Social Determinants of Health

How the most primal of human necessities affect public health today: A global understanding of malnutrition and food insecurity

Food, water, and shelter—the three necessities of our ancestors, dating from tens of millennia ago, are still ever-important to our survival. In modern-day society, food has become an essential aspect of the cultural landscape of cities; as a result, what food one has access to is dependent on their geographical location, income, and status. Unfortunately, nutrition in marginalized communities is often inadequate, resulting in many negative health consequences. In this post, we’ll explore the societal factors underlying malnutrition and food insecurity around the world, from the bridges of Sacramento to the slums of Varanasi. 

To understand the multifaceted impacts of malnourishment, allow me to entertain this (somewhat hackneyed) metaphor. Imagine the human body as a machine. Food is its fuel, but it needs precise amounts of protein, carbohydrates, fats, vitamins, minerals, and water to remain an equilibrium to continue functioning properly. If one is able to achieve this careful balance, their body will remain healthy. If not, then they’re susceptible to a host of diseases and ailments: cardiovascular disease, obesity, anemia, 7 nutritional deficiencies, and much more. Does this sound exaggerated? Unfortunately, this dire picture is true, and over 10 million people die each year from malnutrition and food insecurity.

In developed countries, such as the U.S. and the U.K., much of the homeless population are victims of this. Homelessness results in increased health needs, as a consequence of the increased physical activity and exposure; however, the absence of a stable food source can exacerbate this. Traditionally, sociocultural, psychological, and physiological factors have contributed to our preference of foods, but the cost barrier leaves only a few available options for members of this community. Due to limited income, people frequently purchase high-energy, nutrient-poor foods, such as hamburgers and pizza, which are available at a lower cost than their nutrient-rich counterparts. This results in an increased rate of obesity in the homeless community, leaving them at a higher risk of cardiovascular disease, hypertension, and cancer.

Furthermore, the high rates of alcoholism, substance misuse, and mental health conditions in this community can exacerbate their nutritional deficiencies. Chronic alcohol consumption affects processes responsible for the absorption of food, and as a result, people who consume excess alcohol are greater at risk of becoming malnourished. In addition, mental health conditions, such as depression and anxiety, result in a chronic loss of appetite and decreased food intake.

Homelessness can result in a poor diet, due to the lack of availability of healthy and affordable food options.

In many third-world countries, problems of a similar nature affect those who are malnourished. For example, take India, where rates of poverty and malnourishment are high in urban cities. From my yearly visits to India, I’ve seen firsthand the devastating effects of malnutrition, and I’ve tried to understand the causes behind it.

Hunger on this massive of a scale is caused by a chain of factors. Thousands of households lie destitute, lacking the necessities for life that others take for granted; the cycle of poverty leaves them unable to afford food. Furthermore, rising temperatures pose a threat to farmers’ crops, hurting the region’s ability to produce its own food. Lastly, this problem is exacerbated by corrupt governments that ignore their citizens and instead worsen the situation. These crises compound, and as a result, one out of every six people is affected by malnutrition — that’s 194 million people. 

Personally, much of my inspiration for the field of public health has come from my interest in global visual impairments, such as myopia, which I too am afflicted by. Unfortunately, malnutrition and food insecurity can exacerbate the symptoms of eye-related conditions.

Vitamin A plays a crucial role in vision, acting as a lubricant for the cornea, which protects one from corneal ulcers and retinal damage. Most of us in the U.S. don’t suffer from vitamin A deficiencies, as it’s common in our staple foods, such as carrots, cantaloupes, chicken, and beef. However, those living on a diet consisting of solely one to two foods, as is often the case in impoverished households in developing countries, are at much greater risk of this deficiency. In fact, it’s estimated that several hundred thousand people become blind every year due to the lack of available vitamin A sources.

Every single one of these people offers a unique story of how hunger has affected them personally: mothers caring for their beautiful babies, fathers working day-and-night to afford food, and children going to bed hungry. Their experiences parallel one other’s, tales of suffering through hardship yet fierce hope beating in their hearts. 

In the past few years, we’ve seen increased awareness in the global health community on the issue of malnourishment and food insecurity. Public health is a continual process, through which we can iterate and improve upon strategies to solve the problems our world faces. In doing so, we can utilize the social determinants of health in identifying methods to mitigate issues in a more comprehensive, societal way.

Author’s note: This is the third post of the social determinants of health series, in which I discuss international public health disparities and societal factors contributing to public health. In these posts, I’ll delve into my journey into the field of public health, specifically focusing on eye care/visual impairments in underprivileged communities, while describing my experiences along the way.

Further reading

Bonner, Adrian, editor. Social Determinants of Health: An Interdisciplinary Approach to Social Inequality and Wellbeing. 1st ed., Bristol University Press, 2018. JSTOR, Accessed 27 May 2020.

Heiting, Gary. “Vitamin A And Beta-Carotene: Eye Benefits.” All About Vision, Mar. 2017,

Nambiar, Devaki. The Social Determinants of Health in India. Springer, 2017,

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