Abstract: Purpose The Dutch famine birth cohort study was set up to investigate the effects of acute maternal undernutrition of the 1944-1945 Dutch famine during the specific stages of gestation on later health, with a particular focus on chronic cardiovascular and metabolic diseases, ageing and mental health. Participants The Dutch famine birth cohort consists of 2414 singletons born alive and at term in the Wilhelmina Gasthuis in Amsterdam around the time of the Dutch famine (1943-1947) whose birth records have been kept. The cohort has been traced and studied since 1994, when the first data collection started. The cohort has been interviewed and physically examined in several waves of data collection since that time, allowing repeated measures of a wide range of phenotypic information as well as the collection of biological samples (blood, urine, buccal swabs), functional testing (of heart, lungs, kidney, HPA axis) and imaging of the brain (MRI) and vasculature (ultrasound). Additionally, genetic and epigenetic information was collected. Through linkage with registries, mortality and morbidity information of the entire cohort has been obtained. Findings to date Prenatal famine exposure had lasting consequences for health in later life. The effects of famine depended on its timing during the gestation and the organs and tissues developing at that time, with most effects after exposure to famine in early gestation. The effects of famine were widespread and affected the structure and function of many organs and tissues, resulted in altered behaviour and increased risks of chronic degenerative diseases and increased mortality. The effects of famine were independent of size at birth, which suggests that programming may occur without altering size at birth. Future plans As the cohort ages, we will be assessing the effects of prenatal undernutrition on (brain) ageing, cognitive decline and dementia, as well as overall morbidity and mortality. Registration The Dutch famine birth cohort is not linked to a clinical trial.

Abstract: Droughts will increase in frequency, intensity, duration, and spread under climate change. Drought affects numerous sectors in society and the natural environment, including short-term reduced crop production, social conflict over water allocation, severe outmigration, and eventual famine. Early action can prevent escalation of impacts, requiring drought early warning systems (DEWSs) that give current assessments and sufficient notice for active risk management. While most droughts are relatively slow in onset, often resulting in late responses, flash droughts are becoming more frequent, and their sudden onset poses challenging demands on DEWSs for timely communication. We examine several DEWSs at global, regional, and national scales, with a special emphasis on agri-food systems. Many of these have been successful, such as some of the responses to 2015–2017 droughts in Africa and Latin America. Successful examples show that early involvement of stakeholders, from DEWS development to implementation, is crucial. In addition, regional and global cooperation can cross-fertilize with new ideas, reduce reaction time, and raise efficiency. Broadening partnerships also includes recruiting citizen science and including seemingly subjective indigenous knowledge that can improve monitoring, data collection, and uptake of response measures. More precise and more useful DEWSs in agri-food systems will prove even more cost-effective in averting the need for emergency responses, improving global food security.

Abstract: The 1933 Ukrainian famine killed as many as 2.6 million people out of a population of 32 million. Historians offer three main explanations: weather, economic policies, genocide. This paper documents that (1) available data do not support weather as the main explanation: 1931 and 1932 weather predicts harvest roughly equal to the 1924–1929 average; weather explains up to 8.1 percent of excess deaths. (2) Policies (collectivization of agriculture and the lack of favored industries) significantly increased famine mortality; collectivization explains up to 52 percent of excess deaths. (3) There is some evidence that ethnic Ukrainians and Germans were discriminated against.

Abstract: This paper describes the findings of a historical cohort study of men and women born around the time of the Dutch famine 1944-45. It provided the first direct evidence in humans of the lasting consequences of prenatal undernutrition. The effects of undernutrition depended on its timing during gestation, and the organs and tissues undergoing periods of rapid development at that time. Early gestation appeared to be particularly critical, with the effects of undernutrition being most apparent, even without reductions in size at birth. Undernutrition during gestation affected the structure and function of organs and tissues, altered behaviour and increased risks of chronic degenerative diseases. This demonstrates the fundamental importance of maternal nutrition during gestation as the building blocks for future health.

Abstract: In Ethiopia, famine and extreme poverty are a result of insufficient food relief, poor macroeconomic factors, climate shocks, undiversified livelihoods based on low productivity in rain-fed agriculture, coupled with institutional incapacity. To serve as a context, this paper provides a comprehensive review of the conceptual framework of human development and capability paradigm to food security. In addition, it highlights evidence and a comparative analysis of the Asian green revolution experience, and places emphasis on sustainable and intersectoral growth through agricultural transformation and promotion of rural non-farm economy agenda to reverse the trends of protracted food crises in Ethiopia. Rapid, science-led, and employment-intensive agricultural growth, accompanied by the promotion of the rural non-farm sector, is of great importance to the rural economy. These will bring about farm sector competitiveness and enhanced productivity, environmental outcomes, acceleration of human development, new opportunities provided to the small-scale food producers, and desirable changes to the rural landscape. The study further introduces a brief analysis of the prominent role of social protection instruments in strengthening food entitlements and basic capabilities, including individual agencies. It suggests that actualizing sustainable food security and hastening human development under Ethiopia’s exclusive settings require the recognition of the rural economic heterogeneity as well as holistic and pragmatic policies, which promote sustainable and inclusive growth.

Abstract: Livelihood sustainability has been a major concern for many developing economies across the globe. In Ghana, studies have identified climate change as one constraining player that trigger sustainable livelihood. In the Wa West District of Ghana, studies have paid much efforts on climate change and its perceived effects on livelihood with little attention on climate variability which is a yearly phenomenon. The study aimed to investigate climate variability and rural livelihood sustainability using communities along the Black Volta River in the Wa West District in the Upper West Region as units of analysis. The study employed cross-sectional survey using a mixed method approach to investigate the phenomenon. Purposive and simple random sampling methods were used to select the communities and household heads for the study respectively. Questionnaires and interviews were used as data collections tools and questionnaires were administered to 163 household heads. Descriptive and thematic analytical approaches were employed. The result of the study revealed that respondents of the four communities were engaged in primary (crop farming, animal rearing, shea butter processing and Pito brewing) and secondary livelihood activities (dry season gardening, weaving of birds/fishing nets and hair dressing). Evidently, the study found that short, unstable, drought spelt, warm/extreme weather have affected respondents livelihood especially the primary livelihood strategies. In addition, respondents observed drought, flood, poverty/famine, pest and disease, poor crop yield and bush fires as major climate variability-induced shocks and stresses they experienced over the last one decade. Importantly, the study found that respondents have employed cultivation of short duration crop varieties, shifting of planting dates when bad season is suspected and addition of alternative livelihood as response strategies to climate variability. The practical and policy considerations of the study are discussed.

Abstract: Structural inequities and lack of resources put vulnerable refugee communities at great risk. Refugees flee their country of origin to escape persecution and flee from war, famine and torture. Resettled refugee communities become particularly vulnerable during times of crisis due to limited English proficiency and poor social determinants of health (SDOH), which create barriers to attaining and sustaining health and wellbeing for themselves and their families. The purpose of this case study was to evaluate SDOH among a refugee community in the Southeastern United States. We surveyed the community twice during a 1-year period to assess various elements of SDOH. Among a primarily African and Southeast Asian refugee community, 76% reported difficulty paying for food, housing and healthcare during the first round of surveys. During the second round of surveys at the beginning of the Coronavirus pandemic, 70% reported lost income; 58% indicated concern about paying bills. There was little change during the 12-month study period, showing that SDOH are an enduring measure of poor health and wellbeing for this vulnerable refugee community.

Abstract: In the aftermath of civil war, Spain witnessed a period known as the ‘Years of Hunger’, which would extend throughout the postwar years (1939–52). The dictatorship would lay the blame on external f...

Abstract: BACKGROUND Weight for height has been used in the past as an indicator of obesity to report that prenatal exposure to the Dutch famine of 1944-1945 determined subsequent obesity. Further evaluation is needed as unresolved questions remain about the possible impact of social class differences in fertility decline during the famine and because being overweight is now defined by a Body Mass Index (BMI: kg/m2) from 25 to <30 and obesity by a BMI of 30 or more. METHODS We studied heights and weights of 371,100 men in the Netherlands born between 1943 and 1947 and examined for military service at age 19. This group includes men with and without prenatal exposure to the Dutch famine. RESULTS There was a 1.3-fold increase in the risk of being overweight or obese in young adults at age 19 after prenatal famine exposure in early gestation. The increase was only seen in sons of manual workers born in the large cities of Western Netherlands and not among those born in smaller cities or rural areas in the West. Social class differentials in fertility decline during the famine did not bias study results. CONCLUSIONS The long-term adverse impact of prenatal famine on later life type 2 diabetes and mortality through age 63 is already showing at age 19 in this population as a significant increase in overweight risk.

