11/08/2020 globalhungerindex.org  45 min 🇬🇧 #177890

2019 Global Hunger Index by Severity

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2019 Global Hunger Index Results - Global, Regional, and National Trends

  • Extremely alarming ≥ 50.0
  • Alarming 35.0-49.9
  • Serious 20.0-34.9
  • Moderate 10.0-19.9
  • Low ≤ 9.9
  • Insufficient data, significant concern*
  • Not included or insufficient data**

* See  Box 2.1 for details
**See  About section for details

2019 Global Hunger Index by Severity

Source: Authors. Note: For the 2019 GHI, data on the proportion of undernourished are for 2016-2018; data on child stunting and wasting are for the latest year in the period 2014-2018 for which data are available; and data on child mortality are for 2017. GHI scores were not calculated for countries for which data were not available and for certain high-income countries, countries with small populations, and non-independent territories; see  About section for details. The boundaries and names shown and the designations used on this map do not imply official endorsement or acceptance by Welthungerhilfe or Concern Worldwide.

Explore Country-Level Data (2019)

Note: Rankings and index scores from this table cannot be accurately compared to rankings and index scores from previous reports (see  About section).
Countries that have identical 2019 scores are given the same ranking (for example, Mexico and Tunisia are both ranked 23rd). The following countries could not be included because of lack of data:  Bahrain,  Bhutan,  Burundi,  Comoros, the  the Democratic Republic of the Congo,  Equatorial Guinea,  Eritrea,  Libya,  Moldova,  Papua New Guinea,  Qatar,  Somalia,  South Sudan, the  Syrian Arab Republic, and  Tajikistan. The 17 countries with 2019 GHI scores of less than 5 are not assigned individual ranks, but rather are collectively ranked 1-17. Differences between their scores are minimal.

Order AlphabeticallyOrder by 2019 GHI Score

001  Belarus (>5)
001  Bosnia & Herzegovina (>5)
001  Bulgaria (>5)
001  Chile (>5)
001  Costa Rica (>5)
001  Croatia (>5)
001  Cuba (>5)
001  Estonia (>5)
001  Kuwait (>5)
001  Latvia (>5)
001  Lithuania (>5)
001  Montenegro (>5)
001  Romania (>5)
001  Slovak Republic (>5)
001  Turkey (>5)
001  Ukraine (>5)
001  Uruguay (>5)
018  Brazil (5.3)
019  Argentina (5.4)
020  Kazakhstan (5.5)
021  North Macedonia (5.6)
022  Russian Federation (5.8)
023  Mexico (6.2)
024  Tunisia (6.2)
025  China (6.5)
026  Serbia (6.5)
027  Colombia (6.7)
028  Albania (7)
029  Azerbaijan (7.4)
030  Armenia (7.8)
031  Iran (7.9)
032  Jamaica (8.2)
033  Paraguay (8.3)
034  Saudi Arabia (8.5)
035  Kyrgyz Republic (8.8)
036  Peru (8.8)
037  Fiji (8.9)
038  Trinidad & Tobago (9.1)
039  Dominican Republic (9.2)
040  Georgia (9.2)
041  Panama (9.2)
042  Morocco (9.4)
043  El Salvador (9.6)
044  Mauritius (9.6)
045  Mongolia (9.7)
046  Thailand (9.7)
047  Algeria (10.3)
048  Jordan (10.5)
049  Uzbekistan (10.7)
050  Suriname (10.8)
051  Ecuador (11.3)
052  Oman (11.4)
053  Lebanon (11.6)
054  Turkmenistan (11.8)
055  Guyana (12.6)
056  Honduras (12.9)
057  Malaysia (13.1)
058  Nicaragua (13.3)
059  Ghana (14)
060  South Africa (14)
061  Egypt (14.6)
062  Viet Nam (15.3)
063  Bolivia (15.4)
064  Gabon (15.8)
065  Venezuela (16.9)
066  Sri Lanka (17.1)
067  Senegal (17.9)
068  Iraq (18.7)
069  Myanmar (19.8)
070  Indonesia (20.1)
071  Philippines (20.1)
072  Guatemala (20.6)
073  Nepal (20.8)
074  Eswatini (20.9)
075  Gambia (21.8)
076  Cameroon (22.6)
077  Cambodia (22.8)
078  Malawi (23)
079  Lesotho (23.2)
080  Botswana (23.6)
081  Togo (23.9)
082  Benin (24)
083  Mali (24.1)
084  Cote d'Ivoire (24.9)
085  Namibia (24.9)
086  Kenya (25.2)
087  Lao PDR (25.7)
088  Bangladesh (25.8)
089  Burkina Faso (25.8)
090  Mauritania (26.7)
091  Guinea (27.4)
092  North Korea (27.7)
093  Nigeria (27.9)
094  Pakistan (28.5)
095  Tanzania (28.6)
096  Mozambique (28.8)
097  Ethiopia (28.9)
098  Rwanda (29.1)
099  Guinea-Bissau (29.6)
100  Angola (29.8)
101  Niger (30.2)
102  India (30.3)
103  Sierra Leone (30.4)
104  Uganda (30.6)
105  Djibouti (30.9)
106  Congo, Rep. (31)
107  Sudan (32.8)
108  Afghanistan (33.8)
109  Zimbabwe (34.4)
110  Timor-Leste (34.5)
111  Haiti (34.7)
112  Liberia (34.9)
113  Zambia (38.1)
114  Madagascar (41.5)
115  Chad (44.2)
116  Yemen, Rep. (45.9)
117  Central African Republic (53.6)

The World

About image Photo: Helvetas/Simon B. Opladen 2013; Leandro Ortega Rivas and his son, Armando Ortega Gamaura, display a sample of their quinoa harvest in the Bolivian Altiplano. Here they receive advice from a yapuchiri, an expert farmer who integrates traditional knowledge, new insights, and groundbreaking technologies for disaster risk reduction and climate change adaptation.  Hide

The 2019 Global Hunger Index (GHI) indicates that the level of hunger and undernutrition worldwide falls on the cusp of the moderate and serious categories, at a value of 20.0 (Figure 2.1). This value reflects a decline in the global GHI score in each period examined since 2000, when the global GHI score was 29.0 and fell into the serious category. Underlying this improvement are reductions in each of the four GHI indicators - undernourishment, child stunting, child wasting, and child mortality-since 2000.

