World hunger, food deserts, and meatless Mondays

Daniel B. Oerther |

Nurses among those best able to advance nutrition and food security.


“What’s for dinner?” is a simple question most of us think about daily. In fact, we think about what we will eat at least three times a day and, for some, even more. Many people feel they are experts on the complex subject of nutrition. But if that were the case, many ailments that plague our health would be managed more expertly. Nearly 2,500 years ago, Hippocrates opined, “Let food be thy medicine and medicine be thy food.” Yet, many of our approaches to health care and food security raise barriers that impede our ability to maintain healthy diets.
Daniel B. Oerther
For the past six months, as a Jefferson Science Fellow (JSF) in the U.S. Department of State, I’ve enjoyed learning firsthand about food security and nutrition. Administered by the National Academies, the JSF program is open to tenured, or similarly ranked, faculty members from U.S. institutions of higher learning who are citizens of the United States. Fellows spend one year in residence in Washington, D.C., serving in either the U.S Department of State or the U.S. Agency for International Development (USAID).

Feed the Future
I’ve been fortunate to serve in the Department of State, in the Secretary’s Office for Global Food Security, where I have learned much about Feed the Future. Officially launched in 2010, Feed the Future is President Obama’s signature global hunger and food security initiative. Today, the 19 countries that partner in the program focus on inclusive growth in the agriculture sector, gender integration, improved nutrition, private sector engagement, research and capacity building, and climate-smart development.
Despite the efforts of this and other bilateral and multilateral aid programs, the United Nations Food and Agriculture Organization (FAO) reported in late 2014 that more than 800 million people remain chronically undernourished. In the United States, the Department of Agriculture reported that 14 percent of U.S. households were, some time during the past year, unable to provide adequate food for one or more of its members, due to lack of resources. Also, more than 5 percent of American households experienced food insecurity to such an extent that normal eating patterns were disrupted, and food intake was reduced below levels considered appropriate by household members. These results suggest that much remains to be done to improve food security and nutrition in the United States and around the globe.

Food security
In 1996, the World Food Summit defined food security as existing “when all people at all times have access to sufficient, safe, nutritious food to maintain a healthy and active lifestyle.” The U.N. World Health Organization (WHO) states that food security is built upon three pillars: 1) food availability (sufficient quantities of food available on a consistent basis), 2) food access (sufficient resources to obtain appropriate foods for a nutritious diet), and 3) food use (appropriate use, based on knowledge of basic nutrition and care, as well as adequate water and sanitation). In response to the 2007-08 world food-price crisis, the FAO added “stability” as a fourth pillar, defined as sustained occurrence of the three pillars over time.
These four pillars of food security correspond well to the three currently recognized dimensions of malnutrition: 1) chronic undernourishment caused by insufficient calories; 2) micronutrient deficiency, such as low levels of vitamin A or iron, often associated with inability to afford fortified foods; and 3) obesity, often from lack of healthy dietary choices.
MDGs and SDGs
For the past 15 years, the United Nations Millennium Development Goals (MDGs) have served as time-bound and quantified targets to address the world’s multidimensional extreme poverty. Of the eight MDGs, Target 1C is to cut in half, by 2015, the proportion of people who suffer from hunger. By the end of this year, it is anticipated that the United Nations will, in addition to reporting final results of the MDG program, begin working to achieve the Sustainable Development Goals (SDGs). From 2015 through 2030, the SDGs will guide international efforts to eliminate poverty. Among the 17 goals proposed by the Open Working Group, Goal 2 includes targets to end both hunger and malnutrition by 2030.
It is likely that the final form of the SDGs will be influenced by World Health Organization goals to improve maternal, infant, and young child nutrition by 2025. Those goals include 1) a 40 percent reduction in the number of children under age 5 who are stunted; 2) a 50 percent reduction of anemia in women of reproductive age; 3) a 30 percent reduction in the number of children born with low birth weight; 4) no increase in childhood overweight; 5) an increase in the rate of exclusive breastfeeding in the first six months, up to at least 50 percent; and 6) reduction and maintenance of childhood wasting to less than 5 percent.
Although these are ambitious goals, they are guided by evidence-based nutrition science published in 2008 in The Lancet series on maternal and child undernutrition. In 2013, The Lancet published a follow-up series on the topic, which provided an evidence-based, nutritional-science background for the Second International Conference on Nutrition (ICN2) in Rome in 2014. To document global progress toward achieving these objectives, a global partnership of nutrition experts and political actors, as well as private sector and civil-society members, jointly launched at ICN2 the Global Nutrition Report to “provide a comprehensive narrative and analysis on the state of the world’s nutrition.”
As someone with a passion for healthy diets, I’ve been pleased to immerse myself in the science that supports these diplomatic efforts. The Jefferson Science Fellow program refers to this as providing “accurate science for statecraft.” But this is not my only engagement in this complex topic. 

