Bringing NZ's hidden hunger problem into the open

Tuesday, 30 May 2023

It’s not just how much we’re eating, it’s what we’re eating that affects malnourishment rates, write Elaine Rush and Zac Morse.

Elaine Rush is emeritus professor of nutrition at the Auckland University of Technology and works with the Child Poverty Action Group. Professor Zac Morse is a practising dentist and professor of oral health at the Auckland University of Technology.

OPINION: It is virtually impossible to have life-long good health without consuming a diet with all the essential nutrients, every day. Calories are not enough.

From the moment of conception, energy-dense, nutrient-poor diets reduce the ability to respond to stresses which in turn leads to inflammation.

Lack of essential nutrients, including vitamins, minerals, amino and fatty acids and dietary fibre in the diet leads to lifelong disability.

* Study of 200 countries highlight Kiwi kids among the unhealthiest in the world

Stop-gap but vitally important measures such as Ka ora, Ka ako/Healthy School Lunches, Fruit in Schools and increased food assistance must continue and be increased, argue Elaine Rush and Zac Morse.

* Canterbury children record high levels of tooth decay

* Bigger bodies need bigger servings of vegetables to benefit - study

Essential nutrients are the ones we cannot make ourselves, they must be consumed in the foods we eat. A shortfall of these life-giving nutrients causes ill health and is called hidden hunger, a form of malnutrition.

Other forms of malnutrition are being over- or underweight. You can be malnourished at any size.

Dark green leafy vegetables provide essential vitamins, A and folate included. Research shows that both these vitamins are at inadequate levels in the blood of New Zealand people.

One key driver of malnourishment is food insecurity, the lack of adequate foods prescribed by our food-based dietary guidelines. It costs not just the individual but the whole of society, and it is intergenerational.

When you are unwell, then other costs escalate. For example, if parents can’t get to work, they need benefits. If they and their children can’t access education they will earn less, and if they can’t get health care or afford prescriptions, they get sicker but are less able to afford the foods that promote health.

The evidence is clear from birth-cohort longitudinal studies in Aotearoa New Zealand, where the growth and development of children is tracked from birth.

The Pacific Islands Families study followed children born in the year 2000 at Middlemore Hospital. At age 14 years, boys whose mothers experienced food insecurity during pregnancy had less muscle than those whose mothers were food-secure. Girls weighed more if the mother was food insecure.

We have also shown that children born to food-insecure mothers are less likely to have access to vegetables and fruit, and less likely to clean their teeth which in turn leads to lifelong dental disability.

In the free, national, before-school check of 4-year-old children, one in seven had visible dental decay. Children living in more deprived areas, Māori and Pacific, those who were overweight, and boys had a higher likelihood of visible decay.

Between 2013 and 2019, Under 5 Energise was delivered to 121 early childhood centres in the Waikato region. This nutrition and physical activity intervention programme included the messages that water and milk are the best drinks, not sugary drinks.

A Hawke's Bay study into child wellbeing has discovered that 90 per cent of students aren't eating the recommended daily fruit and vegetables. (Video from May 2022)

The 4-year-old children attending these centres had less dental decay than children not receiving this message. Lack of visible dental decay is an important and early sign of improved well-being.

The Growing Up in New Zealand study, which began in 2008, has demonstrated with measurements up to 12 years of age, that one-in-six children experiences food insecurity at any one time.

It is not always the same children affected at any one time, and not necessarily children in the same place.

Given the importance of providing growing children with adequate food every day, this situation is deeply concerning.

Māori and Pacific children, those with a disability, and those living in more deprived areas are more likely to experience food insecurity. The risk multiplies with each factor.

New Zealand is not a food basket for its own, let alone the world. In a 2016-2018 analysis of all food exports and imports from and to New Zealand, it was shown that we export fat (butter) and protein (meat), fruit (apples and kiwifruit), and import a massive amount of refined carbohydrate – rice, wheat and sugar.

Each year we export enough calories to power 20 million people over that year, and we import enough energy for 10 million. And there are 5 million people in New Zealand. (Which raises questions about those reports that say we produce enough to feed 40 million.)

The New Zealand food and activity guidelines state that youth and adults should consume 5 different vegetables and 2 fruits a day on average. However, only 10% of adults manage to do this.

Elaine Rush is emeritus professor of nutrition at the Auckland University of Technology and works with the Child Poverty Action Group.

Dark green leafy vegetables provide essential vitamins, A and folate included. Research shows that both these vitamins are at inadequate levels in the blood of New Zealand people.

In addition, many children have iron deficiency. Non-communicable diet-related diseases such as diabetes, heart disease, strokes and some cancers occur later in life, but are evidence of poor nutrition in early life.

What can we do?

Stop-gap but vitally important measures such as Ka ora, Ka ako/Healthy School Lunches, Fruit in Schools and increased food assistance must continue and be increased.

The child cannot wait. Therefore, support for families with children should be prioritised so that the child's needs are met.

Core foods, as recommended by the guidelines, must be accessible and affordable.

The whole food system – from farm and sea to fork and waste - must reorientate to focus on national food security first.

All policies and practices, local and national, should consider sustainable food security in their execution.

Production, trade, storage and distribution of food needs to support a safe and stable supply of foods equitably.

Aotearoa has endemic food poverty and hidden hunger. Adequate nourishment through a variety and combination of wholesome, minimally processed foods is a human right and responsibility. The cycle must be broken now, to benefit our children’s children.