This achievement is no small feat. It coincides with a decline in poverty at the global level from 28.6 percent in 1999 to 9.9 percent in 2015 (World Bank 2019a). Poverty and hunger are closely correlated, with each influencing the other (Barrett and Lentz 2016; Headey 2013). Furthermore, the global development community and individual countries have made concerted efforts in recent years to address undernutrition, as evidenced by the increased funding for nutrition initiatives worldwide. However, current action and spending are still insufficient to reach the global nutrition targets to which countries have declared their commitment. It is estimated that an additional US$70 billion beyond current budget expectations over 10 years is needed to achieve the global targets for child stunting, anemia in women, exclusive breastfeeding, and the scaling up of treatment for severe  child wasting. While ambitious in some regards, this amount should be attainable considering the overwhelming benefits expected from these investments (Shekar et al. 2017).

The reduction in GHI scores at the global scale brings into sharper focus the many challenges that remain in the fight against hunger and undernutrition. Extreme climatic events, violent conflicts, wars, and economic slowdowns and crises continue to drive hunger in many parts of the world (FSIN 2019; FAO et al. 2019). Inequalities within country borders allow hunger and undernutrition to persist even in countries that appear to do well according to national averages. The prevalence of undernourishment-the percentage of the population without regular access to adequate calories-has stagnated since 2015, and the number of people who are hungry has actually risen to 822 million from 785 million in 2015 (FAO et al. 2019).

There is still much work to be done before hunger and undernutrition can be eradicated for good. This page provides an overview of the current situation at regional, national, and subnational levels. The  essay for 2019 complements this overview by describing the effects of climate change on food and nutrition security now and in the future. To address the current challenges while also preparing to sustainably feed a world population expected to number about 10 billion by 2050, monumental changes to the global food system are needed (Willett et al. 2019). The reduction in GHI scores since 2000 demonstrates that hunger and undernutrition are not immutable problems and serves as cause for cautious optimism. In many countries, however, progress is too slow to be able to achieve the  second Sustainable Development Goal-known in short as Zero Hunger-by  2030. At the current pace, approximately 45 countries will fail even to reach low hunger as defined by the GHI Severity Scale by 2030. It is now essential to double down on the task of reducing hunger and undernutrition in the many parts of the world that are faltering.

The Regions

About image Photo: Helvetas/Simon B. Opladen 2008; Rupa Chaudari waters seedlings in a riverbed in Nepal. Women, who carry out a large share of agricultural labor worldwide, are often particularly vulnerable to the impacts of climate change. Their knowledge and roles in communities are key to developing adaptation strategies.  Hide

Figure 2.1

GLOBAL AND REGIONAL 2000, 2005, 2010, AND 2019 GLOBAL HUNGER INDEX SCORES, WITH CONTRIBUTION OF COMPONENTS

Source: Authors.
Note: See Appendix B for data sources. The regional and global GHI scores are calculated using regional and global aggregates for each indicator and the formula described in Appendix A. The regional and global aggregates for each indicator are calculated as population-weighted averages, using the indicator values reported in Appendix C. For countries lacking undernourishment data, provisional estimates provided by the Food and Agriculture Organization of the United Nations (FAO) were used in the calculation of aggregates only, but are not reported in Appendix C.

At the regional level, South Asia and Africa South of the Sahara have the highest 2019 GHI scores in the world, at 29.3 and 28.4, respectively (Figure 2.1 above). These scores indicate serious levels of hunger according to the  GHI Severity Scale. In contrast, the 2019 GHI scores of Eastern Europe and the Commonwealth of Independent States, Latin America and the Caribbean, East and Southeast Asia, and the Near East and North Africa range from 6.6 to 13.3, indicating low or moderate hunger levels.

South Asia's high GHI score is driven by its high rates of child undernutrition. The child stunting rate for the region is 37.6 percent, and the child wasting rate is 17.5 percent; both are the highest levels of any region in this report. In South Asia, the key factors that contribute to stunting are poor infant and young child feeding practices, poor nutrition among women before and during pregnancy, and poor sanitation practices (Smith and Haddad 2015). A study of six South Asian countries found that a lower maternal body mass index was significantly associated with child wasting in five of the six countries. Inadequate access to improved water sources and low family wealth were also associated with child wasting in some countries, but not systematically so. Because a reduction in poverty does not necessarily imply adequate access to improved water sources and sanitation, poverty alleviation policies may not be sufficient to reduce child wasting (Harding, Aguayo, and Webb 2018).

Because of its large population, India's GHI indicator values have an outsized impact on the indicator values for the region. India's child wasting rate is extremely high at 20.8 percent-the highest wasting rate of any country in this report for which data or estimates were available. Its child stunting rate, 37.9 percent, is also categorized as very high in terms of its public health significance (de Onis et al. 2019). In India, just 9.6 percent of all children between 6 and 23 months of age are fed a  minimum acceptable diet. As of 2015-2016, 90 percent of Indian households used an improved drinking water source while 39 percent of households had no sanitation facilities (IIPS and ICF 2017). In 2014 the prime minister instituted the "Clean India" campaign to end open defecation and ensure that all households had latrines. Even with new latrine construction, however, open defecation is still practiced. This situation jeopardizes the population's health and consequently children's growth and development as their ability to absorb nutrients is compromised (Ngure et al. 2014; Caruso et al. 2019).

Outside of India, two countries in South Asia have made significant advances in child nutrition, and their experiences are instructive. A 2015 study sought to identify the reasons behind the decline in stunting in Bangladesh at the national level from 58.5 percent in 1997 to 40.2 percent in 2011 (Headey et al. 2015). The study attributed the decrease primarily to rising household wealth associated with pro-poor economic growth and gains in parental education, as well as health, sanitation, and demographic factors reflecting decreased fertility rates. The authors conclude that success in this area can be achieved with robust economic growth and attention to "nutrition-sensitive" sectors such as education, sanitation, and health. Nepal's remarkable reduction in child stunting from 56.6 percent in 2001 to 40.1 percent in 2011 is associated with, and likely attributable to, increased household assets (a proxy for household wealth), increased maternal education, improved sanitation, and implementation and use of health and nutrition programs, including antenatal and neonatal care (Headey and Hoddinott 2015).

