Coping with Food Insecurity towards Sustainable Food ... · Coping with Food Insecurity towards Sustainable Food Systems: The role of the Sociotype and Positive Deviance Elliot Berry

Elliot [email protected]

6/20/2019

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Coping with Food Insecurity towards Sustainable Food Systems: The role of the Sociotype and Positive Deviance

Elliot Berry MD FRCP

Ministry of Health, Jerusalem

Former Director, Braun School of Public Health

Hebrew University – Hadassah Medical School

Current Member

United Nations Multi-stakeholder Advisory Committee on Sustainable Food Systems

Outline:From Food Insecurity Food Security Sustainability Food Security – Insecurity

Global Nutrition Index –

Triple burden of <Mal>nutrition

Coping with Food Insecurity – The Sociotype

Positive Deviance

Sustainability and Sustainable Food Systems

What Policy Makers can do…

Food Security is a Fundamental Human Right

Olivier De Schutter& 250 experts

112pp

Bélanger & Pilling& >175 experts

576pp

47pp


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NationHousehold

Individual

Food Security

AccessibleAvailable

Adequate

Food Security

Stability


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AccessibleAvailable

Adequate

NationHousehold

Individual

Stability

FOOD SECURE Vulnerability

Utilization

Stability

Individual

Household

National

“Short term”

Accessibility

AvailabilityLevel

The Food Security Pathway and its 5th dimension - Sustainability

Waste

Loss

PhysicalEconomic

AquacultureAgriculture

Imports

Quality / SafetyQuantity

Health

SUSTAINABILITYEnvironment, Economic, Culture

GENERATIONS“Long Term”

after Berry et al, 2015

Vulnerable Groups?


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• Victims of Natural Disasters• Victims of Conflict IDPs, Refugees, War victims

• Informal Settlements, Migrant Workers & Families• Marginal Populations in Urban Areas Unemployed, Homeless, Orphans, Street Children

• At-risk social groupsMinorities, Illiterate, Patients, Prisoners, Addicts

• Low-Income Households, 1- parent families• Dependents Servants, Elderly, Handicapped, Special needs, Pregnant & Nursing women, CHILDREN

KumasiMumbai

Most data areUNDERESTIMATES

Vulnerable Groups for FOOD INSECURITY

% of Total Household Spending on Food increases with Poverty (2011)

Ernst Engel’s Law (1821-96): Economics of income expenditure on Food

% Responding “Very Happy” when given choice between: “rather happy”, “not very happy” and “not happy at all”

…nor to Food Security…

However, Wealth (GDP) is not necessarily related to Happiness, 2011


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Number of people who feel they cannot afford food: 2006 - 2012% responding “YES” to Question: “Have there been times in the past 12 months when

you did not have enough money to buy food that you or your family needed?”

Gallup World Poll

Food Insecure peopleexist in EVERY Country

Every country in the world is affected by malnutrition

2018 Global Nutrition Report

* Every country has a malnutrition problem, irrespective of wealth

* 88% of countries experience more than one type of malnutrition burden

Malnutrition in

Mediterranean countries


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Prevalence (%) of ANEMIA among Women of Reproductive Age

2005 – 2016

Prevalence (%) of DOUBLE BURDEN(Wasting and Overweight) among

Children under 5, 2016

? Failure in Public Health ?? How to Measure & Monitor?

Definitions of Indicators for the Global Nutrition Index: only Index to penalize Obesity, to capture the triple burden of Malnutrition

Micronutrient Deficiencies WHO Global Burden of Disease (GBD) Project, 2002 and following

DALYs (Disability-Adjusted Life Years) lost per 100,000 population due to nutritional deficits•Deficiencies: Iodine; Vitamin A; Iron

Nutrient Excess (Obesity)

WHO, age-standardized, 2005 and following

Percent Obesity : Women > 15yrs with BMI ≥ 30 kg/m2

Food Insecurity

PoU Undernourishment %, FAO, S0FI, 2008 and following

Protein Energy Malnutrition (GBD)

Peng & Berry, Global Nutrition 1990 – 2015: A shrinking hungry, and expanding fat world. PLoS ONE 2018; 13: e0194821


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HDI represents the uniformly weighted sum with ⅓ contributed by each of the factor indices: Life GNI now uses the geometric mean of the previous three normalized indices:

HDI = 3 √[LE * EI * II]

LE: Life expectancy at birth

EI: Education Index

II: Income IndexLife Expectancy, Literacy and GDP

To transform any variable into a unit-free index between 0 and 1 (thus allowing different indices to be combined), the formula used is:

X index = __X – min (X) __[max (X) – min (X)]

where min (X ) & max (X) are, respectively, the lowest & highest values the variable can attain.

