The “What”

The World Food Programme reports that one in nine people will go to bed hungry every night (Zero Hunger). Out of this population, undernutrition will affect some of their lives greatly. Usually, more often times than not, we imagine this does not affect Americans, but in all actuality incidence rates, undernutrition is still too high on U.S. soil. Feeding America reports that “13.1 million children lived in food-insecure households in 2015” and over twenty percent of the population of children affected by food insecurity lived in Mississippi and New Mexico (Child Hunger Facts). Interestingly, New Mexico has a large number of Native American reservations with living conditions “‘comparable to Third World” where they are “23 percent more likely to be food insecure” compared to the rest of the United States’ fifteen percent (Native American Living Conditions on Reservations – Native American Aid; Gordan, Odde; Map of Indian Reservations in the Continental US). While food insecurity does not always equate to undernutrition, the lack of access to food is a sufficient cause of undernutrition.

So what exactly is undernutrition? Undernutrition is the result of a lack of food intake which leads to being underweight relative to age, stunting, or being wasted. The immediate cause of undernutrition is the lack of food, but prior disease such as parasites or HIV can augment the speed of undernutrition. The effect of being deprived of nutrients weakens linings of the stomach and respiratory systems and development of the fetus if pregnant. Consequently, this results in a lack of ability to fight infections, mental development, and lactation. In turn, children or women who are pregnant or may become pregnant are impacted the most (Burgess, Louis; What is Undernutrition?).

1. Economic, Social, and Psychological Burdens

What are the costs of undernutrition and why should we care? Undernutrition plays a within social and psychological interactions. At an early age, nutrition is a vital aspect of growth and development and as they develop, if they lack nutrients it can, in turn, affect how they are viewed socially in life. The top micronutrients for development and growth are “iron, vitamin A, iodine, and folate” which leads to the development of the immune system, thyroid gland, and hemoglobin. An absence of vitamin A can lead to blindness or susceptibility to measles or malaria. Lack of iron or iodine can lead to the thyroid, which controls growth and metabolism, and the red blood cells to improperly function leading to developmental delays. For example, if a child survives into adulthood their lack of nutrients will affect their ability to perform as those “who are deficient in iodine and essential micronutrients have on average 13 fewer IQ points than those who are iodine-sufficient” (What is the role of nutrition; Nutrition Overview).

While this may not equate to every case of undernutrition leading to mental retardation or learning disabilities, it is shown that “bullying persists in our schools today especially for students with disabilities” which leads one to conclude that undernutrition effects start long before one reaches adulthood socially and psychologically (U.S. Department of Education). Consequently, students who do make it to school that are affected by undernutrition typically start later, perform poorly, or drop out of school. Clearly, this presents a problem when America’s workforce is taking a direction toward higher education when more than “30 percent of  U.S. adults 25 and older had at least a bachelor’s degree” which has increased by 4.2 percent from 1998 to 2011 (United States Census Bureau). This is even more troubling when looking at Native American populations were “among those 25 and older, 23 percent have less than a high school diploma” and only “46 percent have some postsecondary education” the overall in the U.S only “14 percent” have less than a high school diploma and “57 percent” have some postsecondary education (Gordon, Oddo).

Education, in turn, plays a vital role in the economic sanctions of undernutrition. The World Bank asserts that “schooling is associated with higher individual earnings” which “for an economy, education can increase the human capital in the labor force, which increases labor productivity and thus leads to a higher equilibrium level of output” resulting in more technological advances for an economy (Hanuskek, Wößmann). All in all, undernutrition not only affects an individual’s development it affects their future household income and their input to their local economy. Through impacting local economies those affected by undernutrition are in turn also affecting national and global economies.

III. Epidemiological Profile

Morbidity

1. 1. Number of Cases Before 2008 (Black)
      1. “More than a third of child deaths and more than 10% of total global disease to maternal and child undernutrition”
      2. “relative risk for morbidity associated with zinc deficiency is 1·09 (95% CI 1·01–1·18) for diarrhea, 1·25 (1·09–1·43) for pneumonia, and 1·56 (1·29–1·89) for malaria” after being diagnosed with undernutrition or malnutrition.
      3. Ages “1–59 months the relative risk is estimated to be 1·27 (0·96–1·63) for diarrhea, 1·18 (0·90–1·54) for pneumonia, and 1·11 (0·94–1·30) for malaria” after being diagnosed with undernutrition or malnutrition.
      4. DALYs (Black)
         1. While I could not find a specific value for the US population or Native American populations it is argued that “stunting, severe wasting, and intrauterine growth restriction together were responsible for 2.2 million deaths and 21% of global childhood DALYs” while 0.2% resulted from iron and iodine and “44 million DALYs (10% of DALYs in children younger than 5)”

Mortality (Black)

1. Number of deaths from Undernutrition Complications

1. 1. 1. Iron and Iodine Deficiencies-115,000 deaths globally  
      2. Suboptimal breastfeeding- 1.4 million child deaths globally
   2. Case fatality rates
      1. Estimated 449,000 deaths in children attributed to severe wasting and the implied case fatality is 2%, but actual numbers are unknown and are assumed to be decreasing.

