seven sets of options for policy responses at sectoral level, there are some general opportunities. Governments should bolster the process of democratisation that is underway in many parts of the region. During 19901994, 38 countries held open legislative elections (regrettably several countries are taking a step back with military take-overs and political repression). The best way to consolidate democracy is by strengthening NGOs, freeing up the media, and providing more opportunity for people, especially women, to participate in politics at all levels (women constitute fewer than one third of administrators and managers, and occupy only 12 percent of parliamentary seats and 7 percent of cabinet positions (United Nations Development Programme, 1999)). Democratisation is also the best way to overcome corruption, which has long been endemic throughout the region. There is a culture of corruption, not just nancial wrong-doing but political chicanery of many sorts. Election victories tend to assume a winner-takes-all reaction with respect to wealth, resources, patronage, and the prerogatives of ofce. It is partly due to pervasive corruption that only 64 percent of the World Banks energy projects during 197896 performed satisfactorily, compared with a developing-world average of 79 percent (Covarrubias, 1999). In response, governments should foster transparency

Finally note the strong linkages between poverty and famines. To cite Nobel Prize winning economist Amartya Sen (1999), It is important to realize that people starve when they do not have the means to buy food. Famine can occur even when there is plenty of food in the country, if income collapses because of unemployment or a fall in real value of wages. Many famines have occurred without any decline in food output. One has to shift attention from famine as a food crisis, narrowly dened, to famine as an economic crisis, broadly dened. In turn, this means that famines can be prevented by creating public projects to provide income for potential famine victims. The process combines market mechanisms with government assistance, in contrast to elaborate feeding programs, which disrupt economic and social activity. At the political level, moreover, famines are associated with the absence of democracy. Famines have never occurred in democratic countries, even very poor ones, that have regular elections and a free media. By contract, they have occurred in military dictatorships, in colonial regimes and in oneparty states. Civil disorders and military activities There is the obvious imperative to curb such disruptions. This can best be done through addressing their source causes, as well as by slashing military expenditures. The UN Secretary General Ko Annan (himself an African) has urged the regions governments to cap their military spending at 1.5 percent of GDP forthwith, and to commit themselves to zero growth in defence budgets within ten years. As it is, many governments remain inclined to resolve their problems by military force, though several countries, notably Mozambique, Nigeria and Liberia, appear to have left behind their long-standing proclivity for ever-more war. Malnutrition Overcoming the hidden hunger requires a spectrum of policies, notably those that facilitate food

Food and hunger in Sub-Saharan Africa and openness in all their activities. In turn this can promote scope for a vital lubricant of the regions economies: foreign investment and business. Strong political and legal institutions reduce the risks for foreign entrepreneurs. All this places a premium on political leadershipa resource that is often scarce due to lack of civic traditions at national level, to tribalism and other forms of sectarianism, and to a tendency toward authoritarianism. Fortunately there is an emergent set of new political leaders. Prominent among them is President Museveni of Uganda, who argues for the rule of law, respect for human rights, and democratic processes generally. Most countries now enjoy freedom of the press, and people can join political parties of their choice. Centrally important is to build up the most valuable resource of all, human capital. The process should be helped by the communications and computer revolutions that are greatly expanding the reach of global knowledge. These revolutions can allow the region to leapfrog out-dated technologies that still hold sway in many industrialized countries. Both Ghana and Botswana, for example, have 100 percent digital telephone networks, compared with the developed worlds average of less than 70 percent (World Bank, 1999c). Finally, and with particular respect to starvation crises, all governments should set up early warning systems to alert them to crises while they are still building up. They should establish a rapid relief task force, preferably under the United Nations, ready to ship grain, medicines and other supplies at next to no notice. These numerous openings for policy and action mean that all the regions profound problems can be converted into profound opportunities. SubSaharan Africa can still squeeze through the bottlenecks ahead. There is still time, though only just time, to avert a human tragedy of unprecedented scale. This will require unprecedented efforts by the regions countries, paralleled by similar efforts on the part of the world at large. Could this offer scope for a new form of globalisation? References
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