The State of Food Security and Nutrition in the World 2021 (PDF)

FOOD SECURITY AND NUTRITION IN THE WORLD THE STATE OF TRANSFORMING FOOD SYSTEMS FOR FOOD SECURITY, IMPROVED NUTRITION AND AFFORDABLE HEALTHY DIETS FOR ALL  VIET NAM. A woman with a traditional conical hat selling fruit on the beach. COVER PHOTOGRAPH ©John Keates / Alamy Stock Photo This flagship publication is part of The State of the World series of the Food and Agriculture Organization of the United Nations. Required citation: FAO, IFAD, UNICEF, WFP and WHO. 2021. The State of Food Security and Nutrition in the World 2021. Transforming food systems for food security, improved nutrition and affordable healthy diets for all. 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Queries regarding rights and licensing should be submitted to: [email protected]  FOOD SECURITY AND NUTRITION IN THE WORLD THE STATE OF TRANSFORMING FOOD SYSTEMS FOR FOOD SECURITY, IMPROVED NUTRITION AND AFFORDABLE HEALTHY DIETS FOR ALL ISSN 2663-8061 Food and Agriculture Organization of the United Nations Rome, 2021  CONTENTS FOREWORD vi METHODOLOGY viii ACKNOWLEDGEMENTS ix ACRONYMS AND ABBREVIATIONS xi KEY MESSAGES xii EXECUTIVE SUMMARY xv CHAPTER 1 INTRODUCTION 1 CHAPTER 2 FOOD SECURITY AND NUTRITION AROUND THE WORLD 7 2.1 Food security indicators – latest updates and progress towards ending hunger and ensuring food security 8 2.2 Nutrition indicators – latest updates and progress towards global nutrition targets 29 2.3 Ending hunger and all forms of malnutrition by 2030 38 CHAPTER 3 MAJOR DRIVERS OF RECENT FOOD SECURITY AND NUTRITION TRENDS 51 3.1 A food systems lens is critical to address the major drivers of recent food security and nutrition trends 52 3.2 Impact of major drivers on food security and nutrition 60 CHAPTER 4 WHAT NEEDS TO BE DONE TO TRANSFORM FOOD SYSTEMS FOR FOOD SECURITY, IMPROVED NUTRITION AND AFFORDABLE HEALTHY DIETS? 85 4.1 Six pathways to address major drivers behind recent food security and nutrition trends 87 4.2 Building coherent portfolios of policies and investments 109 CHAPTER 5 CONCLUSION 125 ANNEXES 129 ANNEX 1A Statistical tables to Chapter 2 130 ANNEX 1B Methodological notes for the food security and nutrition indicators 156 ANNEX 2 Methodologies Chapter 2 170 ANNEX 3 Country exposure to the drivers and PoU change point analysis in Chapter 3 179 ANNEX 4 Country group definitions and lists of countries affected by drivers in Chapter 3 181 ANNEX 5 Country group definitions for the analysis of food insecurity and drivers in 2020 186 ANNEX 6 Glossary 188 NOTES 194 | ii |  FIGURES 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 10 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 13 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 14 TABLES 1 Prevalence of undernourishment (PoU) in the world, 2005–2020 11 2 Number of undernourished people in the world, 2005–2020 12 3 Prevalence of food insecurity at severe level only, and at moderate or severe level, based on the Food Insecurity Experience Scale, 2014–2020 17 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 18 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 27 6 The global nutrition targets endorsed by the World Health Assembly and their extension to 2030 31 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 42 8 Key policy areas and goals for integrating humanitarian, development and peacebuilding efforts in conflict-affected areas 92 9 Key policy areas and goals for scaling up climate resilience across food systems 95 10 Key policy areas and goals for strengthening resilience of the most vulnerable to economic adversity 98 11 Key policy areas and goals for intervening along food supply chains to lower the cost of nutritious foods 101 12 Key policy areas and goals for tackling structural inequalities, ensuring interventions are pro-poor and inclusive 105 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 108 A1.1 Progress towards the Sustainable Development Goals (SDGs) and global nutrition targets: Prevalence of undernourishment, moderate or severe food insecurity, selected forms of malnutrition, exclusive breastfeeding and low birthweight 130 A1.2 Progress towards the Sustainable Development Goals (SDGs) and global nutrition targets: Number of people who are affected by undernourishment, moderate or severe food insecurity and selected forms of malnutrition; number of infants exclusively breastfed and number of babies born with low birthweight 143 A2.1 Ranges of PoU and NoU nowcasted in 2020 171 A2.2 Regression coefficients from three models estimated on historic CVy values (2000–2019) 175 A2.3 Rules for progress assessment against the global nutrition targets 177 A4.1 List of countries by combination of drivers 184 | iii |  CONTENTS 4 Moderate or severe food insecurity has been climbing slowly for six years and now affects more than 30 percent of the world population 19 5 The concentration and distribution of food insecurity by severity differs greatly