Food Security and Child Malnutrition

The Impact on Health, Growth, and Well-Being

Areej Hassan, Areej Hassan

• Publisher: Apple Academic Press
• Year: 2016
• ISBN:
  9781315341538
• Edition: 1
• Topic: Medicine
• Subtopic: Nutrition, Dietics & Bariatrics

Food security and child malnutrition are at the forefront of our attention, both nationally and internationally. The chapters contained in this compendium include a range of methodologies—literature review, cross-sectional study, longitudinal study, case-control, and even a focus group!—all of which examine this urgent issue, revealing new perspectives and facets of information. The international roster of contributors present a nuanced look at food security and child malnutrition with research into food security measures in many nations around the world.

The book is broken into several parts, covering

• defining food security
• food security, nutrition, and growth and development
• food security and mental and physical health
• food security and child obesity
• conclusion, with an information study from The Children's Healthwatch on household hardships, public programs, and their associations with the health and development of very young children

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The range of topics and information presented here will be valuable for those involved with food security advocacy, policymakers, researchers, social service professionals working children and families, and others.

PART I
Defining Food Security

CHAPTER 1
The Food Security Continuum: A Novel Tool for Understanding Food Insecurity as a Range of Experiences

Sheryl L. Hendriks

1.1 A COMPLEX PROBLEM

Food insecurity is a problem with multiple manifestations. Multiple contributing causes—social norms, individual behavior and stages in the human life cycle, food availability and quality—make it a problem requiring comprehensive approaches. The difficulty we face is in bringing convergence to our understanding of the varied experiences of human deprivation so as to improve our response to the problem.

The concept of “food security” first began to attract attention in the 1940s and is now widely used in designing, implementing and evaluating humanitarian emergency and development policies and programs. Today the universal definition of “food security”, accepted by the highest level of global governance on food security, the Committee on World Food Security (CFS), describes it as a situation where “all people, at all times, have physical and economic access to sufficient, safe and nutritious food to meet their dietary needs and food preferences for an active healthy life” (CFS 2012 as per the FAO 1996 definition).

© The Author(s) 2015 “The Food Security Continuum: A Novel Tool for Understanding Food Insecurity as a Range of Experiences,” Food Security, June 2015, Volume 7, Issue 3, pp 609-619. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/).

However, the usefulness of the concept is constrained by the plurality of ways of understanding the causes and consequences of food insecurity, and the effects of economic, social, political and environmental interventions. Further complicating the issue is the transdisciplinary nature of the food security research field: the experts from different traditional disciplines working together are giving us a more nuanced understanding of the concept but also potentially muddying the waters. Assorted discourses and paradigms compete for domination, leading to conflicts over terms and concepts (Lang and Barling 2012; Candel 2014). The terms “food security”, “nutrition security”, “food security and nutrition” and “food and nutrition security” are used interchangeably, and some scholars assert a hierarchy among these terms. The proliferation of terms initiated a discussion at the Committee on World Food Security annual meeting in 2012 (CFS 2012). The CFS input note on “coming to terms with terminology” (UNSCN 2012) sets out clearly the origins and development of the contentious terms. But despite a CFS resolution on the use of the terms (CFS 2012), they are still being used interchangeably. This does not make for clarity of understanding or effective policy and program development.

The question of how people experience deprivation continues to perplex us and hamper our efforts to monitor food insecurity situations (Headey and Ecker 2013). Much food security research has attempted to find causal explanations for how material and structural poverty lead to deprivation that manifests in multiple ways. The conclusions often reflect the background and orientation of the researchers. Our plurality of backgrounds (agronomy, economics, sociology, health, nutrition, among others) influences our understanding of what causes food insecurity and consequently of what we must do to deal with it.

