Household water insecurity is strongly associated with food insecurity: Evidence from 27 sites in low‐ and middle‐income countries

Abstract

Objectives: Food and water insecurity have both been demonstrated as acute and chronic stressors and undermine human health and development. A basic untested proposition is that they chronically coexist, and that household water insecurity is a fundamental driver of household food insecurity. Methods: We provide a preliminary assessment of their association using crosssectional data from 27 sites with highly diverse forms of water insecurity in 21 lowand middle-income countries across Africa, Asia, the Middle East, and the Americas (N = 6691 households). Household food insecurity and its subdomains (food quantity, food quality, and anxiety around food) were estimated using the Household Food Insecurity Access Scale; water insecurity and subdomains (quantity, quality, and opportunity costs) were estimated based on similar self-reported data. Results: In multilevel generalized linear mixed-effect modeling (GLMM), composite water insecurity scores were associated with higher scores for all subdomains of food insecurity. Rural households were better buffered against water insecurity effects on food quantity and urban ones for food quality. Similarly, higher scores for all subdomains of water insecurity were associated with greater household food insecurity. Conclusions: Considering the diversity of sites included in the modeling, the patterning supports a basic theory: household water insecurity chronically coexists with household food insecurity. Water insecurity is a more plausible driver of food insecurity than the converse. These findings directly challenge development practices in which household food security interventions are often enacted discretely from water security ones.

“If there is no water, we cannot feed our children”: The far‐reaching consequences of water insecurity on infant feeding practices and infant health across 16 low‐ and middle‐income countries

“…Water insecurity has been shown to be both syndemic with food insecurity (Workman & Ureksoy, ) and a likely driver of it (Brewis, Workman, Wutich, Jepson, & Young, ). It has been shown to be associated with increased emotional, mental, and physical stress for women and caregivers (Aihara, Shrestha, & Sharma, ; Brewis, Choudhary, & Wutich, ; Collins et al, ; Stevenson, Ambelu, Caruso, Tesfaye, & Freeman, ; Workman & Ureksoy, ; Wutich & Ragsdale, ).…”

Water insecurity: An agenda for research and call to action for human biology

“…As Alex Brewis and colleagues () argue, the nexus of water and food insecurity—and its complex impacts on human health—is an exciting area of work that human biologists seem especially well placed to engage. There is a long history of looking at the water‐food nexus through the lens of irrigation and agriculture.…”

“…I believe the water‐food nexus will grow very quickly as an area of scholarship in the next few years, as colleagues like Barbara Piperata (Piperata et al, ) and Amanda Thompson (Thompson, Nicholas, Watson, Teran, & Bentley, ) move into this space. The hypotheses Alex Brewis has laid out for us provide a great point of entry (Brewis et al, ; Wutich & Brewis, ). One very recent example is Choudhary's (Choudhary, Schuster, Brewis, & Wutich, ) analysis, which Alex Brewis, Roseanne Schuster and I collaborated on, showing that household water access and regional water availability impact child nutrition in nationally representative samples from India well beyond the first 1000 days and into childhood.…”

Water & Human Biology and New Developments for the American Journal of Human Biology

“…Most impressive is the way that this set of papers showcases the power and potential of human biology to integrate biocultural, evolutionary, and applied perspectives to explore and address a pressing global health challenge. The volume opens with an introductory overview by Rosinger and Brewis (), and is followed by Amber Wutich's () Pearl Lecture that identifies water insecurity as a critically important research domain for human biologists. The papers by Swanson and Pontzer () and Rosinger () examine the physiology of hydration and water turnover.…”

“…Schell () draws on his long‐term research with the Akwesasne Mohawk Nation in developing a biocultural framework for understanding the impact of PCB contamination on water security in these indigenous communities. Papers by Piperata et al (), Thompson et al (), Brewis et al () and Schuster et al () explore the influence of water insecurity on diverse aspects of nutritional health, ranging from the gut microbiome in children to infant feeding strategies, and the dual nutritional burden. In turn, the contributions by Houck et al () and Dinkel et al () examine the impact water quality and availability on infectious disease risks.…”