Food and Health 1- Measuring food and health

Question 1

What are the different components of food security?

Answer 1

-Affordability

-Availability

-Quality and safety

Question 2

The components of food security: affordability

Answer 2

-Food consumption as a share of household expenditure

-Proportion of population under the global poverty line

-Gross domestic product per person (PPP)

-Agricultural import tariffs

-Presence of food safety net programme

-Access to financing for farmers

Question 3

The components of food security: availability

Answer 3

-Sufficiency of supply

-Public expenditure on agricultural research and development (R & D)

-Agricultural infrastructure

-Volatility of agricultural production

-Political stability risk

-Corruption

-Urban absorption capacity

-Food loss

Question 4

The components of food security: quality and safety

Answer 4

-Diet diversification

-Micronutrient availability

-Protein quality

-Food safety

Question 5

What is the Global Food Security Index?

Answer 5

-It considers the affordability, availability, and quality of food across 113 countries.

-The Index is based on 28 indicators that measure food security in high-, middle- and low-income countries.

-The Index looks beyond hunger to study the underlying factors affecting food security.

Question 6

Changes in food security in 2015

Answer 6

-In 2015, food security improved in almost every region of the world.

-High- income countries still dominate the top of the rankings, but lower-middle-income countries made the biggest gains.

-The Middle East and North Africa (MENA) made
the largest strides in food security.

-Europe is the only region where food security worsened, as the scores of 85 percent of countries fell.

-Diet diversification and access to high-quality protein are increasing rapidly in low-income countries.

-Nutritional standards have improved substantially in almost every region.

Question 7

What is the Global Hunger Index (GHI)?

Answer 7

-It ranks countries on a 100-point scale, with 0 being the best score (no hunger) and 100 being the worst, although neither of these extremes is reached in practice.

-Values lower than 10.0 reflect “low hunger”, 10.0 to 19.9 are described as “moderate hunger”, 20.0 to 34.9 indicates “serious hunger”, 35.0 to 49.9 are “alarming hunger”, and 50.0 or more is described as “extremely alarming hunger”.

-The GHI is based on four component indicators

Question 8

What are the four component indicators that the GHI is based on?

Answer 8

-Undernourishment

-Child wasting

-Child stunting

-Child mortality

Question 9

Define undernourishment

Answer 9

The proportion of undernourished people as a percentage of the population (the share of the population with insufficient calorie intake).

Question 10

Define child wasting

Answer 10

The proportion of children under the age of 5 who suffer from wasting (that is, too thin for their height, reflecting acute undernutrition)

Question 11

Define child stunting

Answer 11

The proportion of children under the age of 5 who suffer from stunting (that is, low height for their age, reflecting chronic undernutrition).

Question 12

Define child mortality

Answer 12

The mortality rate of children under the age of 5 (particularly reflecting the fatal synergy of inadequate nutrition and unhealthy environments).

Question 13

Table F2?

Question 14

According to the 2015 GHI, which regions have the highest rates of hunger?

Answer 14

Africa south of the Sahara and South Asia

Question 15

What is malnutrition?

Answer 15

Any diet that has an inadequate amount of quality or quantity of food, as well as those diets that consume too much food.

Question 16

What is calorie intake?

Answer 16

The amount of food (measured in calories) that a person consumes

Question 17

What factors affect calorie intake?

Answer 17

Age, gender, type of work, physical activity, and climate

Question 18

Malnutrition

Answer 18

Malnutrition means poor nourishment, and refers to a diet lacking in (or with too many) nutrients

Question 19

Examples of the different types of malnutrition

Answer 19

-Deficiency diseases such as pellagra result from a lack of specific vitamins or minerals.

-Kwashiorkor is a lack of protein in the diet.

-Marasmus is a lack of calories/energy.

-Obesity results from eating too many energy/protein foods.

-Starvation refers to a limited or non-existent intake of food.

-Temporary hunger is a short-term decline in the availability of food to a population in an area.

-Famine occurs when there is a long-term decline in the availability of food in a region.

Question 20

As income increases in low-income countries (LICs), there in an increase and change in ___

Answer 20

Food consumption patterns

Question 21

Where do people in LICs generally derive their food energy from?

Answer 21

-Carbohydrates, while the contribution of fats is small and that of meat and dairy negligible

-In Bangladesh, for instance, people derive 80% of their nutritional energy from carbohydrates and 11% from fats.

Question 22

Where do people in HICs generally derive their food energy from?

Answer 22

-Carbohydrates and fats, with a substantial contribution from meat and dairy.

