Topical Area: Global Nutrition
Objectives: Food insecurity may mediate the relationships between social disparities and health. However, these mechanisms have rarely been studied in a comparable manner globally. The study aims to examine the mediation effect of food insecurity in the pathway between macrosocial inequalities and malnutrition at the global level.
Methods: We measured a nation’s macrosocial inequalities through three aspects - income distribution, education, and gender. National food insecurity was represented by the proportion of population who live in households classified as moderately or severely food insecure, assessed using the Food Insecurity Experience Scale. The outcomes included under-5 mortality rate, prevalence of under-5 stunting, and prevalence of under-5 wasting. We applied Pearson correlation tests to assess the crude relations between the macrosocial indices and malnutrition. For mediation analysis, we implemented the difference-in-coefficients method and the structural equation model method, controlling for potential confounders, including gross domestic product (GDP), urbanization, and trade as a share of GDP.
Results: All inequality measures had moderate and statistically significant correlations with the malnutrition outcomes, except income inequality with stunting and wasting (P=0.34 and 0.09, respectively). After adjusting for the confounders, under-5 mortality was positively associated with education inequality and gender inequality, stunting with all three indices, whereas wasting with none of the indicators. Food insecurity significantly mediated and explained 89% and 76% of the total effects of income inequality and gender inequality on under-5 mortality, respectively. However, the adverse effects of the three inequality indices on stunting were not mediated by food insecurity, which only accounted for 18%, 18%, and 5% of the total effects (P=0.60, 0.50, and 0.72), respectively. Furthermore, food insecurity did not mediate the relationship between education inequality and under-5 mortality, explaining only 13% of the total effect (P=0.44).
Conclusions: Globally, under-5 mortality is associated with income and gender inequalities primarily through food insecurity. Direct interventions addressing food insecurity are warranted to reduce the impact of macrosocial inequalities on preventable child deaths.
Funding Sources: NHLBI
Tufts University, Friedman School of Nutrition
Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University
Gitanjali M. Singh
Tufts Friedman School of Nutrition Science and Policy