Global Food Security 21 (2019) 52–59
Contents lists available at ScienceDirect
Global Food Security
journal homepage: www.elsevier.com/locate/gfs
The SDG of zero hunger 75 years on: Turning full circle on agriculture and
nutrition
Derek Byerleea,∗, Jessica Fanzob
a
Georgetown University, Washington, DC, USA
b
Johns Hopkins University, Washington, DC, USA
1. Introduction
As Editors of the Journal of Global Food Security, we recognize that
the year 2018 marked the 75th anniversary of the first international
commitment to ending hunger, made at the UN Conference on Food and
Agriculture, at Hot Springs, Virginia, USA in 1943. That conference set
the goal of ‘freedom from want of food, suitable and adequate for the
health and strength of all peoples’ that should be achieved ‘in all lands
within the shortest possible time’ (US Department of State, 1943). It is
sobering and shameful that 75 years after this clarion call, as well as the
dozens of similar global declarations since 1943 for ending hunger,
some 800 million persons are estimated to be undernourished and over
2 billion adults and children suffer from other forms of malnutrition be
it obesity or micronutrient deficiencies.
While the global burden of malnutrition remains unacceptably high,
there has also been significant progress (Fig. 1). Famines are no longer
as severe and the risk of dying during a famine is less likely than at any
time in history (De Waal, 2017). Although the world added 2.1 billion
people from 1991 to 2017, there were about 200 million fewer under-
nourished people in 2017 compared to 1991. The share of children
suffering from stunting (low height for their age) has fallen significantly
since 1990 with stunting prevalence being cut by one third or more in
all developing regions except Sub-Saharan Africa. However, against
these gains, is the alarming rise in the number of overweight and obese
among all populations, including young children, which now surpasses
the number of undernourished (Fig. 1). Today, an estimated 40 million
children under the age of five are now overweight and 2.1 billion adults
are overweight or obese (FAO et al., 2018; Development Initiatives,
2018).
Beyond the call to action to address world hunger, the Hot Springs
conference was also notable for its strong emphasis on nutrition and its
links with agriculture and food systems. As Margaret Mead, the most
famous anthropologist of the time, noted in her review of the con-
ference, ‘food was recognized as something to eat rather than some-
thing to sell’ (Mead, 1944). Yet after this promising start, this focus on
Corresponding author.
∗
E-mail address: dbyerlee@gmail.com (D. Byerlee).
1
All quotes in this section are from the official Hot Springs conference declaration that can be downloaded at https://collections.nlm.nih.gov/bookviewer?PID=
nlm:nlmuid-25110080R-bk#page/1/mode/2up.
https://doi.org/10.1016/j.gfs.2019.06.002
Received 3 February 2019; Received in revised form 3 June 2019; Accepted 15 June 2019
2211-9124/ © 2019 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/BY-NC-ND/4.0/).
T
nutrition and its links with agriculture was largely forgotten for much
of the next 75 years, as the global community was narrowly guided by a
single metric of hunger, the number of undernourished measured in
terms of calories. Even as recently as 2000, the Millennium Develop-
ment Goal of halving hunger was tracked largely using this metric. The
recently agreed Sustainable Development Goal Two (SDG2) of ending
hunger by 2030 offers hope that the original 1943 vision of integrating
agriculture and nutrition is finally being realized.
In this perspective, we remind our readers of the significance of the
Hot Springs conference and briefly trace the long road that has led us
back to the original vision of ending hunger that recognized the several
dimensions of nutrition, from undernourishment to micronutrient de-
ficiencies. This reflection over 75 years helps appreciate the fact that
today for the first time, the links of agriculture, health and nutrition
outlined in 1943 are again at center stage in the global hunger chal-
lenge as embraced in SDG2. Accordingly, SDG2 offers a better foun-
dation for accelerating progress in reducing malnutrition in its several
dimensions, although we recognize major gaps in knowledge, finan-
cing, and implementation capacity for realizing SDG2 targets.
2. The first UN conference on food and agriculture at Hot Springs
in 19431
The conference was called by US President Franklin D. Roosevelt as
the first of a series of conferences on the post-War architecture of the
proposed United Nations. Some 44 countries attended—a major
achievement in itself given the difficulties of traveling in the middle of a
world war. For the first time, the ‘less advanced nations’, as they were
known, made up a solid majority of 27 participating countries, in-
cluding representation from nearly all of Latin America, China, Egypt,
Iraq, Iran, Ethiopia, and Liberia, as well as the Philippines and India
that were about to gain independence. The conference took place before
the outbreak of the Cold War and the Soviet Union also participated
constructively throughout the conference.