The economic, social, environmental and political systems related to food are inextricably inter-connected: eliminating one cause of food insecurity may bring to light a more deeply rooted cause of which the original insecurity may have been a symptom. For example, we might give cash to a poor community to buy food, only to find that lack of cash was a symptom of another problem, such as a lack of local livelihood opportunities. The contributions of different disciplines are needed to deal with multi-layered problems such as this. But theoretical disagreements may distract from the problem. One such disagreement concerns the direction of causality: there is little consensus as to whether food insecurity is a consequence or a predictor of inadequate livelihoods and poor nutrition (Campbell 1991). Pangaribowo et al. (2013) offer a third argument: that food security is an aim in itself, not just a prerequisite for adequate nutrition. This paper argues that the debates lose direction when they fail to differentiate between the risk factors for food insecurity, food insecurity as a phenomenon in itself and the consequences of food insecurity. There seems to be no end to the overlaps and interactions between the categories. Failure to define the topic leads to confusion when it comes to policies and interventions and how to measure their impact.

How we understand and define food insecurity determines how we measure it (Hendriks and Drimie 2011; Coates 2013; Candel 2014). The measurement can take into account quantitative, qualitative, psychological and social or normative constructs of the experience of food insecurity, qualified by their “involuntariness and periodicity” (Campbell 1991, p 410). Competing approaches to food insecurity measurement have emerged over time and no generally accepted framework exists on which to base the measurement. Despite numerous attempts during the 1990s (see Hendriks 2005 and Headey and Ecker 2013 for reviews of these), measuring food insecurity still evades simplification. Each measure both captures and neglects phenomena intrinsic to the concept of food security, thereby subtly creating priorities among food security interventions (Barrett 2010).

Very few measurement systems are based on a full definition of food insecurity. Pinstrup-Andersen (2009: 137) says that if we interpret the FAO definition quoted above “to mean that the nutritional needs of each individual have to be met for the person to be food secure, the FAO estimate of 800 to 900 million under-nourished people would be a gross underestimate of the prevalence of food insecurity”. He notes also that “if the estimate of two billion iron deficient people is correct, that number would be the lower bound for the number of food insecure people in the world”. He argues that what is at issue is “whether the FAO definition of food security, that is now widely accepted, can be used to dis-aggregate the concept into different kinds of food insecurity depending on the nature and severity of the problem and the type of solution required”.

Understanding the problem of food insecurity is a cumulative process. The following two sections describe how our knowledge has developed incrementally in response to deepening theoretical discourse and also research findings about experiences, causes and consequences. The first of these two sections looks at our incremental theoretical understanding of the four dimensions of food security set out in the World Food Summit definition, availability, accessibility, utilization and stability (FAO 1996), and how these have influenced measurement and interventions. The second discusses how ongoing research has led to an incremental understanding of the experience of human deprivation and the relationships between hunger, under-nutrition, malnutrition and food insecurity. In the next section the author brings together the theoretical and human experience of food security and presents a new framework in which levels of food insecurity are visualized as a continuum. This novel tool combines elements of the triple burden into a single continuum of experiences across emergency and non-emergency as well as obesogenic contexts. The penultimate section discusses some advantages to the application of the continuum for understanding and dealing with food insecurity. The paper concludes by recommending that this diagnostic tool could help improve the accuracy of targeting of interventions, better follow-up and improved accountability for donor spending.

1.2 OUR INCREMENTAL UNDERSTANDING OF THE DIMENSIONS OF FOOD INSECURITY THAT INFLUENCE MEASUREMENT AND INTERVENTION DESIGN

Early conceptualization of food insecurity (prior to the 1980s) relied on a belief that inadequate food supply led to food insecurity. The solution was therefore to produce more food. Consequently, availability of sufficient food was monitored using food balance sheets, from which estimates of food available to meet per capita energy needs were derived (Webb et al. 2006; Pinstrup-Andersen 2009). The physiological consequences of food shortages were measured and monitored anthropometrically. During this period, food security interventions focused on food aid shipments to meet immediate needs and agricultural production strategies to increase food supplies in the long term. But despite increases in global and national food supply following the 1974 world food crisis, under-nutrition rates remained stubbornly high in many parts of the world (Barrett 2010).