-The average consumer in the US, France, and Denmark, for example, derives 45-50% of their food energy from carbohydrates and 40% from fats.

Question 23

Difference in the effect of small increases in income on calorie intake in LICs and HICs

Answer 23

For LICs, a small increase in income may lead to a large increase in calorie intake, while for HICs increases in income may not lead to an increase in calorie intake.

Question 24

What is the nutrition transition mainly influenced by?

Answer 24

By higher income per capita – but food prices, individual and sociocultural preferences, the development of the “cold chain”, and other concerns also play a role.

Question 25

What have the main dietary changes been in HICs since the 1970s?

Answer 25

-The reduction in cereals, while mainly vegetable oil, and, to a smaller extent, meat intake increased.

-Animal protein intake has been stabilizing: an increasing part of the population seems to be interested in reducing/replacing it for various reasons (ethical, health-related, environmental, and economic)

Question 26

What have the main dietary changes been in LICs since the 1970s?

Answer 26

-In LICs the diet has diversified since the 1970s.

-Cereals, including rice, as well as vegetable oil, sugar, meat, and dairy intake are higher compared to 1961–73, although in more recent periods cereal intake is stagnating and even declining.

-Their share of cereals also exceeds the share in HICs.

Question 27

There is a strong positive correlation between level of income and consumption of ___

Answer 27

Animal protein

Question 28

There is a negative relationship between the level of income and ___

Answer 28

Staple food

Question 29

What foods are increasing the total protein availability per capita in LICs?

Answer 29

-Dairy, fish, and pulses

-Sugar intake is stabilizing

-These numbers suggest that the diet in LICs is slowly evolving in the direction of HICs, with the exception of sugar.

Question 30

What is Health- adjusted life expectancy (HALE)?

Answer 30

-An indicator of the overall health of a population

-It combines measures of both age- and sex-specific data, and age- and sex-specific mortality data, into a single statistic.

-HALE indicates the number of expected years of life equivalent to years lived in full health, based on the average experience in a population.

-Thus, HALE is a measure not only of the quantity of life but also of the quality of life.

Question 31

How is HALE calculated?

Answer 31

Compared with conventional life expectancy, which considers all years as equal, to calculate HALE, years of life are weighted by health status.

Question 32

In a survey in Canada, a Health Utility Index obtained from 1994–5 National Population Health Survey data was used to measure health status. Traditional life expectancy and HALE figures were compared to estimate the burden of ill health. What were the findings of this survey?

Answer 32

-The social burden of ill health is higher for women than for men.

-It is highest among those in “early” old age, not among the very elderly.

-Sensory problems and pain are the largest components of the burden of ill health.

-Higher socio-economic status confers a dual advantage – longer life expectancy and a lower burden of ill health.

Question 33

What is a major challenge with HALE?

Answer 33

-The lack of reliable data on mortality and morbidity, especially with low-income countries.

-The lack of comparability of self-reported data from health interviews is also a problem with this indicator.

Question 34

What is HALE?

Answer 34

-An indicator of the average number of years an individual is expected to live in a healthy state

-It is a summary measure that combines both quantity and quality of life

-In other owrds, it combines mortality and morbidity experience into a single measure of population health

Question 35

What can HALE be used to measure?

Answer 35

The burden of disease and injury in a population, risk factors, and the performance of public health efforts.

Question 36

A report published by the Public Health Agency of Canada provides estimates of health-adjusted life expectancy among Canadians with and without ___

Answer 36

-Selected chronic diseases (diabetes and cancer) and chronic conditions (hypertension), and by socio-economic status (income).

-Estimates are provided for females and males and for people of different ages.

Question 37

What is a low socio-economic status associated with in Canada (HALE)?

Answer 37

A loss in health-adjusted life expectancy

Question 38

Statistics about income vs. HALE in Canada

Answer 38

-In 2001, Canadian women and men in the top one-third income group had a health-adjusted life expectancy at birth of 72.3 years and 70.5 years, respectively.

-Compared with the highest income group, being in the bottom one-third income the group was associated with a loss of health-adjusted life expectancy at birth of 3.2 years for women and 4.7 years for men.

Question 39

What factors lead to a loss in health-adjusted life expectancy in Canada?

Answer 39

-Low socio-economic status

-Chronic diseases

Question 40

Chronic diseases vs. HALE in Canada

Answer 40

-The estimates of health adjusted life expectancy by chronic disease status in this report were based on the mortality and morbidity experience of people with and
without diabetes and/or hypertension (high blood pressure) for the 2004–6 period and of people with and without cancer for the 2002–5 period.

-According to the results of this study, the diabetes cohort at age 55 had a loss in health adjusted life expectancy of 5.8 years for women and 5.3 years for men.

-The cohort of people with high blood pressure at age 55 had a loss of 2.0 years and 2.7 years for females and males, respectively.

-The cancer cohort at age 65 had a loss in health-adjusted life expectancy of 10.3 years for women and 9.2 years for men.

Question 41

What is the child mortality rate?

Answer 41

The probability per 1,000 births that a child will die before the age of 5.

Question 42

How is the child mortality rate calculated

Answer 42

Question 43

Advantages of average life expectancy as a health indicator

Answer 43

-It offers a broad interpretation of health and the quality of life

-It is easy to compare across countries or regions

-It is relatively easy to administer with reliability and accuracy.

-It shows gender differences.

Question 44

Disadvantages of average life expectancy as a health indicator

Answer 44

-It doesn’t identify the causes of death or patterns of epidemiology in a country

-As an average, it hides differences between ethnic groups and socio-economic groups

-It may not identify spatial differences such as differences between urban and rural

Question 45

Advantages of infant mortality rate as a health indicator

Answer 45

-It gives a strong indication of health care that targets infant care

-It focuses on a vulnerable age-specific group of the population

-Good data helps target resources better and can help save many lives

Question 46

Disadvantages of infant mortality rate as a health indicator

Answer 46

-It does present as an average and so hides variations within a population such as differences between ethnic groups and/or socio-economic groups

-It is a very narrow focus of health care

-It may also hide spatial differences between rural and urban or across regions

-It relies on decentralized collection of data that isn’t always available making accurate data difficult to get hold of

Question 47

Define infant mortality rate

Answer 47

The number of deaths of babies under one year of age per 1,000 live births in a year

Question 48

Define average life expectancy

Answer 48

The average expected years of life calculated from the year of birth

Question 49

Define maternal mortality rate

Answer 49

The annual number of female deaths per 100,000 live births from any cause related to or aggravated by pregnancy or its management.

Question 50

Advantages of maternal mortality rate as a health indicator

Answer 50

-Like IMR, it provides a strong indication of health care that targets a narrow group - maternal care

-It focuses on a vulnerable group in the population and area of acute health need

-Good data can help target health care and save lives

Question 51

Disadvantages of maternal mortality rate as a health indicator

Answer 51

-The average tends to hide differences, either within the population or across regions

-It is a narrow focus of health care - ignoring large groups

-It relies on good data that is often difficult to measure and unreliable especially in remote rural locations

Question 52

Advantages of access to sanitation rate as a health indicator

Answer 52

-These improvements directly relate to the quality of life and directly improve health through a reduction of disease

-Improved water access impacts women most

Question 53

Define access to sanitation

Answer 53

The percentage of the population in a country living with improved access to water and improved sanitation

Question 54

Disadvantages of access to sanitation as a health indicator

Answer 54

-There tend to be distinct differences between urban and rural areas and so data can overlook under-served regions and neighborhoods.

-The measure doesn’t state the improvement and so does not always mean a tap. It can be a shared water source but in slums, this may be shared by thousands

Question 55

Define access to physicians

Answer 55

The number of physicians per 1,000 or 100,000 in a population

Question 56

Advantages of access to physicians as a health indicator

Answer 56

-This directly impacts health

-Increased physicians correlate with improved health

Question 57

Disadvantages of access to physicians as a health indicator

Answer 57

-Normally presents a distinct urban bias with rural locations left underserved

-Physicians still require health resources. Lack of oxygen in LIC hospitals means many people die where simple affordable intervention would have saved lives

-The number doesn’t tell us which area of health these workers are in and so may not be targeted at the health problems in a country

Question 58

Advantages of HALE as a health indicator

Answer 58

-Looks at a complex range of data that reveals statistical patterns of epidemiology in a country for distinct age groups

-Looks beyond simple longevity of life and shows the quality of health through a person’s life.

-Reveals clear differences in gender

-Reveals specific health concerns for different gender groups allowing for resources to be targeted.

Question 59

Disadvantages of HALE as a health indicator

Answer 59

-High complexity in terms of data collection and relies on sophisticated data recording and resources.

-LICs often lack the resources in terms of health systems and staff to collect the data

-In some cases, the data may be inaccurate or incomplete

Question 60

Key pattern of average life expectancy in the world

Answer 60

Life expectancy is high in all regions with exemption to Africa (especially sub-Saharan Africa). HICs have the highest life expectancy

Question 61

Key pattern of infant mortality rate in the world

Answer 61

-Infant and child mortality is very low in HICs. It remains very high in sub-Sahara Africa and South and Central Asia.