Person Trends (Black; CDC; Gordon, Oddo; The Characteristics of Native American WIC Participants, On and Off Reservations )

1. Note that while there are no specific studies to be found on direct rates of undernutrition in America or specifically Native American populations, there were studies on rates of education and location of populations along with deficiencies in nutrients for the following graphs.

1. Place Trends (Black; Key Statistics & Graphics.)

Those with children are more affected by food insecurity and access to food as seen in the graphs below

1. Time Trends (CDC; Key Statistics & Graphics.)

(Spring 2017)

Works Cited

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    Majid Ezzati, Colin Mathers, and Juan Rivera. Maternal and child undernutrition: global and

    regional exposures and health consequences. Rep. no. 1. Johns Hopkins Bloomberg

    School of Public Health, 17 Jan. 2008. Web. 17 Feb. 2017.

Burgess, Ann, and Danga, Louis. “Undernutrition in Adults and Children: causes, consequences

     and what we can do.” SSMJ. South Sudan Medical Journal, 2010. Web. 17 Feb. 2017.

CDC’s Second Nutrition Report: A comprehensive biochemical assessment of the

     nutrition status of the U.S. population. Rep. no. 2. CDC, 27 Mar. 2012. Web. 17 Feb.

     2017.

“Child Hunger Facts.” Feeding America. Feeding America, n.d. Web. 17 Feb. 2017.

Gordon, Anne, and Oddo, Vanessa. “Addressing Child Hunger and Obesity in Indian Country:

     Report to Congress .” Indian Country. USDA, 12 Jan. 2012. Web. 17 Feb. 2017.

     <https://www.fns.usda.gov/sites/default/files/IndianCountry.pdf >.

Hanuskek, Eric A., and Wößmann,  Ludger. Education Quality and Economic Growth.

     Washington, DC: The International Bank for Reconstruction and Development/The World Bank, 2007. Education               Quality and Economic Growth. The World Bank, 2007. Web. 17 Feb. 2017.

“Key Statistics & Graphics.” USDA ERS – Key Statistics & Graphics. USDA, 11 Oct. 2016. Web.

     01 Mar. 2017.

“Map of Indian Reservations in the Continental US.” National Parks Service. U.S. Department of

     the Interior, n.d. Web. 17 Feb. 2017.

“Native American Living Conditions on Reservations – Native American Aid.” Native American

     Living Conditions on Reservations – Native American Aid. Partnership With Native

     Americans, 2015. Web. 17 Feb. 2017.

Roser, Max. “Hunger and Undernourishment.” Our World In Data. Our World In Data, 2016.

     Web. 17 Feb. 2017.

“The Characteristics of Native American WIC Participants, On and Off Reservations.” Nutrition

     Assistance Program Report Series The Office of Analysis, Nutrition and Evaluation. USDA, May 2002. Web. 1 Mar.             2017.

United States of America. United States Census Bureau. Public Information. Bachelor’s Degree

     Attainment Tops 30 Percent for the First Time, Census Bureau Reports. By Robert

Bernstein. United States Census Bureau, 23 Feb. 2012. Web. 17 Feb. 2017.

United States of America. U.S. Department of Education. Press. Bullying of Students with

     Disabilities Addressed in Guidance to America’s Schools. U.S. Department of Education, 21 Oct. 2014. Web. 17 Feb.         2017.

“Nutrition Overview.” Nutrition Overview. The World Bank, 31 Mar. 2016. Web. 17 Feb. 2017.

“What is the role of nutrition?” UNICEF. Https://www.unicef.org/nutrition/index_role.html, 26

     May 2012. Web. 17 Feb. 2017.

“What is Undernutrition?” UNICEF – Progress for Children – What is undernutrition?UNICEF, 4

     May 2006. Web. 17 Feb. 2017.

“Zero Hunger.” World Food Programme. World Food Programme, 2017. Web. 17 Feb. 2017.