ISSN Electronico 2011-7531 ISSN Impreso 0120-5552 Volumen 31, n.°1, septiembre - dicimbre 2014 Fecha de recepción: 26 de septiembre de 2014 Fecha de aceptación: 10 de noviembre de 2014 DOI: http://dx.doi.org/10.14482/sun.31.1.7412

ARTICULO DE REFLEXION / REFLEXION ARTICLE

Ana Liliana Ríos García¹, Luz Marina Alonso Palacio², Ana María Erazo-Coronado³, Miguel A. Pérez⁴

¹ Médico Especialista en Salud Familiar. Especialista en Gestión Pública. Magíster en Desarrollo Familiar. Docente Departamento de Salud Pública, Universidad del Norte. Barranquilla (Colombia).

² Eco. Magíster en Salud Pública. Magíster en Demografía. Ph.D© .Docente División Ciencias de la Salud, Universidad del Norte. Barranquilla (Colombia).

³ Odontóloga. Especialista en Endodoncia. Especialista en Docencia Universitaria. Ph.D© Universidad del Norte. Barranquilla (Colombia).

⁴ Profesor Ph.D., de Salud Pública y Coordinador de Internados. Departamento de Salud Pública, Fresno State. (USA).

Correspondencia: Ana Liliana Ríos García. Universidad del Norte, km 5, vía a Puerto Colombia. A.A. 1569. Barranquilla (Colombia). ariosg@uninorte.edu.co

Resumen

La Seguridad Alimentaria y Nutricional (SAN) determina en gran medida la calidad de vida de la población de un país y aglutina diversos aspectos de las políticas de Estado, como la educación, la salud, la cultura, el medio ambiente, la alimentación y nutrición y el acceso a servicios públicos y de saneamiento básico, entre otros. Dado que el uso racional de los recursos alimenticios viene acompañado de prácticas culturales para la obtención y preparación de los alimentos, estos aspectos deben ser intervenidos desde perspectivas intersectoriales e interdisciplinarias que abarquen todos los ámbitos: individual, familiar, local, nacional e internacional. En la Declaración de Roma sobre Seguridad Alimentaria Mundial en 1996 los Estados se comprometieron con la erradicación del hambre en todos los países a la mitad de su número, sin embargo en 2015 la cifra aumentó con respecto al a 1996. Colombia, a pesar de no haber legislación sobre el tema, presenta un interés por un cambio, por lo que se ha abordado un interés en todos los sectores. La seguridad alimentaria y sus avances en Colombia requiere revisar experiencias de otros países en materia de políticas de Estado e implementación de estrategias efectivas, ya que este problema es un asunto de Estado y de seguridad nacional.

Keywords: seguridad alimentaria, recursos alimentarios, prácticas culturales y políticas de estado.

Abstract

Food and Nutritional Security (SAN) largely determines the quality of life of the population of a country and brings together various aspects of state policies, such as education, health, culture, environment, food and nutrition and access to public services and basic sanitation. Since the rational use of food resources is accompanied by cultural practices for obtaining and preparing food, these should be operated from intersectoral and interdisciplinary perspectives covering all areas: individual, family, local, national and international. In the Rome Declaration on World Faood Security in 1996, States pledged to eradicate hunger in all countries to half their number, however in 2015, the figure increased from the year 1996. Colombia, despite there is no legislation on the subject, has an interest in a change, so interest has been addressed in all sectors. Food security and progress in Colombia requires reviewing experiences of other countries in terms of government policies and implementing effective strategies, because this problem is a matter of state and national security.

Keywords: food security, food resources, cultural practices and government policies.

Introduction

The fight against poverty and hunger is not new and continues to be a recurrent theme in international discussions due to the close relationship of these issues with the progress and development of nations. It is therefore, not surprising that these two key issues are addressed in the UN Millennium Development Goals (UNMDGs).