-Most regions of the world including LICs have seen a significant lowering of infant and child mortality.

Question 62

Key pattern of maternal mortality rate in the world

Answer 62

-Very low in HICs.

-It remains very high in sub-Sahara Africa and a significant problem in South Asia, Afghanistan, and South East Asia.

Question 63

Key pattern of access to sanitation in the world

Answer 63

-Progress is being made in most countries.

-Still, remote rural locations in sub-Saharan Africa and South Asia lag behind.

-It is also difficult to improve access in rapidly growing and densely housed slums in cities.

Question 64

Key pattern of access to physicians in the world

Answer 64

-Sub-Saharan Africa falls well behind the rest of the world, although South East Asia also has small numbers of doctors.

-Stronger numbers in India and Pakistan perhaps don’t reflect the access for poor rural communities.

-HICs have high numbers, with European countries, Russia and Argentina, Belarus and Greece having the highest.

Question 65

Key pattern of HALE in the world

Answer 65

-HICs live the longest number of years in good health with South Asia and sub-Saharan Africa living the least number of years in good health.

-Data in sub-Saharan Africa needs to be looked at closely in comparison to life expectancy before drawing too many comparisons with other countries.

-The map above is less useful as it doesn’t reflect gender differences.

Question 66

How is IMR calculated?

Answer 66

Question 67

What is the epidemiological transition?

Answer 67

The shift from infectious or contagious communicable diseases (epidemics) to non-communicable diseases that cause a gradual worsening in the health of an individual (degenerative diseases)

Question 68

Example of an epidemiological transition

Answer 68

-For example, a country in an early stage of development would be expected to have a large number of deaths and illnesses from infectious diseases such as respiratory diseases, measles, and gastroenteritis (diarrhea and vomiting).

-By contrast, we would expect a HIC to have more deaths and illnesses from a heart attack, stroke, and
cancers – diseases that are not infectious or communicable.

-The exception to this is the rise in cases of AIDS, and with it TB, in HICs since the 1980s.

Mexico:

Question 69

What was the 2013 Global Burden of Disease study?

Answer 69

A study that looked at 240 disease types for 72 countries

Question 70

What were the key findings of the 2013 Global Burden of Disease study?

Answer 70

-Life expectancy for both sexes increased from 1990 to 2013, while the number of deaths increased over the same period.

-There was a noticeable reduction in age-standardized death rates for cardiovascular diseases and cancers in high-income regions, and reductions in child deaths from diarrhea, lower respiratory infections, and neonatal causes in low-income regions.

-HIV/AIDS reduced life expectancy in southern sub-
Saharan Africa.

-For most communicable causes of death, both numbers of deaths and age-standardized death rates fell, whereas, for most non-communicable causes, demographic shifts have increased numbers of deaths but decreased age-standardized death rates.

-Diarrhoeal diseases, lower respiratory infections, neonatal causes and malaria are still the top five causes of death in children younger than five years.

-The most important pathogens are rotavirus for diarrhoea and pneumococcus for lower respiratory infections.

-Country-specific probabilities of death varied substantially between and within regions.

Question 71

For most countries, the general pattern of reductions in age-sex-specific mortality has been associated with ___

Answer 71

A progressive shift towards a larger share of the remaining deaths caused by non-communicable diseases and injuries.

Question 72

What does assessing epidemiological convergence across countries depend on?

Answer 72

Whether an absolute or relative measure of inequality is used

Question 73

Diagram showing the changes in the top 20 causes of death between 1990 and 2013

Answer 73

Question 74

Changes in reasons for premature death in the US

Answer 74

-In terms of premature death in the United States, ischaemic heart disease, lung cancer, and Alzheimer’s disease were the highest-ranking causes in 2013.

-The highest risk factors were poor diet, high body mass index, and tobacco smoke.

-The greatest reduction in mortality rate from all causes was in males aged 5–9 years (49.2 percent).

-In contrast, females aged 70+ years saw the
the largest increase in mortality rate (0.9 percent).

Question 75

Changes in reasons for premature death in China

Answer 75

-The main causes of premature death in 2013 were cerebrovascular disease, ischaemic heart disease, and road injuries.

-Poor diet, high systolic blood pressure, and air pollution were the leading risk factors in 2013.

-Females aged 28–36 years (84 percent) experienced the greatest reduction in mortality rate from all causes.