Abstract: Early famine exposure has been related to the development of type 2 diabetes; however, little is known about whether the genetic background modifies this association. We aimed to investigate the joint effects of famine exposure at different stages of early life and genetic susceptibility on diabetes risk in adulthood. The study included 8350 participants from the Survey on Prevalence in East China for Metabolic Diseases and Risk Factors (SPECT-China) who were born around the time of the Chinese Great Famine. We determined famine exposure subgroups according to the birth year as nonexposed (1963–1974), fetal-exposed (1959–1962), childhood-exposed (1949–1958), and adolescence-exposed (1941–1948). We developed a genetic risk score of 21 variants previously associated with type 2 diabetes in East Asians. Hierarchical logistic models were used to examine the association of famine exposure and genetic risk with diabetes. The age-standardised prevalence of diabetes in nonexposed, fetal-exposed, childhood-exposed and adolescence-exposed subgroups was 13.0%, 18.2%, 15.1% and 13.2%, respectively. Compared with nonexposed participants, fetal-exposed participants showed an increased risk of diabetes in adulthood (OR 1.47; 95% CI 1.13, 1.93). A higher genetic risk score was associated with an increased risk of diabetes (OR 1.23; 95% CI 1.15, 1.31 per SD increment). The association between famine exposure and diabetes was consistent across genetic risk strata (all p for interaction >0.05). When considered jointly, fetal- or childhood-exposed participants at high genetic risk (highest tertile of genetic risk score) had 2.60-fold (95% CI 1.71, 3.93) and 1.95-fold (95% CI 1.24, 3.05) higher risks of diabetes, respectively, compared with nonexposed participants at low genetic risk (lowest tertile). Prenatal exposure to famine was associated with an increased risk of type 2 diabetes in Chinese adults independent of genetic risk score using 21 variants common in the East Asian population. Famine exposure and genetic susceptibility may exhibit an additive effect on diabetes development.

Abstract: Nutritional insult in early life brings adaptive changes in body structure and functioning that could remain throughout the affected individual’s life course. The long term impact of early life famine exposure on adulthood anthropometric measurements has been recorded in previous studies. However, the results were contradictory. Hence, we extend this study to examine the impact of famine exposure during early life on adulthood’s anthropometry among survivors of the 1983–85 Ethiopian great famine. A total of 1384 adult men and women survived from 1983 to 85 Ethiopian great famine were included in the study. Famine exposure status was classified into five groups: early life-exposed, prenatal-exposed, postnatal-exposed, adolescence-exposed, and non-exposed based on self-reported age and birthdate of the participants. Prenatal, post-natal, and adolescence exposed groups were considered as early life exposed. Following a standard procedure, anthropometric measurements were taken. A linear regression analysis was used to analyze the impact of famine exposure on adult anthropometric measurements adjusted for all possible covariates. The effect of famine exposure on overweight, general obesity, and abdominal obesity was examined using multinomial and binary logistic regression analysis. Compared to non-exposed groups, adult height was lower by 1.83 cm (β = − 1.83; 95% CI: − 3.05, − 0.58), 1.35 cm (β = − 1.35; 95% CI: − 2.56, − 0.14) and 2.07 cm (β = − 2.07 cm; 95% CI: − 3.31, − 0.80) among early life, prenatal and post-natal exposed groups, respectively. Likewise, famine exposure during early life (β = 0.02; 95% CI: 0.01, 0.03), prenatal (β = 0.03; 95% CI: 0.02, 0.03) and post-natal life (β = 0.02; 95% CI: 0.02, 0.03) was positively associated with increased waist to height ratio. However, none of the above exposures resulted in a significant association with body mass index (P > 0. 05). Additionally, exposure to famine during early stage of life was not associated with increased risk of overweight, general obesity and abdominal obesity in adults. Decreased adult height and increased waist-to-height ratio were associated with early life exposure to famine, particularly prenatal and post-natal exposure. These results therefore underscore the significance of avoiding undernutrition in early life, which tends to be important for achieving once potential adult height and to minimize the increased risk of anthropometric markers of abdominal obesity such as waist to height ratio in later life.