The conference built on a series of influential papers on nutrition
D. Byerlee and J. Fanzo
Fig. 1. Improvements over the decades in food security and nutrition
A) Famine mortality from 1860 to 2016. Source: Our World in Data
B) Prevalence of the population that is undernourished. Data shown as share of population that has a caloric intake which is insufficient to meet the minimum energy
requirements necessary for a given individual. Source: FAO
C) Prevalence of children under the age of five years who suffer from stunting. Data shown as children who fall below two standard deviations from the median
height-for-age of the WHO child Growth Standards. Source: World Bank.
D) Prevalence of obesity in adults by region. Data shown as the percentage of adults aged 18 years and older (male and female) with a body mass index greater than
30 kg per meter squared. Source: FAO/WHO.
prepared by the League of Nations in the 1930s culminating in a report
on the The relations of nutrition to health, agriculture and economic policy
(League of Nations, 1937). One of the major participants in the League
of Nations studies, Frank McDougall, an Australian official, is credited
with sowing the seeds of the Hot Springs conference (Way, 2013). He
had visited Washington twice in 1942 and through the support of
Eleanor Roosevelt met with the President and presented a memor-
andum on an agenda for post-war food and agriculture. Even so, there
was a great deal of skepticism about the timing and objectives of the
conference. Another Australian official hoped for ‘a conference that is
less useless than it threatens to be’ while the British economist, John
Maynard Keynes with his eyes on the big economic challenges facing
the post-war world facetiously noted that the new strategy for the UN
architecture ‘will start with vitamins’ (Way, 2013). Notwithstanding
these doubters, participants and observers were unanimous in claiming
the success of the conference that proceeded over 18 days in a spirit of
‘good will and optimism’ (Evang, 1943; Jones and Ray, 1973).
A major feature of the conference was the disciplinary balance of
participants who were mostly professionals (rather than politicians)
drawn from health and nutrition on the one side, and agriculture on the
other. In fact, some of the best-known participants were nutritionists,
such as André Mayer (France) and William Aykroyd (India) who had
been involved in the earlier League of Nations studies. Accordingly, the
conference manifesto provided many references linking nutrition and
agriculture, ‘Nutrition links up on the one hand with public health, and
on the other, with agriculture’ and ‘food policy and agricultural policy
must be considered together.’ After the conference, a follow-on work-
shop was held in Washington to further review the nutritional situation
of five countries (USDA, 1944).
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Global Food Security 21 (2019) 52–59
The conference declaration noted that a great increase in food
production will be needed but qualifies this as a ‘secure, adequate and
suitable supply of food’ and frequently refers to the need for ‘more and
better food’ with ‘greater emphasis on foods rich in vitamins, minerals
and proteins.’ First priority was accorded to calories but ‘preferably
done by means of a variety of foods so that appreciable amounts of
other nutrients are contributed to the diet.’ These included ‘pulses, leafy
vegetables, fish and fruit.’
On the supply side, the conference declaration also encouraged
‘production in single crop areas of a greater diversity of foods,’ ‘home
food production’ and ‘production near consumption centers of vege-
tables, fruits, milk and meat.’ However, to secure food supplies, coun-
tries should also reduce barriers to trade, ‘eliminate excessive move-
ments of prices of food,’ and design ‘emergency reserves.’ In a nod to
modern-day notions of sustainability, it discusses ‘systems of farming
that realize the ends of sustained production by utilizing conservation
practices’ and ‘maintaining the optimal level of productivity consistent
with insuring the preservation of basic resources for future generations.’
Likewise, a parallel theme to today's concepts of value chains and food
systems is expressed through an emphasis on improved efficiency in
‘storage, processing, distribution, .. to food preparation,’ and to pre-
serve and fortify foods to enhance their nutritional value.
Access to food was also highlighted on the food policy agenda when
it stated that ‘poverty is the first cause of malnutrition and hunger.’
