Food and Security is a Global Health Issue

Introduction

The role of a medical anthropologist is to understand health, illness, and healing in a range of human societies to gain incite into an effective approach to improving global health for all peoples. A global health issue encompasses health problems that transcend national boundaries, and more often than not, the prominent issues are ones that are publically recognized epidemics and infectious diseases. Yet, global health encompasses more than just mortality and biological abnormalities; global health also pertains to issues that indirectly effect health and wellbeing. An anthropologist’s major role in global health is to go deeper into the unknown aspects of health to unravel a better strategy or a new approach to improving global health. Food insecurity is not commonly referenced with global health, but extensive research is uncovering comparable trends that point to a probable correlation between global health and food insecurity. Food insecurity is the lack of “physical and economic access to sufficient, safe, and nutritious food that meets dietary needs and food preferences for an active and healthy life” (Hadley & Crooks). The role of medical anthropologists in this study is to understand the complex causes and consequences associated with the availability, access, utilization, and stability of food. In the American Journal of Physical Anthropology, Craig Hadley from the department of anthropology at Emory University and Deborah Crooks from the department of anthropology at the University of Kentucky collaborated to compile research on food insecurity and its effects on global health. In Coping and the Biosocial Consequences of Food Insecurity in the 21^st Century, Hadley and Crooks investigate the mechanism of coping as the mediator to linking food insecurity with health and wellbeing. This article speculates the hypothesis that the change in behavior due to the decline in access to food is related to global health problems, such as nutritional status, chronic diseases, and mental health.

Historical Context

In order to tackle the potential relationships at play, the first task of a medical anthropologist in global health intervention is to understand the development of a problem by looking at its historical context. Anthropologists linked the global food crisis with the global economic crisis and a number of other probable causes that increased the fluctuation of food prices. In Global Health Watch 3, the report mentioned the impact of biofuels in reducing the quantity of food production, and it also mentioned the neglect of agriculture investment, which led to a decrease in cultivation, thus a decrease in the availability of food. Although the population was rising, anthropologist did not believe the supply and demand of food had changed, but that food was being redirected and distributed unevenly. The report also mentioned the unpredictable change in climate that was considered an additional factor in changing the amount of harvest. Likewise, the article by Hadley and Crooks similarly explored a number of plausible factors that contributed to the global increase in hunger, such as demographic shifts, depreciation of economy, uneven trade, etc. Hadley, Crooks, and anthropologists from Global Health Watch 3, contributed to the list of factors that influenced food security but their views were distinctively different. Anthropologists from Global Health Watch 3 separated the topic of the global food crisis from health systems by distinguishing the food crisis in a separate section titled “Beyond Health Care.” This indicates the distinction that the global food crisis is a separate entity from health problems. But as new information surfaced, Hadley and Crooks were able to contrast the former understanding of food insecurity. The purpose of the article is to analyze current research to evaluate whether the global food crisis is intertwined with global health problem. Food security is a highly dynamic condition; therefore, coping is a response to compensate the change in inaccessibility of food and resources. This change in behavior mediates the probable relationships between food insecurity and health.

