Food and Water Insecurity, with Nadia Koyratty Artwork

Buffalo HealthCast

The official health equity podcast of the University at Buffalo’s School of Public Health and Health Professions.

Buffalo HealthCast

Food and Water Insecurity, with Nadia Koyratty

March 02, 2023 • University at Buffalo Public Health and Health Professions • Season 3 • Episode 2

Join UB master's degree students Nicholas Levano (public health), Danielle Nerber (public health and medicine), and Nikitha Cothari (biomedical informatics) as they interview epidemiologist and global health researcher Dr. Nadia Koyratty, PhD, MS about food and water insecurity in low-, middle-, and high-income countries.
Dr. Koyratty is a University at Buffalo School of Public Health and Health Professions alumna, receiving her PhD in Epidemiology and Environmental Health in 2021. She has over 10 years of health and nutrition research experience, both in academia and in industry, specifically focusing on low-, middle-, and high-income countries. Her primary interests lie in the global public health field, with a focus on food security, water security, and non-communicable diseases.

Resources:

Papers Authored by Dr. Koyratty:

Credits:
Host/Writers: Nicholas Levano, Danielle Nerber, Nikitha Cothari
Guests: Dr. Nadia Koyratty, PhD, MS
Production Assistant/Audio Editor: Sarah Robinson
Theme Music: Sungmin Shin, DMA

Intro 0:01
Welcome to Buffalo HealthCast, the official health equity podcast of the University at Buffalo's School of Public Health and Health Professions. In this podcast, we cover topics related to health equity in Buffalo, the US, and globally. This season, we'll take a look at food insecurity and health equity on a global scale. You'll hear from experts around the world who specialize in areas like urban agriculture and food contamination, soil science, food sovereignty, refugee health, intensive agriculture, and more. This season's episodes were completed in Dr. Kasia Kordas' Global Health class, a graduate level course offered at the University at Buffalo, and produced by the School of Public Health and Health Professions.

Nicholas Levano 1:02
Hello, everyone, my name is Nicolas Levano, and today I'm joined with my colleagues Danielle Nerber, and Nikitha Cothari, as well as our guest speaker, Dr. Nadia Koyratty. Our topic of discussion today is food and water insecurity and how they impact child development, health and daily living. Dr. Nadia Koyratty is currently an Associate Research Fellow at the International Food Policy Research Institute. Her work encompasses nutrition, food security, and health in low- and middle-income countries. As a Postdoctoral Research Associate at the University of Maryland in Baltimore County, she has worked on food security during disruptive events such as natural hazards and public health emergencies, such as the recent COVID-19 pandemic. Dr. Koyratty obtained a PhD in Epidemiology from the University at Buffalo, and has a Master's degree in Sustainable Management of Food Quality from the University of Montpellier in France, and from the University of Basilicata in Italy. Her research interests include food sciences, food insecurity, water insecurity, and nutrition interventions in low- and middle-income countries. Thank you for joining us today, Dr. Koyratty.

Dr. Nadia Koyratty 2:05
Thank you for having me.

Nicholas Levano 2:10
So I want to start off about talking with water insecurity. And for many of us who grew up with access to clean and safe drinking water, we often take this for granted and how much of a privilege this is, because it also affects how we perceive the burden of water insecurity. According to UNICEF, if we look at the global burden of food and water insecurity, we see that one in five children do not have access to enough water to meet their everyday needs. And at least 40 million children are severely nutrition insecure. According to you, and based on your experience, what are some of the factors that contribute to water stress, Dr. Koyratty?

