Malnutrition Worldwide

Estimates indicate that 925 million people – more than one in every seven worldwide – are undernourished, and 98 percent live in the developing world. Malnutrition develops when the body does not have the correct amounts of certain key vitamins, minerals, and nutrients to maintain organ function and healthy tissues. In areas affected by drought or other natural disasters, food supplies may be extremely limited, and increases in the number of malnourished individuals may be seen. By exploring new farming techniques and working to ensure that aid is provided in the affected nations, it may be possible to reduce rates of malnutrition.

Two-thirds of malnourished individuals are concentrated in seven countries: Bangladesh, China, the Democratic Republic of Congo, Ethiopia, India, Indonesia, and Pakistan. Other nations, particularly those in regions affected by drought, are also facing massive food shortages and increasing rates of malnutrition. In the Horn of Africa, a reported 10 million people including children and people with disabilities have been affected by the recent drought in this region – the most severe drought in the area in the past 60 years, which has interrupted food production. UN reports show that those who currently do not have access to a reliable source of food include an estimated 3.2 million people in Ethiopia, 3.5 million in Kenya, 2.5 million in Somalia, 600,000 residents of north-eastern Uganda, and 120,000 individuals in Djibouti.

Children are at a particularly high risk of becoming malnourished. World Health Organization estimates indicate that malnutrition contributes to more than one-third of all child deaths worldwide and the United Nations Children’s Fund approximates that 480,000 children in Somalia, Kenya, and Ethiopia will be severely malnourished this year – a 50 percent increase over last year’s figure. Mark Bowden, the UN humanitarian coordinator for Somalia, notes that the nation is currently facing “the highest rate of malnutrition in the whole of Africa, [and] more than 30 percent of children are suffering from global acute malnutrition.” Many malnourished children can be treated through the administration of calorie-dense, nutrient-rich foods including Ready-to-use Therapeutic Food (RUTF). Though RUTF is still not available in some regions, it based on peanut butter and dried skimmed milk and provides sufficient nutrient intake for complete recovery from malnutrition, and can be stored for three to four months without refrigeration, even at tropical temperatures.

According to UN reports, world food production will need to increase by up to 100 percent by 2050 in order to sustain 9 billion people, the expected global population. In addition to utilizing sustainable farming techniques, some experts have suggested the introduction of “super wheat” – a crop that is more resistant to some types of fungus that can destroy crops. Further exploration of crop options and sustainable farming techniques could help to expand the food supply and help to reduce global rates of malnutrition.

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On Food Allergies and Intolerances

Individuals may experience allergies to any number of substances, but reports indicate that a growing number of Americans suffer from allergies to particular foods. Food allergies affect approximately 12 million Americans, including three million children. ”Food intolerances,” though frequently discussed in conjunction with food allergies, are quite different. Individuals with “intolerance” to certain foods may experience adverse reactions and discomfort if they are consumed. It is important to have an understanding not only of the severity and potential risk of food allergies, but of the difference between true allergies and intolerances.

The majority of adverse reactions linked to particular foods are due food intolerances. Individuals can be intolerant to lactose, gluten, or other foods, and may experience nausea, vomiting, stomach cramping, and diarrhea. While these symptoms are surely unpleasant, they are markedly different from the immune response seen in individuals with food allergies. In addition to bowel discomfort, food allergies can cause an anaphylactic response, leading to tingling and swelling of the mouth and face, hives, trouble breathing, dizziness, or fainting. These symptoms are caused by an response in which the body’s immune system mistakenly identifies a particular food as a harmful substance. An allergic reaction involves two components of the immune system: an antibody called immunoglobulin E (IgE), and a mast cell. When an individual consumes - or in some cases is in close contact with - a food to which they have an allergy, the allergen stimulates specialized white blood cells called lymphocytes which produce the IgE antibody for that specific allergen. This IgE is then released and attaches to the surface of the mast cells in the tissues of the body, prompting the cells to release histamine.

Allergic reactions can range in severity, but reports indicate that they cause 30,000 cases of anaphylaxis, 2,000 hospitalizations, and 150 deaths each year in the United States. According to the U.S. Centers for Disease Control and Prevention (CDC), there are eight foods which account for 90 percent for all food-allergy reactions: cow’s milk, eggs, peanuts, tree nuts (walnuts, pecans, etc.), fish, shellfish, soybeans, and wheat. One of the most common food allergies in the United States is to peanuts, affecting an estimated 3.3 million Americans. The incidence of peanut allergies is increasing, and reports indicate that between 1997 and 2008, the rate of child peanut allergies has tripled. Rates of other food allergies have also increased in recent years, and according to the CDC, the number of children with food allergies increased by 18 percent, between 1997 and 2007. While the cause of the increase is not fully understood, it may be due in part to the risk factors associated with food allergies, which include a family history of asthma and allergies, and elevated IgE levels.

