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Food and Health, Stakeholders in Food and Health, Innovations, Diffusion,…
Food and Health
Definitions
Food Security
A state in which people at all times have physical, social and economic access to sufficient and nutritious food that meets their dietary needs for a healthy and active life
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Nutrition Transition
Economic development changes society's patterns of food consumption and activity, which results in a change in nutrition-based diseases
Malnutrition
Deficiencies, excesses or imbalances in a person's intake of energy and or nutrients
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Maternal Mortality Rate
Number of women who die during childbirth per 100,000 live births
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Access to Improved Sanitation
Proportion of a country's population that has access to flush toilets and piped sewerage systems
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Indicators
Global Food Security Index
- Comprehensive composite measure by The Economist
Components
Affordability
Programmes and policies to support consumers when shocks occur
- Agricultural import tariffs
- Food safety net programmes
Vulnerability to price shocks
- Access to financing for farmers
Ability to purchase food
- Proportion living under global poverty line (US$3.10/day at PPP)
- GDP per capita at PPP
- Food comsumption as a share of household expenditure
Availability
Sufficiency of national food supply
- of calories/capita/day
- Food aid levels
- Food loss (post-harvest + pre-consumer as a ratio of total domestic supply of crops and livestock)
Risk of supply disruption
- Volatility of agricultural production
- Political Instability/Corruption
National capacity to disseminate food and research efforts to expand the agricultural output
- Public expenditure on R&D (% of GDP)
- Urban Absorption Capacity (country's capacity to absorb the stresses by urbanisation
Quality and Safety
Variety of average diets
- Diet diversification (% non-starch foods in total dietary energy consumption)
Nutritional Quality
- Nutritional Standards (dietary guidelines, nutrition plan, strategy, monitoring, surveillance)
- Protein Quality (Protein Digestibility Corrected Amino Acid score)
- Micronutrient Availability (iron, vitamin A)
Safety of Food
- Measures enabling food safety (specialised agency, access to potable water)
Singapore Example
- 1 in 2019 to 15 in 2021
- Addition of natural resources + resilience component
Weaknesses
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Costly
- Large amounts of data required
- Complex to collect and analyse
Global Hunger Index
- Composite indicator
- Multidimensional nature of hunger
- International Food Policy Research Institute (100 point scale)
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Weaknesses
Poor countries do not collect required data
- Burundi, Sudan, Syria
- Have significant rates of malnutrition
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Malnutrition
Deficiencies, excesses or imbalances in a person's intake of energy and or nutrients
Undernutrition
- Stunting
- Wasting
- Underweight
- Micronutrient deficiencies
Overnutrition
- Overweight
- Obesity
- Diet-related non-communicable diseases
Health Indicators**
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Maternal Mortality Rate
Number of women who die during childbirth per 100,000 live births
Access to Improved Sanitation
Proportion of a country's population that has access to flush toilets and piped sewerage systems
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Health Adjusted Life Expectancy
Number of years a person can expect to live in good health
- LE-HALE = Society's burden of diseases
- LE adjusted with estimates for disease, disability and non-fatal health outcomes
- Not easy to compute
Pattern of Disease
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Medium Risk Countries
High standard of medical care available from some providers while others offer a lower standard of healthcare
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Some risk of food-borne, water-borne, vector-borne disease
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Extreme Risk Countries
Almost non-existent, severely over-taxed healthcare and lack generally available dental services
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High risk of food-borne, water-borne, vector-borne infections
Large Rapidly Developing Countries
High quality healthcare in major cities but poor quality healthcare in the rest of the country
