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Last week the United Nations Secretary General said he would head a special task force to address food shortages and price rises around the world. Ban Ki-moon said the move was an attempt to avert "social unrest on an unprecedented scale." He added that 100 million people were estimated to have been pushed into poverty over the past two years. "The first and immediate priority, that we all agree, is that we must feed the hungry."

When thinking of food shortages, we envision empty shelves, rather than empty bellies. When we think of feeding the hungry can we really imagine the effect of hunger on 100 million people? We can all imagine what it would be like to be hungry for a day, or even two days. But can we imagine the impact of chronic hunger from not enough food if it happened to us every day for the foreseeable future? How would we feel? What impact would it have on our lives?

Until we understand what hunger means to the individual, it will be a struggle to convince governments and individuals to make sacrifices (fiscal or otherwise) to solve the problem.

Without truly experiencing the full horror of an unrelenting food shortage, we can only imagine the crushing physical, emotional and psychological suffering of individuals, families and communities as they live in a state of semi-starvation with no end in sight.

But we also can gain some insight through anecdotal reports after natural or man-made disasters (droughts or wars) and by examining research studies that have taken healthy volunteers who have been subjected to varying periods of semi-starvation.

During and immediately after the two world wars, starvation, or semi-starvation, was the norm in many locations. Field reports document a set of physical complaints that characteristically appear early in uncomplicated semi-starvation: feelings of weakness, hunger pains, coldness, dizziness and blackouts upon standing up suddenly, and increased frequency of urination. Additional symptoms, including profound changes in behaviour and personality are noted if the semi-starvation is prolonged.

There have been no systematic studies of the psychological consequences of chronic hunger in famine and other natural-disaster conditions of semi-starvation. However, in the mid 1940s, in Minnesota, there was a detailed set of experiments conducted on a group of 36 conscientious observers, all young healthy men, who volunteered to be chronically starved for research purposes.

After a baseline period of observation, the men were provided with about half of their normal food intake for a period of 24 weeks. Researchers meticulously collected information on both clinical and psychological outcomes associated with semi-starvation. The experiment was comparable to a natural famine in terms of the degree of food depreciation, but the volunteers did not have to watch their families and communities experience the same pain and suffering. And there was a clear end date, after which they would receive as much food as they desired.

Despite the differences, the Minnesota men exhibited symptoms of depression, irritability, nervousness and general emotional instability. Social withdrawal, narrowing of interests, obliteration of sexual drive and difficulty in concentration were prominent. Food and eating became their dominant concern. In the Minnesota experiment, as in Holland during the famine in the spring of 1945, semi-starvation apathy became a dominant characteristic.

The behavioural changes in the Minnesota men paralleled the changes in their physiology. For example, the decrease in body temperature was compensated for by the use of more clothing and bedcovers, by revelling in hot showers and by eating their food very hot. Because of excessive loss of fat in the buttocks, the subjects avoided sitting on hard surfaces and carried around cushions or sought out soft chairs. The most important symptoms identified by the volunteers in the Minnesota experiment included chronic hunger pains, tiredness, sensitivity to cold, obsessive thoughts about food and a decrease in sociability.

There is a myth that, after a few days of semi-starvation, hunger pains abate. It is not true. It appears that only under conditions of total starvation (no food but as much water as needed) the subjective experience of hunger pains disappear within a few days. But in chronic hunger, associated with semi-starvation, hunger pangs tend to progressively increase. It is only in the terminal stages of total starvation that appetite fails. Food became the principal topic of conversation, reading and daydreams for almost all Minnesota volunteers.

Cookbooks, menus and information bulletins on food production became intensely interesting to many of the men who previously had little or no interest in dietetics or agriculture. The persistent pangs of hunger distracted the men when they attempted to continue their cultural interests, manual activities and studies.

The even-temperedness, patience and tolerance evidenced during the control period gave way under stress. Irritability increased to the point that it became an individual and group problem. Although the men were well aware of their hyper-irritability, they were not altogether able to control it. Outbursts of temper and periods of sulking were not uncommon. A few had strong urges toward violence, that they were barely able to control. Personal appearance and grooming began to deteriorate as the chronic semi-starvation progressed. The men often neglected to shave, brush their teeth, and comb their hair. Even those who had been meticulous in their grooming now dressed carelessly and presented a slovenly appearance. There was almost total apathy for life and living.

It is interesting that during the 12 weeks of rehabilitation, there was relatively little change in the subjects' eating habits and attitudes towards food. The men continued to want more than they received. Even when those on the highest caloric intake were physically full, they wanted more - their appetites were insatiable.

As a pediatrician and nutritionist, I am greatly distressed about the effect of chronic hunger on the functioning of children. I know that a chronic shortage of food will affect growth and development, but what about a child's psychological response to chronic hunger. In the wake of the First World War and the Russian Revolution there was a famine in Russia. First hand observations mentioned that "food topics incessantly occupied the whole consciousness of pre-school and school children" and "conversations about meals were the only possible approach to them. To everything else they reacted either irritably or negatively."

Children showed a combination of unusual vindictiveness, extraordinary irritability and chronic crying. Teachers said the children became tired more quickly than during prewar days, that they were able to pay attention for only a short time, that their comprehension was slower and their memory poorer, that they were restless, and that discipline was harder to maintain.

Today's food crisis has come at a time when progress was being made toward meeting the Millennium Development goal to eradicate extreme poverty and hunger in many countries. It is a man-made crisis of potentially catastrophic proportions, which we hope will have a made-made solution.

There is a danger, however, that when a problem like this is seen to be too big and too impersonal, finding a solution becomes overwhelming. But this food crisis is more than a headline. It is about people and the pain of hunger and the impact on our society.

Director of the Sprinkles Global Health Initiative, Hospital for Sick Children and Professor of Pediatrics and Nutritional Sciences at the University of Toronto

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