The State ofFOOD SECURITY
AND NUTRITION
IN THE WORLD
2021

This chapter presents the first global assessment of food insecurity and malnutrition for 2020, the year the COVID-19 pandemic spread rapidly across the globe. Prior to the pandemic, progress was already stalled towards meeting SDG Targets 2.1 and 2.2: ending hunger and ensuring access to safe, nutritious and sufficient food for all people all year round; and eradicating all forms of malnutrition. While the pandemic has caused major setbacks, there is much to be learned from the vulnerabilities and inequalities it laid bare. If taken to heart, these new insights and wisdom can help get the world back on track towards achievement of SDG Targets 2.1 and 2.2. This global assessment provides a clear diagnostic to put in place the policies needed.

Section 2.1 presents a comprehensive assessment of the state of food security and progress towards achieving the hunger and food insecurity targets (SDG 2.1). It includes global, regional and subregional assessments for 2020 based on the most recent data collected around the world. Also included are new estimates of the cost and affordability of healthy diets, which provide an important link between the food security indicators in Section 2.1 and the nutrition indicators in Section 2.2. First presented in The State of Food Security and Nutrition in the World 2020, these indicators are systematically updated and disseminated annually in this report.

Section 2.2 presents the latest available evidence on the state of nutrition and progress towards the global nutrition targets defined by the World Health Assembly in 2012 and the Sustainable Development Agenda (SDG 2.2). Updated estimates for four of the nutrition indicators are provided.

Section 2.3 looks ahead to 2030 with new projections regarding the state of food security and nutrition in a scenario further complicated by the COVID-19 pandemic. Estimates of what the prevalence of undernourishment may be in 2030 are provided, based on a general equilibrium model that derives trajectories of food supply, economic growth, poverty rates and real price of food. While projections for the nutrition indicators do not take the COVID-19 pandemic into account, modelled projections of its potential impact on the prevalence of child undernutrition (stunting and wasting) are presented.

Grappling with uncertainty in the face of the COVID-19 pandemic

One thing is certain: 2020 was a year of great economic and human losses, provoked by the onset of a global pandemic that deprived millions of people of their health, lives and livelihoods throughout the world. However, the physical distancing measures taken to contain the spread of the pandemic also resulted in the disruption of data collection activities around the world, posing data and methodological challenges for the assessment of the state of food security in 2020. As a result, the task of estimating how many people were thrust into hunger and food insecurity globally is fraught with more uncertainty this year than in past years.

In this edition of the report, the nowcast (prediction of the recent past) for 2020 of the global prevalence of undernourishment (SDG Indicator 2.1.1) is presented as a range to reflect the added uncertainty around the hunger estimates induced by the unprecedented shock of the COVID-19 pandemic. It is important to note that the 2020 PoU estimates are not based on data reported by countries for 2020. Rather, they are derived by nowcasting the parameters used in the estimation of the PoU, using the best data available to FAO regarding the food supply and reasonable assumptions on the extent of inequality in access to food (Box 2).

In contrast, the 2020 assessments of the prevalence of moderate or severe food insecurity based on the Food Insecurity Experience Scale (SDG Indicator 2.1.2), also presented in this section, are informed mainly by survey data collected by FAO through the Gallup^© World Poll (GWP) in over 140 different countries, and conducted mostly via telephone interviews due to the restrictions imposed by the pandemic (Box 3).

SDG Indicator 2.1.1 Prevalence of undernourishment (PoU)

There is no doubt that the number of people in the world affected by hunger continued to increase in 2020 under the shadow of the COVID-19 pandemic. The long decline in undernourishment from 2005 to 2014 had already come to a halt, as described in previous editions of The State of Food Security and Nutrition in the World. After remaining virtually unchanged from 2014 to 2019, the PoU increased from 8.4 percent to around 9.9 percent between 2019 and 2020 (Figure 1), heightening the challenge of achieving the Zero Hunger target by 2030. The 2020 estimate ranges from 9.2 to 10.4 percent, depending on the assumptions made to reflect the uncertainties around the assessment (Box 2).

FIGURE 1

The number of undernourished people in the world continued to rise in 2020. Between 720 and 811 million people in the world faced hunger in 2020. Considering the middle of the projected range (768 million), 118 million more people were facing hunger in 2020 than in 2019 – or as many as 161 million, considering the upper bound of the range

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In terms of population, it is estimated that between 720 and 811 million people in the world faced hunger in 2020. Considering the middle of the projected range (768 million), 118 million more people were facing hunger in 2020 than in 2019 (Figure 1), with estimates ranging from 70 to 161 million. The 2020 estimates presented in Tables 1 and 2 are based on the middle of the projected range. The full ranges can be found in Annex 2.

TABLE 1

Prevalence of undernourishment (PoU) in the world, 2005–2020

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TABLE 2

Number of undernourished people in the world, 2005–2020

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While the COVID-19 pandemic surely was a contributing factor, changes observed from 2019 to 2020 cannot be attributed only to the pandemic given the many other factors at play, as described in Chapter 3. Notwithstanding, the increase in hunger in 2020 is consistent with existing evidence of the economic hardships induced by the COVID-19 crisis that have likely aggravated inequalities in access to food. The World Bank estimates that the COVID-19 pandemic pushed an additional 119 million to 124 million people into extreme poverty in 2020.¹⁰ Surveys by the World Bank and others reveal staggering proportions of both urban and rural households that reported a decrease in their income after the beginning of the COVID-19 crisis.^11,12

This is despite an unprecedented response by countries worldwide to implement social protection measures. However, the speed, coverage, generosity and duration of the social protection responses varied across regions and countries, as did their effectiveness in mitigating the impacts of the pandemic on poverty. With some exceptions, data suggest that coverage has been relatively short-lived. On average, responses lasted just over three months, and roughly 40 percent of programmes consisted of one-time payments.^13,14

The numbers show enduring and troubling regional inequalities. About one in five people (21 percent of the population) was facing hunger in Africa in 2020 – more than double the proportion of any other region. This represents an increase of 3 percentage points in one year. This is followed by Latin America and the Caribbean (9.1 percent) and Asia (9.0 percent), with increases of 2.0 and 1.1 percentage points, respectively, between 2019 and 2020 (Table 1).

While the regional prevalence estimates reveal the depth of hunger in each region, translating them into numbers of people gives a sense of where most of the people facing hunger in the world live (Table 2). Of the total number of undernourished people in 2020 (768 million), more than half (418 million) live in Asia and more than one-third (282 million) in Africa, while Latin America and the Caribbean accounts for about 8 percent (60 million) (Figure 2). Compared with 2019, 46 million more people in Africa, almost 57 million more in Asia, and about 14 million more in Latin America and the Caribbean were affected by hunger in 2020.

FIGURE 2

More than half (418 million) of the people in the world affected by hunger in 2020 were in Asia and more than one-third (282 million) in Africa

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Looking more closely at subregional differences (Tables 1 and 2), in Africa, the proportion of the population in Northern Africa affected by hunger in 2020 (7.1 percent) is much smaller compared with almost all subregions of sub-Saharan Africa, except for Southern Africa (10.1 percent). In the other subregions, the prevalence ranges from 18.7 percent in Western Africa to 31.8 percent in Middle Africa. The largest number of undernourished people live in Eastern Africa – more than 125 million.

In Asia, the PoU in 2020 ranges from below 2.5 percent in Eastern Asia to a high of 15.8 percent in Southern Asia, which also has the highest number of undernourished people – nearly 306 million. The prevalence of undernourishment in Western Asia (15.1 percent) is nearly on par with that of Southern Asia.

In Latin America and the Caribbean, the estimates point to a PoU of 16.1 percent in the Caribbean, compared with 10.6 in Central America and 7.8 in South America.

As illustrated in Figure 3, all subregions of Africa and Latin America and the Caribbean, and most subregions of Asia, show increases in the PoU from 2019 to 2020, likely reflecting the way the COVID-19 pandemic exacerbated pre-existing drivers of food insecurity and impacted food access by the end of 2020 (see Chapter 3). The sharpest increase in undernourishment was in Western Africa, of 5.8 percentage points in just one year, corresponding to 24.6 million more people. If confirmed, it would be further evidence of the trends noted by FAO and WFP in 2020 for several countries in this subregion,¹⁶ signalling the need for heightened attention as the situation evolves to prevent further deterioration.

FIGURE 3

All subregions of Africa and Latin America and the Caribbean, and most subregions of Asia, show increases in the prevalence of undernourishment from 2019 to 2020, with the sharpest increase in Western Africa

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SDG Indicator 2.1.2 Prevalence of moderate or severe food insecurity in the population, based on the FIES

SDG Target 2.1 challenges the world to go beyond just ending hunger. For optimal health and well-being, it is imperative to ensure access for all to safe, nutritious and sufficient food all year round. SDG Indicator 2.1.2 – the prevalence of moderate or severe food insecurity in the population, based on the Food Insecurity Experience Scale (FIES) – has been specifically chosen to monitor progress towards ensuring access to adequate food for all.

The estimates of the prevalence of food insecurity at severe levels only provide a supplementary lens for monitoring hunger to complement the PoU. Although obtained using very different data and methods, they are expected to correlate with the PoU across populations. This is because people experiencing severe food insecurity are unlikely to be able to acquire enough food to continuously fulfil their dietary energy requirements, which is the concept of chronic undernourishment measured by the PoU.^5,7

The food insecurity estimates in this report are based mainly on FIES data collected by FAO through the GWP (Box 3). However, a growing number of countries are adopting the FIES as a standard food security assessment tool, making FIES data increasingly available from official national sources. This year, FIES or equivalent experience-based food security data collected by national institutions were used for more than 40 countries, covering approximately a quarter of the world population (see Annex 1B). In addition, this year’s report is informed by FIES data collected by FAO in 2020 for a preliminary assessment of the food insecurity situation in the context of the COVID-19 pandemic in a group of 20 countries facing food insecurity crises¹⁷ (Box 4).

BOX 4

Using the FIES to guide and target responses to the COVID-19 pandemic at subnational level

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

Results show that there was an increase in the prevalence of food insecurity in most countries for which previous assessments are available for comparison (Figure A). The increases were, on average, of about 10 percentage points for moderate or severe food insecurity and 5 percentage points for severe food insecurity.

Figure A

Food insecurity in 2020 compared with 2019 (or last available year) in countries facing food insecurity crises

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The representativeness of the sample at the admin-1 level enabled a more detailed assessment of the food insecurity situation in the countries surveyed. Maps illustrating the geographical distribution of food insecurity, like the ones below for Afghanistan and the Democratic Republic of the Congo (Figure B), constitute a powerful tool to help policymakers and programme planners visualize which provinces or regions are most in need and, therefore, should be targeted for interventions aimed at guaranteeing the right to adequate food.

Figure B

Prevalence of moderate or severe food insecurity in Afghanistan and the Democratic Republic of the Congo by province in 2020

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Since FAO first started collecting FIES data in 2014, moderate or severe food insecurity at the global level has been slowly on the rise, from 22.6 percent in 2014 to 26.6 percent in 2019 (Table 3 and Figure 4). Then in 2020, the year the COVID-19 pandemic spread across the globe, it rose nearly as much as in the previous five years combined, to 30.4 percent. Thus, nearly one in three people in the world did not have access to adequate food in 2020 – an increase of 320 million people in just one year, from 2.05 to 2.37 billion (Table 4).

TABLE 3

Prevalence of food insecurity at severe level only, and at moderate or severe level, based on the Food Insecurity Experience Scale, 2014–2020

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TABLE 4

Number of people experiencing food insecurity at severe level only, and at moderate or severe level, based on the Food Insecurity Experience Scale, 2014–2020

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Nearly 40 percent of those people – 11.9 percent of the global population, or almost 928 million – faced food insecurity at severe levels, indicating they had run out of food and, at worst, gone a day without eating. The increase in the prevalence of severe food insecurity from 2019 to 2020 was also equal to the total increase from 2014 to 2019; close to 148 million more people were severely food insecure in 2020.

Although severe food insecurity normally correlates with the PoU, it is worth noting that the increase in the number of severely food insecure people from 2019 to 2020 is somewhat greater than the increase in the estimated number of undernourished presented in the preceding section, based on the middle range estimate in Table 2. This is likely due mainly to the very different nature of the indicators. As explained, the FIES data were collected directly from respondents in surveys, with data collection beginning late in 2020 and extending into early 2021 when the impacts of the COVID-19 pandemic were already more apparent. The 2020 PoU estimates, on the other hand, are nowcasts based on data on food availability and access to food that may not yet reflect the full impact of the COVID-19 pandemic.

The increases in moderate or severe food insecurity from 2019 to 2020 were sharpest in Latin America and the Caribbean (9 percentage points) and Africa (5.4 percentage points), compared with a 3.1-point increase in Asia (Table 3 and Figure 4). However, Africa still has the highest prevalence of food insecurity at both levels of severity. Nearly 60 percent of the population of Africa was affected by moderate or severe food insecurity in 2020, and 26 percent faced severe food insecurity. In Latin America and the Caribbean, 41 percent of the population was moderately or severely food insecure in 2020, and 14 percent was severely food insecure. The food insecurity situation was comparatively better in Asia, where 26 percent of the population was affected by moderate or severe food insecurity in 2020, and 10 percent was facing severe food insecurity. Nevertheless, because of the size of its population, Asia still accounts for half the moderately or severely food insecure people in the world (Figure 5).

FIGURE 4

Moderate or severe food insecurity has been climbing slowly for six years and now affects more than 30 percent of the world population

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FIGURE 5

The concentration and distribution of food insecurity by severity differs greatly across the regions of the world

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Even in Northern America and Europe, where the lowest rates of food insecurity are found, the prevalence of food insecurity increased for the first time in 2020 since the beginning of FIES data collection in 2014 (Table 3). In 2020, 8.8 percent of the population of Northern America and Europe was moderately or severely food insecure, and 1.4 percent was severely food insecure, compared with 7.7 and 1.0 percent in 2019, respectively. The rates were slightly higher in Oceania: 12 percent of the population was affected by moderate or severe food insecurity in 2020, including 2.6 percent who were facing severe levels of food insecurity. It is interesting to note a small improvement in food security in this region in 2020, at both levels of severity – a trend that began in 2017 and seems not to have been altered by the pandemic.

Figure 5 shows that, from a total of 2.37 billion suffering from food insecurity, half (1.2 billion) are in Asia; one-third (799 million) are in Africa; and 11 percent (267 million) are in Latin America and the Caribbean. The figure also illustrates the difference across regions in the distribution of the population by food-insecurity severity level. For example, in addition to being the region with the highest overall prevalence of food insecurity, Africa is also the region where severe levels represent the largest share of the combined total of moderate plus severe food insecurity – 43 percent, compared with 39 percent in Asia and 35 percent in Latin America and the Caribbean. In Northern America and Europe, the proportion of food insecurity experienced at severe levels is much smaller.

Within the regions, there are important differences in food insecurity at subregional level (Table 3). In Africa, moderate or severe food insecurity increased significantly in the Western subregion, from 54.2 percent in 2019 to 68.3 percent in 2020, surpassing the level observed in Eastern Africa (65.3 percent) where the increase was smaller. Severe food insecurity in those two subregions mirrored the same trends, increasing sharply in Western Africa from 19.6 to 28.8 percent during 2019–2020, but much less so in Eastern Africa, from 26 to 28.7 percent. Moderate increases were seen in Southern Africa, where the prevalence of moderate or severe food insecurity rose from 44.3 to 49.7 percent, and severe food insecurity increased from 19.2 to 22.7 percent. Much smaller increases of around 1 percentage point were observed in Northern Africa, where 30.2 percent of the population was affected by moderate or severe food insecurity in 2020, about one-third of whom were facing severe food insecurity (9.5 percent of the population).

In Asia, the largest increases occurred in the Southern subregion, where moderate or severe food insecurity jumped from 37.6 percent in 2019 to 43.8 percent in 2020. There was already a notable increase in this subregion since 2017 when the prevalence was 29.4 percent. Severe food insecurity also rose in Southern Asia in one year, from 18.3 percent to nearly 19.9 percent. There was a small increase in moderate or severe food insecurity in Western Asia, which has the second highest prevalence of food insecurity in the region – 28.3 percent in 2020. A small increase in severe food insecurity was also observed, from 8.8 percent in 2019 to 8.9 percent in 2020. Relatively large increases in food insecurity were observed from 2019 to 2020 in Central Asia, from 13.2 to 18 percent for moderate or severe, and 2.3 to 4.7 percent for severe only. Despite the increase, the subregion is second only to Eastern Asia in having the lowest food insecurity rates in the region, followed by South-eastern Asia. It is worth noting that the prevalence of moderate or severe food insecurity in Eastern Asia is below the average for Northern America and Europe.

The lowest levels of food insecurity in Northern America and Europe – and in the world – are found in Northern and Western Europe, where about 4 percent of the population is affected by moderate or severe food insecurity. In fact, moderate or severe food insecurity declined slightly in these subregions in 2020. In Northern America and Southern Europe, however, moderate or severe food insecurity rose slightly from 2019 to 2020, reaching 7.8 and 9.2 percent, respectively. A notable rise in moderate or severe food insecurity was observed in Eastern Europe in the same period, from 10.4 to 14.8 percent. Severe food insecurity has remained low in all subregions, with increases from 2019 to 2020 in all but Northern America. The largest increases occurred in Eastern Europe (from 1.3 to 2.2 percent) and Southern Europe (from 1.6 to 2.3 percent).

Towards an assessment of the impact of the COVID-19 crisis on food security

In summary, the estimates based on the FIES point to a worse food security situation in 2020 compared with 2019 in most parts of the world. There is little doubt that the COVID-19 pandemic contributed to this deterioration of people’s access to food. As mentioned in Box 3, a modified version of the FIES survey module was used in the GWP data collection to try to assess the impact of the COVID-19 pandemic on food security. On average, approximately 60 percent of respondents experiencing food insecurity at moderate or severe level, and 55 percent at severe level, attributed their poor access to food mainly to the COVID-19 pandemic. However, it is challenging to isolate and measure the impact of the pandemic alone on food insecurity, given the way it has exacerbated pre-existing vulnerabilities and affected so many aspects of people’s lives. Therefore, the results should not be interpreted as referring to the isolated impact of the COVID-19 pandemic on food insecurity, but rather as an indication that people perceive it as being an important factor in their diminished access to food.

The effect was stronger for moderate or severe food insecurity than it was for severe food insecurity. Moreover, the higher the income of the respondent, the less food security was affected by the impacts of the COVID-19 pandemic on employment. These findings may reflect a strong negative impact of the pandemic on the food security of those in the middle-income range who normally count on stable employment, offering hope of rapid improvement in food security once people are able to resume normal work activities.

Gender differences in food insecurity

The individual-referenced questions that constitute the FIES survey module also enable a comparison between the food insecurity status of men and women. Figure 6 shows the prevalence of food insecurity at different levels of severity among adult men and women worldwide and in all regions, highlighting the evolution from 2014 to 2020. At the global level, the gender gap in the prevalence of moderate or severe food insecurity grew even larger during the year the COVID-19 pandemic spread across the world, with the prevalence of moderate or severe food insecurity being 10 percent higher among women than men in 2020, compared with 6 percent in 2019. This is mostly due to the widening of the gap in Latin America and the Caribbean (30 percent in 2020 versus 24 percent in 2019) and Asia (10 percent in 2020 versus 4 percent in 2019). For severe food insecurity, the prevalence is also higher among women than men. The difference increased from 2019 to 2020, with women being 11 percent more food insecure than men in 2020 versus 9 percent more than men in 2019. Thus, the widening of the gap between men and women at the global level in a year impacted by the COVID-19 pandemic was more pronounced for moderate or severe food insecurity.

FIGURE 6

Globally and in every region, the prevalence of food insecurity is higher among women than men

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Historically, women tend to be disproportionally affected by health and economic crises in a number of areas, including but not limited to food security and nutrition, health, time burden, and productive and economic dimensions. The results of this analysis support existing evidence of the disproportionate impact of the pandemic on women’s economic opportunities and access to nutritious foods.²⁰

Affordability of healthy diets: a link between food security and nutritional outcomes

According to WHO, healthy diets protect against malnutrition in all its forms, including non-communicable diseases (NCDs) such as diabetes, heart disease, stroke and cancer. Healthy diets contain a balanced, diverse and appropriate selection of foods eaten over a period of time. In addition, a healthy diet ensures that a person’s needs for macronutrients (proteins, fats and carbohydrates, including dietary fibre) and essential micronutrients (vitamins and minerals) are met, specific to their gender, age, physical activity level and physiological state. Healthy diets include less than 30 percent of total energy intake from fats, with a shift in fat consumption away from saturated fats to unsaturated fats and the elimination of industrial trans fats; less than 10 percent of total energy intake from free sugars (preferably less than 5 percent); consumption of at least 400 g of fruits and vegetables per day; and less than 5 g per day of salt (to be iodized). While the exact make-up of a healthy diet varies depending on individual characteristics, as well as cultural context, locally available foods and dietary customs, the basic principles of what constitutes a healthy diet are the same.^22,23

Estimates of the cost and affordability of healthy diets around the world in 2017, by region and income group, were first presented in last year’s edition of this report.⁷ This year, the estimates were updated to 2019 using the latest available data to monitor the progress towards ensuring affordable, healthy diets for all. While the price and income distribution data needed to update the estimates to 2020 are not yet available, trends in consumer food prices and incomes are discussed with likely implications for the cost and affordability of healthy diets in 2020 and into 2021. For a full description of the methodology and data sources, see Annex 2.

Cost of healthy diets

As seen in last year’s edition of this report, the cost of a diet increases as the diet quality increases, across all regions and country income groups. That analysis was based on three reference diets that simulate incremental levels of diet quality, starting from an “energy sufficient”, to a “nutrient adequate” diet and then a “healthy” diet.⁸ On average, the cost of a healthy diet was 60 percent more than a diet that just meets requirements for essential nutrients, and almost five times as much as a diet that just meets the minimum dietary energy needs through a starchy staple.

Updated results indicate that in 2019, at the global level, the cost of a healthy diet was USD 4.04 per person per day. However, the average cost of the diet and the change in the cost between 2017 and 2019 varies by region and country income group (Table 5).

TABLE 5

Healthy diets were still unaffordable for around 3 billion people in the world in 2019. The number of people unable to afford healthy diets increased in Africa and in Latin America and the Caribbean between 2017 and 2019

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The analysis of the cost of a healthy diet by country income group shows that the largest increases in the cost of a healthy diet occurred in lower-middle-income and high-income countries (14.3 and 6.6 percent, respectively). Increases in the cost of a healthy diet are much smaller in low-income and upper-middle-income countries (5.4 and 5.7 percent, respectively).

Affordability of healthy diets prior to the COVID-19 pandemic

Affordability is a key component of food security and nutrition and is a measure of economic access to food and healthy diets. Because affordability is a measure of the cost of a diet relative to income, changes over time can be the result of changes in the cost of a diet, people’s income, or both. Rising food costs, if not matched by rising income, could result in more people being unable to afford healthy diets. Moreover, wider problems in the economy, such as economic slowdowns and downturns that lead to increases in unemployment and declines in wages, could result in more people finding healthy diets unaffordable, irrespective of price trends.

As a result of the high cost of healthy diets, coupled with persistent high levels of income inequality, it is estimated that around 3 billion people were unable to afford a healthy diet in 2019 (Table 5). Most of these people live in Asia (1.85 billion) and Africa (1.0 billion), although a healthy diet is also out of reach for millions living in Latin America and the Caribbean (113.0 million) and Northern America and Europe (17.3 million).

In comparison, the large increase in the cost of healthy diets in Latin America and the Caribbean coincided with a growing number of people who were unable to afford them. This contrasts sharply with Northern America and Europe, which saw a similar increase in the cost of healthy diets, but with fewer people unable to afford them. In the case of Latin America and the Caribbean, the increased cost of the diet was compounded by falling incomes, resulting in a double hit to the unaffordability of healthy diets, whereas in Northern America and Europe, the rise in the cost was offset by rising incomes.

There are important dynamics at play behind these observed differences related to the context and structural features of a country, notably levels of poverty and income inequality. The poor spend a large proportion of their income on food, therefore small increases in the cost of a diet can be significant in countries where the poor make up a large percentage of the population. For example, small increases in the cost of the diet in Africa affect a larger proportion of the population – an estimated 80 percent of the population cannot afford a healthy diet.

These findings illustrate that a broader policy approach is needed to improve the affordability of healthy diets, one which focuses not only on improving incomes and reducing the costs of healthy diets, but also on addressing inequality (see Chapters 3 and 4).

Affordability of healthy diets in 2020

There is no room for complacency about access to affordable healthy diets – especially given the emergence of the pandemic in 2020 – even in those regions where improvements are observed between 2017 and 2019. While it is not possible to update estimates to 2020 at this time, the number of people who cannot afford a healthy diet is likely to have increased due to the compounding effects of inflation in consumer food prices and income losses, stemming from the economic impacts of the COVID-19 pandemic and the measures put in place to contain it.

