Is your refrigerator running? Aside from needing to catch it, you probably take energy for granted. Imagine that there’s a blackout tomorrow and you have to wash all of your clothes by hand. How many hours would it take you? The extra hours of ironing? We flip on a switch, the lights come on, and more importantly, they stay on. Microwaves have simplified electrical cooking down to 10 digits. For those who can afford it, solar panels offer the opportunity to harness UV energy, and deliver excess solar energy back to the power grid for credit on the utility bill. Scientists can, for the most part, throw tissue samples into -80°C freezers without worrying if the power will stay on. Whatever the use, uninterrupted modern energy sources facilitate a great deal of the work we do. Imagine what that energy can do for the three billion people in developing countries relying on traditional biomass for cooking and heating, and the one and a half billion people without any electricity.

Since 1959, albeit numerous gaps, the United Nations has been observing various international years.

Recognizing the importance of energy for sustainable development, the United Nations General Assembly has designated, by its resolution 65/151, the year 2012 as the International Year of Sustainable Energy for All.

Emphasizing the critical need for electricity in the achievement of the Millenium Development Goals, the UN proffers that:

1. Energy can increase farmers’ productivity, bringing the world one step closer to eradicating extreme poverty and hunger.
2. Energy can light up learning, allowing children to achieve universal primary education.
3. Energy can lift the burdens of women and girls, promoting gender equality and empowering women.
4. Energy can save children’s lives, reducing child mortality.
5. Energy can power modern healthcare, improving maternal health.
6. Energy can give doctors the power to heal, improving the ability to combat HIV/AIDS, malaria, and other diseases.
7. Energy can empower communities while ensuring environmental sustainability.
8. Energy can build bridges to the future, promoting a global partnership for development.

Using traditional biomass including wood, coal, animal dung, and crop waste to cook in and heat homes produces high levels of indoor air pollution, resulting in respiratory diseases such as pneumonia, chronic obstructive pulmonary disease (COPD), and lung cancer. The use of these fuels also impacts several other factors.

Fuel gathering consumes considerable time for women and children, limiting other productive activities and taking children away from school. In less secure environments, women and children are at risk of injury and violence during fuel gathering. (WHO)

Thus, using energy to shift away from this traditional biomass alone can create extensive change. So here’s to a year of sustainable energy for all, energy that can drive global development and improve global health.

IDSA

Despite advances in global transportation logistics, one of the major persisting challenges in vaccine logistics is the cold chain – maintaining an unbroken chain of refrigeration. In order for most vaccines to ensure their integrity and efficacy, they need to stay within specified temperatures. For vaccines requiring refrigeration, this becomes incredibly challenging when compounded with the logistical complications encountered in developing regions.

The Cold Chain Immunization Container was designed for health and relief organizations, such as UNICEF and Doctors Without Borders, working in remote locations in the developing world. It uses a thermoelectric conduction system to keep immunization vials cold to protect their effectiveness. The vials are dispensed individually without the need to open the container, keeping them cold as long as possible.

Juan-David Quiñones, a student from the Art Center College of Design, took a Silver Award from the International Design Excellence Awards with his Cold Chain Immunization Container. With a design-centered solution to the cold chain logistical challenge, Quiñones reminds us of the potential in cross-pollinating disciplines.

For more podcasts from Radiolab, visit www.radiolab.org/series/podcasts/.

Click here for more info.

The diffusion of health promotion and health ideas is as great a challenge as it is a necessity. It calls for a number of effective social marketing strategies as well as the incorporation of new communication tactics. The use of entertainment-education has been made a staple of social marketing and the dissemination of ideas but it requires constant updating to remain marketable to the public. The formation of new alliances and the adoption of new marketing strategies are also needed to keep pace in an ever-evolving world economy. This paper will seek to update current strategies in education-entertainment as well as provide reasons for the health sector to adopt new tactics and form partnerships with the private sector as a means to synergize the promotion of global health ideas.

BACKGROUND

Every new medium of entertainment inadvertently provides a potential new conduit for learning. Commercial interests often spearhead the greatest of technological advances, but these progresses can be utilized for far more than the for-profit sector. Lord John Reith, BBC’s first Director-General, wrote in 1924 “I think it will be admitted by all that to have exploited so great a scientific invention [broadcast radio] for the purpose and pursuit of entertainment alone would have been a prostitution of its power and an insult to the character and intelligence of the people.” (http://www.bbc.co.uk/heritage/story). The British Broadcasting Corporation (BBC) formed the objective to “inform, educate, and entertain” and did so with such radio productions as The Archers and later with television programs such as BBC Nature and BBC Knowledge. The predecessor to the BBC’s groundbreaking radio serial The Archers was The Australian Broadcasting Corporation’s (ABC) The Lawsons which pioneered the use the radio to educate its audience. These radio programs with an agenda that transcended the mere intention to just entertain were trailblazers for a new genre of communication broadcasting, the genre of entertainment-education.

As radio broadcasts filled the homes of millions in the middle of the twentieth-century, movie houses packed in crowds featuring movies, news, and animated shorts. The Walt Disney Company revolutionized the film and entertainment industry with their innovation of cartoon studio productions. Walt Disney used the medium of cartoons during World War II as a vehicle to promote pro-Ally and citizen support propaganda, and created an innovative forum to teach technical operations. With such productions as Donald’s Decision, The Winged Scourge, and Four Methods of Flush Riveting, Walt Disney utilized his media resources to influence audience behavior through social marketing and social merchandizing. The purpose of social marketing and social merchandizing is to sell not products but acceptance and awareness of social and health issues (Singhal et al, 2004). The ideas are presented in a commercial broadcast form such as by intercalating health ideas into television and movie plots and through endorsements by celebrity personalities.

The use of celebrity identification is crucial in promoting health ideas. Celebrities are powerful spokesmen that can increase consumer awareness and generate approving feelings towards the products they endorse (Singhal et al, 2004). But these celebrities can be equally as effective promoting social change and health ideas as they are in promoting goods and services. Celebrities may influence social attitudes and awareness through media advocacy. We see this with comedian Jerry Lewis’ advocacy for Muscular Dystrophy in yearly telethons, actor Christopher Reeves sponsorship of stem-cell research in press conferences and fundraisers, and Sally Struthers’ promotion of aid for child malnutrition in frequently ran television commercials. Sometimes the ill fate of a celebrity serves to raise awareness of health issues. When NBA draft pick Len Bias died by an accidental overdose of cocaine, youth use of the drug reportedly dropped off 75 percent over the next several years (http://www.npr.org/templates/story/story.php?storyId=9332383). A lot of times celebrities choose to take on a philanthropic role in promoting a health cause for personal reasons. Athlete Earvin “Magic” Johnson heavily promoted HIV/AIDS prevention as soon as he learned he acquired the disease (http://www.npr.org/templates/story/story.php?storyId=9332383), likewise actor Michael J. Fox became a spokesperson for Parkinson’s disease after coming out to the press that he had been fighting the disease for years. Even fictional characters often function as role models that can greatly influence public behavior. When an episode of Happy Days aired, actor Henry Wrinkler’s popular character Fonzi decides to get a library card. Libraries reported the next several days after that episode aired, they were flooded with requests for library cards by kids and teens that had watched the show and were influenced to follow in the footsteps of the Fonz (Brown, 1992).

The influence of the entertainment market is an allusive power that can be harnessed by the health industry just as well as it can be used by the for-profit sector. It just takes some imagination to do so.

CURRENT METHODOLOGY

The sophistication of media outlets has brought about new ways in which health ideas are delivered. In a day and age where consumers are over-saturated with information, goods and service companies and health professions alike have to find novel ways to capture the attention of the global audience. But sometimes the most state-of-the-art technology is not needed to reach a modern audience.

The Wonders of Radio

In 1996, a radio program entitled Tinka Tinka Sukh (Happiness Lies in Small Things) first aired on All India Radio (AIR). The program was in a soap opera format that advocated such causes as the elimination of dowries, family planning/population size, and opposition to child marriages. In December of 1996, an AIR station in New Delhi received a poster-sized letter signed by 184 villagers of Lutsaan. Amongst other comments it stated, “Listening to Tinka Tinka Sukh has benefited all listeners of our village, especially the women…Listeners of our village now actively oppose the practice of dowry-they neither give nor receive dowry.” The practice of dowry giving had become a health issue do to the social implications it involved. In the most extreme of cases, brides whose families had given inadequate payment were burned to death in a kitchen accident called a dowry death (Singhal et al, 1999). With such injurious traditions being practiced, the radio program sought to promote the elimination of these activities and with such a response by a faithful audience, was successful in doing so. Though radio in western culture is no longer the most popular format for receiving information and entertainment and is often seen as antiquated, it is a very appropriate medium to help shape social behavior in underdeveloped nations.

Television and Movies

Just as radio, television has provided the health industry a vast and powerful medium to diffuse public health ideas. A survey conducted by Porter Novelli HealthStyles in 2001 found over half of regular drama viewers reported they learned something about a disease and disease prevention from a television show, and one-third acted upon hearing about a health issue (http://www.learcenter.org/html/projects/?cm=hhs). Cable and satellite providers currently offer literally hundreds of channels for the consumer audience’s pleasure. With such a bevy of programming, health promoters have access to every type of target audience imaginable. Programs need only to be tailored to a respective audience to maximize the exposure of the intended message. Popular episodic television such as the medical drama E.R. and dramedy serial Sex and the City are often used to support some sort of health promotion message.

Such organizations as theUSCAnnenbergNormanLearCenteraid the entertainment industry in providing a health education message to their audience. Their Hollywood, Health, and Society (HH&S) project provides topical health ideas to entertainment writers and studios through tipsheets created with the Center for Disease Control (CDC) and the National Cancer Institute (NCI) and through a quarterly newsletter with health updates called “Real to Reel” (http://www.learcenter.org/html/projects/?cm=hhs). By facilitating the process of incorporating health ideas into mainstream television and movie markets, we enhance the exposure of such ideas. It is also a highly cost-effective method to social marketing. Instead of producing something that is marketable and costly, the health message can be “piggybacked” on an established television production with an already established viewer following.

Once again celebrity identification plays a substantial role in winning over audience acceptance of the health message in the television and movie market.

Perhaps the greatest modern testament to the power of celebrity identification can be seen with the influence held by talk show host Oprah Winfry. As stated by conservative pundit Bill O’ Reilly “I mean this is a woman that came from nothing to rise up to be the most powerful woman, I think, in the world. I think Oprah Winfrey is the most powerful woman in the world, not just inAmerica. That’s — anybody who goes on her program immediately benefits through the roof. I mean, she has a loyal following; she has credibility; she has talent; and she’s done it on her own to become fabulously wealthy and fabulously powerful.” Oprah has a rare ability to mobilize communities and disseminate information that produces almost instantaneous results in the American pubic. An episode of her talk show on the dangers of beef during the 1996 mad cow disease epidemic allegedly plummeted cattle prices and purportedly cost the beef industry $12 million (http://www.cnn.com/US/9801/ 21/oprah.beef). With such presence in the world psyche, celebrities like Oprah are essential powerhouses of influence to disseminate health ideas worldwide.

