Food Insecurity


Overview


Food insecurity is a complex, multidimensional problem with a wide variety of definitions and dimensions. Even 20 years ago, there were as many as 200 definitions in various published sources . One early definition of food insecurity captures the complexity of the concept, highlighting issues of access, availability, and acceptability:

food insecurity exists whenever the availability of nutritionally adequate and safe foods or the ability to acquire acceptable foods in socially acceptable ways is limited or uncertain.[1]
FSModel3.png Anderson’s definition also touches on the issues of food safety as well as nutritional adequacy (rather than consuming simply enough calories to survive). Later definitions tease out differences between adequate quantity and quality of foods, as well as emphasize the stability of access to and availability of food or the means to acquire it.

Four major domains of food insecurity (that is, the lack of food security) are 1) availability, 2) access, 3) utilization, and 4) stability over time[2] . As depicted in the figure to the right, it is important to understand that these domains are not isolated; the domains interact and impact each other. For example, food cannot be accessed unless it is available, and food cannot be utilized unless one first has access to it. Insufficient utilization of food can lead to poor health, which may in turn decrease ability to work; this can decrease in ability to work can in turn decrease access to and availability of food.

Food insecurity can lead to malnutrition, which often renders people vulnerable to infectious disease (called the malnutrition-infection complex), leads to alternations of growth and human development[3] , and can even impairment cognition[4] [5] . Food insecurity has also been linked to mental and emotional distress[6] .

Health Impacts: Case Studies


FSModel2.png
Humans must, of course, eat to live—there are biological requirements that must be met in order for us to function. But what humans choose to eat is highly structured by our physical, social, and cultural environments. It is because of this fact that definitions of food insecurity needs to identify more than the physical implications of insufficient quantities of food, such as hunger or malnutrition. Instead, this definition recognizes that mere quantity of food is not enough—food must be of a certain quality or variety to satisfy biological as well as social, cultural, or even psychological needs. As a result, the impact of food insecurity not only physical; there are mental or psychological impacts of a lack of access to food. Worry and anxiety frequently accompanies such experiences; in addition, stigma can arise from acquiring foods in non-socially acceptable ways. These might include begging, stealing, or engaging in sexual transactions to gain access to food, but vary widely, depending on context. [7]

To better illustrate the impact of food insecurity, here are some examples in each of the overarching domains:

Availability: Impact of Global Food Crisis

From about mid-2006 until late 2008, the price of food staples such as rice and wheat rose an average of more than 60%, resulting in increased rates of hunger and instability in a number of countries around the world[8] [9] [10] [11] . The prices of agricultural goods rose sharply in 2007 and 2008; world prices of wheat and maize trebled between 2003 and 2008, and the price of rice was five times higher during the same period[12] . World Food Program reported that the number of undernourished people in the world increased to 963 million people, an increase of about 75 million in 2007 and 40 million in 2008; this increase was largely attributed to the dramatic increase in staple food prices[13] [14] . Alarmingly, the World Food Program estimated that the increases in hunger and food insecurity could reverse roughly seven years of progress on Millennium Development Goals[15] . The Millennium Development Goals are a set of eight international development goals that include the eradication of extreme poverty and hunger, achievement of universal primary education, promotion of gender equality, reduction of child mortality, improvements in maternal health, combating HIV/AIDS, malaria and other diseases, as well as other goals. All UN member states as well as other international organizations goals have agreed to reach these by the year 2015[16] .


Access: Food Everywhere, But No One Can Eat?

According to the Global Hunger Index, among Latin American countries, Haiti has been described as an “outlier” in terms of food insecurity, and maintains a “high hunger index”[17] . The Pan American Health Organization[18] listed the prevalence of malnutrition in 1995 as 67.3%, with malnutrition ranking eighth among causes of general mortality. The Food and Agriculture Organization (FAO) of the United Nations report on the state of food insecurity in the world groups Haiti along with 18 other countries with the “highest prevalence and greatest depth of hunger”, indicating that the prevalence of food insecurity in Haiti is estimated to be nearly 62%, or 4.8 million people[19] . On average, Haitians have suffered caloric deficits of nearly 500 calories a day; to say nothing of the quality of the food they consume[20] .

