scholarly journals Doctors have an ethical obligation to ask patients about food insecurity: what is stopping us?

2021 ◽  
pp. medethics-2021-107409
Author(s):  
Jessica Kate Knight ◽  
Zoe Fritz
Keyword(s):  
Food Security ◽  
Food Insecurity ◽  
Health Behaviours ◽  
Structural Constraints ◽  
Dietary Interventions ◽  
Individual Level ◽  
Ethical Implications ◽  
Policy Interventions ◽  
Effective Interventions ◽  
Effective Policy

Inadequate diet is the leading risk factor for morbidity and mortality worldwide. However, approaches to identifying inadequate diets in clinical practice remain inconsistent, and dietary interventions (on both individual and public health policy levels) frequently focus on facilitating ‘healthy choices’, with limited emphasis on structural constraints. We examine the ethical implications of introducing a routine question in the medical history about ability to access food. Not collecting data on food security means that clinicians are unable to identify people who may benefit from support on an individual level, unable to consider relevant dietary risk factors for disease and disease progression and unable to monitor population trends and inequalities in dietary access in order to design effective policy interventions. We argue that the current lack of routine screening for food insecurity is inconsistent with our approach to other health behaviours (eg, smoking and alcohol use), as well as with doctors’ frequent informal role as gatekeepers to the food aid system, and recent calls for governmental action on food insecurity and health inequalities from individual clinicians and professional bodies. Potential ethical barriers to asking patients about food security are addressed, including concerns about stigma, limiting autonomy, fair resource allocation, unclear professional remits and clinicians’ ability to offer effective interventions. We suggest that there is an ethical imperative for doctors to ask patients about their ability to access healthy food. Gathering this data provides a valuable first step in re-framing the social determinants of health as modifiable risks, rather than inevitable inequities.

scholarly journals A qualitative inquiry of food insecurity in Belize

2021 ◽  
pp. 1-27
Author(s):  
Laurel Dolin Stevenson ◽  
Melissa M. Reznar ◽  
Elizabeth Onye ◽  
Lynna Bendali Amor ◽  
Andre Joel Lopez ◽  
...  
Keyword(s):  
Food Security ◽  
Food Insecurity ◽  
Food Access ◽  
Qualitative Inquiry ◽  
Food Sources ◽  
Family Composition ◽  
Middle Income ◽  
Individual Level ◽  
Education And Employment ◽  
Cayo District

Abstract Objective: To explore and provide contextual meaning around issues surrounding food insecurity, namely, factors influencing food access, as one domain of food security. Design: A community-based, qualitative inquiry using semi-structured face-to-face interviews was conducted as part of a larger sequential mixed-methods study. Setting: Cayo District, Belize, May 2019-August 2019. Participants: Thirty English-speaking individuals (8 males, 22 females) between the ages of 18-70, with varying family composition residing within the Cayo District. Results: Participants describe a complex interconnectedness between family- and individual-level barriers to food access. Specifically, family composition, income, education, and employment influence individuals’ ability to afford and access food for themselves or their families. Participants also cite challenges with transportation and distance to food sources and educational opportunities as barriers to accessing food. Conclusion: These findings provide insight around food security and food access barriers in a middle-income country and provide avenues for further study and potential interventions. Increased and sustained investment in primary and secondary education, including programs to support enrollment, should be a priority to decreasing food insecurity. Attention to building public infrastructure may also ease burdens around accessing foods.

scholarly journals Food insecurity and mental health of women during COVID-19: Evidence from a developing country

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0255392
Author(s):  
Tabassum Rahman ◽  
M. D. Golam Hasnain ◽  
Asad Islam
Keyword(s):  
Mental Health ◽  
Food Security ◽  
Food Insecurity ◽  
Stress Level ◽  
Rural Areas ◽  
Poor Mental Health ◽  
Resource Poor Setting ◽  
P Value ◽  
Individual Level ◽  
Food Security Status

Background This study examines the association between food insecurity and mental health of women during the COVID-19 pandemic in a resource poor setting. Materials and methods Data were collected at two time-points (wave 1 and 2) from 2402 women, one per household, participating in a larger study during extended COVID-19 lockdown in the rural areas of the southwest region of Bangladesh. The primary outcome of the analyses is the association between food insecurity, measured using the Food Insecurity Experience Scale (FIES), and stress level, measured using the Perceived Stress Scale (PSS), for women during the lockdown. General awareness about COVID-19 and attitude towards prescribed preventive measures were also measured since COVID-19 health concerns could exacerbate food insecurity. Results An individual-level evaluation of the effect of wave 2 FIES score on PSS score showed that worsening of the food security status increasing the stress level of the participants (95% CI: 1.61; 2.13; p-value: <0.001). Additionally, a significant negative association was observed between the PSS score and change in food security status between the two waves (Coefficient: -1.15, 95% CI: -1.30; -0.99, p-value: <0.001), indicating that deterioration in food security status over the pandemic period increasing the stress level. At the village level, the results showed a similar pattern. General awareness around ways coronavirus spreads was high, yet there were misperceptions at a higher level. Maintaining hand hygiene, wearing face masks outside the home, and going outside only when necessary were widely practised. Fewer respondents could maintain a 1.5-metre distance from others in the outside and maintained cough and sneeze etiquette. Conclusion The results indicate a higher stress level, a potential contributor to poor mental health, as food insecurity deteriorated. Policy initiatives in ameliorating immediate food insecurity during crises, improving long-term wellbeing, and expanding the reach of mental health support are warranted.

