Homelessness: The Hidden Nutrition Issue

The goal of food system transformation is to build a future where all individuals have access to healthy diets against a backdrop of current challenges such as hunger, poor diet quality, inequity and threats to nature. Charitable food donations serve as the primary food source for people who are experiencing homelessness. They suffer disproportionately high rates of diet-related chronic illness such as hypertension, hypercholesterolemia, and diabetes mellitus but are often poorly diagnosed and treated. Yet, the diets and nutrition of homeless populations receive negligible attention as a public health issue. Social institutions such as shelters and soup kitchens have the opportunities to help affect their health. Since this spring, I have begun a monthly commitment to volunteer at two non-government shelters in Washington DC where there are 6,380 people experiencing homelessness on any given day.

With a very small paid staff, The Father McKenna Center serves hot breakfast and lunch for men experiencing homelessness from Monday to Friday while relying on volunteers to providing such care. Having served hot breakfast to guests on a monthly basis there, I observe that the foods are rich in carbohydrates coupled with animal-source protein, with little addition of fruits or vegetables. It is however worth noting that they serve fresh salads for lunch.

An example of sit-down lunch served at the Father McKenna Center. Source: Father McKenna Centre

At Martha’s Table, I volunteer once a month to assist with their mobile food service, McKenna’s Wagon, that distributes meals for people experiencing homelessness directly in downtown DC. The typical package consists of hot meals (as of July 2022, it was rice and beef stroganoff), sandwiches with American cheese and ham, and bottled water. It struck me that many people then asked if we had any vegetarian alternative for the beef stroganoff. While the amazing cook at Martha’s Table would prepare vegetarian options, the quantity was usually much smaller than the typical hot meals so we could not fulfill the guests’ demand for vegetarian meals. This echoes with a 2016 study in DC through a six-month observation at Georgetown Ministry Center shelter that there were increases in consumption when healthier foods were available, in addition to verbal confirmation of interest for healthier options.

Volunteers for McKenna’s Wagon. Source: Author.

So, what can we do about it? First, we need to debunk the common belief that individuals experiencing homelessness have the tendency to desire junk foods. This is a wake-up call for us to tap the potential to impact food access, choice, and quality for homeless populations by donating healthier food products than the common high-starch, high-sugar foods. A 2015 study in ten shelters across Boston finds that two biggest obstacles for shelters to accessing healthy foods were budget and space constraints, but they could still improve food quality even within a budget constraint. Second, nutrition education programs for the cooks, food providers as well as for the guests should be considered to be included in shelters and soup kitchens. Previous research has demonstrated that such nutrition education in shelters was effective and well-received by guests.

 Such concerted efforts to improve the health among people experiencing homelessness would also spill over in other arenas of social life. In today’s difficult time where wars and global pandemics co-exist, we need to invigorate civic engagement in our own society to generate trust, reciprocity, and cooperation. This in turn will help reduce cynicism, and develop social capital that is a critical source to help tackle the issues of inequality, alienation, and crime in industrialized democracies.

Deviana W. Dewi, MA, is an International Development PhD student at the JHU School of Advanced International Studies and a GFEPP Research Assistant.

Inclusive Transformation of Food Systems for Healthier Diets is More Crucial than Ever, for Better Health, and for Our Planet

After decades of progress, since 2015 the downward trend in global hunger has reversed. The recently released UN State of Food Security and Nutrition in the World 2022 Report says no different. It estimates that as many as 828 people are going to bed hungry and calls for “repurposing food and agricultural policies to make healthy diets more affordable.” Key findings are summarized in FAO’s interactive tool.

Among these key findings are repeated evidence we are failing to address the challenges of our food systems. First, inequities persist in current food systems, such as the ones related to income and gender. Food insecurity remains concentrated in rural areas, where 80% of the world’s extreme poor reside, and who depend in large part on agriculture and natural resources for their livelihoods. Food insecurity and malnutrition affect the poor, rural, women, adolescent girls, children, and those in conflict and geographically isolated areas the most. Second, diets are a top risk factor for disease, and 11 million deaths and 255 million disability-adjusted life years occur every year due to dietary risk factors. Non-communicable diseases (NCDs) are on the rise and are estimated to cause almost 75% of deaths around the world. Food systems transformation towards more nutritious, safe, affordable, and sustainable diets is key to overcoming malnutrition and diet-related NCDs. Amidst COVID-19, it has become even more vital to ensure nutritious, affordable food is accessible for all, and invest in sustainable, resilient, and holistic food systems, and ensure affordability and accessibility of such nutritious diets for all. It is crucial to shift toward healthy eating patterns and improve food production practices to ensure sustainable food systems reach everyone with healthy diets and to reach global goals such as the SDGs, or the Paris Agreement.

Research and evidence are essential to move beyond the current food systems stalemate. The annual Agriculture, Nutrition and Health (ANH) Academy Week showcases new knowledge and multidisciplinary research, providing opportunity for collaboration, exchange, innovation, and learning. It provided an accessible, equitable, and unique learning/knowledge mobilization experience through this year’s 15 learning labs and three-day research conference. In the context of the “new normal”, the event happened as hybrid, bringing in multiple benefits such as reduced travel-related CO2 emission, and more equitable and wider access to resources.