In Africa South of the Sahara, the region's high GHI score is driven up by its undernourishment and child mortality rates, which are the highest of any region, at 22.3 and 7.5 percent, respectively. Meanwhile, its child stunting rate, 34.6 percent, is nearly as high as that of South Asia. Perhaps most troubling is that while the prevalence of undernourishment consistently declined between 1999-2001 and 2013-15, it has since reversed course and begun to rise (FAO 2019b).

Africa South of the Sahara is the region of the world with the highest percentage of the population employed in agriculture, at 55 percent, yet agriculture in the region faces enormous challenges (World Bank 2019a). Governments invest too little in agriculture: most countries fail to meet the Comprehensive Africa Agriculture Development Programme target of directing 10 percent of government spending to agriculture (Shimeles, Verdier-Chouchane, and Boly 2018). Farmers' use of agricultural inputs is inadequate-fertilizer use, for example, is lower in Africa South of the Sahara than in any other region (World Bank 2019b). Use of irrigation is very low, and most farmers are dependent on rainfed agriculture, leaving them extremely vulnerable to drought and changing rain patterns. Access to and use of tractors and mechanization are also extremely limited (Sheahan and Barrett 2018). Because of these and other factors, Africa South of the Sahara has the world's lowest agricultural productivity, as measured by cereal output per hectare (World Bank 2019b). Low productivity combined with high levels of poverty means that households' access to food is constrained in terms of both their own production and their ability to purchase food in the market. Compounding the ongoing challenges facing agriculture and food production in Africa South of the Sahara, extreme climate events such as the 2015-2016 El Niño drought and ongoing violent conflicts in many countries have intensified food insecurity in the region.

While hunger, in the sense of insufficient access to calories, is a pressing concern in Africa South of the Sahara, it has the potential to overshadow key nutritional concerns, including child undernutrition. Of 43 countries in the region with data or estimates on stunting for 2014-2018, 21 have stunting rates over 30 percent (considered very high in terms of public health significance) and an additional 19 countries have stunting rates between 20 and 30 percent (high). Two countries, Sudan and Djibouti, have wasting levels exceeding 15 percent (very high), 6 countries have wasting rates between 10 and 15 percent (high), and an additional 21 countries have wasting rates between 5 and 10 percent (medium) (de Onis et al. 2019).

The Countries

About image Photo: Concern/Gavin Douglas 2019; Patrick Ghembo stands in his maize field in Monyo Village, Malawi, his harvest destroyed by Cyclone Idai. He returned to his farm to fish in order to feed his family, who lived in a temporary camp for displaced people.  Hide