Print Media

Beyond video production, simple print media is also highly effective in diffusing health messages. The Starlight Starbright Children’s Foundation collaborated with Marvel Entertainment to produce an X-men comic book for teens and pre-teens recovering from burn injuries. The comic book entitled X-Men in: Life Lessons features a teenage superhero named T-Ray who suffers from burn injuries and saves the day by learning to overcome the adversity of his disfiguring wounds. The comic book seeks to teach kids social reintegration skills and coping strategies (http://www.starlight.org/site/c.fuLQK6MMIpG/b.1090075/k.702C/The_XMen_in_Life_Lessons.htm). Such print media is very affordable and with such globally recognized characters as Marvel superheroes, the comic book can easily be localized to cater to global markets by translating the text and adjusting to target culture. This medium is also useful when attempting to reach a target audience with a low literacy rate. Comic stripes that use very simple text and that act out the message can reach a larger audience especially in underdeveloped countries.

Digital Media

Like print media, digital media has proven to be an effective means in disseminating health messages. The Internet is a tool that has undoubtedly contributed to the spread of health ideas worldwide. Due to this innovation, information can be available all day, every day. Static web pages provide laymen and health professionals alike with up to date information that is only a few keystrokes away. Academic libraries share information, allowing individuals to access a breadth of information that would otherwise be inaccessible. Such sites as WebMD.com provide comprehensive health information to the general public. Forums and blogs allow patients and their families to communicate and share their life experiences on-line with others. They also allow patients of serious disease a way to communicate and develop a sense of community in a world they may feel alienated from. The Internet also allows for multimedia showcases to provide a level of interactivity that draws in the audience. The Starlight Starbright Children’s Foundation provides a number of interactive games tailored to kids to inform them of their respect disease and tips to help deal with the illness. Games like Sickle Cell Slime-O-Rama and Medical Imaging: Welcome to the Radiology Center give kids incentive to learn more about their illness and help prepare them for medical procedures (http://www.starlight.org/site/c.fuLQK6MMIpG/b.1075955/k.2732/What_We_Do.htm).

The Adoption of Business Marketing

Modern commercial marketing strategies are a lot more aggressive in order to vie in a very competitive and saturated market. Marketing firms such as Mr. Youth use tactics such as guerilla marketing, viral, and stunt/ambush marketing to capture the attention of the ever-fickle youth market. The VERB campaign was a youth social media campaign coordinated by the CDC that aimed to encourage people in their tweens (ages 9-13) to become physically active (http://www.cdc.gov/youthcampaign). Mr. Youth’s promotion of the Verb campaign used such techniques as national tours that went into schools and used activities that promoted physical activity, individuality, and sharing. They utilized yellow dodge balls to help spread the message and delivered them as a commodity to the tweens, getting them to perform their favorite verb in order for them to take one home with them. Each yellow ball was stamped with an access code that the tweens put into the verb website and allowed the tweens to develop a space where they got to communicate and share their ideas about the verb campaign. Sharing is the key to this type of marketing as word of mouth and peer acceptance allows for viral marketing to take affect.

FUTURE METHODOLOGY

The Need for Modernization

As sophisticated as our media systems currently are, we have just scraped the top of the proverbial iceberg. The Internet is an ever changing and ever evolving entity. It is changing from a read-only format produced by webmasters financially backed by large corporations to an interactive playground where ideas and opinions are delivered via top quality formats by multimedia hobbyists. Sites such as youtube.com and blogspot.com allow anyone to broadcast their thoughts and ideas through video or text. High speed Internet and the ability to compress video with such avenues as Flash allow the visual medium of video to achieve a level of accessibility never before seen. This allows for greater diffusion of global health ideas as there is no wait for video streaming, making the Internet just as instantaneous and even more convenient than the television.

These new breakthroughs make it possible to expand the scope of the audience as the technology that delivers the Internet has advanced as well. With satellites and broadband piping, individuals and communities that were previously located too far from metropolitan areas can now have access to a bevy of new services. If even a single Internet portal is established in a village headquarters, the whole community then has access to real-time video, news, and information. Environmental warnings can be delivered to help a community prepare for a natural disaster. Preventative medicine tactics can be shared to reduce the spread of disease epidemics. Primary care health staff can keep in more frequent contact with patients and community leaders to help provide better health solutions. Remote Internet based surgical procedures are also closer to reality and could allow patients who are too remotely located a chance to be operated on by a world-class surgeon thousands of miles away. Just as the radio was effective in promoting social change in the Indian village of Lutsaan, providing culturally sensitive media to a population via the Internet will help to change injurious social behavior but at a quicker rate and with a broader audience. And in turn, underdeveloped communities can give themselves a global presence by communicating with the outside world, perhaps even increasing their own foreign aid by advertising their need for assistance. But the technology has to be provided and it will not come easily. It is not reluctance to use such technology but the sheer cost of establishing the technological infrastructure that is the impediment to modernizing these underdeveloped communities. It will require the aid of non-governmental organizations and call for governmental partnerships with private businesses to shoulder the financial burden. But once it has been established it will help the lives of every member of the community just as previous technologies respectively have proven to be of great benefit.

But until such for-profit/non-profit/public sector alliances are made, more grass roots social marketing must lead by example. The BRAC organization, which has served as a testament to non-profit organization sustainability, has done wonders by providing easy to use health promotion tactics. It has trained armies of instructors to go to homes one-by-one to promote health behaviors such as oral rehydration therapy, a solution that is nothing more than a mixture of water, salt, and sugar, which has drastically decreased the deaths of dehydrated children (http://www.pbs.org/wgbh/rxforsurvival/series/video/c_faz_atl_bangladesh2_qt_h.html). BRAC has opened schools that have grown to constitute eleven percent of the primary schools in Bangladesh(http://www.brac.net/education.htm). It utilizes microfinance to give individuals a chance to create personal business and rejuvenate the economy. BRAC has also created its own bank system and food and agricultural industries to make it self-sustainable. (http://www.brac.net/economicdev.htm) By starting small and focusing on education and sustainability, BRAC has become the role model to how to develop healthy communities. Though the organization has done nothing new in terms of health promotion theory, it is unique in terms of its mindset and its success. By finding a solution that works at the community base and scaling it up so it is works at a larger level, BRAC has learned to franchise global aid in a way that mirrors private business strategy (http://www.pbs.org/wgbh/rxforsurvival/series/video/c_faz_atl_bangladesh2_qt_h.html).

The Power of Cyberspace

There are drastic differences in the strategies needed to promote health in first-world countries than in underdeveloped nations. More of a focus needs to be made on utilizing the available technologies that tend to be easier to access in richer economies. The content capability of the Internet, for instance, is extremely interactive, robust and available. Private-sector businesses such as the Walt Disney Company invest heavily in their Internet presence, and need to in order to stay afloat in a highly competitive entertainment market. Disney.com provides a veritable interactive playground that is just as exciting and entertaining as Disney’s commercial television channels and its theme parks. With high bit-rate video and highly polished interactive games visitors are welcomed by a lavish cyber treasure trove of Disney themed activities. It features online episodes from Disney channel programming, news about Disney characters and special events, and online games that target the child audience and revival home-console based games in terms of quality. In short, just like their theme parks it is a place you can literately spend an entire day visiting. They have also created measures to ensure return patronage. They invite visitors to join such Disney online communities as “Disney Blast” which keeps track of game points won and rewards you with game privileges for points that are collected.

If the Disney.com site is so fantastic, why does the health sector not have a site that is equally as impressive? Simply because to make a website that even comes close takes money, and a lot of it. To start from scratch, campaign agencies would have to develop character branding that is highly appealing to kids, they would have to effectively market said characters which tends to be expensive, create high quality web multimedia that is timely and costly, and all of this has to be financed for a cause that raises no venue. The Starlight Starbright Children’s Foundation have followed in the vain of the Disney on-line multimedia approach, but their quality of work in no way matches the polish of Disney’s, and for kids who are ever jaded by new technology their content is lackluster and antiquated in comparison. Because of this jaded-children factor the health and private sectors are in battle when it comes to providing viably marketable on-line edutainment.

But there is a solution to this multimedia problem. The Starlight Starbright Children’s Foundation was on to something when they collaborated with Marvel Entertainment. Had they tried to produce their own comic book it probably would not have come out nearly as effective as their production with Marvel. Marvel brought the world-renowned character branding and comic publishing expertise and the Starlight Starbright brought the scientific know-how. This type of partnership with the private sector is what needs to be done in first-world countries in order to deliver such highly effective health promotion in the twenty-first century. Instead of starting from scratch, the health sector can utilize character celebrity identification just as it has since the beginning of edutainment to help promote health concerns and curb production costs. The private sector would benefit as corporate philanthropic works provide good publicity for the corporation and further exposure of their product to the public. Also the public sector can provide a number of strategies to push the entertainment industry to be more corporate socially responsible, such as through facilitation as the Norman Lear Center HH&S project has and further strategic partnership with the public sector (Fox et al, 2002).

Home Entertainment and its Ability to Go Beyond the Home

The introduction of the Wiki and the Blog are new innovations that also yield usefulness to public health. These forums for personal expression and collaborative authoring allow individuals as collectives to help themselves. It facilitates in the spread of information and allows for databases of information to be made for the people, by the people. The Walt Disney Company is about to launch a parent wiki that allows parents to share advice and opinions about all aspects of child rearing (http://news.moneycentral.msn.com/provider/providerarticle.aspx?Feed=FT&Date=20070313&ID=6608704). A health-professional wiki would be just as useful for health professionals to share tips and personal lessons in addressing health challenges. It would also facilitate in helping health-professional “to-bes” and everyday laymen a glimpse and understanding at the problems that plague modern health care.

The incorporation of the Internet with the living room entertainment center presents a bevy of new mediums to intercalate public health ideas. Video games consoles are no longer stand-alone systems. They utilize Wi-Fi to access on-line databases they allow players to interact with other players, sometimes halfway around the world. This burgeoning interactive wonderland is a resource that needs to be utilized. By creating game story plots that feature topical health ideas the same way we currently influence the film industry, game content can be educational as much as entertaining. On-line game forums could generate buzz about health ideas if effectively marketed and implemented.

Innovative game systems such as Nintendo’s DS and Wii systems that target the novel and infrequent gamers have the capacity to create a new genre of highly marketable games. Nintendo’s DS system already carries a highly successful line of edutainment games called Brain-Age that are played to increase one’s brainpower (http://www.brainage.com). The Wii system controllers contains Mem chips that allow for groundbreaking interactive play that model real-life movement. The production of exercise-oriented software could easily be adopted by this system and can viably be a huge commercial success. By partnering the private-sector gaming industry with the public and non-profit health sectors, a new genre of entertainment can be created that reverses the negative impact of the sedentary lifestyle that video games up till now have promoted. The for-profit industry would be enticed by the new consumer market it would generate and the health sector would be satisfied by the prosocial and proactive messages these products would promote.

