Editing IPCC:AR6/SRCCL/Chapter-5 (section)

== 5.1 Framing and context ==

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The current food system (production, transport, processing, packaging, storage, retail, consumption, loss and waste) feeds the great majority of world population and supports the livelihoods of over 1 billion people. Agriculture as an economic activity generates between 1% and 60% of national GDP in many countries, with a world average of about 4% in 2017 (World Bank 2019 <sup>[[#fn:r1|1]]</sup> ). Since 1961, food supply per capita has increased more than 30%, accompanied by greater use of nitrogen fertiliser (increase of about 800%) and water resources for irrigation (increase of more than 100%).

The rapid growth in agricultural productivity since the 1960s has underpinned the development of the current global food system that is both a major driver of climate change, and increasingly vulnerable to it (from production, transport, and market activities). Given the current food system, the UN Food and Agriculture Organization (FAO) estimates that there is a need to produce about 50% more food by 2050 in order to feed the increasing world population (FAO 2018a <sup>[[#fn:r2|2]]</sup> ). This would engender significant increases in GHG emissions and other environmental impacts, including loss of biodiversity. FAO (2018a) projects that by 2050 cropland area will increase 90–325 Mha, between 6% and 21% more than the 1567 Mha cropland area of 2010, depending on climate change scenario and development pathway (the lowest increase arises from reduced food loss and waste and adoption of more sustainable diets).

Climate change has direct impacts on food systems, food security, and, through the need to mitigate, potentially increases the competition for resources needed for agriculture. Responding to climate change through deployment of land-based technologies for negative emissions based on biomass production would increasingly put pressure on food production and food security through potential competition for land.

Using a food system approach, this chapter addresses how climate change affects food security, including nutrition, the options for the food system to adapt and mitigate, synergies and trade-offs among these options, and enabling conditions for their adoption. The chapter assesses the role of incremental and transformational adaptation, and the potential for combinations of supply-side measures such as sustainable intensification (increasing productivity per hectare) and demand-side measures (e.g., dietary change and waste reduction) to contribute to climate change mitigation.

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=== 5.1.1 Food security and insecurity, the food system and climate change ===

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The '''food system''' encompasses all the activities and actors in the production, transport, manufacturing, retailing, consumption, and waste of food, and their impacts on nutrition, health and well-being, and the environment (Figure 5.1).

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'''Figure 5.1'''

<span id="interlinkages-between-the-climate-system-food-system-ecosystems-land-water-and-oceans-and-socio-economic-system.-these-systems-operate-at-multiple-scales-both-global-and-regional.-food-security-is-an-outcome-of-the-food-system-leading-to-human-well-being-which-is-also-indirectly-linked-with-climate-and-ecosystems-through-the-socio-economic-system.-adaptation-measures-can-help"></span>
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'''Interlinkages between the climate system, food system, ecosystems (land, water and oceans) and socio-economic system. These systems operate at multiple scales, both global and regional. Food security is an outcome of the food system leading to human well-being, which is also indirectly linked with climate and ecosystems through the socio-economic system. Adaptation measures can help […]'''
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Interlinkages between the climate system, food system, ecosystems (land, water and oceans) and socio-economic system. These systems operate at multiple scales, both global and regional. Food security is an outcome of the food system leading to human well-being, which is also indirectly linked with climate and ecosystems through the socio-economic system. Adaptation measures can help to reduce negative impacts of climate change on the food system and ecosystems. Mitigation measures can reduce GHG emissions coming from the food system and ecosystems.

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==== 5.1.1.1 Food security as an outcome of the food system ====

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The activities and the actors in the food system lead to outcomes such as food security and generate impacts on the environment. As part of the environmental impacts, food systems are a considerable contributor to GHG emissions, and thus climate change (Section 5.4). In turn, climate change has complex interactions with food systems, leading to food insecurity through impacts on food availability, access, utilisation and stability (Table 5.1 and Section 5.2).

