Inequality, Hunger, and Malnutrition:

In the same world where around 800 million people go hungry and 2 billion suffer from some form of malnutrition, more than a third of the adult population is obese and a third of all food produced is lost or wasted (FAO/IFAD/WFP 2011; FAO/IFAD/WFP 2015; FAO 2011). So while the problems in the world food system are vast, they are also unevenly spread.

Typically, groups with the least social, economic, or political power suffer hunger or malnutrition - whether they are barely eking out a living in remote rural areas of poor countries or residing in marginalized communities in the big cities of wealthy states.

This uneven distribution of hunger and malnutrition in all its forms is rooted in inequalities of social, political, and economic power. Therefore, the first step in tackling the inequalities of hunger is to understand how they are embedded in and magnified by the inequalities of power at work in the food system. It is not easy to make sense of power relations. They often operate out of sight and in such complex webs that even the most sophisticated and advanced solutions to hunger may fail to make long-term gains. Policies that do not take into consideration the underlying power dynamics—no matter how practical, technical, or scalable - are unlikely to succeed.

How do inequalities of power lead to unequal nourishment? Power is defined as “the degree of control over material, human, intellectual and financial resources exercised... in the social, economic and political relations between individuals and groups” (VeneKlasen and Miller 2002, 41).

Power may be an abstract concept, but its impact is tangible. In food systems, power is exercised in a variety of ways and spaces, by a variety of actors: through concentrations of capital and market share that allow agri-food corporations to influence the price of food and food inputs as well as their supply or quality; by government offices, international organizations, or public-private partnerships that can influence, implement, or block food policies and, with their intellectual or organizational resources, can shape debates and mobilize public opinion; or through the authority of individuals over decisions about household expenditures and family meals.

As Olivier de Schutter, UN special rapporteur on the right to food from 2008 to 2014, writes in the 2015 Global Nutrition Report, “food systems are defined by political decisions and the differential power of actors to influence those decisions” (IFPRI 2015, 96). In the food system, this differential power appears in various forms, levels, and spaces, ranging from who has the cash to decide what to get for dinner tonight, all the way up to whose voice gets heard in debates about international regulations and policy frameworks.

Global policy debates are increasingly acknowledging the power relations that drive and maintain the inequalities underlying hunger and malnutrition. But they do so unsystematically, in ways that draw attention to the power of men over women in poor households, for instance, while sidelining the power of big firms over national food policies, local markets, and individual food choices. This is particularly problematic because power, measured in terms of financial heft and geographical reach, is highly concentrated among large transnational food companies (Howard 2016).

This concentration of market power has also been associated with rising levels of overweight and obesity in countries transitioning from low- to middle-income status (Baker and Friel 2014; Malik, Willett, and Hu 2013; Monteiro et al. 2013). It is therefore critical to draw attention to the spaces in the food system where power imbalances can be—and are being—challenged, resisted, and shifted.

In 2016, the United Nations (UN) Sustainable Development Goals (SDGs) came into force to guide efforts over the next decade and a half “to end all forms of poverty, fight inequalities and tackle climate change, while ensuring that no one is left behind” (UN 2016).

SDG2, the second of 17 SDGs, aims to “end hunger, achieve food security and improved nutrition, and promote sustainable agriculture” (UN 2014). Yet it draws no attention to the different ways in which different groups are affected by malnutrition. SDG10, meanwhile, targets economic, social, health, and political inequalities, but makes no mention of hunger and nutrition even though groups that experience hunger, micronutrient deficiencies, and overweight and obesity are concentrated among the economically, socially, politically, and geographically disadvantaged.

The intersection of malnutrition with other forms of inequality reflects how the food system amplifies the economic, social, and political disparities that already divide societies. In 2016–2017, the most dire manifestations of inequality in the global food system were the acute food crises and famine affecting 108 million people, heavily concentrated in East Africa and the Middle East (FAO 2017c; FSIN 2017).

The “new famines” of the twenty-first century have stemmed mostly from armed power struggles, in which combatants have used hunger as a weapon (Devereux 2006; Maxwell and Fitzpatrick 2012). The 2016–2017 food crises, though linked to the East African drought, have afflicted people who were already hungry or undernourished because of violence, displacement, climate change, or high food prices (FAO 2017c).

Gender inequality is widely recognized as an axis of nutritional inequality. Many forms of chronic malnutrition are closely associated with low birthweight and child and infant nutrition status, which are linked to women’s lack of power in the household and society. Gender relations influence which children go hungry, as families forced to ration meals often favor boys, who are seen as future breadwinners, over girls, who are considered burdens on the family until they marry and leave (UNICEF 2011). Gender equality and women’s empowerment tend to correlate with better nutrition status in most contexts (Osmani and Sen 2003; Bhagowalia et al. 2015; Malapit and Quisumbing 2015; Cunningham et al. 2015; van den Bold, Quisumbing, and Gillespie 2013; Agustina et al. 2015; Darnton-Hill and Cogill 2010). Yet women’s empowerment is generally treated as a matter of strengthening their purchasing power and control over household decisions, rather than one of redressing women’s lack of collective power in higher levels of the food system - where, for example, debates about agriculture and food-trade policy take place - that directly affect hunger and nutrition.

