“All for One and One for All” Comments on the FAO Food Security Index Elliot M Berry, MD, FRCP Visiting Expert in Nutrition, ESN FAO, Rome and Braun School of Public Health, Jerusalem

The Three Key Messages for World Food Day 16 October Good Nutrition depends on Healthy Diets 2.Healthy diets require Healthy Food Systems – along with education, health, sanitation and other factors 3.Healthy Food Systems are made possible by appropriate policies, incentives and governance Question: How to assess and monitor Sustainable Healthy Food Systems?

Food Secure Temporary Food Insecure Vulnerability Utilization Chronic Food Insecurity PoU Positive Coping Negative Stability Individual Household National Time Accessibility Availability Level The Elements of Food (In)Security Household Consumption & Expenditure Surveys Diet Diversity Anthropometry Biomarkers Health Stats Food Balance Sheets Diet Assessment Coping Volatility Indices *Global Nutritional Index Indicators And many, many more… Waste FIES

“Of making many Indices there is no end....” Food Security as an example at least 9 Household Indices Coping Strategies Index CSI Reduced CSI Household Food Insecurity and Access Scale Household Hunger Scale Food Consumption Score Household Dietary Diversity Scale Self-Assessed Food Security Household Consumption & Expenditure Survey US H-hold FS Surv Mod (HFSSM) at least 8 Overall indices FAO Undernourishment Global Hunger Index Global Food Security Index Poverty & Hunger Index Hunger Reduction Commitment Index Anthropometric Indices Dietary Diversity Score Medical & Biomarker Indicators So why do we need another index??? How different are they? How do they overlap? Maxwell et al. Tufts Univ, 2013 Pangaribowo et al : Foodsecure, 2013

Key: FAOIU – FAO Indicators of Undernourishment GHI – Global Hunger Index GFSI – Global Food Security Index PHI – Poverty & Hunger Index HRCI – Hunger Reduction Commitment Index AI – Anthropometric Indicators DDS – Dietary Diversity Score MBI – Medical & Biomarker Indicators Food and Nutritional Security Indicators: a review. Pangaribowo et al eds, Foodsecure, 2013 … Stability is not covered by any of them Stability Utilization Availability Accessibility Are all 4 elements of Food Security equal, or are some more equal than others...?? Problem of Weightings & Analytic Hierarchy Process

The Problem of Weightings (Wt) in FAO Food Security Index DimensionIndicatorWt∑Wt AVAILABILITY1 Domain 0.25 Av Diet Energy Supply (DES), Av Value of Food Prod Share of DES from cereals, roots etc Av Protein Supply, Av Protein Supply of Animal Origin 0.04, each 0.06, each ACCESS3 Domains 0.25 Physical (Σ0.8) % Paved Roads Road density, Rail- line density , each EconomicDomestic Food Price Index0.08 HealthPrevalence of Undernourishment0.08 UTILIZATION2 Domains 0.25 Pub Health (Σ0.10) Water, Sanitation0.05, each Child Anthrop (Σ0.16) Stunting, Underweight Wasting 0.06, each 0.04 STABILITY2 Domains 0.25 Exposure (Σ0.13) Cereal Import dependency % Land equipped irrigation, Food Imp / Σ merchand Exp , each Shock (Σ0.13) Political Stability, Domestic FPU Volatility Food Supply Variability 0.04, each 0.05

Some additions to the Proposed Food Security Index FAO Utilization level of Household/ Individ Food Safety, Losses & Waste Outcomes Health Status Obesity BMI NCDs, CVD, Diabetes, Cancer Food Insecurity Coping Sustainability Availability Access Utilization Stability/ Vulnerability Outcomes Coping Economic Physical Sustainability Utilization Missing data for micronutrients Vulnerable groups, Pregnancy, HIV, elderly...

“All for One and One for All” FAO Food Security Index – For the Future (1)  Data Collection  Standardization of Methodology,  High Frequency to capture seasonality and vulnerability  GPS and Mobile Phone Technology  Cost  Choice of Suite of Indicators  Problem of Weightings and Evolution of the 4 elements of FS  Appropriate to the Level – National, Household, Individual and Target Populations  At-risk groups: early life malnutrition, elderly, HIV, poor..  To add Losses & Waste, Food Safety, Micronutrients  Health Outcomes: BMI, NCDs...  Coping Strategies – Cultural Dependency  Sustainability fao.org; ekmd.huji.ac.il

“All for One and One for All” FAO Food Security Index – For the Future (2)  Data Analysis and Presentation  Ability to Aggregate & Disaggregate data  Between Countries (Fixed) and Within countries (Flexible)  Geo-spatial methodologies  Monitoring & Evaluation  Validity (corresponds accurately) – problem of ‘gold standard’  Reproducibility (test-retest)  Cross-cultural comparability  Predictive Power  Conclusion: FAO as the natural, “neutral broker” to lead & coordinate a comprehensive Food Security Index along the whole Sustainable Healthy Food System – from Farm to Fork fao.org; ekmd.huji.ac.il

Some Questions for Sustainable Food Security / Systems (SFS) At National Level Under what framework to integrate the many discipline - Agriculture, Health, Environment – involved in Sustainability? How can Bio-Technology / Bio-Fortification help improve Food Security? How will external issues affect Food Security – such as a) Globalization; b) Urbanization; c) Biodiversity; d) Climate change? What should be the criteria for incorporating & prioritizing short and long- term SFS in national policies At Household Level How can communication and information technology be used to improve data collection? What strategies can a) Increase and improve food production; b) Facilitate access ; c) Reduce food losses and waste? At Individual Level How to best assess SFS for different groups – farmers, rural women, consumers, special needs vulnerable groups? Use of Mobile Phones for monitoring Food Security How to improve Behaviour change (education) and Coping skills in culturally sensitive ways?