November 25, 2003

Most of the World Still Does Without


The United States may pride itself as the land of plenty. But the portion of Americans who occasionally go hungry for lack of money to pay for food has not decreased in three decades. And America may have the best trained doctors and most advanced hospitals in the world. But the portion of Americans who periodically can’t afford medical care each year has actually increased since the mid 1970s. By comparison, Canadians, Europeans and Japanese are far less likely to go hungry. But they, too, face a growing challenge in finding the means to pay for a doctor. Meanwhile, widespread basic deprivation–the lack of resources to pay for food and medical care–remains a daily challenge in most of the rest of the world, especially among the poor, according to 38,000 interviews in 44 countries by the Pew Global Attitudes Project.

Hunger Widespread

As most Americans gather for Thanksgiving November 27–traditionally a time for festive overeating and self-indulgence–about one-in-seven of their fellow citizens say they occasionally can’t afford to put food on their tables. And the problem is not getting any better.

As many as 15% of Americans said there have been times in the last year when they did not have enough money to buy food for their families. In contrast, only one-in-eleven Western Europeans (9%) and one-in-25 (4%) Japanese said they periodically go hungry. These proportions have not changed significantly between 1974-5 and 2002, when compared with data collected by Gallup International. Only in Japan, notwithstanding a decade-long economic stagnation, has the proportion of people reporting they occasionally can’t pay for food declined significantly, by 10 percentage points since 1974-5.

In other, poorer parts of the world, putting food on the table is much tougher. Majorities in seven of ten African countries surveyed–including 59% of South Africans and 56% of Nigerians–said they went without food at some point because of the lack of money. And hunger is not simply a function of absolute poverty. Half of Russians (50%) and Ukrainians (55%) also complained they occasionally could not pay to feed their families. Moreover, it has become more difficult to regularly put food on the family table in parts of Latin America. In 2002, nearly half (45%) of Brazilians reported that they skipped meals because of a lack of cash. In 1974-5, only 26% of Brazilians occasionally went hungry.

The good news: for people fortunate enough to live in poor regions that have prospered in the last generation, hunger, while still disturbingly widespread, has declined. Two-in-three (66%) Indians said they periodically went without food in 1974-5. By last year, 44% claimed such deprivation.

While an overwhelming number of people in the United States, Canada and Europe said they have enough to eat, two-in-five low-income Americans at times go hungry, the highest such proportion in the industrial world. Only one-in-four low-income Canadians and Britons are so deprived. The young in the United States are also twice as likely as the old to be unable to pay for a meal – 21% of those aged 18-29 complained that they occasionally can’t buy food, compared with only 9% of those age 65 or older. U.S. women (19%) also were more likely than men (11%) to not be able to afford the occasional meal.

In most of the rest of the world, overwhelming portions of the poor occasionally went hungry: 71% of low income people in Brazil, 66% of low-income people in Russia, 65% of low income people in India. Notably, however, a third (36%) of people who have a middle-class income by Brazilian standards also reported not having enough money for food at times, and half (52%) of middle- class Russians and a quarter (25%) of middle-class Indians faced similar deprivation. Brazilian and Mexican women, like their sisters in the United States, are much more likely than men in their societies to have faced challenges feeding their families. But elsewhere in the developing world, women were not much more likely than men to complain about not being able to put food on the table regularly.

Access to Medical Care Worsening

Access to affordable medical care is often an even tougher challenge than putting food on the table in much of the world, rich and poor. One-in-four (26%) Americans said that there had been times in the last year that they did not have enough money to pay for medical and health care that their family needed. This was twice the percentage of Canadians (13%) and Italians (12%) and five times the percentage of French (5%) who had such complaints.

Moreover, the affordability of medical care is a growing problem in much of the industrial world. In 1974-5, 15% of Americans said they periodically couldn’t afford to see a doctor. In 2002, the percentage had grown to 26%. There was a similar increase in such complaints in Canada-(from 4% in 1974-5 to 13% in 2002) in Britain (from 1% to 11%) and in Italy from 9% to 12%. Access to affordable health care also became a more widespread problem in Brazil (36% to 51%) and Mexico (39% to 45%).

In a sign that government health insurance for older Americans has improved their access to care, only one-in-five (20%) Americans age 65 and older reported they had to go without medical care at some time over the past year because of a lack of funds. Without a comparably large government program for the young, one-in-three (33%) people age 18-29 had to forego health care because they could not afford it.

Overall, there was a stark difference in people’s experience with the American market-oriented health care system and the state-funded medical care provided in Canada and Western Europe. As many as 55% of low-income Americans occasionally could not afford to pay for care, only 25% of low-income Canadians, 17% of low-income Germans and 8% of low-income Japanese faced that problem. The United States lacks a universal health care system; Canada, Germany and Japan each have such a safety net.

Women are relatively disadvantaged by the U.S. medical care system. Nearly one-in-three (31%) American women said they had occasional trouble paying for health care, but only one-in-five (22%) American men had the same complaint. There was no such gender gap in Canada or Western Europe.

As might be expected, the poor almost everywhere have trouble paying for medical care: nearly two-in-three (64%) Nigerians said they had at times lacked the funds to pay for the care their families needed, as did more than half of Indonesians (56%) and three-in-five (61%) Mexicans. Half of Russians (54%) and Ukrainians (56%) had similar complaints.

These findings are drawn from the Pew Global Attitudes Project’s surveys of 38,000 people in 44 nations, conducted during the summer/fall 2002 under the direction of Princeton Survey Research Associates International.

The Pew Global Attitudes Project is a series of worldwide public opinion surveys. The project has issued two major reports, “What the World Thinks in 2002” — based upon 38,000 interviews in 44 nations — and “Views of a Changing World, June 2003” — based on 16,000 interviews in 20 nations and the Palestinian Authority. Surveys were conducted by local organizations under the direction of Princeton Survey Research Associates. The Gallup trends from 1974-5 are drawn from the “Human Needs and Satisfactions” survey published by Kettering and Gallup International in 1977. Full details about the surveys, and the project more generally, are available at