Framework: Food shortage, food poverty, food deprivation Links between levels of hunger Why hunger matters Organization of the volume Works cited Laurie F. DeRose and Sara R. Millman Framework: Food shortage, food poverty, food deprivation Any attempt to reduce hunger requires a sound understanding of which people are affected. The answer to the question whos hungry? matters because hunger is both damaging and avoidable. This volume answers the question at three basic levels of social organization: it identifies hungry regions, hungry households within regions, and hungry individuals within households. Vulnerability to hunger is not distributed evenly at any of these levels, and whether vulnerability results in hunger also depends on the way people organize themselves in relation to hunger. Differentiating between production shortfalls on a regional level (food shortage), inadequate food availability within a household (food poverty), and individual malnutrition (food deprivation) makes it easier to identify the hungry; more importantly, it helps highlight the type of problem leading to hunger. Production difficulties and distribution inequities require different types of solutions, and effectively combating hunger requires finding solutions that address the actual problems. Knowing who is hungry moves us closer to workable solutions. The framework used in this book (see fig. 1.1) distinguishing food shortage, food poverty, and food deprivation does not assume that the real problem, lies at one of these three levels. We have not adopted a strong theoretical view that dictates that efforts to reduce hunger need to be focused primarily on one type of intervention. Instead, our framework is designed to call attention to hunger even when food is abundant, as well as to learn how hunger is avoided even when food is scarce. Part of our task is to show the complex relationships between hunger at the different levels of social organization. The remainder of this chapter outlines the links between these types of hunger and it also overviews the manifestations of hunger in order to show that hunger has consequences, as well as causes, specific to each of the levels of social organization. Links between levels of hunger Hunger is produced when need outstrips food availability, but the determinants of both need and availability are complex: they are controlled by forces both proximate to and quite remote from the individuals they affect. In food shortage, food supplies within some bounded region are less than the amount needed by the regions population. In food poverty, a household is unable to obtain enough food to meet the needs of its members. And in food deprivation, the nutrients consumed by an individual are less than he or she needs. The three situations are causally linked, as shown in figure 1.1. One reason for food deprivation is food poverty, and one reason for food poverty is food shortage. It may seem obvious that if there is not enough food in the region some households will not have enough, and if there is not enough food in the household some members will go hungry. But it is also true that in food- short areas some households are more than adequately provisioned, and in non-food- short areas, some households are not able to meet the needs of all of their members. There are many possible causes of food poverty and deprivation other than food shortage. The distinction among the three levels of social organization is helpful in considering which of the many different causes of hunger may be at work in any particular case and in avoiding the fallacious view of hunger as a single, simple problem. It also provides a framework within which the insights of disciplines focusing on one or another of the levels, and the distinctive policy foci of various organizations, may be integrated. This can easily be seen by considering famine conditions - those in which widespread severe food shortage had led to elevated mortality and mass movements of populations in search of food. Famine has often been viewed as a production failure. Many international food aid efforts focus on simply increasing the supply of food available in such situations. A similar concern for the adequacy of aggregate food supplies in the longer term motivated the work of Green Revolution scientists to increase productive capacity in agriculture after World War II and is among the concerns driving current research in agro- biotechnology. Fig. 1.1 A causal structure of hunger (source: Newman et al. 1990) Recent research on famine (in particular, the work of Amartya Sen) has shown that massive crises of widespread hunger and increased mortality often occur despite aggregate food supplies that are no less adequate - and sometimes even more abundant - than usual. In such cases, the underlying cause of hunger is lack of access to food rather than lack of food. When such an upsurge in food poverty occurs, increasing aggregate food supplies will not necessarily improve the situation; the basic challenge is to develop and safeguard mechanisms of entitlement to food for those who have been denied access to existing food supplies. Widespread entitlement failure may coincide with shortage, as when poor harvests undermine the livelihoods of farmers, reduce aggregate food availability, and drive up prices. Or it may occur quite independently, as when unemployment or rising prices of other goods reduce the amounts of food that certain groups can afford to purchase, or when food supplies are directed away from civilians and toward military needs. The point is that famine has multiple causes: we cannot conclude simply from the fact that some households are food poor that there is any shortfall in aggregate food supply. Similarly, although food poverty is probably the most obvious cause of food deprivation, many go hungry in households that can afford to feed all their members adequately. Disease, voluntary abstention, discrimination, and misunderstood nutritional needs are among the additional causes of hunger that operate at this level. Disease impairs absorption and utilization of nutrients, raises nutritional needs, and may also reduce appetite. In addition, food may be withheld as part of therapy for certain diseases. Food intake is also deliberately restricted by individuals desiring to conform to cultural values for slimness or abstention. In the extreme, hunger strikes for political or religious reasons are carried to the point of starvation. In households that can afford to feed all their members, discriminatory patterns of food allocation may give some more than they need and others less; where household food supplies are scant, such patterns may leave favoured members adequately fed and deprive others disproportionately. Although it is tempting to interpret this pattern as reflecting a deliberate decision to favour one and deprive the other, variations in the adequacy of the diet of members of the same household may also result from a misunderstanding of need. The nutritional difficulties of young children and pregnant women are cases in point. A child may become malnourished despite being given as much as he or she will eat, if the need for a more nutrient-dense diet is not recognized. Although this problem frequently arises in cultures whose diet is based on starchy staples - toddlers do not have the stomach capacity to eat enough of such foods to satisfy their caloric needs - it has parallels in societies with more diverse diets: parents in the United States have to be taught not to give skim milk to children under two. Similarly, nutritional needs during pregnancy may be under-appreciated by women who believe that delivery of a small baby will be less difficult and thus deliberately