Table 2.1

GLOBAL HUNGER INDEX SCORES BY 2019 GHI RANK

 Rank Country 2000 2005 2010 2019
117 Central African Republic 50.7 49.5 42.0 53.6
116 Yemen 43.2 41.7 34.5 45.9
115 Chad 51.5 52.1 50.9 44.2
114 Madagascar 43.2 43.4 36.2 41.5
113 Zambia 52.3 46.0 42.8 38.1
112 Liberia 48.6 42.4 36.0 34.9
111 Haiti 42.7 45.1 48.8 34.7
110 Timor-Leste - 41.8 42.3 34.5
109 Zimbabwe 39.1 39.6 35.8 34.4
108 Afghanistan 52.1 43.2 34.3 33.8
107 Sudan - - - 32.8
106 Congo, Rep. 37.3 37.1 32.0 31.0
105 Djibouti 46.9 43.9 36.6 30.9
104 Uganda 38.9 33.0 30.8 30.6
103 Sierra Leone 53.6 51.1 40.8 30.4
102 India 38.8 38.9 32.0 30.3
101 Niger 52.1 42.4 36.6 30.2
100 Angola 65.1 50.3 38.6 29.8
99 Guinea-Bissau 42.1 40.3 31.0 29.6
98 Rwanda 56.6 44.0 32.4 29.1
97 Ethiopia 55.9 46.0 37.4 28.9
96 Mozambique 49.9 42.3 35.3 28.8
95 Tanzania 42.2 35.9 34.1 28.6
94 Pakistan 38.3 37.0 35.9 28.5
93 Nigeria 40.8 34.2 29.9 27.9
92 North Korea 40.3 32.9 30.9 27.7
91 Guinea 43.6 36.8 30.7 27.4
90 Mauritania 33.4 30.6 24.9 26.7
88 Burkina Faso 46.3 48.1 36.8 25.8
88 Bangladesh 36.1 30.7 30.3 25.8
87 Lao PDR 47.7 35.9 30.5 25.7
86 Kenya 36.9 32.7 27.6 25.2
84 Namibia 30.7 28.4 30.6 24.9
84 Côte d'Ivoire 33.8 35.3 30.9 24.9
83 Mali 44.2 38.4 27.4 24.1
82 Benin 36.7 33.3 28.3 24.0
81 Togo 39.3 37.0 27.2 23.9
80 Botswana 33.4 31.5 28.1 23.6
79 Lesotho 33.1 30.4 26.2 23.2
78 Malawi 44.5 37.7 31.1 23.0
77 Cambodia 43.6 29.4 27.6 22.8
76 Cameroon 39.7 33.7 26.2 22.6
75 Gambia 27.5 26.3 22.5 21.8
74 Eswatini 29.6 27.9 26.5 20.9
73 Nepal 36.8 31.3 24.5 20.8
72 Guatemala 27.7 24.1 22.0 20.6
70 Philippines 25.8 21.4 20.5 20.1
70 Indonesia 25.8 26.8 24.9 20.1
69 Myanmar 44.4 36.4 25.9 19.8
68 Iraq 26.4 24.8 23.8 18.7
67 Senegal 36.3 27.5 23.6 17.9
66 Sri Lanka 22.4 21.2 18.0 17.1
65 Venezuela 15.2 12.7 8.4 16.9
64 Gabon 20.8 18.9 16.4 15.8
63 Bolivia 30.3 27.1 21.6 15.4
62 Viet Nam 28.2 23.8 18.8 15.3
61 Egypt 16.3 14.3 16.3 14.6
59 South Africa 19.2 22.7 16.6 14.0
59 Ghana 28.7 22.0 18.3 14.0
58 Nicaragua 24.6 17.6 16.2 13.3
57 Malaysia 15.5 13.1 11.9 13.1
56 Honduras 20.9 17.8 14.8 12.9
55 Guyana 18.0 16.8 16.0 12.6
54 Turkmenistan 21.8 17.1 15.0 11.8
53 Lebanon 9.1 10.3 8.0 11.6
52 Oman 13.7 15.6 9.8 11.4
51 Ecuador 18.6 17.0 13.2 11.3
50 Suriname 16.0 12.5 11.0 10.8
49 Uzbekistan 23.6 17.8 14.7 10.7
48 Jordan 12.1 8.7 8.3 10.5
47 Algeria 15.6 12.9 10.6 10.3
45 Thailand 18.3 13.2 12.7 9.7
45 Mongolia 31.8 25.0 15.8 9.7
43 Mauritius 15.3 14.0 12.2 9.6
43 El Salvador 16.3 13.3 12.8 9.6
42 Morocco 15.8 17.7 10.0 9.4
39 Panama 20.2 18.3 12.6 9.2
39 Georgia 14.5 10.4 8.4 9.2
39 Dominican Republic 18.3 17.2 12.8 9.2
38 Trinidad & Tobago 12.1 12.9 12.7 9.1
37 Fiji 9.9 9.3 8.6 8.9
35 Peru 20.9 18.2 12.5 8.8
35 Kyrgyz Republic 19.3 14.0 12.4 8.8
34 Saudi Arabia 11.5 13.7 9.2 8.5
33 Paraguay 14.0 12.6 11.6 8.3
32 Jamaica 8.6 8.6 9.7 8.2
31 Iran 13.5 9.4 8.2 7.9
30 Armenia 18.3 12.7 11.3 7.8
29 Azerbaijan 27.5 17.3 12.1 7.4
28 Albania 21.5 16.6 15.1 7.0
27 Colombia 11.3 10.8 9.9 6.7
25 Serbia - - 6.7 6.5
25 China 15.8 13.0 10.0 6.5
23 Tunisia 10.7 8.6 7.9 6.2
23 Mexico 10.6 9.1 7.7 6.2
22 Russian Federation 10.3 7.5 6.4 5.8
21 North Macedonia 7.7 8.5 7.0 5.6
20 Kazakhstan 11.0 12.4 8.6 5.5
19 Argentina 6.6 6.2 5.9 5.4
18 Brazil 12.0 7.0 5.4 5.3
2019 GHI scores less than 5,
collectively ranked 1-17*
Belarus
Bosnia & Herzegovina 9.8 7.2 5.1
Bulgaria 8.2 7.8 6.9
Chile
Costa Rica 6.2 5.5 5.0
Croatia 6.1
Cuba 5.3
Estonia 5.6
Kuwait
Latvia 6.0
Lithuania
Montenegro - -
Romania 8.3 6.4 5.6
Slovak Republic 7.3 6.0
Turkey 10.2 7.3 5.4
Ukraine 13.7
Uruguay 7.7 8.1 5.4

- = Data are not available or not presented. Some countries did not exist in their present borders in the given year or reference period.
Note: Rankings and index scores from this table cannot be accurately compared to rankings and index scores from previous reports (see  About section). Colours correspond to  GHI Severity Scale.
* The 17 countries with 2019 GHI scores of less than 5 are not assigned individual ranks, but rather are collectively ranked 1-17. Differences between their scores are minimal.

Figure 2.2

2019 GHI SCORES AND PROGRESS SINCE 2000

Click to enlarge:

Source: Authors. Note: This figure illustrates the change in GHI scores since 2000 in absolute values. This figure features countries where data are available to calculate 2000 and 2019 GHI scores and where 2019 GHI scores show moderate, serious, alarming, or extremely alarming hunger levels. Some likely poor performers may not appear due to missing data.

According to the 2019 GHI, of the countries for which data are available, four suffer from levels of hunger that are alarming, and one country, the Central African Republic, suffers from a level that is extremely alarming. The four countries with alarming levels of hunger are Chad, Madagascar, Yemen, and Zambia. Forty-three countries out of 117 countries that were ranked have serious levels of hunger. It is critical to understand that GHI scores for several countries could not be calculated because data were not available for all four GHI indicators. However, the hunger and undernutrition situations in nine of these countries-Burundi, Comoros, Democratic Republic of Congo, Eritrea, Libya, Papua New Guinea, Somalia, South Sudan, and Syria-are identified as cause for significant concern (Box 2.1). In some cases, the hunger levels might be higher than in the countries for which GHI scores were calculated.

To understand how the countries included in the GHI compare with each other, Table 2.1 shows the numerical ranking, from lowest to highest hunger levels, for each country with a 2019 GHI score. Appendix E shows how countries compare with others within their regions and how each country's GHI score has changed over time. Appendix C shows the values of the GHI indicators-the prevalence of undernourishment, child wasting, child stunting, and child mortality-for each country, including their historic values. An examination of the individual indicators provides a useful glimpse into the nature of hunger and undernutrition in each country and how it has changed over time.

For nine countries with GHI scores in the moderate, serious, alarming, or extremely alarming categories, their 2019 GHI scores are higher than their scores for 2010, which is the most recent historical reference period in this year's report. These nine countries are the Central African Republic, Jordan, Lebanon, Madagascar, Malaysia, Mauritania, Oman, Venezuela, and  Yemen. Venezuela's GHI score has doubled since 2010, reflecting the severe food shortages and the economic and political crises that have gripped the country in recent years. Hyperinflation, a rapidly contracting GDP, overdependence on oil revenues coupled with falling oil production, and poor governance characterized by rampant corruption and growing autocracy have all contributed to the situation (Labrador 2019). Venezuela's GHI score could quite possibly be higher in future years when more up-to-date data on child nutrition become available.

