**2. Clarification of concepts**

#### **2.1 Food security and insecurity**

As a concept, food security was coined in 1970s following the global economic crisis and the subsequent United Nations Conference that aimed to combat the global food insecurity. Although there is no universally accepted definition of food security, one internationally recognized definition is authored by the World Food Programme of the United Nations which posits that "food security exists when all people, at all times, have physical, social and economic access to sufficient, safe and nutritious food to meet their dietary needs and food preferences for an active and healthy life" [11]. Within this context, a household or, an individual's ability to obtain sufficient and nutritious food to stay healthy is crucial. The definition of food security was also documented as the principle achievement of the 1996 World Food Summit [2] because it operationalized food security

*Lifestyle and Epidemiology - The Double Burden of Poverty and Cardiovascular Diseases...*

syndrome coronavirus 2 (SARS-CoV-2), fondly known as COVID-19 disease which is ravaging the global health and economic system would result in increased extreme poverty by 100 million people with Sub-Saharan Africa accounting for 40 million individuals [1]. Extreme poverty refers to the socio-economic condition of people living below the international poverty line of \$1.90 a day. This population will experience abject poverty in addition to being vulnerable to acute food insecurity, and compromised health lifestyle. It is worth noting that the global concern for food security as a necessity for quality health, dates back to early years of twentieth century post-World Wars (World War I and World War II in 1930s and 1940s, respectively) during which most societies afflicted with non-communicable diseases resulted from several factors including famine which led to their compromised health lifestyle. It was not until 1935, that the first survey report on global nutrition and public health by the League of Nation's Health Division, documented the extent of malnutrition and hunger in the world. The report revealed a critical food shortage in low and middle-income countries [2]. The League of Nations' survey report is fundamental to the present discourse on dietary intake and health implications because it resulted in the Organization's fundamental discussions on action-oriented developmental policies including the need for coordinated

Contemporary episodes of famine and global food insecurity dates back to early 1970s during the world food crisis when food production and consumptions significantly dropped. This prompted the General Assembly of the United Nations to convene the member states to take specific actions to determine the global food challenge using the comprehensive approach of development agenda and international economic operation [3]. The conference, attended by 135 member states from developed and developing countries (including countries in Sub-Saharan Africa) was concluded through the adoption of the following declaration; "Universal Declaration on Eradication of Hunger and Malnutrition" [3]. The participating states were invited within the context of the United Nations Economic and Social Council Resolution [3]. Thenceforth, the issue of food and nutrition security has been prominent on the global development agenda. In other words, the process of eradicating chronic hunger and poverty and the implication on wellbeing has been a

However, contemporary research on the history of global food security revealed that for much of the twentieth century, food security was broadly viewed through the lenses of accelerating food production as remedy to famine and international food insecurity. Within this context, the equal relation between health and agriculture would enhance the international economies [2]. Such a perspective, also promoted the need for meeting human basic needs through fundamental policy objectives using commercial agriculture as means to economic development [2]. Consequently, between 1950s to 1970, the world recorded an increase in food production (particularly staple food and/or cereal); concurrently, production per capita improved by 50% and 20%, respectively [2]. Research on the history of food security [2] also reveals that, the period between late 1960s to early 197os saw an annual food aid distribution by high income countries such as the United States to middle income and low-income countries, dropping from an estimated 17 million tons to only 7 million tons. By 1972, several regions of the world among them Sub-Sahara Africa witnessed bad climate conditions such as drought that resulted in famine or general food insecurity. As a consequence, the global food production in

nutrition-related policies in several countries [2].

priority since the last quarter of the twentieth century.

staple food such as cereal, sharply fell by 30 million tons [2].

While such substantial measures in post-World Wars were undertaken by the international communities, and three decades after the 1970s' Universal Declaration on Eradication of Hunger and Malnutrition, the chronic poverty and

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as a condition that exists at different levels of society including international, national, community, and household or individual level.

Therefore, food security includes factors such as availability, accessibility, utilization and stability. Within the context, availability refers to the quantity of food commodities that result from mass food production that is sufficient enough to feed the entire human population; food accessibility happens when all people have access to sufficient food or an individual's economic power to access or acquire sufficient food for consumption. This implies that high food prices can negatively affect food access. Furthermore, food, utilization refers to an individual's means to acquire safe-nutritious food that meets their basic nutritional needs. Under this notion, nutritious food and food safety includes one's food preference, its conservation and preparations, and "nutrient absorptions in the human body" [2]. Food utilization also refers to the process by which a human body detects the nutrients or calories stemming from macronutrients and micronutrients, feeding practices, and food preparations. This concept is critical to the current discourse as it unveils the importance of dietary intake as one of the key factors to a healthy lifestyle. It could be reasoned that, individuals with compromised-dietary intake are likely to meet the challenge of being unhealthy.

Among conditions that are associated with compromised-dietary intake are cardiovascular diseases such as heart failure, stroke, heart attack, cardiac arrest, obesity, and other non-communicable diseases such as malnutrition and iron deficiency anemia. An individual's nutritional status is determined by biological absorption of the food consumed [12, 13]. In this regard, the basic nutritional knowledge and good dietary habits, clean and safe water, sanitation, and health care should be considered when ensuring food security. Likewise, the food utilization aspect authenticates that nutrition is directly associated with food security and as such, there is food insecurity when the human population is not adequately nourished.

Food stability is another fundamental element when analyzing the notion of food security [12, 14]. From this perspective, an individual is food secure provided that there is stability in the other three elements of food security (availability, accessibility and utilization of the food) over time. Within this context, food security can neither be limited to a particular moment such as, a month or a year but that it should be sustainable. In other words, where there is lack of food stability, transitory or chronic food insecurity occurs. Thenceforth, if a household has adequate and nutritious food intake today, they are regarded food insecure whenever they lack a sustainable food supply because, their health or nutritional status risk being compromised by inadequate food consumption. In cases where there is credit crisis that influence food prices, food security at all levels (international, national community or household) may be difficult to achieve. For instance, the sharp rise in global food crisis in post 2000, resulted in accelerating food prices, anxiety and food riots in some parts of the world [15]. Furthermore, unfavorable weather conditions such as floods and famine, economic factors, or political instability may impact negatively on household or individual food security status.