We take a '''food systems lens''' in the Special Report on Climate Change and Land (SRCCL) to recognise that demand for and supply of food are interlinked and need to be jointly assessed in order to identify the challenges of mitigation and adaptation to climate change. Outcomes cannot be disaggregated solely to, for example, agricultural production, because the demand for food shapes what is grown, where it is grown, and how much is grown. Thus, GHG emissions from agriculture result, in large part, from ‘pull’ from the demand side. Mitigation and adaptation involve modifying production, supply chain, and demand practices (through, for example, dietary choices, market incentives, and trade relationships), so as to evolve to a more sustainable and healthy food system.

According to FAO (2001a) <sup>[[#fn:r3|3]]</sup> , '''food security''' is a situation that exists when all people, at all times, have physical, social, and economic access to sufficient, safe, and nutritious food that meets their dietary needs and food preferences for an active and healthy life. ‘All people at all times’ implies the need for equitable and stable food distribution, but it is increasingly recognised that it also covers the need for inter-generational equity, and therefore ‘sustainability’ in food production. ‘Safe and nutritious food … for a healthy life’ implies that food insecurity can occur if the diet is not nutritious, including when there is consumption of an excess of calories, or if food is not safe, meaning free from harmful substances.

A prime impact of food insecurity is '''malnourishmen''' t (literally ‘bad nourishment’) leading to '''malnutrition''' , which refers to deficiencies, excesses, or imbalances in a person’s intake of energy and/or nutrients. As defined by FAO et al. (2018) <sup>[[#fn:r1410|1410]]</sup> , undernourishment occurs when an individual’s habitual food consumption is insufficient to provide the amount of dietary energy required to maintain a normal, active, healthy life. In addition to undernourishment in the sense of insufficient calories (‘hunger’), undernourishment occurs in terms of nutritional deficiencies in vitamins (e.g., vitamin A) and minerals (e.g., iron, zinc, iodine), so-called ‘hidden hunger’. Hidden hunger tends to be present in countries with high levels of undernourishment (Muthayya et al. 2013 <sup>[[#fn:r4|4]]</sup> ), but micronutrient deficiency can occur in societies with low prevalence of undernourishment. For example, in many parts of the world teenage girls suffer from iron deficiency (Whitfield et al. 2015) <sup>[[#fn:r5|5]]</sup> and calcium deficiency is common in Western-style diets (Aslam and Varani 2016 <sup>[[#fn:r6|6]]</sup> ). Food security is related to nutrition, and conversely food insecurity is related to malnutrition. Not all malnourishment arises from food insecurity, as households may have access to healthy diets but choose to eat unhealthily, or it may arise from illness. However, in many parts of the world, poverty is linked to poor diets (FAO et al. 2018 <sup>[[#fn:r7|7]]</sup> ). This may be through lack of resources to produce or access food in general, or healthy food, in particular, as healthier diets are more expensive than diets rich in calories but poor in nutrition ( ''high confidence'' ) (see meta-analysis by Darmon and Drewnowski 2015 <sup>[[#fn:r8|8]]</sup> ). The relationship between poverty and poor diets may also be linked to unhealthy ‘food environments,’ with retail outlets in a locality only providing access to foods of low nutritional quality (Gamba et al. 2015) – such areas are sometimes termed ‘food deserts’ (Battersby 2012 <sup>[[#fn:r9|9]]</sup> ).

Whilst conceptually the definition of food security is clear, it is not straightforward to measure in a simple way that encompasses all its aspects. Although there are a range of methods to assess food insecurity, they all have some shortcomings. For example, the FAO has developed the Food Insecurity Experience Scale (FIES), a survey-based tool to measure the severity of overall households’ inability to access food. While it provides reliable estimates of the prevalence of food insecurity in a population, it does not reveal whether actual diets are adequate or not with respect to all aspects of nutrition (Section 5.1.2.1).