Food policy should not only include ‘provision for insuring equitable
distribution’ but also offer targeted social protection through free or
subsidized food for ‘special needs of vulnerable groups, such as preg-
nant and nursing women, infants, …and individuals receiving low in-
comes.’ Such measures may include ‘school lunches with nutrients that
D. Byerlee and J. Fanzo
are lacking, as far as possible using local foods.’ These measures would
be accompanied by strong nutritional education programs as well as
access to water and sanitation.
Finally, the conference explicitly put the responsibility on countries
themselves to ‘develop a food and nutrition policy,’ ‘drawn up to suit
the particular circumstances of each country’ under a ‘national nutri-
tional organization’ charged to set its own intermediate goals that can
be progressively raised. The goals set for improved nutrition ‘must re-
cognize differences in climate, taste, social habits and other circum-
stances’ with additional research needed on ‘palatability, food habits,
and shopping habits.’
The implementation of interlinked agriculture, food systems, and
nutritional programs would be based on ‘principles of mutual respon-
sibility and coordinated action’ where ‘governments accept their ob-
ligations to their respective peoples in raising levels of nutrition and
standards of living and to report to one another on the progress
achieved.’ Above all, the conference called for concerted international
action—‘The efforts of each nation can be enhanced by international
collaboration for the benefit of all.’ This was the first step in estab-
lishing the Food and Agriculture Organization of the United Nations to
facilitate the needed collaboration.
These excerpts from the conference declaration show that to a re-
markable degree, it embraced approaches and language that fit today's
discourse on global action on food and nutrition. Of course, there were
gaps and weakness. Two major weakness were the failure to set a
timeframe for making tangible progress on eliminating hunger, and the
lack of metrics for tracking such progress. The conference also gave
only cursory acknowledgement to gender (several prominent female
scientists in nutrition and anthropology were not invited to the con-
ference),2 it was pessimistic about the potential for the millions of
smallholders in densely populated areas to intensify food production,
and it placed faith in governments to lead the new initiative without
recognizing the important roles of non-governmental agencies and the
private sector. Still it was a great start toward a post-war strategy that
put high priority on eliminating hunger through an integrated approach
to food, agriculture, nutrition and health.
3. Narrowing the focus to the supply of food calories, 1950 to 1980
After the War, the immediate focus was on reconstruction and re-
viving agriculture in Europe and to East Asia. By 1950, the global
community was turning to longer-run challenges, but these were very
much oriented to increasing the supply of basic food staples. The shift
away from the broader view of malnutrition espoused in the Hot
Springs conference was the result of the emerging and to most experts,
alarming evidence of rapidly accelerating population growth globally.
The emphasis on increasing the supply of energy-dense cereals was
understandable given that annual world population growth had jumped
from about 10 million per year in the early 1900s to 27 M by 1950 and
was projected to increase to over 90 M annually by the 1980s, a pro-
jection that in retrospect was quite accurate (Bongaarts and Bulatao,
2000). Such rapid growth was unprecedented in world history and re-
sulted in growing Malthusian pessimism about the ability of food pro-
duction to keep pace with population let alone raise energy intake for
the large share of the world's population that was already under-
nourished.
This Malthusian perspective was re-enforced by a series of widely
publicized books starting in 1946 with William Vogt, Road to survival,
and Fairchild Osborne, Our plundered planet, in the US, Fritz Baade, The
Race to the Year 2000 in Germany, and P.K. Wattal, The Population
Problem in India, culminating in the more extreme views on the food-
population race in the 1960s by Paul Ehrlich, The Population Bomb, and
2
The US delegation included one woman at the insistence of Eleanor
Roosevelt (Wilson, 1980).
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Global Food Security 21 (2019) 52–59
William and Paul Paddock, Famine 75!, among many others (Desrochers
and Hoffbauer, 2009). Most scientists and development practitioners
were deeply pessimistic about the capacity of smallholder agriculture to
apply ‘modern methods’ especially in densely populated Asia, the re-
gion that was contributing the largest share of population growth (e.g.
Myrdal, 1968).
The newly-created FAO led the way in establishing a baseline metric
largely focused on calorie consumption through a series of world food
surveys starting in 1946. The first Director General of FAO, John Boyd
Orr, claimed these data showed that half to two thirds of ‘mankind’ was
undernourished and although he had made his name as a nutritionist,
he added to the chorus on the population-food race, couched in terms of
calories (e.g. Boyd-Orr, 1950). One of his staff, P.V. Sukhatme did
clarify and reduce estimates of the prevalence of undernourishment to
‘only’ one third to one half (Sukhatme, 1961). Sukhatme also re-
cognized the importance of other nutrients and pioneered an indicator
of lack of dietary diversity based on the share of calories provided by
energy-dense staples.
With an escalating Cold War and Malthusian fears that food
shortages would stoke communism, the 1960s became the ‘fighting
hunger decade’ expressed by FAO in its Freedom from Hunger
Campaign, the Rockefeller Foundation's Campaign Against Hunger, and
the United States War Against Hunger. The international community
and many countries were mobilized to increase food supply, especially
cereals. The green revolution in the 1960s was consistent with this
focus and as it spread in Asia, it dispelled doubters about the ability of
smallholders to rapidly adopt ‘modern technology.’ The green revolu-
tion also enabled cereal production to keep ahead of population growth
and there is ample evidence that by raising incomes and reducing food
prices, it contributed to reducing hunger when measured in terms of
calories (Evenson and Gollin, 2003; Pingali, 2012). The global average
food energy supply increased from 2,200 kilocalories per person per
day in 1961 to 2,880 kcal four decades later, at the same time that per
capita arable area declined by half (Fig. 2). Much of this increase was in
Asia where per capita calorie supply increased 30 percent from 1970 to
1995 (Hazell, 2009).
Although the green revolution made a major contributions to re-
ducing undernutrition evidence steadily accumulated that other forms
of malnutrition stubbornly persisted in areas experiencing the green
revolution. For example, in India production of micronutrient rich
foods, notably pulses, were pushed into more marginal areas and per
capita consumption of pulses declined (Pingali et al., 2017). Policies
favorable to production of the major cereals in the green revolution
period would also persist in the coming decades undermining incentives
to supply more diversified diets (Pingali et al., 2017).
Despite this progress the focus on the food-population race con-
tinued. Norman Borlaug, architect of the new wheat varieties, in his
acceptance of the Nobel Peace Prize in 1970 warned of the ‘population
monster’ even though the growth rate of world population had already
peaked (Borlaug, 1970). This focus on ‘more food’ (i.e., calories) was
further re-enforced by the 1973-75 food crisis and an unprecedented
spike in global cereal prices. The World Food Conference of 1974 took
place during this crisis and largely endorsed the strategy of scaling up
efforts on food supply, especially cereals, to combat hunger, with re-
latively little attention to the other dimensions of malnutrition.
The focus on food energy supply during this period was accom-
panied by a small and declining share of donor resources explicitly
devoted to nutrition programs (Ruxin, 1996). Further, the nutrition
community became fixated in the 1950s on the ‘protein gap’ that had
emerged as a global priority based on what turned out to be very in-
complete evidence. The UN created a high-level advisory body, the
Protein Advisory Group in 1955 to guide its strategy on improving
protein levels of diets. The nutrition community directed its support to
providing protein supplements to vulnerable groups, such as distribu-
tion of skim milk powder or high protein crop-based formulations for
infant feeding. However, there was some re-orientation of agricultural
D. Byerlee and J. Fanzo Global Food Security 21 (2019) 52–59

Fig. 2. Trends per capita food energy supply and arable land use following the Green Revolution
A) Food energy supply by region. Data shown as daily per capita food supply by world region measured on the basis of average caloric supply (kilocalories per person
per day). Source: FAOB) Arable land use per person by region. Data shown as per capita allocation of land to arable agriculture, measured as arable land cultivation
divided by the national or regional population (hectares per person). Arable land includes land defined by the FAO as land under temporary crops (double-cropped
areas are counted once), temporary meadows for mowing or for pasture, land under market or kitchen gardens, and land temporarily fallow. Source: World Bank..
