In order for a country to see positive growth and development, the health of its people must be of utmost importance. Elwell-Sutton, Finch and Bibby (2019) highlighted that good health creates a thriving economy, communities, and long term improvements in life expectancy and morality. Health however is influenced by many factors varied by one’s location, some of these factors fall under social determinants of health. WHO (n.d) defines social determinants as “the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life.” In St. Vincent and the Grenadines, health care service delivery is largely provided by the public sector, the private sector is also involved as it complements the limited specialty services and alleviate some of the burden on the public sector (PAHO, 2014). PAHO (2012) highlighted that, ‘there is a burden of chronic non-communicable diseases (cardiovascular disease, diabetes mellitus, neoplasm), and injuries and violence on national mortality rates, with the average life expectancy is 71.9 years and the infant mortality rate is 20.8 per 1000 live births.’ Five of the major social determinants of health in St. Vincent and the Grenadines includes, working conditions, economic resources, stress and food.
Food is a basic need in life and the issue comes when there is lack of access to the quality and quantity needed. Raphael (2016) highlighted food security is a determinant of health as it is determinant on life, health, dignity, justice and sustainable development (p. 294). Food security is defined as the state when there is access to sufficient, safe, nutritious food to maintain a healthy and active life (Raphael, 2016), while food insecurity is defined as, “the inability to acquire or consume an adequate diet quality or sufficient quantity of food in socially acceptable way, or the uncertainty that one will be able to do so due to income constraints” Tarasuk 2001 (as cited by Raphael, 2016). According to journals by Leonard, Hughes, Donegan, Santillan, & Pruitt, L. (2018), A Tur-Sinai (2018) and Gundersen, Tarasuk, Cheng, de Oliveira & Kurdyak(2018), the persons mostly affected by food insecurity are the vulnerable in the population, the minority and based on their geographical location and ethnicity and low socioeconomic status. These include the elderly, the poor, blacks, aboriginals, households reliant on social assistance, employment Insurance or workers’ compensation, those without a university degree, those with children under 18, unattached individuals, renters, and those with an Aboriginal respondent. Food insecurity results in high level poverty in communities, it noted to be associated with higher mortality rates and these higher rates are especially large for the most severe food insecurity and contributes to socioeconomic disparities. Gunderson et al. (2018) emphasized the negative health consequences associated with food insecurity in adults includes increased risk of diabetes, hypertension, dyslipidemia, cardiovascular disease, depression, poor sleep, and iron deficiency, it also associated with poorer disease management and indications of greater disease severity across a broad spectrum of communicable and non-communicable diseases.
Food insecurity places those vulnerable to poor health outcomes, higher health costs and increased expenditure on health services out of the total revenue increases. In aim of combating these risks and dealing with food insecurity according to the journals selected includes social safety net, food assistance, ensure Accessibility neighborhood services, economic efficacy, health status and level of expenditure on health services are important factors for reducing food insecurity among elderly population.
In St. Vincent and the Grenadines, having witnessed firsthand the experiences of food insecurity; the vulnerable population includes, children, elderly, the unemployed, the poor and uneducated. PAHO (n.d) reported that “Malignant neoplasms (121-174 per 100,000 population), ischemic heart disease (96-130 per 100,000 population), and communicable diseases (82-101 per 100,000 population) were the three leading causes of death in the period 2009-2013, together with diabetes mellitus, cerebrovascular disease, and hypertensive disease.” Many of these were noted as food insecurity being a contributor of. This is not to say that the government has not made efforts to eradicate this issue, FAO (2018) highlight these as, “building on the Zero Hunger Challenge, emphasizing agricultural diversification, nutrition education, strengthened governance in Food Security and Nutrition (FNS) and poverty reduction programmes; and addressing strategies for reducing food losses and waste across key value chains; and improving the capacity of government to make better evidence based decisions by using an efficient data management system.” Food security is still lacking in many households today.. As a social worker my role is of an advocate and educator for food security. Advocacy is defined as pursuing and acting in the interests of yourself or another, supporting a cause, an idea, or a policy, mobilizing resources to make your support active, motivating people to change, creating change in public policy and opinion (Missoula food bank, n.d). In order to combat this determinant it is important to remember that efforts or steps made in combating it should cause long term effects in order to ensure there is no increase in the number affected. Working along with programs already in place and looking for ways to improve so that the impact would be more, providing job training and economic development programs in order to make a lasting impact. Communities which are more vulnerable, a committee can be formed to study the state of food security in the community and how to best address the issue, this can then be presented to policy makers . As an educator, the advancement of nutrition education is important as this will make persons more aware of the reality of food security and the need to make changes on a micro, messo and macro level. Taylor (2020), highlighted that “each role requires empathy, knowledge, understanding, competence and good communication skills and can further be applied when working with individuals, families, groups, communities or even policy and organisational practice (p. 12).”