Nutritional Status

One health problem that is speculated to relate to insufficient amounts of food is the state of a person’s health in terms of nutrients in diet. The coping behavior affiliated with the nutritional status of a household is the change in diet. Anthropologists believe that the burden of food insecurity would cause households to consume an insufficient amount of food and have “undernutrition,” a term used in the article to describe an inadequate level of nutrition compared to the norm. This hypothesis was applied to various societies to determine the validity of the claim. Many of the studies showed that low income countries confirmed the relationship between underweight and food insecurity. An example that supports the hypothesis is presented in the Argentina study. “In food secure households, ~19% of children were stunted, compared with 25% in moderately insecure households and 33% in households with hunger” (Hadley & Crooks). As food insecurity increased, the percentage of children stunted also increased; the number of children found underweight due to insufficient amounts of food is apparent in the data. Although all the reported studies did not present the same confirming results, error was taken into account, and the overarching conclusion was that there was enough positive backing to support the claim that a relationship between undernutrion and food insecurity existed among low-income households. In contrast, a reverse hypothesis was also formulated. Anthropologists considered that a relationship between food insecurity and overweight/obesity could exist because food insecure households could compromise healthy more expensive choices for cheaper unhealthy choices. However, the overweight and obese research contained mostly inconsistent results and presented only a few cases in which middle to high-income households presented overnutrition due to food insecurity. The trend showed that higher income countries showed more variability in data, therefore, invalidating the predicted relationship between food insecurity and overweight/obese individuals. These results were predicted to be due to the fact that low-income households altered their quantity to cut costs, while middle to high income households altered their quality of food to consume cheaper, energy dense foods. It is significant to acknowledge the trend and relationship that the compilation of this article presents because the impact that food insecurity makes on the nutritional status of individuals represents the high probability that severe cases would hinder growth and development and result in malnutrition. And if food insecurity and obesity develop a stronger correlation, the nutritional statuses of obese individuals result in various risks like diabetes and cancers, such as the heart and liver. Because anthropologists found a possibility that food insecurity could lead to detrimental health effects and possibly chronic diseases, research was extended further into the possible relationship between food insecurity and chronic diseases.

Chronic Diseases

The article also dissects diabetes and HIV to discover if a significant correlation exists between chronic diseases and food insecurity. The coping behavior related to chronic diseases and food insecurity is compromising treatment of illnesses. Individuals are unable to improve their health because of food insecurity restraints. The results from multiple studies showed that “when more severe measures of food insecurity were used, the relationship between household food insecurity and diabetes became statistically significant” (Hadley & Crooks). This showed that more diabetics were found to be food insecure; this relationship complicated the treatment of the disease because food insecure diabetics would have difficulty adhering to the necessary food requirements to maintain blood sugar levels. Because food insecurity is often driven by poverty, low-income socioeconomic status, financial burden is also a significant factor in revealing a relationship between food insecurity and illnesses. The financial stress is mentioned in WHO’s World Health Statistics Report 2012. “Based on data covering 90% of the world’s population, an estimated 100 million people are pushed under the poverty line each year simply because they use health services for which they are forced to pay out of their own pockets.” This shows that some individuals would have to choose food above medical treatment because financial resources limit the possibility of attaining both. There is an apparent relationship among diabetes and food insecurity; therefore, this raises the question of whether diabetics become food insecure due to burdensome medical expenses, or food insecure individuals develop diabetes because of poor food accessibility. Both speculations lead to the same result, the health of diabetics who are food insecure does not improve. The same correlation was found in the HIV study. The issue of high medical costs also pertains to the HIV study. The medical expenses used for treatment of HIV could theoretically be used to attain food security. Since one had to be compromised, there was a significant relationship between HIV individuals who were found to also be food insecure. In sub-Saharan Africa, individuals would decline the antiretroviral therapy (ART), which would suppress the virus and reduce the progression of HIV, because of the burden of food insecurity. “A surprising obstacle to ART initiation for 76% of patients was fear of developing too much appetite on ART but not having enough to eat” (Hadley & Crooks). This lack of resources hindered the treatment of a chronic disease. This case shows that food insecurity was the determining factor for refusing to improve a life threatening disease. “Food insecure participants of ART were 50% more likely to die compared to food secure” (Hadley & Crooks). This data shows that the condition of food insecurity was as important, if not more, than the treatment of HIV. This research is significant because food insecurity is under the radar compared to the urgency of treating HIV, efforts to improve the food crisis is somewhat neglected. But as the study shows, without also addressing the food insecurity problem, other chronic diseases cannot be effectively treated. Therefore, the priority of global health interventions needs to be reevaluated to incorporate the equal dispersion of food. As a result, this would improve the treatment of other global health problems.