Dr. Nadia Koyratty 2:43
So, I would like to address the definition first, of food and water insecurity. Because the statistics that you have given address one portion of food and water insecurity, but it by no means covers the whole aspect of what food insecurity means. So food insecurity covers or refers to availability to food, access to food, which can be financial, social, or physical, and acceptability of food, which refers to if you think about the cultural context, is the food adequate or acceptable to eat? You have vegetarian, you have people who are restricted by their religions, you have people who are restricted by their ethical beliefs. So all of that is part of the acceptability of food, which forms part of food insecurity. There's also the aspect of utilization. And by utilization, I mean, how to prepare food, when the food is actually beneficial to you, since we're talking about children, to the child, and at what ages and what kinds of foods are good for the child to biosynthesize the food for their nutritive value, and reliability as well, because the food that is accessible and available and acceptable, need to be available regularly, they can't be sporadic. There needs to be constant access to acceptable and preferred foods. So that's one aspect. And often when you look at the literature, food insecurity is measured with respect to economic and financial access. So the state of food security and nutrition in the world, that's called SOFI, the SOFI report focuses mostly on undernutrition, undernourishment, overweight or obesity for children food security assessment. It wasn't until very recently that they started using the food insecurity experience scale to assess food insecurity as a whole. But even then they still focused on the economic and financial aspect of food insecurity. And that was at the household or individual level, not at the child level. So there's still some work to be done to actually determine what constitutes food insecurity among children. Because if you look only at the household, food insecurity of the household does not determine food insecurity at the child level, because there are differences in what is allocated to the child in terms of quality and quantity. And that is not covered in the current measurements. And like you said, Nicholas, about 25% of children under five, worldwide are affected, but that's in relation to undernutrition, such as stunting and wasting. Food insecurity itself is not measured.

Danielle Nerber 6:10
Something you said just a few minutes ago, you talked about how important it is for consistency and kind of making sure that we're addressing this at the beginning. In our research, we came across UNICEF, of course, and how they have this whole idea of the first 1000 days, which is that critical window to ensure that children survive and thrive. What do you think about that idea, and how it kind of relates globally?

Dr. Nadia Koyratty 6:39
Well, that's an excellent question. The 1000 days is absolutely a critical period, during which we need to address both food and water insecurity, because based on the flowchart, on the pathway to child undernutrition, or child growth and development, food and water are the other resources that underlie the type of environment in which the child grows and develops. And because poor child growth occurs in utero, we have to focus on the mothers as well, and the mother-to-be during the pregnancy period, which constitute the nine months in the 1000 day period. So mothers need to have access to proper food and safe water, because otherwise that affects the development of the fetus and eventually of the child. And we've seen as well that once a child is born at low birth weight that affects his or her trajectory over time in terms of growth. And there are a lot of implications for this because it affects the physical growth of the child, but also the motor and social skills, the education attainment, the cognitive function, and so on. So definitely the 1000 day window is adequate to intervene. But that said, I don't want to diminish the other time periods during which interventions are still useful. Above five years of age, for example, while the child is growing, because you can't focus on only one timeframe and expect everything to change over time. You need consistency and the 1000 days is going to work one generation and to consistently provide food insecurity over time ensures that multiple generations are protected and are healthy.

Nicholas Levano 8:44
Well, one thing you actually touched on was how environment is also an important factor when it comes to food insecurity. And also how financial situations and accessibility are important to child development. So I was wondering, how does the role of food deserts impact or influence adequate nutrition and development in children?

Dr. Nadia Koyratty 9:04
So food deserts, that's a different beast, because food deserts are very common here in the US. And we've seen that a lot of people will access foods or will have only access to foods that are not generally healthy. Because the shops that are around them, the corner stores, don't have the foods that they need. On the other hand, food deserts in lower and middle income countries, comes mostly as issues with farming, with droughts and flooding, where the farming community are not able to produce as much as they can to eat themselves, and to sell for their households to survive. Does that answer your question?

Nicholas Levano 9:52
Yes it does, it actually reminds me of a concept that we've talked about in our classes related to global health. It's the concept of the Global North and South divide. Basically, this concept covers that typically developed and high income countries have the means to intervene, while low and underdeveloped nations tend to face the burden of these issues. So based on this concept, where do we see these issues of water insecurity and food insecurity seem to be most pressing in the world?

Dr. Nadia Koyratty 10:21
Surprisingly, for me, from what I've observed working in both high- and low-middle income countries, both areas, both regions have their specificities and their issues. It's not that one is better than the other. No, you have to consider the context of the region, like you said. Higher income countries may be able to intervene and address issues easier. But the political situation sometimes hinders that in high income countries. Whereas in low income countries, the issue is a lot of donors and international organizations are the ones that intervene. Governments are often in support of those interventions, or of those help that are provided to address food or water insecurity. So unless and until governments of all the countries whether high- or low-middle income countries come together to address the issues that are most pressing in terms of food access and water access. I think we'll continue seeing issues in terms of child health related to food and water. I also want to stress again, the fact that it's not only low-middle income countries that have food insecurity issues or water insecurity issues. The problem is very widespread and quite significant, even in the US.

