The lack of food has plagued mankind since well before our written history. Droughts, plagues, and natural disasters are among the most publicized causes of food insecurity. Beyond these visible shortages, however, there are hundreds of millions of people throughout the world who chronically experience hunger. These circumstances exist even today and within all nations, despite sufficient food production for the entire world’s population.
Defining Food Security
While efforts to combat hunger at the global level have technically existed since World War II, the problem of food insecurity rose to the international scene with the Rome World Food Summit of 1996. At this forum hosted by the United Nations’ Food and Agriculture Organization (FAO), food security was defined as existing “when all people at all times have access to sufficient, safe, nutritious food to maintain a healthy and active life.” A useful starting point, this definition was transformed into a goal with the Rome Declaration, which calls for significant cuts by UN member nations in their numbers of undernourished people by 2015. Yet, while an excellent goal, the call to action faced an immediate predicament: where to begin?
This dilemma revealed a critical underlying problem: though estimates existed, there was a dearth of specific household food security data in all world regions. In response to this lack of data, new teams of global health and nutrition experts emerged with innovative techniques to assess and monitor food security through¬out the world. Perhaps one of the most successful is led by Professor Rafael Pérez-Escamilla of the Yale School of Public Health, an expert in global health and nutrition who has conducted studies in Ghana, Haiti, Brazil, Mexico, and the United States on topics including HIV, malaria, breastfeeding, and child development. His novel approach to measuring food security with experience-based household surveys has received wide acclaim and is being adopted across the globe.
Measuring Food Security
A true expert in global health and nutrition – he has conducted studies in Ghana, Haiti, Brazil, Mexico, and the U.S. on topics including HIV, malaria, breastfeeding, and child development – Pérez-Escamilla rapidly established collaborations to explore household food security. One of the most successful is centered at the University of Campinas, Brazil. His arrival at the University in 2003 coincided with the launching of President Lula’s Fome Zero Program, designed to eliminate extreme poverty and hunger. Despite this initiative, there was no established method of gathering household food security data.
Thoroughly adapting and translating the U.S. Household Food Security Survey Module, Pérez-Escamilla began with a small-scale feasibility study, surveying 125 households in Campinas, followed by expansions into three additional urban areas in different parts of the country. The wealth of useful information gathered and the clear validity and scalability of the survey went hand in hand, convincing the Brazilian government to invest two million dollars to conduct a nation-wide survey of 130,000 households in 2004, officially inaugurating the Brazilian Food Security Scale (EBIA). However, the success of the scale was due not only to the numbers it reached, but also to the information that it revealed; as a result, EBIA was reapplied in national samples in 2006 and 2009.
Experience-based scales such as EBIA gather more than simple dietary intake data. They explore behavioral responses to household monetary shortages, such as consuming less desirable food items or having particular individuals skip meals. A sample question would ask, in the last three months: “Were you worried that you would run out of food before being able to buy more?” or “Were you unable to offer children/adolescents a healthy and varied diet because you did not have enough money?” or “Did you ever feel hungry but not eat because there was not enough money to buy food?” Such questions reveal far more than simply asking about a lack of resources.
These scales have revealed a pattern of multi-step responses to monetary shortages as opposed to the simplistic interpretation that less money equals less food. The first step is an increase in anxiety during difficult times, when providers worry about their ability to feed their families. This is followed by a decrease in diet quality, where more nutritious foods are given up for cheaper food items. Paradoxically, this step provides a possible explanation for the link between income shortages and obesity, as cheap calories are consumed in lieu of a balanced diet. Next, the adults in the family reduce their food consumption. Finally, the children must reduce their food consumption. Understandably, all steps are accompanied by immense emotional distress for families.
Using the scale data, each household is assigned a score from 0-15 that captures the entire range of food insecurity. These data alone can indicate regions and households that suffer the most from food shortages and/or lack of access to healthy foods and can also provide targets for anti-hunger campaigns. Remarkably, the behavioral and emotional nature of the questions, when combined with socioeconomic, demographic, and mental health indicators, reveal novel insights into the effects of food insecurity.