(For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)

programs—for example, the next international agricultural research Support to nutrition enjoyed a new life after the first UN's interna-
centers created after the first centers for rice, maize and wheat included tional conference on nutrition in 1992. In addition, the UNICEF con-
research on legumes and livestock motivated in part by the need to fill ceptual framework, outlining the causes and consequences of under-
the protein gap.3 This emphasis on protein malnutrition ended abruptly nutrition was developed and adopted widely, and is still used to guide
in 1975 with the publication of high-profile papers that convincingly policy and programming today (UNICEF, 1990). The nutrition com-
refuted evidence of widespread protein deficiency, with lasting damage munity highlighted the high costs of ‘hidden hunger’ from micro-
to the credibility of the field of nutrition science (Mclaren, 1974; nutrient deficiencies, with major international initiatives to address
Waterlow and Payne, 1975). Vitamin A, folate, iron, and iodine deficiencies (Mozaffarian et al.,
2018). This supported a push in the 1990s in agriculture to focus on
‘hidden hunger’ through agriculture-driven biofortification (Pinstrup-
4. Food access and hidden hunger to 2000
Andersen, 2000). Although this deepened silver bullet approaches to
nutrition (Nisbett et al., 2014), the initiative was the start of a gradual
The 1980s and 1990s saw two important developments on the road
process within CGIAR crop research of shifting emphasis from produ-
to SDG2. First, the discourse shifted decisively from food supply to
cing more food to mainstreaming nutrition into its research programs
access to food. Critically, building on Amartya Sen's entitlement ap-
(Underwood, 2000).
proach, FAO in 1982 revised its definition of food security, by ensuring
‘all people at all times have both physical and economic access to the
5. Global goals for a new millennium, 2000 to 2015
food they need’ (Sen, 1982; Shaw, 2007). The focus on access to food
also corresponded to a shift in priorities by donors and international
The beginning of the 21st century marked a watershed moment as
financial organizations to poverty reduction which many read as sy-
the international community once again recognized that a large pro-
nonymous with reducing hunger.
portion of human beings across the world were living in abject poverty
The priority on access to food also gave impetus to social protection
and deprived of basic human rights. The Millennium Development
programs, such as targeted food subsidies and food-for-work programs.
Goals (MDGs) played a significant role in engaging the global com-
Nonetheless, most of these programs were still couched in terms of
munity in a renewed high-level commitment to ending hunger, speci-
access to food calories. For example, the World Bank's first major report
fically halving hunger by 2015. The MDGs served as an important
on hunger and nutrition in 1976, while giving a central role to reducing
policy tool for the international community to promote international
poverty and targeted subsidies, still assessed outcomes in terms of
cooperation on poverty reduction, along with other significant devel-
calories. It lamely justified this metric by claiming that other dimen-
opment issues such as hunger and poor health that debilitated many
sions of malnutrition closely correlated to calorie undernutrition
nations’ progress.
(Reutlinger and Selowsky, 1976; Kennedy and Haddad, 1992).
The first MDG set a combined goal of halving extreme poverty and
Emphasis on, and approaches to broader measures of nutrition
hunger and defined two indicators of hunger, the share of children
‘waxed and waned’ during this period, sometimes recognizing the role
under five years of age, underweight, and the share of the population
of agriculture (Hendricks, 2018). An earlier effort in the 1970s on
undernourished (as measured by calories) (Annex 1). These metrics
multi-sectoral nutrition planning was unsuccessful (Field, 1987), espe-
raised several issues. First, they were inadequate for capturing mal-
cially since agriculture's participation was ‘excruciatingly’ slow’ (Berg
nutrition in all its nuances such as stunting, wasting and overweight
and Austin, 1984). After this experiment and in the wake of the ‘protein
and obesity (Fanzo, 2016). The use of FAO's definition of ‘under-
fiasco’, the 1980s and 1990s were a time of significant ‘navel gazing’ by
nourishment,’ was also critiqued due to its focus on dietary energy
nutritionists and the multi-sectoralism of nutrition turned into iso-
supply rather than nutrients absorbed (Pogge, 2016). At the same time,
lationism employing narrow interventions, such as micronutrient sup-
the indicator for ‘underweight children’ was considered vague and
plements and breastfeeding (Nisbett et al., 2014).
could not be easily translated into measures of the prevalence of
stunting and wasting that could have better guided appropriate inter-
3
A major effort was also mounted to increase the quality of protein in maize ventions to address chronic and acute malnutrition, respectively.
by breeding for higher levels of tryptophan and niacin (Tripp, 1990).

55
D. Byerlee and J. Fanzo
Second, the targets were seen to promote a “one size fits all” ap-
proach, not suitable for every country (Pogge, 2016). In Africa, for
example, stark poverty levels are one of the major causes for mal-
nutrition (Smith and Haddad, 2015) while in India, extremely high
prevalence of diarrhea and stunting among children have been attrib-
uted to unsafe water and poor sanitation (Smith and Haddad, 2015;
Spears et al., 2013). These regional or even national contexts require
different strategies to tackle the burdens of malnutrition.
