	Introduction

The United Nations Food and Agriculture Organization (FAO) reports that world food prices increased dramatically in the first half of 2008, and then over the second half, fell by nearly 50% ( Figure 1 ). This report does not explore the causes of food crises, but analyzes how high food prices, food insecurity, and hunger impact the health of people in countries where food prices increased dramatically. Background on Global Hunger and Food Insecurity

In a 2006 report, FAO estimated that 848 million people in the world were undernourished. Direct Health-Related Consequences of High Food Prices and Food Insecurity

Those who are most affected by higher food prices and disrupted food supplies are the impoverished. Indirect Consequences of High Food Prices and Food Insecurity

Some experts are concerned that the impoverished, who were struggling to feed, clothe, and educate their children before prices began to rise, might decrease spending on health and education. Another group of analysts contend that families struggling to feed themselves will be less likely to take a sick child to the clinic or a pregnant woman to the hospital, which could increase maternal and child mortality rates. Health experts expect that when food prices are high, poor parents will remove their children from school to spend their limited funds on food that has become more expensive rather than on school fees. Deeper Poverty

While global food prices have moderated recently, they remain higher than they were earlier in the decade. Some experts contend that many more may become impoverished and undernourished because forecasts indicate food supplies may remain insufficient and prices may stay higher than the averages of the past decade —though projections indicate they will ease over the next 10 years ( Table 2 ). Increases in Rural-to-Urban Migration

Even as food prices decline, poor farmers remain vulnerable to poverty and hunger. Women and girls are particularly vulnerable during times of food shortages, because of their lower social and economic status, prohibitions against female land inheritance (in some areas), and heightened nutritional needs during pregnancy or lactation. Impoverished women are also more likely to engage in transactional sex to feed their families, while men might turn to migrant or long-distance transportation work. Relatively high HIV transmission rates among migrant workers are well-documented. The CFA outlines two sets of actions to promote a comprehensive response to higher food prices. Issues for Congress

Since the noticeable rise in food prices in the first half of 2008, much of the discussions on how best to improve food security have focused on agriculture and its related issues. While many experts agree that increased investment in agriculture could help to address hunger and poverty, others urge policy makers to simultaneously bolster support for health interventions. Supporters of greater investment in basic health care assert that related programs are a relatively inexpensive way to effectively address hunger-related illnesses in the short- and long-terms. The section below discusses some of the issues the 111 th Congress might consider as it views the health needs of the millions threatened by food insecurity. U.S. efforts to address each of these areas, however, are not always coordinated.
The United Nations Food and Agriculture Organization (FAO) reports that world food prices spiked dramatically in the first half of 2008 and declined somewhat in the latter part of the year. From June 2007 to June 2008, FAO's food price index increased by 44%, with wheat and rice prices increasing by 90% and maize prices by 35%. The food spikes had negative social and economic impacts, especially in low income and least developed countries. Although food prices have stabilized somewhat, they remain higher than they have been over the past decade. In addition, those who were most affected by the food spikes remain vulnerable to future food crises because of persistent hunger and poverty.
Forecasts indicate that prices will remain higher than the averages of the past decade—though they are projected to continuously ease over the next 10 years. Latest estimates indicate that at the end of 2007, there were 923 million under-nourished people worldwide, nearly 90% of whom were in sub-Saharan Africa and Asia. In 2007, high food prices prevented 75 million people from attaining sufficient quantities of food and forced 100 million into poverty.
Many health experts are concerned about the short- and long-term impacts of fluctuating food prices and inconsistent food supplies. In the period immediately following food price hikes, poor families who are already struggling to feed themselves begin to decrease spending on health and education. Some analysts contend that impoverished families will be less likely to take a sick child to the clinic or a pregnant woman to the hospital, which could increase maternal and child mortality rates. Health experts expect poor parents to remove their children from school to spend their limited funds on more expensive food. High food prices might also threaten efforts to control HIV/AIDS. Women and girls, who are particularly vulnerable during times of food shortages because of their lower social and economic status, inability to inherit land (in some areas), and heightened nutritional needs during pregnancy or lactation, might engage in transactional sex to feed their families. Males might turn to migrant or long-distance transportation work. Relatively high HIV transmission rates among these groups are well-documented. Malnutrition usually occurs after families can find no other way to cut spending and decrease food intake. The choices people make as they struggle to absorb the shocks of rising food prices affect other social issues, including housing, migration, education, and health. Responses to higher food prices, consequently, require a comprehensive approach which addresses each of these areas.
Since food prices have begun to rise, much of the discussions on how best to improve food security have focused on agriculture and its related issues. While many experts agree that increased investment in agriculture could help to address hunger and poverty, others urge policy makers to simultaneously bolster support for health interventions. Supporters of greater investment in basic health care assert that related programs are a relatively inexpensive way to effectively address hunger-related illnesses in the short- and long-terms. This report analyzes the direct and indirect effects of food insecurity and hunger on global health, reviews elements of the U.S. government response to global hunger, and identifies policy areas that Congress might examine as it debates how best to address the health needs of the millions threatened by high food prices in the 111th Congress.