Addressing food security is also not a new endeavor. In 1996, the World Food Summit stressed the importance of optimal political and socio-economic environments as a substrate to ensure the elimination of hunger and poverty. In 2000 the UN Millennium Declaration set out specific objectives for promoting development and combating poverty and hunger worldwide. Similarly, the International Conference on Financing for Development held in Monterrey in 2002 called on developed countries to support developing countries by opening their markets thereby stimulating trade and improving the standards of living. In the same year the Johannesburg Summit on Sustainable Development stressed the need to devise "a world free of the indignity and indecency occasioned by poverty, environmental degradation and patterns of unsustainable development" (1). Most recently, the report "Action Against Hunger and Poverty" (1), concluded that there is no justification to persistent hunger and misery given global economic conditions specially since they represent a clear and present danger to the welfare of new generations.

The global acknowledgement that people the world over have a fundamental right to be free from hunger and poverty and to have access to adequate food supplies is also codified in the Universal Declaration of Human Rights. Despite all these international efforts, there is still a need to translate the intentions expressed in the sundry international conferences into effective initiatives aimed at achieving the desired outcomes in terms offood security.

Food security

The first approach to the concept of what would eventually be called food security emerged in the 1970s, under the banner of production and food availability at the global and national levels. The following decade saw the expansion of the concept to include the idea of access to adequate food sources, and by the 1990s the idea of food security had expanded to include not only access to affordable and nutritional food, but affirmed cultural food preferences as a basic human right (2). The concept of food security, especially as it impacts children, continues to evolve.

The Inter-American Institute for Cooperation on Agriculture (IICA) defines food security as "the existence of conditions that enable humans to have physical, economic and socially acceptable access to a safe and nutritious diet which allow them to meet their food needs in a manner consistent with their cultural preferences "(3). Similarly, the Nutrition Institute for Central America and Panama (INCAP) defines food and nutritional security as a state in which all persons enjoy timely and permanent social, physical, and economic access to the food they need, both in quantity and quality, in amounts adequate for their biological use, guaranteeing a state of general well-being that contributes to personal development (3). In its May 2007 report, the Council for Economic and Social Policy (CONPES) stated that "Food and nutrition security includes sufficient and stable food availability in addition to access and timely as well as uninterrupted use of the same in adequate quantity and quality by all persons under conditions that permit adequate biological use leading to a healthy and active life "(5). Food security, therefore, seeks to promote practices that tend to promote self-sustainable development through the production of indigenous foods with high nutritional value accompanied by cultural practices for collection and rational use of resources (4) which may have been damaged as a result of the unchecked exploitation of natural resources.

The authors will explore the issue of food security based on the definition provided by the CONPES specially as they pertain to the developmental needs of children. The key components of the CONPES paradigm are defined below (6):

Importance of food and nutrition security

Research shows that child malnutrition is among the five leading causes of morbidity and mortality in developing countries, therefore, policy makers have been challenged to adopt policies which improve the nutritional status of children (9-10). In populations where conditions include extreme poverty, nutrition problems are common (14). Fortunately, research suggests that ". ...children who have been in intervention programs in which health care and nutrition have been provided have also achieved better physical, motor, cognitive and behavioral" (12). Finally, Daza (13) states that: "... all the actions of the State and society to improve the nutrition of mothers and children will result in better health and improved behavior of children in the school."

In response to the twin afflictions of poverty and hunger the United Nations (UN) adopted the Convention on the Rights of the Child in 1989. This convention changed the way children are viewed and treated with an emphasis on survival, development and protection. Of special interest in the area of food security is Article 24 in calls on countries to

"... recognize the right of the child to the enjoyment of the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of health. States Parties shall strive to ensure that no child is deprived of his or her right of access to such health care services. States Parties shall pursue full implementation of this right and, in particular, shall take appropriate measures combat disease and malnutrition, including within the framework of primary health care, through, inter alia, the application of readily available technology and through the provision of adequate nutritious foods and clean drinking-water, taking into consideration the dangers and risks of environmental pollution.. ..To ensure that all segments of society, in particular parents and children, are informed, have access to education and are supported in the use of basic knowledge of child health and nutrition, the advantages of breastfeeding, hygiene and environmental sanitation and the prevention of accidents; and to develop preventive health care, guidance for parents and family planning education and services."