Finally, most nutrition strategies in the MDG era focused on medi-
calized treatment of malnutrition rooted within the health sector with
little engagement in other sectors, particularly agriculture. While cri-
tical, these nutrition interventions addressed disease-related effects
(mostly infectious diseases) and emphasized the immediate determi-
nants of malnutrition with little engagement or integration of food
systems and their role in delivering healthy diets. Meanwhile, the
agriculture sector, continued focusing on increasing the efficiency of
the supply of staples to address undernourishment but not dietary di-
versity and malnutrition in all its forms (Fanzo and Pronyk, 2011).
Overall, the MDG target of halving undernutrition was largely met
at the global level, but progress was very uneven. China alone ac-
counted for “two thirds of the total reduction in the number of under-
nourished people in the developing regions since 1990” (UN, 2015). In
contrast, although the hunger rate did fall in Sub-Saharan Africa, the
number of undernourished people went up by 44 million owing to a
burgeoning population.
Yet there were major developments in this period that set the stage
for what would become a more integrated SDG goal to address both
hunger and malnutrition. Nutrition become more prominent on the
international development agenda with the Lancet series on under-
nutrition in 2008 that laid out the evidence, the 1,000 Days Initiative
that created focus, and the Scaling Up Nutrition (SUN) movement that
spurred momentum and increased funding to nutrition, although
modest compared to that to agriculture (Fig. 3). The SUN movement
encouraged countries to commit to ending undernutrition and to do so
56
Global Food Security 21 (2019) 52–59
in a collaborative and coordinated way working with civil society or-
ganizations, donors, private sector and researchers. Since its inception,
60 countries have joined the SUN movement to work through a multi-
sectoral and multi-stakeholder approach to scale up nutrition pro-
gramming. The Global Alliance for Improved Nutrition (GAIN) also
began to bridge public-private partnerships and innovation in the nu-
trition space with a particular focus on fortification.
In 2012, the World Health Assembly of the WHO member states
endorsed six global targets for improving maternal, infant and young
child nutrition and committed to monitoring progress in achieving
those targets. The targets were ‘vital for identifying priority areas for
action and catalyzing global change’ (WHO, 2014). These targets have
some overlap with the later SDGs in that they track reducing stunting
and wasting in children under 5, but they also track reducing anaemia
in women of reproductive age, reducing low birth weight and in-
creasing the rate of exclusive breastfeeding.
Increasingly it was recognized that agriculture and nutrition should
work in tandem. Major initiatives followed suit including the CGIAR
research programs HarvestPlus, for developing biofortified crops, and
Agriculture for Nutrition and Health Program to support large-scale
nutrition sensitive agriculture research and programming. In 2013, the
Lancet series released a second undernutrition series, with a seminal
paper laying out “nutrition sensitive” approaches to address malnutri-
tion, which provided the most up-to-date evidence base for agricultural
impacts on nutrition (Ruel et al., 2013). That same year, the Nutrition
for Growth Initiative Summit garnered increased commitments to nu-
trition totaling $19.6 billion (Development Initiatives, 2018).
Finally, in 2014 at the Second International Conference on Nutrition
(ICN2), more than 170 government endorsed two documents – the
Rome Declaration on Nutrition and the Framework for Action – com-
mitting to “eradicating malnutrition and transforming food systems to
make nutritious diets available for all.” At the same time, the Global
Nutrition Report, a data-led, independent initiative, produced its first
annual state of global nutrition publication, meant to spur action.
Fig. 3. Official Development Assistance to
Agriculture and Nutrition, 2007-2016
A) https://data.oecd.org/oda/net-oda.htm (ac-
cessed online 31 May 2019). Note that the scale
for agriculture is roughly ten times that for nu-
trition.
B) Amounts based on gross ODA disbursements,
constant 2016 prices. Figure includes ODA
grants and loans, but excludes other official
flows and private grants reported to the OECD
DAC CRS. Government donors include DAC
member country donors and other government
donors (Kuwait and the United Arab Emirates).