across the regions of the world 20 6 Globally and in every region, the prevalence of food insecurity is higher among women than men 22 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 32 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 34 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 36 10 The COVID-19 scenario projects a small decrease in global hunger between 2021 and 2030, with wide variation in evolution across regions 40 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 44 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 46 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 accumulated additional cases of wasting from 2020 to 2030 is 16 to 40 million 48 14 Impacts of various drivers are transmitted throughout food systems, undermining food security and nutrition 53 15 Low- and middle-income countries face increasing frequency and intensity of drivers 61 16 While poverty declines around the world, income inequality remains high, with an increase in 2020 in low- and middle-income countries 64 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 66 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 68 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 69 20 The majority of undernourished people and stunted children live in countries affected by multiple drivers (2019) 73 21 Hunger is higher and has increased more in countries affected by conflict, climate extremes or economic downturns, or with high inequality 74 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 76 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 78 | iv |  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 79 25 The unaffordability of healthy diets in 2019 is strongly associated with higher levels of both severe and moderate or severe food insecurity 81 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 82 27 Possible pathways towards food systems transformation to address major drivers of food insecurity, malnutrition and unaffordability of healthy diets 88 28 Steps towards food systems transformation for more affordable healthy diets 89 29 Key elements of a portfolio of policies and investments 110 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 111 A4.1 Countries by combination of drivers 183 BOXES 1 Major drivers and underlying factors challenging food security and nutrition in the world: a synthesis from the previous four editions of this report 3 2 Updates to the prevalence of undernourishment and methodology for the 2020 nowcast 9 3 Adapting FIES data collection in the context of the COVID-19 pandemic in 2020 16 4 Using the FIES to guide and target responses to the COVID-19 pandemic at subnational level 23 5 Assessment of progress towards 2030 targets for nutrition indicators 43 6 Methodology: estimates of potential additional cases of stunting and wasting due to the COVID-19 pandemic based on a scenario 47 7 Impact channels of the COVID-19 pandemic on food security and nutrition 56 8 Definition of countries affected by conflict, climate extremes, economic downturns and with high income inequality 71 9 Home-grown school feeding as a lever for food systems transformation 97 10 The Quito Agri-Food Pact: facilitating the transformation of the city’s food systems 100 11 Accelerating food systems transformation by empowering women and youth 104 12 Protecting children from the harmful impacts of food marketing 106 13 Nutrition policy measures to enhance benefits and minimize risks of trade 107 14 Indigenous Peoples’ systemic approaches provide extensive knowledge for the sustainable and inclusive transformation of food systems 122 | v |  FOREWORD The world is at a critical juncture: it is very different to where it was six years ago when it committed to the goal of ending hunger, food insecurity and all forms of malnutrition by 2030. At the time, while we understood that the challenges were significant, we were also optimistic that with the right transformative approaches, past progress could be accelerated, at scale, to put us on track to achieve that goal. Nonetheless, the past four editions of this report revealed a humbling reality. The world has not been generally progressing either towards Sustainable Development Goal (SDG) Target 2.1, of ensuring access to safe, nutritious and sufficient food for all people all year round, or towards SDG Target 2.2, of eradicating all forms of malnutrition. Last year’s report stressed that the COVID-19 pandemic was having a devastating impact on the world’s economy, triggering an unprecedented recession not seen since the Second World War, and that the food security and nutrition status of millions of people, including children, would deteriorate if we did not take swift action. Unfortunately, the pandemic continues to expose weaknesses in our food systems, which threaten the lives and livelihoods of people around the world, particularly the most vulnerable and those living in fragile contexts. This year, this report estimates that between 