While this is partly due to the food inability, we also need to acknowledge that in some cases the population is unable to properly use available food supplies. Thus, factors such as low income, unemployment, ignorance, unhealthiness, among others, are related to malnutrition and are ultimately characteristics of poverty or social marginalization (14- 15).

Food security in latin America

Approximately 850 million people worldwide suffer from undernourishment. Places where hunger is concentrated are also characterized by persistent food insecurity resulting from either food emergencies or from man-made crises lasting for several years. These crises may be result of armed conflict, droughts, floods and the effects of the AIDS pandemic among others.(13) Despite urgent calls to eliminate hunger and poverty in important events such as the World Food Summit and the UNMDG s it is unlikely that we will achieve the goal of reducing in half the number of hungry people by the end of 2015 (13).

Poverty and hunger continue to remain important problems in Latin America where population growth estimates indicate that if current trends continue there will be approximately 40 million undernourished individuals in the region by the end of 2015 (15-18).

According to projections by the Food and Agriculture Organization of the United Nations (FAO), at the beginning of this decade, the largest number of people without adequate access to food can be found in the high middle in countries of Brazil (15.6 million), Mexico (5.2 million) and the Bolivarian Republic of Venezuela (4.3 million). In additional 5.7 million people are affected in the middle income country of Colombia, and in the low income country of Haiti (3.8 million). Together, these five countries account for two-thirds of undernourishment in the region (18).

Following the 2002 FAO meeting in Rome, Brazil became a leader in measuring food insecurity among its inhabitants (18). In 2004, the Brazilian Institute of Geography and Statistics (IBGE) implemented the National Household Sample Survey (PNAD) which included a food security module. Results from this study indicate that 62% of private Brazilian households experienced food insecurity (19).

Other efforts to build a food insecurity profile in Latin America and the Caribbean include tools such as the Caribbean Food Security Scale (ELCSA) (6), which is based on the Supplemental Module Measuring Food Insecurity in the United States (US Household Food Security Supplement Module, HFSSM) and the Lorenzana Scale which was validated in Colombia and was based on Household Food Insecurity Access Scale (HFIAS) developed by the International Development Agency of the United States(18).

Following recommendations by the FAO which has suggested qualitative methods are more appropriate for measuring food security in Latin America, the ELCSA has been applied in Brazil, Bolivia, Colombia, Guatemala and Mexico. This instrument which is inexpensive and easy to apply has been demonstrated to have high internal and external validity and it generates information which can be easily compared to other countries (18).

National context

In Colombia issues to related to poverty are correlated to food security. Between 2005 and 2008 the population in poverty increased from 15.7 to 17.8%. Furthermore, from 2005 to 2008, food inflation in the lowest income groups was found to exceed national inflation levels. Finally, the price of the canasta basica de nutricion (basic food basket) increased between 80% and 90% between the years of 2007 - 2008 resulting in increasing levels of food security (22).

Despite having no legislation on the subject of food security for several years, Colombia has taken steps to address this topic. Through the Consejo de Politica Economica y Social, the federal government has designed the National Plan for Food Security and Nutrition (PNSAN) which is a set of objectives, strategies and actions designed to protect the population from hunger and poor nutrition. The plan, which went into effect in 2012 and is expected to end in 2019, seeks to ensure access to quality food in a timely and adequate manner and seeks to articulate and coordinate various program across the nation.

The National Policy on Food and Nutritional Security promulgated by the Colombian government is based on the work being done by the Institute Colombiano de Bienestar Familiar (ICBF) among poor and underserved populations. The emphasis of this policy is to provide services to children under two years, arguing that in the presence of food insecurity it is necessary to concentrate efforts on this population group in order to assure a good start in life. The policies being advance are tailed to different groups and take into account urbanization levels, gender, ethnicity, social status and disability in order to redefine growth patterns and to create a nutritional surveillance system which is the foundation of intervention strategies (9).

The Intersectorial Commission for Comprehensive Care for Early Childhood was founded in 2011 with the goal of coordinating policies, plans, programs and measures necessary for the implementation of comprehensive care for the very young. One of their biggest accomplishments has been the creation of a healthcare strategy for early Childhood care whose central component is to provide services to pregnant women and children from birth to 6 years of age (20). Each of these national efforts and strategies have been translated into effective intervention programs designed to improve food safety along all segments of the Colombian population.

