Intersection of Food Insecurity and Water Insecurity

Abstract

Food insecurity experienced by children, adolescents, or adults is associated with many substantial consequences on diet, nutrition, physical health, mental health, behavior, learning, family cohesion, physical activity, and other outcomes [1]. These consequences of food insecurity can result from nutritional, biological, psychologic, and social mechanisms because food insecurity can affect dietary intake and is a profound stressor [2]. The development of measures of experiences of food insecurity that are valid and cross-context equivalent has provided national and global monitoring data on population burden and enabled extensive research on the determinants and consequences of food insecurity over the past 35 years [3]. The usefulness of the construct of food insecurity and its experience-based measures have helped fuel interest in other forms of material-need insecurity such as water, housing, transportation, finances, and health care. The conceptualization and development of measures of these other forms of material-need insecurity are nascent, except for water insecurity, for which recent efforts have clarified its conceptualization and developed household and individual measures [4]. The construct of water insecurity is understood to comprise availability, access, use, and stability, all of which are relevant for understanding food insecurity [4]. Much of the assessment of water insecurity has been based on physical measures of water for populations, geographic hydration areas, or sanitation; however, measures of household and individual experiences of water insecurity that are valid and cross-context equivalent have recently been developed [4,5]. Water insecurity is understood to have negative consequences on nutritional, physical, mental, economic, and political well-being. Quantitative documentation of these consequences is being enabled through data collected on households and individuals using experience-based measures of water insecurity [4]. Food insecurity and water insecurity are potentially connected in multiple ways [4]. First, they can coexist in the same areas, households, and individuals. Second, they can act together as stressors. Third, physical, biological, and behavioral mechanisms can link them. For example, unsafe water causes diarrhea in children, thereby affecting feeding and nutrition. Another example is that lack of water causes decreased agricultural productivity, thereby affecting food security. In many contexts, agriculture is an important livelihood activity through which food insecurity and water insecurity intersect. In these contexts, when water insecurity is present, trade-offs between allocating water for agricultural purposes or consumption may be required. Agricultural livelihood interventions, such as one implemented in western Kenya that provided intervention recipients with a foot-powered water pump (along with agricultural and financial training as well as other inputs), have the potential to alleviate both food insecurity and water insecurity [6]. Food insecurity and water insecurity were associated in nationally representative samples of individuals from 25 low- and middle-income countries in 2020, as determined using established experience-based scales for food insecurity and water insecurity [7]. Among 18.3% of people who experienced water insecurity, 66.8% also experienced moderate-to-severe food insecurity, and the prevalence of experiencing moderate-to-severe food insecurity was 2.69 times higher for those who also experienced water insecurity [7]. This study demonstrated that food insecurity and water insecurity intersect but did not address what that intersection means for the health of individuals. In an article in this issue of The Journal of Nutrition, Charles et al. [8] provided evidence about the health consequences associated with the intersection of food insecurity and water insecurity in their study of the detrimental effects of the coronavirus disease 2019 pandemic on women living in informal settlements in Indonesia. Food insecurity was assessed based on 2 items, limiting portion size and limiting the number of meals in a day, similar to items used in validated experience-based scales [3]. Water insecurity was assessed using the 4-item version of the Household Water Insecurity Experiences scale. Food insecurity and water insecurity were associated with symptoms of depression through a statistical interaction, with women who experienced both the forms of insecurity having more symptoms of depression. In their model that adjusted for wealth, disability, and financial situation, for example, water insecurity was not associated with symptoms of depression (difference in symptoms of 0.1) if women did not experience food insecurity but was associated with symptoms of depression (difference of 0.9) if women experienced food insecurity. From the opposite perspective, the association of food insecurity with symptoms of depression was weaker (difference of 1.5) when women did not experience water insecurity and stronger (difference of 2.3) when women experienced water insecurity. Overall, in this Indonesian study, food insecurity was more strongly associated with symptoms of depression than water insecurity. In western Kenya, food insecurity and water insecurity were not strongly associated with each other; however, each was associated independently with physical and mental health [9]. The magnitude of the association with physical health was lower for food insecurity than for water insecurity, whereas the magnitude of the association with mental health was about the same as that for food insecurity and water insecurity. This sample was selected intentionally from a subpopulation that experienced moderate or severe food insecurity, which makes interpreting differences in the magnitudes of the associations difficult. The associations of food insecurity and water insecurity with physical and mental health were additive, i.e., with no evidence of statistical interaction. Given that food and water are basic material needs that intersect, the inability to meet these needs is detrimental to physical and mental health. The challenges to ensuring food security and water security are increasing because of climate change and other global forces that affect all countries, which means that actions to jointly address food insecurity and water insecurity must be a global priority [4]. To inform such actions, taking an intersectional perspective will be helpful. From an intersectional perspective, social identities, conditions, and experiences may converge in an individual and may interact with social systems in the context in which the individual lives, potentially resulting in synergistic effects on health [10,11]. The Indonesian study [8] provided evidence for such synergistic effects of food insecurity and water insecurity; however, the western Kenyan study [9] highlighted that synergism may not be seen in all contexts, perhaps because of social, cultural, economic, or structural differences in contexts as well as differences in sampled populations and measures used. As qualitative and quantitative research from this perspective unfolds, the intersection of other forms of material-need insecurity besides food insecurity and water insecurity should be considered. Doing so will require the development of valid and cross-context-equivalent measures for these other forms of insecurity. Funding The author reported no funding received for this study. Author disclosures The author reports no conflicts of interest.