720 and 811 million people in the world faced hunger in 2020 – as many as 161 million more than in 2019. Nearly 2.37 billion people did not have access to adequate food in 2020 – an increase of 320 million people in just one year. No region of the world has been spared. The high cost of healthy diets and persistently high levels of poverty and income inequality continue to keep healthy diets out of reach for around 3 billion people in every region of the world. Moreover, new analysis in this report shows that the increase in the unaffordability of healthy diets is associated with higher levels of moderate or severe food insecurity. While it is not yet possible to fully quantify the impact of the COVID-19 pandemic in 2020, we are concerned by the many millions of children under 5 years of age who were affected by stunting (149.2 million), wasting (45.4 million) or overweight (38.9 million). Child malnutrition continues to be a challenge, particularly in Africa and Asia. Adult obesity also continues to increase, with no reversal in the trend in sight at global or regional levels. Efforts to eradicate malnutrition in all its forms have been challenged by disruptions in essential nutrition interventions and negative impacts on dietary patterns during the COVID-19 pandemic. On the health front, the interaction between the pandemic, obesity and diet-related non-communicable diseases has underlined the urgency of ensuring access to affordable healthy diets for all. Such myriad setbacks hide some important achievements – such as the increasing prevalence of exclusive breastfeeding of infants under 6 months. The situation could have been worse without governments’ responses and the impressive social protection measures they have put in place during the COVID-19 crisis. However, not only have measures to contain the spread of the pandemic resulted in an unprecedented economic recession, but also other important drivers are behind recent setbacks in food security and nutrition. These include conflict and violence in many parts of the world as well as climate-related disasters all over the world. Given the past and present interactions of these drivers with economic slowdowns and downturns, as well as high and persistent (and in some countries growing) levels of inequality, it is not surprising that governments could not keep the worst-case scenario for food security and nutrition from materializing and affecting millions of people all over the world. Hence, the world is at a critical juncture, not only because we have to overcome more significant challenges to ending hunger, food insecurity and all forms of malnutrition, but also because, with the fragility of our food systems widely exposed, we have an opportunity to build forward better and get on track towards achieving SDG 2. The UN Food Systems Summit, to be held later this year, will bring forward a series of concrete actions that people, food system actors and governments from all over the world can take | vi |  to support a transformation of the world’s food systems. We must build on the momentum that the run-up to the Summit has already generated and continue to build the evidence base on interventions and engagement models that best support the transformation of food systems. This report aims to contribute to this global effort. We are aware that transforming food systems so that they provide nutritious and affordable food for all and become more efficient, resilient, inclusive and sustainable has several entry points and can contribute to progress across the SDGs. Future food systems need to provide decent livelihoods for the people who work within them, in particular for small-scale producers in developing countries – the people who harvest, process, package, transport and market our food. Future food systems also need to be inclusive and encourage the full participation of Indigenous Peoples, women and youth, both individually and through their organizations. Future generations will only thrive as productive actors and leading forces in food systems if decisive action is taken to ensure that children are no longer deprived of their right to nutrition. While this broader food systems transformation is currently at the centre of global attention, this report identifies the transformation pathways needed to specifically address the key drivers behind the recent rise in hunger and slowing progress towards reducing all forms of malnutrition. The report recognizes that these transformation pathways are only feasible if they help meet certain conditions, including creating opportunities for traditionally marginalized people, nurturing human health and protecting the environment. Getting on track towards ending hunger and all forms of malnutrition will require a move away from silo solutions towards integrated food systems solutions, as well as policies and investments that address the global food security and nutrition challenges immediately. This year