A farmer walks up a hillside close to Medellín, Colombia. The country has the world’s largest population of internally displaced people, many of whom are farmers and indigenous people. Both geography and ethnicity can impact a person’s nutritional status. 02 GLOBAL, REGIONAL, AND NATIONAL TRENDS The 2017 Global Hunger Index (GHI) indicates that worldwide levels of hunger and undernutrition have declined over the long term: At 21.8 on a scale of 100, the average GHI score for 2017 is 27 percent lower than the 2000 score (29.9) (Figure 2.1).1 This improvement reflects the reductions since 2000 in each of the four GHI indicators—the prevalence of undernourishment, child stunting (low height-for-age), child wasting (low weight-for-height), and child mortality.2 In the coun- tries included in the GHI, the share of the population that is under- nourished is down from 18.2 percent in 1999–2001 to 13.0 percent as of 2014–2016. Of children under five, 27.8 percent are stunted, down from the 2000 rate of 37.7 percent, and 9.5 percent are wasted, down slightly from 9.9 percent in 2000. Finally, the under-five mortal- ity rate dropped from 8.2 percent in 2000 to 4.7 percent in 2015.3 Despite these improvements, a number of factors, including deep and persistent inequalities, undermine efforts to end hunger and undernutrition worldwide. As a result, even as the average global hunger level has declined, certain regions of the world still struggle with hunger more than others, disadvantaged populations experience hunger more acutely than their better-off neighbors, and isolated and war-torn areas are ravaged by famine. In early 2017, the United Nations declared that more than 20 million people were at risk of famine in four countries: Nigeria, Somalia, South Sudan, and Yemen. These crises are largely “man- made,” the result of violent conflict and internal strife that are pre- venting people from accessing food and clean water and keeping aid organizations from reaching people in need. In Somalia—which has suffered years of war and multiple insurgencies, and until recently was deemed a failed state—an ongoing drought sparked the initial crisis (Economist 2017; UN 2017). In March 2017, the UN Undersecretary- General for Humanitarian Affairs declared the situation the worst humanitarian crisis the world has faced since World War II (UN 2017). It is against this backdrop that we explore the state of hunger in the world. The following sections report on hunger and undernutrition at the regional, national, and subnational levels, and provide insight into how and why these have changed over time. Regional Variations At the regional level, South Asia and Africa south of the Sahara have the highest 2017 GHI scores—30.9 and 29.4, respectively, indicating serious levels of hunger (Figure 2.1). The GHI scores, and therefore the hunger levels, for East and Southeast Asia, the Near East and North Africa, Latin America and the Caribbean, and Eastern Europe and the Commonwealth of Independent States are considered low 1 The regional and global aggregates for each component indicator are calculated as popu- lation-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 the global and regional aggregates only, but are not reported in Appendix C. The regional and global GHI scores are calculated using the regional and global aggregates for each indicator and the formula described in Appendix A. 2 The estimates in this paragraph refer to the countries for which GHI data were available. These estimates can vary slightly from those published by other organizations for the same indicators due to the inclusion of different countries. 3 Black et al. (2013) estimate that undernutrition causes almost half of all child deaths globally. FIGURE 2.1 GLOBAL AND REGIONAL 1992, 2000, 2008, AND 2017 GLOBAL HUNGER INDEX SCORES, WITH CONTRIBUTION OF COMPONENTS 3 5 .2 2 9 .9 2 5 .7 2 1 .8 4 6 .3 3 8 .2 3 4 .9 3 0 .9 4 8 .3 4 3 .5 3 4 .8 2 9 .4 1 9 .3 1 6 .7 1 4 .4 1 2 .8 2 8 .9 2 0 .5 1 6 .6 1 2 .6 1 7 .1 1 3 .6 9 .7 8 .4 1 4 .4 9 .3 7 .8 G H I sc or e 0 10 20 30 40 50 60 '92 '00 '08 '17 '92 '00 '08 '17 '92 '00 '08 '17 '92 '00 '08 '17 '92 '00 '08 '17 '92 '00 '08 '17 '92 '00 '08 '17 World South Asia Africa south of the Sahara Near East & North Africa East & Southeast Asia Latin America & Caribbean Eastern Europe & Commonwealth of Independent States Under-five mortality rate Prevalence of wasting in children Prevalence of stunting in children Proportion of undernourished Source: Authors. Note: See Appendix B for data sources. A 1992 regional score for Eastern Europe and the Commonwealth of Independent States was not calculated because many countries in this region did not exist in their present borders. 2017 Global Hunger Index | Chapter 02 | Global, Regional, and National Trends 11 or moderate, ranging from 7.8 to 12.8 points. Within each region in the low range, however, are also countries with serious or alarming GHI scores, including Tajikistan in Central Asia, which is part of the Commonwealth of Independent States; Guatemala and Haiti in Latin America and the Caribbean; and Iraq and Yemen in the Near East and North Africa region. Seven of 14 countries in East and Southeast Asia have serious scores, though the low score of highly populous China improves the regional average. In the regions with the most hunger, South Asia and Africa south of the Sahara, different indicators drive the high GHI scores. In South Asia, child undernutrition, as measured by child stunting and child wasting, is higher than in Africa south of the Sahara. Meanwhile, Africa south of the Sahara has a higher child mortality rate and strug- gles more with undernourishment, reflecting overall calorie deficiency for the population. Given that three-quarters of South Asia’s population resides in India, the situation in that country strongly influences South Asia’s regional score. At 31.4, India’s 2017 GHI score is at the high end of the serious category. According to 2015–2016 survey data, more than a fifth (21 percent) of children in India suffer from wasting. Only three other countries in this year’s GHI—Djibouti, Sri Lanka, and South Sudan—have data or estimates showing child wast- ing above 20 percent in the latest period (2012–2016). Further, India’s child wasting rate has not substantially improved over the past 25 years (see Appendix C). But the country has made prog- ress in other areas: Its child stunting rate, while still