The Central African Republic has the highest 2019 GHI score in this report-53.6-and is the only country that falls into the extremely alarming category of the countries with sufficient data for calculating their GHI scores. Nearly half of all children in the Central African Republic are stunted, and 60 percent of the population is undernourished. Since 2012 the country has been embroiled in a civil war, contributing to a crisis of hunger and undernutrition. As of June 2019, 605,000 refugees had left the country and an additional 655,000 people were internally displaced out of a population of just 4.7 million (UNHCR 2019d; UN DESA 2019). More than half of the population is in need of humanitarian assistance in 2019, although security concerns often prevent aid agencies from reaching those in need (USAID 2019a). A peace agreement was signed between the government and warring factions in February 2019, but violations of the terms threaten to undermine the agreement (Schlein 2019). The situation in the Central African Republic clearly demonstrates the role that conflict plays in worsening hunger and undernutrition.

At 45.9, Yemen's GHI score is the second highest in this year's report and falls into the alarming category. Its child stunting and wasting rates are estimated to be 61.1 and 17.9 percent, respectively. The country has been affected by civil war since 2014, although there are in fact multiple conflicts at play whose roots go as far back as the 1990s (Ahram 2019). In November 2018 UNICEF's regional director for the Middle East and North Africa, Geert Cappelaere, warned that the war and ongoing economic crisis have had dire impacts on the children of Yemen, including extreme hardship, elevated rates of malnutrition and disease, and increased mortality (Cappelaere 2018). The warring factions signed the Stockholm Agreement in December 2018 to ease the conflict and humanitarian crisis, but as of June 2019 the agreement had still not been fully implemented and some civilians and communities in need were still blocked from receiving humanitarian aid (UN 2019b). It is estimated that 17 million people out of a population of 28 million (World Bank 2019a) will face crisis-level food insecurity or worse through early 2020, with some areas in the west of the country facing emergency-level food  crises. If the security situation deteriorates, the country is at risk of famine (FEWS NET 2019a).

Chad has the third-worst GHI score according to this year's ranking; at 44.2, it is considered alarming. Chad's child mortality rate is 12.3 percent, the second-highest rate in this report. Chad ranks 186th out of 189 countries in the Human Development Index, with only South Sudan, the Central African Republic, and Niger ranking worse (UNDP 2018). In recent years Chad has also experienced an influx of refugees, primarily from South Sudan, the Central African Republic, and Nigeria. By the end of 2018 the number of refugees exceeded 450,000, with more arriving in 2019, putting a strain on resources in the host communities (UNHCR 2019f; UN 2019a). In the Lake Chad basin, incursions of armed groups into Chad from neighboring Nigeria have increased insecurity and disrupted livelihoods, access to markets, and trade (UN OCHA 2019a).

In addition to considering countries' GHI scores and rankings, it is useful to compare countries' individual GHI component indicators:

  • Haiti, Zimbabwe, and the Central African Republic have the highest rates of undernourishment, ranging between 49.3 and 59.6 percent.
  • Stunting rates are highest in Madagascar, Burundi, and Yemen, where data or estimates show that more than half of all children under five suffer from stunting.
  • Wasting is most prevalent in Yemen, Djibouti, and India, ranging from 17.9 to 20.8 percent.
  • The highest under-five mortality rates are in the Central African Republic (12.2 percent), Chad (12.3 percent), and Somalia (12.7 percent).

The situation is more positive in many countries in terms of both their GHI scores and their progress in reducing hunger and undernutrition over time. This year's GHI includes 23 countries with moderate levels of hunger and 46 countries with low levels of hunger. Of the countries with moderate levels of hunger, two-Myanmar and Senegal-had alarming hunger levels as recently as 2000. Of the countries with low levels of hunger, five had serious hunger levels as recently as 2000: Albania, Azerbaijan, Mongolia, Panama, and Peru.

Figure 2.2 shows the progress countries have made since 2000, along with their 2019 GHI scores. Perhaps most informative is the dramatic improvement in GHI scores for the countries on the lefthand side of the figure, particularly Angola, Rwanda, and Ethiopia. These countries each had GHI scores in the extremely alarming category in 2000, largely as a result of civil wars. As is evident throughout this report, violent conflict and war are strong drivers of hunger and undernutrition, yet it is important to realize that even the worst situations can improve with the return of peace and stability.

As noted in the  About section, GHI scores are not calculated for some high-income countries where the prevalence of hunger tends to be very low. This gap occurs mainly for two reasons: (1) not all GHI indicators are appropriate for assessing hunger in these countries and (2) some data are unavailable because they are not regularly collected there. Nonetheless, the high-income countries that are not included in the GHI are not immune to food insecurity.

High-income countries show variable, non-negligible rates of food insecurity as measured by locally adapted household food security scales that yield comparable results: 5 percent of households were food insecure in South Korea in 2008, 7 percent in Canada in 2011- 2012, 12 percent in the United States in 2017, and 17 percent in Portugal in 2005-2006 (Kim et al. 2011; Tarasuk, Mitchell, and Dachner 2014; Coleman-Jensen et al. 2018; Álvares and Amaral 2014). In the United States, 16 percent of households with children under age 18 were food insecure in 2017 at some point during the year (Coleman-Jensen et al. 2018), and a UNICEF study regarding food insecurity in the 28 countries of the European Union found that 18 percent of households with children under age 15 experience moderate or severe food insecurity based on the Food Insecurity Experience Scale (Pereira, Handa, and Holmqvist 2017). The experience- based concept of the household food security scale and measures such as the Food Insecurity Experience Scale should not be confused with the measurement approach of the undernourishment indicator, which reflects shortfalls in calorie intake; the prevalence estimates that result from these two types of measures are not comparable (Ballard, Kepple, and Cafiero 2013).