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==== 5.1.1.2 Effects of climate change on food security ====

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Climate change is projected to negatively impact the four pillars of food security – availability, access, utilisation and stability – and their interactions (FAO et al. 2018 <sup>[[#fn:r10|10]]</sup> ) ( ''high confidence'' ). This chapter assesses recent work since AR5 that has strengthened understanding of how climate change affects each of these pillars across the full range of food system activities (Table 5.1 and Section 5.2).

While most studies continue to focus on availability via impacts on food production, more studies are addressing related issues of access (e.g., impacts on food prices), utilisation (e.g., impacts on nutritional quality), and stability (e.g., impacts of increasing extreme events) as they are affected by a changing climate (Bailey et al. 2015). Low-income producers and consumers are likely to be most affected because of a lack of resources to invest in adaptation and diversification measures (UNCCD 2017 <sup>[[#fn:r12|12]]</sup> ; Bailey et al. 2015 <sup>[[#fn:r13|13]]</sup> ).

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'''Table 5.1'''

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'''Relationships between food security, the food system, and climate change, and guide to chapter'''
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[[File:317dd590af02d7083dcb2788c7e281d9 table-5.1-a.png]] [[File:9094dcdc507f9296c2173e194893fa46 table-5.1-b.png]]

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<span id="status-of-the-food-system-food-insecurity-and-malnourishment"></span>
=== 5.1.2 Status of the food system, food insecurity and malnourishment ===

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==== 5.1.2.1 Trends in the global food system ====

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Food is predominantly produced on land, with, on average, 83% of the 697 kg of food consumed per person per year, 93% of the 2884 kcal per day, and 80% of the 81 g of protein eaten per day <sup>[[#fn:1|1]]</sup> coming from terrestrial production in 2013 (FAOSTAT 2018 <sup>[[#fn:r14|14]]</sup> ). With increases in crop yields and production (Figure 5.2), the absolute supply of food has been increasing over the last five decades. Growth in production of animal-sourced food is driving crop utilisation for livestock feed (FAOSTAT 2018 <sup>[[#fn:r15|15]]</sup> ; Pradhan et al. 2013a <sup>[[#fn:r16|16]]</sup> ). Global trade of crop and animal-sourced food has increased by around 5 times between 1961 and 2013 (FAOSTAT 2018 <sup>[[#fn:r17|17]]</sup> ). During this period, global food availability has increased from 2200 kcal/cap/day to 2884 kcal/cap/day, making a transition from a food deficit to a food surplus situation (FAOSTAT 2018; Hiç et al. 2016 <sup>[[#fn:r18|18]]</sup> ).

The availability of cereals, animal products, oil crops, and fruits and vegetables has mainly grown (FAOSTAT 2018 <sup>[[#fn:r19|19]]</sup> ), reflecting shifts towards more affluent diets. This, in general, has resulted in a decrease in prevalence of underweight and an increase in prevalence of overweight and obesity among adults (Abarca-Gómez et al. 2017 <sup>[[#fn:r20|20]]</sup> ). During the period 1961–2016, anthropogenic GHG emissions associated with agricultural production has grown from 3.1 GtCO <sub>2</sub> -eq yr <sup>–1</sup> to 5.8 GtCO <sub>2</sub> -eq yr <sup>–1</sup> (Section 5.4.2 and Chapter 2). The increase in emissions is mainly from the livestock sector (from enteric fermentation and manure left on pasture), use of synthetic fertiliser, and rice cultivation (FAOSTAT 2018 <sup>[[#fn:r|]]</sup> 21).

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'''Figure 5.2'''

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'''Global trends in (a) yields of maize, rice, and wheat (FAOSTAT 2018) – the top three crops grown in the world; (b) production of crop and animal calories and use of crop calories as livestock feed (FAOSTAT 2018); (c) production from marine and aquaculture fisheries (FishStat 2019); (e) food trade in calories (FAOSTAT 2018); (f) […]'''
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[[File:35e9db66e24f00d2200dbcbcaef883dc Figure-5.2-768x1024.jpg]]

Global trends in (a) yields of maize, rice, and wheat (FAOSTAT 2018 <sup>[[#fn:r1411|1411]]</sup> ) – the top three crops grown in the world; (b) production of crop and animal calories and use of crop calories as livestock feed (FAOSTAT 2018 <sup>[[#fn:r1412|1412]]</sup> ); (c) production from marine and aquaculture fisheries (FishStat 2019 <sup>[[#fn:r1414|1414]]</sup> ); (e) food trade in calories (FAOSTAT 2018 <sup>[[#fn:r1415|1415]]</sup> ); (f) food supply and required food (i.e., based on human energy requirements for medium physical activities) from 1961–2012 (FAOSTAT 2018 <sup>[[#fn:r1416|1416]]</sup> ; Hiç et al. 2016 <sup>[[#fn:r1417|1417]]</sup> ); (g) prevalence of overweight, obesity and underweight from 1975–2015 (Abarca-Gómez et al. 2017 <sup>[[#fn:r1418|1418]]</sup> ); and (h) GHG emissions for the agriculture sector, excluding land-use change (FAOSTAT 2018 <sup>[[#fn:r1419|1419]]</sup> ). For figures (b) and (e), data provided in mass units were converted into calories using nutritive factors (FAO 2001b <sup>[[#fn:r1420|1420]]</sup> ). Data on emissions due to burning of savanna and cultivation of organic soils is provided only after 1990 (FAOSTAT 2018 <sup>[[#fn:r1421|1421]]</sup> ).

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==== 5.1.2.2 Food insecurity status and trends ====

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In addressing food security the dual aspects of malnutrition – under-nutrition and micro-nutrient deficiency, as well as over-consumption, overweight, and obesity – need to be considered (Figure 5.2 (g) and Table 5.2). The UN agencies’ State of Food Security and Nutrition 2018 report (FAO et al. 2018 <sup>[[#fn:r22|22]]</sup> ) and the Global Nutrition Report 2017 (Development Initiatives 2017 <sup>[[#fn:r23|23]]</sup> ) summarise the global data. The ''State of Food Security'' report’s estimate for undernourished people on a global basis is 821 million, up from 815 million the previous year and 784 million the year before that. Previous to 2014/2015 the prevalence of hunger had been declining over the last three decades. The proportion of young children (under five) who are stunted (low height-for-age), has been gradually declining, and was 22% in 2017 compared to 31% in 2012 (150.8 million, down from 165.2 million in 2012). In 2017, 50.5 million children (7.5%) under five were wasted (low weight-for-height). Since 2014, undernutrition has worsened, particularly in parts of Sub-Saharan Africa, south-eastern Asia and Western Asia, and recently Latin America. Deteriorations have been observed most notably in situations of conflict and conflict combined with droughts or floods (FAO et al. 2018 <sup>[[#fn:r24|24]]</sup> ).

Regarding micronutrient deficiencies known as ‘hidden hunger’, reporting suggests a prevalence of one in three people globally (FAO 2013a <sup>[[#fn:r25|25]]</sup> ; von Grebmer et al. 2014 <sup>[[#fn:r26|26]]</sup> ; Tulchinsky 2010 <sup>[[#fn:r27|27]]</sup> ) (Table 5.2). In the last decades, hidden hunger (measured through proxies targeting iron, vitamin A, and zinc deficiencies) worsened in Africa, while it mainly improved in the Asia and Pacific regions (Ruel-Bergeron et al. 2015 <sup>[[#fn:r28|28]]</sup> ). In 2016, 613 million women and girls aged 15 to 49 suffered from iron deficiency (Development Initiatives 2018 <sup>[[#fn:r29|29]]</sup> ); in 2013, 28.5% of the global population suffered from iodine deficiency; and in 2005, 33.3% of children under five and 15.3% of pregnant women suffered from vitamin A deficiency, and 17.3% of the global population suffered from zinc deficiency (HLPE 2017 <sup>[[#fn:r30|30]]</sup> ).

Globally, as the availability of inexpensive calories from commodity crops increases, so does per capita consumption of calorie-dense foods (Ng et al. 2014 <sup>[[#fn:r31|31]]</sup> ; NCD-RisC 2016a <sup>[[#fn:r32|32]]</sup> ; Abarca-Gómez et al. 2017 and Doak and Popkin 2017 <sup>[[#fn:r33|33]]</sup> ). As a result, in every region of the world, the prevalence of obesity (body mass index &gt;30 kg m <sup>–2</sup> ) and overweight (body mass index range between normality [18.5–24.9] and obesity) is increasing. There are now more obese adults in the world than underweight adults (Ng et al. 2014 <sup>[[#fn:r34|34]]</sup> ; NCD-RisC 2016a <sup>[[#fn:r35|35]]</sup> ; Abarca-Gómez et al. 2017 <sup>[[#fn:r36|36]]</sup> and Doak and Popkin 2017). In 2016, around two billion adults were overweight, including 678 million suffering from obesity (NCD-RisC 2016a <sup>[[#fn:r37|37]]</sup> ; Abarca-Gómez et al. 2017). The prevalence of overweight and obesity has been observed in all age groups.

Around 41 million children under five years and 340 million children and adolescents aged 5–19 years were suffering from overweight or obesity in 2016 (NCD-RisC 2016a <sup>[[#fn:r38|38]]</sup> ; FAO et al. 2017 <sup>[[#fn:r39|39]]</sup> ; WHO 2015 <sup>[[#fn:r40|40]]</sup> ). In many high-income countries, the rising trends in children and adolescents suffering from overweight or obesity have stagnated at high levels; however, these have accelerated in parts of Asia and have very slightly reduced in European and Central Asian lower and middle-income countries (Abarca-Gómez et al. 2017 <sup>[[#fn:r41|41]]</sup> ; Doak and Popkin 2017 <sup>[[#fn:r42|42]]</sup> ; Christmann et al. 2009 <sup>[[#fn:r43|43]]</sup> ).

There are associations between obesity and non-communicable diseases such as diabetes, dementia, inflammatory diseases (Saltiel and Olefsky 2017 <sup>[[#fn:r44|44]]</sup> ), cardiovascular disease (Ortega et al. 2016 <sup>[[#fn:r45|45]]</sup> ) and some cancers, for example, of the colon, kidney, and liver (Moley and Colditz 2016 <sup>[[#fn:r46|46]]</sup> ). There is a growing recognition of the rapid rise in overweight and obesity on a global basis and its associated health burden created through non-communicable diseases (NCD-RisC 2016a <sup>[[#fn:r47|47]]</sup> ; HLPE 2017 <sup>[[#fn:r48|48]]</sup> ).

Analyses reported in FAO et al. (2018) highlight the link between food insecurity, as measured by the FIES scale, and malnourishment ( ''medium agreement, robust evidence'' ). This varies by malnourishment measure as well as country (FAO et al. 2018 <sup>[[#fn:r49|49]]</sup> ). For example, there is limited evidence ( ''low agreement'' but multiple studies) that food insecurity and childhood wasting (i.e., or low weight for height) are closely related, but it is very likely ( ''high agreement, robust evidence'' ) that childhood stunting and food insecurity are related (FAO et al. 2018 <sup>[[#fn:r50|50]]</sup> ). With respect to adult obesity there is robust evidence, with ''medium agreement'' , that food insecurity, arising from poverty reducing access to nutritious diets, is related to the prevalence of obesity, especially in high-income countries and adult females. An additional meta-analysis (for studies in Europe and North America) also finds a negative relationship between income and obesity, with some support for an effect of obesity causing low income (as well as vice versa) (Kim and von dem Knesebeck 2018 <sup>[[#fn:r51|51]]</sup> ).