relatively high at 38.4 percent, has decreased in each of the reference periods in this report, down from 61.9 percent in 1992. According to Menon et al. (2017), India has implemented a “massive scale-up” of two national programs that address nutrition—the Integrated Child Development Services and the National Health Mission—but these have yet to achieve adequate coverage. Areas of concern include (1) the timely introduction of complementary foods for young chil- dren (that is, the transition away from exclusive breastfeeding), which declined from 52.7 percent to 42.7 percent between 2006 and 2016; (2) the share of children between 6 and 23 months old who receive an adequate diet—a mere 9.6 percent for the country; and (3) household access to improved sanitation facilities—a likely factor in child health and nutrition—which stood at 48.4 percent as of 2016 (Menon et al. 2017). In Africa south of the Sahara, meanwhile, undernourishment remains stubbornly high, staying virtually the same in 2014–2016 (at 21.6 percent) as in 2007–2009 (at 22.0 percent), and currently constituting the highest regional undernourishment rate in the world. Rising food prices, droughts, and political instability contributed to this stagnation (FAO/IFAD/WFP 2015). Economic growth (particularly in certain sectors of the economy such as agriculture) and invest- ment (especially in public services such as health and education) have helped some countries in the region to reduce their undernour- ishment levels (Soriano and Garrido 2016). Countries such as Angola, Gabon, and Mali have experienced substantial reductions in under- nourishment rates in recent years, achieving rates under 15 percent as of 2014–2016 (FAO 2017b). A common feature among these and other countries in the region that have lowered their undernourish- ment rates is relatively rapid improvement in agricultural productiv- ity (FAO/IFAD/WFP 2015). Although progress on certain indicators has stalled in some places, there has been a steady decline in hunger levels for each region cov- ered in this report (Figure 2.1). Between the 2000 and 2017 scores, Eastern Europe and the Commonwealth of Independent States saw the greatest improvement when measured by the percentage change, though not in absolute terms. During the same period, Africa south of the Sahara, which had the highest regional score in 2000, experi- enced the greatest decline in absolute GHI values—a 14-point drop. Looking all the way back to 1992, however, Africa south of the Sahara and South Asia have made comparable progress; according to their GHI scores, hunger levels for these regions were remarkably close in 1992 and again in the most recent reference period. Country-Level Results The numerical ranking, ordered from lowest to highest hunger levels, for each country included in the GHI is shown in Table 2.1, along with each country’s 1992, 2000, 2008, and 2017 GHI scores. Appendix C shows the values of the GHI indicators—the prevalence of under- nourishment, child wasting, child stunting, and child mortality—for each country, including their historic values. The individual indicators are particularly important because the nature of hunger and under- nutrition—and therefore the right mix of policies and interventions to address them—varies from country to country. Appendix D shows the 1992, 2000, 2008, and 2017 GHI scores for each country, alpha- betized by country name. The 2017 GHI shows that seven countries suffer from levels of hunger that are alarming, and one country, the Central African Republic (CAR), suffers from a level that is extremely alarming. Seven of these eight countries are in Africa south of the Sahara: CAR, Chad, Liberia, Madagascar, Sierra Leone, Sudan, and Zambia. The excep- tion is Yemen, located at the tip of the Arabian Peninsula. As in years past, GHI scores for several countries could not be calculated because data were not available for all four GHI indi- cators. Nevertheless, the hunger and undernutrition situations in many of these countries are cause for significant concern (Box 2.1). 12 Global, Regional, and National Trends | Chapter 02 | 2017 Global Hunger Index TABLE 2.1 GLOBAL HUNGER INDEX SCORES BY RANK, 1992 GHI, 2000 GHI, 2008 GHI, AND 2017 GHI Rank1 Country 1992 2000 2008 2017 2 0 1 7 G H I sc or es le ss t ha n 5 , co lle ct iv el y ra nk ed 1 –1 4 .2 Belarus — <5 <5 <5 Bosnia & Herzegovina — 9.8 7.0 <5 Chile 5.9 <5 <5 <5 Croatia — 6.2 <5 <5 Cuba 10.5 5.3 <5 <5 Estonia — 6.2 <5 <5 Kuwait 20.0 <5 <5 <5 Latvia — 6.7 <5 <5 Lithuania — 5.9 <5 <5 Montenegro — — 5.2 <5 Slovak Republic — 8.0 6.4 <5 Turkey 14.3 10.4 5.6 <5 Ukraine — 13.7 <5 <5 Uruguay 9.7 7.7 6.4 <5 15 Romania 9.3 8.7 6.0 5.2 16 Costa Rica 7.5 6.2 5.0 5.3 16 Macedonia, FYR — 7.7 6.4 5.3 18 Argentina 7.0 6.6 5.8 5.4 18 Brazil 15.9 11.7 5.4 5.4 18 Bulgaria 7.9 8.2 7.6 5.4 21 Kazakhstan — 11.3 10.9 5.8 22 Russian Federation — 10.5 6.8 6.2 23 Mexico 14.0 10.8 8.4 6.5 24 Serbia — — 7.2 6.6 25 Jordan 13.4 10.3 6.5 6.7 26 Trinidad & Tobago 14.5 11.7 10.4 6.9 27 Saudi Arabia 14.3 12.5 11.2 7.1 28 Tunisia 15.4 10.7 8.0 7.4 29 China 25.9 15.8 11.2 7.5 30 Iran 17.5 13.6 8.7 7.6 30 Moldova — 16.3 13.3 7.6 32 Armenia — 18.4 11.4 7.7 32 Georgia — 14.7 8.3 7.7 34 Colombia 14.6 11.3 9.4 8.0 34 Jamaica 12.0 8.4 7.6 8.0 36 Fiji 11.5 9.8 9.1 8.1 36 Lebanon 11.4 9.0 8.2 8.1 38 Peru 28.7 20.9 15.3 8.7 39 Panama 19.9 20.0 14.1 9.2 40 Kyrgyz Republic — 19.7 13.4 9.3 41 Algeria 17.5 15.6 11.3 9.5 42 Azerbaijan — 27.5 15.3 9.6 43 Suriname 17.0 16.0 11.4 9.9 44 Malaysia 19.8 15.5 13.7 10.2 44 Morocco 18.7 15.7 12.0 10.2 46 Thailand 25.8 18.1 12.0 10.6 47 Paraguay 16.7 14.1 12.1 11.0 48 Albania 20.8 21.6 16.5 11.1 48 El Salvador 19.5 16.2 12.7 11.1 50 Oman 20.8 13.7 10.2 11.3 51 Dominican Republic 23.8 18.4 15.4 11.6 52 Turkmenistan — 21.9 16.5 12.2 53 Venezuela 15.2 15.2 9.3 13.0 54 Uzbekistan — 23.8 16.1 13.1 55 South Africa 18.5 18.8 16.6 13.2 56 Mauritius 17.4 15.9 14.3 13.3 57 Mongolia 37.5 31.7 18.1 13.4 58 Nicaragua 36.1 24.7 18.2 13.6 59 Guyana 22.3 17.9 17.0 13.7 60 Gabon 24.2 20.7 17.4 13.8 61 Honduras 25.9 20.6 17.0 14.3 62 Ecuador 22.3 20.5 16.4 14.4 63 Egypt 20.1 16.4 16.6 14.7 64 Viet Nam 40.2 28.6 21.6 16.0 65 Ghana 41.9 29.2 21.9 16.2 66 Bolivia 36.7 30.3 23.9 17.2 Rank1 Country 1992 2000 2008 2017 67 Senegal 37.5 37.3 23.7 18.4 68 Philippines 30.5 25.9 20.2 20.0 69 Guatemala 28.5 27.4 22.2 20.7 70 Kenya 39.1 37.6 29.6 21.0 71 Swaziland 24.0 29.9 30.7 21.2 72 