Mental Health and Other Implications
One of the clearest conclusions is the strong relationship between food security and mental health. Experience-based scales have revealed a strong correlation between mental stress and food insecurity. While somewhat self-evident in retrospect, this discovery adds greater significance to the approach. Studies led by Pérez-Escamilla have revealed high correlations between food insecurity and other negative conditions including domestic violence, depression, chronic diseases, and lack of educational attainment. While other factors may ultimately be responsible for these dynamics, the scale still provides a clear method to investigate them in an inexpensive and readily scalable manner.
How to Use the Data?
The next question to ask is how to best use the massive amounts of data that can be gathered. Here, Pérez-Escamilla takes a step back from his contribution. He says, “The project has empowered each country to own the process by involving policymakers, academicians, and affected individuals. A key focus has been to build capacity within the country to process and use the data.” Developing these resources within a country enables the country to scale up and collect the data independently before using it to shape future policy. A good example is Brazil, where national surveys have been conducted three times, generating data that has been used to shape a food security law that cites the scale as its data source. The scale has been widely popular among academics, with numerous EBIA-related publications appearing in the best Brazilian scientific journals every year.
The regional scalability demonstrated by his studies encouraged Pérez-Escamilla to apply the scale globally. Since his first study, the scale has been used nationally in Colombia, Uruguay, Mexico, and in smaller samples in Haiti, Ghana and Albania. Additionally, the FAO is supporting Pérez-Escamilla’s current effort to standardize experience-based food insecurity measures first in Latin America, the Caribbean and eventually all around the world.
Nevertheless, Pérez-Escamilla believes that the full potential of the scale has yet to be realized. He readily admits that “policymakers have educated me” and that he has used their advice to improve the quality of the scale. He is also exploring novel uses of the scale, including examining the relationship between food insecurity and: malaria in Haiti, obesity in Brazil, HIV and stress in Ghana, and diabetes and depression among Latinos in the United States.
At the end of the day, Pérez-Escamilla emphasizes that the scale in and of itself is only a measuring instrument. It is extremely useful at highlighting problems or discovering new ones, but the actions that can bring change reside in the hands of policy makers. He hopes that the scale demonstrates enough of an impact to demand improvement and ideally even to reveal the underlying causes of food insecurity, providing the impetus for structural change.
Underlying Causes and Structural Changes
Having spent years investigating food security and gaining exposure to communities suffering through food shortages, Pérez-Escamilla knows that true global food security can only be achieved by addressing the underlying causes of insecurity. The biggest culprit, he believes, is social injustice. A vicious cycle occurs when food insecurity leads to a decrease in educational attainment, which decreases future earnings and leads right back to food insecurity. In his words, “Social indicators are the proof in the pudding.” Only policies that address the social determinants of health will lead to significant, long-term improvements in food security.
Fortunately, there are substantial efforts that seek to address the root causes of food insecurity and to gradually bring about structural changes. The most successful are the conditional cash transfer programs of Brazil, Mexico, and Colombia. These programs provide small cash benefits to poor families as long as they keep their children in school and bring them to their medical appointments. Pérez-Escamilla believes that these programs coupled with proper household food insecurity tracking can bring about true change and help to finally turn the tide against food insecurity.
About the Author
SUNNY KUMAR is a sophomore Molecular, Cellular, and Developmental Biology major in Saybrook College. He is a Yale Global Health Fellow specializing in infectious diseases and conducts research in Professor Zhong’s lab investigating the genetic basis and mechanism of neurogenesis and asymmetric stem cell division.
The author would like to sincerely thank Professor Rafael Pérez-Escamilla for his time and excellent research. We wish them continued success in their endeavors.
High-Level Task Force on the Global Food Crisis, United Nations. 2008. “Comprehenisve Framework for Action” Global Food Security Crisis. https://www.who.int/food_crisis/food_crises_july2008.pdf
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