Halving global poverty by 2015 is one of the UN's key goals
Billions of dollars will be wasted unless there is a radical overhaul of the system of giving aid, a report from a leading aid agency warns.
Care International says too much money is being spent on short-term fixes during emergencies, rather than on longer-term prevention work.
The number of people living "on the edge of emergency" has nearly doubled to 220 million in two years, Care says.
The report comes ahead of a high-level UN meeting on poverty goals next week.
Halving poverty and hunger around the world by 2015 are key objectives of the UN's Millennium Development Goals (MDG).
Care says a failure to resolve the underlying issues trapping people in extreme poverty has left millions now unable to cope with surging food prices.
In countless previous emergencies, aid has often arrived too late, was short-term, and policies were targeted too heavily on saving lives rather than building resilience in the population, the report says.
Vanessa Rubin, a hunger adviser for Care, told the BBC it was much more cost effective to support people who were on the brink of a disaster, rather than "fire-fighting when you have to manage an emergency response".
"If we take the example of Niger, in west Africa. In 2005, it was costing about $80 (£44) to save a malnourished child at the height of the crisis," she said.
"Months before that, at the point where children were vulnerable, the equivalent intervention would have been about $1 a day."
She said it was time to take stock, "admitting that business-as-usual hasn't worked, and agreeing to change mind-sets, and really change the way that everyone works".
"That's a big call for the agencies, for donor governments, for governments in the big countries where there are hungry people, and for the UN," she said.
The report, Living on the edge of emergency: Paying the price of inaction, urges donors to better co-ordinate their emergency aid and long-term development commitments.
It also calls for more focus on food production and support for the world's poor, as well as developing early warning systems for disasters.
Next week's meeting of the MDG is aimed at boosting international commitment to halve the number of people whose income is less than $1 (55p) a day by 2015.
The Care report comes a day after the head of the UN's food agency, Jacques Diouf, said the number of people suffering from acute hunger rose by 75 million to an estimated 925 million last year.