Indonesia 35.0 25.5 28.3 22.0 72 Nepal 42.5 36.8 28.9 22.0 74 Cameroon 40.0 39.6 29.5 22.1 75 Cambodia 45.8 43.6 27.1 22.2 76 Togo 45.8 39.0 28.3 22.5 77 Myanmar 55.6 43.6 30.1 22.6 78 Iraq 21.8 26.5 25.7 22.9 79 Gambia 35.2 27.5 23.8 23.2 80 Lesotho 26.5 33.2 28.4 24.1 81 Benin 44.5 37.5 31.7 24.4 81 Botswana 33.8 33.0 30.7 24.4 83 Mauritania 39.4 33.6 23.7 25.2 84 Nigeria 48.8 41.0 33.7 25.5 84 Sri Lanka 31.6 26.8 24.2 25.5 86 Congo, Rep. 39.1 36.0 31.6 25.6 87 Namibia 35.4 30.8 30.9 25.7 88 Bangladesh 53.6 37.6 32.2 26.5 88 Côte d’Ivoire 32.9 32.6 35.1 26.5 90 Malawi 58.2 44.6 31.5 27.2 91 Lao PDR 52.3 48.1 33.4 27.5 92 Burkina Faso 47.0 47.9 36.4 27.6 93 North Korea 31.9 40.3 30.7 28.2 94 Guinea 46.5 44.0 33.4 28.6 94 Mali 51.4 44.2 35.1 28.6 96 Tajikistan — 41.8 32.6 28.7 97 Tanzania 42.9 42.4 33.0 28.8 98 Mozambique 63.6 48.7 37.5 30.5 99 Guinea-Bissau 44.5 43.1 31.4 30.6 100 Djibouti 60.3 46.7 35.1 31.4 100 India 46.2 38.2 35.6 31.4 100 Rwanda 53.3 56.3 36.2 31.4 103 Uganda 41.2 39.2 33.3 32.0 104 Ethiopia — 56.0 40.2 32.3 105 Angola 65.8 57.5 39.7 32.5 106 Pakistan 42.7 38.2 34.7 32.6 107 Afghanistan 50.2 52.7 37.9 33.3 108 Zimbabwe 35.8 40.9 34.5 33.8 109 Haiti 51.6 42.7 42.6 34.2 110 Timor-Leste — — 46.8 34.3 111 Niger 66.2 52.6 37.0 34.5 112 Liberia 51.2 48.2 38.9 35.3 113 Sudan — — — 35.5 114 Yemen 43.5 43.4 36.2 36.1 115 Zambia 48.5 52.3 45.0 38.2 116 Madagascar 43.9 43.6 36.8 38.3 117 Sierra Leone 57.2 54.7 44.5 38.5 118 Chad 62.5 51.9 50.9 43.5 119 Central African Republic 52.2 50.9 47.0 50.9 — = Data are not available or not presented. Some countries, such as the post-Soviet states prior to 1991, did not exist in their present borders in the given year or reference period. 1 Ranked according to 2017 GHI scores. Countries that have identical 2017 scores are given the same ranking (for example, Argentina, Brazil, and Bulgaria are each ranked 18th). The following countries could not be included because of lack of data: Bahrain, Bhutan, Burundi, the Comoros, the Democratic Republic of the Congo, Equatorial Guinea, Eritrea, Libya, Papua New Guinea, Qatar, Somalia, South Sudan, and the Syrian Arab Republic. 2 The 14 countries with 2017 GHI scores of less than 5 are not assigned individual ranks, but rather are collectively ranked 1–14. Differences between their scores are minimal. 2017 Global Hunger Index | Chapter 02 | Global, Regional, and National Trends 13 Russian Federation China Brazil Canada Australia India United States of America Iran Greenland Algeria Argentina Libya Mali Mexico Sudan Kazakhstan Peru Chad Niger Mongolia Egypt Angola Bolivia Saudi Arabia Ethiopia Turkey Nigeria Iraq Colombia Namibia Mauritania Zambia Spain Tanzania Ukraine France Kenya Venezuela Yemen Poland Chile Congo, Dem. Rep. Pakistan South Africa Sweden Somalia Myanmar Finland Italy South Sudan Norway Thailand Mozambique Botswana Afghanistan Indonesia Oman Congo, Rep. Morocco Germany Madagascar Uzbekistan Japan Paraguay Cameroon Viet Nam Syria Turkmenistan Zimbabwe Gabon Belarus Ghana Guinea Romania Central African Republic Ecuador Nepal Lao PDR Guyana Western Sahara Uganda Côte d'Ivoire Senegal Tunisia Malaysia Iceland Uruguay Kyrgyz Rep. Cuba Burkina Faso Benin Cambodia Eritrea S. KoreaTajikistan Greece Serbia Bulgaria Suriname Latvia Austria Malawi New Zealand Jordan Liberia Hungary Ireland Nicaragua Honduras Bangladesh Portugal Togo Philippines Guatemala Georgia Lithuania Panama Azerb. Croatia N. Korea Czech Rep. Estonia Sri Lanka Bhutan Haiti Taiwan French Guiana Bel. Costa Rica Moldova Fiji Denmark Israel Albania Lesotho Belize U.A.E Burundi Dominican Rep. Djibouti Rwanda Kuwait Equatorial Guinea Papua New Guinea Guinea-Bissau Qatar Swaziland Jamaica Timor-Leste Lebanon United Kingdom Brunei Trinidad & Tobago Comoros Hong Kong El Salvador Mont. Mace. Bos. & Herz. Switz. Slovakia Slov. Lux. Armenia Cyprus Bahrain Mauritius Sierra Leone Gambia Neth. Singapore Increase Decrease by 0.0–24.9% Decrease by 25.0–49.9% Decrease by 50% or more Countries with 2000 and 2017 GHI of less than 5 Insufficient data Not calculated* *See Chapter 1 for details Notably, two of the four countries currently facing famine are among those not included in the GHI, yet their populations are indisputably facing extremely alarming hunger. For South Sudan and Somalia, there are insufficient data to calculate GHI scores, yet other data and systems designed to detect acute food-security crises, such as the Famine Early Warning System (FEWS NET), make clear that their hunger levels are extreme (FEWS NET 2017d; FEWS NET 2017b). The GHI scores of the other two famine-threatened countries, Nigeria and Yemen, fall in the serious and alarming categories, respec- tively. They do not fall into the extremely alarming category for two key reasons: inequality (the theme of this year’s report) and timing. Inequality plays a greater role in Nigeria, where 4.5 million people (out of a total population of roughly 180 million) in the northeast of the country are experiencing or are at risk of famine, mainly due to ongoing violence spread by Boko Haram (VOA 2017; UNDP 2017a). The remainder of the country faces minimal food-security concerns (FEWS NET 2017c) and uneven levels of child undernutrition (NBS 2015). In Yemen, the crisis is also fueled by violent conflict, but is more evenly spread throughout the country, with 17 million people (about 65 percent of the population) facing food insecurity (UNDP 2017a; FEWS NET 2017a). Timing, meanwhile, factors into all the scores: GHI scores are based on the most up-to-date data avail- able for the GHI indicators. In the case of the 2017 scores, data are included from the most recent reference period (2012–2016) and therefore reflect hunger and undernutrition in this period. The FIGURE 2.2 COUNTRY PROGRESS IN REDUCING GHI SCORES Percentage change in 2017 GHI compared with 2000 GHI Source: Authors. Note: An increase in the GHI indicates a worsening of a country’s hunger situation. A decrease in the GHI indicates an improvement in a country’s hunger situation. GHI scores were not calculated for countries with very small populations. 