The answer is that it is because they live in poverty – be it a consequence of malnutrition, unsanitary conditions, or poor environmental conditions. The conclusion to be drawn, in a sense, is that poverty is the disease. Poverty is what makes the people in these poor countries prone to this disease.

Consider that 11 million children under the age of 5 die each year because of preventable diseases and malnutrition. Children without food are children without a strong immune system, unable to defend themselves against diseases. According to the World Food Program (WFP), malnutrition is one of the causes of death for 10 million children under five. It is estimated that 53% of deaths in children under the age of 5 are due to undernutrition. The following chart shows the percentage of deaths that are ultimately caused by malnutrition:

According to the WFP, there are two types of acute hunger. Acute hunger or starvation is the result of emergencies, such as wars or natural disasters - however, "emergencies account for just eight percent of hunger's victims". Daily undernourishment affects many more people - where people are chronically hungry and live on less than the 2,100 recommended calories a day. Every minute, 21 children die somewhere in the world because of malnutrition related causes. This is one of the reasons that 5-10% of children in developing countries will develop pneumonia each year (amounting to 154 million cases of pneumonia in children in developing countries each year), why 2 million of these children under age 5 will die, and why pneumonia is associated with 15-40% of all childhood deaths.

Malnutrition results from protein energy deficiency (also known as protein energy malnutrition or PEM), which is caused by the lack of carbohydrates, fats, and proteins, among other things. Malnutrition also results from vitamin and mineral deficiencies. The Food and Agriculture Organization (FAO) estimates that 2 billion people around the world are vitamin and mineral deficient.

852 million people in the world - roughly three times the population of the United States - are malnourished, and 799 million of them live in the developing world. 214 million of these people are chronically malnourished. 167 million children under age five are underweight. About 30% of children in developing countries are underweight – they weigh less than 80% of the standard weight, called Protein-Energy Malnutrition (PEM) – amounting to 146 million underweight children under the age of 5. Low PEM in pregnant/lactating women leads to low birth weight infants, which makes the children vulnerable to pneumonia.

When one thinks of an unhealthy diet in a developed country, most people think about a hamburger (A Big Mac, for instance, has 540 calories), or perhaps a calorie-laden donut. But in a developing country, an "unhealthy diet" amounts to the exact opposite - too few calories, too few essential nutrients, and too little food. Malnutrition is the direct result of poverty.

The fact of the matter is that - even though increased attention worldwide has been given to the starving and malnourished, the amount of hungry people around the world continues to increase. Malnutrition in Africa has increased over the past 30 years in children. In Sub-Saharan Africa, 33 million children are malnourished. Children under 5 die at 22 times the rate of wealthy nations, twice the rate of the developing world. In Ethiopia, for example, 50% of children are malnourished (in contrast, only 3% of American children are malnourished). While most of the malnourished children do not die, they do not get vital nutrients, and hence, are stunted, sickly, and vulnerable to deadly infections. They become intellectually stunted as adults, losing over 15 IQ points. About 3.5 million children there don't have enough iodine (which lowers IQ by 10 or more), and more than half million don’t have enough Vitamin A, which weakens the immune system. Around the world today, 140 million preschool children in 118 countries are Vitamin A deficient. With adequate vitamin A, child mortality would be lowered by 20%. Vitamin A deficiency increases the annual death toll from measles and other diseases by an estimated 1.3 million-2.5 million children.

There are many causes of malnutrition. Drought is chief among them. Drought often results in famines and food becomes scarce, because crops fail when there is lack of rain fall. At times, countries such as Kenya, Somalia, Ethopia, and Djibouti have experienced 5-6 seasons of poor or failed harvests, leading to food shortages affecting 9 million people in those countries. Droughts in 2004 caused crop failure and loss of livestock in Ethiopia, Eritrea, Somalia, Uganda, and Kenya.

Another cause of malnutrition is war, During times of conflict, millions of people are displaced from their homes and farms - this is what is happening in Sudan's Darfur region right now - meaning they must move to other places, abandoning their farmlands, becoming refugees and overloading food production and supply capabilities. Conflict also means that emergency food supply sources are disrupted and cannot reach the people that need them. Food aid distributed by sea is prone to piracy and transporting food by land is expensive, time consuming, and subject to seizure by armed groups.

And one of the causes of malnutrition might be one you don't suspect - global warming. One report found that, because of adverse climate change, there will be a 51% decrease in India's favorable wheat-growing land by 2050, meaning that 200 million more people will be susceptible to hunger. The increase in temperature around the world means that places where growing wheat is favorable will begin to move north and towards higher elevations - away from the developing countries where these crops are the backbone of food production. Another study found that increases in temperature would result in a decrease of growing periods by 20 percent in Sub-Saharan Africa. A team of British climate scientists have predicted that by 2100, if global warming continues at its present rate, nearly 1/3 of the world's population will be affected by extreme drought.

