Food as a global health and social priority

In 2022, WHO warned of an imminent food security crisis in the Greater Horn of Africa. At the time, an estimated 37 million people in the region were acutely food insecure, a product of several years of extreme drought, economic shocks, conflict, and resulting displacement. The humanitarian response so far has been sufficient to avoid a famine being declared, but this does not mean that disaster was averted—by one estimate, 43 000 people died as a result of drought in Somalia in 2022. Although rains from March to May, 2023, have been better than expected, minorly improving food security, they have also led to severe flooding, with more than 250 000 people in Somalia displaced. New data from WHO for 2023 make for dispiriting reading: the number of people who are highly food insecure in the Greater Horn has grown to almost 60 million, and more than 80 000 people in South Sudan and Somalia are on the brink of starvation unless they receive emergency support. Even if future rains improve, recovery will take many years and the region is vulnerable to further shocks. Livelihoods across the region have been disrupted or destroyed. The UN High Commissioner for Refugees estimate that the emergency has created around 5 million refugees, and internally displaced 12·2 million. As a result of the prolonged drought, many countries in the Horn of Africa are reliant on imported wheat. The Black Sea Grain Initiative, an agreement signed between Ukraine and Russia in July, 2022, to allow grain to leave Ukrainian ports, ensured the shipment of crucial supplies to meet demand. With the opening of other shipping routes and favourable production outputs in other countries, Russia's suspension of the deal in July, 2023, had only a temporary impact on wheat prices, although long-term security remains uncertain—conflicts, periodic global weather events like El Niño, and climate change all threaten the food security of countries importing staple food. As one of the global regions with the highest levels of poverty and deprivation, and a high number of households dependent on agriculture and pastoralism, the Greater Horn of Africa is acutely vulnerable to disrupted rain seasons; droughts are historically common. New modelling suggests that the higher temperatures caused by climate change have made extreme droughts in the region at least 100 times more likely. Governments, non-governmental organisations, and aid networks will need to prepare for substantially longer and more severe droughts. Funding such preparations seems a difficult prospect when much of the region cannot meet the funding requirements even to prevent the current situation from worsening—for instance, just 27% of the US$4 billion UN Humanitarian Response Plan for Ethiopia in 2023 has been funded, with 69% of the money raised coming from the USA alone. In areas of food insecurity, outbreaks of communicable diseases—eg, measles and cholera—reflect not only displacement and disruptions to sanitation, routine healthcare, and vaccinations, but also the comorbid role of malnutrition in many globally important infections. People living with HIV have substantially higher energy requirements than people who are not infected, and food insecurity and undernutrition are common. Those who are malnourished are at greater risk of coinfections. New data emphasise the potential of food as medicine. In the RATIONS trial, done in a population in India with high rates of undernutrition, household contacts of patients with confirmed pulmonary tuberculosis who received food rations had a 39% lower incidence of disease compared with contacts who did not receive rations. Such an effect for a multifaceted treatment costing only $4·75 a month per person is both remarkable and unsurprising. When the UN General Assembly meet on Sept 22, 2023, to discuss the ongoing fight against tuberculosis, the importance of nutritional intervention as a simple, effective means of preventing the disease—and likely many others—must be emphasised. Acting early, whether the goal is to prevent disease, avert famine, or prevent global warming-induced droughts, is crucial for saving lives and improving outcomes. It is also cost-effective. In the wake of the 2017–18 Horn of Africa drought, which was met by a relatively rapid and robust humanitarian response, the US Agency for International Development estimated that proactive responses initiated before food prices destabilised could cut donor costs by 30% while protecting incomes and livestock in affected areas. We urge the scale-up of global funding to improve food security and promote climate resilience. Robust research to design better early warning systems, respond more effectively to potential crises, and define the benefits of nutritional interventions will be crucial to solidify political will. For more on drought-related deaths in Somalia see https://www.unicef.org/press-releases/new-study-finds-43000-excess-deaths-may-have-occurred-2022-drought-somaliaFor WHO 2023 food insecurity data see https://www.who.int/publications/m/item/snapshot--greater-horn-of-africa-food-insecurity-and-health---grade-3-emergency--12-july-2023For estimates of refugee numbers see https://data.unhcr.org/en/documents/details/102234For the Black Sea Grain Initiative see https://reliefweb.int/attachments/8bf395f9-b2bc-4343-b7af-7277ca948c5f/WFP-0000151887.pdfFor the role of climate change in droughts in the Horn of Africa see https://public.wmo.int/en/media/news/climate-change-made-horn-of-africa-drought-and-mediterranean-heat-%E2%80%9C100-times-more-likely%E2%80%9DFor UN Humanitarian Response Plan for Ethiopia funding see https://fts.unocha.org/appeals/1128/summaryFor the UN tuberculosis meeting see https://www.who.int/publications/m/item/scope-modalities-format-and-organization-of-the-high-level-meeting-on-the-fight-against-tuberculosis-draft-resolution-submitted-by-the-president-of-the-general-assemblyFor the role of proactive responses see https://agrilinks.org/sites/default/files/summary_economics_of_resilience_es_final_jan_4_2018_-_branded.pdf For more on drought-related deaths in Somalia see https://www.unicef.org/press-releases/new-study-finds-43000-excess-deaths-may-have-occurred-2022-drought-somalia For WHO 2023 food insecurity data see https://www.who.int/publications/m/item/snapshot--greater-horn-of-africa-food-insecurity-and-health---grade-3-emergency--12-july-2023 For estimates of refugee numbers see https://data.unhcr.org/en/documents/details/102234 For the Black Sea Grain Initiative see https://reliefweb.int/attachments/8bf395f9-b2bc-4343-b7af-7277ca948c5f/WFP-0000151887.pdf For the role of climate change in droughts in the Horn of Africa see https://public.wmo.int/en/media/news/climate-change-made-horn-of-africa-drought-and-mediterranean-heat-%E2%80%9C100-times-more-likely%E2%80%9D For UN Humanitarian Response Plan for Ethiopia funding see https://fts.unocha.org/appeals/1128/summary For the UN tuberculosis meeting see https://www.who.int/publications/m/item/scope-modalities-format-and-organization-of-the-high-level-meeting-on-the-fight-against-tuberculosis-draft-resolution-submitted-by-the-president-of-the-general-assembly For the role of proactive responses see https://agrilinks.org/sites/default/files/summary_economics_of_resilience_es_final_jan_4_2018_-_branded.pdf The world is failing on hungerIn September, 2015, the UN adopted the Sustainable Development Goal of achieving zero hunger by 2030. As the halfway point approaches, that target seems distant. In August, 2022, WHO warned that the Greater Horn of Africa, comprising Djibouti, Somalia, Sudan, South Sudan, Ethiopia, Uganda, and Kenya, faced a disastrous and unprecedented food crisis. WHO estimates that more than 37 million people in the region are acutely food insecure, and 7 million children are acutely malnourished. Full-Text PDF Nutritional supplementation to prevent tuberculosis incidence in household contacts of patients with pulmonary tuberculosis in India (RATIONS): a field-based, open-label, cluster-randomised, controlled trialTo our knowledge, this is the first randomised trial looking at the effect of nutritional support on tuberculosis incidence in household contacts, whereby the nutritional intervention was associated with substantial (39–48%) reduction in tuberculosis incidence in the household during 2 years of follow-up. This biosocial intervention can accelerate reduction in tuberculosis incidence in countries or communities with a tuberculosis and undernutrition syndemic. Full-Text PDF