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Potential Solutions to Food Apartheid: Philadelphia and BeyondThakur, Shreya, 0009-0002-5858-6967 05 1900 (has links)
Food apartheid, a term that describes the deliberate nature of food insecurity in the US, is a bioethical issue because people need access to nutritious foods to help sustain a healthy lifestyle, but not all people have this access. The lack of this ability to easily obtain healthy food has contributed to chronic medical issues that span across generations in urban areas such as North Philadelphia. Hospital systems have an ethical obligation to address food apartheid in order to uphold the urban bioethics principles of social justice, non-maleficence, and solidarity. There have been many solutions implemented by local and national organizations and governments to try to combat food apartheid, which healthcare institutions can incorporate in order to benefit their patients. In this thesis, I will discuss some of these solutions and whether they have been shown to be effective in combatting food insecurity. These solutions include fresh food financing initiatives, which aim to open more grocery stores carrying fresh produce in areas affected by food apartheid, and healthy Corner Store Initiatives, which try to increase produce availability in existing corner stores. I will also discuss produce subsidy programs, which discount the price of fresh fruits and vegetables, and urban agriculture, which is usually a community-based initiative to increase access to fresh produce. After a description of the solutions, I will discuss the efficacy of examples of each of these types of programs, and if applicable, will mention if these programs have worked to address food apartheid in Philadelphia. Then I will discuss how well each solution incorporates Urban Bioethics principles. Finally, I will conclude with an analysis on which method may be most sustainable in combatting food apartheid and will explore why healthcare institutions must incorporate these methods in order to improve the effectiveness of the care they provide patients. / Urban Bioethics
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Anemia e insegurança alimentar em crianças em idade pré-escolar / Anemia and food insecurity in preschool childrenRocha, Élida Mara Braga 06 February 2017 (has links)
Introdução: No Brasil, a anemia por deficiência de ferro permanece como problema de saúde pública relevante, especialmente para mulheres e crianças. Nessa questão, a situação de insegurança alimentar (IA) pode vir a ser associada a diversos aspectos de desigualdades estruturais e em saúde, visto que seu conceito permite abordar diversos tipos de iniquidades nutricionais. Objetivos: Avaliar a anemia e a insegurança alimentar e nutricional de famílias de crianças em idade pré-escolar: analisar a influência da vulnerabilidade socioeconômica sobre a prevalência da anemia; identificar os padrões alimentares e sua relação com segurança alimentar e estado nutricional; e investigar a relação entre insegurança alimentar e concentração de hemoglobina de pré-escolares. Métodos: A pesquisa foi do tipo transversal. A população investigada foi de pré-escolares inscritos em creches públicas de Taubaté (SP), em 2014, distribuídas em dois grupos diferenciados pelas características socioeconômicas da região onde estão localizadas: região vulnerável e região abastada. O tamanho da amostra foi calculado partindo do pressuposto que a diferença na concentração de hemoglobina (Hb) entre crianças da região vulnerável e abastada fosse equivalente a 1/3 de desvio padrão da média de Hb da população saudável. As variáveis socioeconômicas e demográficas foram coletadas por questionário semi-estruturado. A concentração de Hb foi obtida por meio de punção digital, considerando anemia Hb<11,0g/dL. Para avaliação antropométrica foi realizada a medida de peso e altura e calculados os Z-escores, a situação de IA foi avaliada pela Escala Brasileira de Insegurança Alimentar (EBIA) e o consumo alimentar habitual foi investigado por meio de um questionário de frequência alimentar. A análise estatística foi descritiva e analítica, com realização de modelagem múltipla. Resultados: A prevalência de anemia foi em torno de 19 por cento dos pré-escolares e a concentração de Hb indicou diferença entre as crianças das duas regiões da cidade, sendo que pré-escolares das creches de alta vulnerabilidade socioeconômica apresentaram menores valores de Hb (p<0,001). Para melhor entendimento do consumo alimentar, identificou-se cinco Padrões Alimentares (PA): Ocidental; Frutas, verduras e legumes; Prudente; Lácteo e Tradicional, possibilitando perceber que os préescolares de