offers a unique opportunity for advancing food security and nutrition through transforming food systems with the upcoming UN Food Systems Summit, the Nutrition for Growth Summit and the COP26 on climate change. The outcomes of these events will certainly shape the actions of the second half of the UN Decade of Action on Nutrition. We stand firmly committed to take advantage of the unprecedented opportunity for these events to generate commitments towards transforming food systems to eradicate food insecurity and malnutrition in all its forms and deliver affordable healthy diets for all, and to build forward better from the COVID-19 pandemic. Qu Dongyu FAO Director-General David Beasley WFP Executive Director Gilbert F. Houngbo IFAD President Henrietta H. Fore UNICEF Executive Director Tedros Adhanom Ghebreyesus WHO Director-General | vii |  METHODOLOGY The State of Food Security and Nutrition in the World 2021 has been prepared by the FAO Agrifood Economics Division in collaboration with the Statistics Division of the Economic and Social Development Stream and a team of technical experts from FAO, IFAD, UNICEF, WFP and WHO. A senior advisory team consisting of designated senior managers of the five UN publishing partners guided the production of the report. Led by FAO, this team decided on the outline of the report and defined its thematic focus. It further gave oversight to the technical writing team composed of experts from each of the five co-publishing agencies. Background technical papers were prepared to support the research and data analysis undertaken by the members of the writing team. This year’s report also included a global call for “best practices in transforming food systems for affordable healthy diets and addressing key drivers of food insecurity and malnutrition”, which generated inputs from more than 80 development institutions and individuals worldwide. Further inputs were derived from an online webinar organized through the Global Forum on Food Security and Nutrition (FSN Forum), which included an expert panel discussion and reflection on the report’s theme. The writing team produced a number of interim outputs, including an annotated outline, first draft and final draft of the report. These were reviewed, validated and cleared by the senior advisory team at each stage in the preparation process. The final report underwent a rigorous technical review by senior management and technical experts from different divisions and departments within each of the five UN agencies, both at headquarters and decentralized offices. Finally, the report underwent executive review and clearance by the heads of agency of the five co-publishing partners. | viii |  ACKNOWLEDGEMENTS The State of Food Security and Nutrition in the World 2021 was jointly prepared by the Food and Agriculture Organization of the United Nations (FAO), the International Fund for Agricultural Development (IFAD), the United Nations Children’s Fund (UNICEF), the World Food Programme (WFP) and the World Health Organization (WHO). The publication was carried out under the direction of Marco V. Sánchez Cantillo and José Rosero Moncayo, with the overall coordination of Cindy Holleman, the Editor of the publication, and the overall guidance of Máximo Torero Cullen, all of whom are from the FAO Economic and Social Development Stream (ES). The development of the report was guided by a Steering Committee consisting of agency representatives from the five co-publishing partners: Marco V. Sánchez Cantillo (Chair), Sara Savastano (IFAD), Victor Aguayo (UNICEF), Arif Husain (WFP) and Francesco Branca (WHO). Alessandra Garbero and Tisorn Songsermsawas (IFAD), Chika Hayashi and Jo Jewell (UNICEF), Eric Branckaert and Saskia de Pee (WFP) and Marzella Wüstefeld (WHO) contributed to the coordination and provided technical support. Valuable comments and final approval of the report were provided by the executive heads and senior staff of the five co-authoring agencies. Chapter 1 of the report was written by Cindy Holleman with inputs from Marco V. Sánchez Cantillo and José Rosero Moncayo (FAO). Chapter 2 of the report was coordinated by Anne Kepple (FAO). Section 2.1 was prepared by Carlo Cafiero with inputs from Piero Conforti, Valentina Conti, Juan Feng, Cindy Holleman, Anne Kepple and Sara Viviani (FAO). Section 2.2 was prepared by Chika Hayashi, Richard Kumapley, Vrinda Mehra and Ann Mizumoto (UNICEF) and Elaine Borghi and Monica Flores Urrutia (WHO), with input from Anne Kepple (FAO), Julia Krasevec (UNICEF), and Katrina Lundberg, Juan Pablo Peña-Rosas and Marzella Wüstefeld (WHO). Section 2.3 was prepared by Carlo Cafiero (FAO); Chika Hayashi, Julia Krasevec, Richard Kumapley, Vrinda Mehra (UNICEF); and Elaine Borghi (WHO), with input from Anne Kepple (FAO), Saskia de Pee (WFP) and Monica Flores Urrutia and Katrina Lundberg (WHO). Olivier Lavagne d’Ortigue (FAO) provided support for data visualization and José Rosero Moncayo (FAO) provided editorial