Though there is no proven treatment for food allergies other than the avoidance of the allergen, experts recommend that individuals with food allergies carry injectable epinephrine at all times, as it can help to mitigate severity of the allergic response. In addition to the physical health-related issues resulting from food allergies, reports indicate that more than 30 percent of children with food allergies have experienced teasing or bullying related to their allergy. By gaining an understanding of food allergies and sharing information about them with others, it may be possible ensure that individuals are better informed about how to help prevent allergic reactions, and lessen the stigma faced by children with food allergies.

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Flooding in Pakistan

Reports indicate that recent flooding in Pakistan has affected the lives of at least 15.4 million people and left a third of the nation – including approximately 7.9 million acres of cultivated land900,000 homes have been destroyed by surges of water, and a reported six million people do not have access to food, shelter, and potable water. In addition, the United Nations indicates that 1,600 have died and more lives are at risk as the threat of water-borne illness continues to rise.

Floods began in late July following a period of particularly heavy monsoon rains and have continued through August. Many have sought shelter in camps established by aid organizations, but public health experts warn that the crowding associated with displaced persons camps could exacerbate the spread of disease. Scabies, a skin infection caused by mites that burrow and cause pimple-like irritation, is becoming increasingly common in the camps. According to some reports, tens of thousands of infected individuals are among the 600,000 people in relief camps set up in Sindh province. In these tented camps which have been established in army compounds, schools, and public buildings, healthcare providers are struggling to contain outbreaks of acute diarrhea, the precursor to fatal cholera.

According to Mark Ward, acting director of the U.S. Agency for International Development’s office for foreign disaster assistance, “When you are dealing with this much water and that many people it [cholera] is almost unavoidable.” In addition, the World Health Organization (WHO) has reported 204,000 cases of acute diarrhea, 263,300 cases of skin diseases, and 204,600 cases of acute respiratory diseases in flood-affected regions. Thousands of cases of suspected malaria have also been documented and the conditions for mosquito-borne as well as water-borne illness are present.

The delivery of treatment for these fast-spreading communicable diseases has been compounded by the lack of adequate clinical facilities. Reports indicate that 200 health facilities were damaged or destroyed. Vaccination programs have been established in Charsadda and Peshawar regions and more than 100,000 children have received polio shots. Despite these efforts, millions, including 3.5 million children are at risk of contracting disease, and require water, shelter, or emergency care. Radio and text messaging campaigns have also been put in place to distribute information about the importance of hand washing and good hygiene.

While funding for humanitarian aid has been limited to date, the UN and other international organizations continue their efforts to garner support. Assuring that food, water, shelter, and medical treatment are available for those who need them is the primary concern of aid organizations currently working in Pakistan. By delivering effective medical treatment in a timely fashion while also working to prevent the spread of diseases, outbreaks can be contained.

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Nutrition and Obesity

The Centers for Disease Control and Prevention indicates that over 26 percent of Americans are obese, and the National Institutes of Health (NIH) recently noted that an estimated 97 million adults in the United States are overweight or obese. For the adult population, obesity and being overweight are defined based on an individual’s body mass index (BMI) - between 25 and 29.9 is considered overweight, and over 30 is considered obese. Obese individuals are at an increased risk for a number of diseases and conditions including: hypertension, type 2 diabetes, coronary heart disease, and stroke.

Time Magazine reports that, according to a report from Trust for America’s Health and the Robert Wood Johnson Foundation, Mississippi has the highest rate of adult obesity nationwide – 33 percent. In addition to being noted as the most obese state for the fifth year in a row, with 21 percent of the population living below the poverty line (per the U.S. Census Bureau), Mississippi is also noted as one of the poorest in the nation. Recent reports indicate that areas with lower rates of obesity such as Colorado, which has the lowest national obesity rate (18.9 percent), are not only usually more affluent than the heavier southern states, but also possess more temperate climates and easier access to outdoor activities.

A report from the Baltimore Sun indicates that in addition to obesity, Americans, particularly children, are also at risk for malnutrition. Despite consuming an adequate or excessive number of calories, obese individuals are not selecting foods that are nutritionally beneficial. Though slightly different from the malnutrition seen in developing nations, Americans lacking vitamins and minerals may also have weakened immune systems. A 2008 study by the Baltimore Health Department indicated that 13.5 percent of Baltimore families with young children lived in a state of “food insecurity,” meaning that they routinely ran out of food or were worried that they would not have enough food. These families often inhabit areas that do not have ready access to supermarkets and grocery stores, known as “urban food deserts.” This lack of options leads individuals and families to select items that are higher in calories but less expensive, and that are also available from convenience stores or fast food restaurants.