Socioeconomic class and geography intersect with, and often surpass, gender as an axis of inequality. As a recent report notes, “Power imbalances, often stemming from economic inequalities, are... a key factor in the way food systems operate” (IPES 2015, 5). Families’ income, social status, and location often appear to play a greater role in determining whether children are stunted than does gender, as data for East Africa show (Figure 3.1 below). In Ethiopia, Tanzania, and Uganda, for instance, children are less likely to be stunted if they live in the capital city, close to the centers of power.

To see how power intersects with the food system, one need only look at the poor nutrition outcomes - such as low weight-for-height (wasting), low height-for-age (stunting), and micronutrient deficiencies - among indigenous peoples, who often face both poverty and sociopolitical marginalization (Valeggia and Snodgrass 2015). In Latin America, many countries suffer severely from the double burden of malnutrition - the coexistence of undernutrition and overnutrition (Rivera et al. 2014). According to one study, almost half of all children in Guatemala are stunted, but the double burden of malnutrition is highest among indigenous peoples in the highland regions: more than a quarter of families there have stunted children and overweight mothers (Ramirez-Zea et al. 2014).

The kind of access people have to changing food markets also shapes hunger and nutrition inequalities (Hossain et al. 2015). In urban settings, marginalized people often find themselves integrated into market-based food systems on adverse terms, stuck in “food deserts” (areas where fresh whole foods are unavailable) or unable to afford healthy foods even when they are available (Walker, Keane, and Burke 2010). It is therefore unsurprising that in high-income countries, including Australia and Canada, the risk of obesity among indigenous people may be as much as 1.5 times higher than for non-indigenous people in comparable areas (Egeland and Harrison 2013). In the United States, obesity rates are highest among people with the lowest incomes, racialized and marginalized groups, and those living in poor areas marked by social division (Ogden et al. 2015; CDC 2017).

Power is not monolithic and immovable. It is exercised in a range of forms (from consumption to advertising to policy making), at various levels (global, national, and local), in multiple spaces (from farmers’ unions to UN committees), offering myriad opportunities for campaigners, activists, practitioners, and policy makers to advocate, devise strategies, and build coalitions for change. The vast inequalities in the food system have generated a similarly wide range of efforts to resist and redistribute power. A necessarily selective sample of these efforts highlights both their potential to redress imbalances of power as well as the challenges such efforts face.

The last decade has seen an unprecedented expansion of “invited spaces” for dialogue and advocacy around nutrition between mutually acceptable parties. In principle, these spaces offer champions of change opportunities to challenge or hold the powerful to account. For instance, the global Scaling Up Nutrition (SUN) Movement, which involves 59 national governments as well as representatives from business, civil society, donors, and UN system networks, aims to “end malnutrition in all its forms” by initiating, supporting, and monitoring progress on nutrition. The Global Alliance for Improved Nutrition (GAIN), meanwhile, aims to “find and deliver solutions to the complex problem of malnutrition” through forging alliances among the public sector, private sector, and civil society.

Both SUN and GAIN take multistakeholder partnerships seriously. But with power so weighted against hungry and malnourished people and so concentrated among transnational corporations, are power relations in the food system likely to be shifted through decisions and alliances made in such spaces? Are the rules of entry and the agendas for dialogue open to proponents of alternative views who seek to shift control over the food system from big corporations to producers, consumers, and advocates of agroecological agriculture? These questions deserve a closer look.

Much work remains to be done to create equitable spaces for policy dialogue, in which the interests of those with little power and at greatest risk of hunger and malnutrition have a real chance at meaningful participation in global policy debates. Invited spaces can, however, create opportunities for “speaking truth to power,” particularly with respect to the performance of national governments, which still have the authority to shape their food systems (Pritchard et al. 2016) and the duty to ensure food security. Initiatives such as the Hunger Reduction and Nutrition Commitment Index aim to create and sustain pressure for reform and national political accountability by gathering data for hunger and malnutrition and monitoring policy change (IFPRI 2015).

For such efforts to be effective, they must have “teeth” - that is, the power to bring sanctions or enforce change (Fox 2015). But “naming and shaming” will only work on actors that can be shamed and are likely to have little effect on governments that are unaccountable to the hungry. Thus better nutrition-related data alone cannot guarantee greater government commitment to fighting hunger and malnutrition and may overshadow the experiences of those affected (CSM 2016). Meanwhile, agrifood corporations may be insensitive to their public image or immune to demands for accountability for hunger and nutrition, and can only be punished where it hurts most - the bottom line.