Multilateral institutions include all multilateral
organizations reporting ODA to the OECD DAC
CRS. Source: Development Initiatives based on
OECD Development Assistance Committee
(DAC) Creditor Reporting System (CRS). Source:
Development Initiatives, 2017.
D. Byerlee and J. Fanzo
6. Moving to a Multi-dimensional Approach to Hunger and
Nutrition, 2015 to 2030
In September 2015, after several years of deliberations, the inter-
national community closed the chapter on the MDGs and adopted a new
set of global goals at the UN General Assembly in New York. These
SDGs were both bolder and broader, encompassing all aspects of sus-
tainable development. They were meant to be aspirational in nature,
aiming to ensure that no one is ‘left behind’ (Development Initiatives,
2017). They were lauded for being more inclusive in their formation,
and more global in nature than the MDGs, which focused on developing
countries (Hawkes and Popkin 2015). Within this context, the approach
to eliminating hunger and malnutrition also took on a more nuanced
multi-dimensional approach, particularly in defining the targets as well
as the re-integration of agriculture and food systems as a vital solution
to addressing malnutrition.
The two goals that directly relate to hunger and malnutrition are,
SDG2 on hunger and SDG3 on health (Annex 1) although several other
goals such as ‘climate change and natural resources, education, and
women's empowerment’ indirectly relate to nutrition (Fanzo, 2016).
From a nutrition perspective there are two primary differences between
the MDGs and SDGs. First, while the MDGs focused on infectious dis-
eases (mainly HIV/AIDS and tuberculosis), the SDGs recognized the rise
of non-communicable diseases (NCDs) across the world such as cancer,
cardiovascular disease, and diabetes. The nutritional transition leading
to a growing obesity epidemic in middle-income countries had been
recognized from the 1990s (Popkin, 1994) but did not hit the interna-
tional nutrition agenda until the ICN2 in 2014. As a result, childhood
obesity is included as a target under SDG2, along with SDG3 that in-
cludes targets to reduce premature mortality caused from NCDs
(Hawkes and Popkin 2015). Recognizing the growing spread of NCDs
also aligned well with the emerging global health agenda (Fanzo 2016).
The progress made during the MDG era in bolstering health systems
across developing countries especially for infectious diseases provided a
valuable entry point for including NCDs in SDG3 (Fanzo 2016).
Secondly, unlike the MDGs that failed to include meaningful in-
dicators to measure the outcomes of undernutrition, the SDGs included
indicators for both stunting and wasting. Despite credible efforts by
various organizations working on nutrition to include more nutrition
indicators, the SDG agenda did not include key indicators and risk
factors to measure the multiple burdens of malnutrition, such as in-
dicators to account for overweight and obesity in adults or targets for
exclusive breastfeeding and dietary diversity or quality, all significant
risk factor in overall global morbidity and mortality in a variety of
disease burdens (Afshin et al., 2019; Fanzo, 2016; Gakidou et al., 2017).
The most recent Global Nutrition Report 2018 highlights the priority of
investing to improve the quality, cost effectiveness, and timeliness of
indicators related to these nutrition and health outcomes (Development
Initiatives, 2018).
A strength of the SDG2 is that it combines agricultural productivity,
sustainable food systems and conservation and sustainable use of bio-
diversity to effectively address the goal. This focus is broadening to a
more holistic view of food systems that incorporate not only agri-
culture, diets and nutrition, but the many elements across the food
system including storage, transport, processing, packaging, markets and
retail and the drivers that impact and shift food systems. This has been
demonstrated in the plethora of reports released since 2017 on food
systems and food environments including reports by the Global Panel,
the Committee on Food Security's High-Level Panel of Experts, and
UNICEF.
This integration inherently requires more complex multi-dimen-
sional approaches to addressing hunger and nutrition that goes well
beyond the food availability and access to food through poverty re-
duction and social protection. Globally, there is broad consensus that
multi-dimensional, -disciplinary, and –sectoral approaches are essential
to address malnutrition. These include at minimum, agriculture, health,
57
Global Food Security 21 (2019) 52–59
educational and environmental interventions that include nutrition into
functioning and effective food, health, and water and sanitation sys-
tems. Multidimensional approaches will also be needed to address the
complexity of the multiple forms of malnutrition and the burden has
different causes and consequences depending on the specific popula-
tion.