Nicholas Levano 11:49
Yeah, this is a very important concept to touch on, especially because as people who've grown around areas where they have access to safe drinking water, and also available access to healthy food options, they may not recognize how widespread this issue really is. When we think about water insecurity and food insecurity, we tend to often think of them as separate issues. However, we recognize that there are overlapping factors that contribute to them. What is the relationship that exists between water insecurity and food insecurity, and how one might promote the other?

Dr. Nadia Koyratty 12:21
So, similar to food insecurity, water insecurity also encompasses different aspects. So water has to be available for households to be water secure, the water has to be of adequate quality in terms of the smell, the taste, and it has to be safe in terms of the microbiological contaminants, levels of microbiological contaminants, to be safe, and the water has to be reliably accessible. And like food, it has to be stable over time, you have to have consistent access to water to be water secure. And in terms of accessibility, I would like to stress the physical accessibility in low-middle income countries. Because a lot of times in rural areas specifically, there are no water systems, as you have here or in higher income countries. So piping systems are not as developed as they are in other countries. So again, water insecurity encompasses all of that - availability, accessibility, quality, safety, reliability. And when thinking about those things, each individual component of water security will affect different aspects of food security. My favorite example to give is always you need to be water secure, to be able to cook the foods that you need. So what do you need when cooking food? You need to prepare the food, you need to clean it, you need to wash it to ensure that the food is safe to cook, you need to clean your utensils, you can't use the same over and over again, you have to have clean utensils. And to do that, you need water. So in a way water security enables the process of cooking and preparing food. And another example would be different types of food requires different processing or culturally acceptable ways to prepare that food. For example, if you're eating beans, often they have to be boiled. There are different types of other foods that you cook either in oil or you steam them. So you have to consider again the cultural context. What is acceptable and what is usual for the people to eat. You can't just go there and tell them they need to prepare their food differently or they need to eat different things. So we have to make sure that the water that is available to them is adequate to prepare their food. So that's one way. And in terms of hygiene that is also related, because you need water to wash your hands, again, to clean your utensils, so that the foods that you cook are actually safe for people to eat.

Nicholas Levano 15:24
One important topic that you talked about with cultural practices, and especially in low income nations, or underdeveloped nations that don't have the proper infrastructure or access to water, we see that water collecting is common practice in these regions. And how does water collecting affect children's safety?

Dr. Nadia Koyratty 15:46
Oh, I love this question. So during my work on food and water insecurity, I came across a lot of different aspects in which water insecurity affects child's health and in different ways. So in countries where the water sources are far away from the households, it's often the responsibility of the child to go and fetch water, that's one. And often that child will be a girl rather than a boy child. And this affects the child's safety in terms of their physical safety, they may fall while fetching water, they may hurt themselves, because where they have to go get water isn't properly paved, for example. The other thing that I found was that mothers who go to fetch water, they often leave their children at home, either without supervision or under the supervision of younger siblings. Now, this is an issue because if something happens to that child, there will be no adult to help out or to guide them. So these are two main ways in which water insecurity or having poor physical access to water can affect directly the child's physical health. But there's also the aspect of child education, like I said, because water is sometimes very far away, you'll find in certain countries, they take up to five to seven hours of walking to get to the water sources. And like I said, also, often it's the children's responsibility to get water because the parents have other things to take care of. And that increases the level of absenteeism in schools. And sometimes the children are just taken out of school altogether and don't get the education that they deserve.

Nicholas Levano 17:52
Yeah. So you mentioned the gender discrepancy. And I wonder how that physical stress of collecting water is toward pregnant women and how that affects developing children that they're carrying?