A different type of partnership between the Internet and television lies within digital cable. The navigability of digital cable and the proprietary feature of Video On Demand (VOD) create a cost-effective forum that has yet to be tapped by the health field. Video On Demand allows the viewer to choose what he or she wishes to view. A bevy of topical health programs can be created and showcased on this medium to capture the digital cable audience. Such website as Utube.com and Google Video currently house a wide array of health themed lectures, symposiums, and video works. Showcasing the same video on VOD in better video quality may possibly attract a larger audience.

Athletic Endorsements: The Other Type of Celebrity

Another type of celebrity besides the Hollywoodactor or actress is the professional athlete. Able to garner just as much influence as any other public figure, a professional athlete would seem just like any other celebrity, but there is one crucial difference. Unlike any other type of celebrity, athletes do not necessarily need to vocalize their endorsement because their equipment can do it for them. We see it with NASCAR drivers and racecars blanketed with corporate logos; we see it with professional surfers, skateboarders, and snowboarders with sponsor stickers littering on their boards. These logos define the sporting equipment and sport enthusiasts pay attention (http://www.usatoday.com/sports/motor/ nascar/2002-07-12-acov-sponsors.htm). Simply getting professional athletes to cover a small area of their equipment with a health promotion logo would generate an amazing amount of attention and requires virtually no work on the celebrity’s part. By this method, health professionals can brand health ideas with the use of logos and by symbolizing an idea, like the Verb campaign’s yellow dodge-ball, they can promote the health idea through this type of guerilla marketing. It is an opportunity for professional athletes to not only be sponsored by big business, but sponsored by good health as well.

Stakeholder Analysis

Table 1. Stakeholder Analysis

CONCLUSION

It is imperative the health sector adopt new methods to disseminate global health ideas. Current education-entertainment practices must be updated to remain competitive to other mediums of entertainment and the health industry can facilitate the efforts by partnering with the private business sector to do so. The health sector can also adopt private marketing tactics that have proven to be successful. By watching the private sector or joining corporations in health promotion ventures, we can reduce the risk of failures and aggrandize our health promotion campaigns. The use of such staple marketing tactics as celebrity endorsements has been proven effective, but social marketing must not stop there. New technologies must be adopted as well as distributed to communities worldwide. More impoverished communities may not be modernized enough to take full advantage of such promotions but new creative campaigns can be made to reach these communities as well. Though it is difficult to quantifiably verify how effective a health promotion may be, the private sector can verify their success through the profitability of their commercial venture. By following the private-sector in their proven successes hopefully we too can be as rich in health as they are in profits.

REFERENCES

BRAC (2005) BRAC. BRACBangladesh. Retrieved March 23, 2007, from http://www.brac.net

British Broadcast Corporation, (2007, March 1)The BBC Story- History of the BBC, The BBC. Retrieved March 15, 2007, from http://www.bbc.co.uk/heritage/story

Brown, W. J. (1992) The Use of Entertainment Television Programs for Promoting Prosocial Messages. Howard Journal of Communications.

Cable News Network (1998) Oprah accused of whipping up anti-beef ‘lynch mob’ – January 21, 1998. CNN. Retrieved on March 30, 2007, from http://www.cnn.com/US/9801/21/oprah.beef/

Fox, T., Ward, H., Howard, B. (2002, October) Public Sector Roles in Strengthening Corporate Social Responsibility: A Baseline Study. The World Bank

Internet Movie Database (2007, March 11) “Happy Days” (1974). Internet Movie Database. Retrieved March 11, 2007, from http://www.imdb.com/title/tt0070992/

Media Matters. (2006, October) Media Matters – After repeated whining O’Reilly to appear on Oprah. Media Matters. Retrieved on March 30, 2007, from http://mediamatters.org/items/200610240003

MSNBC. (2007, March) Financail Time Business News: Disney’s launches ‘wiki’ website aimed at parents. MSNBC Money. Retrieved April 2, 2007, from http://news.moneycentral.msn.com/provider/providerarticle.aspx?Feed=FT&Date=20070313&ID=6608704

National Public Radio, (2007, April 6) NPR: Winning the War on Drugs One Life At a Time. NPR: National Public Radion. Retrieved April 7, 2007 from http://www.npr.org/templates/story/story.php?storyId=9332383

Nickoli Co. (2006) Brain Age. Brain Age. Retrieved April 5, 2007, from http://www.brainage.com

Population Communications International. (2005). PCI – Programs –India. PCI – Population Communication International. Retrieved April 2, 2007, from http://www.population.org/programs_india.shtml

Public Broadcasting Service. (2007). Rx for Survival From the Series: The Story of BRAC. PBS. Retrieved Feb 5, 2007, from http://www.pbs.org/wgbh/rxforsurvival/series/video/c_faz_atl_bangladesh2_qt_h.html

Singhal, A., Cody, M. J., Rogersm, E. M., Sabido, M. (2004) Entertainment-education and Social Change: History, Research, and Practice, Lawrence Erlbaum Associates.Mahwah,New Jersey.

Singhal, A. & Rogers, E. M. (1999) Entertainment-Education: A Communication Strategy for Social Change.LawrenceErlbaum Associates.Mahwah,New Jersey.

The Starlight Starbright Children’s Foundation (2007) What We Do. The Starlight Starbright Childten’s Foundation. Retrieved Febuary 15, 2007, from http://www.starlight.org/site/c.fuLQK6MMIpG/b.1075955/k.2732/What_We_Do.htm

The Starlight Starbright Children’s Foundation (2007) The X-Men in : Life Lessons. The Starlight Starbright Children’s Foundation. Retrieved February 15, 2007, from http://www.starlight.org/site/c.fuLQK6MMIpG/b.1090075/k.702C/The_XMen_in_Life_Lessons.htm

USAToday. (2002) Sponsors Make NASCAR’s wheels go ‘round. Usatoday.com. Retrieved April 7, 2007, from http://www.usatoday.com/sports/motor/nascar/2002-07-12-acov-sponsors.htm

Walt Disney Company, The (2007) Disney.com. The Walt Disney Company. Retrieved April 8, 2007, from http://www.disney.com

Walt Disney Company, The (2004, May) Walt Disney Treasures – On the Front Lines (1943) DVD. The Walt Disney Company. ASIN: B0000BWVAH

Diabetes Mellitus Type 2 (DMT2) in children is becoming alarmingly frequent providing a myriad of health complications for an unpromising future. In this paper I am presenting the problem, as well as providing guidelines to stop and reverse the increasing rate of

DMT2 and its main modifiable risk factors: obesity and sedentary lifestyles.

I. Diabetes and Chronic Diseases

According to the World Health organization (WHO) (WHO, 2005) chronic diseases are the major cause of death in almost every country, representing 60% of the deaths in 2005, or 35 million people. This is double the number of deaths from all infectious diseases (including HIV/AIDS, tuberculosis, and malaria), maternal and perinatal conditions, and nutritional deficiencies combined. Deaths from chronic diseases are projected to continue growing unless actions are taken. In 2005, the WHO projected that for the following ten years the estimated number of people that will die as a consequence of a chronic disease will increase by 17%. Almost half of those affected are under seventy years of age, and may experience a long debilitating condition as well as the possibility of a premature death. Diabetes represents 2% of all chronic disease deaths, or 1,125,000 people.

Chronic diseases are forming pandemics that affect members of all social economic strata. Currently 80% of all chronic disease deaths occur in low and middle income countries, which also comprise most of the world’s population. These pandemics have serious effects on the quality of life of the affected individuals, their families, communities, and countries. The economic consequences are also enormous.

Fortunately, it is possible to prevent and control most aspects of chronic disease and every country has the potential to work toward this goal. In this paper I will address the growing epidemic of Diabetes Mellitus Type 2 (DMT2) in children and its main risk factors.

Diabetes is a chronic disease that occurs when the pancreas either does not produce enough insulin or the body cannot effectively use the insulin it produces. Insulin is the hormone that regulates blood sugar. Hyperglycemia, or raised blood sugar, is a common effect of uncontrolled diabetes. Over time it leads to serious damage to many of the body’s systems, especially the nerves, blood vessels, heart, eyes and kidneys (WHO, 2006).

There are three different types of diabetes. Type 1 is characterized by a lack of insulin production; Type 2 is characterized by the body’s ineffective use of the insulin it produces; and Gestational Diabetes is a type of diabetes that is first recognized during pregnancy. Diabetes Type 2 in children will be the focus of this paper.

Symptoms of DMT2 include excessive excretion of urine, thirst, constant hunger, weight loss, vision changes and fatigue. The main complications of DMT2 are retinopathy (which can lead to blindness), neuropathy, foot ulcers, kidney failure and stroke. The overall risk of death for people with diabetes is at least double the risk of their peers without the disease (WHO, 2006).

The global prevalence of DMT2 is rising steadily (Alberti et al, 2004) and its pervasiveness in youth is an increasing public health concern (Huang & Goran, 2003). Until recently, DMT2 was seen exclusively in adults, and also known as adult onset diabetes, but now it is a major childhood problem, particularly in obese children. There is also an increasing incidence of DMT2 among adolescents (Pinhas-Hamiel et al, 1996). In light of this evidence, the use of a name that does not lead us to make unrealistic conclusions about the disease should be encouraged. DMT2 is now affecting the young population.

The WHO projects that DMT2 deaths will increase by more than 50% in the next ten years if action is not taken (WHO, 2006). Diabetes is the fourth or fifth leading cause of death in most developed countries, and there is substantial evidence that it is an epidemic in many developing and newly industrialized nations (IOTF, undated).

Diabetes is not only one of the leading causes of death and disability, it is also a major risk factor for several other serious diseases such as hypertension. This further reduces the life expectancy of individuals with DMT2 and raises health care costs to society.

DMT2: Prevention and Control

Diabetes, as other chronic diseases, has modifiable and non-modifiable risk factors. In the latter group we have age and heredity, particularly genetics. Most of the risk factors for all the major chronic diseases are modifiable. The two principal factors include unhealthy diet and physical inactivity.

The importance of the modifiable risk factors in the incidence of diabetes is underscored by the fact that the incidence of the disease has grown considerably in recent years, while the genetic composition of the population has not changed. At the same time, lifestyle changes relating to nutrition and levels of physical activity have changed considerably.

A dramatic example of the influence of the environmental factors and modifiable factors associated with DMT2 can be found among Pima Indian communities. DMT2 is rare in Pima Indian communities inMexicowhere the traditional lifestyle has been preserved. At the other extreme, the Pima Indians of Arizona have a very high prevalence of DMT2, around 59 per 1000, and a clear association between DMT2 and obesity in 95% of the cases (NIH, undated) (Fagot-Campagna et al, 2002).

Addressing lifestyle changes related to nutrition and physical activity is the key to a program for preventing and controlling DMT2 and will be the focus of the next two sections. One important consideration is that interventions targeting lifestyle factors in young individuals are particularly beneficial because of their long term effects (Huang & Goran, 2003).

Obesity

Obesity has reached epidemic proportions globally, with at least 20 million children under the age of five being overweight (WHO, undated a). The International Obesity Task Force estimates that 155 million school-age children worldwide are overweight or obese, with a prevalence of overweight in a range 10% to 25% (Parvez et al, 2007). We are not just facing a huge number of cases; we are also facing an increasing trend. The prevalence of obesity in adolescents, for example, has nearly tripled in the past twenty years (NIH, 2002).