scholarly journals The Food Desert as a Concept and Policy Tool in African Cities: An Opportunity and a Risk

2019 ◽  
Vol 11 (2) ◽  
pp. 458 ◽  
Author(s):  
Jane Battersby
Keyword(s):  
Food Security ◽  
Food Insecurity ◽  
Low Income ◽  
Food System ◽  
Food Desert ◽  
African Cities ◽  
Policy Interventions ◽  
Policy Tool ◽  
Poor Access ◽  
African Context

The idea that food insecurity can be resolved by increasing the presence of supermarkets has been gaining traction in African cities and has recently gained political traction in Africa. This paper interrogates the potential value and risks associated with the adoption of the discourse of the food desert in the African context. The paper draws on findings from a households survey, neighborhoods-scale food retail mapping and surveys, and city-wide supermarket mapping conducted in Cape Town (South Africa), Kisumu (Kenya), and Kitwe (Zambia). Following a discussion of why the concept is gaining traction, the paper identifies false assumptions associated with the food desert framing in Africa, namely: supermarkets provide better access to healthier food, low-income areas have poor access to healthy food; and food security can be reduced to economic and physical accessibility. The paper concludes that although the food desert concept may be valuable for African researchers to provoke debates about systemic inequality, the food desert policy narrative should be rejected as it is ill-informed by the lived experiences of food insecurity in African cities and may promote policy interventions that erode rather than enhance the capacity of the food system to meet the food security needs of African urbanites.

scholarly journals Predictors and Inter-Linkage of Household and Individual Food Insecurity in Urban Geriatric Subjects: A Community Based Study from India

2021 ◽  
Vol 9 (2) ◽  
pp. 639-652
Author(s):  
Dr. Priya Keshari ◽  
Dr. Hari Shankar
Keyword(s):  
Logistic Regression ◽  
Food Security ◽  
Food Insecurity ◽  
Well Being ◽  
Household Food Security ◽  
Household Food Insecurity ◽  
Level Energy ◽  
Community Based ◽  
Individual Level ◽  
Household Food

Food insecurity affects many dimensions of well-being. It may lead to under nutrition. Although geriatric subjects from food insecure households are more likely to have inadequate energy, household food security does not necessarily guarantee for energy adequacy at individual level. This community based cross-sectional study was conducted on 616 geriatric subjects to find out predictors of food insecurity at household and individual level and examine energy adequacy at family versus individual level. Subjects were selected by multistage sampling procedure from urban Varanasi, India. A predesigned, pretested proforma was used for collecting socioeconomic information. Food insecurity was assessed using Household Food Insecurity Access Scale; 24 hours recall method was used for energy intakes. For analysis of data SPSS version 22.0 was used. χ2 and logistic regression were used for inferential purpose. Food insecurity at household was 68.2%.The significant association of marital status, religion, type and size of family and literacy status with household food insecurity in univariate analysis got eliminated after applying logistic regression analysis; Adjusted Odds Ratios were higher for SC/ST Caste (2.13; 95% CI: 1-4.5) and upper lower plus lower socio economic status(24.13; 95% CI: 13.87-44.61). On energy intake considerations, of 53.9% subjects with household food insecurity, 80.7% had individual food insecurity whereas of 46.1% subjects with household food security 63.7% subjects had individual food insecurity. Caste and socioeconomic class predicted food insecurity at household level. Energy adequacy at family level did not ensure energy adequacy in geriatric subjects.