An effective strategy to deal with food safety in Colombia has been the Hogares Comunitarios de Bienestar (HCB) which has been in existence since the 1980s. The HCB is considered a model human development strategy for the delivery of services to the poorest urban and rural communities in the country by targeting both family units and the community in general. Currently, HBC is present in 1089 of the 1103 Colombian municipalities, benefiting more than one million children under 5 years of age who belong to the most vulnerable sectors of society. In 2011, the HCB achieved coverage of 54% of the poor population between 0 and 5 years. This program is patterned after the Educate Your Child program which was developed in Cuba and is one of the largest in Latin America (15).

Another strategy has been the Hogar Comunitario Familiar which provides services to specific population segment denominated "community mothers." These community members, working in partnership with the government, provide children with care, affection, education and food according to nutritional guidelines (15).

Current programs administered by the Ministry ofAgriculture and Rural Development have been structured in accordance with the guidelines of food safety policy and seek to encourage food supply as well as to promote food production (9).

In addition to the federal and private initiatives related to food security, researchers have also played a role in dealing with this topic in Colombia. Several studies designed to measure food security were implemented between 2005 and 2010 (15-17). Results from the ELCSA suggest that 57.3% of Colombian households experience food security in Colombia while 42.7% experience food insecurity; these figures represent an increase of almost 3% from 2005 levels (19)

Similarly, results from the 2011 study in Cajica (Colombia) by the nongovernmental organization (NGO) "Children Without Hunger", provide a wake-up call on the need to understand the food security needs of residents in the area. After finding similar results in an exploratory regional study, the Nutrition, Genetics, and Metabolism Group conducted an exploratory study has called for additional research in other municipalities across the nation (19).

Given their role as the future of the nation, Colombia has placed a great deal of effort in improving the welfare of its youngest and most vulnerable population segments. The National Development Plan "Prosperity for All" contains a strategy called "Zero to Forever". This emphasis of this community based intervention is the eradication of conditions that contribute to poverty and extreme poverty which prevent equality even before birth. As a result, "Zero to Forever" is a set of planned activities aimed at promoting and ensuring early child development of girls and boys ensuring comprehensive care for every girl and boy, according to their age, context and condition. One of the areas of special emphasis in the "Zero to Forever" strategy is related to decreasing food insecurity in that group (21).

Regional context

According to the Department for Social Prosperity has identified the Caribbean Coast and the Choco region with the highest rates of food insecurity 58% and 64% respectively) (22,24).

Given the high rates of food insecurity in these regions, it is not surprising that one of the 11 points in the Caribbean Commitment plan is the "Elimination of malnutrition of the infant population from 0 to 4 years and fulfillment of the UNMDG." Several strategies have been deployed to achieve those goals including partnerships with the Banco Interamericano de Desarrollo (BID) in a program known as the "Caribbean without Hunger," this program seeks to eradicate hunger and child malnutrition using strategies suggested by the national plan (24-30).

The "Caribbean Without Hunger" program is comprised of three components including defining a Regional Development Plan; the development of a multisectorial network to implement the action plan, and the monitoring and evaluation of the project. Measuring progress in the region in food safety it has been entrusted to the Observatory of the Colombian Caribbean (11,23,27-30).

Conclusions

There are two UN Millennium Development Goals directly related to food and nutrition security in the global context. Specifically, the UNMDG call for the Eradication of extreme poverty and hunger and 2) reducing child mortality.

The level of compliance with these indicators shows whether a country is making progress and resources available to procure and distribute appropriate nutritional resources to early childhood populations. By investing in programs designed to advance this two goals, it is anticipated that countries will address issues related to nutrition, health, and child development among pediatric populations.

The UNMDG make it priority for developed nations and the so-called third world to direct their efforts to support programs, services, and organizations attempting to decrease food insecurity among vulnerable populations. All these efforts attempt to bring together multiple players to improve access to quality foods while mitigating problems resulting from poor child nutrition including preventable morbidity and mortality.

Conflict of interest: None.

Funding: Universidad del Norte.

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