Abstract
Before about 1750 there was no substantial secular fall in protein–energy malnutrition (PEM) over large areas, nor reason to expect it. We have since learned that sufficient economic advance (poverty reduction) plus scientific advance (in medicine and food production) are achievable to eliminate mass PEM. The two advances are linked via increased demand for labour, and hence wages and employment, for those formerly too poor to afford adequate food. The extra employment income arises first from smallholder and employee food production, and later, as labour is released, from a wide range of specialised, increasingly non-farm, production, with employment income traded for food. This process eliminated mass hunger in Europe in 1750–1960. Only by 1975 had PEM in the developing world retreated to (very high) 1936–8 levels, but it fell sharply in Asia and Latin America in 1975–1990, due to unprecedented growth in staples yields, smallholder and farm employment income, and hence the poor's purchasing power over food. However, since 1990, poverty reduction has slowed (before reaching most of Africa), alongside much slower-staples yield growth, increasing water shortages, and big shifts of grain and land from man to farm animals. These trends prefigure declining progress against PEM in coming decades, unless there is renewed, employment-intensive food-staples-yield growth. That process requires reorienting crop biotechnology and water science towards the needs of small tropical farmers and their staple food crops, and shifting land towards them. Mass PEM is indeed largely due to inadequate ‘food entitlements’ by the hungry, but will not be remedied without growth in their employment, based on further advances in food-staples yields per unit land and water. Recent evidence suggests that early PEM may increase lifelong risks of infection and/or degenerative disease. This factor would increase the ‘squeeze’ on health resources in low-income countries, between the diseases of poverty and those of old age. That situation increases the need to readdress PEM by renewed progress in food production and land distribution.

This publication has 15 references indexed in Scilit: