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Complexity of measuring food and nutrition

security and Indicators for monitoring and evaluating

change

Prof Dr ir D’Haese LucCTA Barbados November 2015

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Introduction

Food security is a valuable concept if used with a clear understanding of what it means, its limitations, and how it interacts with behaviour and non-food factors (Per Pinstrup-Andersen 2008)

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IntroductionFood security is a multi dimensional phenomenon,

which is difficult to define and understand.

The concept of food security has many definitions and as early as 1996 there were more than 200 different definitions and yet it only originated from the mid 1970’s (Maxwell, 1996).

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IntroductionThe 1996 World Food Summit (1996) adopted a

complex definition: "Food security, at the individual, household, national, regional and global levels [is achieved] when all people, at all times, have physical and economic access to sufficient, safe and nutritious food to meet their dietary needs and food preferences for an active and healthy life".

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Introduction Sometimes there is confusion in using the term “Food

Insecurity” and “ Malnutrition” or “Hunger”.

Hunger has to the Oxford English Dictionary three meanings: The uneasy or painful sensation caused by want of food;

craving appetite, also the exhausted condition caused by want of food

A severe lack of food A strong desire or craving

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Introduction

Referring to the Medline plus Encyclopedia, malnutrition is a general term that indicates a lack of some or all-nutritional elements necessary for human health. There are two basic types of malnutrition:

The first is protein-energy malnutrition - the lack of enough protein and calories which all the basic food groups provide. It is this definition of malnutrition that is used when world hunger is discussed.

The second is micronutrient (vitamin and mineral) deficiency. This is not the type of malnutrition that is referred to when world hunger is discussed, however it is significant.

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The conceptual framework emphasizes the difference between ‘Food Security‘ and ‘Nutrition Security’.

Food security refers to the area of causes and effects of food availability at household level (= access to food), here illustrated as the small, dotted triangle.

Nutrition security refers to the entire relationships, depict in the larger lined triangle.

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Introduction Hendriks (2015) noted that a prerequisite for

determining the state of food insecurity is to create a scale against which to measure it.

Food insecurity is not a single experience but a sequence of stages reflecting increasing deprivation of basic food needs, (Rose et al. 1995).

  It is a continuum of experiences ranging from the

most severe form, starvation, to complete food security, defined as a state in which all the criteria of the FAO (1996) definition of food security

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Hendriks (2015) The food security continuum

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Food security and its categorical dimensions From the definition/vision of food security mentioned above

four dimensions of food security have been determined namely food availability, - access, - utilisation and - stability (of both availability and access to food).

AVAILABILITY

ACCESS

UTILISATION

STABILTY

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Food system availability at Global level Within the international context, most frequently

used food insecurity (Global level) measures are i.e. Production trends (function of the weather conditions in the key production areas in the world); Trade agreements; Globalisation (function of world economic growth, population growth, inflation.); and market of agricultural product prices (actual prices and futures).

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Food system at national level Food availability For food security to be attained food must be available in

sufficient quantities and be of appropriate quality. FAO calculates national food balance sheets. Food

availability is the net amount remaining after production, stocks and imports have been summed and exports deducted for each item included in the food balance sheet. (National agricultural production (losses – non food transformations + imports – exports +/- stocks)

“Food security” and “self-sufficiency” are not the same, and a key debate is whether policies aiming for self-sufficiency help or hinder food security.

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Food system at national level At national level data are available from the EIU (2014). The

DuPont Global Food Security Index ((DuPont food security 2014)) uses 25 indicators from a wide range of international organisations

At National level measures are the Food balance sheets complemented with other parameters i.e. Population structure and growth; Import and export parity prices; Volatility of agriculture production and seasonal availability; Access to production resources / national stability; Access to rural services; Urban absorption capacity; Climatic shocks; and Security stocks

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Food system at household level

By extension the food availability can be calculated at household level by determining the physical quantities of food that are

produced (incorporating its determinants of access to resources, land, labour, capital, water, human capital), stored, losses, processed, distributed and exchanged (covering i.e. also gifts).

The availability of sufficient food relates to the overall ability of the agricultural system to meet food demand 

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Food at household level

Accessibility Food accessibility is a measure of the ability to secure

entitlements, which are defined as the set of resources (including legal, political, economic and social) that an individual requires to obtain access to food (Drèze and A. Sen, 1989).

Availability does not assure access, and enough calories do not assure a healthy and nutritional diet.

The distribution of the available food is critical According to Ericksen P.J. (2007) three elements describe

accessibility of food: afford- ability, allocation, and preference.

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Food system at household level Stability Household or individual must have access to adequate food

at all times to be food secure, they cannot risk losing access to food as a consequence of sudden shocks (e.g. an economic or climatic crisis) or cyclical events (e.g. seasonal food insecurity).

So food stability concern therefore both the availability and access dimensions of food security. (Webb and Rogers, 2003) (Drimie S. et al 2009)

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The complex nature of food security: Food security dimensions, levels, and components. Leroy et al 2015

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Food system at household level

Hierarchy

The first three dimensions follow a certain hierarchy: food availability is necessary but not sufficient for food access

food access is necessary but not sufficient for food utilization.

  

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Food system at household level

Hierarchy Food access is needed for sustainable food availability

(chronic undernourishment impairs labour activity and encourages resource depletion).

  Food access and food utilization over time may result in

different conditions as acute food insecurity (famine), seasonal discontinuities (leans seasons) going to assured access and utilization for all individuals.

  The fourth dimension of stability is referring to the risks

people are exposed to; those are crucial to understand food insecurity.

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Food at household level Risk and vulnerability Risk is a cross-cutting issue that influences all components,

it arises in many circumstances: food supply can be affected by climatic fluctuations, etc.; market access can be disturbed by changing global terms

of trade, etc.; physical insecurity crises, loss of coping options or the

collapse of safety nets all negatively affect food access. Diseases, taboos and the lack of adequate nutritional

knowledge could negatively influence food utilization on its turn.

When these negative impacts are not tempered, households become food insecure (Webb and Rogers, 2003).

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Food security indicators at household levelHousehold level measures include i.e. Household

food balance sheet; Household Food Insecurity Access Scale (HFIAS) (USAID (2007) Household expenditure and the share of the food consumption; Household Dietary Diversity Score (HDDS); Hunger index; Food Poverty (FP) and Low Energy Availability (LEA) (also known as the Rose and Charlton indices (2002)); Income sources and income level and stability; Access to production factors/markets; Food prices /level/volatility/inflation; and Resilience strategies

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Food security at individual level The focus of the analysis in this situation is on the level of

individual food consumption. This type of analysis is assessing the relationships between

medical, nutritional and behavioral/societal risk factors, and subsequent morbidity, mortality and changes in risk factors

The extent to which individual food security results in good nutrition depends on a set of non-food factors such as: sanitary conditions, water quality, infectious diseases and access

to primary health care. Nutrition security requires simultaneously ‘food’, ‘health’ and

‘care’.

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Food security at individual level Maxwell (2001) outlines three main shifts in the progression

of thinking about food security: the shift from the global and national to the household and

individual level; the shift from a ‘food first’ perspective to a livelihood perspective;

and the shift from objective indicators to subjective perception of food

insecurity.  Food security analysis becomes more associated to poverty

and inequality. Food security is one the important elements of sustainable livelihoods

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Food security at individual level

At individual level most used measures include: Diet diversity; Micronutrient availability (Vitamin A; iron; zinc; iodine, protein quality….); Stunting/wasting; Food safety (access to water and pit toilets; agencies for food safety…); Intra-household food distribution; Education; Risk perceptions (trends, shocks, seasonality….); and Gender related issues (% of female headed households; access to land.).

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Taking in account the above mention determinants and levels of food and nutrition security the UN agencies organized themselves to answer raise levels of nutrition.

The intersectoral of nutrition and UN agencies role is given in the figure below

28Food systems encompass: 1: activities related to the production, processing, distribution, preparation and consumption of food; and

2: the outcomes of these activities contributing to food security. Brian Thompson, Leslie Amoroso and Janice Meerman

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The diagram below provides logic for this complexity. 1: Science necessarily interacts with social, economic and environmental systems improvements in food crop production may originate from scientific research,

2: but for changes in production systems to be considered sustainable, they must take into account all three elements Royal Society. (2009).

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1.4 Importance of addressing the food and nutrition issue.

Despite the recognized high prevalence of food insecurity still a lot of countries are uncertain regarding the exact number of households who are or not food secure and to what degree food insecure households are affected.

  The multi-dimensionality of food security makes it technically

complicated to develop food security indicators, since it is difficult to develop an indicator for every element of such a multifaceted concept.

