IHSJ Issue: Food Security and Health

Ready to use therapeutic food like nourimanba can quickly and effectively treat malnourished children

Partners In Health believes that extending the paradigm of health interventions to include food, housing, and potable water emblemizes our commitment to address the root causes of poor health.  Food security—the ability of all members of a community to access enough nutritionally adequate and socially acceptable food for an active, healthy life—helps ensure that communities, not just individuals, thrive.

Pervasive food insecurity is the most common underlying risk factor for poor health in the populations served by Partners In Health. Therefore, the IHSJ is studying of the links between food security, nutrition and health. The IHSJ also advocates for improved food security and nutritional support within bilateral and multilateral funding streams. Additionally, the IHSJ is working with MSF to raise awareness of the efficacy and feasibility of ready to use therapeutic food (RUTF) as a treatment for childhood malnutrition. In 2007, the IHSJ brought together over 100 experts from several NGOs, universities, and UN Agencies to look for solutions to food insecurity.

Numerous barriers to food security exist at the local, regional and international level including:

Misconception of food shortages:
A common misconception about food shortages is that they are always associated with famine. Famine does occasionally occur as a consequence of drought, flooding, or other natural phenomena, and the resulting localized, acute suffering is horrific. More disturbing is the unpublicized and prevalent malnourishment of hundreds of millions on a daily basis due to insufficient food intake (unmet caloric requirements and/or nutrient composition). Poverty is the main cause of this malnourishment, whereby lack of income makes the purchase of supplemental food inconceivable. International responses to food and other humanitarian crises are often fueled by images of suffering on the news.* Naturally, when we see people that have been displaced by an earthquake, a hurricane, or by man-made disasters, we feel compelled to act. Unfortunately, persistent malnutrition and poor health as results of poverty are not seen as newsworthy stories—not crises as much as ever-present, abstract truths. With donations driven by emotional appeals at critical moments, the funding mechanisms of many development organizations reinforce the idea of giving in times of urgency. As such, this silent epidemic frequently goes ignored and remains insufficiently funded.

Lack of farming resources and agricultural technologies:
Many of the afflicted live in rural communities, and practice subsistence farming. Only 4% of arable land in Sub-Saharan Africa is under secure water management, which means that nearly every farmer is dependant on rainfall to sustain not only their livelihood, but their one source of food as well. Further complicating the picture is the inability of small producers to afford the investment in other inputs (fertilizers, improved seeds, or technological implements like irrigation systems) that would ameliorate the difficulties that poor soil quality presents.  Given the pervasive nature of inequality, it is a sad reality that finds the poorest people with the least fertile land, unable to do more than eke out their livelihoods. These same groups are often confronted with land tenure issues that grant them little more than sharecropper status, as wealthy owners restrict access to lands or extract rents in the form of a portion of the harvest.

Insufficient and inequitable local infrastructure:
Governments in many of the nations worst affected by food insecurity are often unable to remedy the situation, as the international financial institutions, multilateral agencies, and bilateral donors tie assistance to acceptance of conditions and terms that limit the ability of the government to direct aid, and tend to favor projects that will make a nation more attractive to foreign investment and business opportunities. Though integration into the world market stands to bring revenue to impoverished nations, we must not forget to look at who benefits from these improvements. It is not rural farmers; it is those who have access to funds to invest in business. So roads may get built, but not in the places where the poorest live. Lack of roads means getting to market to sell goods is even more difficult, requiring more time and the ability to pay for transport. Thus, the cycle of poverty extracts payment, in the continued malnourishment and poor health of the poorest, as the twisted irony of "elite capture" is played out and the wealthiest gain the most.

Inequitable trade polices that favor developed nations:
Once integrated into the world market, developing nations are at a distinct disadvantage.
The turmoil over the Doha Development round of the World Trade Organization negotiations in large part focuses on inequitable agricultural trade relationships. The power within the WTO rests with the United States and Europe, who stand to lose favorable access to markets as low-income countries seek increased market access for their own agricultural goods. With little industry centered in developing countries, the export of unprocessed goods and raw materials remains one of the few sources of income for nations not endowed with oil, diamonds, or other natural resources. Increased agricultural production would increase the standard of living in the poorest nations, but trade policies as they stand are stacked against sustained and positive growth.  

Inefficiencies in food aid and development as widely practiced in the international community:
International development policy on food aid further exacerbates the situation, with the majority of resources funneled toward the mitigation of crises. As vital as emergency food assistance is, it is unable to address the factors that created the crisis in the first place. Inefficiencies and protectionist practices within the system of food aid delivery have created a situation that seems to benefit the donors of aid, not the recipients. As an organization committed to social justice and the alleviation of the burdens of poverty, PIH strenuously objects to the continuation of practices that promote food aid as a business undertaking.

Finding solutions:

Our effort to ensure food security is, at its core, a battle to shift the provision of food aid to a rights-based approach, one that recognizes the moral argument to feed the hungry as ever more persuasive than the mere disposal of food surplus or subsidizing wealthy farmers. A rights-based approach to food security acknowledges that social justice considerations of providing food for the poorest on our planet do not allow the distribution of leftovers to stand as the motivation for intervention, and demands that the poor not be treated as second-class citizens.

Instead, we advocate for a paradigm shift to build community-based and informed agricultural programs which support the food security and livelihood needs of the poor. In Lesotho the use of keyhole gardens, which are built up off the ground to decrease bending and allow easy access by farmers who have AIDS, has provided a steady supply of nutrient-rich food to those most in need. At one of the sites in Haiti, Zanmi Lasante has set aside a plot of land dedicated to growing peanuts and vegetables that are used to feed the patients in our nearby clinic and make fortified nutritional supplements for malnourished children (nourimanba), while ajans agrikol (local agricultural extension workers) ensure that the improved farming techniques are not limited to test plots alone. Following the PIH community health worker model, the Zanmi Lasante agriculture program aims to train agricultural workers from local activist organizations in sustainable agriculture techniques. Once trained, these workers will be responsible for teaching these practices to small community groups and individual farmers throughout the region while helping them implement these methods. These approaches highlight the potential role that small-scale, targeted interventions can play in alleviating household food insecurity. 


* According to a recent survey by CARE International, news and current affairs reports are the second largest motivator to donate to an emergency, after fundraising by friends and colleagues

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