ANH Academy is a place for a multidisciplinary, multicultural, and equitable research community to foster collaboration to break down the barriers and silos across all nodes of the food systems to facilitate the knowledge and evidence uptake in policies and programs, and capacity enhancement to improve food systems, nutrition, agriculture, health, and resilience for all, and improve our planet.

Research indicates inequities in the knowledge ecosystem in nutrition and food system in the world

According to the 2020 Global Health 50/50 Report, despite the rise in gender equality and diversity among health organizations’ employment strategies, only 5% of the leaders are women from low- and middle-income countries.

Inequities in the production of academic knowledge related to global health, nutrition, food systems, and research persist, particularly based on geography, institutions, and individual factors including gender,” said Swetha Manohar of Johns Hopkins’ Global Food Ethics and Policy Program (GFEPP). Purnima Menon of the International Food Policy Research Institute called on every single member of the research community to “i) recognize who you are in a knowledge system; ii) what inequities exist around you; iii) where on the research continuum you can do something; iv) and to then do it.

Other takeaways we heard at the conference

  • Major concern is that the current global food system does not feed people equitably or sustainably. Transforming our agri-food systems is key to nourishing all.
  • Food systems are not delivering in terms of livelihoods and environmental impact, and for the most vulnerable in terms of nutrition and well-being.
  • Governments should invest in child nutrition surveillance systems and need to champion child-centered food systems.
  • Sustainable Food Systems toolkit aims to support the integration of sustainable food systems in the work of dietitians and nutritionists. Food and nutrition policy improvement is among the expected contributions. Training modules, key resources such as briefs on relevancy to SDGs, or case studies including LMIC contexts, and a community of practice are part of what the toolkit offers.
  • In South Africa, stunting is still an important issue. Children are losing physical and cognitive capacity, leading to an intergenerational impact.
  • A circular food system design to reduce excess resource consumption, food loss, and waste, include the best production and agro-processing practices, and catalyze recycling. 60% of the waste from African urban centers is biodegradable, and 20% is recyclable. According to UN’s Environment Programme, Africa is missing an opportunity to get back this waste back into the system.
  • Food Systems Countdown to 2030 initiative has the ambition to track food systems and their performance to meet SDGs and beyond. “Food systems transformation is urgent. Covering all aspects of food systems and their interactions requite a comprehensive framework of metrics” said Kate Schneider of the GFEPP. There are 60 collaborators, additional 65 experts, and collaboration with policy people in selecting the indicators. The next steps include finalizing the indicators, performance assessment, tradeoffs and synergies, sustainably.

There are many opportunities to establish a thriving society by creating sustainable food systems that respect the environment and provide sovereignty to communities around nutritious and culturally appropriate food. With the advancements in technology and communication around the globe, food system stakeholders can coordinate and collaborate toward a just food environment. Though the future of sustaining nutritious food is unknown under the influence of crisis and shocks, we have the power to shape it.

Destan Aytekin is an International Health Human Nutrition Ph.D. student at Bloomberg School of Public Health and a Research Assistant at the GFEPP, of Johns Hopkins University (JHU). At the GFEPP, her research focuses on analyzing governance for food systems transformation, and diets, nutrition, and health aspects of the food systems metrics. Prior to joining JHU, she worked at HarvestPlus, International Food Policy Research Institute, in Washington DC.

Jessica Fanzo named to Group Seeking Systemic Solutions for Climate Change’s Impact on Food Systems

Berman Institute faculty member Jessica Fanzo has been named to the recently launched Board for International Food and Agricultural Development (BIFAD) subcommittee on Systemic Solutions for Climate Change Adaptation and Mitigation in Agricultural, Nutrition, and Food Systems. The subcommittee will lead transdisciplinary evidence gathering to advise BIFAD with independent recommendations to improve U.S. Agency for International Development (USAID) programming and strategies.

“As a global community, we must act quickly to avoid the most severe consequence of climate changeon the world’s food supply and the health, food security, and safety of the world’s most vulnerable populations,” said Fanzo.

Dr. Fanzo is the Bloomberg Distinguished Professor of Global Food Policy and Ethics at the Berman Institute of Bioethics, the Bloomberg School of Public Health, and the Nitze School of Advanced International Studies at Johns Hopkins University. She also serves as the Director of Hopkins’ Global Food Policy and Ethics Program, and as Director of Food & Nutrition Security at the JHU Alliance for a Healthier World.

“I am honored to serve on the BIFAD Subcommittee on Systemic Solutions to Climate Change Adaptation and Mitigation. Alongside twelve other global experts, we recently began our work supporting BIFAD and USAID toward our shared goal of a resilient, prosperous, and equitable world with net-zero greenhouse gas emissions. Together, we have the important task of exploring evidence-based climate change action in programs aimed at safeguarding agricultural productivity, inclusive food systems changes, and poverty- and malnutrition-reduction objectives.”