At the height of the global food crisis discussed above, Haiti was already in the midst of a humanitarian disaster; a series of hurricanes and tropical storms (4 in all) had hit Haiti over the course of one month, and much of the country lay in ruin. A United Nations relief chief called the situation the “worst disaster in the last 100 years” [21] .

Riots in Les Cayes and other areas in Haiti illustrated a key food insecurity domain; as people targeted storehouses of aid agencies to acquire food, it became clear that the availability of food was not an issue, though access to it was. News and aid agencies reported that food was available in markets and in storage, but the majority of Haitians could not afford to purchase adequate food to meet their individual or household needs[22] .

Spiraling Food Prices Buffet Poverty-Stricken Haiti



Utilization: When "Enough" Isn't Enough: HIV and Food Insecurity

The malnutrition-infection complex refers to the synergistic relationship between malnutrition and infectious disease. When individuals do not have adequate access to food, it compromises their immune function, making them more susceptible to infectious diseases such as HIV[23] . Further, malnutrition hastens the progression of HIV disease for those who are already HIV-positive, and negatively impacts health and survival rates[24] [25] . HIV has been shown to have detrimental effects on nutritional status through reduced absorption of nutrients in the intestinal tract and insufficient food intake[26] [27] [28] [29] [30] [31] .

Kalofonos[32] discusses the paradox of treating people for an infectious disease like HIV while essentially ignoring other issues like malnutrition and food insecurity. As the author notes, though "hunger is the principal complaint of people on antiretroviral (ARV) treatment" (p. 363), it is a hunger that is magnified by ARV treatment and demonstrates more than an empty belly. The following quotes, according to the author, were typical of conversations among people with HIV:

“Do you know what it is for your organism to be asking for food? It wakes me in the middle of the night, and I have to eat!”
“This treatment really causes hunger!”
“Don’t you know why? The body needs food in order to recover. The organism demands it!”
“What can I do? I have nothing to eat. All I eat is ARVs!”
(p. 363)

While Kalofonos notes that the hunger described by his research participants demonstrates more than just a hunger of the body, it is important to recognize that biological hunger is a likely reality. Even if HIV-positive individuals maintained their usual (hopefully adequate) diets, it might not be enough; individuals infected with HIV have special nutritional needs, such as increased energy requirements, regardless of whether or not they are actually taking ARVs[33] . When the food people have is not enough to satisfy the increasing demands of their bodies and ARV treatment, decisions must be made. In Lesotho, one participant discussed her struggle to remain in treatment when the food she ate was simply not enough[34] :

It is not a good thing to have the same food all the time, every day. And that is also not healthy because I am not the way I look now, I was not as thin as I look now. But because I take the ARVs without having eaten anything that makes my body more weaker every day because sometimes it happens that I eat only once a day yet having to take the ARVs three times a day. It is almost as if there is some sort of parasite or a living thing that is in my body that is taking everything that I put into it. I cannot give this drug what it needs and I am getting thinner with each day. This is my everyday life and it does not change (p. 85)
Because the synergistic relationship between infectious disease and malnutrition has the potential to initiate a downward spiral during which the ability to provide sufficient food for individuals and households is deteriorated, any program that hopes to address food insecurity need also consider the prevalence of infectious disease. This situation has been likened to that of filling a bucket with water when there is a hole in the bottom; supporting food security is insufficient when nutrients can be lost during bouts of infectious disease.

The following videos from Partners in Health shows the treatment of young, orphan baby girl suffering from malnutrition, TB and HIV. The video shows medical procedures such as the insertion of an N-G (Nasogastric) tube, and still images include attempts to insert a central line and intraosseous line. Viewer discretion is advised.