Estimates of the cost and affordability of healthy diets will be updated annually and disseminated in this report, reflecting the most recent data as they become available. Once new data for 2020 are available, it will be possible to estimate the overall economic impact of the COVID-19 pandemic on the cost and affordability of healthy diets. Regional, subregional, national and even subnational differences are expected, given the different timing, duration and intensity of lockdowns, as well as differential impacts of economic shocks on countries.

Global trends

This section assesses progress towards the seven global nutrition targets. These include the six nutrition targets endorsed by the World Health Assembly (WHA) in 2012 to be achieved by 2025, for which 2030 targets²⁶ were subsequently proposed (Table 6). Four out of the six indicators were also selected to monitor progress towards SDG Target 2.2, including anaemia in women 15–49 years which has been newly designated as an SDG indicator (SDG Indicator 2.2.3).²⁷ The seventh target is to halt the rise in adult obesity, which is part of the Global Action Plan for the Prevention and Control of Noncommunicable Diseases adopted by the WHA in 2013.²⁸

TABLE 6

The global nutrition targets endorsed by the World Health Assembly and their extension to 2030

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Progress towards each of the seven nutrition targets is summarized in Figure 7. The latest estimates do not account for the effects of the COVID-19 pandemic because data on nutrition outcomes were not collected or have not yet been fully estimated. The 2020 estimates of childhood stunting, wasting and overweight presented in this edition are based almost entirely on data collected before 2020 as the collection of household survey data on child height and weight were limited this past year due to physical distancing measures to contain the spread of the pandemic; only four national surveys with at least some field work in 2020 are reflected in these updated estimates. Nevertheless, some observed and modelled impacts of the COVID-19 pandemic on nutrition are discussed at the end of this section.

FIGURE 7

Reaching the 2025 and 2030 global nutrition targets remains a challenge. In 2020, an estimated 22 percent of children under 5 years of age were affected by stunting, 6.7 percent by wasting and 5.7 percent by overweight. Nearly 30 percent of women aged 15 to 49 years were affected by anaemia in 2019

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One in seven live births, or 20.5 million (14.6 percent) babies globally, suffered from low birthweight in 2015.²⁹ Low birthweight newborns have a higher risk of dying in the first 28 days after birth; those who survive are more likely to suffer from stunted growth and lower intelligence quotient (IQ), and face increased risk of overweight and obesity and adult-onset chronic conditions, including cardiovascular diseases and diabetes, later in life.^30,31 Data show that little progress has been made to reduce low birthweight since 2012. New low birthweight estimates will be released in early 2022.

Optimal breastfeeding practices, including exclusive breastfeeding for the first 6 months of life, are critical for child survival and the promotion of health and of brain and motor development. Globally, 44 percent of infants under 6 months of age were exclusively breastfed in 2019 – up from 37 percent in 2012. Oceania (excluding Australia and New Zealand) demonstrated the highest levels of exclusive breastfeeding, at 61.3 percent. More than two in five infants under 6 months in Africa (43.6 percent) and Asia (45.3 percent) were exclusively breastfed in 2019, compared with only one in three infants in Northern America (34.7 percent). This practice, however, varies considerably among the subregions of Asia and Africa. Three out of five subregions in Asia have a higher prevalence than the global estimate. Southern Asia has the highest prevalence, with 57.2 percent of infants being exclusively breastfed compared with only 22.0 percent of infants in Eastern Asia. Similarly, in Africa, the prevalence of exclusive breastfeeding is nearly twice as high in Eastern Africa (60.7 percent) compared with Southern (33.5 percent) and Western Africa (32.3 percent). Though many regions have demonstrated progress, two subregions in particular have demonstrated worrying declines in exclusive breastfeeding prevalence, with levels decreasing from 29.7 percent to 25.9 percent in the Caribbean and from 28.5 percent to 22.0 percent in Eastern Asia between 2012 and 2019.

Estimates of childhood stunting and overweight, presented below, have been generated using a new country-level model (see Annex 1B for details). However, as mentioned above, the full impact of the COVID-19 pandemic on child malnutrition is still unfolding and is not captured in the 2020 estimates.

Globally, 149.2 million (22.0 percent) children under the age of five years suffered from stunting (SDG Indicator 2.2.1) in 2020.³² Stunting (defined as being too short for one’s age) undermines children’s physical growth and cognitive development and increases their risk of dying from common infections. It is also associated with increased risk of developing NCDs later in life. The prevalence of stunting has decreased from 33.1 percent in 2000 to 26.2 percent in 2012 and further to 22.0 percent in 2020. In 2020, nearly three-quarters of the world’s stunted children lived in just two regions: Central and Southern Asia (37 percent) and sub-Saharan Africa (37 percent). Eastern Asia and South-eastern Asia have made the greatest progress over the past two decades, with stunting prevalence declining by nearly half, from 26.1 percent in 2000 to 13.4 percent in 2020. Progress on stunting has been slower in Africa, declining from 41.5 percent in 2000 to 30.7 percent in 2020 (only a 26 percent decline in relative terms); the slower decline in prevalence combined with population increases make it the only region where the number of children with stunting has increased since 2000. Some African subregions have shown slower progress. For example, Middle Africa and Southern Africa have decreased their stunting prevalence by less than 20 percent, in relative terms, since 2000.

Child wasting (part of SDG Indicator 2.2.2) is a life-threatening condition resulting from poor nutrient intake and frequent or prolonged illnesses. Affected children are dangerously thin, have weakened immunity and face an increased acute risk of death. In 2020,³² 45.4 million children under five years (6.7 percent) were wasted. Nearly one-quarter lived in sub-Saharan Africa and more than half lived in Southern Asia, the subregion with the highest prevalence of wasting – above 14 percent. This form of malnutrition is the most impacted by the COVID-19 pandemic in the short term, as it is an acute condition with potential to manifest quickly in the face of shocks. The pandemic has likely shifted the global prevalence even further from the global targets. As mentioned above, the estimate of 45.4 million children does not include the impact of the pandemic given the inability to measure children while physical distancing policies were in place. However, one study based on modelling indicates that wasting may have affected around 15 percent more children in 2020 than estimated, putting the lives of tens of millions of children at risk.³³

Childhood overweight (part of SDG Indicator 2.2.2) has immediate impacts on children’s health and well-being and increases the risk of diet-related NCDs later in life. It has been on the rise in many countries, boosted by industry-led marketing and greater access to highly processed foods, often high in energy, fats (particularly saturated and trans fats), free sugars and salt,³⁴ along with inadequate levels of physical activity. For example, a study in Europe found that over half of commercial complementary infant foods contained excessive levels of sugar.³⁵ In 2020, 5.7 percent (38.9 million) of children under five years were overweight.³² There has been little change at the global level in two decades – 5.7 percent in 2020 compared with 5.4 percent in 2000 – and trends in some regions and in many settings are on the rise. While the prevalence of child overweight in Africa is similar to the global prevalence (5.3 percent in 2020), subregional levels show differences, reaching 13.0 and 12.1 percent in Northern Africa and Southern Africa, respectively. There have been notable increases in child overweight between 2000 and 2020,³² especially in two regions, Eastern and South-eastern Asia, and Australia and New Zealand, where levels have increased from 5.2 to 7.7 percent and from 7.7 to 16.9 percent, respectively. A reversal in trajectory is needed to achieve the 3 percent global target for 2030.

New updates from 2019 on anaemia in women of reproductive age (SDG Indicator 2.2.3) are presented in this year’s report. Nearly one in three (29.9 percent) women of reproductive age globally were still affected by anaemia and no progress has been made since 2012. Wide variations exist between regions, with the prevalence in Africa being nearly three times higher than that of Northern America and Europe. The prevalence is particularly high in Western Africa, representing 51.8 percent, with little progress since 2012 (52.9 percent). No region has shown a significant decline in the prevalence of anaemia among women of reproductive age, pointing to the need for consolidated attention and action. Similar patterns hold for anaemia in pregnant women, as well.³⁶

Adult obesity is a diet-related risk factor for several NCDs. Adult obesity continues to rise, with the global prevalence increasing from 11.8 percent in 2012 to 13.1 percent in 2016. All subregions showed increasing trends in the prevalence of adult obesity between 2012 and 2016, and are off track to meet the 2025 WHA target. Northern America, Western Asia, and Australia and New Zealand had the highest levels, at 35.5 percent, 29.8 percent and 29.3 percent, respectively, as of 2016. Latin America and the Caribbean, and Oceania excluding Australia and New Zealand, also show levels above 20 percent. Updated adult obesity estimates will be released in late 2021.

The regional trends described above are summarized in Figure 8 and subregional trends are presented in Table 7 in the next section.

FIGURE 8

Stunting is the only indicator showing substantial improvements in multiple regions since 2000. Two indicators – child overweight and anaemia among women of reproductive age – have seen no progress in two decades. Adult obesity is rising sharply in all regions

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As has been touched upon previously in this report, hundreds of millions of people were already suffering from hunger and malnutrition before the onset of the COVID-19 pandemic. In the long term, without large-scale coordinated action, the combined effects of COVID-19 infection, as well as corresponding mitigation measures and the emerging global recession, could disrupt the functioning of food systems with disastrous consequences for health and nutrition. In the following section, we examine some of the evidence of the impacts of the COVID-19 pandemic on nutrition.

Impact of the COVID-19 pandemic on nutrition

The COVID-19 pandemic has led to multiple economic, food and health system shocks that threaten to reverse the progress made to date in tackling all forms of malnutrition.³⁷ It will likely be some time before empirical data are available on a global scale that allow proper assessment of the impact of the pandemic on nutritional status. However, results of the studies described below provide insight into how the COVID-19 pandemic has impacted nutrition-related factors that ultimately influence nutrition outcomes.

Changes in food and diet patterns

Some data collection efforts have continued during the pandemic through phone and online surveys, and through modified in-person surveys employing infection prevention and control measures. Many nutrition-related surveys undertaken in 2020 included questions on coping strategies adopted by households in the face of the COVID-19 pandemic, shedding light on changes in dietary patterns.

One national survey in Indonesia found that 31 percent of households reported food shortages and 38 percent reported eating less than usual, compared with 3 percent and 5 percent, respectively, the previous year.¹¹ Survey results show that foods consumed by households were neither sufficient in amount nor in diversity, increasing the risk of nutritional deficiencies and irreversible physical and cognitive deficits to children, as well as adult underweight, overweight and obesity, and of developing NCDs. Another study in Yemen found that the dietary diversity of households already consuming poor diets had deteriorated between February and April 2020, with the share of households consuming only three or fewer food groups increasing from 22 to 30 percent during that period. These households reported eating mainly cereals, fats and sugar, instead of nutritious foods.³⁸

Conditions imposed by the COVID-19 pandemic, such as mobility restrictions, closures or limited operating hours of food markets, and price increases of perishable, often more nutritious foods,³⁹ have all provoked changes in dietary patterns. These conditions, along with reduced incomes, can induce families to choose cheaper, highly processed foods with a longer shelf life – often of high energy density and minimal nutritional value – over fresh and more nutritious foods. Forty-nine percent of survey respondents in Brazil reported that their food habits had changed during quarantine and social isolation periods. Among households with children and adolescents under 17 years, this proportion increased to 58 percent. Almost one-third (31 percent) of households with children increased their consumption of highly processed foods, compared with 18 percent of households without children, highlighting how deteriorations in diet quality are taking the greatest toll on children.⁴⁰

The study revealed sociodemographic inequalities in dietary quality in Brazil: people in the lower wealth quintiles, those who became unemployed, people of colour and respondents from the poorer Northeastern region of the country reported increased consumption of highly processed food. The findings highlight the need for policies to focus on the promotion of healthy diets while providing social protection schemes to support vulnerable groups during the COVID-19 pandemic. Similar patterns were observed across the Latin America and Caribbean region as well.⁴¹

Disruption of essential nutrition services

Countries worldwide are facing many challenges as they strive to ensure that health, food, education and social protection systems maintain essential nutrition services while simultaneously responding to the COVID-19 pandemic. Based on a survey tracking the situation of children during the pandemic,⁴² 90 percent of countries (122 of 135) reported a change in the coverage of key nutrition services in August 2020 (Figure 9). Overall, essential nutrition services coverage declined by 40 percent, and nearly half of the countries reported a drop of 50 percent or more for at least one nutrition intervention. Nutrition programmes in schools were the most affected, with an overall 60 percent reduction in service coverage, followed by iron–folic acid supplementation for adolescent girls (45 percent). In most countries reporting data on school-based nutrition programmes, including school feeding and take-home rations (39 of 68 countries with available data), school nutrition programmes were disrupted by as much as 75–100 percent due to COVID-19 mitigation measures (Figure 9).

FIGURE 9

Around 90 percent of countries surveyed reported changes in coverage of key nutrition services due to COVID-19 in August 2020. While 80 percent reported disruptions in coverage, a small proportion witnessed improved coverage

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The COVID-19 pandemic has not only disrupted health systems but also impacted the global community’s ability to monitor nutrition outcomes for children and adults. While in 90 percent of countries, routine information systems continued to function in some capacity, almost half of the countries reported an inability to implement surveys, which are the leading source of data for the monitoring of global nutrition targets.

In addition to key nutrition services being suspended, countries also reported disruptions to other health services such as mass vaccination campaigns, with measles campaigns suspended in 27 countries, putting children with suboptimal growth at a higher risk of death from such infections.^43,44 Moreover, three-quarters of countries reported a considerable degree of disruption of services aimed at the prevention or treatment of NCDs.⁴⁵ According to a survey on continuity of essential health services during the COVID-19 pandemic, management of moderate and severe malnutrition was one of the most frequently disrupted services in April 2021 under reproductive, maternal, newborn, child, and adolescent health and nutrition, affecting 41 percent of reporting countries.⁴⁶

Impact on child malnutrition

Research based on modelled scenarios can contribute valuable insights, at least until new empirical data for 2020 and 2021 are available from a large enough number of countries to allow for an official assessment of the impact of the COVID-19 pandemic at the global and regional levels. One such effort by members of the Standing Together for Nutrition Consortium involved the application of a combination of modelling tools to estimate the joint effects of economic, food and health systems disruptions induced by the pandemic on various forms of maternal and child undernutrition in 118 low- and middle-income countries.⁴⁷ They estimated how many more children may be affected by wasting in 2020, 2021 and 2022 as a consequence of the COVID-19 pandemic. Potential additional cases of stunting due to the pandemic were estimated only for 2022 compared with 2019, given the cumulative nature of stunting. Increases in wasting among young children living in communities badly hit by pandemic-related disruptions in health services, food supply chains and/or loss of jobs and livelihoods are likely to be seen within a matter of months, and could disappear as soon as circumstances improve. Child stunting, on the other hand, reflects more chronic periods of undernutrition or frequent infection, resulting in early developmental deficits, and may not be as easily reversed.⁷

For child wasting, under the moderate scenario, this modelling exercise predicts that an additional 11.2 million children under five years of age in low- and middle-income countries would be affected by wasting from 2020 to 2022 as a consequence of the pandemic – 6.9 million in 2020 alone. For the pessimistic scenario, the estimate of additional cases increases to 16.3 million. For child stunting, under the moderate scenario, the model predicts that 3.4 million more children will be stunted in 2022 due to the impacts of the COVID-19 pandemic – 4.5 million more in the pessimistic scenario.

Though not included in the above modelling study, concerns have been raised over the potential impact of the pandemic on micronutrient deficiencies, as well as on overweight and obesity and the risk of NCDs. The above-mentioned negative impacts on the affordability of healthy diets and diet quality increase the likelihood of micronutrient deficiencies, and along with decreased physical activity, may exacerbate overweight and obesity, as well as NCDs, far beyond the duration of the pandemic. This is particularly concerning as the scientific evidence shows that patients with obesity (including young adults) hospitalized with COVID-19 experienced substantially higher rates of severe outcomes.⁴⁸

2021 year of nutrition

In summary, malnutrition persists in multiple forms and the full impact of the COVID-19 pandemic is still unfolding. Many regions and countries are increasingly dealing with multiple forms of malnutrition simultaneously. This coexistence of undernutrition along with overweight and obesity, associated with diet-related NCDs, in individuals and within households and populations, is referred to as the “double burden of malnutrition”.⁴⁹ For example, wasting and overweight in children under 5 years can coexist in a population at problematic levels. In Oceania (excluding Australia and New Zealand) in 2020, wasting prevalence was 9.0 percent while overweight prevalence was 8.0 percent. Different forms of malnutrition can also interact over the life course and across generations. In order to reach the global targets, malnutrition must therefore be addressed holistically in policies and programmes designed at regional and national level.^50,51 Identifying opportunities to achieve multiple malnutrition goals and targets with single interventions by scaling up so called Double-duty Actions will be key to achieve this goal.^52,50

Various nutrition initiatives and efforts have culminated in notable progress achieved globally in exclusive breastfeeding and stunting. However, accelerated actions are needed, not only to maintain progress, but also to make greater strides towards the global nutrition targets – particularly in the wake of the COVID-19 pandemic. With increased momentum towards the UN Food Systems Summit in September 2021 and the Tokyo Nutrition for Growth Summit in December 2021, now is the time to make concrete commitments and plans towards eliminating all forms of malnutrition over the second half of the UN Decade of Action on Nutrition until 2025^53,54 and towards the 2030 SDGs.

With ten years left to reach the end of the time horizon set for achieving the SDGs, last year’s edition of this report presented a first assessment of the likelihood that Targets 2.1 and 2.2 would be achieved.⁷ The forecast depicted a world that was not on track to achieve Zero Hunger by 2030. Projections also highlighted the tremendous challenges, despite some progress on child stunting and low birthweight, to achieving all global nutrition targets by 2030. This year, with nine years remaining to achieve the targets, renewed efforts were made to look ahead to 2030 in a scenario further complicated by the COVID-19 pandemic.

Towards ending hunger: projections to 2030

With respect to SDG Target 2.1, the conclusion presented in last year’s report that the target of eradicating hunger would be out of reach was based on extrapolation of recent trends in the three fundamental variables used to compute the prevalence of undernourishment for each country: the total supply of food, the population size and composition (which determine the total dietary energy requirements) and the degree of inequality in food access within the population. The simple time-series forecasting methods applied depicted a scenario in which food supplies would not keep pace with population growth, hence reducing the availability of food in per capita terms, while inequality in food access continued to increase.

Clearly, a method that projects the future by extrapolating past trends cannot properly account for the consequences that an unprecedented shock like the COVID-19 pandemic has had – and may continue to have – on the drivers of food insecurity. Therefore, for this edition of the report, a different approach was used.

This year’s projections of the elements that determine the PoU values up to 2030 were estimated using a structural approach based on MIRAGRODEP,⁵⁵ a dynamic general equilibrium model that reproduces the functioning of world agricultural and non-agricultural markets, considers developments in agricultural markets and applies them to the economy as a whole to generate new equilibrium values of a set of macroeconomic parameters. The MIRAGRODEP model was calibrated to the pre-COVID-19 situation of the world economy in 2018 and used to generate projections of macroeconomic fundamentals into 2019–2030 under two scenarios: a reference scenario, aimed at capturing the macroeconomic impact of the COVID-19 pandemic as reflected in the latest available update of the IMF’s World Economic Outlook (WEO), published in April 2021, hereby referred to as the COVID-19 scenario; and a no-COVID-19 scenario based on economic growth projections presented in the October 2019 edition of the WEO, the last one before the pandemic.

Specifically, trajectories of food supply, economic growth and real price of food were derived from the COVID-19 scenario for 171 countries, and of poverty rates for 85 countries. These were used, in turn, to predict the evolution of the DEC for all countries and of the CV for 85 countries. Together with projections of population size and growth rates as provided by the 2019 UN World Population Prospects, these were then used to project the future trajectories of the three fundamental variables that inform the PoU (see above). These trajectories were then linked to the 2020 nowcasts of the same variables to generate the projected PoU series from 2021 to 2030. In the case of the no-COVID-19 scenario, the trajectories of the fundamental variables beginning from 2019 were linked to the pre-COVID-19 situation in 2018 (for details, see Annex 2). Both scenarios assume the trajectories are not disrupted by new conflicts, climate variability and extreme weather events, and economic downturns, the main drivers of recent increases in food insecurity (see Chapter 3). They also assume that momentous actions needed to transform food systems for food security and decrease inequalities in access to food (Chapter 4) are not implemented.

Figure 10 shows the projected series of the number of undernourished globally and at regional level. Under the COVID-19 scenario, following a projected peak of around 768 million (9.9 percent of the population) in 2020, global hunger would decrease to around 710 million in 2021 (9.0 percent), and then continue to decrease marginally to less than 660 million (7.7 percent) in 2030. However, the evolution from 2020 to 2030 is quite different across regions. While a substantial reduction is projected for Asia (from 418 to 300 million people), a significant increase is forecast for Africa (from more than 280 to 300 million people), placing it on par with Asia by 2030 as the region with the highest number of undernourished people. Numbers remain stable in Latin America and the Caribbean, and marginal in other regions.

FIGURE 10

The COVID-19 scenario projects a small decrease in global hunger between 2021 and 2030, with wide variation in evolution across regions

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Comparing the COVID-19 scenario to the hypothetical no-COVID-19 scenario, we see that global hunger in 2030 is projected to be above the level it would have been had the pandemic not occurred. About 30 million more people may face hunger in 2030 compared with the no-COVID-19 scenario, revealing possible persistent effects of the pandemic on global food security.

A closer look at the underlying parameters that inform the estimates of the number of undernourished (see Box 2 and Annex 2) sheds light on what is driving this higher projected number due to the COVID-19 pandemic in 2030. We observe that while the COVID-19 scenario indicates that food supplies will return to levels that would have prevailed under the no-COVID-19 scenario, it also predicts the pandemic will have a lasting impact on GDP growth rates, income inequality and poverty rates that will not be fully absorbed by 2030, thus inducing higher levels of inequality in food access in the COVID-19 scenario compared with the no-COVID-19 scenario. This greater inequality in access to food would therefore be mostly responsible for the observed difference.

The structural approach used to inform the new projections confirms the fundamental result anticipated last year: hunger will not be eradicated by 2030 unless exceptional efforts are deployed. The prospects were already discouraging before the COVID-19 pandemic, which has aggravated the situation. Bold actions are needed to accelerate progress – especially actions to address inequality in access to food (see Chapter 4).

Towards ending all forms of malnutrition: projections to 2030

With respect to SDG Target 2.2 and the WHA global nutrition targets, last year’s report also pointed to insufficient progress towards ending malnutrition in all its forms, even without taking the impact of the COVID-19 pandemic into account. Like the projections for hunger, estimates regarding levels of malnutrition in 2030 are characterized by a high level of uncertainty. Household survey data on child height and weight were, in most cases, not collected in 2020 due to physical distancing measures; moreover, the future of the COVID-19 pandemic, and its impacts over the next decade, are unknown. For this reason, the same approach applied in the last edition of this report to project the nutritional indicators was used, which is based on the rate of observed trends before the pandemic. This rate was then compared with the rate of progress required to achieve the 2030 targets to provide an assessment of progress towards the global nutrition targets (see Box 5 and Annex 2). The limitations of this approach, however, are that it does not include the effect of the COVID-19 pandemic, does not give weight to the more recent trends and does not factor in future potential change in trends.

Globally, progress has been made for some forms of malnutrition, but the world is not on track to achieve targets for any of the nutrition indicators by 2030. The current rate of progress on child stunting, exclusive breastfeeding and low birthweight is insufficient, and progress on child overweight, child wasting, anaemia in women of reproductive age and adult obesity is stalled (no progress) or the situation is worsening (Table 7).

TABLE 7

Most regions have made some progress, but not enough to achieve global targets if trends (before COVID-19) continue; no subregion is on track for the low birthweight target, and adult obesity has been worsening in all subregions

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Progress has been uneven across regions (Table 7 and Figure 11). While almost all subregions are either on track or making some strides towards reducing child stunting, too many are still off track to reach the other global nutrition targets, pointing to the need for accelerated actions to change course between now and 2030. The current level of wasting remains well above the 5 percent global target for 2025 and the 3 percent global target for 2030. While Latin America and the Caribbean is on track for wasting, other regions remain off track, with many children suffering from this life-threatening condition. Most regions are showing no progress or are worsening with respect to the prevalence of children under 5 who are overweight. Particularly concerning are the worsening trends seen in Eastern Asia and South-eastern Asia, and Australia and New Zealand. The prevalence of overweight is greater among older age groups, and preventive interventions in early childhood are critical to reduce the risk of overweight and obesity across the life course.⁵ Meaningful progress in this area is needed to reduce child overweight to less than 3 percent; such efforts would also likely contribute to stem the alarming rise in adult obesity, which is worsening in all subregions. No subregion is on track to achieve either the 2025 or 2030 targets on reducing anaemia in women of reproductive age, with trends stagnating or worsening in all regions except Latin America and the Caribbean. Likewise, based on the latest estimates, no subregion is on track to reach the 2025 or 2030 global targets for low birthweight.

