NYT
May 24, 2009
Op-Ed Columnist
The Hidden Hunger
By NICHOLAS D. KRISTOF

BISSAU, Guinea-Bissau

The most heartbreaking thing about starving children is their
equanimity.

They don’t cry. They don’t smile. They don’t move. They don’t show a
flicker of fear, pain or interest. Tiny, wizened zombies, they shut
down all nonessential operations to employ every last calorie to stay
alive.

We in the West misunderstand starvation — especially the increasing
hunger caused by the global economic crisis — and so along with Paul
Bowers, the student winner of my “win-a-trip” contest, I’ve been
traveling across five countries in West Africa, meeting the
malnourished.

At the extreme, they were like Maximiano Camara, a 15-month-old boy
here in Bissau, who was so emaciated that he risked failure of major
organs. His ribs protruded, his eyes were glassy, his skin was
stretched taut over tiny bones.

(Doctors try to help but are overwhelmed: One was showing me Maximiano
when a nurse rushed in from another room carrying a baby who had
stopped breathing. The doctor paused, revived that child on the next
bed, handed her back to the nurse, and then calmly resumed his
discussion of Maximiano.)

Even if Maximiano survives, hunger may leave him physically stunted.
Or poor nutrition may have already withered the development of his
brain.

It’s impossible to know if Maximiano was starving because of the
economic crisis or because of chronic malnutrition here, but the
hardships in the developing world have been exacerbated by elevated
food prices and declining remittances from workers abroad.

The World Bank has estimated that United Nations goals for overcoming
global poverty have been set back seven years by the global crisis. It
calculates that increased malnutrition last year may have caused an
additional 44 million children to suffer permanent physical or mental
impairment.

Yet one of the great Western misconceptions is that severe
malnutrition is simply about not getting enough to eat. Often it’s
about not getting the right micronutrients — iron, zinc, vitamin A,
iodine — and one of the most cost-effective ways outsiders can combat
poverty is to fight this “hidden hunger.”

Malnutrition is not a glamorous field, and so it’s routinely neglected
by everybody — donor governments, poor countries and, yes,
journalists. But malnutrition is implicated in one-third to one-half
of all child deaths each year; the immediate cause may be diarrhea,
but lurking behind it is a deficiency of zinc.

“That image of a starving child in a famine doesn’t represent the
magnitude of the problem,” notes Shawn Baker of Helen Keller
International, a New York-based aid group working in this area. “For
every child who is like that, you have 10 who are somewhat
malnourished and many more who are deficient in micronutrients.

“Lack of iron is the most widespread nutrition deficiency in the
world, and yet you can’t really see it,” he added.

In my column last Sunday, I wrote about women dying in childbirth. One
reason so many die of hemorrhages is that 42 percent of pregnant women
worldwide have anemia, according to the World Health Organization. And
here in Guinea-Bissau, 83 percent of youngsters under age 5 suffer
from iron deficiency.

An American or European typically has a hemoglobin, or Hb, level of
13, while anemic women and children in Africa are sometimes at 5 or
below.

“In Europe, we get worried when Hb drops to 9, and then we consider a
transfusion,” said Dr. Annette Kröber, a German working at a Doctors
Without Borders clinic for malnourished children in Sierra Leone.
“Here, when we get Hb up to 6, we’re very happy.”

The general rise in food prices (in part because of American use of
corn for ethanol) is leading to more micronutrient deficiencies. One
study found that a 50 percent rise in food prices in poor countries
leads to a 30 percent drop in iron intake.

One solution is to distribute supplements to vulnerable people, or to
fortify foods with micronutrients. A panel of prominent economists
produced the “Copenhagen Consensus” on which forms of aid are most
cost-effective, and it ranked micronutrient supplements as No. 1
(malaria prevention was No. 12, sanitation No. 20, and microfinance
No. 22).

Americans typically get micronutrients from fortified foods, and the
same strategy is possible in Africa. Helen Keller International is
helping Guinea’s leading flour mill fortify its products with iron,
folic acid and vitamin B (zinc is coming soon). We visited the mill,
and managers said that the fortification costs virtually nothing — a
tiny fraction of a penny per loaf of bread — yet it will reduce
anemia, maternal mortality and cognitive impairments around the
country.

None of this is glamorous, but it’s hugely needed — and truly a
bargain.

On May 24, 5:59 pm, Lance  wrote:
>
>
> The general rise in food prices (in part because of American use of
> corn for ethanol) is leading to more micronutrient deficiencies. One
> study found that a 50 percent rise in food prices in poor countries
> leads to a 30 percent drop in iron intake.
>
They don't mention that the only reason for using corn is to prevent
money flowing to the poor countries that grow sugar, which would be a
much better crop to use.

On May 24, 8:38 pm, Peter Brooks  wrote:
> On May 24, 5:59 pm, Lance  wrote:
>
> > The general rise in food prices (in part because of American use of
> > corn for ethanol) is leading to more micronutrient deficiencies. One
> > study found that a 50 percent rise in food prices in poor countries
> > leads to a 30 percent drop in iron intake.
>
> They don't mention that the only reason for using corn is to prevent
> money flowing to the poor countries that grow sugar, which would be a
> much better crop to use.

There are lots of things the article doesn't mention. In a report on a
study of iron deficiency in Zanzibar that I read children were
classified according to the degree of iron deficiency (most were iron
deficient). Anyway there wat a single boy in the most severely iron
deficient group of children. the only explanation I can think of
(since these were infants not menstruating girls) is that the girls
were fed less well than the boys...