Abstract: The authors explore the effects of decentralization on education and health in Ethiopia using an original database covering all of the country’s regions and woredas (local governments). Ethiopia is a remarkable case in which war, famine and chaos in the 1970s-1980s were followed by federalization, decentralization, rapid growth and dramatic improvements in human development. Did decentralization contribute to these successes? The authors use time series and panel data analyses to show that decentralization improved net enrollments in primary schools and access to antenatal care for pregnant women. The main channel appears to be institutional, not fiscal. The authors offer the database as an additional contribution.

Abstract: Research about the economic consequences of past epidemics has mostly focused on the experience of industrialized countries, thus providing little knowledge about the effects of health shocks on developing economies. We fill this gap by studying the impact of the 1918 influenza in Java, with a new dataset on aggregate food production and district-level figures on (i) sugar production, the major export commodity and the predominant source of labour demand; (ii) agricultural and plantation wages, and (iii) annual crude death rates. The mortality impact of the influenza on Java was high, as crude mortality rates doubled in 1918 relative to the preceding years, but its economic impact was mixed. Aggregate food production did not decline, but sugar output did fall in 1919. Indeed, our regional panel data analysis does not establish a direct relationship between regional epidemic mortality variation and sugar output decline. Instead, we hypothesize that economic activity was rediverted towards food production in order to avoid famine that could have resulted from the combined effects of disrupted shipping at the end of the First World War, climatic conditions and the public health crisis. This is supported by both qualitative observations and quantitative evidence suggesting that those regions that were highly suitable for rice production saw a larger reduction in sugar production, and that in regions that had more flexibility in land tenure arrangements experienced substantially greater reductions in sugar output.

Abstract: Intrauterine malnutrition has a long-term effect on human health. This study aimed to evaluate the associations between exposure to famine in early life and obesity in adulthood in Chinese adults. A total of 5033 participants (22,132 observations) of the China Health and Nutrition Survey (CHNS) in 1991–2015 were classified into three famine exposure groups according to their birth year: unexposed (1963–1966), fetal-exposed (1959–1962) and childhood-exposed (1955–1958). Compared with the unexposed group, the fetal-exposed group had higher levels of body-mass-index (BMI) and waist-circumference (WC), and higher prevalence of overweight and central obesity, whereas the childhood-exposed group had lower levels of the measurements. However, the positive associations of fetal exposure with BMI, WC and prevalence of overweight and central obesity were attenuated by additionally adjusting for age at survey. Stratified analysis showed that the adverse effect of fetal exposure to famine was only observed in subjects at several specific age-groups, and in men living in rural areas and in women living in more severe famine exposed areas (p for interaction < 0.05). Our results provide evidence for the weak effect of fetal exposure to famine on body measurements in adulthood, and suggest the importance of severity of famine exposure and timing of exposure.

Abstract: Objective This study aimed to examine the association between early life famine exposure and adulthood cardiovascular diseases (CVDs) risk. Design Data analysis from a national Cross-sectional survey. Setting and participants 5,504 subjects were selected using their birthdate from national baseline data of the China Health and Retirement Longitudinal Survey to analyze the association between famine exposure in early life and CVDs risk in adulthood. Main outcome measures CVDs was defined based on the self-reported doctor's diagnosis of stroke or cardiac events (including heart attack, coronary heart disease, angina, congestive heart failure, or other heart problems). Results The prevalence of CVDs in the unexposed group, fetal-exposed, infant-exposed, and preschool-exposed groups was 15.0%, 18.0%, 21.0%, and 18.3%, respectively. Compared with the unexposed group, fetal-exposed, infant-exposed and preschool-exposed groups had higher CVDs risk in adulthood (P<0.05), even after adjusting for covariates (P<0.05). Compared with the age-matched control group, infancy exposed to famine had a significantly higher adulthood CVDs risk (OR=1.52, 95%CI: 1.15, 2.01; P=0.006). The association seems to be stronger among population with higher education level (Pinteraction=0.043). In addition, sensitivity analysis revealed consistent association between early-life famine exposure and adult CVDs risk when excluding subjects born between October 1, 1962 and September 30, 1964 from unexposed group. Conclusions Early life exposed to the China great famine may elevate the risk of CVDs in adulthood.