Food insecurity transitions among rural households in Nigeria

2020 ◽  
Vol 39 (1) ◽  
Author(s):  
Oluwakemi Adeola Obayelu ◽  
Emem Ime Akpan
Keyword(s):  
Food Security ◽  
Secondary Education ◽  
Food Insecurity ◽  
Primary Education ◽  
Rural Households ◽  
Farm Size ◽  
Dependency Ratio ◽  
Male Adult ◽  
Access To Credit ◽  
Food Expenditure

Food insecurity dynamics of rural households in Nigeria was assessed using a panel data. Results showed that 44.4% of households that were food secure in the first panel transited into food insecurity in the second panel, while 32.5% that were mildly food insecure transited into food security. Furthermore, 25.7% transited from moderate food insecurity to food security, while 38.2% transited from severe food insecurity to food security. About 35.1% of households were never food insecure; 11.4% exited food insecurity 28.0% entered food insecurity; while 25.48% remained always food insecure. Having primary education, secondary education, dependency ratio, household size, share of non-food expenditure and farm size explained food insecurity transition. However, the likelihood of a household being always food insecure was explained by gender, female-to-male-adult ratio, marital status, primary education, secondary education, dependency ratio, share of non-food expenditure, farm size, access to credit and access to remittance.

scholarly journals Food Security, Environmental Health, and the Economy in Mexico: Lessons Learned with the COVID-19

2021 ◽  
Vol 13 (13) ◽  
pp. 7470
Author(s):  
Rebeca Monroy-Torres ◽  
Ángela Castillo-Chávez ◽  
Erika Carcaño-Valencia ◽  
Marco Hernández-Luna ◽  
Alex Caldera-Ortega ◽  
...  
Keyword(s):  
Food Security ◽  
Food Insecurity ◽  
Environmental Health ◽  
Public Policies ◽  
Cost Effective ◽  
Lessons Learned ◽  
Civil Society Organizations ◽  
Human Right ◽  
Healthy Environment ◽  
Mesh Terms

The COVID-19 pandemic showed an impact mainly on the health of people and the economy of households. The levels of food security in the world’s households, especially in Mexico, have decreased. When people do not have food security, their health is compromised and they have financial problems; on the other hand, environmental deterioration has a link with food security. The purpose of this review is to analysis of the current situation in Mexico of food security, environmental health and economy, the main lessons learned in these areas and their proposals integrating public policies. A review was carried out in the main databases (MEDLINE, Embase, CINAHL Plus, Web of Science, CAB Abstracts y PAIS Index) with the following keywords and according to the MeSH terms: Food security, food insecurity, environmental health, public policies, environmental, production, integrating the word COVID-19 in English and Spanish. Only 44.5% of Mexican households presented food security. For food insecurity, 22.6% had moderate and severe food insecurity, while 32.9% had mild insecurity. Food insecurity and the health impacts of environmental origin (waste management during the coronavirus pandemic, water contaminated by bacteria, viruses, and toxins; air pollution) generates impacts on economic activity by not offering food that meets health regulations. Without the application of cost-effective measures and interventions for the prevention and control of patients with obesity, the direct costs for 2023 will amount to 9 million dollars, which worsens the household economy. Despite having laws and policies on the right to food, a healthy environment (water), and opportunities for economic growth, these human rights are not fulfilled. The conclusion is that it is necessary to use a health and agroecological model to promote public policies (health, environment, and economy) that aims to prevent the discussed issues, with multidisciplinary and intersectoral interventions (government, academia, researchers, civil society organizations, industry, and population). This upholds the human right that all people should enjoy an adequate, healthy environment and have access to high-quality food.

scholarly journals Food insecurity, diet quality and body composition: data from the Healthy Life Trajectories Initiative (HeLTI) pilot survey in urban Soweto, South Africa

2021 ◽  
pp. 1-9
Author(s):  
Sarah H Kehoe ◽  
Stephanie V Wrottesley ◽  
Lisa Ware ◽  
Alessandra Prioreschi ◽  
Catherine Draper ◽  
...  
Keyword(s):  
South Africa ◽  
Body Composition ◽  
Food Security ◽  
Body Size ◽  
Food Insecurity ◽  
Diet Quality ◽  
Urban Poor ◽  
Reproductive Age ◽  
Healthy Life ◽  
Life Trajectories

Abstract Objective: To determine whether food security, diet diversity and diet quality are associated with anthropometric measurements and body composition among women of reproductive age. The association between food security and anaemia prevalence was also tested. Design: Secondary analysis of cross-sectional data from the Healthy Life Trajectories Initiative (HeLTI) study. Food security and dietary data were collected by an interviewer-administered questionnaire. Hb levels were measured using a HemoCue, and anaemia was classified as an altitude-adjusted haemoglobin level < 12·5 g/dl. Body size and composition were assessed using anthropometry and dual-energy x-ray absorptiometry. Setting: The urban township of Soweto, Johannesburg, South Africa. Participants: Non-pregnant women aged 18–25 years (n 1534). Results: Almost half of the women were overweight or obese (44 %), and 9 % were underweight. Almost a third of women were anaemic (30 %). The prevalence rates of anaemia and food insecurity were similar across BMI categories. Food insecure women had the least diverse diets, and food security was negatively associated with diet quality (food security category v. diet quality score: B = –0·35, 95 % CI –0·70, –0·01, P = 0·049). Significant univariate associations were observed between food security and total lean mass. However, there were no associations between food security and body size or composition variables in multivariate models. Conclusions: Our data indicate that food security is an important determinant of diet quality in this urban-poor, highly transitioned setting. Interventions to improve maternal and child nutrition should recognise both food security and the food environment as critical elements within their developmental phases.

