Food insecurity in vulnerable groups

The WHO asserts that the global food price crisis threatens public health and jeopardizes the health of the most disadvantaged groups such as women, children, the elderly and low-income families¹. Economic factors play a crucial role and could affect personal nutrition status and health. Poorer households facing food insecurity may be in fear of running out of food, or money to buy food, and face food scarcity. In many cases, they purchase cheaper foods than usual or simply go without food for a day or more².

Economic factors could threaten elderly diets and health

Some elderly people are at risk of malnutrition because of food insufficiency, with consequential lower intakes of various nutrients. In these instances the foods which provide these nutrients, like vegetables and meat are missing from their dietary variety³. For this group, the choice and consumption of food is determined especially by quality, taste, health and economic considerations⁴. Moreover, poor elders often have to curb their spending on food to have money for medical expenses (ironically, often nutritionally related)⁵.

Better dietary quality costs more

The food cost of healthy diets may be more burdensome. In a recent study, we found that, despite taking account of livelihood and income (personal or household), a more diverse diet was associated with higher total food expenditure among a representative Taiwanese elderly population⁶. Elders of lower socioeconomic status tended to choose foods which would have cost less. In addition, elders with the best dietary diversity spent about twice as much on meats and vegetables as those whose dietary diversity was the worse. Compared to those with poor dietary diversity, the best dietary diversity group’s expenditure on dairy and fruits was fourfold and six-fold, respectively.

Vegetable and fruit expenditures are associated with less risk of death in the elderly

Wealthy households have higher expenditures on animal-source foods, vegetables, and fats and oils compared to moderately and severely food-insecure households⁷. Greater vegetable, legume (beans), and fruit intakes are linked to reduced risk of all-cause mortality in older populations^8-10. This may be because of a corresponding reduction in the intake of other less nutritious foods¹¹. In rural Indonesia, households that spend a greater proportion on plant foods have a lower under-5 child mortality¹². In our study of Taiwanese elders, fruit and vegetable (F&V) – but not other food – expenditures, had a protective effect on all-cause mortality. Those whose vegetable intake was Q4 (61-80th percentiles) but not Q5 (81-100th percentiles) had a 45% lower all-cause mortality compared to those in Q1 (the lowest 20%), and for fruit had a 36% lower all-cause mortality13. The amount of food consumed in this group (Q4) for vegetables was 463 g/d and for fruit 377 g/d, which met WHO recommendations. This fits in with public health policy that encourages people to eat five servings of fruit and vegetables a day10,13. Moreover, if older adults increased food expenditure by NT$15 (or US$0.50) per day, with vegetables they would have a 12% lower risk of death, and with fruit, a 10% lower risk of death. A NT$15 increase for each of these food expenditures should not be an economic barrier for most older Taiwanese, but may well be for the socioeconomically marginalized.

Policy implications

That greater F&V intakes can benefit survival is evident^9,10. However, physical factors such as chewing ability¹⁴ and economic factors can limit F&V intakes among older adults. Indeed, the entire food system contributes to the availability, affordability and utility of F&V intakes; in this regard, it is noteworthy that shopping, food storage and food preparation are involved and improve health outcomes^15,16. Public health policy should not only focus on promoting healthy diets or increasing F&V intake per se, but on the reduction of economic barriers to affordable healthy foods, especially F&V. Health departments also need to plan for seasonality and natural disasters (such as typhoons in Taiwan), which can alter the F&V supply dramatically and drive up prices quickly. The resultant unaffordability for the economically marginalized, notably elders and the socially disadvantaged may thereby be minimized. It is clear that attention to food budgeting, with an emphasis on F&V, should form a part of food and health policy.