Question 76

Changes in reasons for premature death in Afghanistan

Answer 76

-In 2013, the main causes of premature death in Afghanistan were lower respiratory infection,
neonatal preterm birth, and congenital anomalies.

-Child and maternal malnutrition, air pollution, and poor diet were the leading risk factors.

-Females aged 1–4 years (61.2 percent) experienced the
the greatest reduction in mortality rate from all causes.

-Females aged 70+ years saw the largest increase in mortality rate (10.6 percent).

Question 77

The double burden (epidemiological transition)

Answer 77

-Due to limited government budgets in developing and emerging economies, there is a lag in health care provision.

-This leaves people, especially those in underserved rural areas, susceptible to infectious diseases and diseases of poverty.

-Some diseases disappear and others appear or re-emerge.

-There are some outstanding examples, such as the emergence of new infectious diseases like AIDS and Zika virus, and Coronaviruses and the increase in infections that were previously controlled, such as tuberculosis and dengue fever.

-For example, the decline in infectious diseases may be slow or stagnant among some groups of the population while non-communicable diseases may be increasing rapidly in another group of the same population.

Question 78

What are the leading contributors to the disease burden in older people?

Answer 78

-Cardiovascular diseases

-Malignant neoplasms

-Chronic respiratory diseases

-Musculoskeletal disease

-Neurological and mental disorders.

Question 79

A substantial and increased proportion of morbidity and mortality due to chronic disease occurs in ___

Answer 79

Older people

Question 80

Although population aging is driving the worldwide epidemic of chronic diseases, ___

Answer 80

-Substantial untapped potential exists to modify the
relationship between chronological age and health.

-This objective is especially important for the most age-dependent disorders (dementia, stroke, chronic obstructive pulmonary disease, diabetes, and vision
impairment), for which the burden of disease arises more from disability than from mortality, and for which long-term care costs outweigh health expenditure.

-The societal cost of these disorders is enormous.

Question 81

What is the worldwide epidemic of chronic diseases strongly linked to?

Answer 81

-Population aging

-In high-income countries, population aging persists as
fertility continues to fall and life expectancy increases slowly.

-For many middle-income countries, mortality has decreased over much of the 20th century and decreasing fertility is leading to a rapidly aging population.

Question 82

What kind of diseases become more prevalent with the epidemiological transition?

Answer 82

Cardiovascular diseases

Question 83

Why do cardiovascular diseases become more prevalent with the epidemiological transition?

Answer 83

As mortality decreases, nutrition improves, and infections are controlled, hypertension (high blood pressure), heart disease, and strokes all become more common, with heart disease contributing most to mortality.

Question 84

Although cardiovascular diseases become more prevalent with the epidemiological transition, ___

Answer 84

-As high-income countries advance into the age of “delayed degenerative diseases”, age-adjusted mortality due to heart disease decreases as a result of better prevention and treatment.

-In low and middle-income countries, heart disease episodes are occurring at younger ages than in high-income countries.

Question 85

What are the characteristics of malnutrition?

Answer 85

-Malnutrition refers to deficiencies, excesses or imbalances in a person’s intake of energy and/or nutrients.

-Malnutrition can be categorized into two groups:

-Undernutrion: includes stunting (low height for age), wasting (low weight for height, underweight (low weight for age), and micronutrient deficiencies or insufficiencies (lack of important vitamins or minerals).

-Overweight, obesity, and diet-related noncommunicable diseases (e.g. heart disease, stroke, diabetes, and cancer).

Question 86

Outline the characteristics of the food security index

Answer 86

-It is a composite index which incorporates a range of different indicators to monitor the provision of food for a country’s population according to their dietary needs.

-The indicators are organized into four categories: affordability, quality and safety, and natural resources and resilience.

-Examples of individual indicators are: food import dependency and change in average food costs.

Question 87

What is the nutrition transition?

Answer 87

A shift from traditional diets to Western-style diets, normally as a country advances into a new level of economic development.

Question 88

Give an example of the double burden

Answer 88

This is still happening in many societies of the Eastern Mediterranean Region where the less affluent sectors have a high incidence of infectious diseases among children while the wealthier sectors show completely different patterns of illness.

Question 89

In what regions of the world is the double burden most prominent?

Answer 89

-In countries that have rapidly developed where inequality, especially between rural poor and urban wealth, is greatest.

-Countries seeing rapid growth in cities also experience the double burden as city residents experience significant shifts in lifestyle and diet.

Question 90

Why is the double burden problematic?

Answer 90

Because it hits the countries least equipped in terms of health resources.