Obesity in children is associated with multiple diseases such as sleep apnea, hypertension, dislipidemia and DMT2. Obesity and DMT2 are linked; most of the diabetes cases in children are attributable to an excess of weight. According to the International Obesity Task Force, about 58% of diabetes globally could be attributed to body mass index BMI above 21kg/m2.

Since there is a strong link between DMT2 and obesity, some authors describe the occurrence of both conditions as a twin epidemic (Zimmet et al, 2001)94.

Insulin resistance is a consequence of weight gain as the pancreas receives more demand to produce insulin. Research by the National Institute of Health shows that many obese children and adolescents have impaired glucose tolerance; a condition that often appears before the development of DMT2.

One of the causes for the increasing incidence of childhood obesity is the increased consumption of calories, especially from sugars and fats. Some contributing factors are the consumption of fast food, larger food portions, and a decrease in the intake of fruits and vegetables. Television viewing is also associated with obesity, both because kids tend to eat while they are watching TV and also because of the effects of the direct marketing of food products -usually unhealthier products- targeting children.

Contemporary levels of obesity in children are unprecedented and there is little knowledge about what will happen when they become adults.

Inactivity

There is a decline in the level of children’s physical activity, which is explained by a more sedentary lifestyle, less time playing outside and more time on the computer.

As was the case with obesity, television viewing is also a contributing factor to inactivity. A study shows that a typical American youth spends approximately four to five hours a day watching TV, using the computer or playing video games (Wild et al, 2005). Urbanization is another contributing factor to inactivity (Wild, 2004). Globalization and industrialization have also increased the incidence of sedentary lifestyles while high levels of violence impede children from playing outside. We also observe less walking and biking and more time traveling in cars.

An estimated 60% of the world’s population does not do enough physical activity (WHO, undated b). According to the WHO, physical inactivity is estimated to cause about 10-16% of global cases of breast cancer, colon, and rectal cancer and DMT2 is reported to cause about 22% of ischemic heart disease. Overall, 1.9 million deaths are attributable to physical inactivity (WHO, undated, a). Inactivity, as obesity, places more demands on the pancreas.

II. Strategies to Fight Diabetes: Treatment versus Prevention

In spite of the fact that there are numerous programs to fight chronic diseases and DMT2 around the world, the number of cases is not falling. On the contrary, as described above, current trends are very worrisome. So much so that the WHO estimates that a 2% annual reduction in chronic disease death rates over and above existing trends during the next 10 years would save 13 million lives; almost 6 million of those lives saved would be of people under age 70 (WHO, undated c).

The WHO proposes investing in chronic disease prevention (WHO, 2005) through strategies that combine population-wide approaches with interventions for individuals. For the WHO, both comprehensive and integrated action is required. Comprehensive action requires combining population wide approaches aimed at reducing the risk throughout the entire population, with strategies that target individuals at high risk. Integrated prevention and control strategies are most effective. Focusing on the common risk factors of DMT2, deals with a number of related diseases, such as heart disease, stroke and diabetes, at the same time (WHO, 2005).

Most of the current DMT2 strategies are based on treatment. However, given the proportions of the epidemic and its incidence among children, attention needs to be directed towards prevention.

There is a lot of theoretical research on how to prevent chronic diseases, but little practical experience. The immense body of available research can be put to work to develop successful interventions.

III. A public health approach to prevent DMT2 in children

In this section I will provide guidelines for action to stop and reverse the increasing rate of DMT2 in children, and its main modifiable risk factors. I will not present a structured program.

The first underlying principle behind my approach is that it will be better to address the DMT2 problem as a public health issue under the heading of primary care and prevention rather than dealing with the consequences of an entrenched condition and its complications in a young population (Alberti et al, 2004). This is not an original idea, see for example the workshop Diabetes Federation Consensus Workshop (2004), but it is an important principle.

A second principle of my approach is that it is very important to work with the younger population. As mentioned previously, the incidence of DMT2 is rising in children. We know the long term effects that the disease can have on adults, and also that the longer a person has the disease, the more likely he or she is to develop its complications sooner in life. Without treatment, young people with pre-diabetes will develop DMT2 and complications will appear at a younger age (Huang & Goran, 2003).

A third principle of my strategy is that it is necessary to build awareness of both the need for lifestyle changes among the whole population, and of the increasing urgency of the disease and need for prevention among the stakeholders. A comprehensive approach designed to change social norms will be more effective in reducing risk factors than the current approach. Lifestyle modification can be more effective than pharmacotherapy; therefore we need to encourage lifestyle modifications. Some studies (Pinelli et al, 1999)(Pinhas-Hamiel et al, 1999) have shown that the lifestyles of families with members with DMT2 share many risk factors. Therefore our intervention should involve entire families, to help them better understand the disease and its risk factors and complications. It’s important to empower families as well as young people, as they can make a difference. There are things parents can do to keep their children healthy concern (Huang & Goran, 2003). Other studies have shown the importance of family involvement and how this has a positive impact in the management of the disease and the psychological well being of the affected children (Tronja, undated).

Combating DMT2 requires action in a wide range of fronts. It requires creating target messages for people of various socioeconomic, racial, and ethnic backgrounds. In addition to other factors, it’s necessary to create a social support network for the affected children as well as for their families.

A fourth principle of my approach to DMT2 is the need to create an appropriate environment to allow changes to take place. Policies should target the environmental factors that affect children’s behavior (Daniels et al, 2005).

A comprehensive plan of action to reduce the incidence of DMT2 in children will require the involvement of several players. Some of them are:

1. Policymakers.
2. The medical community: doctors, nurses, health promoters, nutritionists.
3. Insurers.
4. Patients and the general community.
5. Schools.
6. Private business.
7. Urban design and public transportation systems.
8. Mass media.

1. Policymakers

The International Obesity Task Force (IOTF) recommends specific courses of action in lobbying governments for investment in prevention programs and strategies. There is a need to create both a social and a political change.

Government has a very important role to play in improving the health and well being of the population, and in providing special protection for vulnerable groups, such as children, who can neither choose the environment in which they live nor their diet. Children also have a limited ability to understand the long-term consequences of their behavior. Poor people also have limited choices about what they eat, their living conditions, and their access to education and health care. Supporting healthy choices, especially for those who could not otherwise afford them, reduces risks and social inequalities (WHO, 2005).

A multi-level governmental approach is also needed. A campaign to prevent DMT2 should include different ministries such as health, finance, education, sports, and agriculture; (Zimmet & Alberti, 2006) and it should operate at the different levels of government: local, national and international.

Government intervention can include mandating a greater emphasis on more exercise and dietary education in schools, banning the advertising of unhealthy products (prohibiting marketing to kids, especially for food related products), and taxing less healthy food to give people incentives to consume less of it (Alberti et al, 2004). It is important to work toward making healthy foods more affordable.

Food labels could be another area to focus on as a means to educate and encourage the public to eat healthier.

2. Medical community: doctors, nurses, health promoters, nutritionists

The major role of the medical community can be to educate patients. It can work with the general population regarding prevention, and with diabetic patients in prevention of the disease’s complications as well as its treatment. It can also encourage patients to have a healthier lifestyle with more physical activity and a more beneficial diet. Doctors should emphasize the education of the patients during medical consultations, for example, by having brochures with basic information directed to patients and also to the general public.

The medical community can also help obese children to lose weight. One way to target the obesity problem is by promoting healthier eating habits, with a focus on the daily diet. A possible strategy is to entice the consumption of fruits and vegetables and other foods high in fiber and low in fat, through promotional incentives. Conversely, measures should be made to dissuade individuals from consuming junk foods, and to decrease meal portions.

Children that have impaired glucose tolerance need special attention to prevent them from developing diabetes; and for DMT2 patients it’s imperative to provide the appropriate care and to screen for the most common complications.

Other measures should involve the screening of pregnant woman during the last part of their pregnancy to prevent low birth weight children and treat gestational diabetes. Promoting breastfeeding could also help decrease the occurrence of DMT2 in children95.

3. Insurance.

Health insurance companies can develop policies to promote healthier lifestyles by using incentives to encourage physical activity. They can subsidize memberships to health clubs, provide nutritional consultations, and distribute information to their customers.

There are several creative alternatives that can be implemented to help reduce the incidence of DMT2 and in turn its main risk factors.

4. Patients and the General Community

A key component of my strategy is to include patients in the intervention against the disease. They should have an active role in reducing the epidemic of DMT2, and we need to encourage them and disseminate the message that they can have a positive impact on their health. Patients need to adhere to a healthy diet and include daily exercise in their routines; they can have access to the information and the resources to generate the necessary changes, but in the end it will depend on their willingness to change to acquire the lifestyle modification.

Parents can influence the behavior of their children. Families can develop the habit of eating at home. Families can also work toward reducing television viewing time, and more particularly, parents can try to limit the time their kids spend in front of the TV. Parents can also incorporate more physical activity into their daily lives and the lives of their children.

5. Schools

Schools are in a perfect position to prevent obesity and diabetes because they have daily contact with the whole target population. Schools are an important environment for young kids and can help create healthy lifestyle habits. School based intervention has already shown to be effective in theUSand Singapore96.

Schools could have a great impact on promoting physical activities; including physical education as a daily part of the schools activities. There are successful physical education interventions that can focus on replacing the standard physical education curriculum with one of greater intensity or with more motivation activities such as popular dance (Flores, 1995). Children will not exercise solely to lose weight; recommended activities must be enjoyable and congruent with the child’s and family’s lifestyle, as well as rewarding, independent of the health benefits (Daniels et al, 2005).

School meal programs could also have a key role in encouraging the adoption of healthier foods. School kitchens could incorporate healthier food into lunch and breakfast programs. Classroom instruction about healthy eating, and about diabetes, and its main risk factors could also be done.

6. Private business

Private players should also play a role in this strategy, and adopt the common goal of raising healthier children. They can be included in several different ways. The food industry could be educated and encouraged to develop an awareness of their part in contributing to the increased number of overweight and diabetic children. They could take measures to prevent this, such as reducing portion sizes, incorporating healthier snack options in vending machines, and reducing the amount of sugar in soft drink beverages.

Restaurants and fast food chains could promote healthier options of foods, as well as include the nutritional information of the foods they offer in their menus.

The entertainment and marketing industries could also disseminate the message by choosing role models that opt for healthier food options and a more active lifestyle.

7. Urban design and public transportation system

The importance of an appropriate environment for the changes to take place has already been mentioned. To target sedentary lifestyles, creating environments conducive to physical activities will help produce a change in social norms around exercise. The urban planning department can be involved by working on urban development, so as to encourage an environment that makes exercise easier. This could be done with an increase in the number of parks or places to exercise, and by making them more accessible and in some cases safer. The public transportation system can also play a role by facilitating families to incorporate walks in their daily routines.

8. Media

A media campaign could also be used to disseminate the messages about health, diet, and exercise. Another strategy is to endorse opinion leaders that promote our message. An educational campaign could increase awareness about DMT2 in the different sectors of society, and increase diabetes related knowledge, such as its complications, and how to prevent it.

