Food Insecurity and Public Health

Louise Ivers

• Publisher: CRC Press
• Year: 2015
• Print ISBN: 9781032098661
• eBook ISBN: 9781498760270
• Edition: 1
• Topic: Médecine
• Subtopic: Nutrition, diététique et bariatrie

Affecting more than 800 million people, food insecurity is a global problem that runs deeper than hunger and undernutrition. In addition to the obvious impact on physical well-being, food insecurity can result in risky coping strategies, increased expenditures on medical costs or transportation, and mental health issues. A review of the concepts an

Chapter 1

Food Security and Program Integration

An Overview

Tony Castleman and Gilles Bergeron

The quest for food security can be the common thread that links the different challenges we face and helps build a sustainable future.

José Graziano da Silva

United Nations Food and Agriculture Organization (FAO) Director-General

Introduction

As the quotation above suggests, food security is increasingly recognized as integral not only to reducing hunger and malnutrition but also to broader development goals. Public health programs and policies often consider underlying social, economic, and environmental factors that influence health, and in many contexts, food security emerges as a prominent factor. Direct effects of food security on health occur through nutritional status, itself a critical component of an individual’s health. For example, child malnutrition is a significant source of child mortality (Black et al. 2013). But in addition to this direct effect, food security also affects health through constraints to accessing health care, expenditure decisions, mental health, and other pathways described in further detail in Chapter 2.

Given the relationship between food security and health, understanding the different dimensions of food security and the program approaches used to reduce food insecurity can inform and enhance the design and implementation of public health programs. Varying degrees of integration between food security and health services are called for in different contexts. Programs aimed at improving food security often use different structures, partners, and implementation approaches than public health programs do, and understanding these differences can assist in the planning of when, and how, to integrate food security and health services.

This chapter provides an overview of the concept of food security, related concepts, threats to food security, programmatic approaches, and options and considerations for integrated programming. The overview presented here sets the stage for the remaining chapters of the book, which examine specific aspects of food security and its relationship to health in greater depth.

Dimensions of Food Security

There are several definitions of food security to be found in the literature. This is because the concept has evolved over time and because different agencies emphasize different aspects of food security. One widely used definition is the United Nations (UN) definition that was developed at the 1996 United Nations World Food Summit:

When all people, at all times, have physical, social and economic access to sufficient, safe and nutritious food which meets their dietary needs and food preferences for an active and healthy life (Food and Agriculture Organization 1996).

There are four dimensions of food security: food availability, food access, food utilization, and stability. These four dimensions are widely used in programs, policies, and research. (Previously, USAID [United States Agency for International Development] did not include stability in its food security framework, but it has now been incorporated into the framework for Feed the Future, the U.S. Government’s Global Hunger and Food Security Initiative [Feed the Future 2013].) The definition of each dimension is presented in Figure 1.1. The dimensions can be seen as sequentially conditional on each other, with availability necessary but not sufficient to access, and access necessary but not sufficient to utilization. As Pinstup-Andersen (2009, p. 5) puts it, “…availability does not assure access, and enough calories do not assure a healthy and nutritional diet.”

Figure 1.1

Dimensions of food security.

Note that both the UN and USAID definitions of food security focus on access to food, though both the UN and USAID conceptions of food security include multiple dimensions of food security, only one of which is access. The term “food security” is sometimes used colloquially to refer to access to food. For example, health service providers may refer to their clients’ food security constraints, meaning poor household access to food. In other contexts, the term “food security” is used to encompass aspects that are broader than the four dimensions presented above. For example, Feed the Future states that “a family is considered food-secure when its members do not live in hunger or fear of hunger” (Feed the Future 2013, p. 5). This notion of food security includes anxiety and uncertainty about access to food.

Figure 1.1 is a diagram of the four dimensions and the interactions among them. Horizontal arrows represent the relationship described above, in which availability is necessary for access, and access for utilization. Arrows from stability to the other dimensions signify that the stability dimension means the stability of the other three dimensions. That is, while availability, access, and utilization refer to food availability, food access, and food utilization, stability refers to the stability of food availability, food access, and food utilization. Although the FAO description of stability points out that it can refer to both availability and access, the thick vertical arrow signifies that in programmatic contexts, stability often refers to stable access to food.

Figure 1.1 is a highly stylized, simple diagram of the relationship between the dimensions. Figure 1.2 offers a more detailed conceptual framework that was developed as part of the recent Food Aid and Food Security Assessment of USAID food aid programs. This framework depicts the sources and determinants of three dimensions of food security (not including stability), the pathways by which these factors influence the different dimensions of food security, and the pathways by which these dimensions influence each other.

Figure 1.2

Relationships among the dimensions of food security. (Adapted from van Haeften, R., M. A. Anderson, H. Caudi...

Table of contents

• Foreword
• Preface
• Editor
• Contributors
• Chapter 1 - Food Security and Program Integration: An Overview
• Chapter 2 - Food Insecurity and Health: A Conceptual Framework
• Chapter 3 - Food Insecurity Measurement
• Chapter 4 - Nutrition, Food Security, Social Protection, and Health Systems Strengthening for Ending AIDS
• Chapter 5 - Food Insecurity and Tuberculosis
• Chapter 6 - Food Insecurity and Noncommunicable Diseases among the Poorest
• Chapter 7 - Food Insecurity: Special Considerations for Women’s Health
• Chapter 8 - Understanding Food Insecurity in Navajo Nation through the Community Lens
• Chapter 9 - Overview of the Cost of Hunger in Africa—Executive Summary: Social and Economic Impact of Child Undernutrition in Egypt, Ethiopia, Swaziland, and Uganda
• Chapter 10 - Integrating Nutrition Support for Food-Insecure Patients and Their Dependents into an HIV Care and Treatment Program in Western Kenya