Chapter 1.

Population Growth
and Malnutrition
31

Michael J Klag Parul Christian

Dean, Johns Hopkins Senior Program Officer,
Bloomberg School of Public Women’s Nutrition, Bill &
Health, Baltimore, MD, USA Melinda Gates Foundation,
Seattle, WA, USA; Professor,
Department of International
Health, Johns Hopkins
Bloomberg School of Public
Health, Baltimore, MD, USA
 “Population growth is an important driver of economic progress. Every
stomach comes with two hands attached. Every mouth is backed by a
creative human intelligence. We can solve the problems that are caused
by our growing numbers. In fact, we have been doing so for many
centuries now.”
Steven W Mosher (born 1948), American social scientist and President of the Population Research Institute
Key messages
• The speed at which the world’s
population is increasing is without
precedent and poses a wide range of
complex challenges for nutritionists,
agriculturalists and public health
professionals alike.
• Life expectancy has also increased rapidly,
especially in the developed world.
• At the same time as the world’s
population has been rapidly growing,
childhood mortality rates have seen a
dramatic decline.
• There will be a third more mouths to
feed by 2050. Food production will
have to rise considerably to meet this
demand, and Sub-Saharan Africa will
require special attention.
• Overall population growth will fuel the
growth of urban areas, and the rise of
urban populations will have wide-
ranging health implications.
“The scale, severity and duration of the
world food problem are so great that a
massive, long-range, innovative effort
unprecedented in human history will be
required to master it.”
US PRESIDENT’S SCIENCE ADVISORY COMMITTEE, 1967
32
The magnitude of global
population growth
The world’s population reached 7 billion on October 31, 2011
according to the United Nations Population Fund; according
to the United States Census Bureau, this milestone was
attained on March 12, 2012.1 In the 1970s, it had been at
approximately half this figure. The speed at which the world’s
population is increasing is entirely without precedent (Figure
1). It places enormous strain on the planet’s resources, and
poses a wide range of complex challenges for nutritionists,
agriculturalists and public health professionals alike.
A little over two centuries ago, the world’s population was
1 billion (Table 1). It was to grow sevenfold in the ensuing
two centuries. It took just 123 years to double, under the
influence of the Industrial Revolution and the accompanying
advances in science and medicine. It took 46 years to double
from 2 to 4 billion, but only 39 years to double from 3 to 6
million; and an additional 1 billion was added 12 years later.
In part, this dramatic increase occurred due to a
phenomenon called the “population momentum,” as a larger
percent of the population was in its reproductive years
during the period in question. The World Bank defines
population momentum as: “The tendency for population
growth to continue beyond the time that replacement-level
fertility has been achieved because of a relatively high
concentration of people in the childbearing years.”2 Even as
fertility rates began to decline around the 1970–80s due to
the effect of family planning programs, the previously high
fertility rates resulted in continuing accelerated population
growth. The rate of change in the world population was the
highest during the 50-year period from 1925 to 1975, at 100
to 200 percent (Table 1).
Assuming a medium fertility variant or at replacement levels,
by 2050 the world population will be 9 billion and by 2100,
10 billion (Figure 2). Much of this increase will occur in
developing countries, with the population of high-income
countries remaining relatively constant (Figure 3).
 Figure 1: World population since 10,000 BCE
Chapter 1.2 | Population Growth and Malnutrition

33 Figure 1 | World population since 10,000 BCE

5
Billion People

0
-10000 -8000 -6000 -4000 -2000 0 2015
Source: https://ourworldindata.org/world-population-growth/, accessed July 8, 2016

Figure
Figure 2 |2:Estimated
Estimated and
and projected
projected world
world population,
population, billions,
billions, 1950–2100
1950–2100

28
Contant fertility variant
High fertility varient
Medium fertility varient
24
Instant replacement fertility variant
Low fertility varient