FIGURE 11

Some progress has been made on malnutrition, but the pace must be accelerated, and trends in some forms of malnutrition must be reversed to achieve the 2025 and 2030 global nutrition targets

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If current trends continue, the world is expected to reach the 2025 target for exclusive breastfeeding, but not the 2030 target. Most subregions are making at least some progress towards the 2030 target, except Eastern Asia and the Caribbean – the only subregions experiencing a decline in prevalence. Central America is nearly on track to reach the 2030 target for exclusive breastfeeding, missing the target by only one year if current trends continue. If current rates of progress for exclusive breastfeeding are maintained in Central Asia and Southern Asia, these subregions will reach the 2030 target.

Most regions are making some progress, but not enough to achieve the global nutrition targets. Where progress is being made at the regional level, it can often mask the lack of country-level progress. Figure 12 shows the percentage of countries in each region that are on track and off track, with off track countries differentiated by whether they are making some progress, no progress or worsening. For the target to reduce the number of children affected by stunting by 50 percent, only 25 percent of countries are confirmed to be on track, and within the Africa region, only 9 percent of countries are on track (five countries). For the target to reduce wasting levels to less than 3 percent, only 28 percent of countries seem to be on track based on available data (57 countries). Particularly concerning are the trends in Africa and Asia, where more than half of the countries with data are off track or worsening. Globally, a mere 17 percent of countries are confirmed to be on track to achieve the target of reducing child overweight prevalence to less than 3 percent; no countries are on track in Latin America and the Caribbean and only 2 percent of countries are on track in Northern America and Europe, and Australia and New Zealand. In 2020, about half of the world’s children under five lived in countries that were not on track to achieve any of the three 2030 SDG targets for stunting, wasting or overweight. This analysis provides clear evidence of the need to step up efforts to eliminate child malnutrition if the targets are to be met by 2030.

FIGURE 12

Around half of children live in countries that are not on track to reach one of the 2030 SDG targets for child stunting, wasting and overweight

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Potential additional cases of stunting and wasting due to the COVID-19 pandemic

The projections presented above do not account for the effect of the COVID-19 pandemic on malnutrition. They describe the projected progress towards the global nutrition targets if the trends prior to the pandemic were to continue to 2030. This section presents a scenario (see Box 6) of how the COVID-19 pandemic could potentially affect the prevalence of child stunting and wasting by 2030. While any such projections are highly speculative, they nevertheless illustrate one important point: in a context in which additional effort, attention and action were already called for prior to the pandemic, even more will be needed now – in a situation worsened by the COVID-19 pandemic – to get on track to reach the 2030 targets.

Under a no-COVID-19 scenario, if the AARR of child stunting before the COVID-19 pandemic were to continue, 23.2 percent of children under five years would be expected to be stunted in 2022. In comparison, projections from our COVID-19 scenario indicate that 23.9 percent of children under five years would be stunted in the year 2022 under the pessimistic scenario (Figure 13A), and 23.7 percent under the moderate scenario. While this represents only a small increase in prevalence, even this marginal increase would result in 4.5 and 3.4 million additional stunted children in the year 2022 alone under the pessimistic and moderate scenarios, respectively.

FIGURE 13

Conservative estimates of the potential impacts of the COVID-19 pandemic indicate that an additional 5 to 7 million children may be stunted, and 570 thousand to 2.8 million more wasted, in low- and middle-income countries in the year 2030. However, the ESTIMATE OF THE accumulated additional cases of wasting from 2020 to 2030 is 16 to 40 million

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When making projections to 2030, it is important to consider the cumulative and chronic nature of childhood stunting, as once a child is stunted, he or she will most likely remain stunted in subsequent years. This will result in double-counting if the number of additional stunted children is aggregated every year. To avoid this, we assume that 35 percent of the total number of stunted children each year contributes to the additional stunted population in subsequent years. Furthermore, if we assume that from 2022 to 2030, trends in stunting follow the pre-COVID-19 trajectory, an additional 16 to 22 million children in low- and middle-income countries will be stunted between the years 2020 and 2030 under the moderate and pessimistic scenarios, respectively, compared with the scenario without the COVID-19 pandemic.

The projected additional numbers of stunted children almost certainly underestimate the full impact of the COVID-19 pandemic on stunting for several reasons. The effects of stunting will last beyond age 5 throughout the life course and can have intergenerational effects, as stunted adults are more likely to earn less income and stunted mothers are more likely to give birth to children who will be stunted, leading to intergenerational effects of poverty and stunting. Also, if there are persistent effects of the COVID-19 pandemic and no improvement in the conditions that contribute to increased stunting, such as poor nutrition and disruptions in access to health and nutrition services, it is possible that the additional number of children who are stunted will increase over time (scenario not shown). Furthermore, there will also be an intergenerational effect from deteriorating maternal nutrition during the COVID-19 pandemic (not shown), leading to more mothers with inadequate nutrition giving birth to a cohort of children who are more likely to be stunted (and to experience wasting), which would increase the number of stunted children above our current scenario.⁵⁶

Of the seven global nutrition targets, the most progress in the past two decades has been achieved on child stunting. Still, even before the pandemic, it was projected that 119 million children under 5 would be stunted in 2030 in the 135 low- and middle-income countries, which is well above 85 million, the 2030 SDG target of a 50 percent reduction in the number of children under five who are stunted. Our COVID-19 scenario projects 125 to 127 million stunted children in the year 2030 (20.4 to 20.7 percent), which is 5 to 7 million more children than if pre-COVID trends continued without the effect of COVID-19, and 42 million above the SDG target (Figure 13A). Comprehensive efforts to address the detrimental impacts of the COVID-19 pandemic on maternal and child nutrition are crucial to return to the pre-COVID-19 level of progress, and achieve the 2030 global target for childhood stunting.

With respect to child wasting, under a no-COVID-19 scenario, it is estimated that 6.8 percent of children under 5 years in low- and middle-income countries were affected by this acute form of undernutrition in 2020.³² If the effect of the COVID-19 pandemic is considered, under the pessimistic scenario, the wasting prevalence in low- and middle-income countries is projected to increase to 8.0 percent in 2020, 7.8 percent in 2021 and 7.2 percent in 2022 (Figure 13B), resulting in an additional 16 million children affected by wasting between 2020 and 2022. Under the moderate scenario, 11 million additional children in low- and middle-income countries will suffer from wasting in the three-year period. If we assume that after 2022, trends in wasting follow a similar pattern to the trend before the COVID-19 pandemic, an additional 16 to 40 million children will be affected by wasting between 2020 and 2030, under the moderate and pessimistic modelled scenarios, respectively.

This does not take into account any large future shocks or emergencies that could cause a spike in the number of children affected by wasting. The application of the pre-COVID-19 AARR from 2022–2030 also may not take into account relevant seasonalities associated with wasting. This is because the AARR used represents trends in survey time points that capture a specific cross-section of fluctuating wasting caseload and may not be representative of overall trends. Nevertheless, the immediate effects of the COVID-19 pandemic are manifested first in the acute condition of child wasting and, if economic conditions, food access and dietary patterns do not recover fully, levels of child wasting globally will be elevated. Moreover, the management of moderate and severe undernutrition was one of the most frequently disrupted services.

Based on the scenarios accounting for COVID-19, it is projected that 6.1 to 6.5 percent of children under five (37.3 to 39.6 million children) will be wasted in 2030 under the moderate and pessimistic scenarios, respectively, in low- and middle-income countries (Figure 13B). This represents 570 thousand to 2.8 million more children compared with the no-COVID-19 scenario, and implies a level of wasting which is twice as high as the global target of 3 percent in 2030. Thus, if the rise in child wasting is not prevented, and there are disruptions in caring for these children, child mortality will increase as well. Clearly, the prevention, care, management and treatment of child wasting requires urgent attention.

As the pandemic continues with no clear end in sight, and the economic and other impacts continue to unfold, the trajectory over the next years is difficult to foresee. Evidence is still scarce on the actual effects of the COVID-19 pandemic on various forms of malnutrition, including on the prevalence of child stunting, wasting, overweight, adult obesity, anaemia in women of reproductive age, low birthweight and exclusive breastfeeding. These effects will be compounded through the intergenerational effects of malnutrition and the resulting impact on productivity and, hence, economic recovery. However, it is clear that the COVID-19 pandemic has likely impacted the prevalence of multiple forms of malnutrition, and could have lasting effects beyond 2020, as we are already seeing in 2021. Therefore, exceptional efforts are required to address and overcome the effects of the pandemic as part of accelerating progress towards achieving SDG Target 2.2.

While the simple projected scenarios showing a reversal in progress are discouraging, if the right policies and actions are put in place now, it is possible to get the world on track towards zero hunger and malnutrition. In the context of declining Overseas Development Assistance projections, this would require sufficient and innovative financing, strong commitment and efficient delivery to ensure essential nutrition services are provided to the population in need. Just as the vulnerabilities of food systems have been laid bare by the pandemic, so have many of the actions needed to strengthen their resilience to the various drivers that have been undermining progress. Chapter 3 provides an integrated analysis of these drivers and Chapter 4 lays out pathways for transforming food systems that can help get the world back on track towards zero hunger and malnutrition.

Food systems are extensive networks made up of everything – and everybody – involved in producing, storing, packing, processing, distributing, marketing, consuming and disposing of food, including the social, political, economic, legal and environmental systems.^{57,58,59,60,61,62,63,23,64,65} Agri-food systems, a term increasingly used in the context of transforming food systems for sustainability and inclusivity, are broader as they encompass both agricultural and food systems and focus on both food and non-food agricultural products, with clear overlaps (see Chapter 4, Figure 29). While broader agri-food systems transformation is of utmost importance, it is beyond the scope of this report.

Importantly, food systems perform a central role not only in determining the quantity, quality, diversity and nutritional content of the foods available for consumption, but also in sustaining the livelihoods of millions of people around the world. In addition, food systems have a major impact on human health (both positive and negative) through a variety of different channels,⁶⁶ and on the environmental and ecosystem health of our planet. As such, how food systems function, the cost and quality of the food they deliver, and the impact they have on the health of people and our planet, directly and indirectly impacts outcomes of food security and nutrition. Therefore, any analysis of the after-mentioned drivers and their impacts must be viewed through a food systems lens, which involves considering trade-offs and synergies between these different outcomes.

The previous editions of this report, which analysed in depth each driver separately, taught us that these drivers are not mutually exclusive, as they interact to the detriment of food security and nutrition by creating multiple, compounding impacts at many different points within our food systems. We also learned that drivers do not necessarily move in the same direction, and that there are trade-offs and synergies associated with the policies enacted in response to these drivers. A food systems lens, therefore, becomes essential to better understand how the negative impacts of these drivers interact, and to facilitate the identification of targeted entry points for interventions to address the significant challenges presented by the drivers.

This perspective also allows for an examination of the synergies and trade-offs between policy interventions and how addressing one driver can have positive and negative impacts on different outcomes. For example, an effective response to recover from an economic downturn can improve both food access and utilization, with either negative or positive effects on the environment. A disconnected approach is unable to address the interconnected nature of the challenges, both within food systems and also in the intersection of food systems and other systems, including environmental, health and social protection systems.

FIGURE 14

Impacts of various drivers are transmitted throughout food systems, undermining food security and nutrition

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The diagram also accounts for circular feedback loops that can create compounding impacts that occur over time. For example, economic downturns that reduce the affordability of nutritious foods and increase the consumption of unhealthy diets not only negatively affect people’s nutrition and health, but can also (as shown in the 2020 edition of this report) contribute to broader effects on the environment and climate change, through increased greenhouse gas (GHG) emissions.

Rather than one single impact, drivers tend to create multiple, compounding impacts on food systems

In Figure 14, conflict (political and institutional drivers), climate variability and extremes (bio-physical and environmental drivers), economic slowdowns and downturns (economic and market drivers), and poverty and inequality (economic and sociocultural drivers) are external drivers that act upon food systems (yellow box). Rather than one single impact, these drivers tend to create multiple, compounding impacts on food systems that negatively affect food security and nutrition. Because the drivers coexist and interact, this complexity must be fully understood and addressed when designing programme and policy responses.

For example, as shown in the 2017 edition of this report, conflict negatively affects almost every aspect of food systems,¹ from production, harvesting, processing and transport to input supply, financing, marketing and consumption. Direct impacts can be significant, particularly in regard to the destruction of agricultural and livelihood assets (such as land, livestock, crops, seed stocks or irrigation infrastructure), the forced or corrupt seizure of natural resources, and displacement from land, livestock grazing areas and fishing grounds. When conflict and civil insecurity severely disrupt and restrict trade and movements of goods and services, there can also be a negative effect on the availability of food, including nutritious foods that constitute a heathy diet, and upward pressure on prices of traded goods, which negatively affects food access and food utilization at the household level. Conflict disrupts the flow of food, funds, labour and other essential items through markets; creates shortages; and contributes to price hikes, thereby damaging market functionality. Conflicts can also erode finances for social protection and healthcare and so damage health and nutrition.¹

BOX 7

Impact channels of the COVID-19 pandemic on food security and nutrition

©FAO/Ismail Taxta

The COVID-19 pandemic and the measures put in place to counter it have delivered one of the most devastating blows to global food security and nutrition in recent times, with multiple impacts on food systems (Figure 14) and the channels through which food systems affect diets, including the affordability of healthy diets (systems supporting food production, food supply chains, food environments, consumer behaviour).⁷⁴ The number of people suffering from chronic hunger in the world, as measured by the prevalence of undernourishment (PoU), increased by up to 161 million more people in 2020 – the largest single-year increase in decades (Figure A).

Figure A

The COVID-19 pandemic contributed to the largest single-year increase in global hunger in decades

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Additionally, by the end of 2020, at least 155 million people suffered from acute food insecurity* requiring urgent humanitarian assistance in 55 countries/territories (Integrate Food Security Phase Classification/Cadre Harmonisé [IPC/CH] Phase 3 or above).⁷⁵ Of these, economic shocks were a primary driver of acute food insecurity in 17 food crisis countries affecting 40 million people in Crisis or worse (IPC/CH Phase 3 or above). By comparison, in 2019, economic shocks constituted the primary driver in just eight countries with around 24 million people in Crisis or worse (IPC/CH Phase 3 or above), or equivalent.

The most destructive effects of the COVID-19 pandemic on food security and nutrition emanate from the unprecedented reach and scale of the economic downturns caused by the pandemic containment measures (economic and market drivers). These plunged the world and most countries into economic recession in 2020, with per capita incomes contracting in more countries than at any time in the recent past. People employed in the informal sector in many countries around the world saw their incomes significantly reduced or disappear. In high-income countries, governments provided support to employers to retain employees, albeit at reduced salaries.

While food supply chains have proven to be more robust than originally predicted, the pandemic is eroding people’s ability to purchase food as they lose their incomes and livelihoods. As a result, not only are more people unable to afford healthy diets, increasing their risk of any form of malnutrition, but more people are going hungry because they lack sufficient quantities of food. In addition, school closures have led to the suspension of critically important school food and nutrition programmes. Food assistance programmes such as food banks and various other initiatives have experienced a significant and continuous increase in demand for their services throughout 2020, in both developing and developed countries. This rise in demand stems from income loss and subsequent increased unaffordability of foods resulting in many more people depending on food assistance to maintain a healthy diet and avoid food insecurity.

This economic downturn translates directly into increased unaffordability of food and greater food insecurity and malnutrition – as people have less income to buy food, let alone more expensive nutritious foods required for healthy diets. Migrant workers have been affected by lockdowns, trade disruptions, layoffs and illness,⁷⁶ although remittances sent to their home countries show a smaller decline than previously predicted.⁷⁷ Women have been particularly hard hit by the economic and social fallout of the COVID-19 pandemic. The pandemic has pushed more women into extreme poverty than men, with women also facing higher job losses, shrinking work hours and greater care burdens.⁷⁴ As highlighted in Chapter 2, the gender gap has grown even larger in the year of the pandemic – with the prevalence of moderate or severe food insecurity being 10 percent higher among women than men in 2020, compared with 6 percent in 2019. (see Chapter 2, Figure 6).

But the COVID-19 pandemic is not only having multiple demand-side effects on access to food; there are also supply-side effects that are negatively affecting people’s capacity to access food and healthy diets. These include border closures, travel restrictions, quarantines, and market, supply chain and trade disruptions. These negative effects restrict people’s physical access to sufficient, diverse and nutritious sources of food, especially in countries hit hard by the pandemic or already affected by high levels of food insecurity and malnutrition. High-value perishable commodities are going to waste along the chains, as essential workers in food and agriculture are barred from crossing borders and food supply chains are being disrupted. Closure of markets, including informal markets, also exacerbates the unaffordability of healthy diets.

The adverse effects of the pandemic physical distancing measures have tended to be more immediate and pronounced for highly perishable fruits and vegetables, for which production and trade are more labour-intensive as compared with other food commodities such as staple foods.^78,79,80 While impacts may be less than expected and more evidence is needed, there are some reports of food losses and waste, especially of fruits and vegetables, fish, meat and dairy products.⁸⁰ Furthermore, travel restrictions are causing severe labour shortages in food and agriculture production and processing industries, leading to production and supply disruptions. Moreover, school closures have led to missed meals normally provided through school food and nutrition programmes. As a response, some countries have started door-to-door meal delivery service to children.**

The COVID-19 pandemic and related containment measures have exacerbated other drivers, widened inequalities, and exposed structural vulnerabilities of local and global food systems. While the COVID-19 pandemic is itself driving a global economic downturn, it has negatively affected several regions of the world while interacting with conflict or climate variability and extremes, or a combination of both (see analysis below and Figures 19 and 24) as well as more localized drivers, such as the locust outbreaks in East Africa (Kenya and Somalia) and South Asia (India and Pakistan). It has also combined to worsen food crises in emergency contexts.⁷⁵ For example, acute food insecurity requiring emergency response has increased in El Salvador, Honduras and Nicaragua due to the double impact of hurricanes Eta and Iota and the economic effects of the COVID-19 pandemic. In the Democratic Republic of the Congo and South Sudan, the combined effects of conflict and climate variability and extremes, including droughts, cyclones or seasonal flooding, have been aggravated by the economic effects of the pandemic.^75,81

The global economic recession that started in 2020 is extending into 2021 for many countries, with regional and international trade impacts, record levels of unemployment, lost livelihoods and rising poverty levels in many countries around the world.^82,25,10 The uneven pace of recovery from the effects of the COVID-19 pandemic and containment measures will mean that some countries will continue to face significant food security and nutrition challenges related to these in 2021, and possibly beyond, especially in contexts where this is combined with conflict and climate-related disasters. As shown in Figure 24, in 2020, in countries affected by economic downturns combined with climate-related disasters and conflict, increases in undernourishment were more than five times greater than in countries only affected by economic downturns.

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The impacts of economic slowdowns and downturns can also be felt particularly hard in the food and agriculture sectors, both because of what happens within the sector (e.g. reduced ability to invest in the next planning cycle) and because of urban–rural linkages. These impacts can be especially harmful to countries lagging behind in terms of economic development, as the food and agriculture sectors account for substantial shares of employment and output in these countries. The need to change consumption patterns can lead vulnerable households to shift away from nutritious foods towards more energy-dense foods with minimal nutritional value, or to cut spending on a range of basic services for health and disease prevention. Economic slowdowns and downturns also reduce the fiscal space for government to provide support to the poor.

As shown in the 2020 edition of this report, the factors that drive the cost of nutritious foods are found throughout the food system. On the food production or supply side, low levels of productivity,^70,71 high production risks and insufficient diversification towards the production of more nutritious foods are key drivers of the cost of healthy diets, especially in low-income countries. In food supply chains, inadequate food handling and storage,⁷² poor road infrastructure⁷ and limited food preservation capacity lead to food losses (especially for highly perishable foods)⁷³ and inefficiencies along the food supply chain that drive up the cost of nutritious foods.⁷ On the demand side, food environments influence consumer behaviour; moreover, the preferences of consumers also represent an important factor driving the cost and affordability – and the availability – of healthy diets.⁷ Rapid rates of urbanization have resulted in more work-away and eat-away-from-home habits, with a direct impact on the demand for easy-to-prepare, highly processed foods or convenience foods that are often energy dense and high in fat, sugar and/or salt. Such foods have also become more widely available and affordable, but do not necessarily contribute to healthy diets. However, consumer demand can also be a positive force: for example, increased demand can also encourage production of nutritious foods, making it more available at a lower cost.

Inequality and sociocultural stratification magnify the negative effects of other drivers

Poverty and inequality (economic and market drivers) and sociocultural stratification and empowerment, including gender and power dynamics (sociocultural drivers), are important external factors (Figure 14) that tend to magnify the negative effects of other drivers. Importantly, inequality is related to economic and market drivers in a broader sense (i.e. multidimensional), including inequality in access to resources (land, water) and basic services (health, education, etc.). Their impacts are felt throughout food systems and food environments, ultimately affecting the affordability of healthy diets and food security and nutrition outcomes. The 2019 edition of this report analysed the nexus between economic growth, poverty, and food security and nutrition, factoring in inequality. Analysis reconfirmed that economic slowdowns and downturns are associated with increases in food insecurity, but also showed that not only does income inequality increase the likelihood of food insecurity, but high income inequality amplifies the negative effect of economic slowdowns or downturns on individual food security.^5,6

There are circular interconnected impacts of drivers on other systems, including environmental and health systems

Beyond their direct impacts on food systems, these major global drivers weaken food security and nutrition through interconnected and circular impacts on other systems, including environmental and health systems. For example, as explored in depth in the 2020 edition of this report, diets of poor quality and insufficient quantity have broader impacts on human health and the environment, including increased morbidity, mortality and the social costs associated with multiple forms of malnutrition, including stunting, wasting, micronutrient deficiencies, overweight and obesity, as well as costs associated with environmental degradation and GHG emissions (broader impacts: economic, socio-economic, environmental) (Figure 14).

Current food consumption patterns are a leading cause of morbidity and disability – with poor diets accounting for 8 million premature deaths globally every year⁸³ – which require higher spending on healthcare, placing significant burdens on national healthcare systems and economies.⁵⁹ The 2020 edition of this report estimated that if current food consumption patterns continue, diet-related health costs linked to NCDs and their mortality are projected to exceed USD 1.3 trillion per year by 2030.⁷ At the same time, current food consumption patterns are leading to significant environmental impacts and associated costs. The diet-related social costs (i.e. economic costs) of GHG emissions associated with current dietary patterns is projected to exceed USD 1.7 trillion per year by 2030.⁷

These broader impacts – and their repercussions on other systems – are important as they fuel a circular feedback loop impacting drivers that affect the food system, for example in the way diets affect GHG emissions, which are a driver of climate change that then affects the food systems (bio-physical and environmental drivers) (Figure 14).

Governance and policy shape how food systems function and the outcomes they produce, including both positive and negative food security and nutrition outcomes

Other factors that need to be taken into consideration are the policies and governance – including legislation and finance – that shape food systems, and hence food security and nutrition outcomes (policy and governance) (Figure 14). They can be a positive force, but also a negative one.

For example, food and agricultural policies have the power, either directly or indirectly, to positively affect the availability, access to and cost of nutritious foods. Policy measures, including food standards, fiscal, labelling, reformulation, public procurement and marketing policies, can also shape healthier food environments.

On the other hand, some economic policies may result in an economic slowdown, or governance may trigger conflict. For example, protectionary trade measures and input subsidy programmes tend to protect and incentivize the domestic production of staple foods, such as rice and maize, often to the detriment of more nutritious foods, such as fruits and vegetables.^7,84,85 These measures and programmes can also keep the cost of fruits and vegetables above the world market rate or restrict farmers to just producing the staple crops – both of which also reduce consumer access to a diverse diet. Similarly, liberalization of trade and investment rules can also reshape food systems and thus influence food security and nutrition in both positive and negative ways – whether by improving access to diverse, nutritious foods or by increasing the availability and affordability of foods that are high in fat, sugar or salt. Finally, non-tariff trade measures can help improve food safety, quality standards and the nutritional value of food, and minimize any unintended consequences, but they can also drive up the costs of trade and hence food prices, negatively affecting the affordability of healthy diets.⁷

It is, however, not only about having the right policies; governance, legislation and institutions are key to the implementation of policies and to ensuring they consider the impacts on all dimensions of food security and nutrition (policy coherence) and on all stakeholders, especially the most vulnerable. For policies to be enforceable, they need to be grounded in legislation. This
highlights the importance of an enabling legislative environment for food security and nutrition. Such a legal framework is composed of complex networks of interlinked legal areas and is best construed through a food systems lens to ensure consistency and coherence.

In particular, it is also very important to consider institutional deficits and power imbalances. For example, poorer households, even net-food sellers, are exposed to volatility in food prices, owing to their weak bargaining position in food chains that keeps them from capturing the benefits from higher prices.⁸⁶ The agency dimension of food security is also key to addressing power asymmetries and reducing inequality, for example, by enhancing the participation of the rural poor in food systems transformation and its benefits. Agency goes beyond access to material resources in that it includes empowerment – the ability of people to take actions that help improve their own well-being, including food security and nutrition, as well as their ability to engage in society in ways that wield influence.⁵⁸

These drivers differ from country to country and even within countries, and in the way they interact. They also increase and decrease in intensity, and may disappear altogether for a time. However, what is common across countries is the lack of resilience of food systems to the negative effects of these drivers and their lack of capacity to deliver food security and good nutrition under these circumstances.