The International Covenant on Economic, Social and Cultural Rights (ICESCR), which St. Vincent and the Grenadines is a party of states, confers on all human beings the core entitlements essential to human fulfillment, e.g. the rights to work, social security, family life, education and participation in cultural life more importantly, the ICESCR’s guarantee of the right of everyone to the enjoyment of the highest attainable standard of physical and mental health (Prah, 2010). Prah (2010) goes on to emphasize the importance of good health in allowing individuals to exercise a range of human rights – both civil and political (e.g. physical integrity, personal security, political participation), social and economic (e.g. employment, education and family life), hence, health is necessary for well functioning societies and can hinder economic prosperity, political participation, collective security. In order to be able to promote social justice in food security, one must first know how much is still present , research must be conducted, from this we must be able to see the area in which are affected and what contributes to it. From this interventions and discussions on policies to make the necessary changes and improvements.
As social workers our roles include advocate, educator, counsellor, mediator, case manager and so much more to those who are in need, vulnerable and lack access to service and resources that span from the micro to macro level. NASW (2016) notes that, social worker are to be, “advocate for clients’ rights to self determination, confidentiality, access to supportive services and resources, and appropriate inclusion in decision making that affects their health and well-being, encourage social work participation in the development, refinement, and integration of best practices in health care and health care social work and promote social work participation in system wide quality improvement and research efforts within health care organizations. Taylor (2020) highlights that values of social work includes social justice, dignity and worth of individuals, service, integrity, competence and the importance of human relationships. Therefore, as a social worker in this field it would be my obligation and responsibility to work towards aiding in the enhancement of those vulnerable to lack of food security and ensuring those who aren’t vulnerable to this stays this way.
Food security as a social determinant is very much present in many households, even with programs and policies set up by the government. With this fact more should be done in areas already implemented to work with those affected and new intervention strategies or interventions should be put in place to ensure long term impact on eradicating this determinant. In order to do this, more research must be conducted to have a real view of those impacted and effects of lack of food security, with this information we would best be able to see how impactful present programs have been, where changes and improvements are required and what additional interventions may be required.
References
- A Tur-Sinai, A. (2018). Food Insecurity among Older Adults: The Role of Social, Health and
- Economic Factors. European Journal of Public Health, Volume 28, Issue suppl_4, November 2018, cky214.002, doi:10.1093/eurpub/cky214.002
- Elwell-Sutton, T., Finch, D. and Bibby, J. (2019). The nation’s health Priorities for the new government. Retrieved February 12th, 2020, from https://www.health.org.uk/news-and-comment/blogs/the-nations-health
- FAO. (2018). Saint Vincent and the Grenadines and FAO Boosting agricultural productivity and building resilience. Retrieved from http://www.fao.org/3/a-ax426e.pdf
- Gundersen, C., Tarasuk, V., Cheng J., de Oliveira, C., Kurdyak, P. (2018). Food insecurity status and mortality among adults in Ontario, Canada. PLoS ONE 13(8): e0202642. https://doi.org/10.1371/journal.pone.0202642
- Leonard, T., Hughes, E. A., Donegan, C., Santillan, A. & Pruitt, L. S. (2018). Overlapping geographic clusters of food security and health: Where do social determinants and health outcomes converge in the U.S?. Population Health, 5, 160-170. Doi:10.1016/j.ssmph.2018.06.006
- Missoula food bank. (n.d). Food security advocacy handbook. Retrieved from http://www.missoulafoodbank.org/wp-content/uploads/2015/10/Food-Security-Advocacy-Handbook.pdf
- PAHO. (n.d). Country Report: Saint Vincent and the Grenadines. Retrieved from https://www.paho.org/salud-en-las-americas-2017/?page_id=169
- PAHO. (2014). Report on St. Vincent and the grenadines national consultation on the strategy for univesal health coverage. Retrieved from file:///C:/Users/G.E.T/Downloads/universal-health-St-Vincent-and-the-Grenadines-Report-2014.pdf
- Raphael, D. (Ed.). (2016). Social Determinants of Health. Toronto, Ontorio: Canadian Scholars’ Press Inc.
- Sastre, F. Rojas, P. and Khoury, H. A. (2014). Improving the Health Status of Caribbean People: Recommendations from the Triangulating on Health Equity Summit.
- Taylor, H. T. (2020). Social Work Practice in Health Care within a Caribbean Context. The University of the West Indies, Open Campus, St. Lucia.
- WHO. (n.d). Social determinants of health. Retrieved from https://www.who.int/social_determinants/sdh_definition/en/