Box 2.1

COUNTRIES WITH INSUFFICIENT DATA, YET SIGNIFICANT CONCERNS

In the case of 15 countries assessed for this report, data were unavailable for one or more indicators used in the GHI formula, preventing the calculation of their 2019 GHI scores. In some cases, data are unavailable as a result of violent conflict or political unrest. These contexts are causal factors and strong predictors of hunger and undernutrition, so the countries with missing data may be the ones with citizens in the greatest distress due to hunger. Based on the available data that we have assessed and information from international organizations that specialize in combating hunger and undernutrition, we have determined that nine of the countries with missing data are cause for significant concern. The following is a brief explanation of what is known about the hunger and nutrition situation in each of the nine countries; the table below shows the existing GHI indicator values for these countries.

 BURUNDI: At 55.9 percent, Burundi's child stunting level is the second highest of all countries covered in this report, 5.1 percent of children in Burundi experience wasting, and 6.1 percent die before the age of five. Approximately 1.7 million Burundians out of a population of 11 million were estimated to face crisis or emergency levels of food insecurity in 2018 (FSIN 2019). Burundi is ranked 185th out of 189 countries on the 2018 Human Development Index (UNDP 2018), and its rate of poverty is extremely high at over 70 percent (World Bank 2019a). More than 340,000 refugees have fled Burundi in recent years, most since 2015 (UNHCR 2019b). Climate shocks, political instability, and structural economic issues all contribute to food insecurity, while poor child feeding practices, food insecurity, a high burden of disease, and inadequate water, sanitation, and health facilities all contribute to poor child nutrition (FSIN 2019).

 COMOROS: Densely populated and heavily reliant on agriculture, the Comoros suffers from poor environmental management and has limited resources to support its growing population. A low-lying island nation in the Indian Ocean, the Comoros is vulnerable to the effects of climate change and has been repeatedly hit by natural disasters (Burak and Meddeb 2012). A Category 4 hurricane struck the Comoros in April 2019, damaging hospitals, water supplies, agriculture, and livestock, and this damage has in turn worsened food insecurity and child undernutrition (WHO 2019b). An estimated 39.9 percent of children are stunted, 9.2 percent are wasted, and 6.9 percent die before the age of five.

 DEMOCRATIC REPUBLIC OF CONGO (DRC): In the DRC 42.7 percent of children under age five are stunted, 8.1 percent are wasted, and 9.1 percent do not live to the age of five. The DRC has been beset by ongoing conflict and far-reaching poverty in recent decades. These factors, along with the deterioration of infrastructure and productive assets, high food prices, and a decline in agricultural production, have worsened food security (WFP 2015; FAO 2019a). As of December 2018, about 3.1 million people were internally displaced (IDMC 2019a) and more than 800,000 refugees from the DRC had fled to neighboring countries. More than 500,000 refugees, mainly from Burundi, Central African Republic, and South Sudan, had come to the DRC as of February 2019 (UNHCR 2019c). According to the latest data, 13 million people in the DRC-approximately a quarter of the population-face crisis or emergency levels of food insecurity (USAID 2019b). In North Kivu province, food insecurity is compounded by the current Ebola outbreak, resulting in a spiraling confluence of hunger and disease for the affected families (Norwegian Refugee Council 2019).

 ERITREA: Data from Eritrea are extremely limited, with the latest child nutrition data from 2010 showing the stunting rate to be excessively high, at 52.0 percent, and the wasting rate to be 15.3 percent. Undernutrition in Eritrea is related to the challenges of food production that result from limited arable land, water shortages, and frequent droughts. Severe poverty also curtails people's ability to buy food (UNICEF 2015a). As of December 2018, over half a million refugees were displaced from Eritrea, making it one of the 10 largest refugee- producing countries in the world (UNHCR 2019e). A peace agreement signed between Eritrea and Ethiopia in 2018 officially ended hostilities that had been ongoing between the two countries since 1998, creating the possibility for economic and social reforms (Otieno 2018).

 LIBYA: Since 2011 Libya has undergone a period of unrest, including ongoing conflict between rival groups over control of the country (WFP 2019a). As of December 2018, approximately 1.1 million people in Libya were in need of humanitarian assistance, including 270,000 internally displaced people (IDPs), IDP returnees, refugees, and asylum seekers-all groups particularly vulnerable to food insecurity (UNHCR 2019a; FAO GIEWS 2019). Food insecurity in Libya is driven primarily by people's inability to access food rather than a lack of food availability. However, instability has led some farmers to abandon agricultural activities, while others report that the conflict has limited their ability to obtain inputs and decreased their productivity (FAO GIEWS 2019).

 PAPUA NEW GUINEA: As even Papua New Guinea's National Food Security Policy acknowledges, data on food security in the country are extremely limited, hampering decision making and policy evaluation (GoPNG 2018). A recent survey conducted in four rural areas of the country found that on average, individuals in poor households in all four areas did not meet minimum calorie requirements and that average protein consumption among individuals in both poor and nonpoor households was insufficient in three out of four areas (Schmidt et al. 2019). Previous research supports the finding that protein consumption in the country is insufficient (Omot 2012). Climate change and frequent natural disasters-including most recently the El Niño- induced drought in 2015/2016 and an earthquake and volcanic activity in 2018-are also key challenges that jeopardize food security (FAO 2018c).

 SOMALIA: In 2016/2017 Somalia experienced a severe drought that brought the country to the brink of famine. Consequently, households in some parts of the country still have smaller livestock herds and lower food security (FEWS NET 2017a, 2019b). A delayed start to the rainy season in April and May 2019 has resulted in another drought and is predicted to negatively impact agricultural production and food security later this year, putting up to 2.2 million people in crisis or emergency levels of food insecurity by September. Armed conflict in parts of the country also disrupts access to food (FEWS NET 2019b). Over 2.6 million people of a total population of about 15 million are internally displaced in the country owing to conflict, flooding, drought, and food insecurity (IDMC 2019b; UN DESA 2019). Somalia's child mortality rate, at 12.7 percent, is the highest among all the countries included in this report.