Analysis shows that this food systems vulnerability is further compromised and made worse by high and persistent levels of inequality – in terms of income, productive assets and basic services (e.g. health, education). Income and wealth inequalities are closely associated with access to food and, as a consequence, to hunger. If we are to end hunger, food insecurity and malnutrition in all its forms, food systems need to be transformed and inequality reduced in order to strengthen resilience to the negative effects of these drivers. A food systems approach is necessary to overcome the complexity of this challenge, by gaining an understanding of the interrelationships among key drivers and their negative impacts to help formulate appropriate solutions. Only then will a global transformation be possible to achieve well-functioning, resilient food systems that deliver affordable healthy diets.

As highlighted above, conflict, climate variability and extremes, and economic slowdowns and downturns can negatively affect food security and nutrition through their impacts on our food systems. As a result, all dimensions of food security and nutrition are likely to be affected, including food availability, access, utilization and stability. This is corroborated by the association found between the occurrence of these drivers and the food security and nutrition indicators, as we detail in this section.

Drivers are increasing in frequency and intensity, undermining food security and nutrition

In the last ten years, the frequency and intensity of conflict, climate variability and extremes, and economic slowdowns and downturns have increased and are undermining food security and nutrition around the world. Of particular concern are low- and middle-income countries because the negative impacts on food security and nutrition are greatest in these countries: they carry the biggest burden of the world’s population who are undernourished (13 percent) and children who are stunted (24 percent). Further, these countries experience multiple forms of malnutrition, including child overweight (6 percent) and adult obesity (18 percent).

High-income countries also face the increased occurrence of some of these major drivers, notably climate variability and extremes, and economic slowdowns and downturns. In the context of these countries, some people will become food insecure and malnourished as a result of the drivers, particularly during the COVID-19 pandemic. However, the analysis here focuses on low- and middle-income countries, where the major drivers exhibit the most significant impacts on hunger and malnutrition.

There has been a notable and significant increase in the frequency and intensity of conflict, climate variability and extremes, and economic slowdowns and downturns in the last ten years among low- and middle-income countries (Figure 15). For our analysis of the latter two drivers, we focus specifically on climate extremes and economic downturns.

FIGURE 15

Low- and middle-income countries face increasing frequency and intensity of drivers

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Conflict

Climate extremes

Countries face increasing climate variability and more frequent climate extremes, linked in part to climate change.⁴ The number of low- and middle-income countries exposed to climate extremes has steadily been on the rise over the past twenty years, from 76 percent of countries in 2000–2004 to 98 percent in 2015–2020. More strikingly, countries’ exposure to climate extremes has significantly magnified in terms of intensity (three or four types of climate extremes in a five-year period) (Figure 15B). The frequency, or number of years a country is exposed in each subperiod, increased by 42 percentage points, from 30 percent in 2000–2004 to 72 percent in 2015–2019 (not shown in figure). In terms of increasing intensity, 52 percent of countries were exposed to three or four types of climate extremes (heat spell, drought, flood, or storm) in 2015–2020, compared with 11 percent in 2000–2004. In other words, the number has almost quintupled in the last 20 years (see Annex 3 for definitions, methodology and data sources).

The analysis at the regional level confirms the intensity of climate extremes found at the global level. For instance, the occurrence of three or more types of climate extremes has increased by 39 percentage points for countries in Africa, from 10 percent in 2000–2004 to 49 percent in 2015–2020. Similarly, the percentage of Asian countries experiencing multiple types of climate extremes increased to 57 percent in 2015–2020, up from 11 percent in 2000–2004. The intensity of climate extremes in Latin America and the Caribbean also moved from 9 percent in 2000–2004 to 57 percent in 2015–2020.

Economic downturns

Even before the COVID-19 pandemic, global economic reports had highlighted that economic slowdowns, stagnation and outright recessions were evident in several economies and already leading to increased unemployment and declines in income.^5,90,91 The economic growth rate, as measured by the percent variation of real GDP per capita growth from one period to another, is typically used to gauge whether an economy is slowing down or contracting. In most regions, this rate rebounded after the sharp 2008–2009 global economic downturn. But the recovery was uneven and short lived, as many countries experienced generally declining trends in growth since 2011. Since 2014, poor and uneven growth has been especially pronounced in sub-Saharan Africa, Latin America and Western Asia. The percentage of countries experiencing economic downturns within these regions increased from 25 percent in 2014 to 38 percent in 2019. As a result, these regions experienced a severe reduction in their GDP per capita growth compared with other regions from 2014 to 2019 (Figure 15C).

The measures put in place to contain the COVID-19 pandemic delivered a significant economic hit, sending most countries into recession during 2020. For low- and middle-income countries, per capita income contracted in 117 of 129 countries with information available on GDP per capita growth. Specifically, 94 percent of the countries in sub-Saharan Africa, Latin America and Western Asia experienced an economic downturn in 2020, and 86 percent in other regions (Figure 15C). The 2020 global recession proved to be the deepest in decades, despite the extraordinary efforts of governments to counter the downturn with fiscal and monetary policy support. While some countries have seen their economies begin to recover in 2021, it is forecasted that many will not. One of the factors that will make recovery in 2021 less likely in some countries is the growing external debt burden, which could crowd out investments in economic recovery and social protection, as a result of which food security and nutrition could worsen. The global economic recession that started in 2020 has extended into 2021, with record levels of unemployment, lost livelihoods and rising poverty levels in many countries around the world.

Poverty and inequality

FIGURE 16

While poverty declines around the world, income inequality remains high, with an increase in 2020 in low- and middle-income countries

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Nexus between drivers and underlying causes and interconnected circular associations

Although the trends in the occurrence of conflict, climate variability and extremes, economic slowdowns and downturns, and underlying causes of poverty and inequality are presented separately, in fact, they often interact, and tend to create interconnected circular associations. For example, as highlighted in the 2017 edition of this report, conflict can wreak havoc on economic production and growth, causing deep economic recessions. In turn, economic recessions that drive up inflation and lead to sharp increases in food prices tend to exacerbate the risk of political unrest, as witnessed in 2007–2008 when food riots broke out in more than 50 countries.¹ Similarly, increasing climate variability and extremes, especially severe droughts, tend to jeopardize food security in terms of food availability and access, which is found to increase the risk of conflict.¹

The Dry Corridor in Central America – in particular in El Salvador, Guatemala and Honduras – is highly vulnerable to climate-related disaster risks due to its geographical location, high occurrence of climate extremes, including recurrent droughts, excessive rains and severe flooding, and institutional and socio-economic weaknesses.^3,4 People’s livelihoods are very climate-sensitive, with more than 1 million families relying on subsistence farming. Moreover, levels of poverty, inequality, food insecurity and malnutrition are alarming, particularly among rural populations and Indigenous Peoples. The reoccurring and increasing cycles of climate variability and extremes are not only a threat to food security and nutrition, but often trigger large-scale human displacement and migration – with those left behind being mostly the elderly, women and children. This exodus creates a breeding ground for conflict, and feeds a circular association of increased poverty, inequality and greater vulnerability to climate extremes.

Disentangling the nexus, and the causal factors between the drivers and underlying factors of poverty and inequality, is often so complex and challenging that it is not always clear which comes first and what follows. However, it is possible to observe the occurrence of the drivers simultaneously or over time, and their associated links with changes in food security and nutrition.

Increases in undernourishment occur in correspondence with conflict, climate extremes and economic downturns

Conflict, climate extremes and economic downturns critically challenge food systems – either through effects on systems supporting food production, food supply changes, food environments or consumer behaviour, or any combination of these – with impacts on food security and nutrition. This is particularly the case where a country’s food system is highly vulnerable to the impacts of the drivers and the country has high levels of poverty and inequality but does not have sufficient support in place to counter the fallout.

FIGURE 17

More than half of low- and middle-income countries experienced increasing PoU change points in correspondence with one or more drivers (conflict, climate extremes, and economic slowdowns and downturns) between 2010 and 2018

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Around 45 percent, or 27 of the 60 countries, experienced an increase in the PoU in correspondence with one driver. Of these countries, most were in correspondence with economic slowdowns or downturns (18 countries), followed by climate extremes (9 countries), while, interestingly, conflict always occurs in combination with other drivers. However, seven of these countries not only experienced an increase in PoU in correspondence with one driver in a given year, but also experienced increases in other years in correspondence with a combination of drivers. As a result, 52 of the 79 PoU increases occurred in correspondence with a combination of drivers (in 40 of the 60 countries): 32 change points in 26 countries with climate extremes and economic slowdowns and downturns, 10 change points in nine countries with all three drivers combined, 5 change points in five countries with conflict and climate extremes, and the remaining 5 change points in five countries with conflict and economic slowdowns and downturns.

As seen from this analysis, there are more PoU increases (79) than there are countries (60), which also means that several countries experienced more than one increase in the PoU during the period 2010–2018. In other words, several countries faced recurring PoU increases during this period. Although most countries (44 of 60) experienced PoU increases while at the same time being affected by one driver or a combination of drivers in a single year, several countries (16) experienced an increase in the PoU in correspondence with any of the drivers for two or three years. In particular, for 13 of the countries, this simultaneous occurrence is recorded for two years; three countries (Democratic Republic of the Congo, Gambia and Lebanon) witnessed it for three years.

Importantly, reoccurring PoU change points are seen where different drivers prevail. Only in 4 of the 16 countries with reoccurring increases in the PoU did these changes coincide with the occurrence of the same driver(s), while the remaining 12 countries experienced different drivers or combinations of drivers. For instance, Côte d’Ivoire, Lebanon and Lesotho first experienced increasing PoU change points in correspondence with economic slowdowns and downturns (in 2010, 2014 and 2013, respectively) and then in combination with climate extremes (Lebanon in 2018, and the other two in 2017). Similarly, the Democratic Republic of the Congo reported increasing change points in correspondence with all three drivers in two years (2011 and 2017) and with conflict and climate extremes in 2014. Afghanistan also experienced increasing PoU change points in correspondence with all three drivers in 2011, and with conflict and economic slowdowns and downturns in 2014.

While a PoU change point analysis is usually needed to detect statistically significant inflection points and increases in the PoU from year to year, the sharp and unprecedented rise in the PoU from 2019 to 2020 allows for a more direct approach. In this case, it is possible to detect an increase in 2020 by comparing the 2019 to 2020 PoU increase with the increase from 2017 to 2019 (see Annex 5 for methodology). This approach is applied to examine the 2020 increase in the PoU and whether one or more of the drivers exerted influence at the same time.

FIGURE 18

The 2020 increase in the number of undernourished was more than five times greater than the highest increase in undernourishment in the last two decades, and the economic downturn was twice as severe than previously recorded in low- and middle-income countries

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Most low- and middle-income countries for which there are PoU and GDP per capita data for 2020 (81 of 107) registered an increase in the PoU from 2019 to 2020. The magnitude of this single-year increase in the PoU is higher than the increase from the previous two years in most countries (66 of 81) (Figure 19). Only 15 countries with a PoU increase from 2019 to 2020 did not have an increase higher than the one from 2017 to 2019.

FIGURE 19

In 2020, most low- and middle-income countries hit by economic downturns exhibit an increase in the PoU, but oftentimes economic downturns occur simultaneously with climate-related disasters and climate extremes

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Almost all the low- and middle-income countries with an increase in PoU in 2020 higher than the increase during the previous two years (60 of 66) show this increase amid an economic downturn (Figure 19). Of these, 11 countries show an increase in the PoU occurring with economic downturns only, while for the rest of the countries, the increases occurred under the influence of economic downturns and a combination of other drivers.

Highest levels of food insecurity and malnutrition seen in countries affected by multiple drivers

The extent to which a driver or factor negatively affects people’s food security and nutrition depends on their degree of exposure and their vulnerability to its impact. In the analysis that follows, countries are categorized based on whether they are “affected” by a driver or factor, i.e. countries affected by conflict, countries affected by climate extremes, countries affected by economic downturns and countries with high inequality. The variables used to define the different categories are provided in Box 8.

In summary, two criteria are used for a country to be categorized as being affected by a driver: (i) evidence of the occurrence of an event related to the driver in a country, for example, the occurrence of a conflict, a climate extreme, or an economic downturn; and (ii) evidence of a vulnerability to the impacts of such an event, which refers to conditions that increase the probability that the occurrence of the driver event will negatively affect the country’s food security and nutrition situation.

For example, a country affected by climate extremes is a country where there is evidence of the occurrence of climate extremes over agricultural areas (exposure) and where there is an increased probability that these climate extremes will result in negative outcomes of food insecurity and malnutrition (vulnerability). If both conditions are met, then a country is categorized as a “country affected by climate extremes”. A country can be affected by more than one type of driver if it meets the criteria, e.g. a country can be affected by both climate extremes and conflict.

Although there are many vulnerability factors related to each driver, many are problematic to define consistently across countries for a global analysis due to the lack of data and comparability. In this analysis, a small subset of indicators are selected for the analyses that serve as a proxy for best measure of, vulnerability related to the drivers and their relative importance to food security and nutrition, and measurability across the 133 low- and middle-income countries (LMICs).

As seen above, 2020 represents a unique year in that most low- and middle-income countries experienced steep economic downturns. As a result, for that year there is an unusually high number of countries affected by multiple drivers, with economic downturns combed with climate extremes and conflict. For this reason, it is important to separate this analysis and first examine the pre-COVID-19 period.

In the pre-COVID-19 period, most or 70 percent of low- and middle-income countries were affected by at least one of the drivers (93 of 133). Of the 133 low- and middle-income countries, only 40 countries are not affected by any of the three drivers, while most countries are affected by either one driver (52 countries) or a combination of drivers (41 countries). For countries affected by one driver, most are affected by climate extremes (38 countries), followed by conflict (8 countries) and economic downturns (6 countries). Climate extremes are the most common driver affecting countries, either as a single driver or in combination with other drivers (75 countries). Conflict is the second most common driver affecting countries, either as a single driver or in combination with other drivers (40 countries), followed by economic downturns (24 countries). For countries affected by one or more drivers 41 percent also have high income inequality (38 of 93 countries).

For countries affected by multiple drivers, more countries are affected by conflict and climate extremes (23 countries), followed by climate extremes and economic downturns (9 countries). Five countries are affected by all three drivers. See Annex 4 for a list of countries affected by drivers.

The majority of chronically undernourished people and stunted children live in countries affected by multiple drivers (Figure 20). Moreover, countries affected by multiple drivers also have a significantly higher prevalence of undernourishment and of stunted children. In 2019, the unweighted average of the PoU in countries affected by multiple drivers (17 percent) was 6 percentage points higher than in countries affected by one driver or countries not affected by any driver (Figure 20A). A salient finding is that most of the hungry people live in countries affected by multiple drivers: 381.4 million of the 650.3 million chronically undernourished globally in 2019 (Figure 20A).

FIGURE 20

The majority of undernourished people and stunted children live in countries affected by multiple drivers (2019)

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Child stunting shows a similar pattern. In 2019, for countries with available information, the unweighted average prevalence of stunted children in countries affected by a combination of drivers was 6 percentage points higher than in countries affected by one driver only, and 9 percentage points higher than in countries not affected by any driver (28.5, 22.6 and 19.6 percent, respectively) (Figure 20B). Around 130 million, or 90 percent, of the total number of stunted children under the age of five lived in countries affected by one or more drivers (Figure 20B). However, the drivers are not the only influencing factors determining food security and nutrition outcomes in these countries, and a deeper analysis is therefore called for.

If we update the analysis to identify countries affected by the different drivers including year 2020, of 133 low- and middle-income countries, the number of countries not affected by any of the drivers decreases from 40 to only 14 (compared with 2010–2019), while most of the countries (80 countries) are affected by a combination of drivers, and only a few are affected by one driver (39 countries). Climate extremes continue to be the most common driver affecting countries, either as a single driver or in combination with other drivers (104 countries). Economic downturns, however, either as a single or in combination, are the second most common driver affecting countries (72 countries), followed by conflict (40).

Consequently, in 2020, the number of undernourished people who live in low- and middle-income countries affected by multiple drivers increases significantly to more than 585 million people (no figure shown). Countries affected by multiple drivers also have a much higher prevalence of undernourishment in 2020 (16 percent) compared with countries affected by one driver or not affected by any driver (10 and 8 percent, respectively). Similarly, in 2020 the highest prevalence of stunting occurred in countries affected by multiple drivers (23 percent), compared with countries affected by one driver or not affected by any driver (18 and 14 percent, respectively). However, child stunting decreased from 24 percent in 2019 to 21 percent in 2020 for low- and middle-income countries.

Hunger increases the most where there is conflict, climate extremes, economic downturns and high income inequality

As shown in the previous chapter, world hunger, as measured by the PoU, reversed course after a long period of decline and began to slowly increase in 2014. Given the reversal in the downward trend and the recent increases in undernourishment, even before the COVID-19 pandemic, it is important to examine trends more closely in low- and middle-income countries affected by conflict, climate extremes and economic downturns, as well as differences for countries with high income inequality.

This analysis shows that the reversal in the PoU trends in 2014 and the continuous increase (especially pronounced from 2017) is largely attributed to low- and middle-income countries affected by conflict, climate extremes and economic downturns, and to countries with high income inequality (Figure 21). The PoU is higher and has increased more in countries affected by these drivers.

FIGURE 21

Hunger is higher and has increased more in countries affected by conflict, climate extremes or economic downturns, or with high inequality

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Of the 110 low- and middle-income countries with available information, the largest increase in the PoU is observed in countries affected by economic downturns. The group of countries affected by economic downturns have had increases in the PoU that started as early as 2010, surpassing countries affected by other drivers to have the highest PoU (Figure 21).

Countries affected by conflict exhibit a small but increasing trend in their PoU from 16 to 16.9 percent between 2017 and 2019. Though not shown in Figure 21, the PoU is even higher and with greater increases in countries where conflict is compounded by protracted crisis. During the years 2010–2019, countries in protracted crises reported the highest PoU at an average level of 30 percent, with an increase of 1.5 percentage points between 2017 and 2019 (from 28.7 to 30.2 percent).

It is strikingly clear from Figure 21 that 2020 represents a clear departure from previous years, as surges in the PoU are seen across all low- and middle-income countries. As seen earlier, the economic downturns resulting from the COVID-19 pandemic and its containment measures delivered the hardest blow in decades to world hunger, contributing to a sharp and significant increase in undernourishment in a single year.

There are also important differences in trends depending on whether a country is affected by more than one driver (multiple drivers) and depending on the country income group (Figure 22). Focusing on the most recent period of increase before the COVID-19 pandemic, between 2017 and 2019, low- and middle-income countries affected by one or more of the drivers show an increase in the PoU of 4 percent, while countries not affected by any driver show a decreaseof 3 percent. Overall, between 2017 and 2019, countries affected by multiple drivers exhibit the highest increases in the PoU (6 percent), which is 12 times larger than those in countries affected by only a single driver (0.5 percent).

FIGURE 22

Low-income countries affected by conflict and climate extremes show the largest increase in the PoU, while for middle-income countries, the largest increase occurs during economic downturns

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Considering all low- and middle-income countries, 24 of the countries affected by economic downturns show the largest increase in PoU (1.5 percentage points), while 36 countries affected by multiple drivers show the second largest increase (1.0 percentage point) (Figure 22). This compares with a 0.1 percentage point increase for the 45 countries affected by a single driver, and a 0.3 percentage point reduction for the 29 countries not affected by any driver.

A further breakdown of this analysis considers all possible combinations of multiple drivers that can affect low- and middle-income countries. Given 110 countries with available information on undernourishment, eight mutually exclusive groups are created. Figure A4.1 shows countries grouped by the eight categories denoting different combinations of drivers and Table A4.1 provides the country list. The largest increases in the PoU (not shown in figure) are seen by the nine countries affected by both climate extremes and economic downturns, with a 2.1 percentage point increase during 2017–2019, followed by the five countries affected by all three drivers, which feature an increase of 2 percentage points (Afghanistan, Central African Republic, Democratic Republic of the Congo, Nigeria and Yemen). Countries experiencing the combination of conflict and climate extremes (18 countries) or conflict and economic downturns (4 countries), feature a 0.4 and a 0.5 percentage point increase in the PoU, respectively.

Between 2017 and 2019, low-income countries affected by the drivers show the largest increase in the PoU (from 30.8 to 32.4 percent), which is 2.5 times higher than to the increase reported by middle-income countries affected by the drivers over the same period (from 8.9 to 9.1 percent) (Figure 22). Specifically, there is a 1.6 percentage point PoU increase in low-income countries, which is higher than the 0.2 percentage point PoU increase for middle-income-countries (no increase for lower-middle-income countries and 0.4 for upper-middle-income countries). Low-income countries also feature high increases across all three drivers, as well as when affected by a single driver or multiple drivers. Low-income countries affected by conflict (11 countries) and climate extremes (14 countries) feature increases that are, respectively, 2.3 and 1.4 percentage points, which are higher compared with middle-income countries affected by these drivers (Figure 22). Furthermore, the 2.3 percentage point increase in low-income countries affected by conflict is higher also compared with low-income countries not affected by conflict (no increase in the PoU).

In contrast with low-income countries, increases in the PoU among middle-income countries during this period are primarily seen for countries affected by economic downturns and multiple drivers (Figure 22). Middle-income countries affected by economic downturns (16 countries) feature a 1.7 percentage point increase in the PoU, compared with middle-income countries not affected by economic downturns (74), which show a 0.3 percentage point reduction. Of these, 8 lower-middle-income countries had a 1.9 percentage point increase, and 8 upper-middle-income countries had a 1.4 percentage point increase.

High income inequality is also a factor in the PoU increases during this period, especially in middle-income countries. Middle-income countries with high income inequality (39 countries) have a higher increase in the PoU than middle-income-countries without high income inequality. Specifically, the former had a 0.3 percentage point increase, and the latter a 0.3 percentage point reduction. Furthermore, considering middle-income countries affected by one or more drivers, they show a 2 percent increase in the PoU between 2017 and 2019, while those with the additional burden of high income inequality had a double increase in the PoU (4 percent).

In contrast to recent trends in the prevalence of undernourishment, the prevalence of child stunting shows a continuing declining trend from 2017 to 2019. However, an analysis of child stunting for countries affected by conflict, climate extremes and economic downturns, as well as differences for countries with high income inequality, did not reveal any notable patterns, indicating the presence of other stronger drivers behind these trends. Similarly, while there is an increase in adult obesity from 2012 to 2016 that is observed across low- and middle-income countries, the analysis indicates that this increasing trend is driven by structural factors related to the economic development of a country and associated changes in food environments, rather than by contingencies related to the drivers. In fact, the increase in adult obesity is correlated with country income level and with the nutrition transition that often accompanies economic development. Indeed, middle-income countries feature a statistically significant higher increase than low-income countries (1.9 compared with 1.4 percentage points), with the highest increase reported by upper-middle-income countries (2.1 percentage points).

Regional differences in drivers and impacts on food security and nutrition

A regional analysis shows differences in trends related to the different drivers. The analysis in this section focuses on low- and middle-income countries in Africa, Asia, and Latin America and the Caribbean. These are the three regions of the world where most of the undernourished people and stunted children are located and where there are sufficient data for analysis. We first analyse the period 2017–2019, followed by a focused look at 2020.

FIGURE 23

Latin America and the Caribbean feature the highest increase in THE PoU from multiple drivers, while Africa is the only region where THE PoU increased under the influence of all three drivers from 2017 to 2019

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Countries affected by economic downturns in Africa, Asia, and Latin America and the Caribbean show the highest PoU increase from 2017 to 2019, compared with countries affected by climate extremes or conflict (Figure 23). The largest increase is seen in Africa and Latin America and the Caribbean (2 percentage points). Africa is the only region where a surge in PoU is associated with all three major drivers. Of the 24 countries affected by economic downturns, 11 are in Africa (27 percent of countries), 6 in Asia (19 percent of countries) and 5 in Latin America and the Caribbean (22 percent of countries). There are also countries outside these regions affected by economic downturns but not shown in the figure: two in Oceania.

Climate extremes are an important driver in Africa, with countries affected by climate extremes in this region showing a 1.2 percentage point PoU increase from 2017 to 2019, whereas Asia reports a 0.4 percentage point reduction (Figure 23). There are 21 countries in Africa affected by climate extremes (51 percent of countries) and 24 countries in Asia (77 percent of countries).

Countries affected by conflict in Africa show a 1.7 percentage point increase in the PoU during 2017–2019 (Figure 23). In contrast, the one country affected by conflict in Latin America and the Caribbean (Colombia) shows no increase in the PoU.