As discussed in Section 5.1.1.1, different methods of assessing food insecurity can provide differential pictures. Of particular note is the spatial distribution of food insecurity, especially in higher-income countries. FAO et al. (2018) <sup>[[#fn:r52|52]]</sup> reports FIES estimates of severe food insecurity in Africa, Asia and Latin America of 29.8%, 6.9% and 9.8% of the population, respectively, but of 1.4% of the population (i.e., about 20 million in total; pro rata &lt;5 million for US, &lt;1 million for UK) in Europe and North America. However, in the USA, USDA estimates 40 million people were exposed to varying degrees of food insecurity, from mild to severe (overall prevalence about 12%) (Coleman-Jensen et al. 2018 <sup>[[#fn:r53|53]]</sup> ). In the UK, estimates from 2017 and 2018 indicate about 4 million adults are moderately to severely food insecure (prevalence 8%) (End Hunger UK 2018; Bates et al. 2017 <sup>[[#fn:r54|54]]</sup> ). The UK food bank charity, the Trussell Trust, over a year in 2017/18, distributed 1,332,952 three-day emergency food parcels to people referred to the charity as being in food crisis. Furthermore, a 2003 study in the UK (Schenker 2003) <sup>[[#fn:r55|55]]</sup> estimated that 40% of adults, and 15% of children admitted to hospitals were malnourished, and that 70% of undernourishment in the UK was unreported.

In total, more than half the world’s population are underweight or overweight (NCD-RisC 2017a <sup>[[#fn:r56|56]]</sup> ), so their diets do not provide the conditions for ‘an active and healthy life’. This will be more compromised under the impacts of climate change by changing the availability, access, utilisation, and stability of diets of sufficient nutritional quality as shown in Table 5.2 and discussed in detail below (Section 5.2).

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'''Table 5.2'''

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'''Global prevalence of various forms of malnutrition.'''
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[[File:c8fb620800627393de484ab97d440584 table-5.2.png]]

HLPE: High Level Panel of Experts on Food Security and Nutrition; SOFI: The State of Food Security and Nutrition in the World; GNR: Global Nutrition Report; MND: Micro nutrient deficiency (iron deficiency for year 2016, uses anaemia as a proxy (percentage of pregnant women whose haemoglobin level is less than 110 grams per litre at sea level and percentage of non-pregnant women whose haemoglobin level is less than 120 grams per litre at sea level).

* a Body mass index between 25 kg m <sup>–2</sup> and 29.9 kg m <sup>–2</sup> .
* b Body mass index greater than 30 kg m <sup>–2</sup> .
* c Prevalence of overweight/obesity among adults (age ≥18) in year 2016. Data from NCD Risc data source.
* d UNICEF WHO Joint Malnutrition.
* e In 2011.
* f Anaemia prevalence in girls and women aged 15 to 49.

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=== 5.1.3 Climate change, gender and equity ===

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Throughout, the chapter considers many dimensions of gender and equity in regard to climate change and the food system (Box 5.1). Climate change impacts differ among diverse social groups depending on factors such as age, ethnicity, ability/disability, sexual orientation, gender, wealth, and class ( ''high confidence'' ) (Vincent and Cull 2014 <sup>[[#fn:r57|57]]</sup> ; Kaijser and Kronsell 2014 <sup>[[#fn:r58|58]]</sup> ). Poverty, along with socio-economic and political marginalisation, cumulatively put women, children and the elderly in a disadvantaged position in coping with the adverse impacts of the changing climate (UNDP 2013 <sup>[[#fn:r59|59]]</sup> ; Skoufias et al. 2011 <sup>[[#fn:r60|60]]</sup> ). The contextual vulnerability of women is higher due to their differentiated relative power, roles, and responsibilities at the household and community levels (Bryan and Behrman 2013 <sup>[[#fn:r61|61]]</sup> ; Nelson et al. 2002 <sup>[[#fn:r62|62]]</sup> ). They often have a higher reliance on subsistence agriculture, which will be severely impacted by climate change (Aipira et al. 2017 <sup>[[#fn:r63|63]]</sup> ).