famílias beneficiadas pelo Programa Bolsa Família apresentavam PA Tradicional, caracterizado pelo consumo de arroz, café e feijão; que está fortemente relacionado ao excesso de peso infantil (p<0,05). Quanto à situação de IA, esta atinge 41,2 por cento das famílias e mesmo que a análise bivariada tenha verificado que a IA influencia a concentração de Hb, após ajuste do modelo multivariado essa associação perdeu a significância (p>0,05). Conclusões: A influência da vulnerabilidade socioeconômica sobre a prevalência da anemia em pré-escolares foi evidenciada, com polarização de condições adversas sobre as creches frequentadas por famílias de baixa renda, de mães com baixa escolaridade e beneficiárias de programa social. Além disso, essas famílias apresentaram maior risco de consumo alimentar inadequado, propiciando problemas nutricionais a longo prazo. Mesmo não havendo associação estatisticamente significante da IA com a concentração de Hb e com indicadores antropométricos, essas relações devem ser encaradas com muita cautela, além de serem descritas e discutidas de forma crítica para ponderação dos resultados de uma escala de percepção, como é o caso da EBIA / Introduction: In Brazil, iron deficiency anemia remains a relevant public health problem, specially for women and children. In this respect, the situation of food insecurity (FI) may prove to be associated with various aspects of structural inequalities and health, as its concept allows addressing various types of nutritional inequities. Objective: Evaluate anemia, food and nutrition insecurity of families of children in preschool age; analyze the influence of socioeconomic vulnerability on the prevalence of anemia; identify dietary patterns and their relation to food security and nutritional status; and investigate the relationship between food insecurity and concentration of preschool hemoglobin. Methods: The study was crosssectional. The investigated population was enrolled preschool children in public day care centers in Taubaté (SP) in 2014, divided into two different groups by socioeconomic characteristics of the region where they are located: vulnerable region and wealthy region. The sample size was calculated on the assumption that the difference in hemoglobin (Hb) between children of vulnerable and wealthy region was equivalent to 1/3 of Hb mean standard deviation of the healthy population. Socioeconomic and demographic variables were collected by semi-structured questionnaire. The Hb concentration was obtained by finger prick, considering anemia Hb <11.0 g/dL. Anthropometric assessment was performed to measure height and weight and calculated the Z-scores, the FI situation was assessed by the Brazilian Food Insecurity Scale (EBIA) and the usual food intake was investigated by means of a food frequency questionnaire. The statistical analysis was descriptive and analytical, with performing multiple modeling. Results: The prevalence of anemia was around 19 per cent of preschool and Hb concentration indicated difference between children of the two areas of the city, and preschool children of high socioeconomic vulnerability creches had lower Hb values (p <0.001). For a better understanding of food consumption I have identified five Dietary patterns (DP) West; Fruits and vegetables; Prudent; Dairy and Traditional, allowing realize that the preschool families benefiting from the Bolsa Família Program had DP Traditional, characterized by the consumption of rice, coffee and beans; that is strongly associated with childhood overweight (p <0.05). As for the FI situation reaches 41.2 per cent of families and even the bivariate analysis has verified that the FI influence the Hb concentration after model multivariate adjustment this association was no longer significant (p> 0.05). Conclusions: The influence of socioeconomic vulnerability on the prevalence of anemia in preschool children was observed, with polarization of adverse conditions on day care frequented by lowincome families, mothers with low education and beneficiaries of social programs. In addition, these families had higher risk of inadequate food consumption, providing long-term nutritional problems. Even with no statistically significant association between FI with Hb concentration and anthropometric indicators such relations should be viewed with caution, and are described and discussed in a critical way for consideration of the results of a sense of scale, such as the EBIA
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Consumo de alimentos entre adolescentes de comunidades pesqueiras do Rio Grande do Norte(RN)Liberalino, Laura Camila Pereira 18 March 2011 (has links)
