As riots spread from Haiti to Bangladesh to Egypt over the soaring costs of basic foods, threatening to cause political instability and disrupt the achievement of the Millennium Development Goals, Mirjam Musch - Plan Adviser on Health - looks at how food insecurity affects the health of poor families in developing countries.

An emerging generation of scientific evidence demonstrates a direct link between inadequate food and a variety of poor developmental outcomes. The research shows that youngsters have a poorer overall health status due to food insecurity and hunger, are sick more often, are more likely to have ear infections, have higher rates of iron deficiency anaemia, and are hospitalised more frequently. In short, being hungry makes kids unhealthy.

What is most telling is that the above research doesn't refer to food insecurity in a developing country, but to the situation in a district of the United States. Yet the interaction between food insecurity and low health status seems to go beyond geographic boundaries, and can even affect groups living within societies that have ample food supplies.

The effects on poor families Families trying to survive in extreme poverty often go without the food they need and make agonising choices ranging from adequately feeding their children to buying medicine when they are sick to sending them to school.

At its most basic level, hunger results from a deficiency of calories and proteins. However, hunger and malnutrition involve micronutrient deficiencies which results in serious health issues. Persistent malnutrition leaves children weak, vulnerable, and less able to fight such common childhood illnesses as diarrhoea, acute respiratory infections, malaria, and measles. Children who are mildly to moderately malnourished are at greater risk of dying from these common preventable diseases.

Malnutrition can lead to decreased energy levels, delayed maturation, growth failure, impaired cognitive ability, diminished capacity to learn, decreased ability to resist infections and illnesses, shortened life expectancy, increased maternal mortality, and low birth weight.

For poor families, people first feel anxious about running out of food. At the next stage, they begin to compromise on the quality and quantity of the foods they eat by choosing less expensive options which are not consistent with healthy eating. As resources get scarcer, food-insecure people feel hungry because they are unable to purchase enough food to satisfy their basic needs. At the most severe stage, food insecurity is experienced as not eating at all.

Psychological and physical effects There are negative psychological, social and physical consequences across this continuum. In food insecure households, the degree of inadequate nutrient intake varies with the degree in which family members are required to cut back on the quality and quantity of food they buy and eat.

The United Nations presented worrying facts on the effects on health caused by hunger: 25,000 lives are lost each day from hunger and poverty; even a bad case of diarrhoea can lead to death due to physical weakness caused by hunger; malnutrition causes more than half of all children's deaths. More than 100 million children are stunted physically and mentally from malnutrition, wrecking their chances for a good education and productive future.

The research into the effects of food insecurity on the health of children in developed country previously mentioned also states that at-risk children are more likely to have poorer mental health, be withdrawn or socially disruptive, and suffer greater rates of behavioural disorders. Although the economic security of a poor family's household in a developing country is completely different, as they spend over 70% of their income on food, in comparison to the 10% of an average American family, Plan has witnessed similar - and truly more negative - effects on the health of children who for the first time enter the Early Childhood Community Development centres (ECCD) and other educational projects in Plan countries.

The health status of a person cannot be attributed to the efforts of the health care sector alone, but to a series of influential factors in the direct environment of the person. This implies that the health status of poor families and their children cannot be improved by isolated interventions in one of the sectors. In other words, to substantially improve the health of poor families, we need to reduce their vulnerability at various levels by improving access to basic services such as basic education, water and sanitation, primary health care, income generating projects, and food security programmes.

The right to food

In order to stop the downward cycle of poverty, food insecurity and illness, an integrated "out of the box" approach is needed, in line with a different behaviour, approach and critical thinking at the professional level. Plan has integrated a rights-based approach in its food security programmes. The right to food and the right to provide for your own (full) plate is nowadays considered as a fundamental human right and internationally related to the government's responsibility to provide social protection and promote household economic security. In order to enhance ownership of this right, one of our main challenges will be to carefully examine the coping strategies of poor families and their children to overcome food insecurity.

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