  The multidimensionality leads to methodological and

conceptual challenges in measuring food security. Several methods of analysis and at different levels need to be combined in order to get a good picture of food security.

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1.4 Importance of addressing the food and nutrition issue.

In the process of choosing indicators trade-offs are involved.   The objective necessitating measurement commonly drives

the choice of indicator.

Each indicator reflects on a different dimension of food security. Each measure captures and neglects different phenomena intrinsic to the concept of food security, thereby subtly influencing prioritization among food security interventions. (Barrett, 2010)

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Measuring food security Several challenges arise when measuring

food security. First it is difficult to measure “what is enough food”;

given that there are different units of analysis (individuals or households), and

different possibilities to refer to food (calories, protein, micro-nutrients and food quality and safety), and

the estimation of the precise caloric needs for different groups in the population (calories are mostly used to refer to food) is not straight forward.

Next to the difficulties of measuring enough food, it is also important to consider measuring how far people fall below the threshold.

33Measuring food security Several challenges arise when measuring

food security.Secondly it is important to separate risk and outcomes.

good nutritional status depends also on factors such as health and sanitary conditions;

secure access to enough food to meet household food needs is a necessary but not a sufficient condition for a good nutritional status. Issues of food quality of food are also important.

There are also several problems taking i.e. the household as a unit: members have different preferences, households are dynamic

and not static, there are intra-household resources allocations and there could be also gender and youth discrimination.

34Measuring food security Several challenges arise when measuring

food security. Insufficient household food security is only one of the causes of malnutrition.

Poor anthropometric results, especially stunting, may reflect the past history of the nutritional status but not necessarily the current situation.

Food intake is not only an outcome of current and past household food security, but it is also part of the process of ensuring future household.

  Various international food aid agencies , targeting food aid and emergency

activities and monitoring interventions all attempt to determine the change in consumption (total food budget) and income sources as a result of a crisis compared to baseline normal periods

An other category of measurement tool mentioned by Hendriks (2005 op cit) is the Coping Strategy Index (CSI) developed by CARE International and the World Food Program (WFP). Coping strategy indexes are shown to be good proxies for food intake, food budget shares, food frequency, etc.

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Given the level of analysis and the different categorical dimensions the following indicators are most frequently in used:

At Global level

Production trends (function of the weather conditions in the key production areas in the world)

Trade agreements Globalisation (function of world economic growth, population growth,

inflation..) Market of agricultural product prices (actual prices and futures) Energy market (Fuel, fertilisers..)

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Given the level of analysis and the different categorical dimensions the following indicators are most frequently in use:

At National level Food Balance

National agricultural production – losses – non food transformations + imports – exports +/- stocks

Population structure and growth Import and export parity prices Volatility of agriculture production and seasonal availability Access to production resources / national stability

Land Water Access to finances Labor/ productivity

Production and distribution cost Access to services

Expenditure on agriculture research an development Agriculture infrastructure including storage facilities

Urban absorption capacity Climatic shocks Security stocks

37Given the level of analysis and the different categorical dimensions the following indicators are most frequently in used:

At household level Household food balance sheet Storage losses Household Food Insecurity Access Scale (HFIAS) (see infra) Household expenditure and the share of the food consumption Household Dietary Diversity Score (HDDS) ( see infra) Hunger index; Food poverty (FP) and Low Energy Availability (LEA) also known as the Rose

and Charlton indices Income sources and income level and stability of

Formal/informal income Access to food safety nets/ social grants/ school feeding schemes .. Access to remittances Proportion of the population living under the poverty line and its link with food poverty

Access to production factors/markets GDP/CAPITA Food prices /level/volatility/inflation Resilience strategies Terms of trade/ transaction costs

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Given the level of analysis and the different categorical dimensions the following indicators are most frequently in use:

At individual level Diet diversity Micronutrient availability (Vit A; iron; protein quality….) Stunting/wasting Food safety ( access to water; agencies for food safety…) Intra-household food distribution Social and health risks ( HIV/AIDS…) Livelihood stability; diversification; opportunities Education Risk perceptions (trends, shocks, seasonality ..) Human behavior Political stability Gender related issues (female headed households..)

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This poses a problem since this requires a measure for comparison and such a golden standard does not yet exist.

The form depends on the needed information and the purposes and decisions for which it will be used.