Africa is the only region with PoU increases from 2017 to 2019 associated with all three drivers (conflict, climate extremes and economic downturns) (Figure 23). Moreover, countries affected by conflict and climate extremes in Africa show a higher increase in the PoU compared with countries affected by the same drivers in Asia and Latin America and the Caribbean. Interesting differences in the change in the PoU from 2017 to 2019 are found within the regions. African countries affected by conflict and economic downturns show higher increases in the PoU than African countries not affected by the same drivers (the latter show a small increase around 0.3–0.4 percentage point). Similarly, countries affected by economic downturns in Asia and Latin America and the Caribbean have higher PoU increases than countries not affected by this driver, which show a 0.6 percentage point reduction in Asia, and a 0.2 percentage point increase in Latin America and the Caribbean.

The highest increase in the PoU, a 2.1 percentage point increase, is observed in countries affected by multiple drivers in Latin America and the Caribbean (Figure 23). Africa also registered very high increases in the PoU for countries affected by multiple drivers (1.9 percentage point increase). The most frequent combination of drivers in Africa is conflict and climate extremes (five countries). In Latin America and the Caribbean, four countries are affected by multiple drivers: three by climate extremes and economic downturns, and one by conflict and climate extremes (Colombia).

Countries affected by multiple drivers (one or more of the drivers) consistently show among the highest PoU increases during 2017–2019. In this period, for all three regions analysed (Africa, Asia, and Latin America and the Caribbean), around 36 percent of low- and middle-income countries were affected by multiple drivers, of which 15 are in Africa, 15 in Asia and 4 in Latin America and the Caribbean. Countries affected by multiple drivers show a 1.9 percentage point increase in Africa and a 2.1 percentage point increase in Latin America and the Caribbean, and no increase in Asia (Figure 23). On the other hand, while almost half the countries affected by drivers experience multiple drivers in Asia, during this period, it is only countries affected by economic downturns that show an increase in the PoU.

In 2020, all low- and middle-income countries with available information were affected by economic downturns, with the exception of nine countries (Bangladesh, China, Egypt, Ethiopia, Guyana, Iran, Myanmar, Turkey and Viet Nam). Guyana, for instance, grew at a rate of 43.5 percent in 2020, having completed an extraordinary year of oil production. Similarly, Iran’s GDP grew by 8 percentage points in 2020, due to favourable oil revenues in the second half of the year.

Figure 24 shows PoU increases for economic downturns and various combinations with other drivers in 2020. When economic downturns occur along with other drivers (either climate-related disasters, conflict, or a combination of both), the largest PoU increase is seen in Africa (5.2 percentage points), followed by Asia (3.1 percentage points). Of the 49 countries affected by multiple drivers, 16 are in Africa (16 of 41 African countries), 18 are in Asia (18 of 30 Asian countries), 8 are in Latin America and the Caribbean (8 of 21 countries in Latin America and the Caribbean), and the remaining 7 countries in North America and Europe and Oceania. Of the 7, 3 countries are in North America and Europe (3 of 9) and 4 countries in Oceania (4 of 6).

FIGURE 24

In 2020, Africa, Asia, and Latin America and the Caribbean witnessed significant increases in THE PoU while being hit by economic downturns combined with climate-related disasters, conflict, or a combination of both

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There are many countries (49 of the 107 countries) with an increase in the PoU in 2020 that were affected only by the single driver of economic downturns, but the PoU increase on average, was much smaller than the increase in countries affected by economic downturns combined with other drivers (Figure 24). On average at the world level, the increase was 1.1 percentage point lower, and 1.5 percentage points lower for both Africa and Asia.

Economic downturns combined with climate-related disasters affected 35 countries and led to significant increases in the PoU in all three regions (Figure 24). The largest increase is seen in Latin America and the Caribbean (2.1 percentage points), followed by Africa (1.6 percentage points) and Asia (1 percentage point). Of the 35 countries, 9 are in Africa (9 of 41 African countries), 12 are in Asia (12 of 30 Asian countries) and 8 are in Latin America and the Caribbean (8 of 21 countries in that region).

In 2020, countries affected by conflict combined with other drivers had a high PoU increase. Countries in Africa affected by all three drivers of economic downturns, climate-related disasters and conflict show the highest increase in the PoU (5.2 percentage points), while countries in Asia affected by economic downturns and conflict show the second highest increase (3.1 percentage points).

Increasing unaffordability of healthy diets is strongly associated with severe and moderate forms of food insecurity

FAO has begun to systematically monitor the cost and affordability of healthy diets around the world in this report. The new 2019 estimates presented in Chapter 2 provide an important opportunity to better understand how these are related to food insecurity, and how changes over time affect food insecurity and the different forms of malnutrition.

In last year’s edition of this report, it was shown that the unaffordability of healthy diets in 2017 was strongly associated with undernourishment and different forms of malnutrition, including child stunting and adult obesity. These results are reconfirmed this year by an analysis of estimates for 2019, which shows that high levels of unaffordability of healthy diets are strongly correlated with high levels of both severe and moderate or severe food insecurity, as measured by the FIES (Figure 25). As expected, the lower the income of the country, the higher the levels of both unaffordability of healthy diets and severe and moderate or severe forms of food insecurity.

FIGURE 25

The unaffordability of healthy diets in 2019 is strongly associated with higher levels of both severe and moderate or severe food insecurity

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Looking at the intersection between the percentage of the population that cannot afford a healthy diet, the percentage of the population who are moderately or severely food insecure, and whether or not these populations live in countries affected by drivers reveals interesting patterns (Figure 26). In countries affected by one or more drivers, on average, the percentage of the population who are moderately or severely food insecure is almost 10 percentage points higher (44 percent) than that of countries not affected by any driver (34 percent). Moreover, a larger percentage of the population cannot afford a healthy diet (57 percent) compared with the percentage in countries not affected by any driver (41 percent). Countries affected by multiple drivers exhibit the highest levels of unaffordability (68 percent), which is, on average, 39 percent higher than countries affected by a single driver and 66 percent higher than countries not affected by any driver. Those countries also show higher levels of moderate or severe food insecurity (47 percent), 12 percent higher than countries affected by a single driver (42 percent) and 38 percent more than countries not affected by any driver (34 percent).

FIGURE 26

In 2019, countries affected by multiple drivers and countries affected by conflict (alone or combined with other drivers) exhibited among the highest percentage of the population who cannot afford a healthy diet and are moderately or severely food insecure

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Countries affected by conflict have among the highest levels of moderate or severe food insecurity and unaffordability of healthy diets in 2019, irrespective of whether they are affected by conflict alone, or by conflict in combination with other drivers. The only exception is countries affected by conflict in combination with climate extremes, which have a lower level of moderate or severe food insecurity than countries affected by climate extremes combined with economic downturns (Figure 26). The few countries that were affected by all three drivers of conflict, climate extremes and economic downturns show the highest levels of unaffordability (94 percent of their population) and moderate or severe food insecurity (69 percent of their population).

The analysis shows (not presented graphically here) that there is a positive correlation between the 2017–2019 change in the number of people who cannot afford a healthy diet, for both moderate or severe food insecurity, and severe food insecurity in 2019. While the former variable may not explain much of the variability in the FIES-based indicators given a low coefficient of determination (R-squared of around 0.06), the correlation is statistically significant.

Thus, countries where the unaffordability of a healthy diet increased between 2017 and 2019 also show higher levels of food insecurity (both severe and moderate or severe). Further descriptive statistics and tests of significance suggest that this positive association is attributable mainly to lower-middle-income countries.

FAO has only begun to systematically monitor the cost and affordability of healthy diets. Therefore, it is expected that, as more data points over time become available, the capacity to analyse and better understand how changes in the cost and affordability of healthy diets affect food insecurity and the different forms of malnutrition will significantly improve. Furthermore, a systematic price collection of the key food items that form healthy diets will allow to build a healthy food basket populated with country-relevant food items that can be compared across countries while capturing local realities at the same time.

Global calls for action towards food systems transformation

Over the past several decades, food systems have delivered a wide variety of foods needed to feed a fast-growing and more urbanized world population. But many of these food systems have not succeeded in providing safe and nutritious foods to nourish the entire world’s population adequately, as nearly three billion people could not even afford a healthy diet before the onset of the COVID-19 pandemic. Moreover, a growing proportion of the world’s population now consumes diets containing highly processed energy-dense foods and beverages high in fats, sugars and/or salt.⁹⁴

The inability of food systems to provide households with adequate access to nutritious foods that contribute to healthy diets – especially in the aftermath of containment measures aimed at stemming the still ongoing COVID-19 pandemic – has amplified the call for a transformation of food systems⁷ to make healthy diets available and affordable to all. The urgent need for this transformation has become central to a global debate aimed at addressing some of the greatest challenges to sustainable development, specifically the challenge of ending hunger, food insecurity and malnutrition in all its forms by 2030. Three global summits to be held during the course of 2021 will address issues central to this debate, including the UN Food Systems Summit in New York (and the Pre-Summit held in Rome), the 26th UN Climate Change Conference of the Parties (COP26) in Glasgow, and the Tokyo Nutrition for Growth Summit.

This transformation of food systems demands innovative systemic changes supported by an enabling environment of institutions, policies, laws, regulations and investments with coherent and complementary objectives, across sectors.^86,95 In addition, incremental transitions at small scale and structural changes to institutions, legislation and standards at larger scale are needed – in coordinated and integrated ways – to achieve the desired transformation.⁹⁶ Importantly, coordinated action by all key players in public and private sectors, academia, civil society and international institutions is essential, as is recognized by the aforementioned global events. The challenges associated with achieving such changes are immense, and require significant mobilization of financial resources, while ensuring the identification of win-win solutions and managing trade-offs.

Best practices help illustrate transformative changes needed

As there are no one-size-fits-all solutions, country-level experiences provide illustrative examples of what it takes – in very practical and innovative ways – to transform food systems. In particular, coherence of policy measures and investments between food systems and closely related systems, such as agri-food, health, environmental and social protection systems, are considered. The examples demonstrate how transformative measures, especially inclusive governance mechanisms, technology, data and innovation (in addition to legislation, standards and other measures), can lead to successful transformation of food systems.

Well over 100 contributions were received in response to a global “call for best practices in transforming food systems for affordable healthy diets and addressing major drivers of food insecurity and malnutrition”⁹⁸ issued for this report, supplemented by a questionnaire circulated among partner agencies. Examples of best practices and the lessons drawn from them are detailed in the sections below. The contributions demonstrate how major drivers of food insecurity and malnutrition can be addressed and which key policy actions are needed along one or more of six identified pathways. In all cases, the importance of ensuring better integration of various policy platforms, and of measures and actions across and within sectors is highlighted, with emphasis on sectors covering natural resources, food, agriculture, health, social welfare, education, marketing, trade and investment.

A key challenge that restricts successful transformation of food systems is that existing national, regional and global policies, strategies, investments and legislation are compartmentalized into distinct dialogues: for example, separate discussions on priorities for political stability or economic recovery, disaster risk reduction and climate resilience, trade and development in food and agriculture sectors, or restoring health systems and ensuring adequate social protection.^1,3,5,7 Too often, there is insufficient recognition – or lack of action, where there has been recognition – of important relationships and complementarities among these dialogues and their relevance to key functions of the food systems, such as ensuring the sufficient production and supply of nutritious foods and the affordability of healthy diets.

Even though it is easier said than done, these challenges can only be overcome through the formulation and implementation of cross-sectoral portfolios of policies and investments that comprehensively address the major drivers whose widespread effects on food systems are resulting in negative food security and nutrition outcomes (as presented and analysed in Chapter 3). These portfolios need to be well targeted and provide incentives for all actors to change behaviour and to engage constructively in innovative and systemic changes that will lead to transformed food systems.

The sections below discuss six possible pathways (Figure 27) along which food systems can be transformed to address the major drivers of food insecurity and malnutrition identified and reviewed in previous chapters – and as summarized in Box 1. Every one of the pathways builds on key recommendations from the previous four editions of this report (2017–2020) and corresponds to one or more of the major drivers discussed and analysed in Chapter 3.

FIGURE 27

Possible pathways towards food systems transformation to address major drivers of food insecurity, malnutrition and unaffordability of healthy diets

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These transformation pathways form a basis for formulating a coherent set of policy and investment portfolios to enable the transformation of food systems (see also Figures 28 and 29). The relevant set of pathways is derived from a context-specific situation analysis (see below) that determines which driver or combination of drivers impacts most on the identified food system and on related food security and nutrition outcomes. The pathways may also complement and reinforce each other.

FIGURE 28

Steps towards food systems transformation for more affordable healthy diets

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Drawing upon illustrative examples from country case studies, in addition to policy recommendations from the scientific community and previous editions of this report, the remainder of this chapter reviews practical steps for building the recommended portfolios of policies and investments along the six transformation pathways. Figure 28 illustrates the recommended steps in the entire process towards food systems transformations that address the major drivers of food insecurity, malnutrition and unaffordability of healthy diets for all. Broadly speaking, the process requires (i) an in-depth context-specific situation analysis; (ii) the formulation of coherent cross-sectoral portfolios of policies, investments and legislation, and including accelerators that spur the transformative processes; and (iii) the implementation of these portfolios with adequate monitoring and evaluation, as well as accountability mechanisms in place.

The situation analysis covers a context-specific and comprehensive assessment of which major drivers impact negatively on food systems and result in poor food security and nutrition outcomes, based on available data and information as provided annually in this report (and in other key references at global, national and local levels).^{99,100,101,102,103,104} Depending on which drivers of food insecurity and malnutrition are present, stakeholders decide where in the food system systemic changes are needed to achieve desired outcomes. Furthermore, through a multi-stakeholder consultation, the relevant policy, investment and governance environments in the country are identified, taking into account the most relevant institutions and any political economy issues.⁷ All of the above will help identify which pathways towards food systems transformation are most appropriate within a given context.

For each applicable pathway, recommended policy options and best practices are then reviewed to illustrate the type of actions that could be taken and to inform the formulation of policy and investment portfolios – and associated accelerators – for food systems transformation. This part of the process is illustrated in the section below. The disastrous impact of the ongoing COVID-19 pandemic on human health and economies worldwide, and the importance of social protection systems to help ensure adequate access to nutritious foods for the most vulnerable, demonstrate the interconnectedness of, especially, the agri-food, health, environmental and social protection systems. Ensuring coherence among these and other relevant systems is a sine qua non condition to facilitate the transformative processes. This and other key building blocks of policy and investment portfolios (Figure 29) are discussed in more detail in Section 4.2.

Examples of best practices along six pathways towards food systems transformation

As many countries are affected by the major drivers, which also interact (elaborated in Chapter 3), several pathways will apply simultaneously, calling for coherence among them to ensure efficiency in implementation. Similarly, many of the best practices and policy measures discussed in this section are supportive of more than one pathway. For example, best practices in building resilience to climate variability and extremes (pathway 2) may also provide increased levels of resilience in countries affected by economic slowdowns and downturns (pathway 3) or conflict (pathway 1). Furthermore, given persistent and high levels of income inequality in most LMICs, in particular, best practices and policy measures elaborated under pathway 5 apply to many countries. Similarly, the best practices and policy measures discussed under pathway 6, which focuses on the food environment and consumer behaviour, generally apply to challenges faced by most food systems.⁷

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

It is important to recall that the majority of the chronically food insecure and many of the malnourished live in countries affected by insecurity and conflict. Therefore, it is imperative that conflict-sensitive policies, investments and actions to reduce immediate food insecurity and malnutrition be implemented simultaneously with those aimed at a reduction in the levels of conflict, and aligned with long-term socio-economic development and peacebuilding efforts.¹ Under conditions of violent conflict, entire food systems are often severely disrupted, challenging people’s access to nutritious foods. Emergency food assistance programmes, emergency support to ensure clean water, quality health services and sanitation, and interventions to maintain livelihoods are among the typical crisis response and social protection mechanisms implemented to ensure minimum levels of food security and nutrition.

In Yemen, conflict is the main driver of severe food insecurity and malnutrition, requiring a large-scale humanitarian response. Acute malnutrition has reached record levels, affecting half the children under five years of age.¹⁰⁵ Among the major causes are a high prevalence of communicable diseases due to poor water quality. Near the capital Sana’a, a breakdown of a major wastewater treatment plant in 2017 resulted in contaminated water being used for vegetable production, causing cholera outbreaks and a scarcity of fresh vegetables in peri-urban areas. Through an emergency intervention in 2018–2019, cost-effective small-scale water treatment plants were built and water-efficient drip irrigation systems installed covering 60 ha of irrigated land for vegetable production. The intervention produced multiple benefits, including clean water provision, availability of uncontaminated vegetables, and restored livelihoods.^97,106 This example highlights the importance of ensuring local food systems provide minimum levels of access to safe and nutritious foods, also in conflict-affected areas.

In conflict-affected areas, peacebuilding efforts are of paramount importance in achieving long-term food security and improved nutrition. Furthermore, resilience-building programmes, as well as social protection mechanisms, should be put in place without delay; otherwise, individuals and households may engage in increasingly destructive and irreversible coping strategies (such as selling productive assets) that threaten future livelihoods as well as their food security and nutrition.¹ Conflict-affected countries have been particularly hard hit during the COVID-19 pandemic. For example, due to movement restrictions, it has often been difficult to reach refugees and internally displaced persons (IDPs) with humanitarian assistance and other forms of support needed to ensure sufficient access to nutritious foods.

Deep economic crises can unfold where the structural causes of conflict situations are linked to competition over natural resources, including productive land, forest, fisheries and water resources. Policies supported by institutional and legal reforms, where needed, should address these causes and aim to mitigate – and if possible, prevent – their impact on food systems, food security and nutrition, and the economy at large. Especially in the context of protracted crisis situations, with possible periods of low (but persistent) levels of conflict and prolonged periods of displacement, it is critical to maintain food and agricultural production, sustain food supply chains and ensure people’s access to nutritious foods and healthy diets.⁵

The above scenario applies in Somalia, where people have experienced a three-decade-long protracted crisis with periods of severe food insecurity and malnutrition (and including famine in 2011), in addition to frequent extreme climate events (mainly droughts and floods). In recent years, appropriate action has been taken as, for example, in response to drought-induced large-scale food insecurity and malnutrition that affected up to 6 million people during 2017–2019, including acute malnutrition among 900 000 children.¹⁰⁷ A nutrition-sensitive “Cash+” programme was implemented in 2018 that combined unconditional long-term cash transfers with livelihood support to build resilience to future shocks, while maintaining productive capacity and food supply chains.¹⁰⁸ Agricultural households were provided with seeds and tools for home gardening, and pastoralists were given support for livestock, which improved animal health and milk production. The programme has increased access to food by households under emergency conditions, improved the quality and diversity of their diets, and enhanced the nutrition knowledge of the programme’s participants through nutrition and food safety education.

In a context of escalating conflict, displacement, climate shocks and commodity price fluctuations in the Central Sahel (Burkina Faso, Mali and Niger), a multi-pronged food systems approach has been implemented, where food production, transformation, logistics, retail and consumption are aligned with the objectives of responding to the food security and nutrition crises, while also strengthening systems to better respond to, manage and prevent future crises. At the food production level, farmers are supported with productive assets, training in climate-smart agriculture practices and improved market access. At the food processing level, the capacities of women’s groups and local agribusinesses are strengthened to produce fortified blended foods and fortified staples to improve the nutritional quality of food available on the market. And at the food environment level, to prevent malnutrition, access to nutritious foods and protection against price fluctuations is provided through a food voucher system for locally available nutritious foods that are otherwise not affordable. In addition, nutritionally vulnerable women and children are supported with programmes to prevent acute malnutrition. Hence, multiple entry points are used to ensure linkages among food, health and social protection systems, and to develop the capacity of governments to improve food quality and safety, and to systematically analyse food price data for decision-making. In this way, short-term emergency needs are met, and the resilience of individuals, households and communities strengthened.¹⁰⁹

Prior to the recent violent and deadly conflict with Israel, Palestine had already endured a fragile security situation for decades, affecting food security and nutrition. Restrictions on the movement of people and goods, as well as limited access to natural resources and international markets, had placed a heavy burden on local food systems and people’s livelihoods. In spite of the difficult circumstances, there have been efforts to strengthen the resilience of food systems within the context of periodic conflict, as well as social, environmental and economic shocks. Some food systems have been transformed into more resource-efficient and diversified market-led systems through improved agricultural knowledge, strengthened post-production and market capacities, increased value chain services and empowered producer cooperatives. Results (prior to the recent conflict) show a 12 percent improvement in land productivity, 10 percent improvement in marketing values, 15 percent reduction in production costs and an overall 10 percent increase in profitability among the agribusinesses run by small- and medium-scale farmers supported by the project.⁹⁷ Production of high-value crops, compliant with international quality and safety standards, and strengthened linkages between small-scale producers (and their cooperatives) and other value chain actors, including distributors and marketers, have raised export revenues, in addition to nutritious and safe foods being made available on local markets.

Drawing upon key policy recommendations from the 2017 edition of this report, complemented by more recent evidence, Table 8 provides a short list of the most important policy measures to be considered for integrating humanitarian, development and peacebuilding efforts in conflict-affected areas.

TABLE 8

Key policy areas and goals for integrating humanitarian, development and peacebuilding efforts in conflict-affected areas

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2. Scaling up climate resilience across food systems

The ways we produce food and use our natural resources can help deliver a climate-positive future in which people and nature can coexist and thrive.¹¹⁰ This is important, not only because food systems are affected by environmental degradation and climate events, but also because food systems themselves impact on the state of the environment and are a major driver of climate change. Central to this effort are priorities to protect nature, to sustainably manage existing food production and supply systems, and to restore and rehabilitate natural environments.^111,112

Solutions require increased partnerships and multi-year, large-scale funding in support of (among others): integrated disaster risk reduction and management programmes; climate change adaptation policies; and practices that are short-, medium- and long-term in scope³ to mitigate the impact of climate variability and extremes, including on persistent poverty and inequality.¹¹³ Adopting climate-sensitive approaches in food and agricultural investments can reduce food security risks associated with climate extremes, build long-term resilience and strengthen coping mechanisms along food supply chains.¹¹⁴

The implementation of climate resilience policies and programmes requires adapting and refitting tools and interventions such as risk monitoring and early warning systems, emergency preparedness and response, vulnerability reduction and resilience-building measures, shock-responsive social protection mechanisms, risk transfers (including climate risk insurance) and forecast-based financing, in addition to strong risk governance structures in the environment–food–health system nexus.³ To ensure their enforceability, such tools may need to be grounded in legislation. Climate risk and food insecurity are deeply intertwined in rural areas of the developing world, which has led to the development of various asset insurance schemes targeted specifically at poor and vulnerable households. The challenges of making micro-insurance markets work are multiple; nevertheless, available analysis suggests the potential gains to solving these challenges are substantial.¹¹⁵

In Zambia, new initiatives aimed at raising climate resilience include the introduction of agricultural insurance for vulnerable households. Households that adopt conservation agriculture techniques are provided with access to agricultural insurance, which in turn allows for investment in riskier projects with potentially higher revenues. Under this approach, agricultural insurance is not only important for building climate resilience but could also lead to poverty reduction and increased food security and improved nutrition. Elsewhere, different types of agricultural insurance schemes aimed specifically at poor and vulnerable smallholder households have been developed.

Implementing insurance schemes against disaster risk in agriculture is a costly endeavour that faces several challenges and constraints (e.g. infrastructural, regulatory and socio-economic). Nevertheless, integrating agricultural insurance schemes as a component of broader social protection programmes can lead to increased smallholder resilience and reduced rural poverty, while also reducing the cost of existing social protection mechanisms and strengthening the planning capacities of public agencies, when it comes to mitigating and transferring the risk of natural disasters. This has been demonstrated by a number of successful agricultural insurance schemes implemented in recent years, such as the Index-based Livestock Insurance (IBLI) programme in Ethiopia and Kenya.¹¹⁵ Likewise, in Mexico, the CADENA Programme has scaled up smallholder access to agricultural insurance through a subsidized public–private insurance scheme, which promotes the engagement of the private insurance sector in small-scale agriculture in providing insurance coverage related to a wide variety of climate-related risks.¹¹⁶

A proven approach to building climate resilience is climate-smart agriculture (CSA), which builds resilience in multiple ways through climate-sensitive and socio-economically beneficial approaches that have demonstrated triple wins in food systems transformation: CSA approaches sustainably increase agricultural productivity and improve incomes, build resilience to the impacts of climate change and reduce GHG emissions.¹¹⁷

In Lao People’s Democratic Republic, diversified and climate-resilient agricultural practices introduced in 2016 through farmer field schools and farmer nutrition schools resulted in positive impacts on soil conservation, biodiversity, and income and nutritional outcomes. In particular, community-based approaches with a strong focus on women’s empowerment resulted in increased purchasing power and higher dietary diversity among women and children, in addition to positive impacts on children’s health.⁹⁷

In Ethiopia, during 2015–2020, a CSA project focused on supporting women resulted in increased crop revenue while reducing the risk of food deficits that many participants had experienced before the implementation of the project. Other examples worldwide have demonstrated that the adoption of sustainable agricultural practices raises productivity and enhances food systems resilience, while helping to reduce poverty, food insecurity and malnutrition.³

Access to water is essential for smallholders to build climate resilience while also working towards more equitable and sustainable livelihoods. It is estimated that 77 percent of small-scale farms across LMICs are located in water-scarce regions, while only 37 percent have access to irrigation.¹¹⁸ In arid areas of the Sahel region, climate change has exacerbated irregular rainfall and other climate extremes, such as repeated droughts and floods. The consequences have been devastating for the poorest rural households, who have seen their vulnerability worsen as they struggle to cope with these shocks. Efficient, sustainable and fair management of water resources is more than ever a priority to improve the resilience of vulnerable communities and raise their levels of food security and nutrition.¹¹⁹ Many studies have documented how investments in water-harvesting techniques and irrigation infrastructure result in win-win solutions as the increased water-use efficiency also rises crop yields.¹¹⁸

In Kiribati, the combination of climate change, limited access to clean water, and unreliable imported food supplies have contributed to growing malnutrition and unhealthy diets. A community development project began in 2014 to provide rainwater-harvesting infrastructures and training related to household food production (home gardening and poultry). As a result, households reported an 80 percent reduction of cases of diarrhoea and dysentery and a 90 percent improvement in terms of access to clean water.¹²⁰

Land is another crucial natural resource to build resilience to climate extremes. Many vulnerable producers face degradation in the quality of their land, which is increasingly linked to poverty and food insecurity, and higher levels of vulnerability to climate change. A vast majority of people living on degraded agricultural land live in LMICs.¹²¹ In Ethiopia, a 2015–2020 landscape restoration project not only helped raise farm productivity through soil and water conservation, but also successfully linked farmers to markets, thereby raising their income-generating potential. Households reported improvements in food security, average household income grew significantly and minimum dietary diversity scores increased.⁹⁸ In India, a 2012–2016 land restoration and crop intensification project used traditional water storage systems (haveli) in combination with infrastructure investment and technology transfers, with positive effects on degraded and rainfed lands: crop yields increased by 10 to 70 percent, and average household incomes grew by 170 percent.^97,122 This approach also enabled groundwater recharges, resulting in improvements in water-use sustainability.