Obviously, solutions to malnutrition in developing countries are needed urgently. One of the most effective ways to do this, of course, is to provide food. However, in some cases, simply providing food does not create the incentive to create food, leaving many families stuck in the cycle of poverty.

The governments of many developing countries already help malnourished citizens. South Africa, for instance, gave nutrient-fortified flour to 30 million of their 46 million citizens. Nigeria adds Vitamin A to flour, cooking oil, and sugar. Ethiopia plants to iodize all salt to combat iodine deficiency. The United Nations covers 3 out of every 4 children and gives them twice a year Vitamin A supplements.

The WFP, in 2005, distributed 4.2 million metric tons of food aid to 73.1 million people. Since its inception, 47 million tons of food aid has been distributed. This aid has reached 1.2 billion people.

However, it is often found that there are simply not enough resources to combat malnutrition. In Ethiopia, the government and various United Nations agencies care for 20,000 malnourished children. But according to Iqbal Kabir, chief nutrition expert at UNICEF in Ethiopia's capital, "...we can count 70,000. We can't treat them all."

According to the International Food Policy Research Institute (IFPRI), if current investment trends continue, the number of malnourished children will grow to 3.3 million. A decrease in investment would lead to 55.1 million malnourished children in Sub-Saharan Africa alone by 2025.

The IFPRI study goes on to state that $4.7 billion is needed, in addition to current investment, each year, in order for Africa to combat child malnutrition.

Lack of dietary diversity and essential minerals and vitamins contribute to increased child and adult mortality. Something as simple as providing Vitamin A to children may very well help solve the problem in the short term, but again – what is the long term solution? What can we do to alleviate the problem of malnutrition – the problem of lower respiratory infections – for the next generation?

2.4 billion people do not have access to sanitary facilities. Poor sanitation affects two-thirds of Africa. According to Maria Mutagamba (Uganda's water minister), "Children pass away every other minute because they don't have access to clean water." Water can be the source of pneumonia, diarrhea, and other diseases if it is not clean and is left untreated.

Diseases spread through water are caused as a result of the lack of personal hygiene, as well as environmental pollution. Poor sanitation contributes to this - 90% of wastewater flows into water sources without treatment in developing countries. This is best shown through the case of diarrhea, which is primarily spread through contaminated water in the developing world. Governments and non government organizations (NGOs) around the world have been putting money into clean water and sanitation for years. CARE has helped 10 million people in 30 countries get safe drinking water since the 1950s, and in 2003, 3 million people in 29 countries were able to access clean water because of CARE's work. UNDP (United Nations Development Program) has a budget of $900 million for sustainable water development. However, today, clean water is still unavailable to over a billion of the world's people. The disparity between the rich and the poor is shocking - in the United States, the flush of a toilet uses more water than a person living in Africa might use during the course of an entire day.

Clean water is often accessed from streams and rivers, however when a family is not located near one, it becomes necessary to transport water at great distances. In the story of Elma Kassa, a 13 year old girl from Ethiopia:

The case of Elma Kassa is one that further serves to make a point - that of women and water. In many countries, according to the WHO, it is often women and young girls who are tasked with walking great distances to get water. Already burdened with other household chores, many of these girls will also not receive an education.

The WHO reported that people normally need 20 liters each day for their personal hygiene and health. 10 liters of this is for drinking and cooking. However, when water sources are too far away or are too expensive, the usage of water usually declines to less than 15 liters per day.

Innovative solutions are needed to solve these problems. As it's simply not practical to install water pipes in these rural areas, people have come up with other solutions. For instance, Living Water for the World is a group that helps to facilitate the construction of filtration and purification equipment. The standard equipment provided can clean 300 gallons an hour, for a cost of roughly $2,300. When measured in the benefit to a community, this might actually be relatively cheap; however the funds to buy these filtration systems are still needed. Another solution is the LifeStraw, developed by the Vestergaard Frandsen Group. It is a portable filtration system that is shaped like a straw, that cleans the water as one drinks through its use of mesh filters, iodine-impregnated beads and active carbon - and they only cost $2.

700 million people around the world today inhale smoke from burning wood and fuels because they live in rural areas. The inhalation of smoke puts them at increased risk for acute respiratory infections.

600 million people living in urban areas in Africa, Asia, and Latin America live in unhealthy homes.

All of these environmental factors contribute significantly to the incidence of pneumonia. Combating these would certainly help reduce acute respiratory infection mortality rates around the world, but the question is how this should be done.

Michael G (14) and Patrick G (12), Doors to Diplomacy 2007