support and input to Sections 2.1 and 2.3. Nona Reuter (UNICEF) provided support for data visualization in Sections 2.2 and 2.3. Chapter 3 of the report was coordinated and written by Cindy Holleman and Valentina Conti (FAO), with input from Aurelien Mellin and Trudy Wijnhoven (FAO); Aslihan Arslan, Romina Cavatassi, Ilaria Firmian, Stefania Gnoato, Caterina Ruggeri Laderchi, Tisorn Songsermsawas, Isabelle Stordeur and Sakiusa Tubuna (IFAD); Chika Hayashi and Jo Jewell (UNICEF); Eric Branckaert, Saskia de Pee, Simone Gie and Sarah Piccini (WFP); and Elaine Borghi, Karen McColl, Leanne Margaret Riley and Marzella Wüstefeld (WHO). Updated agro-climate analysis and prevalence of undernourishment change point detection were provided by Maria Dimou, Michele Meroni, Felix Rembold, Anne-Claire Thomas, Andrea Toreti, Ferdinando Urbano and Matteo Zampieri (European Commission – Joint Research Centre), while updates to climatology indicators were provided by Christopher Jack with inputs from Olivier Crespo and Pierre Kloppers (University of Cape Town). Marco V. Sánchez Cantillo provided editorial support to the sections of this chapter. Chapter 4 of the report was coordinated and written by Mark Smulders and Giovanni Carrasco Azzini (FAO), with input from Melisa Aytekin, Luisa Castañeda, Mariana Estrada, Yon Fernandez de Larrinoa, Ileana Grandelis, Cindy Holleman, Julius Jackson, Susan Kaaria, Lourdes Orlando, Marzia Pafumi, Luana Swensson, Mikaila Way and Trudy Wijnhoven (FAO); Tarek Ahmed, Daniel Anavitarte, Ilaria Bianchi, Antonella Cordone, Isabel de la Peña, Aolin Gong, Caterina Ruggeri Laderchi, Joyce Njoro, Karla Sofia | ix |  ACKNOWLEDGEMENTS Pita Vidal and Tisorn Songsermsawas (IFAD); Jo Jewell (UNICEF); Eric Branckaert, Saskia de Pee, Simone Gie and Sarah Piccini (WFP); and Maria De Las Nieves Garcia Casal, Katrin Engelhardt, Hyun Jin Kim, Karen McColl, Benn McGrady, Kathryn Robertson and Marzella Wüstefeld (WHO). Further inputs to Chapter 4 were received from FAO, IFAD, UNICEF, WFP and WHO colleagues, as well as technical experts around the world in response to a global call for “best practices in transforming food systems for affordable healthy diets and addressing key drivers of food insecurity and malnutrition”. Inputs were also provided by Grahame Dixie and Erin Sweeney from Grow Asia. More than 80 development institutions and individuals worldwide responded to a similar call for best practices in transforming food systems through the Global Forum on Food Security and Nutrition (FSN Forum), facilitated by Svetlana Livinets and Elise Polak (FAO). Chapter 4 also drew lessons from an expert panel through an online webinar organized by the FSN Forum. The panellists included: Tim Benton (Chatham House), Michael Carter (University of California, Davis), Jessica Fanzo (Johns Hopkins University), Ndidi Nwuneli (Sahel Consulting), David Spielman (International Food Policy Research Institute [IFPRI]) and Robert Townsend (World Bank). Marco V. Sánchez Cantillo provided editorial support to the sections of this chapter. Chapter 5 of the report was written by Marco V. Sánchez Cantillo with inputs from Cindy Holleman and José Rosero Moncayo (FAO). Numerous colleagues from different technical units and departments across the five co-publishing agencies provided valuable technical comments and input to the report. An agency-wide technical clearance process facilitated a comprehensive review by many technical experts from the five co-authoring agencies. Listing each of the contributions would be challenging and furthermore increase the risk of important omissions. Juan Feng, Abdul Sattar and Sara Viviani were responsible for preparing undernourishment and food security data with input from Verónica Boero, Marinella Cirillo, Filippo Gheri, Adeeba Ishaq, Talent Manyani, Ana Moltedo, María Rodríguez, Firas Yassin and under the supervision of Carlo Cafiero in Section 2.1. Supporting data were provided by the Food Balance Sheets team, led by Salar Tayyib of the FAO Statistics Division (ESS). Valentina Conti and Cindy Holleman (FAO) were responsible for preparing the analysis of the cost and affordability of healthy diets in Section 2.1, with input from Yan Bai, Leah Costlow, Alissa Ebel, Anna Herforth, William A. Masters and Aishwarya Venkat (Tufts University), and Piero Conforti, Jean Marie Vianney Munyeshyaka and Michele Vollaro (FAO). Richard Kumapley (UNICEF) was responsible for consolidating the nutrition data in Section 2.2, with input from Chika Hayashi, Julia Krasevec and Vrinda Mehra (UNICEF), and Elaine Borghi, Monica Flores Urrutia and Leanne Riley (WHO). Carlo Cafiero prepared the 2030 projections of undernourishment with input from Juan Feng, Adeeba Ishaq and Abdul Sattar (FAO) in Section 2.3. David Laborde generated key input for the 2030 projected scenarios of undernourishment as part of a research collaboration with IFPRI. Chika Hayashi and Richard Kumapley (UNICEF) and Elaine Borghi and Giovanna Gatica