Dr. Nadia Koyratty 18:01
Yeah, yeah, I did cover that in one of my papers, where fetal development is affected because of the load of carrying water. And that there is no explanation for that other than it's heavy, it hurts the person, they may have back issues, which has been reported before, they may have back issues, they may fall because of the load of water that they're carrying, they may have to walk too far to get access to water and thus affect their ability to take care of themselves to feed themselves adequately. Fetal development has actually been shown to be affected by the distance by which pregnant women have to walk to get water.

Nicholas Levano 18:48
But it's very important that it's also recognized that there's also physical hazards that present barriers to children's health, especially absenteeism, how you mentioned that, because of the long distance they have to cover, children are losing days in school, which affects their education level. And we know how important education is when we talk about determinants of health.

Dr. Nadia Koyratty 19:07
Absolutely, and eventually it affects the economic development and the population development as a whole of the country.

Nicholas Levano 19:16
Have you seen any documented research in regards to how food and water insecurity and malnutrition - what it does to the health of a child?

Dr. Nadia Koyratty 19:24
Yeah, so food and water, like I said, are resources that form part of an environment in which the child grows and develops. So if you have inadequate resources, including food and water, that leads to different health issues. For example, stunting is an indication of the poor resources, whether it's just food or water or other kinds of resources. And food insecurity and water insecurity has been shown to affect early child development in terms of things like social development, speech attachment to parents, cognitive development where IQ levels are lower among those who have food and water insecurity in their environment. It cannot, further down the line, when you look at a lifecycle approach, it also affects the types of diseases that the child gets, and the wages that the child gets eventually when they grow up, and the type of economic influence it has over the population as a whole. Those are documented impacts that you can find in all of the literature on early child development.

Danielle Nerber 20:58
So we're going to switch gears now, I'd like to talk a little bit more about some real time issues that have been kind of happening around the globe lately and the impacts and dive a little bit deeper into Dr. Koyratty, your particular research and interests.

Nikitha Cothari 21:18
Hi, I'd like to ask my first question from the COVID perspective. So now we know that COVID caused a lot of hardships and people all over the world, both in high income and low-middle income countries. So you've done some research on what the pandemic has done in relation to food insecurity. Do you mind sharing about that a little bit?

Dr. Nadia Koyratty 21:38
Absolutely not. So the research that I did on disasters included both natural disasters such as hurricanes and tornadoes, and COVID-19. So COVID-19, in particular, because it was labeled as a public health emergency, I actually did a few in depth interviews with different people who everyone was affected by COVID. But I did interviews with different people to get an idea of the experiences that they had with respect to food insecurity during COVID. And a lot - there's so much to talk about. First, a lot of people lost their jobs. I mean, we all know that a lot of people lost their jobs, and they had reduced income. And with reduced incomes, often it's the food that gets sacrificed first. So lower quality or cheaper food products are bought, rather than what people would normally like to buy, for many reasons, because - either because their economic or financial capacity is reduced, because they have to pay the mortgage, they have to pay the electric bill, the water bill, whatever it is. So financial, and economic hardship affects food insecurity, in terms of access, economic access, and the quality of food that is eaten and the preference associated. And during COVID, we also saw increased prices on certain foods, on certain food items. For example, in New York City, eggs increased in prices by, I think, 35 or 40%. Now, eggs are kind of a basic thing for most people. And the fact that the prices increased affected, obviously people's purchasing habits. There was also issues with markets, generally, the food markets where imports were affected. Not enough food was being imported into the country, or if it was, it was stuck somewhere without being able to enter the country. So one example is Mauritius, where a lot of food is imported from other countries outside of the island. And the ships that brought in the food were stuck at the port because of COVID. So they couldn't unload the foods. So that definitely affects what foods are available on the market as well. And in terms of food processing, so COVID affected the whole food system. And I touched on the markets, the prices, and I will also touch on the production side. We saw that meat production had halted at some point in time in the US, and that was because certain workers in the meat production line were affected by COVID and they had to shut everything down and make sure that the disease didn't spread. So that affected the availability of meat on the market and hence the prices of meat as well. And we also saw that there was a huge loss in milk. I'm not sure what the issue was, but it happened during COVID, where a lot of milk was thrown out.

