Hektoen International

A Journal of Medical Humanities

The arrival of the black horse

Kevin R. Loughlin
Boston, Massachusetts, United States


Four horsemen of Apocalypse (1887) by Viktor Vasnetsov

When He broke the third seal, I heard the third living creature saying, “Come.”  I looked and behold, a black horse, and he who sat on it had a pair of scales in his hand. And I heard something like a voice in the center of the four living creatures saying, “A quart of wheat for a day’s wages and three quarts of barley for a day’s wages; but do not damage the oil and the wine.” – Revelation 6: 5-6

The Bible warns us of the Four Horseman of the Apocalypse: pestilence, war, famine, and death. Humanity in the twenty-first century is faced with the coming of the third horseman—famine.

Mankind has never before confronted the convergence of a population explosion, the disappearance of fossil fuels, and global warming. The consequences of this toxic brew are daunting and unpredictable. Jimmy Carter alerted the global community about twenty years ago of the interrelationship of war and hunger in an editorial, “The First Step To Peace Is Eradicating Hunger.” He concluded, “There can be no peace until people have enough to eat. Hungry people are not peaceful people.”1 A confluence of factors suggest that famine later in this century is highly likely unless dramatic steps are taken.


Contributing factors

In 1900, the world population was 1.6 billion. Today it is 7.6 billion and by mid-century it is projected to be 9.7 billion.2,3 The sheer increase in the population itself is daunting enough, but it becomes even more ominous when one considers that a disproportionate amount of growth will occur in the developing world.4

Besides, the world is only now beginning to realize that fossil fuels (coal, oil, and gas) are finite. Various experts debate when, specifically, will the globe exhaust its supply of fossil fuels. Some have suggested that oil will be depleted by 2052, gas by 2060, and coal by 2088.5 The actual years of depletion are arbitrary. What is important is that later in this century there will be severe shortages of all fossil fuels. Nobel laureate Burton Richter has commented, “The world will continue its profligate use of fossil energy for the next 50 years. Beyond that there is only uncertainty.”6

The impact of global warming is multifactorial. The IPCC (Intergovernmental Panel on Climate Change) expects sea levels to rise eight to twenty-four inches by the end of this century because of global warming.7 A twenty-inch rise in sea level would displace about fifty million people globally.8 Beyond the impact on coastal regions, global warming influences every component of the biosphere and will unalterably change agriculture and all aspects of food production. The heat-trapping nature of carbon dioxide and other gases was first demonstrated in the mid-nineteenth century.9 This “greenhouse” effect has caused the planet’s average temperature to rise about 1.62 degrees Fahrenheit in a little over 100 years. According to NOAA (National Oceanic and Atmospheric Association) and NASA (National Aeronautics and Space Administration), the ten warmest years on record have all occurred since 1998 and the five warmest years in the global record have all come since 2010.10 This severe global warming affects every aspect of food production. The warming and acidification of the oceans impacts marine life and subsequent fishing harvest. The temperature increase impacts land use, growing season, and crop selection and viability throughout the globe. Melting glaciers and severe droughts will continue to cause dramatic flooding and wildfires that destroy farmlands for years or decades. Forests, farms, and cities will be forced to confront new pests, heat waves, and water shortages, all of which will damage or destroy agriculture and fisheries. It has been predicted that many plant and animal species will become extinct.11

As the global population increases, it is projected that there will be a marked increase in urbanization. A megacity is defined as a city with more than ten million inhabitants. In 1950, there were only two megacities, New York/Newark and Tokyo. In 1995 there were fourteen, today there are twenty-two, and by 2025 it is predicted there will be thirty or more, many in developing countries in Asia, Africa, and South America.12 The agricultural sequelae of urban expansion are considerable. Cities generally expand by urban sprawl and purchase the relatively cheap surrounding farmland, which impacts not just the supply of agricultural acreage, but contributes to the propinquity and cost of food to the growing urban markets.  Parallel to this increased urbanization will be an increase in the “middle class” in regions where previously none existed. Specifically, in China and India, economic observers anticipate an increase in food prices from consumer demand among the newly affluent.13

The average citizen on the planet consumes 20% more calories than in the 1960s. It is forecast that the global requirement for food by 2050 will be 70-100% larger than today.14 Although some of that increase will be due to sheer population growth alone, much of it can be attributed to urban expansion and the concomitant burgeoning of the global middle class with increased caloric requirements. The corollary to this increased caloric demand will be an exacerbation of the water crisis, as 70% of fresh water is used to grow food.15

The potential for increased demand for meat in the diet of the growing middle class should not be underestimated. The annual meat consumption in the United States is 271 pounds per person and in Europe is 163 pounds per person. These values have been relatively stable over the last generation. However, in China the meat consumption has tripled to 119 pounds during the same interval and India is just beginning its ascent.16

Perhaps the most tragic contributor to food shortages is waste. SIWI (The Stockholm International Water Institute) estimates that more than half the world’s food is wasted. Specifically, they estimate that we harvest approximately 4,600 calories per person per day but consume only about 2,000.17 The stark reality is that although there are estimates that almost one billion people are starving, we are wasting food that would be sufficient to feed three billion.18 Eliminating waste alone could eradicate the food crisis.


