Friday, October 15, 2010
Oxfam's current campaign, "Sow the Seed," is asking world leaders to support the world’s poorest food producers as they fight climate change. This campaign officially begins on World Food Day, which leads up to the climate summit in Cancun November 29.
Our two "asks" in the US are for our members of Congress to:
1. Pass the Global Food Security Act. Strengthen it to support communities in their efforts to build resistance to climate change - and combat the adverse effects of climate change on their crops.
2. Urge President Barack Obama to establish a fair, accessible and accountable global climate fund at the climate summit in Cancun later this year that will sow the seed for a binding global climate agreement by 2012.
People can get involved in advocating for these causes with Oxfam by
a) joining an Oxfam Action Corps if you live in one of the following cities:
New York, NY
San Francisco, CA
Several of my fellow Oxfam Action Corps NYC volunteers have been in Iowa this week for the Norman Borlaug Dialogue / World Food Prize event, learning more about ending world hunger. You can find out more about OAC NYC at http://www.oxfamactioncorpsnyc.org/ (the other OAC pages are linked from here as well). Or alternatively, visit http://www.oxfamactioncorps.org
b) Tomorrow (World Food Day), Oxfam Action Corps in these various cities will be holding events to get petition signatures and have people plant seeds through creative activities. If you do not live in one of these cities, you can still support the Sow the Seed campaign by growing a "virtual plant" by taking the actions listed on the website, sowtheseed.net - growing plants, uploading photos of plants grown at home for the "photo petition," and sharing and promoting the actions through your own social networks. The number of actions taken around the world will be shown as a rolling number on this virtual plant.
c) Get advocacy updates from Oxfam America by signing up at http://oxfamamerica.org/
Sunday, May 9, 2010
Food Security and HIV/AIDS in Kenya (by Kelly Moltzen)
In Kenya, as well as many other places around the world particularly in sub-Saharan Africa, human immunodeficiency virus (HIV) is still a huge epidemiological issue despite access to antiretroviral medications. One of the reasons for the high rates of HIV in Kenya is because people do not have access to adequate food, thereby compounding the effects of the disease on the immune system. Rates of food insecurity in Kenya are very high, particularly in rural areas. There are many contributing factors to the problem of food insecurity, not excluding political corruption, which led the World Bank and the IMF to delay giving loans to the government in 2006. In addition, Kenya suffers from severe droughts which reduce agricultural output, and low investment in the country’s economic growth.2 There is still no funding specifically dedicated to food security for the HIV population.1
In any country in which it occurs, the coexistence of HIV, poverty, and food insecurity has devastating impacts on people’s health.1 HIV worsens nutritional status, further leading to the decline in health of people living with HIV/AIDS (PLWHA). When HIV-infected people do not receive sufficient food to nourish them and help them recover, this leads to the perpetuation of the disease and increased numbers of PLWHA. This happens through several mechanisms, occurring through biological as well as social and economic pathways.4 HIV can be transmitted horizontally when food insecure women – who are responsible for the health of their families – engage in transactional sex to make money to buy food for their families. It can also be transmitted vertically, as pregnant malnourished women with HIV have a greater chance of transmitting the disease to an unborn infant than well-nourished pregnant women. In particular, factors associated with higher mother-to-child transmission are low iron and Vitamin A stores, low BMI, and maternal weight loss.4
Food insecurity also impacts access to treatment and care services.4 While the Kenyan Ministry of Health has worked with Doctors Without Borders to provide free access to ARV treatments in the Nairobi slums of Kibera, a considerable number of eligible individuals have not accepted the offer for medications. Oftentimes, even when receiving free ARV medications, parents need to choose between paying for transportation to attend health care appointments, and using the money to adequately feed themselves and their children.4 This problem seems like it would be even larger in rural areas than urban areas, where traveling is less convenient. Also, in the study of Kibera, one of the main reasons for not accepting the offer for medications was because of a fear of taking the medication on an empty stomach.5
Lack of food has shown to negatively impact the efficacy of antiretroviral (ARV) medications. Food insecurity has been associated with a decrease in the effectiveness of protease-inhibitor based regimens, and specifically a 30% decrease in drug plasma concentrations.4 Very high viral loads have been found among those receiving highly active antiretroviral treatment (HAART).4 Taking ARV regimens with food has been shown to increase the bioavailability of medications by as much as 700%.4 The ability of the human body to suppress the virus has shown to be 70% lower in people reporting food insecurity, even after levels of adherence to the medication regimen were taken into account.4 Thus, it is of paramount importance that patients receive adequate nutrition, if there is any chance of halting the spread of HIV in sub-Saharan Africa and elsewhere.