GNI modelled on the Human Development Index (UNDP)

GNI formula: uniform geometric mean

GNI = 3 √ [(1 - D ) * (1 – E) * (1 - IN)], Where

D = Relative score of Nutritional Deficits (log MNDs)

E = Relative score of Nutritional Excess (% OBESITY)

IN = Relative score of Food Insecurity (log PEM)

The World GNI has “improved” from 1990-2015

0.42

0.43

0.44

0.45

0.46

0.47

0.48

1990 1995 2000 2005 2010 2015

GN

I

Year

0

200

400

600

800

1000

1200

1990 1995 2000 2005 2010 2015

DA

LYs

du

eto

PEM

Year

6

8

10

12

14

16

18

1990 1995 2000 2005 2010 2015

%o

ffe

mal

eo

be

sity

Year

200

400

600

800

1000

1200

1400

1990 1995 2000 2005 2010 2015

DA

LYs

du

eto

mic

ron

utr

ien

td

efi

cie

ncy

Year

Obesity

Global Nutrition Index

Micronutrient Deficiency

Protein Energy

Malnutrition

Peng & Berry, Global Nutrition 1990 – 2015: A shrinking hungry, and expanding fat world. PLoS ONE 2018; 13: e0194821

Depends where you live…

Is Obesity aDisease ????


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Global Nutrition Index by World Bank & WHO Country Groups (n)

W Pacific LMIC(16)

E Med LMIC(16)

Europe LMIC(20)

*SE Asia LMIC(11)

American LMIC(36)

*African LMIC(45)

*HIC (52)

Box-whisker plotLine - Median; borders 75% 25% percentilesWhiskers – maximum and minimum values

HIC High Income CountriesLMIC Low and Middle Income Countries

From Global Nutrition Sustainability “Securities”

Ensuring Food Security

Sustainability “Securities” Ensuring Food Security - F’ E’ W’

Threats to Population linked to: Eating less Fruit & Vegetables Increased risk of NCDs Poor Mental Health Behavioral, Emotional and

Education Barriers in Children Social Exclusion Increased Health Costs

FOOD SECURITY

Soil Security

Climate Security

Economic Security

Political Security

Energy Security

Water Security

EAT – Lancet commission on healthy diets from sustainable food systems, 2019Rose, Heller, Roberto. J Nutr Educ Behav 2019; 51: 3

ACTIONSTRATEGIES

https://www.independentsciencenews.org/news/gmo-golden-rice-offers-no-nutritional-benefits-says-fda/

https://www.independentsciencenews.org/news/gmo-golden-rice-offers-no-nutritional-benefits-says-fda/


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Some Ways to Solve Food Security at Different Dimension Levels

Solution Availability Accessibility Utilization Stability

Agricultural Production

X

Communication and Transport

X X

Nutritional Education

X X X

Reduce Rural Poverty

X X

Food Fortification Supplementation

X X

Control Disease X

Control Birth Rate X X X

Level Availability Accessibility Utilization Stability

Macro • Agriculture & Trade policies• Birth control Programs

• Price policy• Food Stamps• Communication & Transport

• Motherhood Programs• Fortification/ Supplementation

• Saving & Loan Policy• Micro Finance

Meso • Small scale drip irrigation projects

• School-Feeding Programs

• Measles, Polio immunizationMaln Infect

• Community Planning Committees

Micro • Use of Fertilizer • Breast Feeding Coaching

• Latrine Construction• Growth Charts

• Food Storage

Examples of IMPLEMENTATION STRATEGIES for Food Security & Nutrition at different Community levels

adapted: K. Klennert. ed. Achieving Food & Nutrition Security. InWEnt, Capacity Building Internat., Germany, 2009


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Osnat KeidarFrom PhD Dissertation

Health Promoting Schools - Improving Health & Hygiene in informal settlements in Korogocho, Nairobi, Kenya

They said it could not be done……

BMI improved just through hand washing

**

*p<0.05 **p<0.01

Keidar, Berry, Donchin:European Journal of Public Health, Vol. 26, Supplement 1, 2016, 254

** *

SDGs 3, HealthSDG 6, Sanitation


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Coping with Food Insecurity:

the role of the Sociotype

Introducing the SociotypeQ: How do we COPE with

“LIFE” in general and chronic disease and Food Insecurity in particular?

