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Methodologies
Published in Pamela Mason, Tim Lang, Sustainable Diets, 2017
Food security measures developed for use at the country level often emphasise food availability, which is measured by tools such as food balance sheets. Such data are used to create the FAO’s core food security measure, the prevalence of undernourishment. Inaccuracies and differences in interpretation of data have led to varying estimates of the numbers of food insecure households and the FAO now publishes a set of additional food security indicators along with its estimate of the prevalence of undernourishment. These metrics examine variations in the dietary energy supply, protein of animal origin, food prices, food access and factors that determine food access. Other indices measuring one or more aspects of food security at national level include the Global Hunger Index developed by the International Food Policy Research Institute (IFPRI) and the Global Food Security Index designed by the Economic Intelligence Unit (one of several companies of the Economist Group, a publicly traded multinational).
Food and Nutrition Security within the Household
Published in Bill Pritchard, Rodomiro Ortiz, Meera Shekar, Routledge Handbook of Food and Nutrition Security, 2016
In poor countries with per capita incomes of $825 or less, the top 10 risks of death included child underweight; unsafe water/sanitation/hygiene; and indoor smoke from solid fuels (ranked first, fourth, and sixth respectively), all of which are a direct consequence of poverty. Poverty is also associated with poor sanitation and hygiene that can increase the risk of diarrhoea and contribute to stunting among children (Grantham-McGregor et al. 2007) (See also, Cumming et al., chapter 29, this volume). To capture the multidimensionality of hunger, IFPRI’s Global Hunger Index includes measures such as undernourishment, child underweight and child mortality (IFPRI 2013). These three measures are directly related to women’s role in the household. For women, early marriage and repeated pregnancies will adversely affect both the physiological health of the mother, as well as their children’s nutritional status. Similarly, poor literacy levels will imply low-levels of knowledge of farming techniques, health care, sanitation and hygiene, which can adversely affect other household members.
Social determinants of tuberculosis: context, framework, and the way forward to ending TB in India
Published in Expert Review of Respiratory Medicine, 2021
Anurag Bhargava, Madhavi Bhargava, Anika Juneja
The burden of TB in post-independence India can be attributed was related to three factors; persistence of poverty, endemic chronic undernutrition, and poor access and quality of healthcare services for the poor. Poverty persisted after independence in a large part of the population, largely rural but also the poor urban migrants. The growth in per capita income was only 1% per year for many decades, with increasing income inequality which further increased post-liberalization [43]. Poverty reduces best when economic growth occurs with economic equity. Secondly, while famines did not reappear in independent India, endemic hunger became entrenched and manifested as chronic undernutrition [44]. We lacked nationally representative data on child and adult nutrition before the National Family Health Surveys (NFHS) were launched in 1992–1993. Successive surveys revealed poor nutritional indicators in the children and adults alike [45,46]. The national averages also obscure inequalities, since in NFHS-4; rural areas had higher rates of undernutrition in adult women than urban (26.8% vs.15.5%) [47]. While 35.8% women in the low standard of living index were underweight (Body mass index < 18.5 kg/m2) compared to 11.6% in the high standard of living index [47]. According to WHO, the situation is considered ‘serious’ when the prevalence of low body mass index (BMI) is 20–39%, and ‘critical’ if it is more than 40% [48]. India ranked 102nd among 117 qualifying economies in the Global Hunger Index in 2019 with a score of 30.3 (which was 32.5 in 1990) [49]. The high levels of undernutrition are a reflection of poor food security related to poor purchasing power, an unhealthy environment with overcrowding, poor air and water quality, and poor availability of healthcare services. Finally, although healthcare infrastructure expanded remarkably post-independence, universal healthcare coverage was still distant. There was no NTP for 15 years post-independence, and the subsequent poorly funded, weakly performing programme till 1997 led to continuing transmission, morbidity and high mortality. Lack of universal coverage and a poor TB programme also allowed the dominant provider of TB care. In the current programme there is a move to provide universal access to quality TB care and the private sector is being incentivized to participate in the NTEP.