Programs should be directed to the general population as well as to diabetic patients. The general public will benefit from the program in two ways: not only the increased prevention of DMT2 but, also, the increased prevention of other chronic diseases that share the same risk factors.

IV. Obstacles and challenges

Several obstacles are likely to appear during the implementation phase of this strategy to reduce the incidence of DMT2 in children. I expect to find some sort of resistance to change from every one of the players involved. It is impossible to exactly anticipate the sources and types of obstacles that the plan will face. This section describes some possible obstacles and challenges that the DMT2 prevention program might encounter from the different players as an example of the importance of being aware of the plausible resistance to change.

A first example is that it may not be easy to achieve consensus among policy makers to establish prevention of DMT2 and its main risk factors as a public health priority. Even after the strategy is adopted, it might be very hard for the patients and the general community to accept their responsibility for the problem and to take a step toward action to protect their own health.

The medical community is already overwhelmed with short visits and an increasing number of patients, and even this intervention that has the long term benefit of healthier patients, will require more time dedicated to prevention during daily visits.

Insurance companies will be happy to have a healthier group of patients, but will also need to adjust to create the necessary changes.

One of the greatest sources of resistance could come from private business, the food industry in particular. It will resist the restrictions on advertising I propose, the call for more disclosure of the nutritional content of food. As the food industry did not always assume a responsible role in the health care of the population in the past, making them participants in the initiative will be important.

Schools will also have extra responsibilities in educating children in the areas of nutrition and physical activity. The DMT2 prevention program can help them to achieve an understanding of why it is important to make these changes in the areas of physical activity and nutrition. If they do not know why they are doing something, most likely they will not do it. It is also important to help schools through partnerships with other players such as the private sector and the medical community.

The public transportation system and urban designers will need to take into consideration the new demands of the society, and adapt the environment to make it easier to have a healthier lifestyle. For the mass media campaign, it will be a challenge to target the population with clear messages.

V. Summary

The next table summarizes my principal points:

VI. Conclusion

This paper explored the problem of DMT2 in children and its possible solutions. It shows that the problem is increasing and that there are things that can be done to change that trend. A central aspect of the fight against DMT2 is to attack its two main risk factors: obesity and inactivity. The paper advocates the creation of an integral solution to the DMT2 epidemic and to prioritize DMT2 in children as an important public health problem.

The integral solution proposed in the paper includes the participation of several players with an important role in fighting this disease: policy makers, the medical community, insurers, patients and the general community, schools, private business, urban design and public transportation planners, and the media. The response to the DMT2 epidemic should be of the same magnitude as the problem, which accounts for over 1% of all deaths. It is necessary to start working toward curbing the DMT2 epidemic in children NOW!

Reference

Alberti G, Zimmet, P, Shaw J, Bloomgarden Z, Kaufman F, Silink M. (2004), “Consensus Workshop Group: type 2 diabetes in the young: The evolving epidemic”. The international Diabetes Federation. Consensus workshop. Diabetes Care; 27: 1798-1811.

Daniels S, Arnett D, Eckel R, Gidding S, Hayman L, Kurmanyika S, Robinson T, Scott B,St. Jeor S, Williams C. (2005), “Overweight in children and adolescents. Pathophysiology, consequences, prevention and treatment.” American Health Association; 111: 1999-2012.

Fargot-campagna A, Pettitt DJ, Engelgau MM, et al. (2000), “Type 2 diabetes among North American children and adolescents: an epidemiologic review and a public health perspective”. Journal of Pediatrics. May: 136 (5): 664-72.

Flores R (1995), “Dance for health: improving fitness in African American and Hispanic adolescents”. Public Health Rep.; 110: 189-193.

Huang TT-K, Goran MI.(2003), “Prevention of type 2 diabetes in young people: a theoretical perspective”. Pediatric Diabetes. 4: 38-56.

IOTF, International Obesity Taskforce. (undated), Diabetes and Obesity. Retrieved February 17, 2007 from: http://www.iotf.org/diabetes.asp

Kitagawa T, Owada M, Urakami T, Yamanchi K. (1998), “Increased incidence of non-insulin dependent diabetes mellitus among Japanese school children correlates with an increased intake o fanimal protein and fat”. Clin Pedatr 37:111-116.

National Institutes of Health (undated). “The Pima Indians. Obesity and Diabetes” in The Pima Indians: Pathfinders for Health. Retrieved February 17, 2007 from: http://diabetes.niddk.nih.gov/dm/pubs/pima/obesity/obesity.htm

National Institutes of Health.(2002), “Many obese youth have condition that precedes Type 2 Diabetes”. Retrieved February 17, 2007 from: www.nichd.nih.gov/mewws/releases/obese.cfm

Parvez H. Bisher K. and Meguid EN. (2007), “Obesity and Diabetes in the developing world – a Growing challenge”. The New England Journal of Medicine, Volume 356:213-215 January 18.

Pinelli L, Elerdini N, Faith MS, Agnello D, Ambruzzi A, De Simona M, Leggeri G, Livieri C, Monetti N, Peverelli P, Salvatoni A, Seminara S, Uasone R, Pietrobwlli A. (1999), “Childhood obesity: Results of a multicenter study of obesity treatment in Italy”. J Pediatr Endocreinol Metab. 12 Suppl 3: 795-799.

Pinhas-Hamiel O, Dolan LM, Daniels,SR, Standiford D, Khoury PR, Zeiter P (1996), “Increased incidence of non insulin dependent diabetes mellitus among adolescents”. J Pdatr 128:608-615.

Pinhas- Hamiel O, Standford D, Hamiel D, Dolan LM, Cohen R, Zeitler PS.(1999), “The type 2 family: a setting for development and treatment of adolescent type 2 diabetes mellitus”. Arch Pediatr Adolesc Med. Oct; 153 (10): 1063-1067.

Tronja R. Nansel.(undated). National institute of health. National institute of Child Health & Human development. “Family management of childhood diabetes”. Retrieved Febraury 17, 2007 from: www.nichd.nih.gov/about/org/despr/studies/chrondis/fmod.cfm

Wild S, Roglic G, Green A, Sicree R, and King H. (2004), “Global Prevalence of Diabetes, Estimates for the year 2000 and projections for 2030”. Diabetes Care, Volume 27, Number 5, May

Wild S Roglic G., Green A., Sicree R., King H. (2005), “Generation M: Media in the lives of 8-18 years old.Menlo Park”. Kaiser Family Foundations.

World Health Organization (2005), “Chronic diseases: A vital investment”.Genova,Switzerland. Retrieved February 17, 2007 from: http://www.who.int/chp/en/

World Health Organization (2006). Fact sheet N 312. “Diabetes”. Retrieved February 17, 2007 from: www.who.int/mediacentre/factsheets/fs312/en/index.html

World Health Organization (undated, a), “Global Strategy on Diet, Physical Activity and Health”. Retrieved February 17, 2007 from: www.who.int/dietphysicalactivity/en/

World Health Organization (undated, b), “Diabetes Programe”. Retrieved February 17, 2007 from: www.who.int/diabetes/BOOKLET_HTML/en/index9.html

World Health Organization (undated, c), “Preventing chronic diseases: a vital investment”. Retrieved February 12, 2007 from: www.who.int/chp/chronic_disease_report/en/

Zimmet P, Alberti KG (2006), “Introduction: Globalization and the Non-communicable Disease Epidemic”. OBESITY Vol. 14 No. 1 January, 1-3.

Zimmet P, Alberti KG, Shaw J. (2001), “Global and societal implications of the diabetes epidemic”. Nature. 414:782-7.

Their first programs began with malaria prevention education, sponsorship of an orphaned kindergartener, and the establishment of the first girls soccer team in the region. Since then, the organization has expanded the soccer team, sponsored more students, provided health education in different countries and completed a background assessment for a future microloan project. Room for Compassion primarily operates in Shirati, Tanzania and has programs initiating in Port-au-Prince, Haiti and Guwahati, India. Our inter-disciplinary team consists of public health, media and engineering professionals dedicated to our mission of alleviating poverty.

For more on Room for Compassion, visit www.roomforcompassion.org.

Global food supplies in the world are enough to feed each individual on this planet. Unfortunately, there are still over 800 million people in the world suffering from chronic hunger, in other words they lack food security. Food security exists when all people, at all times, have access to sufficient, safe and nutritious food to meet their dietary needs and preferences for an active and healthy life (FAO). When considering the reasons why people around the world lack food security, access to food becomes an important factor that needs to be addressed. In this paper, we will look at the past and present state of global programs and policies regarding food security, and discuss some of the reasons why people lack access to sufficient food. Future trends will also be considered, and from these findings possible future solutions to address the issue of food security around the world will be discussed, along with the challenges and obstacles that might be faced when trying to implement these suggestions.

Introduction – Food Security and its Importance in Livelihood Security

Food is an important aspect for the survival, health, and well being of the individuals that make up any community.  Thousands of years ago, individuals obtained their food by hunting and gathering. Later we figured out that we could grow food, and agriculture was developed about 8000 years ago. This allowed human populations to become more stable. The introduction of agriculture was a big advancement in our evolution, because it allowed for the time to establish more communities, and have the time to think about other things that would eventually lead to the day and age that we are currently living in. Agriculture is a very important part of our history, in particular in the development of civilizations. Although agriculture was a long evolutionary leap for communities around the world, which allowed for the continual advancement of these communities, we are now noticing the negative affects that large scale agriculture can have on the earth’s environment, and how globalization has contributed to the change of agriculture into large corporate enterprises that marginalizes the most poor, creating challenges for communities and security of food. Currently there is an abundance of food, but there are over 800 million individuals in this world that are affected by not having enough food to sustain themselves on a daily basis. In other words they lack food security.

Since the 1970s, there have been several definitions for food security that have been established. The United Nation’s Food and Agriculture Organization (FAO) has established one of the most commonly accepted definitions – it states that “food security exists when all people, at all times, have access to sufficient, safe and nutritious food to meet their dietary needs and food preferences for an active and healthy life” (FAO, 2006). In the 1979 World Food Program Report, food security was conceptualized as an “assurance of supplies and a balanced supply-demand situation of stable foods in the international market.” The World Bank defined food security as the “access by all people at all times to enough food for an active and healthy life (World Bank, 1986).” All of these definitions encompass the issues of production in relation to food availability; distribution in that food should be accessible by all; and consumption in that each individual’s food needs should be met in order to live active and healthy lifestyles. Therefore for food security to exist, availability and accessibility of food to meet individual food needs should also be sustainable (Ayalew, n.d.). The opposite of food security is food insecurity, and the Hunger Task Force has described food insecurity as “a condition in which people lack basic food intake to provide them with the energy and nutrients for fully productive lives. (2007)”

Food security is very important for the livelihood of all human beings on this earth because food is an essential part of life, and without it you cannot have nutrition and well-being. Without nutrition and well-being one cannot live to their full potential, and provide a secure livelihood. According to the United Nations, all humans have basic human rights that should be respected at all levels of society, including the right to food. The United Nations has developed declarations in order to provide guidance for countries to assure that each individual is respected with the most basic human rights. In the Universal Declaration of Human Rights (UN, 1948), it was established that all humans should have the right to an adequate standard of living, including food. Additionally, in the Universal

Declaration on the Eradication of Hunger and Malnutrition (UN, 1974) it states that “every man, woman, and child has an inalienable right to be free from hunger and malnutrition.” Unfortunately many of these human rights are violated, in particular in developing countries and many living in extreme poverty are hungry and undernourished.  These rights have been established, so that the livelihood of individuals, which is the means by which a person or households make a living over time, is secure. In order to live secure lives, and to have the opportunity to progress at all levels of society, from the individual to the communal, food is one of the most basic necessities in life. If you consider the basic needs of humans, it comes down to food, water, oxygen, and reproduction. Although these rights have been declared, and it’s expected that all nations follow, many people in this world today cannot meet their most basic needs. Ensuring food security and good nutrition are essential in maximizing human potential and attaining health for all.