HIV prevalence in Kenya is more concentrated in the west of the country6 and where there are higher poverty rates, small plots of land, and poor soil quality.1 There are over 1.5 million people in Kenya currently living with HIV, and there are approximately 100,000 deaths from AIDS per year in this country. Up to 700 people reportedly die on a daily basis in Kenya from infections related to their HIV status. One study found that PLWHA were more likely to be malnourished than people whose status was not established.7
The study found that the majority of foods eaten by PLWHA were low in nutrients that help build up the immune system and maintain adequate weight, and that there was not a lot of variety in the foods consumed.7 High protein foods such as meats and legumes were found to be consumed by less than a quarter of the sampled households.7 Interestingly, those surveyed showed a lack of nutrition knowledge in terms of which foods were appropriate for PLWHA to eat to support a healthy immune system.7 This is likely related to the literacy rates, as many people cannot understand educational brochures which are handed out if they are illiterate. The literacy rates in Kenya are approximately 80% for females and 90% for males, as estimated in 2003.2
Additionally, there are high numbers of widows, orphans, and falling school attendance rates in Kenya.1 Many children must care for their ailing parents who have HIV/AIDS, and this adversely affects their ability to participate fully in obtaining their education. Mishra et al found that “orphans, fostered children, and children of HIV–infected parents are significantly less likely to attend school than non–orphaned/non-fostered children of HIV–negative parents.”
The Academic Model Providing Access to Healthcare (AMPATH) identified over 67,000 individuals from 17 clinics in Kenya as food insecure in 2007, which amounts to 33.5% of the total number of people assessed.1 AMPATH began as a collaboration between a consortium of universities in Indiana and the Moi Teaching and Referral Hospital and Moi University School of Medicine. When the extent of the problem of HIV and food insecurity was realized, AMPATH established partnerships with the World Health Organization’s World Food Program (WFP) and the United States Agency for International Development (USAID), and began producing food on farms in Kenya to complement food donations.1
Essentially, these international aid organizations are working with clinical staff and community groups to provide resources and support to HIV patients and their families. Nutritionists assess all patients in the AMPATH clinics with the Household Food Insecurity Access Scale used by USAID.1 The nutritionists were given criteria to use to decide who would qualify for the program, which included meeting one or more of the following: “a) having insufficient access to food to support patient recovery; b) Body Mass Index (BMI) below 19; c) Household income less than 3,000 Ksh per month; d) CD4 count less than 200.”3 In general, however, the nutritionists subjectively decide eligibility status, giving food insecurity the most weight.3 Those who qualify for the program are provided 6 months of nutrition support, as this is the amount of time thought necessary to recover and be able to carry out activities of daily living; however, there is some flexibility in the length of time a patient could receive the food support.1,3
The amount of food allotted to patients is determined based on the number of people in the household.1,3 Monthly follow-ups are used so that patients renew their “food prescription” on a regular basis1; patients are also weighed and receive nutrition counseling during these monthly follow-ups.3 Patients are enrolled either through the WFP or through the “HAART and Harvest Initiative” (HHI), and fill their food prescriptions at distribution sites on a regular basis, depending on how far the site is from their residence.3 When patients are weaned off food support, they are enrolled in the “Family Preservation Initiative” which provides education on income generating activities or food production.1,3 They could also choose to attend patient-led support group meetings.3
To provide necessary food to the patients, a combination of production, purchase, and donation of food is used; as stated, food production is “a key component of the AMPATH nutrition program.” 1 Six farms were started, 4 of which are used for high production of food (3 rural, 1 urban), and two of which are used for educating patients on how to increase the yield of small plots they may own.1,3 A continuous source of water is provided, which allows the farms to produce a year-round supply of fresh vegetables.1 Over 20 tons of vegetables are produced per month, and an expected 4 tons of fruits are also expected to be produced as the farms become more productive.1
In addition to food production, the WFP provides food donations of legumes, corn, corn-soy blends, and cooking oil, for up to 30,000 recipients and 1500 orphans and vulnerable children; an additional 2,000 people receive corn-soy blends from USAID. AMPATH also coordinates the distribution of eggs and milk which are produced by patients within the program,1 as well as local and exotic herbs.3
Industrial engineers from Purdue University worked with AMPATH to design a computerized nutritional information system that could be used to coordinate the distribution of food to patients throughout western Kenya. The foods available, as well as patients needing that food, are entered into the system, which then helps coordinate who will pick up, transport, and deliver the food to the proper places. Altogether, food and fixed costs of the program cost $0.27 per patient per day. 1
The AMPATH model and collaboration with the WFP and USAID provides a remarkable opportunity to improve the nutritional status of Kenyans, especially those living with HIV/AIDS. It uses an academic partnership, teaches native Kenyans how to farm the land and uses the crops they produce as part of the food support package given to the HIV/AIDS patients and their families. It also provides the patients with nutrition education, and an opportunity to learn skills on income-generating activities through the Family Preservation Initiative.