A: Well, it all depends on your

SOCIOTYPE……

Berry EM & DeGeest S. Tell me what you eat and I will tell you your sociotype:

coping with diabesity. RMMJ 3:e0010, 2012.

Berry EM. The role of the sociotype in managing chronic disease: Integrating

bio-psycho-sociology with systems biology. Medical Hypotheses 77 : 610, 2011

Nutrition

& Fitness

Multi-Disciplines: Anthropology, Medicine, Nursing, Physiology, Psychology, Sociology, & more…


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Genotype

Individual

Relationships

Context

PHENOTYPEObservable

CharacteristicsBehavior Patterns

Personality

e.g. COPING

Sociotype

in utero Childhood Adolescence Adult Middle Age Old Age

Sociotype x Genotype determines Phenotype

RelativelyUnchanging

Input

ConstantlyChanging

Inputs

E X P E R I E N C E

Why you are, how you are &

Why you do, what you do…

Nutrition, Epigenetics, µRNA…

1. Individual / HealthIntra-personal

• Nutrition, Growth & Development

• Physical Health & Well Being

• Psychological / Mental / Emotional HealthSense of Humor

• Spiritual Belief System(s)

• Coping strategies throughout the life cycle for disease, aging & misfortune


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2. RelationshipsInter-personal

Family:• With Parents • With Siblings• With Cousins • With Spouse (mate selection)• With Children

Friends: Social Networks

Work and Strangers…

Sexual Partners / Lovers

3. Context - Community

Education

Employment

Economic Situation

Environment •Home•Leisure Time•Work

Political SystemMigrants / Strangers

Ideological Beliefs & Societal values


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Sociotype in Action: Kid injured in playgroundParent's responses

1. “Oh it’s really nothing, just a scratch. Be a MAN - Boys don’t cry…

2. “I know it hurts, Let me kiss it better. Let’s clean it with water, put on a plaster & you will be just fine

3. “It’s MY fault, I should not have let you go wild. Oh how terrible! We must go to the doctor immediately, and get anti-tetanus, then to the ER ...

4. “It’s YOUR fault for not being more careful

Which Mother said what? Cultural normsRussian, American, Nordic, Jewish, English, Polish…

(Affection & Justification)would Father be different??? Consistent Messages

School of Public Health –JerusalemAmalia Waxman

Individual Behaviour<Health>

Change in<Relationships>

<Context>

Consider also:• Juggling the # & type of those balls…..• Soles of your shoes….

LIFE TASK

(of Sisyphus?)

Sociotype“ BAGGAGE”

Experiences,

Load/Unload

FUEL =

NUTRITION

?Octane

P Puska napkin, Restaurant Geneva 2001


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Some questions for Sociotypic research: from the 3 Domains

INDIVIDUAL / HEALTH• How would you have been different if 5cms ↑ or ↓ in height?• How to live with Special Needs, blindness, stuttering, deformity?• Are you hungry in your Head or your Stomach?• How to cope with Aging, Chronic Disease - Diabesity, CVA, IBD, Arthritis, Colostomy, Post-Transplant or post Traffic accident?RELATIONSHIPS• At what age do you stop trying to please your parents?• What determines how we choose our partners?• Do people change?• How do families cope with a sick child? • How to deal with, Divorce, Bereavement (child)?• How to care for a parent/spouse with dementia?CONTEXT• How to deal with Job Dismissal, Retirement? • How to deal with Economic crises, Wars, Natural Disasters?

Questions may overlap domains, Answers may

CHANGE with TIME, & are NOT given by RCTs

Coping & Mastery skills are lower in less educated, the poor & the ill: data from 1296 subjects

4.2

4.4

4.6

4.8

5

5.2

5.4

5.6

0-8 9 12 13-15 16+

Co

pin

g &

Mas

tery

Years of Education

3.5

3.7

3.9

4.1

4.3

4.5

4.7

4.9

5.1

5.3

5.5

Better Same Worse

Relative Economic SituationHealth Status

Berry et al, 2017


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Individual / Health

Relationships

Context

35.8%

19.9%

19.6%

Men Women

26.6%

14.5%

16.2%

SociotypeCopingScore

The influence of Sociotypic Domains on Coping in 572 Men and 724 Women

Berry et al, 2017

Total 75.3% 57.3%

r = 0.38

r = 0.39

r = 0.55

Correlationsbetween

the domains0.353 – 0.421

Nutritional Status

INDIVIDUAL

Health Status

Breast Feeding

ProfessionalAdvisersCarers

FriendsSocial

Networks

PartnersFamily -Nuclear

Extended

RELATIONSHIPSHousehold

& Community Stores

Cultural values

EmergencyPlans

Socio-EconomicSituation

PoliticalPreparedness

CONTEXT

Living/ Working

Conditions

Sanitation

Religion

Agricultural Production

Disasters: Natural / Manmade

Stability, Sustainability

Accessibility

Utilization

Availability

Experience

Ecological model of the Sociotype involved in the stresses of, and coping strategies for, Food Insecurity