 SOUTH SUDAN: A civil war that began in 2013 has plunged South Sudan into crisis. In some parts of the country there is ongoing violence and disruption of trade routes, farming, and key livelihood activities (FEWS NET 2019c). Nearly 2 million people within the country are displaced (IDMC 2019c). Almost 7 million people of a population of 12.5 million were expected to face crisis- level food insecurity or worse as of July 2019, with the threat of famine looming (USAID 2019c). Furthermore, 860,000 children from 6 to 59 months of age were expected to suffer from moderate or severe acute malnutrition in 2019 (IPC 2019). The child mortality rate is 9.6 percent; data and estimates for the other GHI indicators are not available.

 SYRIAN ARAB REPUBLIC: Since the onset of the Syrian civil war in 2011, the country has faced widespread food insecurity, ongoing violence, and massive human displacement, including 5.7 million refugees who have fled the country and 6.2 million people who are internally displaced (WFP 2019b; CFR 2019). As of May 2019, 6.5 million people out of a population of 18 million were considered unable to meet their basic food needs owing to spiking food prices, diminished agricultural production, and loss of livelihoods (WFP 2019b). Additionally, Syria's important role in regional agricultural trade means that the crisis has negatively affected food security in neighboring countries (Fathallah 2019).

EXISTING GHI INDICATOR VALUES

Country Undernourishment
Prevalence of undernourishment
2016-2018 (%)
Child Stunting
Stunting in children under five
2014-2018 (%)
Child Wasting
Wasting in children under five
2014-2018 (%)
Child Mortality
Under-five mortality
2017 (%)
 Burundi - 55.9 5.1 6.1
 Comoros - 39.9* 9.2* 6.9
 Congo, Dem. Rep. - 42.7 8.1 9.1
 Eritrea - - - 4.3
 Libya - 22.4* 8.0* 1.2
 Papua New Guinea - 39.9* 7.1* 5.3
 Somalia - - - 12.7
 South Sudan - - - 9.6
 Syrian Arab Republic - - -

Source: Authors. See Appendix B for a list of data sources. Note: - = not available. *indicates authors' estimates.

Within Country Borders

About image Photo: Glinski/Welthungerhilfe; Fatama shows the bread produced by families in the village of Arel Khan, Afghanistan. The village had been struggling economically and few trees mean it was hard to find wood. Since the distribution of energy efficient stoves by Welthungerhilfe, families have been able to save time and money and children can continue to go to school instead of collecting wood.  Hide

Figure 2.3

SUBNATIONAL INEQUALITY OF CHILD STUNTING

Click to enlarge:

Source: Authors. Based on surveys included in UNICEF/WHO/World Bank (2019), WHO (2019a), UNICEF (2019), and MEASURE DHS (2019) from 2014-2018. Countries included are those with subnational stunting data available for 2014-2018. If more than one survey has been completed for a country during this period, that with the most recent subnational values is used. Note: The number in parentheses following each country name indicates the number of subnational units into which the country was divided for the sake of the survey, which can influence the degree of disparity that is revealed. All stunting values in this figure are taken directly from original survey reports. The national averages may vary slightly from those used for GHI calculations, which in some cases underwent additional analysis before inclusion in UNICEF/WHO/World Bank (2019) and WHO (2019a).

Inequality in varying degrees is ubiquitous throughout the world. Disparities can fall along geographic, ethnic, racial, gender, or other lines. Examining hunger and undernutrition at the national level inevitably misses important distinctions between groups within the country and risks overlooking populations that fare worse than average, perhaps critically so.

This section examines child stunting data for subnational geographic units, such as states, departments, or regions depending on the country. Childhood stunting is a key indicator because it can result from a wide range of factors-not just inadequate consumption of calories, but insufficient intake of micronutrients, failure to absorb micronutrients because of broader physical health problems, and recurrent diseases that affect child growth. Child stunting is highlighted here because subnational data for this indicator are available for a wide range of countries and because, unlike child wasting, child stunting is not subject to seasonal variation to a significant degree.

Figure 2.3 illustrates the subnational disparities in child stunting rates for children under the age of five in 60 countries. For each country with available data, this figure shows the stunting rates for the states or areas with the highest and lowest stunting levels, as well as the national average. In addition to inequality in nutrition and health, several other factors influence the size of the within-country gap in stunting levels, such as the number of subnational units into which a country is split for the sake of the survey, national population size and land area, and the average national stunting level.

Remarkably, even in those regions of the world with the lowest GHI scores in this report-Eastern Europe and the Commonwealth of Independent States, Latin America and the Caribbean, and East and Southeast Asia-some countries have subpopulations with stunting levels well above 30 percent, the threshold at which stunting is considered "very high" in terms of its public health significance (de Onis et al. 2019). For example, in the Commonwealth of Independent States, the highest stunting rate in Tajikistan is 31.9 percent in the Gorno-Badakhshan Autonomous Oblast, whereas the rate in the Districts of Republican Subordination is just 15.3 percent. In Latin America the highest stunting rate in Guatemala is extraordinarily high, at 70.0 percent, in Totonicapán department, while its lowest rate is 25.3 percent in Guatemala department. In Southeast Asia, stunting rates in the Philippines range from 45.2 percent in the Autonomous Region of Muslim Mindanao to 23.1 percent in the Central Luzon region.

An examination of subnational stunting data and, where possible, the change in stunting rates over time for particular states or departments can call attention to areas within a country that are losing ground, stagnating, or excelling in the fight against child undernutrition. This is invaluable information for local government authorities charged with addressing malnutrition. It can also point donors, policy makers, and nongovernmental organizations to areas that need additional resources and help identify success stories that can serve as models for other areas.

An example of remarkable improvement is in Kirehe district in Rwanda. According to the 2010 Rwanda Demographic and Health Survey, the stunting rate in Kirehe was 50.7 percent that year. By the next survey round in 2014-2015, its stunting rate had dropped to 29.4 percent. By contrast, at the national level, stunting fell more modestly in that period, from 44.2 to 37.9 percent. The success in Kirehe was possible because of a combination of factors. Kirehe district leaders were strongly committed to reducing undernutrition, particularly after the Rwandan president visited the district in 2009. They instituted the District Plan to Eliminate Malnutrition, which was implemented and monitored by a multisectoral committee. That plan and institutional structure were replicated at smaller levels down to local villages. Community health workers were trained and empowered to play a critical role in implementing community-based nutrition interventions. Several development organizations provided funding and support for the efforts in Kirehe (World Bank 2018).