Food insecurity, which is a condition in which people lack basic food intake to provide them with the energy and nutrients for fully productive lives (Hunger Task Force, 2006; “Food Security”, 2007), can lead to famine and hunger, which could lead to stunting and chronic nutritional deficiencies in individuals (Ayalew, n.d.). Famine is an absolute lack of food affecting a large population for a long period of time (Ayalew, n.d.). Hunger is related to undernourishment and is related to poverty. People become weak after not having adequate food for days. Chronic hunger and malnutrition causes decreased body size, otherwise known as stunting. This process can start in utero if the mother is malnourished and is continued through the first three years of life (“Food Security”, 2007). Stunting can cause a premature failure of vital organs during adulthood, higher rates of disease and illness, and defects in childhood cognitive development (“Food Security”, 2007). Hunger and malnourishment leads to higher infant and child mortality. Hunger is not only a consequence but also a cause of poverty. It compromises the health and productivity potential of individuals, families, and entire nations, and their efforts to escape poverty (FAO, 2006).

There are several reasons why food insecurity exists. Natural disasters, drought, conflict, high rates of population growth and poverty are the main factors that contribute to food security issues. The leading cause of hunger and malnutrition is poverty. There is a direct relationship between food consumption levels and poverty (FAO, 2006). Poverty causes a lack of purchasing power among the poorest segments of the population. Many are chronically hungry due to extreme poverty. Currently there are about 1.2 billion people living on less than $1 per day (World Bank, 2001).

Drought and other climatic extremes and natural disasters also contribute to food insecurity. Droughts usually extend over several seasons, and can cause differential patterns of rainfall. In order to cope with such irregularities, farmers in these areas have learned to plant different crops at different times, and have had to sometimes resort to hunting and gathering in times of stress. Floods, is another natural disaster that can affect food insecurity. Floods can destroy crops, drown animals, and cause reservoirs to fill up with silt. When regions don’t receive normal rainfall it causes areas to be limited in what can be grown. The impact of droughts can be exacerbated by continual forms of degradation of natural resources, in particular land and vegetation. For example soil erosion causes runoff of rainwater, resulting in land productivity decline, loss of biodiversity, and continuing desertification (Susswein, 2001).

Conflict can also cause food insecurity, because it diverts the nations resources, directly and indirectly, from more productive and socially beneficial uses (UN, 2000). Conflict also moves able-bodies men away from agricultural production, to areas of conflict, putting a larger work burden on women. In areas of conflict, those that are the most poor are affected the most, since many times people are displaced from their homes, and their assets are depleted.  Also, food is unfortunately used as a weapon; soldiers starve opponents into submission by seizing or destroying food or livestock. Fields and wells are often mined or contaminated, forcing farmers to abandon their land.

National food production, or having the availability of food at the national level, does not guarantee food security. This is because food is not always distributed evenly to each region and to each household. Individuals, who don’t produce their own food, might be able to access food in their country through markets, but only if they have the ability to pay.. In poor, underdeveloped countries, many people may not have purchasing power to buy food. Also, some national governments lack the necessary financial resources to purchase surplus and to distribute it to those in need, especially when millions of people are in need. (Ayalew, n.d.)

Food insecurity threatens global security. People that experience hunger, are disadvantaged in their capacity to earn a livelihood. Societies that are devastated with hunger can’t develop to their full economic and social potential (FAO, 2006) for example the productivity of developing countries could be cut by 2% in GDP in some cases because of food insecurity [WFP].

This paper will look the past, and present state of global programs and policies regarding food security, and discuss some of the reasons why people lack access to sufficient food. Future trends will also be considered, and from these findings possible future solutions to address the issue of food security around the world will be discussed, along with the challenges and obstacles that might be faced when trying to implement these suggestions.

Historical Perspective on Food Security

The state of food security in the world became an issue prominantly in the 1970s (Ayalew, n.d.), but it was first raised as an issue of concern in the late 18th century by Thomas Robert Malthus’ An Essay on the Principle of Population of 1798 (Rosegrant & Cline, 2003). In his essay he predicted that if population growth continued the way it was going, and agriculture productivity didn’t step up, then the world would begin to suffer war, plague, and famine. The world did step up, and between the 1940s and 1960s agricultural production increased in many developing countries as a result of programs in agricultural research, extension, and infrastructure, largely funded by the Rockefeller Foundation, Ford Foundation, and other major agencies. This transformation is known as the Green Revolution. The green revolution led to significant increases in agricultural production and it helped to avoid widespread famine. The green revolution helped spread technologies that had been widely used in industrialized nations to other developing nations, such as pesticides, irrigation projects, and synthetic nitrogen fertilizers. It also encouraged more widespread use of seeds that had been created to be “high yield varieties,” which are seeds that significantly outperform traditional varieties in the presence of adequate irrigation, pesticides, and fertilizers (“Green Revolution”, 2007). The green revolution increased staple food crop production to a level that provides adequate energy to satisfy the needs of the global population (Gebremedhin, 1997).

World hunger became a major global health concern in 1974 during the World Food Conference held inRomeby the United Nations, under the Food and Agriculture Organization (FAO). It was proclaimed that “every man, woman and child has the inalienable right to be free from hunger and malnutrition in order to develop their physical and mental faculties. (“World Food Conference”, 2007).” The conference set as its goal the eradication of hunger, food insecurity and malnutrition within a decade. After this conference, there was a reduction in number of undernourished in the 1970s of 37 million, and 100 million in the 1980s, but it was not enough to meet their goal.

In 1996, the FAO of the United Nations called a World Food Summit (WFS) that was held inRome. This summit was called in response to a widespread under-nutrition and growing concern about the capacity of agriculture to meet future food needs. Two key documents were produced, the Rome Declaration on World Food Security, and the World Food Summit Plan of Action. In the Rome Declaration, participating world leaders pledged an ongoing commitment to efforts to eradicate hunger in all countries, and set themselves the immediate target of halving the number of chronically undernourished people on the globe by the year 2015(FAO, 2006). The Plan of Action sets goals for government and non-governmental organizations to achieve food security, at the individual, household, national, regional and global levels. (“Food Security”, 2007).

World hunger was again brought to the international table, during the Millennium Declaration of the United Nations in 2000, and listed as one of the eight major Millennium Development Goals (MDG). The UN committed in its 1st goal to “Eradicate extreme poverty and hunger,” and specifically states that it will reduce by half the proportion of people who suffer from hunger by the year 2015, compared to proportions in 1990, and increase the amount of food for those who suffer from hunger (“Millennium Development Goals”, 2007).

Global Food Security Issues Today

Global food supplies have improved enormously since the early 1960’s. More food is being produced today than ever before (Gebremedhin, 1997). It is estimated based on current trends and improved agricultural technology, that food production will be sufficient to meet the demands of the world’s population by 2010 (Gebremedhin, 1997). Although contradictory to Malthus’ projections, global food availability does not ensure food security to any particular country because what is available in the world market may not be accessible to famine-affected individuals in developing countries, such asAfrica(Ayalew, n.d.). Poorer countries may not generate enough currency to be able to purchase food from the world market to alleviate issues of hunger in their countries. Unfortunately, although agricultural production has increased, there is still a large problem with global hunger. So the problem is not the supply of food production, but the access to the food supply, and more importantly, access to the technology to increase food production. Currently there is more widespread and vocal acknowledgment that persistence chronic hunger in a time of plenty is an unacceptable contradiction.

The FAO estimated that there were 854 million undernourished people worldwide in 2001-2003, comprising of 830 million in the developing countries, 25 million in the transition countries and 9 million in the industrialized countries. There has been an overall reduction in both the number and prevalence of undernourished people since the WFS baseline period in 1996 in Asia, the Pacific, Latin American and the Caribbean, but the average rate of reduction is much slower than what it needs to be in order to halve the undernourished population by 2015 (FAO, 2006).  Unfortunately, inAsiaand the Pacific, the number of undernourished has reverted to an increasing trend over the last part of the decade, although the prevalence has continued to decline. This is because of population increases; therefore there were larger absolute numbers inChinaandIndiain 2001-03 relative to 1995-97 (FAO, 2006).

Sub-SaharanAfricais the greatest challenge among the developing regions, with the highest prevalence of undernourishment, with one in three people deprived of access to sufficient food (FAO, 2006). There has been a slight reduction in proportion of undernourished people in the region of sub-SaharanAfrica, but the number of undernourished people increased from 169 million to 206 million. In order to reach the WFS target there would need to be a reduction to 85 million by 2015 (FAO, 2006). It is projected that the prevalence of hungry people will continue to decline but the actual number of hungry people will not fall below that of 1990-92. (FAO, 2006).

In 2006, ten years after the World Food Summit inRome, the FAOs committee on World food Security conducted an assessment of the implementation of the Plan of Action, and the progress towards achieving the target of eradicating hunger in all countries and halving the number of undernourished people by 2015. (FAO, 2006). When looking at the total numbers, virtually no progress had been made towards the objective (FAO, 2006). The number of undernourished people in the developing countries had only declined by 3 million, from 823 million to 820 million, from 1990-92 (baseline period for WFS target) to 2001-2003 (FAO, 2006). Despite not being able to reduce the numbers of hungry people, there has been some progression, which is indicated by the reduction of a proportion of undernourished people in developing countries by 3 percentage points, from 20 percent in 1990-92 to 17 percent in 2001-2003 (FAO, 2006). When taking a closer look at the numbers, it is more clear that some countries have progressed more than others, while other countries have had set backs (FAO, 2006).

Asia and the Pacific, and Latin America and theCaribbeanare the only regions that have made progress towards the WFS target, although they are very far from reaching the goal (FAO, 2006). All other regions have been moving away from the target by varying degrees. In terms of reaching the MDGs most regions are working towards the target reducing the prevalence of undernourishment, except for the Near East andNorth Africa. We are closer to the MDG target of halving the proportion of undernourished people by 2015, but still very far from the WFS target of halving their number (FAO, 2006).