Mental Health

The last health problem analyzed in relation to food insecurity was mental illnesses. Because food has an important biological and social value, the lack of sufficient food would cause stress, and stress was speculated to cause the onset of mood disorders, such depression and anxiety (Hadley and Crooks). The research conducted presented confirming results in all cases that food insecurity associated with nearly three times greater odds of symptoms of anxiety and depression. Mental health disorders were associated with food insecurity in adults and behavioral disorders were associated with food insecure in children. In Global Health Watch 3, the section entitled “mental health” mentioned the same complimentary results like the article. “Financial insecurity, related to lower income, can promote feelings of hopelessness and shame, which increases stress. In Tanzania, a study found that food insecurity and changes in food insecurity across seasons were strong predictors of symptoms of anxiety and depression. In Ethiopia, it was found that stressful life events in addition to food insecurity increased susceptibility to mental disorders” (Global Health Watch 3). This information also supports the relationship between the lack of food and mental health. Another speculation in the research of mental health deals with the same concerns referenced in the chronic diseases study. Which direction is the reaction occurring? An individual may develop food insecurity because his mental illness limits his capacity to sustain security, or food insecurity may onset feelings of anxiety and depression and cause the individual to become mentally ill. The complexities surrounding this subject have to do with interpreting whether food insecurity seems to cause adverse health or whether adverse health causes individuals to become inadequate in attaining sufficient amounts of food. Although the answer is unclear the same conclusion is still reached; the global food crisis must be addressed as a priority.

Research

The research presented in the article ranged from different models and various questionnaires that sometimes varied the reliability of comparing multiple cases. The difficulties accompanying the study dealt with the specifics of defining and measuring the variable “security.” The error in the inconsistency of data was postulated to be the result of the variation by culture and society or caused by the method used to extract information from a sample of people. There is no clear objective tool to measure the food insecurity. In terms of chronic illnesses like diabetes, the researchers who conducted the study stated that individuals would self diagnose or under diagnose and skew the results. Therefore, anthropologists played a crucial role in constructing, validating, and adapting scales to maximize the accuracy of data (Hadley & Crooks). Nevertheless, the shift in “medicalizing” food insecurity is accompanied by error. This is similar to the concepts discussed in class involving the medicalization of conditions like ADHD, anorexia, and evil eye. Opposition in globally recognizing a state or condition is difficult because cultures disagree with the legitimacy and diagnosis of conditions. There is a lot of room for variation and error. However, if a problem such as food insecurity is widespread, the persistence of the condition, along with the possible correlations involved with it, indicates its significance.

Conclusion

Food insecurity has been a global concern and a serious issue, yet its adverse effects have only recently been speculated to concern health. Its relationships are still a very new concept. After seeing the anthropological perspective on food insecurity, questions concerning “why” are addressed. It sheds light into the understanding of why individuals would refuse treatment of life threatening diseases, or why a large population of diabetics is found to also be food insecure. Conceptually, the anthropological perspective is a view that is uncommon, but foresees new solutions. However, the plethora of research accumulated in this article did not completely confirm speculated associations between food insecurity and global health problems; conclusions were unclear. “While anthropologists are trained to find patterns, we are also trained to recognize the disjunctures and contradictions that are part and parcel of everyday experience” (Hadley & Crooks). It may seem frustrating that opposition in every speculated relationship concludes in ambiguity and no closure, but the ultimate goal of an anthropologist is not to find a solution, but the emphasis is on understanding the problem in order to find a solution. The practical perspective determined from the anthropological perspective would be to prioritize food insecurity in global health efforts. The speculated relationships clearly showed that food insecurity encompasses aspects of health that are critical and cannot be effectively treated if food insecurity is neglected.

By Stella Whang

Craig Hadley1,*, Deborah L. Crooks2
Article first published online: 25 OCT 2012

DOI: 10.1002/ajpa.22161

Global Health Watch 3: An Alternative World Health Report. London: Zed, 2011. Print.

World Health Organization. World Health Statistics 2012. N.p.: World Health

Organization, 2012. Print.