Karen Ensle EdD, RDN, FAND, CFCS
Rutgers Cooperative Extension of Union County
Undernutrition including low body weight compared to height along with low height for age and underweight for age would help indicate malnutrition along with a lack or excess of important vitamins and minerals. In contrast, overnutrition is the excessive consumption of nutrients and calories that can harm health.
Malnutrition is also characterized by the imbalance of a person's energy intake or nutrients along with either the lack, excess or poor balance of calories. There are many issues concerning malnutrition including accessing healthy foods, having a working and clean kitchen, grocery stores and farmers markets in proximity with fresh produce available and accessible. Having corner stores and bodegas stocked with healthy food and beverages is generally not available in low-income areas which impacts health. Frequently, few grocery stores are in these communities, and healthy, nutritious foods may not a priority if there is food in the home.
The health of our nation depends upon the health and well-being of our children and families. All families—no matter who they are, where they live, or how much money they make—should have the resources they need to foster healthy development from their child's earliest years. As a nation of abundance, we must come together to ensure that all families can raise healthy children by addressing the broader social and economic circumstances that make it difficult for too many families to fulfill their aspirations for their children.
The Social determinants of health are factors that impact our health status, functioning and quality of life. They are grouped into five domains: Economic stability, Education, Healthcare, Environment and Social/Community. Malnutrition can result from a variety of sources and factors that extend beyond food. They may include places where we live and work, the people we interact with, the education we receive and businesses and services around us, as well as the community and physical environment where we live. All these factors influence our access and consumption of healthy food. The social determinants create the road for our lifestyle and health.
Low-income households often spend most of their income on housing, medical needs and then food. Even the least expensive health care services and screenings may be avoided due to costs. Transportation costs and availability to get to work may use up most of household income and leave little left over. Education quality and access may be limited and can be affected as well. Low finances don't allow funding for the best schools or better housing and community environments. Poor education in the areas of health and nutrition can lead to poor food and beverage choices at the corner store and lead to disease development and malnutrition. Lack of fresh produce and healthy foods may not be available in urban or rural areas. Farm markets may be too far from home and cost more than food available at the local corner store or bodega. Education can also affect job access which means lower salaries and lower expectations of life and health. Thus, the cycle of poverty and poor health continues.
The United Nations Children's Fund framework on the "causes of malnutrition and death" discusses underlying outcomes for child nutrition. These include the relationship between nutrient intake and immunity at the immediate level, which is affected by access to food and health systems, adequate childcare, and sanitary environments. It is the social determinants of health which cover a range of social, economic, and political drivers affecting malnutrition in all its forms. Taking small steps to understand the complex mix of factors that make up the basic determinants helps one understand the importance of good nutrition and access to healthy food for all populations.