20

16

12

0
1950

1960

1970

1980

1990

2000

2010

2020

2030

2040

2050

2060

2070

2080

2090

2100

Source: https://ourworldindata.org/world-population-growth/, accessed July 8, 2016

Source: United Nations, Department of Economic and Social Affairs, Population Division (2011): World Population Prospects: The 2010 Revision. New York.
(Updated: April 15, 2011)
 34

Mexico City, one of the world’s megacities

Table 1 | World population milestones

Year World Population Interval

1804 1 billion
1927 2 billion 123 years later
1960 3 billion 33 years later
1974 4 billion 14 years later
1987 5 billion 13 years later
1999 6 billion 12 years later
2011 7 billion 12 years later

Change in population profiles over time

In many European countries, the total fertility rate – the countries in Africa and Asia have a high total fertility rate.
average number of children a woman will have during her Family planning strategies are urgently needed in these
lifetime if she experienced the current age-specific fertility countries, both to limit the number of children born and to
rates and if she survived through the end of her childbearing ensure appropriate intervals between births.
years – is below the level of 2.0 which is required to replace
Meanwhile, life expectancy has grown rapidly, especially in
the population without increasing it. In Germany, for
the developed world. In the USA, for example, it increased
instance, it is only 1.4. In the USA, it stands at just above
by 56% for males and 63% for females between 1900 and
this figure, at 2.1. China, with its policy of one child per
2000. The proportion of the population aged over 65 is
family, had a total fertility rate of 1.7 in 2014, according to
projected to more than treble from 7% (111 million people)
the World Bank, whereas India scored a higher than
to 23% (450 million) by 2050. By 2050, the Western Pacific
replacement level at 2.5. Countries in Africa, by contrast,
Region will have the second oldest population of all WHO
demonstrate a very high total fertility rate, with Niger
regions – just below Europe where 25% of the population
scoring highest of all at 7.2. With certain exceptions, most
 Chapter 1.2 | Population Growth and Malnutrition

35

will be aged over 65. With a projected population of 450
million older people by 2050 globally, the Western Pacific
Region will have far more older people than any other world
region. At the same time as the population growth has been
occurring and fertility rates have been declining, childhood
mortality has been dramatically declining globally. It is
projected to continue to do so across different regions,
although the decline has slowed somewhat in recent years in
Sub-Saharan Africa.
Overall population growth will fuel the growth of urban
areas, which may become home to 50% of the world’s
population by 2050. The number of megacities is expected to
grow to 36 by 2025, from a baseline of two in 1970 (Tokyo
[Japan] and New York-Newark [USA]). These two cities are
predicted to be accompanied in the top ten by Delhi (India,
32.9 million), Shanghai (China, 28.4 million), Mumbai (India,
26.6 million), Ciudad de México (Mexico, 24.6), São Paulo
(Brazil, 23.2 million), Dhaka (Bangladesh, 22.9 million),
Beijing (China, 22.6 million) and Karachi (Pakistan,
20.2 million). Tokyo’s population will grow from its 1970
figure of 23.3 to 38.7 million, and New York-Newark’s from
16.2 to 23.6. London, the first great metropolis of the
Industrial Revolution, will occupy only 36th place, with a
population of 10.3 million. Despite the massive increase in
the size of existing megacities, more and more of the population
will be residing in smaller urban areas, as these get built in
response to overall population growth (Figure 4). After 2050,
rural populations are predicted to remain stable, while the
urban population of the planet will continue to grow.