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Previous issue date: 2011-03-18 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Food consumption is an indirect method of evaluation of the nutritional status and may contributes as a previous indication for nutritional interventions on public health as well as provide support for national policies on food and nutrition. Dietary practices and inadequate food consumption at the age of childhood and adolescence may be related to the great probability of morbidity and mortality by non-transmittable chronicles diseases in the adult age. The aim of this study was to identify the feeding practices and evaluate the dietary consumption by adolescents in the fishing communities of Rio Grande do Norte, in an attempt to verify its nutritional (un)safety, as well knowing the energy intake, analyze possible associations between inappropriate macronutrients with gender and age, estimates the prevalence of inadequate intake of micronutrients and identify feeding practices around the consumption of fish. This is a cross-sectional study with 201 adolescents aged from 10 to 19 years old in fishing communities in the city of Macau RN, 2008. Dietary practices related to fish consumption were identified by structured questionnaire. The food consumption was obtained by 24 hour recall, with the aid of a photographic record of food and utensils. Dietary intake information was adjusted by the interpersonal and intrapersonal variances, according to Iowa State University. To estimates the total energy consumption by the adolescents we ve used the equation of Estimated Energy Requirement (EER). The analysis of carbohydrates, proteins, vitamins and minerals like phosphorus, magnesium, zinc and iron, was provided by the Estimated Average Requirements (EAR); fiber, calcium and sodium analysis by Adequate Intake (AI); the total lipids by the Acceptable Macronutrient Distribution Ranges (AMDR); and the content and quality of fats by the recommendations of the American Academy of Pediatrics. Descriptive statistics and differences between medians were verified by the Kruskal-Wallis test. To detect associations between variables we ve used the prevalence ratio (IC95%), the Mantel-Haenszel (p-value < 0.05) and multiple logistic regressions between selected nutrients and gender and age variables. The age distribution was predominantly masculine (59.2%) in the range from 10 to 13 years old (70.1%). Fry was the most used way of preparation of the fish (76.8% for fish and 46.1% for seafood), with average per capita consumptions of 94g. The higher prevalence of inadequacy was the excessive consumption of lipids (girls: 47.6%; boys: 26,0%; RP=1.95; IC95% from 1.25 to 3.04) and saturated fatty acids (girls: 24.4%; boys: 10.1%; RP=2.42; IC95% from 1.25 to 4.67). The adolescents from age of 14 to 18 years old had 3.05 (IC95% from 1.35 to 6.93) times the probability to consume saturated fatty acids over the recommendations than adolescents from 10 to 13 years old. Most inadequate prevalence for micronutrients with inferior consumption was of phosphorus among feminine gender (80%) and magnesium among masculine gender (98%). Inadequate prevalence of total lipids and high saturated fatty acids in girls and 14-18 years old adolescents may represents a previous indication for the development of non-transmittable chronicles diseases in that population. The exposure to nutritional unsafety present in significant section of macronutrients and micronutrients may provide elements for the control of adequate intake control, and nutritional disturbance and non-transmittable chronic diseases preventions among adolescents of Ponta do Tubarão State Sustainable Development Reserve, Macau, RN (Brazil). / O consumo alimentar é um método indireto de avaliação do estado nutricional e pode contribuir como indicativo precoce para intervenções nutricionais em saúde pública, bem como fornecer subsídios para as políticas nacionais de alimentação e nutrição. As práticas alimentares e o consumo alimentar inadequados, ao atingir crianças e adolescentes, podem relacionar-se com maior probabilidade de morbi-mortalidade por doenças crônicas não transmissíveis quando adultos. O objetivo deste estudo foi identificar as práticas alimentares e avaliar o consumo dietético entre adolescentes de comunidades pesqueiras do Rio Grande do Norte, na tentativa de verificar a sua (in)segurança nutricional, bem como, conhecer a ingestão energética, analisar possíveis associações entre a inadequação dos macronutrientes com o sexo e a faixa etária, estimar a prevalência de ingestão inadequada de micronutrientes e identificar práticas alimentares em torno do consumo de pescado. Trata-se de um estudo transversal com 201 