The term “healthcare” often evokes the images of hospitals, doctors, nurses, white coats, test tubes and stethoscopes, but rarely does “food security” make the list. Yet hunger– the result of poor nutritional availability in many impoverished communities– plays a significant role in human development and mortality across the globe.
“The whole healthcare system focuses on illness. We don’t get to focus on health very much,” said Dr. Shannon Galvin at a panel Friday at the Feinberg School of Medicine in honor of Northwestern’s Global Health Day and this year’s One Book One Northwestern selection, The Last Hunger Season by Roger Thurow.
One Book One Northwestern, hosted by the Office of the President, seeks to engage the Northwestern community in conversation around a thought-provoking title each year. Freshman receive a free copy, although everyone is encouraged to read and attend the many lectures, film screenings and discussions about the issues in the book.
Panelists Friday used The Last Hunger Season as a lens to discuss the myriad of macro and micro-economic forces affecting hunger and health around the world. The book traces Kellogg School of Management alumnus, Andrew Youn’s quest to improve living conditions for Kenyan subsistence farmers, who experience the irony of living in one of the highest-producing regions in the world, yet starving on an individual basis.
Farmers there lack the resources to weather out the months-long “hunger season”– the time between the planting season and harvest– which forces them to buy maize and other staples on a global market, made expensive by high demand during the hunger season. When it is time to sell their crops, the market is over-saturated, forcing prices to plummet. Yet they are pressured to sell due to a lack of proper storage for their crops, and desperation after months of starving. Consequently, farmers sell at a low price and rarely have enough money left over to tide the next hunger season. During these times, families encounter numerous bouts of malnutrition and disease– often the result of compromised immune systems due to poor nutritional intake.
Youn began the One Acre Fund, a social enterprise, to teach farmers more efficient farming techniques, distribute higher-yield seeds and offer lessons in savings and economics (for example, to save crops to sell until later in the year when the price rises). The farmers Thurow followed miraculously saw yields improve up to four-fold. By empowering themselves to compete in the global market, they all hoped to have endured their last hunger seasons.
“It just seemed like a really positive way to impact people, where they were taking ownership for improving their lives,” said Nancy Cunniff, project coordinator for One Book One Northwestern.
The panelists and attendees Friday (mostly Feinberg students) offered important insights about why context, especially food availability, is important in determining health outcomes.
Radiologist Dr. Jennifer Nicholas previously worked in Kenya, examining arm fractures amongst children in the Masai tribe. She hypothesized that many of the fractures were due to the degeneration of bone structure due to poor nutrition, a fact other health care providers had overlooked.
Health economist Diane Schanzenbach revealed lessons from her own research into the United States food stamp program. She discovered that the program positively impacted health and education outcomes for children receiving public assistance in the 1960s. Those who had access to food were more likely to graduate high school and attend college, and less likely to be on public assistance as adults. “And why is that?” she asked. “Because we didn’t diminish their human potential early in life.”
Yet hunger does negatively affect the ability of people to live a full life and break the cycle of poverty. In The Last Hunger Season, Kenyan parents often expressed the desire for their children to succeed in school. However, excessive hunger compromised the ability of their children to concentrate and perform well. Dr. Galvin presented staggering numbers to confirm: hunger affects 850 million people world wide and is implicated in the deaths of about 45 percent of children under the age of five, though the primary cause is not usually identified as hunger.
Dr. Galvin implored medical students attending Friday to consider the contextual issues– poverty, hunger, malnutrition– underlying the presentation of symptoms and disease in patients. “If you go work overseas, you’ll be…in a setting where you want to treat someone for TB or malaria or heart disease or various other illnesses, but they aren’t eating enough. They can’t get enough to eat,” she said. “So, as healthcare providers, we see the consequences of this but sometimes we’re a little bit removed from working on the solutions.”
Those solutions often go beyond the clinic. The panelists gave students a glimpse of the larger issues at play when treating a patient. “The problems in the book are dealing with policies, and public health and markets,” said Daniel Young, the Deputy Director for the Center for Global Health, which hosted the panel. “So I think it’s interesting to present those perspectives to the students, because that’s not usually the approach they come to first. That’s valuable for them.”
The lessons hit home for first-year medical student, Molly Lohman. She says she is determined to find a way to incorporate knowledge of economics, politics and culture into her practice of medicine, and believes that her studies at Feinberg have encouraged her to think seriously about these forces.
“I really appreciate, in our curriculum, [professors are] trying to get us to open up to all the factors that affect health,” she said. “We’re not just taking a small science and medicine class that focuses on the molecular cause of disease. They’re really trying to get us to see the broader issues that create disease.”