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Serious infections of dengue, malaria, cholera, typhoid at certain parts
Epidemiological Transition
- Trend of diseases in a country
- Infectious (malnutrition + poor sanitation)
- Degenerative + non-infectious (sedentary urban-industrial lifestyle)
Stages
1: Era of Pestilence and Famine (Sub-Saharan Africa)
- Mostly contagious (diarrhea, malaria, tuberculosis)
- High death rate
- Low life expectancy (40-50)
2: Era of Receding Pandemics (rapid industrialisation, India, Brazil, Indonesia)
- Improved healthcare quality, hygiene, diets
- Lower death rate
- Increased population growth and life expectancy (60s)
3: Era of Human-induced, degenerative diseases (NA, Europe, Australasia, East Asia)
- Economic development (improved healthcare, hygiene, diets)
- Reduction of contagious diseases --> replaced
- Life expectancy increases to 70-80
Potential 4th stage
- Reemergence of past diseases
- HIV/AIDs
- Evolution of antibiotic-resistant strains of bacteria
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Disease Burden
Impact of a health issue (financial, mortality, morbidity)
- Mostly elderly (non-communicable + communicable)
High Income Countries (UK, Australia)
- Encourage elderly not to go to nursing homes (government expenditure)
- Daily home visits by healthcare workers (prolong independence)
Low Income Countries
- Communicable diseases dominate , elderly more susceptible (declined immunity)
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Economic/Social Burden
- On healthcare system --> treat more old people (UK, Aus)
- Remain at home to reduce govt expenditure --> visits from healthcare workers
- Family members have to care for them
Nutrition Transition
- Economic development changes society's patterns of food consumption and activity, which results in a change in nutrition-based diseases
Stages
2: Famine begins
- Abandon nomadism to form settlements = food cultivation
- Less diverse diet (limited to what they can grow)
- Famine (poor climate and understanding of environment)
- Gender and social inequalities in malnutrition
3: Receding Famine
- Industrialisation = agricultural surplus
- Commercial agriculture = access to larger variety of food = less famines
- Inactivity = less lean and muscular
4. Degenerative Disease
- Economic development = increased consumption of convenience foods
- Sedentary lifestyle = obesity and degenerative diseases prevalent
1: Collecting Food
- Traditional hunter-gathering societies
- More time and energy to find food
- Highly varied diet (high carbs and fibre, low fats)
- Little to no obesity
5: Behavioural Change
- Change in diet to prevent disease
- Consume less processed food, more fibre (fruit and veg), less meat
Closely related to economic development
- Globalisation spreads energy dense + nutrient-deficient diets to LEDCs
- Rapid shift to 2/3 --> 4 in large cities with open access to world food markets and transport links
- Change in diet in LEDCs --> farmers grow more pattern 4 foods = greater cost and burden in healthcare
Disease of overnutrition are expected to exceed undernutrition in the economically poor countries by 2030
Diffusion of innovations and disease
- Innovation: idea perceived as new
- Adoption: decision and subsequent implementation
- Diffusion: spread of something over space and time
Expansion: develop from source area and spreads out while remaining strong at the source area
- In populations whose locations are fixed
- Phenomenon moves, not people
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Hierarchical: spreads through an ordered sequence of classes/ places
- Eg large cities to remote areas
- Eg Hip Hop: urban centres --> world
Relocation Diffusion: moves into new areas and leaves the source behind
- Moves with migrants --> spread via expansion at new locations
Network: spreads via transportation and social networks
- Eg HIV spread along transport routes in S. Africa
Mixed Diffusion: combination of contagious and hierarchical diffusion
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Innovations, Diffusion, Barriers
Farming: manipulate the natural ecosystem by controlling processes within them to achieve the desired ecosystem to harvest the outputs for subsistence and commercial use
Physical Factors
SoilsFertile: rich in minerals
- Alluvial near rivers
- Volcanic
Poor
- Hard igneous rocks = few nutrients and easily eroded, Granite
- Acidic
- Alkaline (swamps)
- Salty (coastal)
- Thin (mountainous)
Climate
- Temperature: average minimum 6, decreases with altitude
- Rainfall: limitation before irrigation
Human Factors
Labour
- Subsistence: small , family --> to consume most of the produce
- Commercial: large, hired --> to profit from sale
Capital