adolescentes entre 10-19 anos, de comunidades pesqueiras do município de Macau-RN, 2008. As práticas alimentares referentes ao consumo de pescado foram identificadas por um questionário estruturado. O consumo alimentar foi obtido por recordatório de 24 horas, com auxílio de um registro fotográfico de alimentos e utensílios. As informações dietéticas foram ajustadas pela variabilidade intra e interpessoal, conforme a Iowa State University. Para estimar o gasto energético total dos adolescentes, utilizou-se a equação da Estimated Energy Requirement (EER). A análise dos carboidratos, proteínas, vitaminas e os minerais fósforo, magnésio, zinco e ferro, realizou-se pela Estimated Average Requirement (EAR); fibras, cálcio e sódio, pela Adequate Intake (AI); lipídios totais, pelos Acceptable Macronutrient Distribuition Ranges (AMDR) e o teor e qualidade das gorduras, pelas recomendações da Academia Americana de Pediatria. Foram calculadas estatísticas descritivas e as diferenças entre medianas verificadas pelo teste de Kruskal-Wallis. Para detectar associações entre variáveis, utilizou-se a Razão de Prevalência (IC95%), o teste de Mantel-Haenszel (p-valor < 0,05) e regressão logística múltipla entre nutrientes selecionados e as variáveis sexo e faixa etária. A faixa etária predominante foi de 10-13 anos (70,1%) e o sexo foi o masculino (59,2%). O modo de preparo do pescado mais utilizado foi a fritura (peixes: 76,8%; mariscos: 46,1%), com consumo per capita médio de 94g. A maior prevalência de inadequação foi o consumo excessivo de lipídios (meninas: 47,6%; meninos: 26,0%; RP=1,95, IC95%1,25-3,04) e de ácidos graxos saturados (meninas: 24,4%; meninos: 10,1%; RP=2,42, IC95% 1,25-4,67). Os adolescentes de 14-18 anos tiveram 3,05 (IC95% 1,35-6,93) mais chances de consumir ácidos graxos saturados acima da recomendação do que os de 10-13 anos. As maiores prevalências de inadequação para os micronutrientes com consumo inferior foram para o fósforo entre o sexo feminino (80%) e o magnésio entre o sexo masculino (98%). As prevalências de inadequação de lipídios totais e ácidos graxos saturados elevados, nas meninas e nos adolescentes de 14-18 anos, poderão representar indicador precoce para o surgimento de doenças crônicas não transmissíveis nesta população. A exposição à insegurança nutricional presente em parcela significativa dos macronutrientes e dos micronutrientes, poderá fornecer elementos para o controle da ingestão dietética adequada e para a prevenção de distúrbios nutricionais e doenças crônicas não transmissíveis, entre os adolescentes da Reserva de Desenvolvimento Sustentável Estadual Ponta do Tubarão, Macau, RN (Brasil).
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Estudo dos determinantes da insegurança alimentar em pacientes atendidos em um serviço de assistência especializada em HIV/AIDS / Study of food and nutrition insecurity factors concerning HIV/AIDS patients who are treated in a specialized assistance serviceCozer, Mirian 13 December 2016 (has links)
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Previous issue date: 2016-12-13 / People living with HIV/Aids are generally a vulnerable group in many aspects: socially,
economically and/or regarding health issues. Therefore, food and nutrition insecurity might be
a recurring problem. Our research aims to determine insecurity prevalence concerning this
group of people who are treated in Francisco Beltrão/PR Specialized Assistance Service
(SAS). This dissertation is described as a cross-sectional study, with data collection from a
questionnaire. The analysis was carried out through quantitative and qualitative
methodologies and a statistics software that was used in order to develop our descriptive stats:
frequency calculus, rate and standard deviation. As for comparisons between proportions we
employed Yates's or Fischer's chi-square test, correcting 2x2 charts. Results were considered
statistically meaningful on p<0,05 level. 126 individuals living with HIV/Aids were
participants on the research. These people are treated in the SAS, they are all over 18 and
under 60 years old. They underwent a questionnaire with questions ranging from social to
economic and health aspects of their lifes. After that they went through anthropometric
evaluation and an individual interview with the researcher. Our aim there was to determine
their food and nutrition insecurity levels through the Brazilian Food and Nutrition Insecurity
Scale (EBIA). 61,9% (N=78) of the interviewees faced food and nutrition insecurity in some
level, the prevalence was of 16,7%: 9,7% with small insecurity; 4,9% with moderate
insecurity and 2,1% with major insecurity. This condition is more significant in individuals