Chickens and eggs
In 2008, I collaborated with nurses and educators to initiate a school-lunch program for 1,200 students in a rural school district of Tanzania. Our efforts raised financial support from donors in the United States; purchased supplies in Tanzania and prepared food locally in that country; and shared science, technology, engineering, math, and medical (STEMM) lessons among Tanzanian schools and partnering schools in the United States.
Three years later, we leveraged the ongoing success of the Tanzania program to launch a nutritional partnership with a village in Kenya. Donations from the United States helped purchase chickens, feed, and supplies to construct chicken coops. Widows maintained the chickens, eggs were collected and sold to supplement local income, and chickens were sold as meat, with proceeds used to purchase local grain for the village’s school-lunch program. These projects gave me a deeper, more personal understanding of nutritional challenges faced by developing countries. I also found that the firsthand experience I gained in helping implement a school-lunch program more than 10,000 miles from home made it much easier to feel empathetic toward those with similar needs elsewhere.

Deserts and Mondays
For example, to supplement my work overseas, I have become involved in local awareness-raising activities, including campaigns to reduce urban food deserts and promote meatless Mondays. Food deserts, first documented in a 1995 U.K. government report as “populated areas with little or no food retail provision,” often correspond to geographic areas where it is difficult to obtain food without access to an automobile. They include rural areas as well as low-income urban communities. With financial support from the Robert Wood Johnson Foundation, our team partnered with local grocers, ministers, and community leaders to evaluate and make recommendations to our city council to improve food access in a low-income neighborhood of more than 20,000 people that lacks a full-service grocery.
Meatless Monday addresses “the prevalence of preventable illnesses associated with excessive meat consumption.” Dormant since World War II, the campaign was revived in 2003 by Sid Lerner in association with the Johns Hopkins Bloomberg School of Public Health. Meatless Mondays improve health while reducing the negative environmental impact of greenhouse gas emissions that arise from meat production. In each of these projects, I found my greatest challenge was learning how to effectively communicate my understanding of the scientific issues to a passionate audience highly engaged in promoting a food agenda that was “near-and-dear” to their hearts.
As a result of these experiences, I have also learned how to effectively partner with local communities, through establishment of community gardens, to improve access to wholesome food and raise awareness about nutrition. In 2009 and again in 2012, I participated in the growing movement of “local agriculture.” Sometimes known as “slow food” or “victory gardens,” the concept isn’t new, but the rapid emergence of these initiatives offers innovative community builders a dynamic opportunity to improve food security and nutrition.
My efforts borrowed heavily from the model provided by Growing Power, a nonprofit organization that describes itself as “the last functional farm within the Milwaukee city limits.” Important as it is to grow food, one of the very real benefits of such a model is the growth of community that springs up—organically, as it were—from the gardening effort.

It’s complicated!
Food is complicated: It’s a requirement for life. For some, it’s a passion. And to many, food is a source of great frustration and anxiety. My experiences with local community gardens, awareness-raising campaigns, international partnerships, and global diplomacy related to food security and nutrition have given me many insights into this complexity.
My advice to nurses who want to become involved in this area so essential to life: 1) Know your nutrition science and emphasize evidence-based research. 2) Look for opportunities to empathize with populations you plan to serve. And 3), beware of the polarizing, highly politicized nature of food. Because everyone eats every day, it is virtually impossible to have a discussion about food with someone who doesn’t believe that they know what’s best. Strong scientific knowledge and evidence-based research are antidotes to that phenomenon. Food insecurity can arise for many reasons, and the most effective interventions often require significant situational knowledge.
Finally, perhaps in no other area is the debate about cause versus correlation as strong as in food. I’ve met people who swear by their raw food or vegan diet, and I’ve met others who live and breathe the Atkins diet of meat, eggs, and cheese. I’ve been in meetings where shouting matches have occurred between those advocating replacement of vending-machine cola with cafeteria-line milk and those who demand soy-based milk to avoid undue stress on dairy cows. In my opinion, nurses are among health care professionals best prepared to advocate for improvements in food security and nutrition, and I am proud of my association with Sigma Theta Tau International as I engage in this work.

Daniel B. Oerther
PhD, PE, BCEE, honorary member of the Honor Society of Nursing, Sigma Theta Tau International and Jefferson Science Fellow in the U.S. Department of State, is the John A. and Susan Mathes Chair of Environmental Health Engineering at Missouri University of Science and Technology. 
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