14 Global, Regional, and National Trends | Chapter 02 | 2017 Global Hunger Index FIGURE 2.3 HOW SERIOUS, ALARMING, AND EXTREMELY ALARMING COUNTRIES HAVE FARED SINCE 2000 Central African Republic Sri Lanka Madagascar IraqIndonesia Pakistan Gambia Chad Namibia YemenZimbabweIndia Uganda Côte d'Ivoire Haiti Philippines Guatemala Mauritania Botswana Liberia Zambia Lesotho Republic of Congo Guinea-BissauSwaziland Bangladesh Sierra Leone North Korea Tajikistan Tanzania Djibouti Niger Benin Guinea Mali Afghanistan Mozambique Nigeria Malawi Nepal Togo EthiopiaBurkina Faso Lao PDR Angola Kenya Cameroon Rwanda Myanmar Cambodia 0 10 20 30 40 50 60 15 20 25 30 35 40 45 50 55 P er ce nt r ed uc ti on in G H I sc or e si nc e 2 0 0 0 2017 Global Hunger Index score moderate serious alarming extremely alarming Lower reduction in hunger Higher reduction in hunger GHI Severity Scale Source: Authors. Note: This figure features countries where data were available to calculate 2000 and 2017 GHI scores and where 2017 GHI scores were equal to or greater than 20, reflecting serious, alarming, or extremely alarming hunger levels. Some likely poor performers may not appear due to missing data. extent of the current crises will therefore be reflected in future GHI indicators and scores. The Central African Republic, which has the highest 2017 GHI score, has suffered from instability, sectarian violence, and civil war since 2012. Livelihoods have been lost, markets disrupted, and food security weakened (USAID 2017a). As of May 2017, there were 500,000 internally displaced persons in this country of just 5 million people. Underlying CAR’s high GHI score are its very high under- nourishment value of 58.6 percent, the highest in this year’s report, and its child mortality rate of 13 percent, the fourth highest in the report. The country’s child stunting and child wasting estimates are also high and cause for concern. Despite these troubling cases, there is cause for optimism. Of 119 countries, 43 have low 2017 GHI scores (under 10). Roughly half of these are in Eastern Europe and the Commonwealth of Independent States. The rest are in Latin America and the Caribbean, the Near East and North Africa, and East and Southeast Asia. From the 2000 GHI to the 2017 GHI, the scores of 14 countries improved by 50 percent or more; those of 72 countries dropped by between 25 and 49.9 percent; and those of 27 countries fell by less than 2017 Global Hunger Index | Chapter 02 | Global, Regional, and National Trends 15 25 percent (Figure 2.2). Only CAR showed no progress; its 2017 and 2000 GHI scores are the same. Just as overall GHI scores vary considerably, so do the component indicators. In terms of undernourishment, Zambia, Haiti, and CAR have the highest shares of undernourished people: between 45.9 and 58.6 percent of their populations cannot meet their minimum calorie needs. Stunting, meanwhile, is most prevalent in Timor-Leste, Eritrea, and Burundi, each with levels at or exceeding 50 percent. Wasting is most prevalent in Sri Lanka, Djibouti, and South Sudan, where 21.4 to 27.3 percent of children under age five are affected. Finally, the under-five mortality rate is highest in Angola (15.7 percent), Chad (13.9 percent), and Somalia (13.7 percent). According to the 2017 GHI, 52 countries have scores of 20 or higher, and thus still suffer from at least serious levels of hunger. Figure 2.3 shows how these countries have fared since 2000. The countries in the lower right of the figure, including CAR, Chad, and Madagascar, have high GHI scores and low rates of hunger reduction since 2000. The countries near the top of the figure have seen sizable reductions in hunger, and those in the upper left, such as Cambodia, Myanmar, Kenya, Cameroon, Togo, and Nepal, have experienced rel- atively rapid improvements and are nearing the moderate category. Kenya’s score has dropped by 44 percent since 2000, moving the country from the alarming to the serious category, verging on moderate. Underlying this progress is improvement in each of the GHI indicators. Kenya has experienced steady economic growth in recent years (WFP 2017a), and has worked to improve food security and nutrition. In 2012, Kenya’s government put in place a National Nutrition Action Plan (NNAP), complemented by investments in agriculture, disaster-resilience, food-fortification, and other related initiatives (Dayton Eberwein et al. 2016). Kenya has yet to reach its nutrition targets, and some localities are lagging behind and face more serious hunger and nutrition challenges. The drought affect- ing East Africa this year has created additional food-security chal- lenges for large parts of the country, with harvests, livestock, and food prices negatively affected (FAO GIEWS 2017b). Aside from the immediate drought-related needs, Dayton Eberwein et al. (2016) esti- mate that a full range of nutrition interventions with national cover- age would require an investment of US$213 million over five years, while a slightly scaled-down package for the areas in greatest need would require $135 million. Nepal’s GHI score was also in the alarming category in 2000, but is now in the serious category, verging on moderate. Nepal has experienced declines in undernourishment, child stunting, and child mortality, while its child wasting rate has remained unchanged. According to one study, Nepal’s remarkable reduction in child stunting between 2001 and 2011 is associated with, and likely attributable to, increased household assets (a proxy for household wealth), increased maternal education levels, improved sanitation levels, and imple- mentation and utilization of health and nutrition programs, includ- ing antenatal and neonatal care (Headey and Hoddinott 2015). Yet despite Nepal’s progress there are still deep inequalities within the country, discussed in more detail in the subnational section below. Angola, Ethiopia, and Rwanda, all of which experienced violent conflicts in recent decades, had 2000 GHI scores in the extremely alarming category. The 2017 scores of each, however, are 42 to 44 percent lower, placing them in the serious category. These coun- tries still have major challenges to overcome. All have stunting lev- els between 37 and 38 percent, and Angola’s child mortality rate (15.7 percent) is the highest in this year’s report. Yet they have already come back from the highest levels of hunger and under- nutrition, providing hope for countries currently in the throes of vio- lent conflict, massive food insecurity, and even famine. The situation in Ethiopia, which experienced multiple civil wars and extreme famines between 1974 and 1991 (de Waal 1991), has substantially improved, but remains tenuous. Most of the popula- tion is engaged in rainfed agriculture (Asmamaw 2017) and