Cormac O Grada surveys five millennia of famine history, synthesizing research on causes, consequences, and responses to food crises that have killed hundreds of millions of people. O Grada, an economic historian, examines how famines emerge from combinations of natural disaster, political failure, and market dysfunction. He traces how food systems' vulnerability has shifted over centuries, from purely local subsistence crises to famines triggered by global market disruptions or deliberate policy choices. The book analyzes famines' demographic effects: how mortality patterns differ by age and sex, how populations recover, and what long-term consequences survivors carry. O Grada examines the political economy of famine relief, showing how responses have ranged from effective intervention to deliberate neglect or even weaponization of hunger. He challenges simple narratives that blame nature or overpopulation, showing that most modern famines result from human choices and could be prevented. The book examines how economic development has reduced famine risk in much of the world while political conflict continues generating food crises in vulnerable regions. O Grada provides essential context for understanding contemporary food security challenges and the conditions under which famine remains possible in an era of unprecedented agricultural productivity.