Famine, like poverty, has always been with us. No region and no century has been immune. Its scars — economic, psychological and political — can long outlast its immediate impact on mortality and health. Famines are a hallmark of economic backwardness, and were thus more likely to occur in the pre-industrialized past. Yet the twentieth century suffered some of the most devastating ever recorded. That century also saw shifts in both the causes and symptoms of famine. This new century's famines have been ‘small’ by historical standards, and the threat of major ones seemingly confined to ever-smaller pockets of the globe. Are these shifts a sign of hope for the future?