However, as noted by Mamlin et al, the current system still relies heavily on food donations and is unsustainable in the long run.1 It is necessary to teach more Kenyans how to till the land and increase the number of farms and gardens producing crops. There should be more diversity of crops grown on these farms, as this would help not only decrease dependence on foreign food aid, but also to improve the nutritional status of Kenyans – both PLWHA and those currently without the disease. By improving the nutrition of all Kenyans, this will strengthen people’s immune systems and make them less susceptible to acquiring and transmitting HIV to others.
Currently the country is still receiving a significant amount of corn-soy blend through the WFP and USAID. 1 Alternatively, people could learn to grow a variety of crops that are diverse, have a high nutrient density, and are native to the land in Africa, such as amaranth, millet and sorghum. Research is beginning to show a tendency towards increased food security in Kenya when traditional crops are grown. In rural areas, people should be provided with support needed to start new farms with a variety of crops. This can provide a source of nutrition as well as become an income-generating activity if a sufficient number of crops are grown. If these farms aim to produce large numbers of crops on a scale which could feed the nation of Kenya (either directly or through increased trade), it may be necessary to invest in resources to help farmers cope with the effects of climate change. Climate change has a greater negative impact on developing countries such as those in Africa, and has led to droughts and desertification across the continent. Work should be done to expand Navdana, the program Dr. Vandana Shiva has started in India which is a women-centered movement focused on biodiversity and food sovereignty in the face of climate change.
On a smaller scale, in both rural and urban areas, gardens can be built alongside hospitals to provide patients with both nutritious food and the educational and physical exercise of harvesting the crops. In urban areas, support should be provided to allow people to start their own gardens at home.
There are already non-profit organizations helping to start these types of gardens to support PLWHA in Kenya, such as Development in Gardening (DIG). DIG has a partnership with USAID, so this relationship should be fostered further in order to provide more individuals with the opportunity to garden.
For the multitude of reasons outlined above, ensuring the food security of HIV/AIDS patients and their families is critical in improving the health of the patients and helping to limit the spread of HIV. This should be done by training Kenyans to increase the food productivity of their land in a sustainable manner.
 Mamlin J, Kimaiyo S, Lewis S, et al. Integrating Nutrition Support for Food-Insecure Patients and Their Dependents Into an HIV Care and Treatment Program in Western Kenya. American Journal of Public Health. 2009;99(2):215-221.
 The World Factbook. Kenya. Central Intelligence Agency. https://www.cia.gov/library/publications/the-world-factbook/geos/ke.html. Accessed December 14, 2009.
 Byron E, Gillespie S, Nangami M. Integrating nutrition security with treatment of people living with HIV: lessons from Kenya. Food Nutr Bull. 2008; 29:87–97. http://programs.ifpri.org/renewal/pdf/KenyaAMPATH.pdf. Accessed December 14, 2009.
 Anema A, Vogenthaler N, Frongillo EA, Kadiyala S, Weiser SD. Food Insecurity and HIV/AIDS: Current Knowledge, Gaps, and Research Priorities. Current HIV/AIDS Reports 2009;6:224–231.