Abstract: This rapid review summarises the evidence on the ways in which social inequalities and discrimination affect the risk of famine or severe food insecurity. Looking at the risk at the national and sub-national level, gender and other horizontal inequities can affect a society’s risk of violent conflict and therefore food insecurity, while fragile livelihoods associated with ethnic marginalisation can impact regional food security. At the individual and household level, there is a lack of disaggregated data on people’s social characteristics and famines. There is a broader literature on the impact of systemic discrimination (based on gender, age, disability, sexuality, and ethnic identity) on individuals’ and households’ livelihoods and assets, thereby increasing their vulnerability to food insecurity. A key finding from the literature is the gender gap, with women more at risk of being food insecure than men. Also, some ethnic groups are highly vulnerable particularly in conflict-related famines; starvation is used as a warfare tactic in political and ethnic conflicts. There is evidence of how social inequalities heighten individuals’ risks during food crises and famines, including through exposure to protection threats, while limiting their access to essential services and humanitarian assistance. A broad range of measures seeks to address the multi-dimensional ways in which social inequalities affect vulnerability and resilience to food insecurity.

Abstract: Because Stalin’s policy of famine creation in the early 1930s has been viewed through the prism of communist theory and practices, scholars have paid less attention to the imperial/colonial discourse of the period. This essay attempts to show the suitability of applying theoretical models of dependence and imperialism to analyze the dynamics and consequences of the collectivization of agriculture and the Holodomor (the mass deaths through starvation in Ukraine). The pressure applied to all regions of the USSR, resulting from the “communist experiment,” was in Soviet Ukraine supplemented and intensified, and, at some points, determined by a system of centre-periphery relations, characterized by political domination, control, the subordination of regional political elites to the centre, and the exploitation of economic resources. The appropriation of sovereignty over the Ukrainian republic by the central government in Moscow included establishing full control over Ukraine’s food resources, such as determining grain harvesting and distribution. The ongoing exploitation of Ukrainian economic resources and the anti-Ukrainian terror caused the Ukrainian famine of 1928-29. These also became significant factors in the onset of the 1932-33 Holodomor.

Abstract: Background: Early-life exposure to the Chinese famine has been related to the risk of obesity, type 2 diabetes, and nonalcoholic fatty liver disease later in life. Nevertheless, the long-term impact of famine exposure on metabolic associated fatty liver disease (MAFLD), a recently proposed term to describe liver disease associated with known metabolic dysfunction, remains unknown. The aim of our study was to explore the relationship between early famine exposure and MAFLD in adulthood. Methods: A total of 26,821 participants (10,994 men, 15,827 women) were recruited from a cohort study of Chinese adults in Shanghai. We categorized participants into four famine exposure subgroups based on the birth year as nonexposed (1963–1967), fetal-exposed (1959–1962), childhood-exposed (1949–1958), and adolescence-exposed (1941–1948). MAFLD was defined as liver steatosis detected by ultrasound plus one of the following three criteria: overweight/obesity, type 2 diabetes, or evidence of metabolic dysregulation. Multivariable logistic regression models were performed to examine the association between famine exposure and MAFLD. Results: The mean ± standard deviation age of the participants was 60.8 ± 6.8 years. The age-adjusted prevalence of MAFLD was 38.3, 40.8, 40.1, and 36.5% for the nonexposed, fetal-exposed, childhood-exposed, and adolescence-exposed subgroups, respectively. Compared with nonexposed participants, fetal-exposed participants showed an increased risk of adulthood MAFLD (OR = 1.10, 95% CI 1.00–1.21). The significant association between fetal famine exposure and MAFLD was observed in women (OR = 1.22, 95% CI 1.08–1.37), but not in men (OR = 0.88, 95% CI 0.75–1.03). In age-balanced analyses combining pre-famine and post-famine births as the reference, women exposed to famine in the fetal stage still had an increased risk of MAFLD (OR = 1.15, 95% CI 1.05–1.26). Conclusions: Prenatal exposure to famine showed a sex-specific association with the risk of MAFLD in adulthood.