In an effort to increase the availability of food with substantial nutrition, many communities have established community gardens or have encouraged residents to purchase shares in community supported agriculture (CSA) programs. Through community gardens, participants are able to gain a sense of increased food security, save money, increase their environmental awareness, and provide nutritious food to their families. For individuals in urban settings or those who may not be able to participate in programs to grow their own produce, CSA programs may be available. By supporting local farms and farmers, those who choose to buy shares are able to receive locally grown fruits and vegetables and may see a cost-savings over commercially available produce. In cities like Chicago and others worldwide, individuals and businesses may also participate in “greening” efforts aimed at lowering carbon emissions and producing nutritious foods. Rooftop gardens also help to lower heating and cooling costs and reduce rainwater runoff as well as providing nutritious food.

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CDC Information on Obesity - NIH Report on Obesity - Time Magazine on Southern Obesity - Trust for America’s Health Report - Baltimore Sun Report - Press Release on Chicago’s Urban Food Desert - On Rooftop Gardens

Food Shortage in Ethiopia

As a result of poor harvest yields and food shortages, food prices have increased 52 percent between 2007 and 2008, according to the Food and Agriculture Organization (FAO). Areas of Asia, the Pacific, and Sub-Saharan Africa are experiencing particularly large increases in food costs. The Humanitarian Practice Network reports that for individuals with limited means, these higher prices make it difficult or impossible to meet their food needs. The FAO indicates that the number of people classed as under-nourished worldwide increased by 75 million in 2007, reaching a total of 923 million individuals. Women-headed households, the urban poor, and those affected by conflict situations or natural disasters are among those most likely to be affected by food shortages.

The World Food Programme (WFP) has identified 30 countries and territories as being “in crisis” with regard to food shortage and other humanitarian concerns. Ethiopia, Africa’s second most populous country, is among the countries for which food shortages and rising prices are a pressing concern. 4.6 million Ethiopians are threatened by hunger and malnutrition, and 10 million have been affected by droughts. In addition to six major droughts in the last two decades, the region has been denied access to the ports of Eritrea following a border war. The BBC reports that following the United Nations’ food deliveries to Ethiopia this month, no further deliveries will be made until September or October. Because of worldwide food shortages, the UN has stated that it has “no option but to cut back” on the provisions, which have already been reduced by a third since July 2008.

In areas like Ethiopia where food and medications as well as medical services are often scarce, telemedicine initiatives may allow for the provision of better care to those suffering from illnesses related to malnutrition and/or poor quality food and drinking water. By utilizing the Internet, telemedicine programs like iConsult make it possible to provide humanitarian healthcare assistance without the cost and risk associated with traveling to conflict-affected areas.

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Food and Agriculture Organization - United Nations World Food Programme - BBC News Report on Food Shortage

Jaspars, S. and Wiggins, ODI, S. (2009). “The global food crisis: an overview” Humanitarian Exchange. Humanitarian Practice Network, Number 42.

Image from a report on hunger in Ethiopia from The Economist

Health Among Aboriginal Populations

Rural areas often do not have the same quality of resources – especially health resources – available to urban areas. Among indigenous groups such as the Aboriginal and Torres Strait Islander populations of Australia, this is a particularly pressing problem. According to the Australian Government’s Australian Institute of Health and Welfare, as of 2001 an estimated 2.4 percent of Australia’s population identified as being of “Aboriginal origin,” “Torres Strait Islander origin,” or both. Around 25 percent of the indigenous Australian population – compared to two percent of the non-indigenous population – lived in areas classified as “remote” or “very remote.” As in other nations, non-urban areas often are not surveyed regularly, so gaps in health and welfare information are not sufficiently monitored or addressed.

The Australian Medical Association reports that representatives from the Indigenous Dentists’ Association have called for measures to improve oral health among indigenous groups such as the fluoridation of community water supplies. Per Medical News Today, the Dietitians Association of Australia indicates that due to the lower economic means of many people living in remote areas, high-quality nutritious food is not always available. Further, items such as sodas, sweets, and fried food are more available in rural areas and are lower-cost. Since one in every three Aboriginal people over the age of 15 worries about going without food, making healthy food options more available and affordable is a major concern to improving the overall health of the population.

Areas like the Northern Territory, where around 29 percent of the population are indigenous, also face a shortage of medical professionals to treat the conditions exacerbated by poor-quality food and lack of appropriate medical and dental care. Telemedicine programs such as iConsult provide opportunities to improve medical care in these areas and treat or lessen the severity of many conditions.

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CIA World Factbook – Australia - Australian Medical Association (Healthcare Providers) - Medical News Today (Food and Nutrition)