There is no doubt that the green revolution changed the face of agriculture in the world. Its affects on food security on the other hand are not so clear. Some argue that because the world population has grown by about four billion since the green revolution began, the green revolution prevented greater famine and malnutrition than if it hadn’t happened. Nonetheless the green revolution is responsible for feeding billions of people, and it helped to avoid widespread famine (“Green Revolution”, 2007). But as it was mentioned before, increasing food production is not synonymous with increasing food security. Some argue that the Green Revolution may have decreased food security for some people. The technology pushed by the green revolution was not suitable for poor farmers. This is based on the shift of subsistence-oriented cropland to cropland oriented towards production of grain for export and/or animal feed (“Green Revolution”, 2007). For example, the Green Revolution replaced much of the land used for growing legumes that fed Indian farmers for wheat, which did not make up a large portion of the farmers diet. The green revolution also declined biodiversity, has contributed to the killing of fish and pollution of rivers because of pesticides, and has contributed to soil depletion. This can create issues of food insecurity.

Countries that have managed to reduce hunger have experienced rapid overall economic growth and achieved greater gains in agricultural productivity than those experiencing set backs or stagnation (FAO, 2006). Some countries that are suffering setbacks in hunger reduction are experiencing conflict or other forms of disaster (FAO, 2006).  Countries that rely on a poor agricultural resource base and exhibit weak overall economic and institutional development, with persistent population growth also have bad projections. (FAO, 2006). “To accelerate the pace of global hunger reduction, it is essential to halt and reverse the rising trend in numbers where it occurs and to broaden success in hunger reduction to other sub regions. This will evidently be critical in those sub regions where the prevalence of undernourishment is most severe. (FAO, 2006)”

Currently the most common form of aid has been in the form of international aid. It was calculated by the United Nations that almost all of the deaths from hunger and disease could be stopped with a cost of $195 billion a year. In 2002 both at the Monterrey Conference and Johannesburg Summit, 22 developed countries pledged to work towards each giving 0.7% of their national income in international aid, which would raise the amount needed to “substantially eliminate” extreme poverty according to the United Nations.

The World Food Program delivers food aid to over 90 million people every year. They do this in the form of rations for workers that help build vital infrastructure to start development, and offering children food aid as a reward for going to school for the educational development of children.

Food Security in the Future

In order to plan for the future, and find solutions for food security, it is important to consider the projections of food supply made by the FAO. It is also important to consider the future trends of global health that may have an affect on food security. According to the International Food Policy Research Institute there are 9 driving forces or emerging issues in global health that will affect the ability to achieve the WFS and MDG targets. These driving forces that will impact any future efforts to accomplish the MDGs and WFS target, are accelerating globalization and trade liberation, technological changes, degradation of natural resources, increases water scarcity, health and nutrition crisis, rapid urbanization, and changes in farming practices, conflicts, climate changes, and changing roles and responsibilities of key actors (IFPRI, 2002).

The FAO has made projections in reaching MDG and WFS targets. MDG seem more reachable, while WFS don’t seem promising(FAO, 2006). As population increases, the number of hungry people will probably remain the same or increase, while the prevalence can decrease. Baseline Projections of global food supply of International Food Policy Research Institute’s (IFPRI’s) International Model for Policy Analysis of Agriculture Commodities and Trade (IMPACT), global cereal production is estimated to increase by 56% between 1997 and 2050, and livestock production by 90%. Developing countries will account for 83% of cereal demand growth, and 85% of meat-demand growth to 2050. International agriculture trade will increase substantially, cereal will double by 2025 and tripling by 2050 in developing countries. So there will still be hungry people, with a bigger demand for agricultural products. In the current state of how agricultural is in the world currently, there is an overwhelming dependence on these large farms.  Throughout the years, these large agricultural firms have created a stronger dependence to them. Unfortunately, this is a reason why many individuals, in particular in developing countries should be given the tools to do their own local farming, and not rely heavily on large agricultural firms.

There are other challenges that need to be faced. Climate changes due to global warming will cause more droughts, natural disasters, and rising sea levels, all of which can have a negative affect on crop yields. Some predict that moderate climate change won’t adversely affect the world food supply, if farmers take the right steps to adjust to climate change, and also because increased levels of carbon dioxide will increase yields. However, developing countries that don’t have the technology will fair bad. In warmer or tropical environments, climate change may result in more intense rainfall between prolonged dry periods, as well as reduced or more variable water resources for irrigation. Climate changes can also cause erosion and further desertification.

Water scarcity is increasingly becoming a problem, because of rising population, growing industrialization, and expanding agriculture, all of which cause an increase in water demand. In some areas, countries have built dams, reservoirs, and or digging wells, and other have even tried to recycle and desalinate (remove salts) water (Water Conservation, n.d.). These solutions can often be very expensive, and could possibly create other environmental and human rights issues in the development of these water storage systems. A large proportion of the population that suffer from food insecurity issues, live in arid and semi-arid parts of the world, where rainfall is limited and irregular.  In these areas, reduced rainfall or prolonged dry spells can lead to crop failure. The common solution used in this situation would be irrigation, but because of water scarcity and high costs in irrigation infrastructure, this can be an impossible task in developing countries (FAO, 2000). Therefore alternative solutions should be used to increase the quantity of water. Water harvesting is a proven technique to increase food security in drought prone areas, and it’s a way to control erosion and recharge ground water (Prinz, Wolfer, & Siegert, n.d.). The idea of ground water recharging by harvesting rainwater is gaining importance in many regions.

With increasing environmental issues its important for food security advocates to push governments to take on more environmentally friendly initiatives, such as cutting carbon emissions (by finding alternative ways of generating electricity), and finding ways to raise water productivity. Environmental issues go hand in hand with issues that relate to food. If the earth is not doing well, as the past few years have indicated that we are headed, then our food production may decrease due to the earth’s instability. Even such issues as saving the rainforest, will be beneficial for the issue of food security. In the rainforest, water seeps gently into the ground as forest vegetation breaks the fall.  This groundwater in turn can feed wells, lakes and rivers. Therefore saving the rainforest, means protecting water ‘catchments’ (Water Conservation, n.d.). This issue cannot be taken lightly.The global rise in HIV/AIDS will also affect food security, in particular in the most affected regions of the sub-Saharan Africa. It is possible that many adults in the labor force will be affected by HIV/AIDS and will be removed from affected households, causing these households to have less capacity to produce or buy food, as assets are often depleted for medical or funeral costs. (Rosegrant et al., 2003)

Increasing urbanization is also important to consider, because income growth and rapid urbanization are forces that are driving an increase demand for higher valued commodities, such as meats, fruits, and vegetables (Rosegrant et al., 2003). Urban food security and its related problems should also be considered (FAO, 2006). Currently about half of the world’s population lives in urban centers, and this is projected to increase in the next years [UN].

Conflict is another issue that is likely to arise and cause many food insecurities for many people. Some argue that because of climate changes, there will be a lot of civil societal pressures stemming from environmental insecurities. With climate change it is possible that some countries will become increasingly competitive with their resources, causing tension between countries that could lead to political conflicts.

Globalization has had both positive and negative implications on different groups of people. Globalization in food and agriculture has been described by the FAO as the “the expansion of foreign private investment in agriculture, food processing and marketing, to a large extent but not only through transnational corporations and an increasing international trade in food facilitated by the reduction in trade barriers (2003).” The globalization in food has increased the challenges faced in making any changes to the industry. It implies, agricultural subsidies, and international policy trade agreements. Another effect of globalization is the increasing growth of the fast food industry internationally, which has grown rapidly because of trade and foreign investment. With increasing urbanization, the globalization of fast food will create further problems in terms of malnourishment, and increase in obesity, contributing to the increase trend from infectious diseases to more non-communicable diseases.

Ideas and Suggestions to Increase Food Security

It is impossible to conceive one solution for the global health issue of food insecurity. Each region faces different challenges that must be addressed in order to successfully tackle the issue of food insecurity. Therefore, instead of thinking about solutions to deal with food insecurity at the global level, local solutions will have the most impact in the lives of communities. Before discussing suggestions for increasing food access to individuals living in hunger, consideration of the most effective ways to increase food insecurity and poverty need to be discussed. In doing this, it leads to the importance of including agriculture (both in rural and urban environments) in any solutions created for dealing with food insecurity.

Agriculture can be beneficial to alleviate poverty in both rural and urban areas, because it helps to reduce food prices, create employment, and improve farm income (SASIX, 2007). According to the FAO, agriculture can be much more effective, than any other sector at reducing poverty and hunger in both rural in urban areas (2004). So agriculture, in the hands of the most vulnerable, holds the most hope in dealing with food insecurity issues. But as discussed before, the forms of agriculture that have commonly been used could lead to soil depletion, causing problems for future generations. Therefore new forms of eco-friendly agriculture that are sustainable need to be encouraged.

Permaculture is an eco-friendly form of agriculture that is relatively new, but is based on agricultural principles that are thousands of years old. Permaculture is a design system that utilizes a systems thinking approach to create sustainable human habitats by observing and duplicating nature’s patterns. It integrates ecology, landscape, organic gardening, architecture, agroforestry, green and ecological economics and social systems. Permaculture can solve many issues, such as increased costs of developing new water sources, soil degradation in irrigated areas, groundwater depletion, water pollution, and ecosystem degradation. This form of agriculture is self-sustainable, meaning that very little human labor is needed to sustain, and it practically does it by itself, therefore sustainable.

As it has shown to be affective it is important to promote small scale, bottom up, community appraoches in addressing food security. It seems feasible to conduct small-scale projects of permaculture that are relatively low-cost (finding solutions that are cost-effective) and require low labor input. Permaculture, as shown in many parts of the world, has provided fast pay-offs of investments, and the projects are well integrated, dealing with different issues that need to be addressed (poverty, economic development, food security, and self-sustainability). The encouragement of these local projects will provide farms that are in the local community, therefore creating many benefits for the community.

A solution to encourage local change, around the world would be to establish an action plan that cities and towns around the world can sign on to. Something similar has been done for the development of sustainable cities through an association called the International Council for Local Environmental Initiatives (ICLEI) Local Governments for Sustainability. Its an international association of local government organization all over the world, that have made a commitment to sustainable development. This organization focuses on making change at the local government level since it is the closest level of governance to the people. At this level, the government can play a vital role in educating, mobilizing and responding to the public. Local authorities at this level can construct, operate and maintain economic, social and environmental infrastructure, oversee planning processes, establish local environmental policies and regulations, and assist in the implementing of national and global policies (ICLEI, 2007).

Although making change at the local level sounds like it would make the most impact on communities, relying solely/completely on local governments is unrealistic. There are some local governments in developing countries that don’t have the proper infrastructure or power to make changes. Some local governments are in such a financial burden, that they may be at the mercy of large corporations that may be contributing to the economy, but are not doing much to assists its community members.

Addressing Food Security in Rural Environments

Permaculture trainings could be offered to communities in rural areas by establishing learning centers. Permaculture demonstration projects could be used to train individuals that live in rural areas. At these trainings, they will learn how they can use permaculture in the most effective way to deal with issues of water scarcity and depleted soil. With the use of permaculture, small farmers will also learn the importance of biodiversity in their farms, and be provided seeds to begin their farm. These trainings would be offered in the form of a teach-the-trainer format, so that these individuals also have the capacity to train others in their community about eco-friendly agricultural techniques. In order for individuals to start their farms, it is important to provide micro-loans/financing in order to start-up their food production. At these trainings, they will also receive training on how to market their higher cash crops.