The territorial management and knowledge systems of Indigenous Peoples are useful for improving climate resilience, as these systems have enabled them to generate food in some of the most hostile environments and fragile ecosystems in the world.^112,123,124 In Guatemala, the Maya Ch'orti' Indigenous Peoples living in the Dry Corridor (Corredor Seco) have subsisted on farming in a dry environment for years, but increasing drought fuelled by climate change has led to increasing rates of food insecurity and malnutrition. A reforestation and water management project is now bringing renewed impetus to the use and conservation of endemic vegetal and animal species that are well adapted to the dry environment. The Maya Ch'orti' have benefited from this support, which has led to a reduction of stunting by 51 percent following improved food consumption and diet quality.⁹⁸

The utilization of traditional varieties and wild edible species from local food systems to increase climate resilience has also been applied in Brazil, Kenya, Sri Lanka and Turkey.⁹⁷ The approach seeks out potential improvements along food value chains, building farmers’ capacity to produce traditional crops and species in adequate quantity and quality, while raising consumer awareness and demand for these products. This initiative also builds on linkages with other programmes: in Brazil, local products have been included in the public procurement system, and in the meals that are part of the school feeding programmes. In Kenya, traditional products have been included in farm-to-school networks that provide school meals, while in Sri Lanka, 32 market outlets are now selling products made from traditional food crops.¹²⁹

Country examples of best practices presented above illustrate some of the innovative measures towards building climate resilience that have evolved in recent years. Key policy areas and goals for scaling up climate resilience across food systems are presented in Table 9. The 2018 edition of this report contains an in-depth discussion of policy areas and measures aimed at strengthened resilience to climate variability and extremes.

TABLE 9

Key policy areas and goals for scaling up climate resilience across food systems

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3. Strengthening resilience of the most vulnerable to economic adversity

In 2020, as world GDP contracted by an estimated 3.3 percent during the COVID-19 pandemic,¹³⁰ counteractive measures, including stepped-up social assistance, employment and social insurance programmes, and large-scale emergency measures to protect economies worldwide, demonstrated the importance of building resilience in the face of economic adversity.¹³ Critically, the need for economic and social policies, institutions, legislation and other measures to be in place well in advance of economic slowdowns and downturns became evident, as these measures are designed to counteract the effects of adverse economic cycles when they do arrive, especially for the most vulnerable population groups, and to maintain access to nutritious foods and healthy diets. In the immediate term, such policies, laws and investments must include social protection mechanisms and primary healthcare services, while supporting household income and livelihoods through social assistance or active labour market policies.

Social protection programmes have been central to government policy responses to the consequences of the COVID-19 pandemic on people’s incomes and livelihoods. By May 2021, more than 200 countries and territories in the world had implemented at least one social protection initiative, comprised mostly of cash and in-kind transfers, waived or postponed financial obligations and labour regulations. Together, these measures have benefited just over 1.5 billion people worldwide.¹³ Importantly, largely due to financial constraints, many COVID-19-related social protection responses had low coverage, provided small transfers and could be maintained only for a limited period of time. Cash transfer programmes, for example, were implemented on average for only four months. In Timor-Leste, one of the poorest countries in the world, a universal cash transfer was established in June 2020, followed by a subsidy for three months directed at self-employed and informal workers,¹³ which helped buffer the income shock of measures taken during the pandemic on the population.¹³¹

In Panama, an inter-ministerial programme aimed at providing support to families affected by the COVID-19 pandemic has delivered in-kind food transfers to some of the most vulnerable populations. Procured directly from food producers nationwide, the programme provides diverse and nutritious foods including animal source foods, fruits, vegetables, legumes, roots and tubers. In Jamaica, rural livelihoods were supported by reinforcing the Government’s public procurement mechanism during 2020, with a focus on female-headed farming households. In addition, in-kind transfers consisting of locally grown fresh foods were delivered to the programme’s beneficiaries, supporting both household incomes and food intake.

Elsewhere, in Brazil, the mandatory closure of schools due to the pandemic put the continued implementation of a nationwide school feeding programme targeting millions of beneficiaries at risk. The programme was rapidly modified to enable in-kind food transfers to be delivered directly to children’s homes instead. Even under much more difficult circumstances, food kits include at least 30 percent locally procured fresh foods, as established by Brazil’s school feeding law.⁹⁷

Before the COVID-19 pandemic, school feeding programmes reached 388 million children worldwide, representing one of the largest social protection mechanisms. Between 2013 and 2020, the number of children receiving meals through school feeding grew by 9 percent globally and by 36 percent in low-income countries. This growth reflects a widespread institutionalization of these programmes, as 80 percent of countries have integrated school feeding into their policies (up from 42 percent in 2013) with 90 percent of their funding coming from national budgets.¹³² The importance of school food and nutrition programmes has been underscored during 2020–2021, as millions of children globally have missed out on their meals as schools closed to stem the spread of the COVID-19 disease. To date, 27 countries have not re-opened schools, seven of which have important school food and nutrition programmes.

In several countries, in an effort to further institutionalize school feeding programmes, innovative approaches include home-grown school feeding (HGSF) and school gardens that improve the nutritional status of school children while also promoting access to an increased supply of affordable nutritious foods. Other benefits of these initiatives include raising awareness of the importance of healthy diets and shifting households’ food demand towards more nutritious foods. Arguments in favour of HGSF as a transformative measure to strengthen food systems are presented in Box 9.

In Ethiopia, a further innovative social protection scheme provides digital access to monthly food vouchers, tailored to household size for an amount based on the cost of a nutritious diet. In rural areas, mothers with children under two years of age are provided vouchers for the purchase of fresh fruits, vegetables and eggs. These are redeemed with local retailers, who themselves have received training to improve the quality and safety of their food supply. As a complementary action, changes in social behaviour are encouraged through community counselling and media campaigns to promote improved dietary diversity and care practices and to raise demand for fresh fruits and vegetables. An external evaluation revealed that the voucher programme has increased the profits of rural food retailers by as much as 40 percent and shortened food supply chains, while also having a positive impact on the dietary diversity of mothers and their children.⁹⁷

In Kyrgyzstan, an ongoing “Cash Plus” approach aims to strengthen the impact of the national cash transfer programme. Positive results at household level include increased and more diversified food production for own consumption and stepped-up engagement in income-generating activities. Seventy-four percent of households increased agricultural productivity, and 90 percent of beneficiaries improved dietary diversity and nutritional outcomes, for both mothers and their children.⁹⁸

As countries move beyond the COVID-19 pandemic, it is vital that adequate levels of public spending on health and social protection systems be maintained. Any cuts would likely increase hardship among already disadvantaged groups, weaken performance, increase the risk of negative health and nutrition outcomes, add to fiscal pressures and undermine development gains.^139,140 In the medium term, these policies should be institutionalized as part of national social protection systems, together with increasing access to social services.⁵ In addition, other innovative measures towards building economic resilience should be implemented, such as stepping up access to agricultural insurance for food producers, many of whom are vulnerable to both climate-related and economic shocks.¹⁴¹ Such insurance schemes (as discussed under pathway 2) can help reduce poverty, especially when combined with social protection schemes.¹⁴²

Country examples under this third pathway have highlighted the importance of a number of innovative social protection mechanisms aimed in particular at strengthening resilience of the most vulnerable populations to economic slowdowns and downturns, as also experienced during the COVID-19 pandemic. There are many other longer-term policy measures that need to be considered to strengthen economic resilience as discussed in detail in the 2019 edition of this report. Several key policy areas and goals are presented in Table 10.⁵

TABLE 10

Key policy areas and goals for strengthening resilience of the most vulnerable to economic adversity

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4. Intervening along food supply chains to lower the cost of nutritious foods

Interventions along food supply chains are needed to increase the availability of safe and nutritious foods and lower their cost, primarily as a means to increase the affordability of healthy diets. This pathway calls for a coherent set of policies and investments from production to consumption aimed at realizing efficiency gains and cutting food losses and waste to help achieve these objectives.⁷ Incentives should, among others, stimulate diversification of production in the food and agriculture sectors towards nutritious foods, including fruits, vegetables, legumes and seeds, as well as animal source foods and biofortified crops, in addition to investments in innovation, research and extension to raise productivity. Elsewhere in the supply chain, the nutritional quality of food products and beverages can be improved by post-harvest fortification of staple foods in line with international guidelines.^{143,144,145,146} Food manufacturers and retailers can also reformulate their products to eliminate industrially produced trans-fatty acids and reduce levels of saturated fat, sugars and/or salt (see also pathway 6).

Fortification and biofortification have been used as a cost-effective measure to reduce micronutrient deficiencies while increasing the availability – and lowering the cost – of nutritious foods. The fortification of staple foods has been an effective strategy to supply micronutrients to entire populations (such as universal iodization of salt, and iron and folic acid fortification of wheat or maize flour). In Peru, the fortification of rice with 9 vitamins and minerals has been scaled up, where it has been included in the school feeding programme and other social protection programmes. Considering that micronutrient deficiencies and anaemia are widespread in the population across socioeconomic groups, the country approved the national rice fortification law in 2021.

In Zimbabwe, in the context of a programme promoting conservation agriculture for increasing climate resilience and agricultural productivity, farmers participating in the programme adopted biofortified varieties of different crops. The increases in productivity after the adoption of climate resilient techniques also improved the availability of micronutrients among participating households. Finally, in Rwanda, iron-biofortified beans have been introduced and rapidly adopted by farmers. By the end of 2018, it was estimated that 20 percent of beans produced in the country were iron-biofortified, and 15 percent of the population was consuming these. Regular consumption of fortified beans can provide up to 80 percent of daily iron needs. Iron-biofortified varieties have also produced yields with iron levels that are 20 percent above those of other varieties, turning them into an attractive alternative for farmers.⁹⁷

Small and medium-sized enterprises (SMEs) play a central role in maintaining local community-based food systems, and can help ensure an adequate supply of safe and nutritious foods. Their role in achieving food security and good nutrition has been increasingly recognized.¹⁴⁷ For example, SMEs engaged in food processing in Africa procure 95 percent of their food supplies from smallholders, demonstrating their importance in the development and transformation of the whole food system.¹⁴⁸ And while the economic impact of lockdowns during the COVID-19 pandemic has hit many SMEs particularly hard,¹⁴⁹ given the way SMEs are embedded in local communities, they also play a key role in building forward from crisis conditions and ensuring sufficient access to safe and nutritious foods.

In Kenya, SMEs involved in the fruit and vegetable supply chains have received government support¹⁵⁰ with the objective of enhancing their role in promoting healthy diets with sustainability considerations. Support components include building capacities to ensure food quality and safety, improving access to financial resources and strengthening market linkages. Similarly, in Myanmar, SMEs at the food production level have received support to diversify their products through direct transfers, increased access to new technologies and training in sustainable production techniques. More than half of the programme’s participants have seen their incomes increase by 50 percent, and their expansion of production to include fresh vegetables has significantly increased the supply of nutritious foods in local markets.¹⁵¹ In Sao Tome and Principe, a recent five-year development project facilitated the marketing of organic, high quality cacao, coffee and pepper by developing farmer cooperatives and family plantations to increase sales to domestic and export markets through public-private partnerships. Results from the impact assessment of these programmes demonstrated positive and significant impacts on agricultural incomes (by 46 percent) and on increased levels of dietary diversity (5 percent).¹⁵²

Rapid rates of urbanization worldwide are placing tremendous pressure on ever longer food supply chains to deliver nutritious foods safely and sustainably to ever more congested metropolitan areas. In many urban and peri-urban areas, poverty and inequality prevent the most vulnerable from accessing sufficient nutritious foods, while changing food environments and consumption patterns have led to rising levels of overweight, obesity and diet-related NCDs. Various processes linked to urbanization pose challenges but also present opportunities to create food systems that are more inclusive in providing greater access to nutritious foods to all, while also being environmentally sustainable.¹⁵³ In this context, appropriate urban food policies and efficient rural–urban linkages are critical for the transformation of food systems for greater affordability of healthy diets in peri-urban and urban settings (Box 10).¹⁵⁴ Small- and medium-sized cities can play a key role in strengthening rural–urban linkages because of their proximity to surrounding rural areas (referred to as a “functional territory”) and in addressing key social, economic and environmental challenges.¹⁵⁵ Appropriate policy action can play a major role in supporting such functional territories to improve livelihoods and strengthen the resilience of people and of agri-food systems. Development of food systems in these functional territories furthermore holds potential for sustainably reducing poverty, food insecurity and malnutrition, as food systems respond to the growth of cities and the concurrent transformation of diets, which itself is dependent on rural-urban linkages.¹⁵⁶

Urban agriculture is likely to deliver positive impacts on both dietary diversity and household incomes.¹⁵⁷ In Brazil, a longstanding project has been creating urban gardens in informal settlements and schools in Rio de Janeiro. The food produced has been for own consumption by the engaged households, with surpluses donated or sold to the neighbouring community, thus improving access to nutritious foods and generating income for urban dwellers. As in many other places, maintaining the supply of nutritious foods in urban areas has become a great challenge under the COVID-19 pandemic. In Ecuador, linkages between some areas of the city of Quito with a high prevalence of COVID-19 cases and farmers from the surrounding province have been strengthened through neighbourhood cultural societies that have established a marketing and distribution network, receiving food baskets from farmers and then distributing them to buyers directly at their homes. These baskets include fresh fruits and vegetables produced organically, so urban dwellers have access to nutritious foods and farmers face a shorter marketing chain, which allows them to sell their products at a lower cost. These practices have continued following the pandemic lockdowns, creating new and innovative linkages between urban dwellers and rural food producers.⁹⁷

The country cases under this fourth pathway highlight some of the key areas where there are opportunities for interventions along the food supply chain to lower the cost of nutritious foods, which are listed in Table 11. Additional policy recommendations aimed at lowering the cost of nutritious foods are discussed in more detail in the 2020 edition of this report.

TABLE 11

Key policy areas and goals for intervening along food supply chains to lower the cost of nutritious foods

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

Persistent and high levels of inequality seriously limit people’s chances to overcome hunger, food insecurity and malnutrition in all its forms. Policies, investments and laws that address underlying structural inequalities faced by vulnerable population groups in both rural and urban areas are needed, while also increasing their access to productive resources and new technologies. About 80 percent of the extreme poor live in rural areas, where poverty rates are three times higher than in urban areas. The COVID-19 pandemic has aggravated this situation, exacerbating inequalities and negatively impacting on the lives and well-being of the rural poor, in particular.¹⁶⁰ If implemented successfully, this fifth pathway can reduce extreme poverty and structural inequalities through accelerated food systems transformation that is both pro-poor and inclusive.

In rural areas in particular, the transformation of agri-food systems presents an opportunity to some of the poorest smallholders who are not well integrated into food value chains. In South-eastern Asia, rural poverty among smallholders is exacerbated by the lack of access to productive resources and poor market integration, further compounded by climate-related and economic shocks, as well as periodic plant and animal disease outbreaks.⁹⁷ In this region, the integration of poor smallholders into food value chains has been facilitated through public-private-producer partnerships (PPPPs) that provide opportunities to overcome poverty and structural inequalities, especially where reinforced by improved governance mechanisms and multi-stakeholder platforms.⁹⁷

In Indonesia, in 2017, the total production and value of cocoa had fallen by 70 percent from its peak in 2009, hitting smallholders’ incomes and livelihoods particularly hard. Since 2014, in an effort to reduce the number of cocoa farmers living below the poverty line and empower them to engage in a more efficient and resilient cocoa supply chain, a multi-stakeholder “whole of value chain” approach was introduced. The PPPP approach engaging 150 000 smallholders included, among others, increased access to financing and productivity-enhancing technologies, the introduction of traceability systems, product certification to capture premium prices, improved primary processing, nutrition education and the establishment of farmer organizations. Over a five-year period, cocoa yields increased by 73 percent, while empowered smallholders saw their incomes increase by more than 200 percent.⁹⁷

In Viet Nam, about 500 000 mostly poor smallholder farmers earn their livelihoods from coffee production. In mid-2020, coffee prices had plummeted by 48 percent from a peak in late 2016, before recovering but remaining volatile. To help reduce smallholder vulnerability to both economic and climate-related shocks, provincial and district-level coffee boards were established to assist smallholders with improved technologies and good environmental practices in coffee production. The improved practices allowed the coffee to be certified for a premium on producer prices, while also strengthening the resilience of coffee growers not only to climate shocks, but also to likely future economic shocks.⁹⁷

In Morocco, over the past decade, a cross-sectoral territorial approach has been implemented to address regional inequalities within the country.¹⁶¹ A major investment programme has transformed a large geographic area of 5.2 million people, covering 16 provinces in the remote oases and argan tree zones. The programme focused on transforming the agri-food value chains of date palm and argan trees, two high-value crops. The population previously experienced relatively high levels of poverty, illiteracy and malnutrition, associated with harsh living conditions and vulnerability due to various natural and environmental threats (desertification, soil erosion, water scarcity, extreme weather conditions).⁹⁷ Over a ten-year period, the cross-sectoral territorial investment programme resulted in a 41 percent increase in regional per capita GDP, a 33 percent increase in farmer incomes and a 50 percent reduction in poverty rates, among many other positive development indicators.

Another initiative concerned with improving livelihoods of people living in remote areas is the Mountain Partnership Products (MPP) Initiative that aims at strengthening the resilience of mountain peoples, their economies and their ecosystems in eight countries.⁹⁷ In providing access to a certification and labelling scheme based on environmentally and ethically sound approaches, the MPP Initiative promotes short value chains, while ensuring transparency and trust between producers and consumers, fair compensation for the primary producers, conservation of agrobiodiversity and preservation of ancient techniques implemented in several countries. In Bolivia, for example, women producing certified honey from a local bee variety were able to strengthen their linkages with local markets, while preserving cultural traditions and local biodiversity.

In Nepal, during 2011–2018, an agriculture project covering some of the most remote hilly and mountainous areas of Karnali province adopted a whole value chain approach, to bridge information and access gaps between producers and markets. Targeted actions sought to make the new value chains more inclusive by breaking down the barriers that typically hold back participation of under-represented groups such as women and ethnic minorities. Results show that the project was successful in increasing annual income by 32 percent among its target groups, with crop and livestock income increasing by 47 percent and 44 percent, respectively.¹⁶² Results show that project participants experienced lower levels of food insecurity (by 9 percent) and a higher food consumption score (by 4 percent).

The Nepal example alludes to a strong and common theme across many of the best practice case studies reviewed: the importance of empowerment, in one way or another, of poor and vulnerable population groups, often smallholders with limited access to resources or those living in remote locations, as a major lever in transformative change. Measures of empowerment vary widely, but include in particular the need for increased access to productive resources (access to natural resources, agricultural inputs and technology, financial resources, as well as knowledge and education). Other empowerment measures relate to strengthened organizational skills (increased engagement in producer groups and cooperatives), certification programmes (e.g. for locally produced organic products), and importantly, access to digital technology and communication.

The effects of the COVID-19 pandemic have furthermore exposed structural inequalities, as women’s productive and income-generating capacities have been impacted disproportionately, because of reduced economic opportunities and access to nutritious foods, while at the same time having to increase their workloads. Hence, policy responses should consider women’s roles in agri-food systems and ensure that their multiple needs – as guardians of household food security, food producers, farm managers, processors, traders, wage workers and entrepreneurs – are adequately addressed.¹⁶³ Beyond merely “levelling the playing field”, policies and interventions that help strengthen women’s roles in food systems and their decision-making capacity can be a powerful source of food systems transformation.¹⁶⁴ The potential of addressing gender gaps to increase productivity has been well established,¹⁶⁵ while there is growing evidence that empowering women also results in improved nutritional outcomes for their children.¹⁶⁶ Innovations that support women’s productive capacity either directly or indirectly by freeing up women’s time are especially empowering, such as making drinking water more easily accessible, and enabling women to engage in productive activities, such as growing fruits and vegetables for household consumption.¹¹⁹

Youth represent a tremendous opportunity for transformative change in food systems, especially in less developed countries, where more than 80 percent of the youth live.¹⁶⁷ Youth (aged 15–24 years) make up about 16 percent (1.2 billion) of the world’s population,¹⁶⁸ and as potential young entrepreneurs, they represent the future agents of change. Yet, the youth of today face greater constraints when compared with adults in accessing decent jobs,¹⁶⁹ productive resources, social capital and governance mechanisms that shape food systems.¹⁷⁰ Strengthening their skills and agency through training, positive role models and mentorship is central to untap their entrepreneurship and innovation potential.¹⁷¹ Young entrepreneurs engaged in agri-food systems have been particularly hard hit by the COVID-19 pandemic, exacerbating existing challenges that young people face when engaging in agri-food systems, notably because of limited access to productive resources, finance and markets.¹⁷² Generally, a lack of economic dynamism and employment opportunities in rural areas leads young people to migrate out of necessity.¹⁷³ Hence, within broader efforts to boost responsible investments, specific action is needed to increase youth access to productive resources, finance, markets and connectivity, as well as decision-making. Social norms that might prevent young rural people from taking advantage of new opportunities, especially vulnerable groups, such as young women and indigenous youth, also need to be addressed.¹⁷⁴

Additional evidence of how the empowerment of both women and youth could accelerate food systems transformation for improved food security and nutrition is presented in Box 11.

Community-based approaches are key to building relationships and strengthening social cohesion, improving aspirations, confidence and trust, all of which are critical in tackling structural inequalities and in ensuring that policies, legislation and interventions are pro-poor and inclusive, and deliver equitable services. In Burundi, the Caisse de Resilience (CdR) is an integrated community-based and participatory approach that combines technical, financial and social dimensions in a mutually reinforcing way. Under this approach, small groups of rural households receive training in sustainable agricultural practices through farmer field schools, while a savings and loans fund managed by communities themselves enhances their financial capacities. This community-based participatory approach has resulted in increases in agricultural production of 30 to 60 percent, as well as increases in household income by some 40 to 52 percent.⁹⁷

While recognizing the need to combat poverty in both rural and urban settings, illustrative country examples provided under this fifth pathway highlight the importance of tackling structural inequalities (as also illustrated in Chapter 3), while ensuring interventions are not only pro-poor and inclusive, but also empower women and youth as a means of accelerating transformative change in food systems. Key policy areas and goals in this regard are presented in Table 12. Additional policy recommendations supportive of this pathway can be found in the 2019 edition of this report.