Abstract: Famine means destitution, increased severe malnutrition, disease, excess death and the breakdown of institutions and social norms. Politically, it means a failure of governance – a failure to provide the most basic of protections. Because of both its human and political meanings, ‘famine’ can be a shocking term. This is turn makes the analysis – and especially declaration – of famine a very sensitive subject. This paper synthesises the findings from six case studies of the analysis of extreme food insecurity and famine to identify the political constraints to data collection and analysis, the ways in which these are manifested, and emergent good practice to manage these influences. The politics of information and analysis are the most fraught where technical capacity and data quality are the weakest. Politics will not be eradicated from analysis but can and must be better managed.

Abstract: European famines and their legacies continue to play a significant role in heritage practices and societal debates. This calls for an examination of recent scholarship about these heritages of hung...

Abstract: The impact of an adverse prenatal environment such as famine exposure on the development of adulthood non-communicable chronic illnesses, including diabetes and hypertension has been well articulated in the recent past and supported by evidence. However, there exist few longitudinal studies conducted on the long term consequences of prenatal famine exposure on adulthood kidney function. Hence, we set out to examine whether prenatal exposure to the Ethiopian Great Famine (1983–1985) was associated with changes in estimated glomerular filtration rate (eGFR) and the risk of developing chronic kidney disease (CKD) later in adult life. The study was conducted in 219 famine exposed and 222 non exposed cohorts in Raya Kobo district, North Wollo Zone, Northern Ethiopia. Estimated GFR was computed from standardized serum creatinine using the CKD Epidemiology Collaboration (CKD-EPI) equation. The definition of CKD includes those with an eGFR of less than 60 ml/min/1.73 m2 on at least in two occasions of 90 days apart (with or without markers of kidney damage). Linear and logistic regression analyses were employed to examine the independent effect of prenatal famine exposure on eGFR and CKD respectively. The mean (SD) serum creatinine of exposed and non-exposed groups were 0.78 (0.2) and 0.75 (0.2) respectively. The mean (SD) eGFR of exposed groups was 107.95 (27.49) while the non-exposed 114.48 (24.81) ml/min. In linear regression, the unadjusted model to examine the association between famine exposure and eGFR resulted in a significant negative beta coefficient (β = − 0.124: 95% CI: − 11.43, − 1.64). Adjusting the exposure for outstanding covariates of kidney health, including systolic blood pressure, fasting blood sugar and blood glucose did not alter the inverse relationship (β = −.114 95% CI: − 10.84, − 1.17). In the unadjusted bivariate logistic regression model, famine exposure resulted in nearly 2.7 times higher odds of developing CKD (OR: 2.68, 95% CI: 1.16, 6.2). The odds remained equivalent after adjusting for systolic blood pressure, fasting blood glucose and body mass index (OR = 2.61: 95% CI: 1.120, 6.09). In the study setting, prenatal exposure to the Great Ethiopian Famine was associated with decreased eGFR and higher risk of developing CKD among survivors. These findings may imply that famine in early life may play a significant role in the development of kidney dysfunction in adulthood.

Abstract: The introductory article to the special issue “Empire, Colonialism, and Famine in the Nineteenth and Twentieth Centuries” begins by pointing to some recent literature on famine theory, where stress has been made on responses of authorities to famine and on the political nature of modern famines. Literature on the connection between imperial policies, colonial rule, and famines is also briefly discussed. The Soviet Union is treated as an empire in the essay, and some of the literature on this question is also surveyed. The article then offers summaries of and highlights from essays in this volume that resulted from papers presented at two conferences on the theme “Empires and Famines in Comparative Historical Perspective,” held in 2016 in Toronto and in 2017 in Kyiv. These include papers on famine and food policies during World War II in occupied Ukraine and Moldova. Essays on famines in Soviet Ukraine, British-ruled Ireland, and British-ruled Bengal, India, are summarized as well as an essay on Raphael Lemkin’s views on genocide and famine and an essay that looked at minorities in Mao’s China during the 1958-62 famine. The essay concludes with the observation that the investigation of imperial policies, colonial rule, and famine should be pursued further, especially in the case of the Soviet Union where this line of research is just beginning.