Developing countries and organizations that are particularly working with large rural populations dealing with food insecurity should raise funds for the implementation of permaculture in different regions of the country. Information and trainings could be provided, and motivational campaigns can be launched to help push communities into action that will prove fruitful (Prinz et al., n.d.). Incorporating permaculture designs in rural communities is also beneficial in developing community resiliency. With the ever-expanding force of globalization, and the implications of it, it seems as though there has been a movement away from community, and communal living. This sense of detachment from the community causes many types of insecurities in the lives of its community members. So proposing to make change at the local level, working together as communities may have plentiful of positive affects on the community building community resiliency. Building resiliency in communities has shown to help communities in negative situations that can occur in a community, such as natural disasters.

Addressing Food Security in Urban Environment

Permaculture can also be applied in urban environments. Again with the use of local initiatives, it is important to encourage urban development planners and local authorities to incorporate sustainable buildings and urban agriculture that use permaculture principles to meet the needs of a growing urban population.

Large urban centers should have citywide community garden policies that will facilitate and maintain the development of green spaces. With policy in place, local community members can have support against developers that are just hungry for the money that could be made developing empty lots that could be converted to community gardens. There are non-profit organizations that are organizing around developing community gardens, but they are limited at what they can do. Their efforts might help in increasing community gardens in the short term because they depend on the land purchases. If the city were to get involved, and instilled some type of policy, such as eminent domain, to acquire land that could be converted to community gardens. The city could also change zoning regulations to establish more open green spaces available for community members to use as gardens for subsistence gardening. Urban areas could do this along with other efforts to improve community issues, such as affordable housing.

Community gardens established with the help of the city could be linked up with projects related to affordable housing using vacant city-owned land to be converted into permanent garden sites. Policies are needed to institutionalize community gardens as a public good like parks and affordable housing. Community gardens can be very beneficial in an urban environment. Since many urban dwellings are predominately close to each other with insufficient space for gardens, or they are multi-unit housing with no green space or very limited and restricted green space, community gardens play a vital role in providing a minimal amount of sustainable feeling comfort ability/sustainability. They can be a source of fresh healthy food for the community that surrounds it. They also serve other functions. It also serves as a community gathering place, and a place where people can be creative and be entrepreneurs. Community gardens also provide nicer looking communities, and a place where the surrounding air can be cleansed. Another solution that could be done in an urban environment is working with the local schools to establish school gardens that could serve as community gardens for the use of families in need at the school.

Historically, food and agriculture policies have centered on the interests of producers, especially large-scale producers. However, food has consumption value as well as commodity value. Given the magnitude and persistence of food insecurity in the world, there is a need for clear global policy on food as food, and not simply as another commodity to be marketed (Kent, 2004) Progressive policy action must increase agricultural productivity, boost incomes, and reduce poverty in rural areas where most of the poor live (Rosegrant et al., 2003). Food security in developing countries could be substantially improved by increased investment and policy reforms in the areas of human resources, agricultural research, rural infrastructure, water resources, farm-based agricultural management, community-based agricultural management, and natural resources management (Rosegrant et al., 2003). Urban policies could help increase food security by implementing policies for urban planners and architects such as zoning for urban green spaces, community gardens, and creating buildings that are sustainable, environmentally friendly, and have roof top gardens.

Not only are investments in policy reform necessary, but also it is very important to increase investments in people. For example education in agricultural areas will provide increased abilities to adopt the use of advanced technologies and crop-management techniques to achieve high rates of return on land. Educating women also brings in a lot of advantages, lower fertility rates, raising productivity, and improving environmental management. Providing educational resources for primary education and for the poorest groups of regions can serve to empower communities. Also, investing in health and nutrition, including safe drinking water, improved sewage disposal, immunization, and public health services can also contribute to poverty reduction. Increased investments in infrastructure and rural roads are also important for food security (Rosegrant et al., 2003).

Encouraging policies that will deal directly with food security issues are important, but it is also important to implement policies that deal directly with environmental issues. In particular policies that will protect and increase water availability. Knowing how important water is to the earth, it is important for people around the globe to adapt more water-friendly habits and practices that will help to protect and restore the quality of these waters. Advocating for healthy watersheds in the community can be extremely valuable, not only for the restoration of the earths soil, but also in terms of monitory savings that could be achieved from taking full advantage of watersheds. Even actions such as implementing a public outreach campaign to reduce nonpoint source pollution, could help protect waterways that are so important to our ecological system. Nonpoint source pollution, is discharge from a cumulative amount of people in a community, that when considered individually, would have relatively minimal impacts on the quality of water. The amount of careless and unknowingly of pollution from each individual in a community creates cumulative effects on these impacts. These activities could include applying pesticides, or washing cars.

Policies that encourage large farms to establish water-harvesting techniques should also be implemented. Large farms could be awarded using incentives, for incorporating water-harvesting techniques into their farm protocols. Also, the establishment of a large demonstration farm, using the principles of permaculture could be used to show large farms the techniques that they could use to improve crop yields and water restoration.

Challenges and Opportunities

All levels need to change in order to fight persistent and widespread hunger, at the local, national, and international level. National and local governments bear the primary responsibility because they can create an environment in which individuals and communities can effectively address hunger. These changes need to be made using bottom-up or grassroots organizing strategies, in order to develop community empowerment. Communities at the local level could work together, and create partnerships with NGOs, businesses, and industry. Governments of developing countries have a responsibility (should be accountable) to find solutions that will should end trade-distorting policies, and focus on contributing to sustainable food security and poverty reduction; and relieve unpayable debt of poor countries. In urban environments, developers have invested interest in property that might be at stake to community organizers that are trying to mobilize around the formation of community gardens. Its unfortunate but many developers hold their own interests above the interests of entire communities. Commercial and real estate developers could be required to set aside land for community gardens. These are all challenges that need to be faced.

Conclusions

With increased trends in global warming, and population growth, it is imperative that environmental and food issues are made priorities in the agendas of national and local governments, as well as non-profit organizations. It should become a larger topic of discussion of communities in general. Al Gore’s recent release of his documentary on global warming, “The Inconvenient Truth,” increased awareness and discussion in theUnited States. It was a flurry of excitement that hadn’t happened on this topic before. It raised consciousness to many environmental health issues that many individuals, before this movie, were not aware of at all. Environmental issues have been slow in coming to the forefront, but with every small progression made, there is a step towards making change for the larger picture. This growing popularity to this issue is important, and hopefully it does not dissipate. It is important because environmental issues and food security issues go hand in hand.

In order to address food security around the globe, poverty issues must also be addressed. Permaculture provides the techniques to provide food, but also to enable economically advancement. It is important to think of small-scale permaculture projects that can improve communities in rural areas around the world, and how urban permaculture agriculture can improve the lives of communities in urban areas, while at the same time addressing global policies that hinder the fight for food security.

References

Ayalew, Melaku. (n.d.) What is Food Security and Famine and Hunger? Retrieved March 15, 2007 at http://www.bradford.ac.uk/research/ijas/ijasno2/ayalew.html

Food and Agricutlure Organization (FAO) (2000) Water Harvesting for Improved Rainfed Production and Supplementary Irrigation. Retrieved on March 18, 2007 on http://www.fao.org/ag/Agl/aglw/wharv.htm

FAO (2006) The State of Food Insecurity in the World: Eradicating World Hunger – taking stock ten years after the World Food Summit. Retrieved March 15, 2007, from ftp://ftp.fao.org/docrep/fao/009/a0750e/a0750e00.pdf

FAO (n.d.) The Special Programme for Food Security. Retrieved March 15, 2007, from http://www.fao.org/spfs/

Food security. (2007, March 13). In Wikipedia, The Free Encyclopedia. Retrieved March 17, 2007, from http://en.wikipedia.org/w/index.php?title=Food_security&oldid=114744738

Gebremedhin, Testa G. (1997) A critical analysis of the causes of world food insecurity, Land reform, land settlement and cooperatives, No.1, pp.18-35

Green Revolution. (2007, March 18). In Wikipedia, The Free Encyclopedia. Retrieved 01:04, March 19, 2007, from http://en.wikipedia.org/w/index.php?title=Green_Revolution&oldid=116113758

Hunger Task Force – Understanding Hunger (2007) Retrieved on March 15, 2007 on http://www.hungertaskforce.org/understanding_hunger/understanding_hunger/

ICLEI – Local Governments for Sustainability (2007) About ICLEI. Retrieved on April 1, 2007 on http://www.iclei.org/index.php?id=global-about-iclei

International Food Policy Research Institute (IFPRI) (2002). Achieving Sustainable Food Security for All by 2020: Priorities and Responsibilities. Retrieved March 15, 2007, from http://www.ifpri.org/2020/books/actionshort.pdf

Kent, George. (2004) The Globalization of Food and Agriculture. Retrieved on March 17, 2007 on http://topics.developmentgateway.org/foodsecurity/rc/filedownload.do?itemId=1007188

Millennium Development Goals. (2007, March 11). In Wikipedia, The Free Encyclopedia. Retrieved 02:06, March 19, 2007, from http://en.wikipedia.org/w/index.php?title=Millennium_Development_Goals&oldid=114235851

Prinz, D, Wolfer, S, Siegert, K. (n.d.) Water Harvesting for Crop Production. Retrieved on March 19, 2007 on http://www.fao.org/ag/Agl/aglw/wharv/wh01/sld017.htm

Rosegrant, Mark W. & Cline, Sarah A (2003). Global Food Security: Challenges and Policies. Science 302, 1917-1919

SASIX (2007) Food Security Projects. Retrieved on March 19, 2007 on http://www.sasix.co.za/projects/index/?sector=FS

Susswein, P.M, van Noordwijk, M., Verbist, B. (2001) Forest watershed functions and tropical land use change. International Centre For Research in Agroforestry. Retrieved on March 19, 2007 at http://www.worldagroforestrycentre.org/sea/Products/Training/Materials/lecture%20notes/ASBLecNotes/ASBLecNote%207.pdf

United Nations (1948). Universal Declaration of Human Rights, UN General Assembly Resolution 217 (III) A, Official Records of the Third Session of the General Assembly, Part I, 21, Sept.-12 Dec. 1948, Resolutions. Retrieved March 15, 2007, from http://www.un.org/Overview/rights.html

United Nations (1974). Universal Declaration on the Eradication of Hunger and Malnutrition. Retrieved March 15, 2007, from http://www.unhchr.ch/html/menu3/b/69.htm

United Nations (2000) The elimination of food insecurity in the Horn of Africa: A strategy for concerted government and UN agency action FINAL REPORT. Retrieved on March 17, 2007 on http://www.fao.org/docrep/003/x8406e/x8406e00.htm

Water Conservation (n.d.) Retrieved on March 17, 2007 on http://edugreen.teri.res.in/EXPLORE/water/conser.htm

World Bank (1986) Poverty and Hunger – Issues and options for food security in developing countries.

World Bank (2001) Global Economic Prospects and the Developing Countries 2001. International Bank for Reconstruction and Development,Washington,DC.

World Food Conference. (2006, March 18). In Wikipedia, The Free Encyclopedia. Retrieved 01:33, March 19, 2007, from http://en.wikipedia.org/w/index.php?title=World_Food_Conference&oldid=44354722