The work of Sen in the 1980s led to a widespread awareness that access to food was as essential as having a positive national food stock balance. Sen advanced the understanding of food insecurity when he pointed out that people experience food deprivation because they have difficulty accessing it and not necessarily because it is not available in the marketplace. In his work on poverty Sen viewed food security as a household purchasing power issue affected by access to income and other resources (such as transfers and gifts), market integration, price policies and market conditions (Sen 1981). Food security measurement consequently shifted to identifying subjective experiences of hunger and “coping” strategies as determinants of food security. Consequently, during the 1990s, intervention focus shifted to poverty reduction, food price stabilization and social protection policies (Webb et al. 2006; Barrett 2010).

However, Renzaho and Mellor (2010) warn that it is misleading to measure food security through coping strategies without taking into account the social, cultural, and political contexts in which they occur and that to look at food insecurity solely from the perspective of availability or access to food, without taking into account the importance of how food is used, “paints an incomplete picture”. The term “utilization”—one of the four dimensions of food security in the FAO’s World Summit 1996 definition—reflects concerns about whether people make good use of the food to which they have access. The concept of utilization, i.e., nutrition, covers dietary quality, especially micronutrient deficiencies, food safety and the ability to absorb and metabolize essential nutrients (Barrett 2010).

It was during the 1990s that the emphasis fell on utilization as the key to attaining food security. Micronutrient deficiencies increase the risk of both chronic and infectious diseases, aggravate the effects of disease and lead to irreversible loss of cognitive and physical function, especially during a child’s first 1000 days (from conception to the age of two) (Barrett 2010). Increased awareness of the scale and impact of micronutrient deficiencies led to a new focus on “hidden hunger” and the importance of nutrition-focused interventions to break the cycles of poverty that perpetuate food insecurity. Mere availability of food—at national or household level—does not ensure access to an adequate diet for all citizens. Health and well-being depend on a diverse diet that provides adequate quantities of macro and micro nutrients. Issues of nutritional quality, food safety, access to safe drinking water and sanitation became important in the design of food security programs, with the health sector becoming a major partner in such programs. Nutrition-sensitive and nutrition-specific programs have grown in popularity since the turn of the century. They initially included micronutrient-focused interventions (fortification, supplementation and biofortification) and food-based interventions such as those that support household gardens. The necessity for nutrition-sensitive agricultural interventions became particularly apparent after the global food crisis of 2008/2009 (Frongillo 2013).

Measurement of food security related to utilization is based either on dietary quality (food consumption and dietary diversity) or biochemical analysis of the effects of food consumption. Both are relatively expensive. Moreover, nutrient requirements are individually determined and depend on, among other things, the sex and age of each individual. It is therefore difficult to generalize consumption and nutrition data across populations and the data cannot simply be aggregated at household or national levels as has been done with dietary energy intake in the past (Coates 2013). Such simplification ignores dietary quality. For example, stunting levels of young children can be aggregated at household level and across populations. However, nutrition is only measured at the individual level. Therefore, it cannot be said that a household is well nourished unless all members of the household meet all the criteria for sound nutrition specific to their age, weight, height, sex and level of activity. In the past, energy intake was simply used against referenced standards and thresholds established against standard deviations above or below the norm. Moreover, energy intake is only one requirement for sound nutrition.

These first three food security dimensions—availability, access and utilization—are hierarchical in nature: food availability is necessary but not ...

Table of contents

• Cover Page
• Half Title
• Title Page
• Copyright Page
• About the Editor
• Contents
• List of Contributors
• Acknowledgments and How to Cite
• Introduction
• Part I: Defining Food Security
• Part II: Food Security, Nutrition, and Growth and Development
• Part III: Food Security and Mental and Physical Health
• Part IV: Food Security and Child Obesity
• Part V: Conclusion
• Keywords
• Author Notes
• Index