there- fore vulnerable to food insecurity due to inconsistent rainfall (USAID 2017c). This year, the drought in East Africa is severely impacting crops and livestock in Ethiopia, putting millions in need of humani- tarian assistance (FAO GIEWS 2017b). In 2005, Ethiopia’s govern- ment established the Productive Safety Net Programme (PSNP), a large-scale program to prevent future food crises. It includes pub- lic-works projects and cash or food transfers for households that are unable to participate in the public-works component. Some partici- pants also receive agricultural support through a complementary pro- gram (Gilligan et al. 2009). Research has shown that a combination of PSNP assistance and provision of agricultural support services improves households’ food security (Gilligan et al. 2009), and that PSNP reduces child undernutrition (Debela et al. 2009). The gov- ernment has put in place other initiatives to support food security and nutrition, and has committed to ending child undernutrition by 2030. The country still needs to increase agricultural research and development; improve coordination between sectors such as nutri- tion, agriculture, and health; and expand coverage of targeted nutri- tion programs (Compact2025 2016). Subnational Hunger and Undernutrition An examination of subnational-level data reveals wide disparities within countries. These differences in hunger and nutrition pro- files mean that, in most countries, a one-size-fits-all approach to tackling hunger and undernutrition is unlikely to yield the best 16 Global, Regional, and National Trends | Chapter 02 | 2017 Global Hunger Index FIGURE 2.4 SUBNATIONAL INEQUALITY OF CHILD STUNTING 0 10 20 30 40 50 60 70 80 Child stunting rate (under age five) Stunting rate, lowest region Stunting rate, national average Stunting rate, highest region Serbia (4) Moldova (4) Dominican Republic (9) Jordan (12) Kazakhstan (16) Bosnia & Herzegovina (3) Montenegro (3) Armenia (11) Turkey (12) Tunisia (9) Thailand (5) Mongolia (5) Turkmenistan (6) Algeria (7) Guyana (9) Mexico (5) Kyrgyz Republic (9) Sri Lanka (25) El Salvador (5) Gabon (10) Azerbaijan (9) Ghana (10) Senegal (4) Egypt (4) Haiti (11) Honduras (18) Mauritania (11) Namibia (13) Gambia (8) Swaziland (4) Kenya (8) Tajikistan (5) Zimbabwe (10) Togo (6) Guinea-Bissau (9) North Korea (10) Myanmar (15) Côte d'Ivoire (11) Comoros (3) Philippines (17) Guinea (8) Liberia (15) Cameroon (12) Cambodia (19) Nigeria (37) Lesotho (10) Benin (12) Tanzania (30) Bangladesh (7) Malawi (3) Nepal (15) Angola (18) Rwanda (5) Sierra Leone (14) Sudan (18) Ethiopia (11) India (34) Chad (21) Zambia (10) Afghanistan (34) Congo, Dem. Rep. (11) Niger (8) Lao PDR (17) Pakistan (5) Guatemala (22) Yemen (21) Timor-Leste (13) Source: Authors. Based on surveys listed in UNICEF/WHO/World Bank (2017) and WHO (2017), from 2012–2016. Countries included are those with subnational stunting data available for 2012–2016. 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. 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 2017. 2017 Global Hunger Index | Chapter 02 | Global, Regional, and National Trends 17 BOx 2.1 COUNTRIES WITH INSUFFICIENT DATA, YET SIGNIFICANT CONCERNS GHI scores for 2017 could not be calculated for 13 countries because data on the prevalence of undernourishment and, in some cases, data or estimates on child stunting and child wast- ing were unavailable. Yet the countries with missing data may be the ones suffering most. Therefore, we still review the hun- ger and undernutrition situations in such places. To monitor and evaluate progress, it is essential that the national governments of these countries, along with the appropriate international orga- nizations, take all steps necessary to make the missing data available without delay. Only when the extent of the problem is known can it effectively be tackled. The table below shows the existing GHI indicator values for the nine countries without GHI scores that we have determined to be cause for significant concern. We base this determination on the available data and information from international organi- zations that specialize in hunger and undernutrition. BURUNDI: Burundi’s child stunting level, estimated at 56.6 percent, is the highest of all countries covered in this report. In 2014, the last year that adequate data were avail- able to calculate full GHI scores for Burundi, it had the highest score of all countries for which scores could be cal- culated, placing it in the extremely alarming category (von Grebmer et al. 2014). More than a decade of violent conflict (1993–2005) contributed to Burundi’s poor food security and nutrition situation (Verwimp 2012; WFPUSA 2015). Mercier et al. (2016) show that household exposure to violence during Burundi’s civil war still contributed to decreased household welfare in 2012 and predicted that the effects would per- sist through at least 2017. Due to political unrest beginning in 2015, hundreds of people had died and roughly half a million (of a total population of 11 million) had been inter- nally displaced or fled the country as of early 2017 (USAID 2017b). The UN Office for the Coordination of Humanitarian Affairs’ 2017 Humanitarian Response Plan says 7.3 million people, 65 percent of the population, live below the extreme poverty line. COMOROS: Comoros’s child stunting rate is 32 percent; child wast- ing rate, 11 percent; and under-five mortality rate, 7 percent. A low-lying island nation in the Indian Ocean, the Comoros is vul- nerable to the effects of climate change and has been repeatedly hit with natural disasters. Densely populated and heavily reli- ant on agriculture, the country suffers from poor environmental management and has limited resources to support its growing population (Burak and Meddeb 2012). In addition, the Comoros has experienced at least 20 coups since gaining independence from France in 1975 (CSIS 2008). EXISTING GHI INDICATOR VALUES Country Child Stunting Stunting in children under five 2012–2016 (%) Child Wasting Wasting in children under five 2012–2016 (%) Child Mortality Under-five mortality 2015 (%) Burundi 56.6* 7.6* 8.2 Comoros 32.1 11.1 7.4 Congo, Dem. Rep. 42.6 8.1 9.8 Eritrea 53.3* 14.7* 4.7 Libya 25.9* 5.8* 1.3 Papua New Guinea 41.5* 7.1* 5.7 Somalia — — 13.7 South Sudan 36.9* 27.3* 9.3 Syrian Arab Republic — — 1.3 Source: Authors. Note: * indicates IFPRI estimates; — = not available. Undernourishment values are not available for countries in this table. 