7. Conclusion
Our tour of 75 years while undoubtedly incomplete, does reveal that
nutrition was very much on the agenda of the initial UN conference on
food and agriculture in 1943 that set for the first time a global goal of
eliminating hunger. The conference also emphasized that both agri-
culture and nutrition working together would be required to meet the
global hunger challenge. Despite these good intentions, the agricultural
and nutrition communities largely went their separate ways for the next
50 years. The agricultural community focused on producing more cal-
ories while the nutrition community varied in its focus from proteins to
micronutrients with few links to agriculture. There were good reasons
for this—Malthusian fears about the population explosion and big gaps
in research evidence in the nutrition field—but the focus endured much
longer than needed. A more balanced approach in terms of ‘more and
better food’ as espoused in 1943 would have resulted in better nutrition
in all its forms today.
Through a long and circuitous process, we are finally today in a
position to better integrate agriculture and nutrition to jointly attack
the multiple burdens on nutrition. The SDGs have put nutrition center
stage despite some important gaps, such as an indicator for adult obe-
sity. The high-level and inclusive process of formulating the SDGs has
also strengthened country ownership of the SDG agenda and time
frames and enhanced mutual accountability, again as originally en-
visaged in 1943. The inclusion of rich countries in the SDG agenda has
highlighted the fact that malnutrition is a global issue, not just one
facing developing countries.
Continued growth in productivity of food staples remains central to
reducing undernourishment in low income countries, especially in
Africa (Mason-D’Croz et al., 2019) but there is growing evidence that
better linking agriculture to nutrition pays in terms of nutritional out-
comes, as shown in two recent articles in this journal. A recent review
by Ruel et al. (2018) finds that nutrition-sensitive agricultural programs
are more effective when they include nutrition behavioural change
communication and women's empowerment and engagement, and
when they incorporate water, sanitation and hygiene interventions.
Further Gillespie et al. (2017) highlights stories of learning that have
improved implementation of nutrition-oriented programs and enhanced
nutritional outcomes.
While nutrition and agriculture are now better aligned, there are
still gaps in knowledge in how to scale-up, and improved the cost ef-
fectiveness and sustainability of interventions and programs (Ruel
et al., 2018). Providing a level playing field for producing nutritious
and diversified diets also remains a thorny challenge to overcome
vested interests inherited from green revolution food policies (Pingali
et al., 2017). There is also a significant gap in overall funding for nu-
trition—nutrition still receives less than 1% of official development
assistance to address undernutrition (Fig. 3) and less than .01% to ad-
dress overweight, obesity and non-communicable diseases
(Development Initiatives, 2018).
Much work remains to develop and implement up-to-date and cost-
effective metrics of micronutrient deficiencies and healthy diets that
help understand, analyse and characterize food security, diets, nutrition
outcomes and food systems, more generally. While we have data that
describes broad trends, we often lack data on who is hungry and why,
what people eat and why, the impacts on nutritional growth indicators
and how food system transitions are shaping these outcomes. We are
also limited by the ability to disaggregate metrics by population groups,
wealth and other categories to understand who is vulnerable, where
D. Byerlee and J. Fanzo
and why. There are also limitations on the capacity to use metrics to
effectively drive decision making.
While the SDG challenge is daunting, it is also imperative to era-
dicate hunger and significantly reduce malnutrition in all its forms by
2030. As highlighted in the 2018 Global Nutrition Report, the global
burden of malnutrition is ‘unacceptably high’ and impacts every
country in the world in one form or another but ‘if we act now, it is not
too late to end malnutrition in all its forms. In fact, we have an un-
precedented opportunity to do so’ (Development Initiatives, 2018). The
Annex 1
Annex 1
MDGs and SDGs targets related to hunger and malnutrition
Millennium Development Goals
MDG1-Eradicate extreme poverty and hunger
Target 1.C.: ‘Halve between 1990 and 2015 the proportion of people in the
developing regions who suffer from hunger.
The indicators were:
•1.8 Proportion of children under five who are moderately or severely underweight
(weight for age < two standard deviations (SDs) below the median weight for age of
the international reference population
•1.9 Proportion of population below minimum level of dietary energy consumption
(measured by the FAO estimates of dietary energy supply)
Source: For MDGs, United Nations, 2015. For SDGs, https://unstats.un.org/sdgs/files/Tier%20Classification%20of%20SDG%20Indicators_31%20December
%202018_web.pdf.
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