Figure 3 | Growth in developing v. developed countries 1965–2050

Figure 3: Growth in developing v. developed countries 1965–2050

10
Developing countries
Developed countries

6
Billion People

0
1965

1970

1975

1980

1985

1990

1995

2000

2005

2010

2015

2020

2025

2030

2035

2040

2045

2050

Source: Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat (2007)
 Chapter 1.2 | Population Growth and Malnutrition

Figure 4: Urban and rural populations by development area, 1950–2050

Figure 4 | Urban and rural populations by development area, 1950–2050 36

6
More developed regions
urban populations
More developed regions
rural population
5
Less developed regions
urban populations
Less developed regions
rural population
4
Billion People

Source: UN, World Urbanization Prospects: The 2011 Revision

Aerial view of Shibuya in Tokyo, Japan –

the world’s most populous city.
Sub-Saharan Africa
Sub-Saharan Africa in particular will require special
attention. Although the rate of population growth in this
region is declining rapidly, it will continue to increase from
770 million in 2005 to 2 billion by 2050. Chronic hunger
and malnutrition are already high in Sub-Saharan Africa,
and so this region will face a special challenge in the years
to come. Vulnerability to climate and dependence on
rainwater for irrigation makes the agricultural economy of
Sub-Saharan Africa as a whole extremely fragile, and this
tendency has been accentuated by lack of appropriate
investment in agriculture in recent decades. The
development of smallholder farming may be key to the
region’s success in the future. There is cause for hope,
however, when one reflects that Asia had only two staple
crops during the “Green Revolution” masterminded by
Norman Borlaug in the 1960s and ’70s: Africa has no fewer
than eight. Borlaug, who developed high-yielding, disease-
resistant, semi-dwarf varieties of wheat, was credited at the
time with saving a billion lives.
 37

0
1
2
3
4
5
6
7
8
China, Hong Kong, SAR

Lagos,
Slovakia

Figure
Malta
Portugal
Slovenia

the capital
Lithuania

Germany 1.36
Russian Federation

5: Total
TFYR Macedonia
Barbados

of Nigeria,
Serbia
Trinidad and Tobago

fertility
Armenia
Belgium

seen by
Denmark
Brazil
Bahamas
Australia
Dem. People’s Rep. of Korea

fromcountry,
Myanmar

USA 2.07
Uruguay
Turkey
New Caledonia

Figure 5 | Total fertility by country, 2005–2010

Guyana

Source: UN Department of Economic and Social Affairs – Population Division.

Bangladesh

the air. The 2005–2010

Réunion
Uzbekistan
Guam
Panama
Bhutan
Western Sahara
Fiji
Botswana
Laos
French Guiana
Gabon
Zimbabwe
city’s population currently stands at 21 million.

Micronesia
Samoa
Guatemala
Solomon Islands
Côte d’lvoire
Eritrea
Central African Republic
Gambia
Equatorial Guinea
Niger 7.19

Benin
Angola
Chad
Mali
 Chapter 1.2 | Population Growth and Malnutrition

Figure 6: Gains in US life expectancy: 1900–2050

Figure 6 | Gains in US life expectancy: 1900–2050 38

90

80

70

Female 0
Male 0
60
Age

Female 65
Male 65

50

40

30
1900 1920 1940 1960 1980 2000 2020 2040

Source: Courtesy of Agree, 2011.

Figure 7: Childhood mortality, 1950–2050

Figure 7 | Childhood mortality, 1950–2050

330

280

230
Deaths per 1,000 births

180

130

Sub-Saharan Africa
South-central Asia
80 World

30

Source: WHO World Population Prospects: The 2004 Revision.

 Street scene in India.
39
Urbanization and health
The growth of populations living in urban environments has
wide-ranging health implications. One in three urban dwellers
lives in slums, where nutrition, sanitation, and air and water
quality are usually very poor. This amounts to 1 billion
people worldwide. Urban air pollution kills approximately
1.2 million people each year around the world, mainly due
to cardiovascular and respiratory diseases. Much of this
pollution, although not all of it, is attributable to emissions
from motor vehicles. The incidence of tuberculosis is also much
higher in big cities. In the Democratic Republic of Congo, for
example, 83% of people with tuberculosis live in cities.
Urban environments also tend to discourage physical activity
and promote consumption of unhealthy, calorie-dense diets
that are high in refined carbohydrates such as white flour and
white rice. The process of refining a food not only removes the
fiber; it also removes much of the food's nutritional value,
including B-complex vitamins, healthy oils and fat-soluble
vitamins. The consumption of the many processed foods that
characterize the modern Western diet results in higher
prevalence of obesity, diabetes and related non-communicable
diseases, which account for 63% of deaths worldwide.
Countering these factors, the provision of health services is
more efficient in cities; but the growth of urban populations