Bolivia reduced its child stunting rate from 27.1 percent in 2008 to 16.9 percent in 2016. The reduction was broad based, with reductions in stunting rates between 2008 and 2016 for each department for which valid measurements were available. Potosí department had the highest stunting rate of any department in 2008, at 43.7 percent. In 2016, it still had the highest rate, but it was substantially lower at 29.8 percent. Approximately two-thirds of the population of Potosí is indigenous, and the state has one of the highest levels of poverty (Gigler 2009). The government has recognized the diverse ethnic, cultural, and linguistic identities within the country and acknowledged that its indigenous groups often face the greatest food insecurity and undernutrition. Bolivia's success is attributed in part to the implementation of the Family Community Intercultural Health Program, which included policies to ensure that health workers were sensitive to cultural beliefs and traditions in the communities where they worked. The government also implemented the Desnutrición Cero (Malnutrition Zero) program, which included evidence-based interventions recommended by the Lancet Series on Maternal and Child Nutrition (Weisstaub, Aguilar, and Uauy 2014).

Cambodia's child stunting rate declined from 39.9 to 32.4 percent between 2010 and 2014; 17 of its 19 provinces experienced declines in their rates during that period. The two provinces of Kampong Chhnang and Svay Rieng, however, experienced increases in stunting rates between 2010 and 2014. Stunting in Kampong Chhnang rose from 40.3 to 42.8 percent, while in Svay Rieng, the stunting rate went from 31.2 to 32.8 percent. Neither are dramatic increases, yet the lack of progress in the context of national improvements is troubling. In both provinces there was also an increase in the proportion of households classified in the lowest (poorest) wealth quintile between 2010 and 2014.

It is, of course, important to consider disaggregated hunger and nutrition indicators other than child stunting. When formulating policies and interventions to address undernutrition, the key is to use these and other data as tools for both diagnosing the problem and devising solutions to address existing shortcomings.

The 2019 country case studies provide a more detailed look at two countries,  Niger and  Haiti, ranked 101st and 111th out of 117 countries, respectively. The analysis provides an overview of the context for each country and considers how and why their GHI scores and the underlying indicator values have changed over time.

Conclusion

About image Photo: Rommel/Welthungerhilfe; Market place in Jamshedpur, India.  Hide

This year's GHI simultaneously demonstrates cause for a degree of optimism, reasons for concern, a dose of realism, and, perhaps most of all, a large degree of uncertainty.

It is reasonable to view the progress made globally in reducing hunger and undernutrition over almost 20 years and find grounds to believe that the world can and will continue to make progress in the quest to eliminate these maladies. Good governance, smart investments, and solid sustained programming show results and protect human rights, prosperity, and equality. Maintaining a degree of optimism is important, particularly if it serves as motivation to continue with the hard work that is required.

At the same time, there are many reasons for concern. The number of undernourished people in the world is increasing. Extreme weather events are jeopardizing food production and food security and are only expected to increase in number and severity in conjunction with global climate change. Too many countries are in the midst of violent conflicts that have precipitously increased their hunger levels.

Inequalities in child nutrition at the subnational level and ongoing food insecurity even in high-income countries provide a dose of realism. Even in countries that may seem, on the surface, to have succeeded in reducing hunger and undernutrition, problems remain. There will always be a need to monitor the food security situation even in thriving economies and to provide support in these societies to those who struggle to access adequate nutritious food.

Lastly, in the case of climate change, there is a tremendous degree of uncertainty. As discussed in the following chapter, we know many of the actions we must take to mitigate, prepare for, and adapt to climate change, but we have no global-scale experience to look back on as a guide or a guarantor of success. It will take humanity's ingenuity, dedication, and perseverance to ensure that we collectively achieve Zero Hunger while tackling the unprecedented challenge of climate change.

Footnotes

  1. The worldwide estimates in this paragraph include the 117 countries in this report with 2019 GHI scores plus 15 countries for which some but not all of the GHI indicator data or estimates were available.  globalhungerindex.org
  2. The poverty rates expressed here are poverty headcount ratios at $1.90 per day (2011 purchasing power parity).  globalhungerindex.org
  3. This estimate was based on the additional financing that would be needed between 2016 and 2025. The global nutrition targets discussed here and analyzed by Shekar et al. (2017) are four of the six targets established by the World Health Assembly in 2012.  globalhungerindex.org
  4. The 2030 projections are linear projections based on the existing 2000, 2005, 2010, and 2019 GHI scores for each country. These projections are not comparable to projections from previous reports owing to changes in data availability and revisions of the existing data.  globalhungerindex.org
  5. A "minimum acceptable diet" is a standard that combines minimum dietary diversity and minimum meal frequency, with different recommendations for breastfed and non-breastfed children, who need to receive milk or milk products as a substitute for breast milk.  globalhungerindex.org
  6. Ranked according to 2019 GHI scores. Countries that have identical 2019 scores are given the same ranking (for example, Mexico and Tunisia are both ranked 23rd). The following countries could not be included because of lack of data: Bahrain, Bhutan, Burundi, Comoros, the Democratic Republic of Congo, Equatorial Guinea, Eritrea, Libya, Moldova, Papua New Guinea, Qatar, Somalia, South Sudan, the Syrian Arab Republic, and Tajikistan.  globalhungerindex.org
  7. Countries are not included in this trend analysis if their hunger level is still considered low even if it has increased since 2010.  globalhungerindex.org
  8. This is according to the Acute Food Insecurity Phases of the Integrated Food Security Phase Classification: Phase 1 (minimal), Phase 2 (stressed), Phase 3 (crisis), Phase 4 (emergency), and Phase 5 (famine) (IPC 2017).  globalhungerindex.org

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