restrict their intake during pregnancy. Automatic interpretation of all differences in the adequacy of individual diets within households as discrimination, inappropriately classifies problems caused by disease, household survival strategies, or misunderstood need and could easily lead to ineffective interventions. At each of these three levels, vulnerability to hunger, its social distribution, and corrective response clearly have a political dimension. The explicit or implicit promise of food security comprises an essential aspect of the social contract between political leaders and their constituents. An end to hunger cannot come about without political leaders who make ending hunger a priority and devote resources to this end (Barraclough 1989). Politicians are important social actors shaping the economic, social, and cultural framework for community organization. Specific descriptions of political obligations are also contained in the emergent concept of the human right to food (Messer 1996; Oshaug et al. 1994). Why hunger matters The significance of hunger lies primarily in the damage it does to those who suffer it, and secondarily in the ramifications of efforts made to avoid it. Figure 1.1 shows how some of the consequences at the individual level can easily lead to extreme changes at the other levels of social organization. This figure is a great oversimplification of both the causes and consequences of hunger but it helps highlight some of the significant relationships between hunger and human development, including the impact of hunger on the environment, economic growth, health and family planning, and political order. Some of the possible consequences of food shortage, food poverty, and food deprivation are presented below, along with further explication of the causal relationships between these consequences. We begin with a relatively lengthy discussion of the effects of food deprivation, in order to increase awareness of how devastating hunger is for the individual; this in turn will facilitate understanding of how individual hunger profoundly affects the social order. This is clear from the conceptual framework. Effects of hunger on the individual We define individual hunger as consumption of a diet insufficient to support normal growth, health, and activity. This definition leaves open questions of whether norms are fixed across populations and over time, and of what nutritional requirements are associated with them. These questions, each the subject of considerable controversy, are discussed in subsequent chapters. In the sense we use the term, hunger does not necessarily imply appetite. Individuals may eat enough of certain bulky diets to feel satiated and yet obtain fewer calories and less of some or all nutrients than they need, while those who eat enough of a more nutrient-dense diet to satisfy their appetites may also be malnourished and vulnerable to diet-related chronic disease: excessive fat is growing as a dietary problem in urban communities in developing countries. The physiological effects of hunger vary according to the particular nutrient(s) deficient (or in excess) in the diet and also the age, health, and reproductive status of the individual. The discussion below focuses first on protein-energy malnutrition and then turns to micronutrient deficiencies. Variations in the impact of malnutrition over the life cycle are taken up in the following section on effects of hunger on the household. Protein-energy malnutrition The combined insufficiency of calories and protein, or protein-energy malnutrition (PEM), is now considered to be the most widespread form of hunger. Although protein deficiency - including its severe clinical form, kwashiorkor - was once considered the predominant form of undernutrition, nutritionists now agree that most traditional vegetarian diets, consumed in quantities sufficient to meet energy needs, generally provide adequate protein as well, even where animal foods are absent. Nevertheless, some of those subsisting on largely grain- or tuber-based diets may be at risk of protein deficiency. Young children (particularly weanlings) need more nutrient-dense, protein-rich foods because of their smaller intake capacities. There is mounting evidence that, even if weaning foods are eaten in sufficient quantity to meet energy requirements, there may be important protein and micronutrient deficiencies (Allen et al. 1991; Brown 1991; Golden and Golden 1991; McGuire 1991; Pollitt 1991; West 1991). Protein quality may also be a problem for poorer segments of the population who may not be able to afford the more expensive non-grain elements in traditional combinations of vegetable foods that together make complete proteins. If they must subsist on only grain, rather than roots or grains with a complementary sauce or garnish (or with another vegetable food that provides the rest of the amino acids to make a complete protein), the quality of protein available to them is less satisfactory. The manifestations of severe protein deficiency overlap with conditions caused by inadequate caloric intake, but protein deficiency carries with it additional problems from fat accumulation in the liver, oedema, and severe anaemia (Hamilton et al. 1985). When diets are also inadequate in energy, individuals adjust by reducing expenditures through curtailment of physical activity. This behavioural shift has an emotional analogue in apathy (including reduced appetite) and irritability. The costs are obviously reductions in work, in socializing, and, for children, in the interaction with their environment that contributes to their learning and development. Some physiological adaptation to scarcity also occurs: the basal metabolic rate, or use of energy to power such basic and essential life processes as respiration and circulation, is reduced. But such adaptations have limits that vary across individuals and possibly within individuals over time; causes of this variation are not well understood. These should be viewed as adjustments to scarcity that are made at some cost to the well-being of most individuals. Another consequence of low energy intakes is reduced growth (in children) or weight loss. Energy expenditure may be maintained at a level in excess of consumption by metabolizing reserves in the form of stored body fat. Later, lean body mass in the form of muscle and even organ tissue will also be consumed if inadequate intake persists. Weight loss accompanies the initial stages of inadequate energy in take but, if prolonged, is followed by wasting - in its severe clinical form, marasmus. Death from starvation is the ultimate outcome where intake less than expenditure continues long enough. However, most hunger-related deaths are due to infectious disease rather than starvation per se: with severe malnutrition, ability to resist infection deteriorates sharply. The relationship between malnutrition and infection is a reciprocal and synergistic one. Disease leads to a deterioration in nutritional status at the same time that malnutrition increases susceptibility to disease. Effects of disease on nutritional status involve shifts in the types and quantities of foods consumed (whether due to custom or loss of appetite) and to decreased absorption and diarrhoea. Parasitic organisms, as in malaria or schistosomiasis, or intestinal worms, divert nutrients for their own use. Energy, protein, and micronutrient needs are elevated in order to fight off infection. Immune function also deteriorates with extreme PEM; evidence is more mixed as to possible increases in susceptibility to infection with mild to moderate malnutrition.
Posted on: Tue, 24 Jun 2014 09:36:25 +0000
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