In the next table a combination of indicators give as an example of indicators taking in account the different dimensions of the food security (availability,

accessibility, utilisation and sustainability) and level of analysis (global, national, household level and individual

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Examples of FS indicators evaluation methods

Food balance Household food insecurity access scale. (HFIAS) Diet diversity score Anthropometric measurements Months of Adequate Household Food Provisioning Low Energy Availability Food Consumption Score (FCS)

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Food Balance

Food balance sheets are used to calculate national food security and are used by the FAO.

Information on production, stock available at the beginning of the year and imports are used for supply side, then exports, non food utilizations and stock available at end of year are subtracted to find food availability to the country as well as deficits (if any).

  Income and expenditure surveys are done to estimate the

economic situation of a household, in the food security quantities of food purchased, food consumed from own production and food received in kind are estimated monetary wise.

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Food Balance

The share of the budget spent on food is then computed by dividing food expenditure by household expenditure.

The following indicators can be deduced from Income and expenditure data, it should be noted that they are not exclusively from income and expenditure data:

Quantities of different foods consumed per capita, (see also Dietary diversity score)

Energy available per capita, Contribution of staples to total energy, Percentage of households or people who are food insecure or food

deficient, Percentage of household expenditure dedicated to food (Smith

and Subandoro 2007). 

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Household food insecurity access scale. (HFIAS)a tool developed by FANTA.

The tool asks nine questions which represent universal domains of the experience of insecure access to food.

These questions represent apparently universal domains of the household food insecurity (access) experience and

can be used to assign households and populations along a continuum of severity, from food secure to severely food insecure.  

Each of the questions is asked for a recall period of four weeks (thirty days).

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Household food insecurity access scale. (HFIAS) Each of the questions is asked for a recall period of four

weeks (thirty days).   The respondent is first asked an occurrence question that is

whether the condition in the question happened at all in the past four weeks (yes or no).

If the respondent answers “yes” to an occurrence question, a frequency of occurrence question is asked to determine whether the condition happened rarely (once or twice), sometimes (three to ten times) or often (more than ten times) in the past four weeks (Coates et al.,

2007)

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Two indicators can be computed. The first one is the HFIAS score for each household by

summing the codes for each frequency of occurrence question. The maximum score for a household is 27 The minimum score is 0. The higher the score the more food insecurity ( access) the household experienced. The lower the score, the less food insecurity ( access) a household experienced ( Coates et al, 2007)

A second indicator that can be computed is the Household Food Insecurity Access Prevalence (HFIAP). The HIASP indicator categorizes households into for levels of household food insecurity (access) : food secure, and mild, moderately and severely food insecure as they respond affirmatively to more

severe conditions and/or experience those conditions more frequently.

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Diet diversity score Hoddinott and Yohannes (2002) define dietary diversity as the sum of the

number of different foods or food groups consumed by an individual or household over a specific time period.

  This indicator is a proxy for quality of diet and is highly correlated with

adequate caloric and protein intake, quality of protein consumption, and food consumption can also be used as an indicator of food security.

  According to Swindale and Bilinsky, (2006) diet diversity is also an

attractive proxy indicator for other following reasons:  A more diversified diet is an important outcome in and of itself. A more diversified diet is associated with a number of improved outcomes in

areas such as child anthropometric status. Questions on dietary diversity can be asked at the household or individual level,

making it possible to examine food security at the household and intra- household levels.

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Diet diversity score To better reflect a quality diet, the number of different food groups consumed

is calculated, rather than the number of different foods consumed.

A set of twelve food groups (see table below) is normally used by FANTA to calculate the HDDS. The respondent is asked a series of yes or no questions to collect the data for the HDDS indicator.

The questions refer to the household as a whole, not to any single member of the household). As a general rule, foods consumed outside the home are not included in the calculation.

FANTA makes a difference between the individual dietary diversity score (IDDS) from the household dietary diversity (HDDS).

For the HDDS 12 food groups are normally used as a proxy of food security.

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Diet diversity scoreThere are other techniques used to collect food

frequency consumption by using the recall method be it 24 hour, 7 or 30 day,

These have a disadvantage in that they rely a lot on the memory of the participant except the food record, which involves the recording of food consumed.

To assess food security, the household consumption data is converted to average caloric equivalents per person and compared to recommended caloric intake (Bashir & Schilizzi, (2012).

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 Anthropometric measurements

Anthropometric measurements are a commonly used proxy of food consumption and hence food security

  simple to conduct, their cost compared to other surveys is low and the information

they produce is precise.

Mostly data on weight for height and weight for age for children under five are collected, for adults the body mass index (BMI) is compiled.