Lance

On May 24, 11:44 pm, Gary  wrote:
> On May 24, 8:38 pm, Peter Brooks  wrote:
>
> > On May 24, 5:59 pm, Lance  wrote:
>
> > > The general rise in food prices (in part because of American use of
> > > corn for ethanol) is leading to more micronutrient deficiencies. One
> > > study found that a 50 percent rise in food prices in poor countries
> > > leads to a 30 percent drop in iron intake.
>
> > They don't mention that the only reason for using corn is to prevent
> > money flowing to the poor countries that grow sugar, which would be a
> > much better crop to use.
>
> There are lots of things the article doesn't mention. In a report on a
> study of iron deficiency in Zanzibar that I read children were
> classified according to the degree of iron deficiency (most were iron
> deficient). Anyway there wat a single boy in the most severely iron
> deficient group of children. the only explanation I can think of
> (since these were infants not menstruating girls) is that the girls
> were fed less well than the boys...
>
The girls wouldn't be, even if older, anorexia can often lead to
delayed menarche.

The boys probably were fed better - boys are a better investment in
tough conditions, from the purely reproductive point of view.

Peter Brooks wrote:
> On May 24, 11:44 pm, Gary  wrote:
> > On May 24, 8:38 pm, Peter Brooks  wrote:
> >
> > > On May 24, 5:59 pm, Lance  wrote:
> >
> > > > The general rise in food prices (in part because of American use of
> > > > corn for ethanol) is leading to more micronutrient deficiencies. One
> > > > study found that a 50 percent rise in food prices in poor countries
> > > > leads to a 30 percent drop in iron intake.
> >
> > > They don't mention that the only reason for using corn is to prevent
> > > money flowing to the poor countries that grow sugar, which would be a
> > > much better crop to use.
> >
> > There are lots of things the article doesn't mention. In a report on a
> > study of iron deficiency in Zanzibar that I read children were
> > classified according to the degree of iron deficiency (most were iron
> > deficient). Anyway there wat a single boy in the most severely iron
> > deficient group of children. the only explanation I can think of
> > (since these were infants not menstruating girls) is that the girls
> > were fed less well than the boys...
> >
> The girls wouldn't be, even if older, anorexia can often lead to
> delayed menarche.
>
> The boys probably were fed better - boys are a better investment in
> tough conditions, from the purely reproductive point of view.

Strange. It is claimed that high status people have more boys because
boys are a better investment if you are high status. The obvious
conclusion is girls would be the better investment in tough
conditions. A poor, sickly boy is not that likely to get a mate (girls
tending to seek partners with higher status) but girls of low status
can often interest a high status male in sex. Hmm. I think you are
wrong about your claim.

Lance

On May 25, 8:49 am, Lance  wrote:
> Peter Brooks wrote:
> > On May 24, 11:44 pm, Gary  wrote:
> > > On May 24, 8:38 pm, Peter Brooks  wrote> > > > On May 24, 5:59 pm, Lance  wrote:
>
> > > > > The general rise in food prices (in part because of American use of
> > > > > corn for ethanol) is leading to more micronutrient deficiencies. One
> > > > > study found that a 50 percent rise in food prices in poor countries
> > > > > leads to a 30 percent drop in iron intake.
>
> > > > They don't mention that the only reason for using corn is to prevent
> > > > money flowing to the poor countries that grow sugar, which would be a
> > > > much better crop to use.
>
> > > There are lots of things the article doesn't mention. In a report on a
> > > study of iron deficiency in Zanzibar that I read children were
> > > classified according to the degree of iron deficiency (most were iron
> > > deficient). Anyway there wat a single boy in the most severely iron
> > > deficient group of children. the only explanation I can think of
> > > (since these were infants not menstruating girls) is that the girls
> > > were fed less well than the boys...
>
> > The girls wouldn't be, even if older, anorexia can often lead to
> > delayed menarche.
>
> > The boys probably were fed better - boys are a better investment in
> > tough conditions, from the purely reproductive point of view.
>
> Strange. It is claimed that high status people have more boys because
> boys are a better investment if you are high status. The obvious
> conclusion is girls would be the better investment in tough
> conditions. A poor, sickly boy is not that likely to get a mate (girls
> tending to seek partners with higher status) but girls of low status
> can often interest a high status male in sex. Hmm. I think you are
> wrong about your claim.
>
I think that the matter seems much more complicated than either of us
have thought. Looking at some references, it seems that advantage
during famines depends on a number of factors, including age. Here,
for example:

http://books.google.com/books?id=UTCGZ-Z9OP4C&pg=PA244&lpg=PA244&dq=sex궫抣騩&source=bl&ots=0MTJDn26j5&sig=5_yDiDzTswxAsiWvWCdeH3lnuZA&hl=en&ei=B0kaSvyEB8bRjAfEw-D0DA&sa=X&oi=book_result&ct=result&resnum=4#PPA245,M1

Part of the problem is, I think, a question of to whom the cost of
children falls. Bride prices, dowries and so forth are responses to
this question.

Also, the economic benefit to an individual family, vs a reproductive
benefit to the population as a whole. The Chinese one-child system has
led to a huge surplus in males over females, presumably recognition of
these costs. China is not a wealthy part of the world, in the main.