Determinants of food insecurity among elderly people: findings from the Canadian Community Health Survey

2021 ◽  
pp. 1-15
Author(s):  
Moses Mosonsieyiri Kansanga ◽  
Yujiro Sano ◽  
Isaac Bayor ◽  
Joseph Asumah Braimah ◽  
Abraham Marshall Nunbogu ◽  
...  
Keyword(s):  
Food Security ◽  
Food Insecurity ◽  
Community Health ◽  
Elderly People ◽  
Health Survey ◽  
Policy Issue ◽  
Integrated Approach ◽  
Canadian Community Health Survey ◽  
Health Concern ◽  
Community Health Survey

Abstract Food insecurity among elderly people is a major public health concern due to its association with several health conditions. Despite growing research and implementation of diverse income-based policy measures, food insecurity among elderly people remains a major policy issue in Canada. Additional research could inform food policy beyond strategies that target improving the financial resources of elderly people. Drawing data from the Canadian Community Health Survey (N = 24,930), we explored the correlates of food insecurity among older adults using negative log-log logistic regression techniques. Our findings show that certain categories of elderly people are more prone to food insecurity. These segments include seniors who are visible minorities (OR = 1.29, p < 0.01), live alone (OR = 1.13, p < 0.05), have a very weak sense of community belonging (OR = 1.40, p < 0.001), in poor physical health (OR = 1.20, p < 0.01), and those in lower age and income categories. These findings corroborate previous studies that demonstrate that food insecurity among elderly people is a complex phenomenon influenced by diverse socio-economic factors. In Canada, food security policies targeted at elderly people have largely prioritised poverty alleviation through income support programmes. While these programmes can improve the purchasing power of elderly people, they may not be sufficient in ensuring food security. There is a need to embrace and further investigate an integrated approach that pays attention to other contextual socio-economic dynamics.

scholarly journals Understanding Food Waste, Food Insecurity, and the Gap between the Two: A Nationwide Cross-Sectional Study in Saudi Arabia

Foods ◽  
2021 ◽  
Vol 10 (3) ◽  
pp. 681
Author(s):  
Nora A. Althumiri ◽  
Mada H. Basyouni ◽  
Ali F. Duhaim ◽  
Norah AlMousa ◽  
Mohammed F. AlJuwaysim ◽  
...  
Keyword(s):  
Saudi Arabia ◽  
Food Insecurity ◽  
Food Waste ◽  
Cross Sectional ◽  
Household Level ◽  
Individual Level ◽  
Factors Associated ◽  
Household Factors ◽  
Cooked Food ◽  
The Individual

Background: Food waste and food insecurity may co-exist in various balances in developing and developed countries. This study aimed to explore the levels of food waste and food insecurity, the factors associated with them, and their relationships at the household and individual levels in Saudi Arabia. Methods: This study was a nationwide cross-sectional survey conducted via computer-assisted phone interviews in January 2021. Quota sampling was utilized to generate balanced distributions of participants by gender across all the administrative regions of Saudi Arabia. Data collection included household demographics, food waste and disposal, the Food Insecurity Experience Scale (FIES), and the Household Food Insecurity Access Scale (HFIAS). Results: Out of the 2807 potential participants contacted, 2454 (87.4%) completed the interview. The mean age was 31.4 (SD = 11.7; range = 18–99) and 50.1% were female. The weighted prevalence of uncooked food waste in the last four weeks was 63.6% and the cooked food waste was 74.4%. However, the food insecurity weighted prevalence at the individual level (FIES) was 6.8%. In terms of food insecurity at the household level (HFIAS), 13.3% were in the “severely food insecure” category. Moreover, this study found that “moderately food insecure” households were associated with an increased likelihood to waste uncooked food (relative risk (RR) = 1.25), and the “mildly food insecure” (RR = 1.21) and “moderately food insecure” (RR = 1.17) households were associated with an increased likelihood to waste cooked food. However, “food secure” households were associated with a decreased likelihood to waste cooked food (RR = 0.56). Finally, this study identified four household factors associated with food waste and three household factors that were associated with “severe food insecurity.” Conclusions: This first national coverage study to explore food waste and food insecurity at the individual level and household level, identified household factors associated with food waste and food insecurity and identified new associations between food waste and food insecurity in Saudi Arabia. The associations found between food waste and food insecurity are potential areas of intervention to reduce both food waste and food insecurity at the same time, toward achieving the Sustainable Development Goal (SDG) targets related to food waste and food security.

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