Dominguez (WHO) were responsible for the analyses in Section 2.3 and Annex 2, including on progress towards global nutrition targets and of the potential impact of the COVID-19 pandemic on child stunting and wasting by 2030, with input from Julia Krasevec and Vrinda Mehra (UNICEF). Support for report production came from Giovanni Carrasco Azzini, Andrew Park (consulting editor) and Daniela Verona in the FAO Economic and Social Development Stream. The FAO Meeting Branch and Language Services Branch of Governing Bodies Servicing Division (CSG) carried out the translations, in addition to the contributors mentioned above. The Publishing Group (OCCP) of the FAO’s Office of Communications provided editorial support, design and layout, as well as production coordination, for editions in all six official languages. | x |  ACRONYMS AND ABBREVIATIONS AARR Average annual rate of reduction ADER Average dietary energy requirement ASAP Anomaly Hotspots of Agriculture Production ASEAN Association of Southeast Asian Nations BMI Body mass index CGE Computable general equilibrium CH Cadre Harmonisé (harmonized framework) CHIRPS Climate Hazards Group Infrared Precipitation with Stations CPI Consumer price index CRED Centre for Research on the Epidemiology of Disasters CSA Climate-smart agriculture CV Coefficient of variation CV|r CV due to energy requirements CV|y CV due to income DEC Dietary energy consumption DES Dietary energy supply ECMWF European Centre for Medium-Range Weather Forecasts FAO Food and Agriculture Organization of the United Nations FBDGs Food-based dietary guidelines FBS Food Balance Sheet FIES Food Insecurity Experience Scale FImod+sev Prevalence of moderate or severe food insecurity FIsev Prevalence of severe food insecurity GDP Gross domestic product GHG Greenhouse gas GWP Gallup World Poll HCES Household Consumption and Expenditure Survey HDP Humanitarian-development-peace HGSF Home-grown school feeding IDP Internally displaced person IFAD International Fund for Agricultural Development ILO International Labour Organization IMF International Monetary Fund IPC Integrated Food Security Phase Classification IQ Intelligence quotient JME Joint Malnutrition Estimates LIFDCs Low-income food-deficit countries LMICs Low- and middle-income countries MDD Minimum Dietary Diversity MDD-W Minimum Dietary Diversity for Women MDER Minimum dietary energy requirement MIRAGRODEP Modelling International Relations under Applied General Equilibrium MPP Mountain Partnership Products NCD Non-communicable disease NoU Number of undernourished PoU Prevalence of undernourishment PPP Purchasing power parity PPPP Public-private-producer partnership SD Standard deviation SDGs Sustainable Development Goals SMEs Small and medium-sized enterprises UCDP Uppsala Conflict Data Program UNICEF United Nations Children's Fund USD United States dollar VCC Virtual call centre WEAI Women’s Empowerment in Agriculture Index WEO World Economic Outlook WFP World Food Programme WHA World Health Assembly WHO World Health Organization | xi |  KEY MESSAGES è Well before the COVID-19 pandemic, we were already not on track to meet our commitments to end world hunger and malnutrition in all its forms by 2030. Now, the pandemic has made this significantly more challenging. This report presents the first global assessment of food insecurity and malnutrition for 2020 and highlights the need for a deeper reflection on how to better address the global food security and nutrition situation. è World hunger increased in 2020 under the shadow of the COVID-19 pandemic. After remaining virtually unchanged for five years, the prevalence of undernourishment (PoU) increased 1.5 percentage points in just one year – reaching a level of around 9.9 percent, heightening the challenge of achieving the Zero Hunger target by 2030. è It is projected that between 720 and 811 million people in the world faced hunger in 2020. Considering the middle of the projected range (768 million), around 118 million more people were facing hunger in 2020 than in 2019 – or as many as 161 million more, considering the upper bound of the range. è More than half of the world’s undernourished are found in Asia (418 million) and more than one-third in Africa (282 million). Compared with 2019, about 46 million more people in Africa, 57 million more in Asia, and about 14 million more in Latin America and the Caribbean were affected by hunger in 2020. è New projections confirm that hunger will not be eradicated by 2030 unless bold actions are taken to accelerate progress, especially actions to address inequality in access to food. All other things constant, around 660 million people may still face hunger in 2030 in part due to lasting effects of the pandemic on global food security – 30 million more people than in a scenario in which the pandemic had not occurred. è While the global prevalence of moderate or severe food insecurity (measured using the Food Insecurity Experience Scale) has been slowly on the rise since 2014, the estimated increase in 2020 was equal to that of the previous five years combined. 