The subcommittee is envisioned to support USAID’s role in accelerating systems change and transformative climate change adaptation and mitigation approaches in agriculture, food systems and nutrition, and in targeting climate finance to benefit smallholder farmers.  Subcommittee members bring a breadth of expertise across disciplines, diversity of views, and organizational perspectives to tackle the greatest challenge to food security.

Work Begins on Project to Incorporate Human Rights-Based Frameworks into Food Systems Policy and Planning

The Consortium for People-Centered Food Systems, led by Bloomberg Distinguished Professor Jessica Fanzo at Johns Hopkins University, has initiated the first phase of its ten-year effort to foster human rights-based approaches to food systems policy and planning. This effort seeks to strengthen the capacity of governments, peasants, and other people living in rural areas to adopt and incorporate human rights frameworks such as the UN Declaration on the Rights of Peasants and Other People Working in Rural Areas (UNDROP) into food policy and food systems action.

Adopted in 2018, UNDROP proposes that countries work with rural food system actors to create policies that promote and protect the right to adequate food, food security and food sovereignty, sustainable and equitable food systems, and others, such as the right to land, water, and seeds.

This interdisciplinary project seeks to use advocacy, build capacity, and develop accountability tools to better integrate human rights frameworks into the food systems policy context. Led by Dr. Fanzo, the project consortium includes academics, development practitioners, ethicists, and lawyers from Johns Hopkins University, RikoltoInternational Institute of Rural Reconstruction, and CIAT on behalf of the Alliance of Bioversity International and CIAT. The project is jointly funded by member organizations and the Swiss Agency for Development and Cooperation.

“Small-scale farmers produce more than 80% of the world’s food, but this diverse population suffers disproportionately from hunger, poverty, discrimination, violent conflict, and climate change. Human rights instruments like UNDROP represent a major step forward in protecting their human rights, but more work is needed to integrate them into food systems policy effectively,” says Dr. Fanzo.

Dr. Fanzo is the Bloomberg Distinguished Professor of Global Food Policy and Ethics at the Berman Institute of Bioethics, the Bloomberg School of Public Health, and the Nitze School of Advanced International Studies at Johns Hopkins University. She also serves as the Director of Hopkins’ Global Food Policy and Ethics Program, and as Director of Food & Nutrition Security at the JHU Alliance for a Healthier World.  Faculty joining Dr. Fanzo in this work from JHU include Drs. Leonard RubensteinAnne Barnhill, Swetha Manohar, and Rebecca McLaren.

Initial project activities will take place in Cambodia, Ethiopia, Honduras, and Uganda, and are funded by the Swiss Agency for Development and Cooperation. In each of these countries, project team members are partnering with Rikolto, IIRR, CIAT, and local stakeholders to assess the food systems context and identify potential areas for improvement in awareness, capacity, accountability, and policy coherence. Later phases of the project will aim to scale the approach to other countries and produce global guidance on putting people’s rights at the center of food systems. In the next few months, countries will begin by sensitizing the project in the four countries with local stakeholders and governments and will produce a paper on what it means in practical terms to integrate rights into food systems action and policy.

For media inquiries, contact: Jamie Smith, Jamie.smith@jhu.edu

Agri-food Systems Transformation: New, Ambitious Framework Proposed to Monitor Progress

Sustainable, resilient, just, and equitable food systems that support access to healthy diets for all are possible. Realizing this potential is of utmost, urgent importance if the world is to achieve the Sustainable Development Goals by 2030, the Paris Agreement, and other global goals. The UN Food Systems Summit in 2021 highlighted both the challenge and the opportunity for food systems transformation. However, at present there is no rigorous, coordinated effort to monitor all aspects of food systems and their interactions to set priorities and track progress. In a new paper, “Viewpoint: Rigorous monitoring is necessary to guide food system transformation in the countdown to the 2030 global goals,” Dr. Jessica Fanzo of the Johns Hopkins Berman Institute of Bioethics and colleagues call attention to this need for global food systems monitoring in order to inform decisions and support accountability for and good governance of the transformation process.

Under the leadership of Dr. Fanzo, Dr. Lawrence Haddad of GAIN, and Dr. Jose Rosero Moncayo of the United Nations Food and Agriculture Organization, over 50 collaborators have come together to propose a rigorous monitoring framework for food systems populated with a clear set of relevant, high quality, interpretable, and useful indicators to support evidence-based policymaking and those who hold decision-makers to account. In this initial paper, the authors have developed an overarching framework that establishes five core thematic areas in need of monitoring: (1) diets, nutrition, and health; (2) environment and climate; and (3) livelihoods, poverty, and equity; (4) governance; and (5) resilience and sustainability. Under these areas, they have established indicator domains and will go through a rigorous process over the next year to select the indicators to be monitored within each and produce a baseline assessment of global food systems.

Learn more about Professor Fanzo’s work in Food Systems Monitoring.