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Stages of Coping with Food Insecurity

1. Uncertainty & Worry

2. Inadequate Quality

3. Insufficient Quantity

4. Socially Unacceptable Behaviors

Coates et al. J Nutr 1438S, 2006

Resilience (= Chronic Coping):Absorptive: Take in your strideAdaptive: Move with it...Transformative: Get out of the situation

Coping strategies for Food Insecurity classified by Sociotypic Domain

Strategy Individual Relationships Environment

Dietary Change

Physiologic mechanisms in response to hypocaloric intake

• Rely on less tasty & expensive foods • Ration the money to buy prepared food

Increase short-term Food Availability

Reduce number of meals eaten in a day

Borrow food, or rely on help from a friend or relative

• Gather wild food, hunt, or harvest immature crops• Consume next season seed stockPurchase food on credit

Decrease # of people

Send children to eat with neighbors

Send household members to beg

Rationing Strategies

• Feed according to working members of HH • Restrict consumption by adults in favor of small children • Periodic fasts

Limit portion size at mealtimes


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Coping strategies for Food Insecurity classified by Sociotypic Domain

Strategy Individual Relationships Environment

Dietary Change

Physiologic mechanisms in response to hypocaloric intake





Purchase food on credit

• Gather wild food, hunt, or harvest immature crops• Consume next season seed stockPurchase food on credit







Coping strategies for Food Insecurity classified by Sociotypic DomainStrategy Individual Relationships Context

Dietary Change

Physiologic mechanisms in response tohypocaloric intake





Purchase food on credit

• Gather wild food, hunt, or harvest immature crops• Consume next season’s seed stock• Purchase food on

credit, • Sell Assets







Unacceptable

Behaviors...

Steal

Trash cans

Sex 4 Food

OxFam


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Questions on coping with Food Insecurity by domains of the Sociotype

INDIVIDUAL

• How to feed people with limited economic resources?

• How to keep up the food quality and prevent malnutrition?

• How to eat previously unacceptable food – culture / religious taboos?

RELATIONSHIPS (Family, Community)

• How to decide to whom to distribute the food? - at-risk pregnant women, children, elderly?

• How to cope if someone falls ill?

• How to borrow or get credit?

CONTEXT

• How to use the community collective power to get through the “hard” season? – building resilience

• How to prioritize resources under economic hardship?

• How aid should be allocated and operated?

• How financial tools and markets should play their role？

The Sociotype is involved with both the dynamic assessment of the Stresses of Food Insecurity and the Coping strategies to deal with them

Food Insecurity ↑

S O C I O T Y P EIndividual: Relationships: Context

LivelihoodAssets &

Experiences

PrimarySecondary

Assessment

CopingStrategies

Constant Feedback

↓ FoodInsecurity Repeated Cycles

Level: Availability,

Accessibility, Utilization,

Stability

Peng W, Dernini S and Berry EM. (2018) Coping With Food Insecurity Using the Sociotype Ecological Framework. Front. Nutr. 5:107.


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INDIVIDUAL / HEALTH:“Tell me what YOU eat and

I will tell you what YOU are”RELATIONSHIPS:“Tell me how a FAMILY eats and

I will tell you how it FUNCTIONS”CONTEXT:“Tell me how a NATION eats and

I will tell you its VALUES”

Do kids go to bed hungry??= COPING with FOOD INSECURITY SOCIAL JUSTICE – EQUITY & SUSTAINABILITY

Conclusions: The Sociotype & Coping with Food Insecurity

FOOD

CULTURE

↓ ↓

Peng, Dernini & Berry. Coping with food insecurity using the Sociotype ecological framework. Frontiers in Nutrition. 2018. 5:107

Individual Health

Relationships

Context

Exercising at a RED Light

1 Hand squeeze

2 Isometric hand press

3 Stomach into Spine

4 Pelvic Floor - O Ring

Documents

Coping with Food Insecurity towards Sustainable Food ... · Coping with Food Insecurity towards Sustainable Food Systems: The role of the Sociotype and Positive Deviance Elliot Berry