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Food availability decline and Sen's entitlement are two leading approaches in understanding causes of famine. Previous research based on case studies has given independent support to each approach. This paper analyses the Chinese famine of 1959–61 by considering jointly the urban bias and the decline in food availability as causes. We find that both factors contributed significantly to the increase in death rates during this famine. To our knowledge, this paper is the first econometric study to assess the importance of famine causes using the entitlement approach.