who have less than three minimum wages worth of income, according to the following odds
ratio (OR): 0,151 (0,0644 - 0,3544), odds ratio (OR): 0,2174 (0,0468 - 1,0099). 74,45% of
those who suffer from this condition live with up to three minimum wages worth of income
(R$2.376,00). When analysing non communicable chronic diseases we checked that patients
with one NCCD or more were under greater risk of suffering from food and nutrition
insecurity, however, not meaningful regarding p<0,05. Concerning the patients nutritional
situation there were more eutrophic ones for the body mass index (BMI) and arm
circunference (AC) evaluation parameters. According to the theoretical model for food and
nutritional insecurity we could see that, on the triad that assumes distal risk factors as social,
demographic and economic attributes were meaninful. We emphasize that these variables can
directly act on food and nutritional insecurity, the third distal risk factor might be affected by
it (demographic attribute), causing insecurity to happen. 63% (N=70) from the participants
under insecurity have CD4 cell count over 200/mm3 and 62% (N=56) viral load below 40
copies/ml, which indicates that HIV/Aids presence is not a decisive factor for insecurity in
contrast to food habits and life quality, which are usually decisive for causing it. Alongside it
66% (N=52) from the non-safe participants have habits such as drinking alcohol, which is
another life quality decisive factor. According to the obtained results it is possible to affirm
that the disease compromises the individual in his/her working potential, which causes
him/her to be more susceptible to food and nutrition insecurity, and this can be seen as an
inequality cause concerning the economic system once poverty and inequality are decisive
factors for food and nutrition insecurity and, for that reason, its estimates can be used, as a
complementary factor, in order to identify biases and driving factors for regional development
as a whole. / Portadores de HIV/Aids são formados por um público vulnerável tanto no aspecto social,
quanto no econômico e no que concerne à saúde. Estes aspectos fazem com que eles se
encontrem em situações de insegurança alimentar (InSA). Esse estudo objetivou determinar a
prevalência e fatores de risco deste fator em pessoas vivendo com HIV/Aids (PVHA)
atendidas no Serviço de Assistência Especializada (SAE) em Francisco Beltrão/PR,
caracteriza-se como estudo do tipo transversal, com coleta de dados através de questionário
aplicado pela pesquisadora. A análise deu-se através de métodos quantitativos, por meio de
software estatístico para a realização da estatística descritiva, com cálculos de frequências,
médias e desvios-padrão. Para as comparações entre proporções utilizou-se o teste do Quiquadrado de Pearson, teste do Qui-quadrado de Yates ou teste do Qui-quadrado de Fischer
com correção para tabelas 2x2. Os resultados foram considerados estatisticamente
significantes ao nível de p<0,05. Participaram da pesquisa 126 pessoas que vivem com
HIV/Aids em tratamento no SAE, com idade superior a 18 anos e inferior a 60 anos, os quais
responderam a um questionário contendo perguntas de cunho social, econômico e de saúde,
com posterior avaliação antropométrica e anamnese individual, objetivando determinar seu
nível de insegurança alimentar e nutricional através da Escala Brasileira de Insegurança
alimentar (EBIA). Por meio das análises verificou-se que 61,9% (N=78) da amostra
encontrava-se em algum grau de InSA, perfazendo uma prevalência de 16,7%, sendo 9,7%
para a insegurança leve; 4,9% para insegurança moderada e uma prevalência de 2,1% para a
insegurança grave. A probabilidade de InSAé maior em indivíduos que possuem renda menor
de três salários mínimos, conforme a odds ratio de (OR) 6,6206 (2,8218 - 15,5332). Destacase que 74,45% dos participantes em InSA vivem com até três salários mínimos (R$2.376,00).
Ao analisar as doenças crônicas não transmissíveis (DCNT) verificou-se que pacientes que
possuíam uma ou mais de uma DCNT, apresentavam maiores risco de estar em insegurança
alimentar, porém, sem significância ao p<0,05. Com relação ao seu estado nutricional obtevese o predomínio de eutróficos para os parâmetros avaliativos de índice de massa corporal
(IMC) e circunferência braquial (CB). Conforme modelo teórico proposto para InSA
verificou-se que na tríade que pressupõe os determinantes distais como os fatores sociais,
demográficos e econômicos houve significância para a renda, sendo caracterizado como
fatores econômicos. Ressalta-se que essas variáveis podem agir de maneira direta na InSA,
podendo haver interferência com os demais determinantes distais desencadeando a InSA.