 Unge C, Johansson A, Zachariah R, et al. Reasons for unsatisfactory acceptance of antiretroviral treatment in the urban Kibera slum, Kenya. AIDS Care 2008, 20:146–149.
 Kenya. Epidemiological Country Profile on HIV/AIDS. WHO. 2008. http://apps.who.int/globalatlas/predefinedReports/EFS2008/short/EFSCountryProfiles2008_KE.pdf. Accessed December 14, 2009.
 Kuria, EN. Food consumption and nutritional status of people living with HIV/AIDS (PLWHA): a case of Thika and Bungoma Districts, Kenya. Public Health Nutrition. 15 June 2009; 1-5. Published online: doi:10.1017/S1368980009990826.
 Mishra V, Arnold F, Otieno F, Cross A, Hong R. Education and Nutritional Status of Orphans and Children of HIV-Infected Parents in Kenya. AIDS Education and Prevention. 2007;19(5):383–395.
 Board on Science and Technology for International Development. The Lost Crops of Africa. Volume I: Grains. National Research Council. Washington, D.C.: National Academy Press; 1996.
 Figueroa Gomez de Salazar B, Tittonell P, Ohiokpehai O, Giller K. The Contribution of Traditional Vegetables to Household Food Security in Two Communities of Vihiga and Migori Districts, Kenya. Wageningen University. 2008. http://www.icuc-iwmi.org/Symposium2008/Theme%201/T1.3-Blanca%20Figuero.pdf. Accessed December 14, 2009.
 Navdana. Available at: http://navdanya.org/. Accessed December 14, 2009.
Thursday, May 6, 2010
I recently wrote a newsletter on combating childhood obesity during a pediatric rotation of my dietetic internship at Jacobi Medical Center in the Bronx. Here's the content...
Improving the school food environment through your child’s school’s Parent Teacher Association (PTA) and your Community
Many school PTAs sell unhealthy foods such as candy or potato chips as fundraisers for their school, to fund after-school activities. Parents and teachers want the best for their children, but these unhealthy foods actually make children believe that these foods are acceptable snacks and can be consumed on a regular basis. As an alternative, the District Public Health Office has developed a Fundraiser Guide to help PTAs choose healthy food (or non-food!) options for school fundraisers. The toolkit can be found at this link: http://www.nyc.gov/html/doh/downloads/pdf/dpho/dpho-fundraiser-guide.pdf
School Breakfast Program
Many children either do not eat breakfast in the morning or pick up an unhealthy option, such as a bacon, egg & cheese sandwich, for breakfast on their way to school. When children don’t start the day off right with a healthy breakfast, they’re more likely to have difficulty paying attention and focusing on classwork while at school. The Department of Education has approved all schools in New York City to have a school breakfast program, but many schools have not signed up yet or only offer the program to a few classes at the school. The school breakfast program means that every child in the classrooms to which it is provided will get the same, healthy breakfast – a great way to start off the day. If your child does not currently participate in the School Breakfast Program, speak with the principal at your school or your school’s PTA about the possibility of signing up or expanding the program to cover more students.
Child Nutrition Reauthorization and the School Lunch Program
The Department of Education’s Office of SchoolFood (OSF) works hard within its budget to make sure all children get a school lunch that meets certain nutritional standards while also tasting good to the children. However, the United States Department of Agriculture (USDA) only gives a certain amount of money to improve school food, and this amount of money is not enough for the OSF to make all the changes it would like to. There is currently a bill in Congress called Child Nutrition Reauthorization, which if passed will increase the amount of money spent on childhood nutrition programs – including school food – by $4.5 billion over 10 years. This would bring healthier foods into all schools, including vending machine items. However, the amount of money that is truly needed to improve school food is $4 billion per year. To find information on how to call your Congressman to ask for more money for child nutrition, see this link: http://www.congress.org/congressorg/issues/basics/
Another thing you can do to improve the quality of school food is: together with your child’s principal and PTA, speak to Billy Doherty at the Office of School Food about connecting your child’s school to a local farmer to get fresh, local fruits and vegetables delivered to the school. Many farmers from local areas, such as Upstate New York and other nearby states, already sell their fruits and vegetables to people in NYC at farmers markets.
