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Famine is defined as an extreme shortage of food or lack of access to food by a population, accompanied by an increase in death rates. Deaths during famine occur not only due to malnutrition, but also from infectious diseases to which malnutrition predisposes the population and from the social ills brought about by food shortage. Famine is a true public health emergency, and unfortunately has been a common human experience throughout history. The fundamental menace of famine is expressed in the Biblical reference to the "four horsemen of the apocalypse"—meaning famine, pestilence (disease), war, and death.

There have been thousands of famines over the last several centuries. The causes have included natural disasters such as droughts and floods; war, civil strife, and population displacement; and economic failure. In spite of the fact that worldwide food production has improved in the past several decades, and that global food supplies are sufficient to feed the world's current population, an estimated 20 percent of people in developing countries—more than 800 million people—lack access to enough food on a regular and predictable basis. The number of countries experiencing severe food shortages has almost tripled since 1990. Compared to poverty, which is the most common cause of malnutrition worldwide, famine is preventable. Access to food has been repeatedly recognized as a basic human right. Promotion of this right requires international cooperation and a coordinated effort.

CAUSES OF FAMINE

The immediate causes of famine are inadequate food production or market availability, price fluctuations, and limited household assets. Underlying causes, however, almost always involve misguided or deliberate public policy, repressive political systems, or natural or human-caused disaster. In countries with preexisting widespread poverty, unemployment, or debt, natural and human-caused disasters are the most common causes of food shortages and famine. Additionally, hunger has been often used as a deliberate weapon. Access to food is such a basic human need that control of the food supply translates into direct political and economic power. Over and over again in history, specific populations have been the victims of an interruption of their food supply with the intent to subdue them or drive them away.

An example of the chain of events that leads to a "natural" famine (not the direct result of war or civil strife) is a poor harvest due to a drought or flood, resulting in reduced wages and rising food prices. The overall result is a decline in both food availability and food access.

Large famines caused millions of deaths in the early 1930s in the Ukraine, and in 1959–1961 in China; both occurred due to policies that resulted in reduced food availability. One of the most recent tragedies with regard to food shortage began in the mid-1990s in North Korea, where a steady economic decline and a series of floods, droughts, and failed harvests was superimposed on the economic blow brought about by the abrupt end of preferential trade with the former Soviet Union. A closed governmental system has limited humanitarian aid in this situation.

War and civil strife are two of the greatest causes of famine. Armies destroy crops and consume available food. Mass migration is also common for those living in war zones. Civil wars often cause famine, as everyone within the country is affected. Famines due to war occurred in Holland in 1945, the Sudan in 1988, Somalia in 1991, and a large famine in Zaire in 1991 was due to civil war. Severe food deprivation characterized the ethnic conflict in the Great Lakes region of Africa in the late 1990s. The Bosnian war of 1998 included deliberate interruption of the flow of basic food supplies to the Kosovar population.

Finally, there are several parts of the world where famines occur on a regular basis. Much of Africa and Southeast Asia are subject to repeated food shortages. Nations in these areas are chronically vulnerable to changes in weather, or they have unstable political situations. India suffered recurrent famines up until the time of independence from colonial rule in the mid–twentieth century, but has not experienced a major famine since that time, illustrating that prevention is possible even in chronically famine-prone areas.

CONSEQUENCES OF FAMINE

The consequences of famine are physical, psychological, social, and economic. Malnutrition results from food shortage within weeks. Children fail to grow and cannot learn in school, and both adults and children experience weight loss, lack of energy, and decreased work ability. Permanent blindness can result from vitamin A deficiency that accompanies a deterioration of dietary quality. Malnutrition also puts people at a high risk of dying from common infectious illnesses. Diseases such as measles, malaria, pneumonia, and diarrhea are the most common causes of death during famine. Psychological impacts result from fear and uncertainty about having enough to eat or to feed one's family. Socially, migration is a common occurrence during periods of famine, and resettling in other areas or in refugee camps disrupts social relationships and hierarchies. Lack of food also creates disharmony as people resort to desperate measures (such as stealing) in order to eat, or when old conflicts are renewed due to some groups having more food than others. Losing land ownership and selling valuable assets such as livestock, jewelry, or other goods can prevent families from recovering financially after a famine.

RESPONSES TO FAMINE

Responses to famine take place at the individual, governmental, and international level. At the individual level, families go through a series of progressively more drastic coping behaviors. First, food consumption becomes more restricted, and households attempt to generate more income to purchase food. Adults will usually restrict their own food consumption in order to protect children. Typically, adults take on extra jobs and unemployed family members enter the labor force to earn additional money. If the stress continues, families borrow or accept donations from friends, relatives, or government agencies, and they may sell household items, livestock, or even vital assets such as seeds and land in order to obtain money to buy food. In extreme cases, people leave their homes and migrate to other areas in order to survive.

Responses at the government level depend upon how early an impending famine is detected and how prepared a government is to respond to the situation. For example, in Rajasthan, India, there is a governmental system of grain storage that can be distributed during periods of shortage. There are also programs in place for public works projects so that people can work for food during a crisis period. Furthermore, investment in roads, trains, and communications helps get food to people faster in times of need. In contrast, most of sub-Saharan Africa has little in the way of effective government antifamine plans and policies. Most of the sharing and distribution of food reserves takes place on an individual or community basis, and most countries do not have food stocks to distribute in case of emergency. Food must be imported, which is expensive, or countries are forced to rely on international food aid when famine threatens.

Many organizations provide food aid to countries and individuals during famines. The World Food Programme of the United Nations is the largest international mechanism for providing food aid where it is needed; up to date information can be found at the program's web site, http://www.wfp.org. The Hunger Site, at http://www.thehungersite.com, provides a world map where each click on a location is linked to donations from multiple donors to the World Food Programme. Many other governmental and nongovernmental organizations are also involved in responding to food emergencies as they arise.

PREVENTING FAMINE

Famine can be prevented in several ways. One strategy is to pay more attention to environmental issues, such as the rotation of crops to help to keep the soil rich in nutrients or maintaining vegetative growth in fields year-round to keep soil from being blown or washed away. New agricultural technologies, including new fertilizers and pesticides and genetically improved crops, can also help avoid famine without harming the environment. Storing food during years of good harvest and redistribution of extra food and seeds to those who need them is another way of maintaining a food reserve. Finally, communication and coordination among communities and governments in need is essential to help prevent famine. Governments in famine-prone areas need to be able to predict in advance what areas may be vulnerable, assess needs, obtain food and necessary supplies, and transport these items to food-short areas in a timely manner. In Africa, a system called the Famine Early Warning System has had success in famine prevention. This program uses several methods to assess impending risks of famine. The program monitors weather in Africa and uses satellite photographs to see if plants are healthy or deteriorating. It also monitors crop growth, food availability, and prices in local markets.

Famines due to "natural" causes can be avoided through coordinated effort to keep governments and people alert and prepared and to provide mechanisms for people to get food when they need it. Food emergencies caused by war, civil strife, and political will depend on recognition of and respect for the fundamental right to food as a basic human right, and on enforcement of this principle in international law.

GAIL G. HARRISON

AME STORMER

NASRIN OMIDRAR

(SEE ALSO: International Health; Nutrition; Politics of Public Health; Poverty and Health; Refugee Communities; Right to Health; War)