Implications of COVID-19 pandemic for food and nutrition security of people affected by Hansen's disease
The COVID-19 pandemic generated a broad health crisis with global economic repercussions and adverse political and social effects in middle and low income countries such as Brazil, where socioeconomic impact was magnified by prevailing low economic growth and policies of fiscal austerity.1 Social distancing measures and restrictions on movement, imposed to contain transmission, have impacted the economy, compromising income generation and access to sources of income.2 From a health and economic standpoint, the most vulnerable population groups did not receive adequate or timely assistance through effective government actions favouring adherence to such measures.3 Financial restrictions in poorer households created difficulties in meeting basic needs, particularly access to food.4
People experiencing general loss of income tend to seek alternatives to mitigate hunger by adopting practices such as hyper-dilution of food and reduced portion sizes, thereby diminishing nutrient intake, restricting consumption of healthy foods and increasing consumption of cheaper and less nutritious food. The COVID-19 pandemic has threatened food and nutrition security (FNS) by increasing the number of people exposed to conditions that violate the human right to adequate food. The failure to meet basic food requirements is called food insecurity (FI), classified as: mild FI - concern about the quantity and nutritional quality of food in the near future; moderate FI - reduced amount of food available for adults in the household; severe FI - restricted amount of food available for children and adults and feeling of hunger among household members.5
Poverty and social vulnerability experienced by many Brazilian families have deepened in recent years. In December 2020, out of 212 million Brazilians, 117 million lived with some degree of FI. Of these, 43 million did not have enough food (moderate and severe FI) and 19 million faced hunger (severe FI). This situation arose from the dismantling of social protection policies and systems, especially in the health sector.6 These difficulties are amplified in socially vulnerable groups, especially those who, in the pre-pandemic period, were already facing situations of FI.7 Persons affected by Hansen’s disease represent one such group, known to be nutritionally vulnerable.8
FI contributes to worsening nutritional status and to the onset and development of diseases. Conversely, the presence of diseases may reflect deterioriating nutritional status.9 Poverty is a determinant of Hansen's disease, and inadequate diet will compound other factors aggravting poor health status. Studies conducted in Bangladesh and Brazil showed that low total energy intake, limited variety of nutrients, and absence of food stocks in households were factors contributing to Hansen's disease.8,10,11 Moreover, adverse effects of Hansen’s disease such as physical disabilities, stigma, and prejudice increase individual vulnerability and impact on access to work and income.10 This further compromises the financial sustainability of the household, creating difficulties in accessing food of sufficient quantity and quality, giving rise to FI or worsening FI that already exists.5
Before COVID-19, prevalence of FI was higher among persons affected by Hansen's disease than in the general population.8 The emergence and spread of the pandemic has intensified FI problems and increased the risk of vulnerable groups experiencing hunger.7 These circumstances demand a joined-up response comprising initiatives and policies to guarantee food security based on food (availability, production, commercialization, and access) and nutrition (good eating practices and appropriate use of nutrients) as a human right. However, the National Hansen’s Disease Strategy does not address nutrition. We propose that a rights-based approach to policy is needed, providing adequate food, social assistance and income support to minimize FI among people from vulnerable social groups, including persons affected by Hansen's disease.
Daniel M. Favalessa and Simon M. Collin.
1. Rossi P, Mello G. Choque recessivo e a maior crise da história: a economia brasileira em marcha à ré. Centro de Estudos de Conjuntura e Política Econômica - IE/Unicamp. Nota do Cecon, n. 1, Abril de 2017 [Internet]. [cited 2021 May 07]. Available from: https://www.eco.unicamp.br/images/arquivos/NotaCecon1_Choque_recessivo_2.pdf
2. Aquino EM, Silveira IH, Pescarini JM, Aquino R, Souza-Filho JAD et al. Medidas de distanciamento social no controle da pandemia de COVID-19: potenciais impactos e desafios no Brasil. Ciência & Saúde Coletiva. 2020; 25 (suppl 1): 2423-2446. Available from: https://doi.org/10.1590/1413-81232020256.1.10502020
3. Brasil. Auxílio emergencial: 96 milhões de pessoas solicitaram benefício pelo aplicativo, explica Onyx - TV Senado [Internet]. 07/05/2020. [cited 2021 May 07]. Available from: https://www12.senado.leg.br/tv/programas/noticias-1/2020/05/96-milhoes-de-brasileiros-acessaram-aplicativo-para-solicitar-auxilio-emergencial-explica-onyx
4. Oliveira TC, Abranches MV, Lana RM. (In)Segurança alimentar no contexto da pandemia por SARS-CoV-2. Cad. Saúde Pública. 2020; 36(4): e00055220. Available from: https://doi.org/10.1590/0102-311X00055220
5. FAO, FIDA, OMS, PMA y UNICEF. El estado de la seguridad alimentaria y la nutrición en el mundo 2020. Transformación de los sistemas alimentarios para que promuevan dietas asequibles y saludables. Roma, FAO; 2020. [cited 2021 May 15] Available from: https://doi.org/10.4060/ca9692es.
6. Rede Brasileira de Pesquisa em Soberania e Segurança Alimentar e Nutricional (Rede PENSSAN). Insegurança alimentar e Covid-19 no Brasil. 2021. [cited 2021 May 26] Available from: http://olheparaafome.com.br/VIGISAN_Inseguranca_alimentar.pdf
7. Naja F, Hamadeh R. Nutrition amid the COVID-19 pandemic: a multi-level framework for action. Eur J Clin Nutr. 2020; 74: 1117-1121. Available from: https://doi.org/10.1038/s41430-020-0634-3
8. Teixeira CSS, Medeiros DSD, Alencar CH, Ramos Júnior AN, Heukelbach J. Nutritional aspects of people affected by leprosy, between 2001 and 2014, in semi-arid Brazilian municipalities. Ciência & Saúde Coletiva. 2019; 24(7): 2431-2441. Available from: https://doi.org/10.1590/1413-81232018247.19642017
9. Whitney EN, Cataldo CB, DeBruyne LK, Rolfes SR. Nutrition for health and health care. Wadsworth/Thomson Learning, 2001.
10. Wagenaar I, Van Muiden L, Alam K, Bowers R, Hossain MA, Kispotta K, et al. Diet-related risk factors for leprosy: A case-control study. PLoS Negl Trop Dis. 2015; 9(5): e0003766. Available from: https://doi.org/10.1371/journal.pntd.0003766
11. Anantharam P, Emerson LE, Bilcha KD, Fairley JK, Tesfaye AB. Undernutrition, food insecurity, and leprosy in North Gondar Zone, Ethiopia: A case-control study to identify infection risk factors associated with poverty. PLoS Negl Trop Dis.2021; 15(6): e0009456. https://doi.org/10.1371/journal.pntd.0009456