The individual is categorised as undernourished when the anthropometric measurements fall below the International reference standard (Cogill, 2003).

  Anthropometric data does not always correlate with food access and food

availability, because nutritional status is an outcome of an array of factors for example care practices, hygiene and disease prevalence.

  Another drawback that has been cited is that anthropometric measure such a

stunting revile past food security problems not present.

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Months of Adequate Household Food Provisioning The Months of Adequate Household Food Provisioning (MAHFP)

measures how many months of the past year a household was able to provide itself with enough food.

The household respondents were asked which months of the past twelve months the household did not have access to sufficient food to meet their household needs.

The focus of these questions is the months in which there is limited access to food regardless of the source of the food (i.e., purchase, barter, or production).

The MAHFP is than calculated as followed; each month of the year being either 0 or 1 reflecting yes or no to question two.

This index ranges between 0 and 12.

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Low Energy Availability A household is defined to have a Low Energy Availability

(LEA) when the energy available in the household food supplies was less than the sum of its members’ recommended energy intakes.

A simple ratio was created to capture this concept. The numerator is a sum per month of the energy available in

each household’s reported food purchases plus the energy consumed from food produced at home.

The denominator is a sum of the recommended energy intakes for each individual in a household, multiplied by thirty to convert it to the same monthly time frame as the numerator.

Households that scored <1 on this ratio were defined as having a low energy availability (Rose and Charlton, 2002).

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Food Consumption Score (FCS)

The FCS is a composite score that includes information on three aspects: household dietary diversity using information on food group

consumption in the past 7 days, frequency of food group consumption (number of days in the past

week), and nutritional value using weights.

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Food poverty The food poverty measures the percentage of households

who have access to sufficient income to purchase a nutritionally adequate basic diet.

The food poverty index provides insight into the types of households suffering from different types of problems. The classification of “food secure”, “food insecure” or in “situation of hunger” based on this indicator allows tailoring policy responses to the need. It relies on data from the income and expenditure surveys, household size as well as on the data on rural and urban food prices, the monetary value of home production and the energy value of an adequate basic food plan.

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Food poverty The approach is compiled on the basis of ‘balanced daily food

plates’, to serve as a basis for the calculation of the cost of an individual’s ideal daily food intake (Schönfeldt, et al, 2013).

The composition of food choices is based on the National Food Consumption Surveys (Labadarios, et al, 2008; Steyn, Nel, et al 2006) and portion sizes are estimated according to National Food Based Dietary Guidelines.

Nutrient calculations are done using package information on the Food Composition Tables of the country.

The recommended daily energy intake of adults ranges between 10 000 and 12 000 kiloJoules, The value of for children is around 8 000 kilojoules (Whitney, & Rolfes, 2010; BFAP, 2013).

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ConclusionThe multi-dimensionality of food insecurity makes it

technically complicated to develop food security indicators, since it is difficult to develop an indicator for every element of such a multifaceted concept.

The multidimensionality leads to methodological and conceptual challenges in measuring food security. As a result, several methods of analysis need to be combined in order to get a good picture of the state of food insecurity. In the process of choosing indicators trade-offs are involved.

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Conclusion

Each measure captures and neglects different phenomena intrinsic to the concept of food insecurity, thereby subtly influencing prioritization among food security interventions (Barrett, 2010).

In this regard, a good measure of food insecurity needs to be relevant, credible, low cost, time sensitive, appropriate for the decisions that need to be made and comparable across locations, cultures and food security standards

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Conclusion Webb, Coates, Frongillo, Rogers, Swindale & Bilinsky

(2006), Remans, (2014), Stein, (2014), emphasise that there is no single measure that is perfect to capture all aspects of food insecurity, largely because a way has not yet been found to identify when and where the many facets of food insecurity interact. Multiple indicators should be more accurate in determining the levels of household food insecurity and identify the most vulnerable households.

It includes a mix of direct and indirect outcome indicators to develop some scale or index of household food security to either differentiate between food secure and food insecure households or to monitor the impact of various influences

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Conclusion

It can be strongly argued that, in terms of policymaking, the choice of a specific food security indicator within a generally broad range is not as important as the fact that there is consensus over the indicator. To varying degrees, the choice of an appropriate indicator is arbitrary and open to dispute. However, the political and social consensus that merges around the chosen indicator determines to a large extent the “success” of the indicator (Oosthuizen 2012)