More on Farmers Markets…
There are many farmers markets located throughout the city, including some in the
Kids and Gardening
There are many success stories of children trying new fruits and vegetables if they are involved in growing the food themselves. As a matter of fact, First Lady Michelle Obama has planted a garden at the White House and has local schoolchildren harvest the vegetables to teach them the importance of gardening and eating healthy. Some children in NYC and the Bronx are involved in community gardens, oftentimes through the school curriculum. Every child should have this opportunity! Talk to others in your community and your child’s school to find out if there are any community gardens near you. Perhaps you could work with the school’s PTA, or your child’s principal and science teacher to see about involving students in vegetable gardening during the school day.
Supermarkets & Bodegas
In December 2009, the City Council approved bringing more supermarkets into low- and moderate-income areas of NYC, including sections of the Bronx, through the Food Retail Expansion to Support Health (FRESH) Initiative. The new FRESH supermarkets will offer a full line of grocery products, including fresh fruits and vegetables, fresh meats, dairy and other food and nonfood products, and will also be a source of new local jobs.
Until these new supermarkets are built, you can still change the food choices available in your neighborhood. Your local grocery or bodega owner generally sells what he thinks his customers want to buy. If you do not like the foods in your local store, ask to speak to the owner and let him know what options you would like to buy. If he is able to stock the healthier food items to sell to you, he will most likely do so because he knows people want it. Some ideas of things to ask for are low-fat milk and yogurt, apple chips, pita chips, pretzels, whole wheat bread, regular peanut butter, jelly, plain nuts such as almonds and walnuts, and fruits and vegetables that are either fresh, frozen, or canned in light syrup (note: many stores do not have the capacity to sell foods that need to be frozen or refrigerated).
There’s no need to ask for water, because you can get this for FREE from the sink or water fountain! NYC water is generally of very good quality and you can save a lot of money by buying a reusable BPA-free bottle and filling it with water on your own.
Bronx Health REACH
Bronx Health REACH, a part of the Institute for Family Health, is an organization that works on trying to improve the quality of food served in the Bronx. REACH also works to educate the community about how to live a healthy lifestyle through the food and exercise choices we make. One of the focuses of REACH is working with churches in the community to empower its members to lead a healthy lifestyle. REACH has developed a “God’s Health Squad” toolkit for church leaders to use with youth groups. More information can be found on the website, http://institute2000.org/bhr, the blog, http://bronxhealthreach.blogspot.com, or by contacting Kelly Moltzen (see bottom of post).
NYC Strategic Alliance for Health (SAfH)
The NYC Strategic Alliance for Health (SAfH) was founded in 2008 to combine the efforts of local organizations, Elected Officials, and other community based organizations in an effort to improve the environments, systems, and policies that affect physical activity, nutrition, and tobacco-use within schools and the broader community of the South Bronx and East & Central Harlem. The efforts that are found to work best will be shared with other NYC neighborhoods who are also working to decrease health inequities.
A brief overview SAfH’s Goals:
· Require organizations that work in New York City Housing Authority (NYCHA) community centers to lead daily physical activity programs
· Improve the play street program in target areas by changing policy
· Include a new option in the NYC Department of Health and Mental Hygiene’s Adopt a Bodega initiative that will offer Bodega owners resources for renovations that will allow fruits and vegetables to be sold and maintained on site
· Establish a policy at the NYC Department of Education that will provide elementary schools with a Physical Activity and Nutrition Award
· Establish a policy requiring elementary after-school programs to include daily time for physical activity
For more information, contact: Geysil Arroyo, Community Coordinator
646-672-2385 or email@example.com
What’s On Your Plate? Film
Want to watch a movie about healthy and not-so-healthy food in NYC, narrated from a kids’ perspective? The film “What’s On Your Plate?” is just that. It follows two curious girls who are on a mission to understand where their food comes from, and what’s in it. The girls interview many influential people in NYC, including Manhattan Borough President Scott Stringer, Chef Jorge Collazo from the NYC Department of Education’s Office of School Food, and Anna Lappé, author of the newly released book Diet for a Hot Planet, about the impact of our food system on climate change. You can find out more information about where and when “What’s On Your Plate?” is being screened in NYC at the website whatsonyourplateproject.org.