Nikitha Cothari 25:21
In keeping with the theme of impact of disasters and food security, I believe you also have an interest in more national hazards such as climate change. What kind of impacts are we seeing globally in families and children in relation to this?

Dr. Nadia Koyratty 25:36
Yeah, so climate change leads to a lot of natural hazards. We've seen that - droughts, floods, increased tornadoes, hurricanes, wildfires, and as we've seen recently in Buffalo, snowstorms. All of these natural hazards, obviously, will impact food access, because they impact the whole food system. I'll give an example of some interviews that I did with victims of Hurricane Florence in North Carolina. So because of the hurricane, a lot of people reported closed roads, roads that were flooded, roads that were damaged, that prevented them to access food stores. That's one way. The second way was, several people said that their house was destroyed, their kitchen was destroyed. So you can't expect people to be able to cook without the basic necessities like a stove. Or you can't expect people to have access to save food, when their fridge is not working because of power outages or loss of electricity. So these were some ways in which food insecurity is impacted during natural disasters here in the US, and also because of different road closures or monitoring of specific areas, sometimes, trucks, food trucks that bring food to families that are affected by natural disasters can't get through, they can't get to the affected communities. The one thing that was good was that communities that are very cohesive, they will share the food that they have. One particular person, it was a very emotional interview, one particular person said that they lost their home completely. And they were walking around aimlessly trying to find other people. And they came across a house that was partially in good condition. And there was someone there cooking, and that person invited them over to have lunch or dinner with them. So the sharing component also comes into play. Yes, food insecurity is affected, but it can be helped or it can be - the effects can be lowered with help from communities and from different areas, from different people, from different organizations. Food production and food access or food availability is also affected during natural disasters. For example, food stores, like I said, if there's a power outage or you lost electricity, or you lose electricity. Even the stores lose electricity, right? So everything that's in the freezer is lost. And all that's available are foods on the shelf. And all that people can access and eat are foods on the shelf. And sometimes that's not fruits and vegetables. Sometimes that's food that is not nutritionally adequate. Sometimes that's food that needs to be cooked but then you can't cook because you don't have the basic stove or kitchen equipment. I think that covers high income countries. In low income countries, we've seen that disasters, well, natural disasters like droughts affect many different countries. When I was in Zimbabwe, for example, and working on food insecurity, there were crises in terms of rainfall, where for two years subsequently, the rain fell. The rainfall was behind the time, so if the rain was supposed to fall in October, it fell instead in December, so that affected the harvesting of products, of food products. The planting season, it affected the lean season, it affected the hungry season in the community. So people were harvesting less than than they would normally. And that obviously led to food insecurity, especially among the rural populations, but also among the urban populations because they obtain their food from the rural areas. And if the rural areas are producing less, that means less is available for the urban areas because they will keep most of it for themselves to eat.

Danielle Nerber 30:22
And I'd like to start wrapping it up a little bit and just kind of focus a little bit more on what you do think will be good possible solutions and promising interventions that might be out there to help with food and water insecurity, particularly as it pertains to child health. And the one project that I came across that I believe you got to see firsthand in Zimbabwe, was the Shine Project, which is also known as the Sanitation Hygiene Infant Feeding Efficacy Project. Could you kind of talk about what that trial was aiming for and what that experience of traveling there was like for you?

Dr. Nadia Koyratty 31:02
Sure. So being in Zimbabwe was great. That was one good experience. Working with the Shine, so I wasn't involved in the development of the Shine trial, I was part of it when it was wrapping up. And the main objective of the Shine trial was to address stunting among children and anemia among pregnant women. So they did a randomized control trial that involved infant feeding practices. So that included education to mothers of newly born children, and breastfeeding and water. The second intervention was water, sanitation, and hygiene. So for this intervention, they focused on encouraging people to treat their water before drinking, on hand washing for hygiene, and on building toilets for sanitation. And those two interventions were also combined. So we had the standard of care arm, the infant feeding arm, the wash arm, the water/sanitation/hygiene arm, and the fourth arm included both the infant feeding and the water sanitation and hygiene intervention. So the purpose was to see what effect the combined food, the combined nutrition intervention, and the wash intervention would have on stunting, whether it actually improved the incidence of stunting in children and whether it improved anemia in the mothers. The one thing I would say is that the intervention was not on food insecurity. And the intervention was not on water insecurity. Like I mentioned, their nutrition intervention included breastfeeding and complementary feeding education, and the water intervention included treating the water. So in terms of water insecurity, the wash arm only addressed safety of water, safety and quality of water, because they showed the households that participated, how to treat their water and why they should be drinking clean water. And the nutrition intervention was to educate mothers on how to breastfeed and what to feed their children after six months of age. So there's definitely things that they did that showed improvement. But as a whole, they did not address food insecurity and water insecurity with all the aspects that I mentioned before.