- Subsistence: little
- Commercial: large (purchase land, machinery, labour)
Government
- Type of farming --> consolidate smaller holdings = large commercial farm
Culture and Technology
- Food produced
- Extent to which purchased inputs may be needed (machinery, fuel, labour, seeds)
Sustainable Agriculture: ability of a farm to produce food indefinitely without causing irreversible damage to ecosystems
Indicators
Energy Efficiency Ratios: measure of the amount of energy input into a system compared with the output
- Total outputs/inputs
1 = more efficient
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Unsustainable Practices
Monoculture: growth of a single crop species
- Same age: extract same minerals without compensatory replacement of minerals by other species
- Require constant intervention (chemical herbicides, pesticides)
Pesticides
- Genetic resistance: leave behind resistant pests --> inbreed and multiply
- Kill off desirable species (predators, competitors, parasites of pest)
- Non-biodegradable materials in food chain: DDT --> biological magnification
Wastewater
- Salty soils = saline water runoff pollutes rivers, streams
- Excess nutrients from manure = algal bloom in rivers
Agribusiness
- Abandon growing food
- Grow tea, tobacco, cotton for export
- Earn more money than food crops
Inputs
Physical Environment
- Vary by season
- Water, sunlight
- Type of soil --> poor/high altitude (grazing), rich (crops)
Human Environment
- Cultural differences
- Crop grown
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Agricultural Innovations
Green Revolution: rapid increase in productivity of agriculture through the use of science and technology
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High Yielding Varieties
- Eg Miracle Wheat (1960): hybrid strain, increase productivity in Mexico by 3x, 60% in Asia
- Eg Miracle Rice: mature faster
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Mechanism: farm machinery, irrigation, drainage
- Increased speed of work = increased yields/cycle
- Unemployment
- Large energy expense
Improvement in distribution and storage of food: infrastructure
- Cold-chain: distribute more widely
- Improved packing methods = distribute greater varieties
Genetically-modified Organisms
- Too expensive for LDC farmers
- Eg Golden Rice: infused with Vitamin A to prevent blindness
- Bt corn: natural pesticide
- Expensive + power over patents --> decreased accessibility
Hydroponic Farming
- Less land
- Urban environment
- Recycles water, contains pollution, reduces transportation costs
- Grows limited foods (not staples)
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Disease Case Studies
Vector-Borne: Malaria
- Parasite spread by Anopheles female mosquitoes
- Endemic in tropical areas
- 600,000 under 5 die per year in Sub-Saharan Africa
Causes
Socioeconomic
Overcrowded Living Conditions
- Share spaces and items
- Unhygienic
- No windows or doors --> bite at night
Lack of Proper Sanitation
- No proper clearing of stagnant pools = breeding
Limited access to healthcare
- Shortage of doctors
- Lack services
- High cost of malarial treatment
Eg India: 6 doctors/10,000 people, 4% GDP on healthcare --> highest malaria cases in Asia
- Rural = travel far for medical centres = delayed treatment = increased chance of spreading
- Unaffordable = seek cheaper, ineffective treatment
Environmental
Poor drainage and stagnant water
Eg Rajasthan, India: water from Great Indian Thar Desert leaks = habitats for mozzies
Climate
- Monsoon: debris accumulates in stormwater drains = stagnant pools of water
- Temperature: 22-30 = Increased lifespan, frequency of biting
- Humidity: 60% for survival --> increase = longer lifespan
Impacts
Social
Higher death rate
- At least 537,000 died in 2010, causes 40% of deaths in Congo, Nigeria
Infant MR
- 140/1000 die from malaria within a year of birth in Nigeria
- lower birth weight
Economic
Burden on Households
- Greater medical expenses (34% of household income in Ghana)
Cost of Healthcare
- 40% of public health spending
- Building maintenance
- Invest in hospitals, clinics
- Purchase medication, insecticide-treated nets
Lowers Productivity
- Africa: economic growth slowed up to a year
Water-borne: Cholera
- Ingestion of contaminated food and water
- 1.3 - 4m cases
- 21,000 - 143,000 deaths
Impacts
- Financial burden
- Lower productivity
- Increased strain on healthcare
- Lower social mobility
- Higher death rate
Haiti: drought, storms, political unrest, covid = increased price of food
Solutions
Food Insecurity
Economic
Microfinance
- difficult to access loans for small scale farmers
- $50-100 with generous repayment = build farms