will create a host of practical, logistical and financial
challenges, placing huge burdens on public health systems in
general and healthcare budgets in particular (Table 2).
Global poverty has declined in the past two decades, and
the global poverty ratio is predicted to fall from its 2005
figure of 21% to 2.5% in 2050. 3 Economic growth has
occurred, but is highly variable within countries, and over
time will even lead to higher income inequality within
individual countries. In India, for example, the top 20% of
earners in rural settings can only match the incomes made
by middle and upper middle earners in cities. The lowest
earners in urban settings are far ahead of the rural poor,
who account for 80% of rural populations, and the urban
top 20% of earners far outstrip all other categories.4
Disturbingly, the GINI Index – a measurement of the
income distribution of a country's residents that helps define
the gap between the rich and the poor – is increasing in
countries with high economic growth and high populations,
An escalator in a crowded shopping mall. Economic growth is likely to lead to higher income
inequality not just between nations but also within individual countries.
Chapter 1.2 | Population Growth and Malnutrition
40
with greater disparities observable in urban than in rural
areas. In absolute terms, however, large swathes of the
world’s population will still rise out of extreme poverty.
A recent USDA report predicts an improvement in the
global food insecurity situation, projecting that only 6% of
the world population will have inadequate access to food by
2026, compared to 17% at present. Decreased food prices
and increasing incomes, especially in Asia, may be linked to
this decline. 5
Population growth is contributing to climate change, which
is putting pressure on food systems and will impact
agricultural yields. Food systems themselves contribute
19–29% of greenhouse gas emissions, and agricultural
production accounts for 80–85% of total food systems
emissions, although significant variation by country exists.
The relationship between climate change and nutrition is
discussed in detail elsewhere in this book.
 Chapter 1.2 | Population Growth and Malnutrition

41 Table 2 | Implications of change for global health The nutrition transition

Confidence Modernization, urbanization, economic development and
Health effect level
increased wealth are also leading to predictable shifts in diet
Increase in malnutrition and consequent High referred to as the “nutrition transition”. This is broadly
disorders, including child growth and
development.
classified into five patterns (Table 3).

Increase in death, disease, and injury from heat
waves, floods, storms, fire and drought.
Mixed effects on malaria, with some
contractions balanced by expanded
geographic range and change in seasonality.
Change in the range of some vectors of
infectious diseases.
Increase in diarrheal diseases.
Increase in number of people exposed to
dengue fever.
Decrease in cereal crop productivity in low
latitudes for even small temperature increases.
Source: IPCC Fourth Assessment Report Climate, 2007.
High Most low-and middle-income countries are currently moving
from pattern 3 (end of famine) to pattern 4 (consuming more
Very high energy-dense diets). This shift from traditional diets to
Western-style diets has been a key contributor to the obesity
epidemic in low- and middle-income countries. Meanwhile,
High childhood stunting (low height for a given age), an indicator of
undernutrition in the earliest years of life, and which results in
Moderate increased mortality and cognitive deficits, is still at unacceptably
Low high levels. Although declines in stunting are observed
worldwide, and the MDG target of halving the incidence of
Moderate stunting worldwide by 2015 was nearly achieved, 162 million
children were stunted in 2012, with particularly high levels of