First Lady Michelle Obama is very involved in supporting a healthy lifestyle for children. She has started the “Let’s Move” initiative to fight childhood obesity, which aims to give “parents the support they need, provide healthier food in schools, help our kids to be more physically active, and make healthy, affordable food available in every part of our country.” You can find out more here: http://letsmove.gov/
People’s Garden NYC Petition
There is currently a petition asking Mayor Bloomberg to plant a vegetable garden outside of City Hall as a symbol of the City’s dedication to healthy food. If this garden becomes reality, it would be managed by children and seniors from the nearby area, and the food grown would be donated to a local food pantry or soup kitchen. You can learn more about it and sign the petition here: http://peoplesgardennyc.org/
NY Coalition for Healthy School Food
The New York Coalition for Healthy School Food is organization that works on improving food for all children in New York. Learn more here: http://www.healthyschoolfood.org/
Super Kids Nutrition
Find information on healthy eating for your kids from the experts! There are articles, activities, book suggestions and more at http://superkidsnutrition.com/
Dr. Dolgoff’s Weigh
Dr. Johanna Dolgoff is a pediatrician who focuses on weight management. She has many resources online that you can get for free at her website, http://drweigh.com/
SNAP-Ed Recipe Finder Database Search for low-cost recipes by ingredient, recipe name, cost, and more: http://recipefinder.nal.usda.gov/
Want to learn more about the food system by watching videos? Here are a few you can watch online:
· Urban Farming NYC http://tinyurl.com/urbanfarmingnyc
· The Meatrix http://www.themeatrix.com/
· The True Cost of Food http://www.sierraclub.org/truecostoffood/movie.asp
· The Story of Stuff http://www.storyofstuff.com/
This newsletter was written by Kelly Moltzen, a dietetic intern at the Bronx Veterans Affairs Medical Center, graduate student studying public health at New York University, and previous Nutrition Intern at Bronx Health REACH. She can be reached by email at firstname.lastname@example.org. You can also follow her on twitter at twitter.com/kellymoltzen or visit her blog: food4thoughtandaction.blogspot.com/.
Thanks for reading!
Farmers Markets in the Bronx
Greenmarket Farmers Markets: EBT/Food Stamps and WIC & Senior FMNP Coupons Accepted. For every 5 EBT dollars spent, customers receive a $2 Health Buck coupon to purchase additional produce.
Lincoln Hospital Greenmarket
149th Street at Park Ave, Bronx, 10451
Tuesdays and Fridays, June 29 through November 23, 8am - 3pm
New York Botanical Garden Greenmarket
Dr Theodore Kazimiroff Blvd at Bronx Park Rd, New York, 10458
Wednesdays, June 16 through November 29, 9am - 6pm.
Poe Park Greenmarket
Grand Concourse at E 192 St, Bronx, 10468
Open Tuesdays, July 6 through November 23, 8am -3pm
Harvest Home Farmers Markets:
1400 Pelham Parkway
Tuesday, 8 am – 4 pm
June 16 - November 24
Forrest Ave. Market
Forrest Avenue Betw. 156th & Westchester
Wednesday, 8 am – 4 pm
July 8 - November 18
North Central Bronx
Mosholu Pkwy North & Jerome Ave
Wednesday, 8 am - 6 pm
July 8 - November 18
Mt. Eden Ave. Market
Thursday, 8 am - 4 pm
May 21 - November 19
Castle Hill Avenue
At Castle Hill & Hart St
Saturday, 8 am – 4 pm
July 11 - November 21
Coop City Market
Coop City Blvd.,Greenway #3
Saturday, 8 am - 6pm
July 11 - November 21
Morris Park Market
1734 Williamsbridge Road
Our Saviour Lutheran Church Parking Lot
Saturdays, 8 am - 4 pm
July 11 - Nov 21
Echo Park Market
On Tremont Avenue
Betw. Anthony &
Wednesday, 8 am – 6 pm
July - Nov 2
165th Grand Concourse
Sunday, 8am - 4pm
July 12 - Nov 22
For more information:
Greenmarket http://cenyc.org/ourmarkets or call (212) 788-7476
Harvest Home Farmers Market http://www.harvesthomefm.org/Locations.html or (212) 828-3361