TABLE 12

Key policy areas and goals for tackling structural inequalities, ensuring interventions are pro-poor and inclusive

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

Access to nutritious foods and healthy diets is not only a matter of cost and affordability. Many elements of the food environment determine dietary patterns, while culture, language, culinary practices, knowledge and consumption patterns, food preferences, beliefs and values all relate to the way food is sourced, generated, produced and consumed. Dietary patterns have been changing and have had both positive and negative impacts on human health and the environment.⁵⁸ Hidden costs to human health and to the environment that characterize most food systems today are ignored. Given that they are mostly not measured either, they also go unaddressed and are unaccounted for in food prices, ultimately jeopardizing the sustainability of food systems. Therefore, based on the specific country context and prevailing consumption patterns, there is a need for policies, laws and investments to create healthier food environments and to empower consumers to pursue dietary patterns that are nutritious, healthy and safe and with a lower impact on the environment.⁷

The promotion and increased availability of highly processed foods has led to increased consumption of unhealthy diets affecting all ages. Promotion of breastmilk substitutes dissuades mothers from breastfeeding and weakens the ability of healthcare workers to fully support lactating mothers. Large food companies target much of their marketing to youth, and small-scale local production of foods of high energy density and minimal nutritional value is also expanding rapidly. As a result of these food environment changes, childhood overweight and obesity are rising as fast or faster than underweight is falling in every region of the developing world.¹⁸³

Early adolescents are seeing the largest increases in the incidence of overweight, but it should be noted that it is an issue that has its roots in early childhood and even during the gestational period. The promotion and marketing of foods can influence food preferences and consumption, even in ways that consumers may not be aware of.⁶⁸ This has been recognized as one of the main drivers that explain today’s dietary patterns, with children especially showing a susceptibility to this influence.^184,185 Restrictions on food marketing to children should be implemented as part of a comprehensive package of measures to create healthy food environments that enable dietary choices for optimal nutrition and good health. International guidelines can provide clear recommendations on the marketing of breastmilk substitutes, complementary foods, and foods and beverages for older children.^186,187,188 Highlights of best practices from several countries are presented in Box 12.

BOX 12

Protecting children from the harmful impacts of food marketing

Protecting children of all ages from the harmful impacts of food marketing is an essential food system action, a moral imperative and a human rights obligation.^{198,199,198,200} It can be done through a combination of legislation on marketing of breastmilk substitutes, foods for infants and young children, and marketing to which children are exposed in general. Notwithstanding the existence of global rules on food marketing,^{186,201,186,202} no country has yet implemented comprehensive best practice legislation to protect children from birth to 18 years from the harmful impact of food marketing. Nevertheless, a number of countries have implemented elements of best practice, including India,²⁰³ Brazil,^204,205, the Philippines,²⁰⁶ Chile²⁰⁷ and Turkey²⁰⁸ as summarized below.

Because the determinants of malnutrition are so multi-factorial, it is very challenging to unpick the nutritional impact of any single policy measure, but data from India and Chile point to how well the laws are working. In India, sales of infant formula remained steady between 2002 and 2008, while sales in China, in comparison, more than tripled; the more robust Indian marketing legislation has been proposed as a factor.²⁰⁹ Exclusive breastfeeding in India increased from 46 percent in 1992 to 55 percent in 2015.²¹⁰ Following implementation of Chile’s law of food labelling and advertising, pre-school children’s and adolescents’ exposure to advertising for restricted foods dropped,²¹¹ and sales of these foods in school food kiosks dramatically declined.²¹² Purchases of foods and beverages high in salt, sugar, energy or saturated fat,²⁰⁷ which are required to carry front-of-pack warning labels, fell by 24 percent following introduction of the regulation.²¹³

The barriers that countries face in implementing food marketing laws include opposition from powerful vested interests, as well as difficulties in addressing cross-border marketing and monitoring digital marketing. International guidance is available to support countries in implementing comprehensive measures to protect children of all ages.^{186,187,186,214} Marketing measures should be considered as part of a comprehensive portfolio of policies to reduce all forms of malnutrition and to support healthy diets.

Elements of best practice to protect children from the harmful impact of food marketing

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Regulatory approaches can be used to improve the nutritional quality of widely available processed foods that enable dietary patterns with more positive impacts on health. Since 2004, Argentina has implemented successive policies to reduce industrial trans fats in the food supply, including voluntary reformulation in cooperation with the food industry, mandatory trans-fat labelling and, ultimately, mandatory limits for levels in foods.¹⁸⁹ By 2015, 93 percent of foods were reported to be compliant.¹⁹⁰ Multisectoral cooperation between relevant government ministries and research institutes, consumer groups, academia and the food industry provided technical support to the process.

In the Republic of Korea, “green food zones” were established in 2009–2010, prohibiting the sale of foods of high energy density and minimal nutritional value, including fast foods, within 200 metres of selected schools. By 2017, “green food zones” were established around more than 90 percent of all schools. This was part of a wider package of regulatory measures introduced to protect the nutrition of children and young people, including, among others: introduction of traffic-light nutrition labelling and menu labelling in chain restaurants; a ban on sales of sweetened beverages within all school premises; restrictions on marketing for high-calorie, low-nutrient foods and high-caffeine foods directed at children and food quality certification for children’s foods.^{191,192,193,194}

Efforts to encourage the consumption of nutritious foods and avoid negative impact on human health include the reformulation of foods,¹⁹⁵ which targets the main sources of food that are of concern to human health, such as saturated fat or trans fats, sugars and/or salt. In Kuwait, the Food and Nutrition Administration identified locally produced bread as a key source of salt in the population’s diet and approached the government-owned flour mills and bakeries, which produce most of the country’s bread, about progressively reducing the levels of salt.¹⁹⁶ Within two months, the salt content of flat white bread had been reduced by 10 percent, and within the year, a 20 percent reduction of salt content had been achieved.¹⁹⁷

Many countries have seen their food systems transform rapidly as a result of globalization.⁷ Over the past several decades, increasing levels of international trade in food and agricultural products have played a key role in ensuring a sufficient supply of staple foods, while also maintaining dietary diversity in the provision of nutritious foods, in particular where the availability of fresh fruits and vegetables may drop significantly for part of the year. Yet, trade policies, including protectionary trade measures, may affect the availability and cost of nutritious foods on local markets, as well as the supply and price of energy-dense foods. Similarly, while non-tariff trade measures can help improve food safety, quality standards and the nutritional value of food, they can also drive up the costs of trade and hence food prices, negatively affecting affordability of healthy diets.

In Peru, for example, the US-Peru free trade agreement eliminated a 25 percent tariff on soft drinks from the United States of America, which resulted in increased investment flows, followed by an increase of 122 percent in soft drink production in the country (including juices, bottled water and energy drinks).²¹⁵ An initial rise in sugar consumption from sugar-sweetened beverages eventually stagnated at elevated levels. As part of a comprehensive approach to NCD prevention in Peru, especially given rising prevalence of overweight and obesity, the country has raised taxes on sugar-sweetened beverages.²¹⁶ Since 2019, a tiered system of taxation – with higher tax rates on drinks with higher levels of sugar – has been in place. As well as the expected impact on consumer purchases, especially when combined with the front-of-pack warning label required on beverages high in sugar, this type of tax can act as a powerful driver for industry to reformulate products to reduce the sugar content.

A number of nutrition policy measures can enhance benefits and minimize risks of increased trade and investment in global food systems (Box 13).

Table 13 summarizes the key policy areas, including related laws and regulations to strengthen food environments and changing consumer behaviour to promote dietary patterns with positive impacts on human health and the environment. Additional policy recommendations related to this pathway can be found in the 2020 edition of this report.

TABLE 13

Key policy areas and goals for strengthening food environments and changing consumer behaviour to promote dietary patterns with positive impacts on human health and the environment

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Key elements of portfolios of policies and investments

As elaborated above and illustrated in Figure 28, the formulation of comprehensive portfolios of policies and investments starts with a context-specific situation analysis to obtain an in-depth understanding of the country context, including the nature and intensity of major drivers impacting upon food systems and the prevailing food security and nutrition situation, in addition to the identification of relevant actors, institutions and governance mechanisms. The situation analysis will enable countries to assess which combination of pathways towards the transformation of food systems is most relevant, given the way in which the major drivers of food insecurity and malnutrition have affected them, and which policy measures and investments are most appropriate to form part of the portfolio (Figure 29, left-hand side).

FIGURE 29

Key elements of a portfolio of policies and investments

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Given the cross-sectoral nature of interventions needed to transform food systems and achieve food security and improved nutrition (as illustrated in the examples presented in the previous section), coherence with policies and investments between agri-food, environmental, health, social protection and other systems such as education, energy, trade and finance is essential for effective transformative change (Figure 29, right-hand side). Coherence is needed not only for effective formulation, but also for the efficient and accelerated implementation of the portfolios, all of which call for multi-stakeholder governance mechanisms and supportive institutions. Importantly, apart from access to productive and financial resources, systemic transformative change requires development and generation of (and access to) appropriate technology, data and innovation, referred to as accelerators to spur the transformative processes (Figure 29, right-hand side).

Following the in-depth discussion of best practices and policy measures along the six possible pathways towards the transformation of food systems in the previous section, the remainder of this chapter reviews the importance of coherence across relevant systems, as well as the role of accelerators. A number of existing systems approaches that represent useful frameworks for building coherent portfolios and facilitating multisectoral investments and action to achieve food security and improved levels of nutrition are also briefly discussed.

Coherence of food system policies and investments with other systems

The overall performance of food systems depends on their coherence and interaction with several other systems, including especially the wider agri-food systems, in addition to environmental, health and social protection systems. Other systems play a critical role throughout the food system, from providing the necessary knowledge and skills in food production to nutrition education for school-aged children and raising consumer awareness for better informed choices towards minimizing the negative impacts of food consumption on human health and the environment. Energy systems are essential to the functioning of food systems, as they provide the energy for food production, transportation, food processing, storage and consumption. In the specific context of food systems transformation, energy systems are critical in ensuring increased productivity and in reducing food losses and waste. Increased energy efficiencies may help lower the cost of safe and nutritious foods.

Given the important interrelationships among systems, food systems emerge as a potential common space for advancing co-benefits for a range of policy goals efficiently and effectively.⁵⁷ Hence, apart from the identification of policy and investment portfolios to transform food systems themselves, policy coherence is needed, not only across the different transformation pathways described above, but also with other systems that underpin the long-term sustainability of these food systems, as shown graphically in Figure 30.

FIGURE 30

Ensuring coherence and complementarity among agri-food*, environmental, health, social protection and other** systems for food systems transformation for food security, improved nutrition and affordable healthy diets for all

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Agri-food systems comprise both agricultural and food systems and encompass the entire range of actors and their interlinked value-adding activities. This includes the primary production of food and non-food products in agriculture, fisheries and forestry, as well as food storage, aggregation, post-harvest handling, transportation, processing, distribution, marketing, disposal and consumption.²²⁴ Agri-food systems interact with non-food supply chains through the purchase of agricultural inputs and by providing intermediate inputs to the production of non-food commodities, such as maize for biofuel production or cotton for textiles. As stated in Chapter 3, while broader agri-food systems transformation is of utmost importance, it is covered extensively in the forthcoming publication on The State of Food and Agriculture in the World 2021,²²⁴ and is beyond the scope of this report.

Nevertheless, in the context of building portfolios of policies and investments towards the transformation of food systems, ensuring coherence among those policies and investments specifically aimed at food systems on the one hand, and those in the broader agri-food systems domain on the other, is important for a number of reasons – not least given the importance of agri-food systems in providing income and employment for millions of households. Clearly, both agri-food systems as well as food systems (forming an integral part of agri-food systems) are affected by the same drivers outlined in Chapter 3, and influenced and shaped by the same social, economic and natural environments in which their production systems are embedded.

Environmental systems interact with food systems primarily at the production level in providing the necessary environmental conditions and nutrients in the agriculture, fisheries and forestry sectors for food to be produced. Food and agricultural production systems, on the other hand, impact on the environment in multiple ways, including through their impact on biodiversity, soil and water quality, animal and plant health, greenhouse gas emissions, toxicity, as well as food loss and waste. Hence, there is an increased recognition of the need for nature-positive production and supply models which “produce more with less” to ensure sufficient nutritious food supplies for a growing world population over the coming decades. Nature-positive production involves actions aimed at the three interrelated goals of protecting nature, sustainably managing existing food production and supply systems, and restoring and rehabilitating natural environments:¹¹¹

• ▸ Protecting nature: Given how inefficient current systems are, it is possible to maintain production levels, while halting the encroachment on natural ecosystems and protecting marginal agricultural areas rich in biodiversity, such as peatlands and mangroves. A recent global estimate suggests that up to 40 percent of global agricultural land could be restored without reducing production, if inputs used and crop distribution were optimized while respecting biodiversity hotspots.²²⁵

• ▸ Sustainably managing existing food production and supply systems renews ecosystems’ ability to provide healthy soil and clean water, and also supports biodiversity. This is accomplished by increasing efficiency while reducing external inputs, favouring the circular use of resources, and supporting multiple ecosystem services (e.g. through rotations that diminish the need for chemical fertilizers while promoting soil health and carbon absorption). A rich menu of options exist (ranging from regenerative practices based on intercropping and short rotations to precision agriculture and innovations for sustainable agriculture), to be adopted and tailored to the local context.

• ▸ Restoring and rehabilitating natural environments: Nature-positive production can contribute to restoring the one-third of global land considered degraded, by either rewilding it or by restoring its agricultural productivity (and therefore helping to avoid additional land conversion for agriculture), while also contributing to preserving the quality of all land resources.

Health systems and their services are vital in ensuring that people are able to consume foods and utilize the necessary nutrients for their health and well-being. Food systems may exert both positive and negative impacts on human health through multiple interrelated pathways, which are influenced by factors arising from within and outside food systems, including social, economic and environmental determinants of health. Closer examination of the food–health nexus indicates that unhealthy diets are among the key risk factors driving the global burden of disease; moreover, the negative health impacts associated with poor quality diets are significant. According to the Global Burden of Disease initiative, 20 percent of premature deaths worldwide are associated with a poor quality diet.²²⁶ Poor quality diets include those diets with too high a content of foods high in fats, sugars and/or salt of minimal nutritional value and too low levels of protein quality. Adequate breastfeeding and child feeding for infants and young children are important to ensure good quality diets. With current food consumption patterns, diet-related health costs linked to mortality and NCDs are projected to exceed USD 1.3 trillion per year by 2030.⁷

Food systems impact human health and well-being in several ways, including through: unhealthy diets and food insecurity; zoonotic pathogens (originating from both farmed and wild animals) and antimicrobial resistance (AMR); unsafe and adulterated foods; environmental contamination and degradation; and occupational hazards.¹³⁹ Illnesses may occur from the ingestion of foods containing various pathogens and toxicants; there are also risks with the consumption of altered and novel foods. Globally, an estimated 33 million healthy life years are lost due to the consumption of unsafe food.²²⁷ Malnutrition in all its forms increases susceptibility to foodborne diseases, zoonosis, physical injuries and mental health issues and vice versa, while healthy diets and healthy food systems help protect against these susceptibilities. With specific reference to zoonotic diseases, the multisectoral and multidisciplinary One Health approach builds national mechanisms to address health threats at the human-animal-environment interface.^228,229

Many of the public health policy goals rely on the effective functioning of food systems to deliver safe and nutritious foods in a sustainable way (as also reflected in the SDGs). For example, the nutritional quality of foods produced and supplied affects dietary goals and diet-related health goals. At the same time, the ways in which food is grown, distributed and consumed also affect environmental goals, while employment and income generation in agriculture affect economic goals for producers and farmers, including strategies aimed at the reduction of rural poverty and income inequality.

Poverty and inequality make these food system-related health impacts more likely and increase their severity. There can be serious health consequences from different forms of environmental contamination – including from heavy metal contamination, fertilizers, pesticides, air pollution and smog, GHG emissions and microplastic pollution. Similarly, there are many occupational hazards (e.g. the use of pesticides, drowning and physical injuries) that affect the health of, among others, farmers, agricultural workers, fisherfolk, those working within the food processing and retail sectors, and other food chain workers.¹³⁹

Policies, laws, regulations and investments in health systems form part of the food–health nexus. Universal health coverage is essential to ensure healthy lives and to promote human well-being. Universal coverage implies that all people can use the health services they need and that these services are of sufficient quality and do not expose people to financial hardship. Inputs from health systems can support and reinforce food systems transformation, for example, through the provision of essential nutrition actions in universal health coverage,²³⁰ including among others:

• ▸ Nutrition counselling during pregnancy and support to breastfeeding and complementary feeding, alongside food system measures to regulate the marketing and promotion of breastmilk substitutes and foods for infants and young children.

• ▸ Early detection and support for the management or treatment of different forms of malnutrition, which is critical in informing food systems transformation, as well as social protection needs in crisis situations.

• ▸ The use of micronutrient supplements for vulnerable groups can be an appropriate interim measure until food systems are transformed to provide greater dietary diversity and ensure everyone has access to affordable healthy diets at all times.

Additional health system actions can be reinforced through nutrition-responsive social protection systems, including social transfers, maternity leave protection and breastfeeding support policies. In the context of the COVID-19 pandemic, it has been particularly critical to strengthen the health system response for nutritional care, as already strained healthcare systems are being forced to divert resources from essential nutrition-related services.^37,46,66,231 The inextricable linkages between food systems and health systems highlighted above demonstrate the importance of coherence among food and health systems policies, laws, regulations and investments.

Food environment policies that foster food system changes towards healthy diets are also important. As illustrated in pathway 6 above, relevant policies are needed to create healthy food environments by using standards and legislation to improve the nutritional quality of food products and beverages; use fiscal policies to influence relative prices of nutritious foods and foods high in fats, sugars and/or salt; limit harmful food marketing; require packaged foods to carry nutrition labels that help people to choose healthier diets; and ensure that foods contributing to healthy diets are served in schools, hospitals, care homes and other public institutions, as well as food aid programmes. In addition, policies that encourage changes in consumer behaviour to encourage healthier and more sustainable food consumption and food waste reduction are needed.⁷

Social protection systems represent a set of policies and programmes, often grounded in enforceable legislation, that address economic, environmental and social vulnerabilities to poverty, food insecurity and malnutrition by protecting and promoting livelihoods, in particular through the reduction of financial and social barriers to accessing food and other essential needs.^7,232 The impacts of a sudden loss of income and employment for hundreds of millions across continents has stretched the capacity of social welfare and social protection systems to the limit, resulting in deeper inequalities and increased poverty levels.²³³ Millions of children have been out of school for more than a year, losing out not only on education, but also daily school meals that make up an important proportion of their daily nutrient requirements.²³⁴

Nutrition-sensitive social protection programmes are particularly effective in supporting poor people and those living under crisis conditions who do not have basic access to sufficient nutritious food to consume healthy diets nor to essential complementary nutrition, health and sanitation services. However, social protection policies and programmes do not always lead to greater affordability of healthy diets. Coherent investments in food, agriculture and social protection are crucial for eradicating hunger and poverty, but their effect on increasing the quality of diets and the affordability of nutritious foods depends on several factors, including effective targeting, adequate transfer amounts and modalities, and effectively integrating nutrition-specific components.^235,236,237

Social protection programmes can be effective in overcoming drivers of food insecurity and malnutrition in all its forms and in improving the affordability of healthy diets in two principal ways:

• ▸ Supporting household incomes and livelihoods for the poorest and most vulnerable groups. Measures include boosting job creation and implementing labour market policies, such as public works programmes that can be used as short-term measures to support purchasing power in times of crisis and for developing assets that bring future returns to livelihoods; social assistance initiatives, such as cash transfer programmes that provide support to meet the most immediate needs and that enable households to invest in their productive activities; ²³⁵ and increasing universal access to healthcare, education and social services that could safeguard against setbacks to families, nations and regions.⁵

• ▸ Improving access and affordability of healthy diets through school food and nutrition programmes (among others) especially designed to improve dietary diversity, while also encouraging the purchase of fresh food from local producers. In-kind transfers, especially in places where food markets are not functioning well, could increase access to nutritious foods, in addition to food subsidies, especially those focused on nutritious foods and targeted at the most vulnerable.⁷

Large-scale investments in social protection systems have served as powerful instruments for strengthening people’s access to nutritious food, particularly for vulnerable groups in both urban and rural settings. And while it is recognized that the capacity of LMICs to finance such investments has been limited, with the right investments, laws, regulations and policies in place, social protection, health systems and food systems can work together to improve coverage of a population’s health and nutritional needs.³⁷

Importantly, given the impact of measures to stem the COVID-19 pandemic, such complementary policies and investments should ensure that public funds are used to keep local and national food markets functioning, strengthen health responses for nutritional care, and empower women and caretakers who make household decisions, especially about food choices. Actions to protect food workers and close gaps in food distribution are critical to reach the most vulnerable.³⁷ Importantly, social protection is more than a short-term response to acute situations of food insecurity and malnutrition. It is when reliable and well targeted, social protection can support households to engage in new economic activities, and to capitalize on opportunities created by the continued economic dynamism of food systems, thereby bringing about longer-term improvements in access to healthy diets, in addition to stimulating the development of local economies.^238,239,240

The role of accelerators in food systems transformation

The effective and efficient implementation of portfolios of policies and investments requires an enabling environment of governance mechanisms and institutions that facilitate consultation across sectors and key stakeholders.²⁴¹ At the same time, scaling up the availability of technologies, data and innovative solutions is key to accelerating the transformative processes.²⁴² Food systems transformations are often attributed mainly to technological innovations, overlooking the importance of social and political conditions in enabling its implementation.²⁴³ Importantly, a wide range of institutional, policy and socio-cultural innovations are needed to enable the deployment and adoption of new technologies and innovations for systemic transformation of food systems.²⁴⁴

Lessons drawn from country-level best practices towards food systems transformation confirm the relevance of accelerators linked to institutional, policy and socio-cultural factors with high transformative potential, combined with the implementation of new technologies, the extended use of data and the promotion of innovative solutions to build resilience to food insecurity and malnutrition drivers. These two broad categories of accelerators of food systems transformation – effective governance and institutions, and access to technology, data and innovations – are discussed below.

Governance and institutions

In 2016, more than three-quarters of countries reported having multisectoral mechanisms to coordinate nutrition work – most commonly involving health, agriculture and education.²⁴⁶ Such coordination mechanisms may need to be further expanded to ensure a whole-of-government approach and for increased policy coherence. Case studies have identified strengths and weaknesses in current governance mechanisms: a 2017 diagnostic study on food systems governance in South Africa reviewed what forms of institutional arrangements are most appropriate. It found that the existence of three governance mechanisms created various challenges as the dominance of single government bodies in programme implementation limited flexibility in policy responses and lacked stakeholder participation.²⁴⁷

In Mexico, an inter-sectoral governance mechanism was established in 2020 with multiple objectives to address poverty, inequality, environmental challenges, food insecurity and malnutrition through the sustainable transformation of food systems. The mechanism involving 18 thematic working groups covering a wide range of public sector institutions, civil society and UN agencies concerning health, food and the environment. Over a short period of time, the body has successfully promoted the introduction of the front-of-package nutritional labelling, as well as an agreement to phase out glyphosate and genetically modified corn for human consumption. The still pending formal recognition of this inter-sectoral approach towards the transformation of food systems in Mexico remains a constraint, as it prevents the institutions engaged from raising the necessary investment and undermines further progress towards food security and improved nutrition.⁹⁷

Political dialogue and advocacy are essential to generate political commitment and broad support for food systems transformation. While policymaking remains the role of government, a key condition for transformative change is to create an enabling environment that allows different actors in public and private sectors and within civil society to interact, while setting up transparent rules of engagement, including identifying and managing conflicts of interest. Within food systems, interaction is needed among smallholders and agribusinesses; among food suppliers, marketing agencies and consumers; and among regulators and those who must comply with the regulations. Multi-stakeholder mechanisms that engage in the formulation and implementation of policies and investments, and that provide robust safeguards against possible abuse and conflicts of interest, have proven to be effective consultative platforms. Effective governance should also include built-in accountability mechanisms and strengthened oversight, monitoring and evaluation, including multisectoral information systems for reliable and timely data to inform policy development.