Invited spaces tend to give some civil society activists and scholars some access to powerholders. But there are numerous movements rooted in struggles around agriculture, peasants’ rights, poverty, and hunger operating at the grassroots level that have little access to these spaces. Transnational food-sovereignty and food-justice movements aim to radically redistribute power in the food system (Holt-Giménez and Shattuck 2011; Holt-Giménez and Patel 2012). These movements organize people disempowered in the global food system and also aim to demonstrate viable agroecological alternatives to current agricultural practices (Edelman 2003; Holt-Giménez and Altieri 2013).

Spearheaded by the international peasant movement La Via Campesina, the food-sovereignty movement seeks to shift control away from transnational corporations toward small-scale producers and consumers, giving them “sovereignty” - that is, more power to take decisions over what food they grow and eat (Patel 2009). The food-sovereignty and food-justice movements believe that returning control - over land and inputs, local markets, and national policies - to those with limited power in the food system will make it more ecologically beneficial and better able to provide nourishment. In the past decade, these movements have played a key role in opening the debate about the human and ecological costs of food-system globalization and demonstrating alternative models.

National right-to-food movements and their supporters, such as the Global Network for the Right to Food and Nutrition, articulate popular demands for action on hunger and nutrition, often outside of invited spaces. These movements confront power directly, but within the international human-rights framework. They seek to tackle accountability for hunger by combining evidence-gathering and publicity campaigns with grassroots efforts to mobilize for, secure, and uphold rights. Such movements sometimes manage to claim policy spaces once closed to them - shifting the power dynamics in unexpected directions - as was the case with the Committee on World Food Security (CFS), now deemed the UN’s “most inclusive body.”

Popular struggles over power in the food system also include food riots, quite apart from food-sovereignty or right-to-food movements. History has shown that food riots tend to break out when food prices spiral out of control, as they did during the global food-price spikes of 2008 and 2010–2011 (Bohstedt 2016; von Braun 2010). Between 2007 and 2012, riots erupted in more than 30 countries, shaping the political and policy responses to food crises during these years (Berazneva and Lee 2013; Hendrix and Haggard 2015; Arezki and Bruckner 2011; Bellemare 2015; Schneider 2008). Some of the most violent struggles took place in middle-income countries such as Algeria, where 800 people were injured in clashes with police.

Protests against high food prices in the Middle East and North Africa helped trigger the Arab Spring (Lagi, Bertrand, and Bar-Yam 2011). Rebellions over food prices are often linked to wider contests over economic injustice and inequality, and are deeply rooted in shared perceptions of the morality of food systems and related struggles over wages, working conditions, and civil and political rights (Hossain and Kalita 2014; Hossain and Scott-Villiers, forthcoming). Such outbreaks of violence intrude into the policy space, borrowing the power of mass media to grab the attention of political elites (Swinnen, Squicciarini, and Vandemoortele 2011) and get their concerns on the policy agenda (de Brito et al. 2014).

Between 2007 and 2012, fears of unrest and loss of political legitimacy led many political and policy elites to respond to public anger, taking high-profile action against speculators, stabilizing local prices through market interventions and food grain reserves, establishing cash or food transfers to the most vulnerable, and investing in domestic agriculture (Hossain and Scott-Villiers, forthcoming). Food riots are the undesirable but likely consequence of people’s loss of power over their food systems, but in some cases they prompt a rebalancing of those systems.

The uneven distribution of hunger and nutrition reflects the unequal distribution of power in the food system. In its hourglass shape, the power at the center amplifies poverty and marginalization at both ends of the system: at one end, small-scale farmers and low-paid food producers suffer hardship; at the other end, those excluded from or adversely incorporated into globalized food markets face hunger and malnutrition.

Transnational corporations’ growing control over what we eat - which often deepens existing inequalities - has generated a wide range of spaces and forms of resistance. Power analysis encourages us to look beyond the obvious and the measurable, to trace the effects of interests operating at multiple levels of the food system, to find opportunities where and when they arise, and to enter spaces where that power can be challenged, resisted, and redistributed.

Achieving the Sustainable Development Goals’ aim of “leaving no one behind” demands approaches to hunger and malnutrition that are both more sensitive to their uneven distribution and more attuned to the power inequalities that amplify the effects of poverty and marginalization in all forms of malnutrition. Power analysis can help equalize change in the food system if:

• researchers and analysts use its conceptual tools to name all forms of power that keep people hungry and malnourished, helping draw attention to forms of power that are hard to see because they are exercised, for example, in complex webs of supply chains and distribution networks or through the “soft power” of marketing, advertising, and research funding;

• intervention design focuses more strategically on where power is exerted, highlighting how and when policies and interventions aimed at changing people’s eating habits should be accompanied by actions to address influences on those habits that operate higher up the system - for instance, real power would derive from women organizing to demand the enforcement of breast-milk-substitute regulations, food-security programs that are fair and provide nutritious food, and a seat at the food-policy table;

• activists, practitioners, policy makers, and all champions of eradicating hunger and malnutrition can identify and exploit spaces for change in the food system, highlighting obstacles to reform, changing the rules by which decisions get made, devising sanctions with the “teeth” to hold the powerful to account, and empowering the hungry and malnourished to challenge and resist loss of control over the food they eat.