Table 3 | The five patterns of the nutrition transition

Pattern Description Commentary

1 Hunter-gatherer
2 Early agriculture
3 End of famine
4 Overeating,
obesity-related
diseases
5 Behavior change
Source: IPCC Fourth Assessment Report Climate, Behavior change
Individuals live highly active lifestyles, hunting and foraging for food. Diets typically are rich in
fibrous plants and high in protein from lean wild animals.
Famine is common, slowing individuals’ growth and decreasing their body fat.
Famine recedes as income rises and nutrition improves.
As income continues to rise, individuals have access to an abundance of high-calorie foods, and
they become less active, leading to increases in obesity and obesity-related chronic diseases,
such as diabetes and heart disease.
In response to increasing rates of obesity and obesity-related chronic diseases, individuals change
their behavior – and communities promote behavior changes – to prevent these conditions.

prevalence in south Asia, Sub-Saharan Africa, the Caribbean,
and Oceania. Appropriate breastfeeding and complementary
feeding practices are key to the prevention of stunting, as are
adequate levels of sanitation and hygiene.
Meat consumption, which is important for meeting
requirements for intake of animal protein as well as the
micronutrients iron, zinc and vitamin A, is growing
worldwide. There are, however, vast regional discrepancies
in levels of meat consumption, with citizens of Bangladesh,
Nigeria, Ethiopia, the Democratic Republic of Congo and
Burma consuming an average of just 0–10 g meat per day and
those of the USA, France and The Netherlands consuming
70–80 g daily. If the consumption of milk is included, over
70% of the world’s population consumes less than 30 g of
animal protein per day.6 Nevertheless the consumption of
meat, vegetable oils, sugar and pulses is projected to increase
in developing countries, many of which are undergoing a
nutrition transition. This will place considerable demands on
the world’s food production systems, and alternative sources
of food, such as fisheries and aquaculture, should be explored.
Outlook
According to the FAO, there will be a third more mouths to
feed by 2050, despite an anticipated decline in fertility rates
across the globe.7 Food production will have to rise by 70% to
meet this need, which will place huge demands both on the
environment and on the world’s agricultural systems.
According to the best-case scenario, 4.5% of the world’s
population will be malnourished in 2050 (as opposed to 12.4%
in 2005); the worst-case scenario puts this figure at 5.9%
(Tables 4 and 5). Approaches to making agriculture more
innovative, efficient and sustainable, and to ensuring that it
delivers not just more calories but also improved nutritional
content, are discussed in chapters 3 and 4 of this book.
 Chapter 1.2 | Population Growth and Malnutrition

Table 4 | World food supply and demand projections: best-case scenario 42

WORLD FOOD SUPPLY AND DEMAND IN MARKET FIRST SCENARIO

World crop production Crop land Yield Crop loss ratio
(million metric tons) (million hectares) (tonnes/hectare) (percent)

2005 4,190 1,544 2.71 30.3%

2050 6,584 1,617 4.07 22.3%
percentage change 57.1% 4.7% 50.0%
avg ann. percentage change 1.0% 0.1% 0.9%

CALORIES AVAILABLE PER PERSON

World OECD Non-OCED Sub-Saharan Africa
2005 2,800 3,421 2,662 2,256
2050 3,207 3,635 3,135 2,588
percentage change 14.5% 6.3% 17.8% 14.7%
avg ann. percentage change 0.3% 0.1% 0.4% 0.3%

PERCENTAGE OF POPULATION MALNOURISHED

World OECD Non-OCED Sub-Saharan Africa
2005 12.4% 1.9% 14.8% 30.7%
2050 4.5% 0.0% 5.3% 18.5%
Source: Hillebrand E, White Paper, Expert Meeting on how to feed the world in 2050, FAO 2010.