The Association of Southeast Asian Nations (ASEAN) has made wide use of multi-stakeholder platforms (MSPs) in seeking transformative change, including to strengthen food value chains at country and subnational levels, as well as addressing issues of regional concern (such as implications of the COVID-19 pandemic), in addition to exploring opportunities to strengthen smallholder engagement in food value chains through digitization. In six of the ASEAN member nations, public-private-producer partnerships (PPPPs) are being supported by country networks and a regional network, composed of more than 520 organizations across the region, representing the public sector, multinational corporations, local agribusinesses, civil society, farmer associations, and academic and research institutions.²⁴⁸

Technology, data and innovation

Technology, data and innovation – at food production levels, throughout the food value chain, and in the consumer environment – represent an essential set of accelerators to speed up transformative change in food systems. Technological innovations over the past century have been responsible for fundamental improvements in food production, processing and distribution, leading to important improvements in human well-being. The challenges currently faced by all actors in introducing systemic changes towards healthier, more equitable, resilient and sustainable food systems call for urgent technological and innovative changes.²⁴⁹ The list of available technologies at all stages of the value chain that can increase the availability of nutritious foods is immense, and ranges from improved vegetable seed varieties to hydroponics to vertical farming in urban areas. Meanwhile, there are numerous new technologies across the food system with transformational potential that are ready to be adopted.²⁴⁴

Beyond the data and analytical capacity needed for an in-depth situation analysis to inform priority actions in the transformation of food systems referred to above, there is also a need for improved data, analysis and decision-making tools in the implementation of policy and investment portfolios for the accelerated transformation of food systems. New means are being explored to fully exploit the ongoing data revolution to help transform food and agricultural systems worldwide through evidence-based, country-led and country-owned initiatives. Sophisticated tools are available, including advanced geo-spatial modelling and analytics to identify opportunities to raise incomes and reduce vulnerabilities of rural populations, who constitute the vast majority of the world’s poor.²⁵⁰

Innovations along the food value chain. Measures taken to contain the COVID-19 pandemic have had an unprecedented impact on food value chains. Both the food supply and demand side have faced important challenges: linkages between farmers, intermediaries, wholesalers, processors and retailers have been more difficult, due to lockdown measures, while consumers have had to endure not only physical challenges in accessing food (with the closure of retail stores and mandatory stay-at-home orders), but also drastic reductions in their economic access to food. Economic recessions have triggered record losses in income, employment and livelihoods worldwide, hitting in particular the most vulnerable populations the hardest.²⁵¹

Nevertheless, and contrary to some initial assumptions, most food supply chains have shown to be resilient and have continued functioning, as innovations were introduced and speedy decisions were taken to protect food supply chains as an “essential service” during the pandemic.²⁵² And, while these measures have been applied more widely to modern and vertically integrated supply chains rather than to traditional (i.e. much shorter) food supply chains, measures taken during the COVID-19 pandemic have accelerated changes in food supply chains worldwide. Many innovations and new technologies have spread rapidly, including an unprecedented expansion of digitization, to maintain food supply chains during the periods of lockdown and constrained transportation and distribution systems.²⁵¹

In Bangladesh, COVID-19 lockdowns put tremendous pressure on farmers, as the flow of agricultural products and inputs was heavily disrupted. Farmers faced challenges in procuring inputs such as fertilizers and feed, and in selling their harvested products. There were significant drops in prices of all perishable products such as milk, vegetables and fish. With breaks in the supply chains and increasing concerns over health risks faced by their members and farm workers, farmer organizations facilitated the setting up of virtual call centres (VCCs). VCCs facilitate local coordination and communication to support farmers in continuing to sell their commodities, buying essential inputs and services, and sharing best practices during the pandemic. The VCC innovation has improved efficiency and productivity through cooperation and technology, and also increased smallholder incomes. This has strengthened direct linkages between food producers and traders, while benefitting local communities through increased economic activity.⁹⁷

New and promising technologies can effectively reinforce food systems’ resilience to the drivers of food insecurity and malnutrition, at the same time that these are transformed to provide healthy diets with sustainability considerations. For example, solar powered irrigation systems are climate-friendly, reliable and affordable if adequately managed. In the Near East and North Africa, a regional initiative has given special focus to the use of solar energy for agricultural irrigation and sustainable development. The system has reduced the negative environmental impacts of agriculture, decreasing soil pollution from diesel spillovers and greenhouse gas emissions.²⁵³

In Benin, the use of biofertilizer and isotopic techniques has led to a four-fold increase in soybean production between 2009 and 2019, raising smallholder incomes and the availability of healthy soya-based foods, while leading to significant increases in soil fertility as well as export earnings. In Argentina, Mediterranean fruit flies had repeatedly damaged valuable cash crops (cherries, pears and apples) for large-, medium- and small-scale producers of the Patagonia and Mendoza regions, leading to substantial production losses and reduced revenues. Furthermore, frequent use of pesticides had caused health concerns for both producers and consumers. The introduction of the Sterile Insect Technique (SIT) to control the fruit flies led to the suppression and eradication of the fruit fly, which subsequently led to substantial increases in production and international trade in the fruit sector – i.e. greater economic resilience and increased revenues for Argentinian farmers and traders.⁹⁷

The field of innovation is not only related to scientific or engineering advances. For example, the high amount of investment required for food systems transformation will require new and innovative financing mechanisms, in addition to enabling legal and regulatory frameworks, while innovative components in social protection programmes can increase their effectiveness and improve their sustainability and positive effects in facilitating the access to healthy diets for the most vulnerable.²⁴⁹ The COVID-19 pandemic has put a tremendous pressure on these areas, which have called for innovative solutions: in some sub-Saharan countries, including Malawi, Nigeria and Togo, satellite images have been used, combined with other methods, in the selection of new beneficiaries entitled to stepped-up cash transfer programmes following increased support needed as a consequence of the COVID-19 pandemic.¹³

Capitalizing on win-win solutions and managing trade-offs

The successful transformation of food systems towards greater affordability of healthy diets for all, sustainably produced and with improved resilience to identified drivers, calls for win-win solutions to be fully exploited, and for trade-offs to be carefully managed. As with all systemic changes, there will be winners and losers, while the introduction of new technologies and innovations, and the subsequent changes in food systems performance, will produce both positive and negative spillover effects.²⁴⁹ The above-mentioned coherence among systems, as well as the cross-cutting accelerators, play a key role in maximizing the benefits and minimizing negative consequences of transformation for food security, improved nutrition and affordable healthy diets: that is why policy coherence, understood as a situation where the implementation of policies in one area do not undermine others (and even reinforce each other where feasible),²⁵⁴ is needed in building transformative multisectoral portfolios. Below, examples of systems approaches demonstrate how win-win solutions can help speed up the type of transformative processes with greater efficiency that this report is calling for, while at the same time managing necessary trade-offs towards more sustainable and inclusive food systems transformation.

Examples of systems approaches for building coherent portfolios

Territorial approaches

As highlighted under several of the pathways reviewed in this report, territorial approaches can facilitate comprehensive and systemic approaches towards the transformation of food systems. In policy development and the implementation of transformative action, territorial approaches advocate for cross-sectoral and multi-level governance mechanisms, as well as coherence across different spatial levels, while focusing on linkages and opportunities between systems in a given territory.²⁵⁵ As such, territorial approaches lend themselves to realizing efficiency gains, while managing trade-offs in policy implementation. Hence, with the benefit of involving all relevant actors in a given space, territorial approaches represent ideal frameworks for responding to the particular context, as well as the dynamic and evolving nature of drivers impacting on food systems and allow policymakers to design coherent and more effective multisectoral policy portfolios.

This approach has been implemented in Colombia, where a 50-year conflict had left rural areas and populations in poverty and with limited institutional capacity. Since the 2016 Peace Agreement, territorial development plans have been implemented in 16 territories. These consist of investment plans grouped into eight pillars, including land tenure, infrastructure, health and education services, housing, water and sanitation, among others.²⁵⁶ The Great Green Wall project in the Sahel represents another territorial approach: an ambitious 11-country project that seeks to transform the lives of 100 million people by focusing on the agro-ecological potential of landscape restoration, while also producing food, increasing food security, creating jobs and promoting peace in a politically fragile region.²⁵⁷ In a context of climate change and desertification, the project creates opportunities for increasing biodiversity and reversing land degradation in ways that create “green jobs”. Focusing on enhancing the ability of small-scale producers to cope with climate change, the project also invests in improved access to markets and strengthened value chains, expanding the use of solar energy, and capitalizing on agroforestry and community-led efforts to achieve food security and improved nutrition.²⁵⁸

As introduced under pathway 4 above, territorial approaches to food systems transformation also apply to urban and peri-urban settings. With over half of the world’s population now living in urban settings,²⁵⁹ municipal authorities responsible for cities and urban places can play an important role in transforming food systems to improve food security and nutrition and to help raise the affordability of healthy diets. City authorities can, for example, use their regulatory and planning powers to shape the food environment (e.g. zoning of fast food outlets, calorie labelling, advertising restrictions, or taxation of beverages with a high sugar content).¹⁹⁴ One example is the Milan Urban Food Policy Pact, an international agreement among cities to “develop sustainable food systems that are inclusive, resilient, safe and diverse, that provide healthy and affordable food to all people in a human-rights based framework, that minimize waste and conserve biodiversity while adapting to and mitigating impacts of climate change.” The pact has been signed by 211 cities worldwide with the aim of fostering city-to-city cooperation and exchange of best practices.²⁶⁰

Coherent policy portfolios also have to address increased exposure and vulnerability of livelihoods, particularly of disadvantaged population groups. Without proper planning, climate variability and extremes will affect vulnerability to future extreme events.³ Any rise in climate extremes can exacerbate the vulnerability of disadvantaged population groups, with adverse long-term developmental effects if no action is taken to increase resilience at all levels (productive, social, climatic and environmental). To be successful across livelihoods and food systems and to address food insecurity and all forms of malnutrition, climate resilience policies and programmes should be built around climate risk assessments, science and interdisciplinary cross-sectoral knowledge, in addition to “blended” humanitarian, development and peace approaches that are participatory and inclusive as well as driven by the needs of climate-vulnerable groups.³

Ecosystem approaches

In regard to coherence among food and environmental systems, the transformation and “greening” of food systems can be a powerful tool to build resilience to climate and economic shocks simultaneously. The IMF has estimated that green multipliers are several orders of magnitude larger than non-green ones.²⁶¹ When portfolios of policies and investments for the greening of food systems are designed and implemented in such a way as to be an engine of economic recovery, they can create viable jobs and sustainable livelihoods, address inequality, and promote food security and nutrition. Hence, strengthening climate resilience of food systems is not only good for sustainability and reducing the carbon footprint – it is also good for ending hunger and malnutrition in all its forms. Similarly, developing or updating national food-based dietary guidelines (FBDGs) through the full integration of environmental sustainability elements in each of the guideline’s recommendations, according to national contexts and using these FBDGs to guide agriculture and food policies, is one way help to drive the greening of food systems.²³

The potential for boosting the provision of ecosystem services, while increasing productivity, food security and resilience, has been illustrated by a number of integrated watershed management interventions. In Kenya, an innovative Water Fund supports farmers in the Upper Tana River Basin in adopting sustainable land and water management practices. In addition to strengthening smallholder resilience to the impacts of climate variability and extremes, the Water Fund has helped raise productivity and profitability of coffee and other value chains. The integrated approach of the Water Fund has furthermore improved the quality of drinking water for the capital Nairobi, while raising the country’s hydropower output. Hence, this investment has contributed to water and energy systems directly and to food, health and social protection systems indirectly.²⁶²

In Mexico, a community-based forest management project has been designed to address and overcome problems linked to deforestation and forest degradation in rural communities of marginalized forest areas in Campeche, Chiapas and Oaxaca. The project shows successful results in regard to environmental benefits. Project beneficiaries report being more resilient to shocks (8 percent higher than comparison group), particularly to climatic shocks, and also less affected by drought (16 percent lower). Moreover, incomes from off-farm activities have increased significantly (by 22 percent). On a more general level, total assets have also increased (15 percent), particularly productive assets (41 percent), reflecting investments in business enterprises and improvements in the domain of economic mobility.²⁶³

Coordinated policy action under protracted crisis conditions

As highlighted under the first pathway, in conflict-affected countries, it is imperative that policies, investments and actions to reduce immediate food insecurity and malnutrition are implemented simultaneously with those aimed at a reduction in the levels of conflict, and are aligned with long-term socio-economic development and peacebuilding efforts. In Iraq, a three decade-old protracted crisis has had devastating effects on agri-food systems, causing large population displacements, destruction of agricultural infrastructure, loss of livelihood assets and the severe disruption of food value chains. Low productivity compounded by the impact of climate change has raised challenges in the food and agriculture sectors, which are major sources of employment in both rural and urban areas.⁹⁷ During 2020, largely due to repercussions of the COVID-19 pandemic, poverty levels rose from 20 percent (2017–2018) to as much as 35 percent in central governorates.²⁶⁴

Urgent policy recommendation to support Iraq on a sustainable path to recovery include: the scaling up of social protection mechanisms; ensuring basic services for the poor; protecting jobs, SMEs, and vulnerable workers in the informal economy,²⁶⁵ as well as cross-cutting reforms for private sector-led diversification and growth by creating sustainable job opportunities.²⁶⁶ Along these lines, a multisectoral and multi-partner food systems and value chain programme involving the Ministries of Planning, Agriculture, Water Resources, Trade, Education and Migration, aims to support the return of millions of formerly internally displaced people (IDP) and host communities by providing employment to help them rebuild their livelihoods. The cross-sectoral programme (2020–2024) is a component of a UN-led humanitarian-development-peace (HDP) nexus programme and supports: (i) an enabling environment through policy engagement and legislation changes, facilitating trade and improving working conditions; (ii) building capacity of public and private service providers; (iii) supporting smallholders to adopt sustainable practices; (iv) strengthening agri-food SMEs by providing technical and financial support; and (v) promoting agribusiness development and network linkages. The comprehensive portfolio of policies and investments will strengthen the management of Iraq’s natural resources, support fair and sustainable employment opportunities, build human capital and strengthen private sector growth towards long-term recovery and development in Iraq.

In Palestine, more than 1.7 million people were food insecure in 2018 – about one-third of the population.²⁶⁷ This estimate rose to more than 2 million following the outbreak of the COVID-19 pandemic in 2020,²⁶⁸ and before the recent outbreak of violent conflict with Israel. Apart from causing a health crisis, the pandemic aggravated the humanitarian situation, while lockdowns impacted negatively on socio-economic development in Palestine. In response to the crisis, emergency policy measures were put in place to maintain agri-food systems, with additional measures to mitigate the effect of the crisis on vulnerable groups while protecting and promoting their livelihoods.²⁶⁹

After decades of humanitarian response, the above measures reflect stepped-up efforts over the past five years to strengthen a HDP nexus approach.²⁷⁰ In this context, in late 2020, the Palestinian cabinet endorsed its first National Food and Nutrition Security Policy (NFNSP, 2019–2030),²⁷¹ complemented by a National Investment Plan for Food and Nutrition Security and Sustainable Agriculture (NIP, 2020–2022).^268,272 In spite of the protracted crisis, the NFNSP and NIP – formulated by the Ministry of Agriculture, in cooperation with, among others, the Ministries of Health, Social Development, Education and Higher Education, the Palestinian Water and Environmental Authorities, and the Central Bureau of Statistics – jointly aim at consolidating policy frameworks and coordinating and prioritizing interventions by different actors. The renewed policy approach rests on strengthening the link between agricultural development, social protection and economic empowerment to simultaneously address the most urgent as well as structural development needs of the Palestinian people. Regrettably, given the most recent outbreak of violent conflict between Israel and Palestine, current efforts are inevitably focused on peacebuilding, which remains the most important priority in the near future.

Indigenous Peoples’ food systems

A good example of holistic and interconnected systems, providing nutritious and varied foods within healthy environments while preserving biodiversity, are the food systems of Indigenous Peoples.^273,274 In recent decades, these sustainable and resilient food systems – which have managed to generate food and medicines for hundreds of years – have been negatively affected by climate change, extractive industries, expansion of commercial agriculture and persistent marginalization, resulting in displacement, violence, structural poverty and inequality.^{112,275,276,277} The ongoing COVID-19 pandemic has exacerbated their food insecurity, particularly in urban and peri-urban areas and in communities that rely more on market access to food.

In spite of these challenges, Indigenous Peoples have demonstrated that integrated approaches that go beyond food are fundamental to improving food environments and social protection systems.^273,278 Their food systems are founded on a holistic and systemic view that encompasses spirituality, life and culture, with biotic and abiotic components in the ecosystem, as well as the interconnections between them. These food systems involve the totality of human capacity for the sustainable production, generation, utilization, access, availability, stability and management of foods that are nutritious and fulfilling.²⁷⁹

Indigenous Peoples’ food systems provide best practices on sustainability, incorporating seasonality, a broad food base, resilience, food generation, self-governance, management of collective rights and ecosystems management. These practices could be applied elsewhere to create healthier, more sustainable food systems. In the United States of America, where Indigenous Peoples are twice as likely to be food insecure than non-indigenous,²⁸⁰ the Oneida Nation in Wisconsin is confronting food insecurity and malnutrition among its people, including high levels of diabetes and obesity resulting from excessive consumption of processed foods. An integrated community food systems approach has been set up to revitalize their beliefs, cosmogony and governance, and a local food systems’ governance coalition has been established to restore their lands and waters to sustainably produce nutritious foods for their people. Their farm-to-school programme has been nationally recognized as a successful way of including nutritious foods in children’s school menus that are both local and culturally appropriate. Furthermore, their intercultural and integrated approach to food within governance, policy, investment and community leadership has strengthened the food environment for the Oneida Nation, improved public health and reinforced intergenerational commitment to sustain their food systems.⁹⁷

Living in more than 90 countries across seven socio-cultural regions, Indigenous Peoples represent 6.2 percent of the world population (476 million). While one in five of the world’s extreme poor belong to Indigenous Peoples, their economic poverty is in sharp contrast with the cultural and ecological richness of their societies: they speak 4 000 out of the 6 700 languages remaining worldwide, and while their land and territories encompass around 25 percent of the Earth’s surface, these contain 80 percent of the remaining terrestrial biodiversity and see lower rates of deforestation.

Given their global presence and their wealth of knowledge, Indigenous Peoples are key partners to contribute to global debates around sustainable and resilient food systems. Their food systems are diverse and nutritious, help to preserve biodiversity and have demonstrated to be resilient and adaptive to shocks. Despite the growing contributions on sustainability that Indigenous Peoples can make towards the transformation of food systems, their voices are still marginalized in policy discussions and decision-making processes.²⁸¹ To help rectify this, the Global-Hub on Indigenous Peoples’ Food Systems brings together Indigenous and non-Indigenous experts, scientists and researchers to co-create knowledge and evidence that can influence policy.²⁸² Drawing upon experiences of Indigenous Peoples worldwide, Box 14 provides guidance on best practices towards systemic approaches for the sustainable and inclusive transformation of food systems.

Having monitored for five years the progress made towards ending hunger and all forms of malnutrition in the framework of SDG 2, and examined the major drivers behind that progress, this year, The State of Food Security and Nutrition in the World completes a pentalogy of editions that closes on both a negative and positive note.

The negative note is obvious. Chapter 2 of this report makes it clear that, with less than a decade to 2030, we are not on track to ending world hunger and malnutrition – in fact, we are moving in the wrong direction. The picture is bleak. After remaining virtually unchanged for five years, the prevalence of undernourishment increased from 8.4 percent in 2019 to around 9.9 percent in 2020, meaning that between 720 and 811 million people in the world faced hunger in 2020 – as many as 161 million more people than in 2019. Beyond hunger, the outlook is also discouraging. For the global prevalence of moderate or severe food insecurity, the estimated increase in 2020 was equal to that of the previous five years combined. Thus, nearly one in three people in the world (2.37 billion) did not have access to adequate food in 2020 – an increase of almost 320 million people in just one year. Related to this, the high cost of healthy diets coupled with persistent high levels of income inequality put healthy diets out of reach for around 3 billion people in 2019 across all regions. This number will likely increase in 2020, affecting most regions, due to the COVID-19 pandemic.

Moreover, the goal of ending all forms of malnutrition remains a challenge. Although data limitations have prevented this report from fully accounting for the impact of the pandemic, it is estimated that 22.0 percent of children in 2020 were affected by stunting, 6.7 percent were suffering from wasting and 5.7 percent were overweight. An estimated 29.9 percent of women aged 15 to 49 years in 2019 around the world were affected by anaemia, and adult obesity is increasing sharply in all regions. The current rate of global progress towards targets for these nutrition indicators is insufficient or is even stalled or worsening.

As indicated in Chapter 3, driving these unwelcome trends are the increasing frequency and intensity of conflict, climate variability and extremes, economic slowdowns and downturns, and high levels of inequality. Economic downturns in 2020, which were mainly a consequence of COVID-19 containment measures all over the world, have contributed to one of the largest increases in world hunger in decades, which has affected almost all low- and middle-income countries, and can reverse gains made in nutrition. But the downturns resulting from the COVID-19 pandemic were just a small part of a much bigger problem: more alarmingly, the pandemic has exposed the vulnerabilities forming in our food systems over recent years as a result of major drivers such as conflict, climate variability and extremes, and economic slowdowns and downturns. These major drivers are increasingly occurring simultaneously in countries, with interactions that seriously undermine food security and nutrition. It has been shown that the majority of children who are hungry and stunted live in countries affected by a combination of these drivers. Moreover, increases in hunger in 2020 were even larger in countries where economic downturns were combined with climate-related disasters or conflict, or both.

It is also important to consider that millions of people are food insecure and malnourished in all its forms because they cannot afford a healthy diet. The aforementioned drivers and high levels of inequality, as well as other factors driving up the cost of nutritious foods – in the realms of food production, food supply chains and food environments, as well as consumer demand and the political economy of food – are behind this significant deficiency in our food systems. Evidence already suggests that countries where the unaffordability of a healthy diet increased between 2017 and 2019 also show higher levels of severe as well as moderate or severe food insecurity, especially lower-middle-income countries.

While the COVID-19 pandemic and its impacts have been an immense challenge for the world, they may also be a warning call of unwelcome events to come if we do not commit to more resolute actions to change course. As the report has shown, the major drivers threatening food security and nutrition are also interconnected with, and have circular impacts on, other systems, including environmental and health systems. This creates interconnected circular associations, contributing to increased food insecurity and malnutrition and leading to current and future vulnerability. These major drivers each have their own trajectory or cyclicality that ensures they will continue to occur and could even worsen in the coming years; therefore, bolder and scaled-up actions are needed to build resilience to their negative effects on food security and nutrition.

On a more positive note, there is a solution going forward, and Chapter 4 of this report has pointed us to it. Given that the major drivers negatively affect food security and nutrition through their impacts on food systems, the solution lies in the transformation of these systems, and in fact there is already momentum to do so. The world has noted that food systems are central to the goal of eradicating hunger and malnutrition in all its forms and ensuring that everyone can afford a healthy diet. The UN Food Systems Summit 2021 will bring forward a series of concrete actions that people from all over the world can take to support a transformation of the world’s food systems. To that end, this report has identified six pathways that, alone or frequently in combination, specifically address the negative impacts of the major drivers behind the recent rise in hunger and slowing progress to reduce malnutrition in all its forms. These include: (i) integrating humanitarian, development and peacebuilding policies in conflict-affected areas; (ii) scaling up climate resilience across food systems; (iii) strengthening resilience of the most vulnerable to economic adversity; (iv) intervening along the food supply chains to lower the cost of nutritious foods; (v) tackling poverty and structural inequalities, ensuring interventions are pro-poor and inclusive; and (vi) strengthening food environments and changing consumer behaviour to promote dietary patterns with positive impacts on human health and the environment.

The complex challenges to food security and nutrition call for greater synergy and coherence in policy formulation and implementation across sectors, supported by more strategic investments from both the public and private sectors, which is key to avoid undesirable trade-offs. This also means that silo solutions are no longer an option. What are required are integrated portfolios of policies, investments and legislation, built along the particular transformation pathways needed in each context, that can specifically address food security and nutrition challenges head on.

The persistence of socio-economic inequalities and poverty is a major issue – one that any process of food systems transformation cannot afford to ignore. This amplifies the need to provide vulnerable and historically marginalized populations with greater access to productive resources, technology and innovation to empower them to become agents of change towards more equitable and sustainable food systems. The successful transformation of food systems towards greater affordability of healthy diets for all, sustainably produced and with improved resilience to the major drivers identified, calls for win-win solutions to be fully exploited, and for trade-offs to be carefully managed. Hence, it is not enough to address the factors driving up the cost of nutritious foods; the inequalities and low incomes faced by many vulnerable people also need to become a thing of the past.

As with all systemic changes, the actions taken along the six transformation pathways proposed in this report will result in winners and losers. The introduction of new technologies and innovations will serve as important accelerators in the comprehensive portfolios of policies, investments and legislation aimed at transforming food systems to increase the affordability of healthy diets. However, adequate governance will need to be in place to ensure no one is left behind in the access to these accelerations and potential inequalities and divides are prevented. Timely availability of data and information at both national and subnational levels will also be critical to monitor progress towards targets and to target interventions where they are needed most. As presented in this report (Chapter 2), having food security estimates based on the Food Experience Scale at disaggregated geographical level has allowed policymakers and programme planners to visualize which provinces or regions are most in need of interventions to guarantee the right to adequate food. Moreover, more and better data allow for carrying out situation analyses covering context-specific and comprehensive assessments of which key drivers are impacting negatively on food systems and resulting in poor food security and nutrition outcomes (as noted in Chapter 4).

Policy coherence – understood as a situation where the implementation of policies in one area do not undermine others and even reinforce each other where feasible – across systems, as well as cross-cutting accelerators, play a key role in maximizing the benefits and minimizing the negative consequences of transformation. These conditions will be critical to building transformative multisectoral portfolios of policies, investments and legislation that become win-win solutions and help manage trade-offs. Systems approaches are also needed, such as territorial approaches, ecosystems approaches, Indigenous Peoples’ food systems and interventions that systemically address protracted crisis conditions.

This report recognizes the urgency for the broader food systems transformation that is needed and is currently at the centre of global attention. At the same time, it makes the case that, for getting back on track towards meeting SDG Target 2.1, ensuring access to safe, nutritious and sufficient food for all people all year round, and SDG Target 2.2, eradicating all forms of malnutrition, we must focus on the transformation pathways and policy coherence that help most in addressing the major drivers behind the recent rise in hunger and slowing progress towards reducing all forms of malnutrition.