Potential Solutions

Agriculture expenditures serve to illustrate the contrast between the haves and have nots. At the beginning of the twenty-first century, wealthy nations were barely spending 1.8 cents of every science dollar on agriculture research. China, India, and Brazil, which had been investing 12% of their science dollars on food research in the 1980s, reduced it to seven percent as other research priorities emerged.19 To put agricultural research priorities in perspective, at the start of the millennium total global expenditures on agricultural research totaled $23 billion compared to $1.5 trillion on armaments.20 Not only is greater funding for agricultural research the right ethical thing to do, it is the smart economic thing to do. It has been estimated that the ROI (Return on Investment) for agricultural research funding is 17:1 for every dollar spent.21

Americans have to accept responsibility for leadership to solve this problem while there is still time. It is sobering to acknowledge that although China leads in global-warming pollution, producing 28% of all carbon dioxide emissions, the United States places second, comprising four percent of the world’s population but producing 16% of global CO2 emissions. And the United States is number one, by far, in cumulative emissions over the past 150 years.22

Every species faces a moment of survival or extinction. Could the cruel irony facing our species be that our demise will not be an immediate, sudden extinction from nuclear weapons, the overarching fear of the last seven decades, but rather a slow, inexorable starvation from a preventable worldwide famine? One can reasonably argue that it is the third rider on the black horse—famine—that is the underpinning of the other horsemen of the apocalypse—pestilence, war, and death.

We possess the scientific knowledge to confront the arrival of the third horseman. Will we heed the admonition of Jimmy Carter that “hungry people are not peaceful people”?1 There are sixty armed conflicts where deaths have occurred in the past year.23 World Refugee Day estimated that in 2017 the number of refugees and people displaced by conflict and disorder worldwide reached a record high of 68.5 million.24 Finally, the United States Food and Agriculture Organization estimated that about 815 million people, over 10% of the world’s population, were suffering from chronic undernourishment.25 The image of the Four Horsemen could not be more compelling. The unanswered question is:  will humanity’s response be sufficient and timely?



  1. Carter J. First Step Toward Peace Is Eradicating Hunger. International Herald Tribune 6/17/99
  2. World Population by Year. http://www.worldometers.info/world-population/world-population-by-year/ accessed 9/4/18
  3. World Population. https://en.wikipedia.org/wiki/World_population accessed 9/4/18
  4. Benna UG and Corba SB, eds. Population Growth and Rapid Urbanization in the Developing World. Advances in Electronic Government, Information Service Reference(IBI Global), Hershey  Pa. 17033
  5. The End of Fossil Fuels .https://www.ecotricity.co.uk/our-green-energy/energy-independence/ the-end-of-fossil-fuels accessed 9/4/18
  6. Richter B. Beyond Smoke and Mirrors: Climate Change and Energy in the 21st Century. Cambridge University Press 2010 p.81
  7. Cribb j. The Coming Famine: The Global Food Crisis And What We Can Do About It. University of California Press 2010 p.61
  8. Intergovernmental Panel on Climate Change, Climate Change 2007: Synthesis Report. Summary for Policymakers, November 2007
  9. Climate Change: How do we know? NASA Global Climate Change, Vital Signs of the Planet. https://climate.nasa.gov/evidence/ accessed 9/4/18
  10. The 10 Hottest Global Years on Record. Climate Central. http://www.climatecentral.org/gallery/graphics/the-10-hottest-global-years-on -record accessed 9/11/18
  11. MacMillan A. Global Warming 101 p.5 https://www.nrdc.org/stories/global-warming-101? accessed 9/4/18
  12. The growth of megacities-Populationmatters. http://www.populationmatters.org/growth-megacities/ accessed 9/11/18
  13. Stoekel A. High Food Prices: Causes , Implications and Solutions. June 2008 http://rirdc.infoservices.com.au/downloads/08-100 pdf.
  14. Dow Jones Newswire “ Global Food Demand to Double by 2050, Research Key: Experts” October 16,2007
  15. Cribb J. op.cit. p.10
  16. These 2003 figures are derived from FAOSTAT, the searchable database of the Food and Agricultural Organization of the United Nations(FAO)
  17. Lundquist J, deFraitore C, and Molden D Saving Water: From Field to Fork-Curbing Losses and Wastage in the Food Chain Stockholm International Water Institute Policy Brief 2008, www,siwi.org/sa/node.asp?node=343
  18. Cribb J. op.cit. p.71
  19. Cribb j. op.cit. p.105
  20. Pardey PG, James J, Alston J. et al. Science , Technology and Skills, October 2007. www.apec.umn.edu/faculty/ppardey/publications.html
  21. Ratzer DA, executive summary of “Benefit-Cost Meta-Analysis of Investment in the International Agricultural Research Centers of the Consultative Group and Iternational Agricultural Research.
  22. MacMillan A, op.cit, p.6
  23. List of ongoing armed conflicts. https://en.wikipedia.org/wiki/List_of_ongoing_armed_conflict accessed 9/11/18
  24. World Refugee Day 2018: Number of Forcibly Displaced People Reaches Record High. https://www.actionagainsthunger.org/story/worl-refugee-day-2018-number-forcibly-displaced accessed 9/11/18
  25. 2018 World Hunger and Poverty Facts and Statistics https://www.worldhunger.org/world-hunger-andpoverty-facts-and-statistics/ accessed 9/11/18



KEVIN R. LOUGHLIN was born in New York City and grew up on Long Island. He graduated from Chaminade High School and received an A.B. from Princeton University. He received an M.D. from New York Medical College, an M.B.A. from Boston University and a M.A.(Hon.) from Harvard University.  He has served as a trustee of the American Board of Urology and as a member of the board of directors of the American Urologic Association and as program director of the Harvard Program in Urology. He has been named on numerous “best doctor” lists throughout his career and was the recipient of the Lifetime Achievement Award given by the New England Section of the AUA. He has written over 250 articles in medical journals and is the author/editor of 11 books. He is an avid Red Sox fan and enjoys participating in road races and swimming. He lives in Boston.


Summer 2018  |  Sections  |  Food

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