Through impacts on food prices (Section 5.2.3.1) poor people’s food security is particularly threatened. Decreased yields can impact nutrient intake of the poor by decreasing supplies of highly nutritious crops and by promoting adaptive behaviours that may substitute crops that are resilient but less nutritious (Thompson et al. 2012 <sup>[[#fn:r64|64]]</sup> ; Lobell and Burke 2010 <sup>[[#fn:r65|65]]</sup> ). In Guatemala, food prices and poverty have been correlated with lower micronutrient intakes (Iannotti et al. 2012 <sup>[[#fn:r66|66]]</sup> ). In the developed world, poverty is more typically associated with calorically-dense but nutrient-poor diets, obesity, overweight, and other related diseases (Darmon and Drewnowski 2015 <sup>[[#fn:r67|67]]</sup> ).

Rural areas are especially affected by climate change (Dasgupta et al. 2014 <sup>[[#fn:r68|68]]</sup> ), through impacts on agriculture-related livelihoods and rural income (Mendelsohn et al. 2007 <sup>[[#fn:r69|69]]</sup> ) and through impacts on employment. Jessoe et al. (2018) <sup>[[#fn:r70|70]]</sup> using a 28-year panel on individual employment in rural Mexico, found that years with a high occurrence of heat lead to a reduction in local employment by up to 1.4% with a medium emissions scenario, particularly for wage work and non-farm labour, with impacts on food access. Without employment opportunities in areas where extreme poverty is prevalent, people may be forced to migrate, exacerbating potential for ensuing conflicts (FAO 2018a <sup>[[#fn:r71|71]]</sup> ).

Finally, climate change can affect human health in other ways that interact with food utilisation. In many parts of the world where agriculture relies still on manual labour, projections are that heat stress will reduce the hours people can work, and increase their risk (Dunne et al. 2013 <sup>[[#fn:r72|72]]</sup> ). For example, Takakura et al. (2017) <sup>[[#fn:r73|73]]</sup> estimates that under RCP8.5, the global economic loss from people working shorter hours to mitigate heat loss may be 2.4–4% of GDP. Furthermore, as discussed by Watts et al. (2018) <sup>[[#fn:r74|74]]</sup> ; people’s nutritional status interacts with other stressors and affects their susceptibility to ill health (the ‘utilisation pillar’ of food security): so food-insecure people are more likely to be adversely affected by extreme heat, for example.

In the case of food price hikes, those more vulnerable are more affected (Uraguchi 2010 <sup>[[#fn:r75|75]]</sup> ), especially in urban areas (Ruel et al. 2010 <sup>[[#fn:r76|76]]</sup> ), where livelihood impacts are particularly severe for the individuals and groups that have scarce resources or are socially isolated (Revi et al. 2014 <sup>[[#fn:r77|77]]</sup> ; Gasper et al. 2011 <sup>[[#fn:r78|78]]</sup> ) ( ''high confidence'' ). These people often lack power and access to resources, adequate urban services and functioning infrastructure. As climate events become more frequent and intense, this can increase the scale and depth of urban poverty (Rosenzweig et al. 2018b <sup>[[#fn:r79|79]]</sup> ). Urban floods and droughts may result in water contamination increasing the incidence of diarrhoeal illness in poor children (Bartlett 2008 <sup>[[#fn:r80|80]]</sup> ). In the near destruction of New Orleans by Hurricane Katrina, about 40,000 jobs were lost (Rosemberg 2010 <sup>[[#fn:r81|81]]</sup> ).

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