18 Global, Regional, and National Trends | Chapter 02 | 2017 Global Hunger Index DEMOCRATIC REPUBLIC OF CONGO (DRC): The DRC has for decades struggled with one of the world’s most relentless emergencies. Recently, escalating conflict displaced 1.4 million people in Kasai Province. As of January 2017, more than 5.7 million peo- ple were facing crisis-level food insecurity and 173,000 were facing emergency-level food insecurity (ACAPS 2017). Roughly 43 percent of children under age five are stunted, 8 percent are wasted, and the child mortality rate is nearly 10 percent. According to the United States Agency for International Development (USAID), “Recurrent conflict and subsequent internal displacement of persons, lack of improved agricultural inputs and techniques, pervasive crop and livestock diseases, poor physical infrastructure, gender inequity, and a rising fer- tility rate are among the many factors challenging food security in DRC” (USAID 2016). ERITREA: Child undernutrition levels are extreme in Eritrea, with the child stunting rate estimated at 53.3 percent and child wasting at 14.7 percent. In 2014, the last year for which a GHI score could be calculated for Eritrea, the coun- try had the second highest score (von Grebmer et al. 2014). Undernutrition in Eritrea is related to the challenges of food production due to limited arable land, water shortages, and frequent droughts. Severe poverty also limits people’s ability to buy food (UNICEF 2015). LIBYA: Libya’s child stunting rate is estimated at 25.9 percent, child wasting at 5.8 percent, and child mortality at 1.3 percent. While these values are not extremely high, updated data are urgently needed to shed light on how six years of intermittent civil war and political strife have affected food security and undernutrition. Conflict and instability have damaged supply chains in parts of the country, limiting access to agricultural inputs and diminishing agricultural production. High unemploy- ment and inflation rates have put further stress on the popu- lation (FAO GIEWS 2017a). These factors are worsening food security in Libya, particularly for the country’s roughly 250,000 internally displaced persons (WFP 2017c). PAPUA NEW GUINEA: Child stunting in Papua New Guinea is estimated at 41.5 percent and child wasting at 7.1 percent. As a result of drought and frosts brought on by El Niño in 2015–2016, a third of the country’s population suffered from food insecurity, and businesses, schools, and other services were strained (FAO 2015, UNDP 2017b). The country has yet to fully recover from this latest El Niño event and remains vulnerable to additional natural disasters, including the pos- sibility of another El Niño episode occurring in late 2017 (UNDP 2017b). SOMALIA: Together, severe drought, high levels of internal dis- placement, and difficulties providing humanitarian assistance to Somalia’s population brought Somalia to the brink of famine in 2017. More than a quarter of the population (nearly 3 million people out of a total population of 11 million) are believed to be facing crisis or emergency-level food insecurity (FEWS NET 2017b). A 2011 famine in Somalia claimed 250,000 lives (WFP 2015). Child mortality is the only GHI indicator for which data are available for Somalia; at 13.7 percent, it is the third highest rate of child mortality among the countries included in this report. SOUTH SUDAN: In February 2017, the UN declared that the coun- ties of Leer and Mayendit in Unity State were in the midst of famine (FAO 2017a). Other localities face emergency situa- tions and could cross the official threshold into famine. As of May 2017, nearly 6 million South Sudanese were believed to be facing levels of food insecurity ranging from critical to cat- astrophic (IPC 2017b). In 2013, a struggle for power between opposing groups erupted in a civil war that still rages today. The acute food crisis, driven by conflict and insecurity, has had massive impacts, including population displacement, dis- ruption of markets, impending harvest deficits, and ongoing challenges for aid workers seeking to reach those in greatest need (IPC 2017a). SYRIAN ARAB REPUBLIC: As a result of the Syrian civil war that began in 2011, current data on the country are limited or non- existent. Up-to-date figures on the prevalence of undernourish- ment, child stunting, and child wasting were not available for this year’s GHI. But reports indicate that hunger has increased in Syria and nutrition has suffered. In May 2017, FAO reported: “As the Syrian war enters its seventh year, food production remains at a record low. Hunger is rampant and deepening across the country with over half the population unable to meet their daily food needs” (FAO 2017d). 2017 Global Hunger Index | Chapter 02 | Global, Regional, and National Trends 19 results. Subnational-level data can be particularly helpful in target- ing programs, as geographical targeting has been shown to be both effective and less expensive than household or individual targeting (Mesoamerica Nutrition Targeting Program Study Group 2002; Morris et al. 2000). Region- or state-level data, together with other infor- mation—for example, from focus group interviews—can serve as a solid foundation for good program and policy design. Figure 2.4 provides a snapshot of subnational disparities in child stunting rates for children under age five in 67 countries.4 Childhood stunting is a key indicator because it can be caused by a wide range of factors, including not just lack of food but also insufficient intake and absorption of micronutrients related to broader physical health and recurrent diseases that affect child growth. For each country with available data, this figure shows the average national stunting rate as well as that of the regions with the highest and lowest rates in the country. Several factors influence the size of the regional 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. It is therefore impossible to determine which countries have the highest levels of inequality in stunting based solely on the size of the gaps between the highest and lowest subnational stunting rates. That said, several interesting patterns do emerge. First, stunt- ing levels vary widely within countries in all regions of the world. For example, Latin America has one of the lowest regional hunger levels, yet stunting levels in Guatemala’s departments range from 25 percent to a shocking 70 percent. Second, some countries have relatively low national stunting levels, but have states or regions with levels that are problematically high. In Gabon, where the national stunting rate is only 16.5 percent, the highest regional rate is 34.5 percent. Similarly, some countries with high national stunting levels include regions where the stunting levels are extreme, as in Afghanistan. Third, although making direct comparisons between countries can be prob- lematic, some stand out as having more severe inequalities than do comparable countries. For example, Nepal and Angola have similar average stunting levels and population sizes, and they are divided into roughly the same number of subnational units for the under- nutrition surveys. Yet the highest regional stunting rate in Nepal is 64 percent compared to 51 percent in Angola. Each of these exam- ples is described in more detail below. Guatemala’s 2017 GHI score, 20.7, is serious, just above the mod- erate category. Guatemala is situated in Central America, where every other country’s GHI score is moderate or low. Yet Guatemala’s aver- age stunting rate is very high, at 46.5 percent, and in some depart- ments the stunting levels are abysmal. The areas with the highest stunting rates—Totonicapán at 70 percent, Quiché at 69 percent, and Huehuetenango at 68 percent (MSPAS, INE, and ICF International 2015)—are contiguous departments in the west of the country. The population of this area, considered to be Guatemala’s poverty belt, is heavily indigenous and was disproportionately affected by Guatemala’s civil war (1960–1996) (IFAD 2012). Guatemala Department, the department with the lowest stunting rate at 25.3 percent, is domi- nated by the nation’s capital, Guatemala City. Gabon has a relatively low national stunting rate, but has regions where the prevalence of stunting is high. The highest regional rate is 34.5 percent in the northeastern province of Ogooué-Ivindo, while the national average is only 16.5 percent (DGS and ICF International 2013). Ogooué-Ivindo is sparsely populated and relatively undevel- oped. The lowest regional stunting level, 10.6 percent, is in the com- bined area of Libreville and Port Gentil, the country’s two largest cities. Gabon is relatively prosperous compared to other countries in Africa south of the Sahara, with its economy fueled by petroleum sales. But its resources are spread unevenly among the population, and poverty, hunger, and undernutrition still exist (World Bank 2017). Nepal’s average national stunting rate is high at 37.4 percent, but not extraordinarily so. The highs in some areas, however, are extreme—63 percent in the Far-Western Hills and 64 percent in the Mid-Western Mountains (Central Bureau of Statistics 2015). These rugged, mountainous areas are in the poorest part of the country (ADB, n.d.; IFAD, n.d.), where rainfall is scarce, the land is not conducive to farming, and household landholdings for farming are smaller than in the rest of the country (IFAD, n.d.). Access to purchased food is constrained due to poor infrastructure, including limited roads and markets (IPC 2012). According to one study, the Mid Western and Far Western regions should “be understood as dif- ferent from the rest of the country (the Eastern, Central and Western regions together) on the basis of the high level of chronic poverty found there” (DFID 2013). The subregion with the lowest prevalence of stunting is Eastern Terai, at 25 percent. In terms of infant and young child feeding practices, the Mid- Western Mountains and Far-Western Hills subregions have poor records, with only about one-quarter of children between the ages of 6 and 23 months receiving minimally acceptable dietary diversity, compared to about a third of children in Nepal as a whole. In addition, just over 50 percent of children in the Far-Western Hills met recom- mended standards for meal frequency, compared to three-quarters of children in the country overall (Central Bureau of Statistics 2015). In terms of child health, Eastern Terai had higher-than-average rates of 4 Child stunting is highlighted here because subnational data are available for a wide range of countries and because, unlike child wasting, it is not significantly subject to seasonal varia- tion. Data are drawn from surveys conducted in 2012–2016, the same reference years used for child undernutrition data for 2017 GHI scores. 20 Global, Regional, and National Trends | Chapter 02 | 2017 Global Hunger Index child illness, but people there were more likely than people in the Mid- Western Mountains and Far-Western Hills to seek advice or treatment for their children, and caregivers were more likely to recognize warning signs of serious illness (Central Bureau of Statistics 2015). This is noteworthy because good health is essential for proper child growth, in part because healthy children are better able to absorb nutrients. In Afghanistan, the national prevalence of child stunting is 40.9 percent. The stunting rate in Farah Province, 70.8 percent, is the highest of any region in any country for which there are sub- national stunting data in this report. The province with the country’s lowest rate, 24.3 percent, is Ghazni (MPH, UNICEF, and AKU 2014). Farah is an interesting case. It is neither one of the poorest provinces in Afghanistan, nor one of the provinces facing the highest levels of food insecurity (World Bank 2011; CSO 2014). As Higgins-Steele et al. (2016) point out, however, many factors other than poverty affect children’s nutrition status, including “health status, dietary intake, food availability, care of mothers and children, health environment and services, and public policies and laws.” Farah Province is very remote and stands out in lack of access to drivable roads. Only 27 percent of the population lives within 2 km of a drivable road. This is one of the lowest rates in all of Afghanistan— far below the national average of 80 percent (CSO 2014). In addi- tion, of Afghanistan’s 33 provinces, Farah has the fifth lowest rate of household use of iodized salt. In Farah, the salt in just 17 percent of households tested positive for iodine versus the national aver- age of 44 percent (MPH, UNICEF, and AKU 2014). Lack of iodized salt is associated with child stunting (Krämer et al. 2016; Semba et al. 2008). Farah also has an extremely low female literacy rate of 11.1 percent (the national