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. è Close to 12 percent of the global population was severely food insecure in 2020, representing 928 million people – 148 million more than in 2019. è At the global level, the gender gap in the prevalence of moderate or severe food insecurity has grown even larger in the year of the COVID-19 pandemic, with the prevalence of moderate or severe food insecurity being 10 percent higher among women than men in 2020, compared to 6 percent in 2019. è 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, especially the poor, in every region of the world in 2019. This number is slightly less than in 2017 and will likely increase in most regions in 2020 due to the COVID-19 pandemic. è Shifting to healthy diets that include sustainability considerations can contribute to reducing health and climate change costs by 2030, because the hidden costs of these diets are lower compared with those of current consumption patterns. è Globally, malnutrition in all its forms also remains a challenge. Although, it is not yet possible to fully account for the impact of the COVID-19 pandemic due to data limitations, in 2020 it is estimated that 22.0 percent (149.2 million) of children under 5 years of age were affected by stunting, 6.7 percent (45.4 million) were suffering from wasting and 5.7 percent (38.9 million) were overweight. The actual figures, particularly for stunting and wasting, are expected to be higher due to the effects of the pandemic. | xii |  è Most children with malnutrition live in Africa and Asia. These regions account for more than nine out of ten of all children with stunting, more than nine out of ten children with wasting and more than seven out of ten children who are affected by overweight worldwide. è An estimated 29.9 percent of women aged 15 to 49 years in 2019 around the world are affected by anaemia – now a Sustainable Development Goal (SDG) Indicator (2.2.3). However, the data reveal stark regional differences: more than 30 percent of women in Africa and Asia were affected by anaemia, compared with only 14.6 percent of women in Northern America and Europe. Adult obesity is increasing sharply in all regions. è Globally, 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 or the situation is worsening. è 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. These will be compounded through the intergenerational effects of malnutrition and the resulting impacts on productivity. Exceptional efforts are required to address and overcome the effects of the pandemic as part of accelerating progress towards achieving SDG Target 2.2. è Conflict, climate variability and extremes, and economic slowdowns and downturns (now exacerbated by COVID-19 pandemic) are major drivers of food insecurity and malnutrition that continue to increase in both frequency and intensity, and are occurring more frequently in combination. è The reversal in the PoU trends in 2014 and continuous increase, especially pronounced in low- and middle-income countries from 2017, are largely attributed to countries affected by conflict, climate extremes and economic downturns, and to countries with high income inequality. è Between 2017 and 2019, the PoU increased by 4 percent in countries affected by one or more of these major drivers while it decreased by 3 percent in countries not affected by them. While middle-income countries affected by these drivers registered only a 2 percent increase in the PoU, the increase for those with high income inequality was double – 4 percent. è In the same period, countries affected by multiple drivers exhibited the highest increases in the PoU, 12 times larger than those in countries affected by only a single driver. è Drivers that are external (e.g. conflicts or climate shocks) and internal (e.g. low productivity and inefficient food supply chains) to food systems are pushing up the cost of nutritious foods which, combined with low incomes, are increasing the unaffordability of healthy diets. The percentage of the population who cannot afford a healthy diet in countries affected by multiple drivers in 2019 was 39 percent and 66 percent higher, respectively, than in countries affected by a single driver or no driver at all. Increases in the unaffordability of a healthy diet are associated with higher levels of food insecurity, especially among lower-middle-income countries. è In 2020, almost all low- and middle-income countries were affected by pandemic-induced economic downturns, and the increase in their number of undernourished was more than five times greater than the highest increase in undernourishment in the last two decades. When those countries were also affected by other drivers, particularly climate-related disasters, conflict, or a combination, the largest increase in undernourishment was seen in Africa, followed by Asia. | xiii |