- Money may not be used effectively for farming
- Still lack skills for farming
Growing Food Crops
- Commercial farmers switch from food --> biofuels = increased food prices, lower self-sufficiency
- Difficult to change to produce food crops
- Lack knowledge to produce food crops
- Supply chain to TNCs disrupted
Management
Crop substitution
- Plant foods that demand less water + less vulnerable to droughts
- Lack technology to develop drought-resistant crops
- May have different food preferences
Reducing Food Wastage
- 30-50% of food is wasted (storage/preparation management, vermin attacks)
- Wastage of leftovers in developed countries
- Lack financial means to improve food storage and transportation
- Less stockpiled = saves cost
- Lowers cost of food as less is wasted
- Do not have to produce more = efficient energy, land use
Raise Farm Productivity:
- Educate farmers through training + observing model demonstrations
- Better resources to narrow productivity gap
- Improve access to seeds and facilities
- Not all farmers can qualify
Technology
Expand Irrigation
- Increase yields in semi-arid areas
Improve Transport and Service Infrastructure
- Transport food to areas where it is needed
- Invest in water and electricity infrastructure = learn new techniques
Political
Food Aid
- Relief: targeted, freely distributed to victims
- Project: targeted at vulnerable to improve nutritional status, support specific developmental activities
- Programme: to government to manage
Free Trade
- Each country produces products in has a comparative advantage in --> export without taxes
- Economically developed countries pay fair prices
- Producers provide cheaper food
Land Reforms
- Low-income = small, fragmented farms -_> cannot use the economies of scale and machinery
- Japan/China: consolidate small farms into larger farming units
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Diseases
Curative Healthcare
- Treatment
- Expensive (hospitals, productivity, informal care)
Primary Healthcare
- Prevention
- Usually cheaper
- Less economic losses from absence from work
- Screening, education
- Less strain on hospitals in public health emergencies
Dengue
- Each time one is infected, it is more serious --> better to prevent
Factors affecting type of healthcare
- Nature of Disease
- Diffusion pattern
- Wealth of community
- Cost of medicine
Case Study: HIV/AIDS
- Sexual contact, infected needles, blood transfusion, pregnant mums
- Mostly expansion diffusion, some relocation (stigma, lifestyle, education, lapse in medical practice
Uganda
Causes
Economic
Vice Trades
- Illegal drugs
- Commercial sex work
Mobility
- Move for better job = socially excluded = higher chance of taking part in risky activities
Social
- Lack transport to obtain treatment in time
- Extramarital affairs
- Idea that treatment will save them
Impacts
Social
- High death rates among females = less children born = smaller workforce
- 1.2M living with HIV/AIDS
Economic
- Absent = lowers productivity
- Loss of skilled labour
- Costs US$5900 to treat one HIV patient/year = 12x GDP/capita
Measures
- Lowered HIV prevalence (14% in 1990 - 6.4% in 2008)
- Increased education = more pregnant women voluntarily test (20% in 2005 - 66% in 2010)
- Complacency of older generations
- Drug resistance in future
Government
ABC AIDS Control Programme (Abstain, Be faithful, Condom)
- National AIDS Policy: 5 year strategy = prevent, care treatment, social support
- Uganda AIDS Commission: plan and coordinate prevention and control activities
NGO
- The AIDS Support Organisation: healthcare, emotional support
Definitions
- Epidemic: affects a large group of people within a community, population or region
- Pandemic: epidemic spread over multiple countries or continents
- Endemic: belongs to a particular group of people/country --> greater than expected = outbreak = potential for epidemic
- Antigenic shift: gradual change in virus over time (seasonal influenza)
- Antigenic drift: 2 virus strains combine and infect the same cell = entirely new strain
Case Study: Ebola, Africa = S. Africa, Central (Congo, South Sudan, Uganda) West Africa
- Spread by direct contact with infected body fluids
Causes (West Africa)
- Treat sick relatives with home remedies
- Custom of washing bodies of the dead
Responses
- Contact tracing
- Increased awareness
- Travel restrictions
- Quarantine
Local
- Few health facilities
- Understaffed
- Poorly equiped
International
- Media focused on danger to other countries instead of the humanitarian crisis
- Limited donations
- Healthcare workers prevented from going to help
Impacts
11,000 deaths, 17,000 post-ebola syndrome
- 22,000 children lost at least 1 parent
- Other diseases neglected