Lesotho: Pediatric emergency, part 1 (Slide show of still photos)


Lesotho: Pediatric emergency, part 2 (Video)


Elderly Food Insecurity in the United States


In 2010, 7.9% of food insecure households in the United States contained an elderly member and 8% of food insecure households were composed of only an elderly person.[35] The elderly represent a population in need of special consideration for food security measurement because of their vulnerability to health problems, economic constraints, and social considerations:

The existing measures for food insecurity in the United States may not properly measure the experiences of the elderly. The variables used in the U.S. Household Food Security Survey Module (FSSM), the tool used to measure food security in the nationally representative Current Population Survey (CPS), is effective for measuring the subjective experience of not be able to acquire enough food in culturally acceptable ways to maintain health but not issues that affect primarily elderly populations, such as maintaining health by eating certain foods perceived as “healthy.”[36] The survey also does not capture elderly individuals who may have the economic means to buy food but cannot physically shop alone or prepare food alone because of functional limitations. Wolfe, Frongillo & Valois (2003) call for the inclusion of variables that measure concerns over eating for health, and not being physically capable of preparing food into the FSSM in order to capture experiences specific to the elderly.[37]

Nutritional deficits, poor quality of life and self reported health status, mental health issues, cognitive impairments, and exacerbation of already existing health conditions are some of the negative health outcomes related to food insecurity in the elderly. [38] None of the research on elder food insecurity focuses on specific health consequences, the majority of research focuses on the mechanisms by which health and food security interplay in late life.

Elderly economic constraints facilitate negotiations between buying food, medications, and heating and cooling use. [39] Sara A. Quandt, an applied medical anthropologist, works on elder food issues in the United States. Her research identifies the number of prescriptions a rural elder is taking, dietary habits, and poverty as strong predictors for food insecurity among a sample of elderly living in Appalachia.[40] The research is situated in the historical and lived contexts of rural Appalachian participants, highlighting lived experience as an important mechanism in food security production.

Research on elder use of assistance programs report an underutilization of services by the population due to concerns of stigma attached to receiving aid, lack of perceived need of aid, transportation restraints, and physical limitations.[41] How to encourage food aid assistance among the elderly is a current public health problem.


Online Resources



Food Security and the Rural Female Farmer from Reel Story Films on Vimeo.

"Food Security and the Rural Female Farmer" is a documentary short that highlights the day-to-day issues and systemic challenges faced by rural female famers in Chile. The film initially premiered in October in Washington DC at the 2009 IICA-OAS Food Security Conference


Christine Olsen discusses Hunger and Food Insecurity in the U.S. [link]


Food 'Insecurity' for 15-percent of Americans




Further Reading


  • The Food and Agriculture Organization of the United Nations (FAO) Report The State of Food Insecurity in the World. Find graphics, reports, and data about global food insecurity at http://www.fao.org/publications/sofi/en/
  • Food and Agriculture Organization of the United Nations (FAO). (2003). Measurement and Assessment of Food Deprivation and Undernutrition. International Scientific Symposium Rome, 26-28 June 2002. http://www.fao.org/docrep/005/Y4249E/y4249e00.htm#Contents
  • Frankenberger, T.R., Frankel, L., Ross, S., Burke, M., Cardenas, C., Clark, D., Goddard, A., Henry K., Middleberg, M., O 'Brien, D., Perez, C., Robinson, R. & Zielinski, J. (1997). Household Livelihood Security: A Unifying Conceptual Framework for CARE Programs. In Proceedings of the USAID workshop on performance measurement for food security, December 11 -12, 1995, Arlington, VA. Washington, DC, United States Agency for International Development.
  • Pérez-Escamilla, Rafael and Segall-Corrêa, Ana Maria (2008). Food Insecurity Measurement and Indicators. Revista de Nutrição [online] 21(suppl.):15s-26s. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1415-52732008000700003&lng=en&nrm=iso
  • UNICEF (1990) Strategy for Improved Nutrition of Children and Women in Developing Countries, Policy Review paper E/ICEF/1990/1.6, UNICEF, New York.


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References


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