average is 17 percent) (CSO 2014). Low female literacy is associated with child undernutrition worldwide (Frongillo et al. 1997). Tackling Afghanistan’s formidable nutrition challenges, both in Farah and in the country as a whole, will require a range of actions to address both the immediate and underlying causes of undernutrition (Varkey et al. 2015). The preceding examples focus on geographic inequalities within countries. But there are many dimensions of inequality—both intra- national and international—based on ethnicity, locality (rural–urban), gender, age, and wealth. These dimensions of inequality, which often underlie and contribute to geographic inequality, are described in more detail in the following chapter. Progress and Challenges As the issue of famine looms large, it is easy to lose sight of the progress that has been made in the fight against hunger and under- nutrition. The 2017 Global Hunger Index shows positive develop- ments on many fronts, but there are still deep inequalities in hunger and undernutrition at the regional, national, and subnational levels. Too many people lack access to the quantity and quality of food they need. And too many people are not healthy enough to nutritionally benefit from food, for example, because infectious diseases pre- vent them from properly absorbing nutrients. The United Nations’ Sustainable Development Agenda includes the goal of ending hun- ger worldwide, while “leaving no one behind” (UN 2015). Examining hunger through the lens of inequality brings into sharper focus those populations, at all levels, who have so far been left behind. As we make progress in combating hunger, we should apply lessons learned and concentrate attention and resources on the areas where hun- ger and undernutrition are still unacceptably high in order to further decrease hunger in the future. 2017 Global Hunger Index | Chapter 02 | Global, Regional, and National Trends 21 Russian Federation China Brazil Canada Australia India United States of America Iran Greenland Algeria Argentina Libya Mali Mexico Sudan Kazakhstan Peru Chad Niger Mongolia Egypt Angola Bolivia Saudi Arabia Ethiopia Turkey Nigeria Iraq Colombia Namibia Mauritania Zambia Spain Tanzania Ukraine France Kenya Venezuela Yemen Poland Chile Congo, Dem. Rep. Pakistan South Africa Sweden Somalia Myanmar Finland Italy South Sudan Norway Thailand Mozambique Botswana Afghanistan Indonesia Oman Congo, Rep. Morocco Germany Madagascar Uzbekistan Japan Paraguay Cameroon Viet Nam Syria Turkmenistan Zimbabwe Gabon Belarus Ghana Guinea Romania Central African Republic Ecuador Nepal Lao PDR Guyana Western Sahara Uganda Côte d'Ivoire Senegal Tunisia Malaysia Iceland Uruguay Kyrgyz Rep. Cuba Burkina Faso Benin Cambodia Eritrea S. KoreaTajikistan Greece Serbia Bulgaria Suriname Latvia Austria Malawi New Zealand Jordan Liberia Hungary Ireland Nicaragua Honduras Bangladesh Portugal Togo Philippines Guatemala Georgia Lithuania Panama Azerb. Croatia N. Korea Czech Rep. Estonia Sri Lanka Bhutan Haiti Taiwan French Guiana Bel. Costa Rica Moldova Fiji Denmark Israel Albania Lesotho Belize U.A.E Burundi Dominican Rep. Djibouti Rwanda Kuwait Equatorial Guinea Papua New Guinea Guinea-Bissau Qatar Swaziland Jamaica Timor-Leste Lebanon United Kingdom Brunei Trinidad & Tobago Comoros Hong Kong El Salvador Mont. Mace. Bos. & Herz. Switz. Slovakia Slov. Lux. Armenia Cyprus Bahrain Mauritius Sierra Leone Gambia Neth. Singapore *See Box 2.1 for details **See Chapter 1 for details Not calculated** Insufficient data Insufficent data, significant concern* Alarming 35.0–49.9 Serious 20.0–34.9 Moderate 10.0–19.9 Low ≤ 9.9 Extremely alarming 50.0 ≤ FIGURE 2.5 2017 GLOBAL HUNGER INDEX BY SEVERITY Russian Federation China Brazil Canada Australia India United States of America Iran Greenland Algeria Argentina Libya Mali Mexico Sudan Kazakhstan Peru Chad Niger Mongolia Egypt Angola Bolivia Saudi Arabia Ethiopia Turkey Nigeria Iraq Colombia Namibia Mauritania Zambia Spain Tanzania Ukraine France Kenya Venezuela Yemen Poland Chile Congo, Dem. Rep. Pakistan South Africa Sweden Somalia Myanmar Finland Italy South Sudan Norway Thailand Mozambique Botswana Afghanistan Indonesia Oman Congo, Rep. Morocco Germany Madagascar Uzbekistan Japan Paraguay Cameroon Viet Nam Syria Turkmenistan Zimbabwe Gabon Belarus Ghana Guinea Romania Central African Republic Ecuador Nepal Lao PDR Guyana Western Sahara Uganda Côte d'Ivoire Senegal Tunisia Malaysia Iceland Uruguay Kyrgyz Rep. Cuba Burkina Faso Benin Cambodia Eritrea S. KoreaTajikistan Greece Serbia Bulgaria Suriname Latvia Austria Malawi New Zealand Jordan Liberia Hungary Ireland Nicaragua Honduras Bangladesh Portugal Togo Philippines Guatemala Georgia Lithuania Panama Azerb. Croatia N. Korea Czech Rep. Estonia Sri Lanka Bhutan Haiti Taiwan French Guiana Bel. Costa Rica Moldova Fiji Denmark Israel Albania Lesotho Belize U.A.E Burundi Dominican Rep. Djibouti Rwanda Kuwait Equatorial Guinea Papua New Guinea Guinea-Bissau Qatar Swaziland Jamaica Timor-Leste Lebanon United Kingdom Brunei Trinidad & Tobago Comoros Hong Kong El Salvador Mont. Mace. Bos. & Herz. Switz. Slovakia Slov. Lux. Armenia Cyprus Bahrain Mauritius Sierra Leone Gambia Neth. Singapore *See Box 2.1 for details **See Chapter 1 for details Not calculated** Insufficient data Insufficent data, significant concern* Alarming 35.0–49.9 Serious 20.0–34.9 Moderate 10.0–19.9 Low ≤ 9.9 Extremely alarming 50.0 ≤ Source: Authors. Note: For the 2017 GHI, data on the proportion of undernourished are for 2014–2016; data on child stunting and wasting are for the latest year in the period 2012–2016 for which data are available; and data on child mortality are for 2015. GHI scores were not calculated for countries for which data were not available and for certain countries with small populations. The boundaries and names shown and the designations used on this map do not imply official endorsement or acceptance by the International Food Policy Research Institute (IFPRI), Welthun- gerhilfe (WHH), or Concern Worldwide. Recommended citation: “Figure 2.5: 2017 Global Hunger Index by Severity.” Map in 2017 Global Hunger Index: The Inequalities of Hunger, by K. von Grebmer, J. Bernstein, N. Hossain, T. Brown, N. Prasai, Y. Yohannes, F. Patterson, A. Sonntag, S.-M. Zimmermann, O. Towey, and C. Foley. 2017. Bonn, Washington, DC, and Dublin: Welthungerhilfe, International Food Policy Research Institute, and Concern Worldwide.