Table 5 | World food supply and demand projections: conservative estimates

WORLD FOOD SUPPLY AND DEMAND IN TREND SCENARIO

World crop production Crop land Yield Crop loss ratio
(million metric tons) (million hectares) (tonnes/hectare) (percent)

2005 4,190 1,544 271 30.3%

2050 6,150 1,620 3.8 24.1%
percentage change 46.8% 4.9% 39.9%
avg ann. percentage change 0.9% 0.1% 0.1%

CALORIES AVAILABLE PER PERSON

World OECD Non-OCED Sub-Saharan Africa
2005 2,800 3,421 2,662 2,256
2050 3,099 3,648 3,013 2,507
percentage change 10.7% 6.6% 13.2% 11.1%
avg ann. percentage change 0.2% 0.1% 0.3% 0.2%

PERCENTAGE OF POPULATION MALNOURISHED

World OECD Non-OCED Sub-Saharan Africa
2005 12.4% 1.9% 14.8% 30.7%
2050 5.9% 0.0% 6.8% 21.4%
Source: Hillebrand E, White Paper, Expert Meeting on how to feed the world in 2050, FAO 2010.
 Rice terraces in Longsheng
County, Guangxi, China. Feeding
the world’s burgeoning
population will require
innovations in agriculture.

43

My personal view
Michael J Klag
Population growth underlies many of the most important
challenges facing the world today. In the future, the world
will be more populous, especially in low- and middle-
income countries, more urban, and with an older and
more obese population which will be characterized by
even greater economic disparities than is the case today.
All these trends will impact poor countries more severely
than wealthy ones.
Family planning is essential to curb population growth,
and Family Planning 2020 (FP2020) has a key role to play
Further reading
Rosen S, Thome K, Meade B. International Food Security
Assessment, 2016–2026. A report summary from the Economic
Research Service. USDA June 2016. http://www.ers.usda.gov/
media/2109786/gfa27.pdf, accessed July 22, 2016.
Vermeulen SJ, Bruce M, Campbell BM. Climate Change and Food
Systems. Annu. Rev. Environ. Resour. 2012. 37:195–222. http://
www.annualreviews.org/doi/abs/10.1146/annurev-
environ-020411-130608, accessed July 22, 2016.
The special challenge for sub-Saharan Africa. High Level Expert
Forum – How to Feed the World in 2050. Rome: FAO, October
2013. http://www.fao.org/wsfs/forum2050/wsfs-background-
documents/issues-briefs/en/, accessed July 22, 2016.
World agriculture: towards 2015/2030 Summary report. FAO, 2002.
http://www.fao.org/docrep/004/y3557e/y3557e00.HTM, accessed
July 22, 2016.
Cleland J, Bernstein S, Ezeh A et al. Sexual and Reproductive Health
3. Family planning: the unfinished agenda. Lancet 2006; 368:
1810–27. http://www.thelancet.com/pdfs/journals/lancet/
PIIS0140-6736(06)69480-4.pdf, accessed July 22, 2016.
Chapter 1.2 | Population Growth and Malnutrition
here. FP2020 is a global partnership that supports the 44
rights of women and girls to decide, freely, and for
themselves, whether, when, and how many children they
want to have. FP2020 works with governments, civil
society, multilateral organizations, donors, the private
sector, and the research and development community to
enable 120 million more women and girls to use
contraceptives by 2020. FP2020 is an outcome of the 2012
London Summit on Family Planning where more than 20
governments made commitments to address the policy,
financing, delivery and sociocultural barriers to women
accessing contraceptive information, services and supplies.
Donors also pledged an additional US$2.6 billion in
funding. It is very important that this goal be achieved.
References
1 http://www.worldometers.info/world-population/, accessed December 14, 2015.
2 http://www.worldbank.org/depweb/english/modules/glossary.
html#momentum, accessed July 8, 2016.
3 Hillebrand, E. Poverty, growth and inequality over the next 50 years. FAO, 2010.
4 Sen, A (mimeo, 2004) based on NSS data.
5 Rosen S, Thome K, Meade B. International Food Security Assessment,
2016–2026. A report summary from the Economic Research Service. USDA
June 2016. http://www.ers.usda.gov/media/2109786/gfa27.pdf
6 FAOSTAT 2001.
7 FAO Expert Meeting, 2009.