Danielle Nerber 33:56
Thank you for sharing that. And I think what you just shared kind of beautifully connects to some of the points that we made earlier, one being when we brought up the first 1000 days, it sounds like the Shine Project, you know, attempted to kind of take into account the breastfeeding issue and how to kind of address it early on. But like you said, it's about consistency. It's about carrying on those interventions past those 1000 days into early childhood, into adolescence, and so on. And the same idea of how water and food are so interconnected and how it's important to address both of them. And it sounds like with this project, it kind of, like you said, lacked the ability to change the infrastructure in the built environment, and really kind of hone in on maybe the root causes of water and food insecurity. So with that being said, I know this is going to be a big broad question to end with, but what do you see as sustainable interventions? More particularly, I guess, for low and middle income countries where resources might not be as available, what kind of would be your dream idea of how to attempt to fix these solutions, particularly as it pertains to child health?

Dr. Nadia Koyratty 35:14
Hmm, that's a great question. And I think the first thing I would like to address in your question was when you said, lack of resources, that is not really true in most of the lower middle income countries that I have visited. The resources are definitely there. It's utilization of those resources to address food and water insecurity that is lacking the resources in terms of the physical availability of things on the technical skills available, those are there, those are present, what we lack is commitment from different entities, policies to address these issues. And the way I see things forward is not with a single intervention, either for food or water insecurity, like I mentioned, because food insecurity and water insecurity have so many different aspects, availability, access, reliability, quality, safety, utilization, all of these are needed for security related to food and water. So the idea that I have is to focus on the food system as a whole. So address all the sources from the beginning to the end user. And ensure that every step of the way is optimized and efficient to ensure that no person is food insecure, or water insecure. And once you've addressed the system as a whole, I'm not saying this is going to take two minutes, but it's definitely going to take years of practice and of interventions at each level to reach an environment that is adequate for the child to grow healthily, and for adequate development of the population. And again, I think the endpoint shouldn't be just the child, it should be the population as a whole, and you start with a child or you start with the pregnant women first. But that has an intergenerational effect, just like if you approach food and water insecurity as in a system, dynamics modeling for instance.

Danielle Nerber 37:52
I want to reiterate and I thank you for clarifying that these countries like you said, they do have the resources, it's just figuring out how to utilize it, how to make those connections and how to build capacity in the communities because ultimately, I think that's how sustainable and effective programs are going to be created in order to help the situation. Thank you so much for joining us and sharing all your knowledge, it was absolutely a pleasure. Does anybody have any last minute thoughts or ideas? Nadia, you as well, if you have anything you want to wrap it up with, that would be great.

Dr. Nadia Koyratty 38:35
No, not that I can think of, maybe just be aware of your peers who may be food and water insecure. There are a lot of people even at college level who are food insecure. And they may be embarrassed to share that information, but you can always share the resources that UB has available for addressing or for helping people who are food insecure.

Sarah Robinson 39:15
This has been another episode of Buffalo HealthCast. Thank you to our guest Dr. Nadia Koyratty, for taking the time to be featured on our podcast today. This episode was written and recorded by Nicholas Levano, Danielle Nerber, and Nikitha Cothari for Dr. Kasia Kordas' Global Health class in the Fall of 2022. Our theme music was written and recorded by Sungmin Shin, of the UB Music Department. I'm Sarah Robinson, your production assistant and sound editor for this month's episode. Join us next time on Buffalo HealthCast to learn more about health equity in Buffalo, the US, and around the globe.