Detectou-se que 63% (N=70) dos pacientes analisados em condições de InSA possuem
contagem de células CD4 acima de 200/mm3 e 62% (N=56) com carga viral abaixo de 40
cópias/ml, indicando que a presença do HIV/Aids não é o fator determinante para a InSA,
podendo denotar-se que o hábito alimentar e qualidade de vida adotados podem caracterizarse como fatores provocadores da InSA. Corroborando esses dados tem-se que 66% (N=52)
dos não seguros apresentam o hábito de ingerir bebidas alcoólicas, o que se apresenta como
mais um fator de qualidade de vida. Diante dos resultados obtidos, verifica-se que a doença
compromete o indivíduo no seu potencial laborativo acarretando, dessa forma, maior
suscetibilidade à InSA, o que pode ser um marcador de desigualdades relativas ao sistema
econômico, sendo a pobreza e a desigualdade social fatores determinantes para a InSA e, por
esse motivo, suas estimativas podem ser utilizadas, de forma complementar, para a
identificação dos vieses e fatores propulsores do desenvolvimento regional.
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Ignoring a Silent Killer: Obesity & Food Security in the Caribbean (Case Study: Barbados)MacDonald, Tara 05 September 2012 (has links)
Obesity and obesity-related diseases – such as type 2 diabetes – have become the most crucial indicators of population health in the 21st century. Formerly understood as ‘diseases of affluence’, obesity is now prevalent in the Global South posing serious risk to socioeconomic development. This is particularly true for rapidly developing countries where nutrition transitions are most apparent. There are many factors which impact on risk of obesity (e.g. gender, culture, environment, socioeconomic status, biological determinants). The problem is further aggravated within small island developing states where food security is exacerbated by factors associated with globalization and development. The thesis examines the surge of obesity and type 2 diabetes within Caribbean populations, using Barbados as a case study. A holistic approach was applied using an ecological health model. Moving away from the lifestyle model, the theoretical framework underpinning included sub-theories (e.g. social constructivism, feminism, post-colonial theory, concepts of memory and trauma).
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Ignoring a Silent Killer: Obesity & Food Security in the Caribbean (Case Study: Barbados)MacDonald, Tara 05 September 2012 (has links)
Obesity and obesity-related diseases – such as type 2 diabetes – have become the most crucial indicators of population health in the 21st century. Formerly understood as ‘diseases of affluence’, obesity is now prevalent in the Global South posing serious risk to socioeconomic development. This is particularly true for rapidly developing countries where nutrition transitions are most apparent. There are many factors which impact on risk of obesity (e.g. gender, culture, environment, socioeconomic status, biological determinants). The problem is further aggravated within small island developing states where food security is exacerbated by factors associated with globalization and development. The thesis examines the surge of obesity and type 2 diabetes within Caribbean populations, using Barbados as a case study. A holistic approach was applied using an ecological health model. Moving away from the lifestyle model, the theoretical framework underpinning included sub-theories (e.g. social constructivism, feminism, post-colonial theory, concepts of memory and trauma).
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Ignoring a Silent Killer: Obesity & Food Security in the Caribbean (Case Study: Barbados)MacDonald, Tara January 2012 (has links)
Obesity and obesity-related diseases – such as type 2 diabetes – have become the most crucial indicators of population health in the 21st century. Formerly understood as ‘diseases of affluence’, obesity is now prevalent in the Global South posing serious risk to socioeconomic development. This is particularly true for rapidly developing countries where nutrition transitions are most apparent. There are many factors which impact on risk of obesity (e.g. gender, culture, environment, socioeconomic status, biological determinants). The problem is further aggravated within small island developing states where food security is exacerbated by factors associated with globalization and development. The thesis examines the surge of obesity and type 2 diabetes within Caribbean populations, using Barbados as a case study. A holistic approach was applied using an ecological health model. Moving away from the lifestyle model, the theoretical framework underpinning included sub-theories (e.g. social constructivism, feminism, post-colonial theory, concepts of memory and trauma).
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Adaptation strategies for climate change-induced household food and nutrition insecurity in smallholder maize farming within Thulamela Local Municipality, South AfricaMahlawule, Khanyisa Dorris 18 September 2017 (has links)
MRDV / Institute for Rural Development / See the attached abstract below
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