Abstract

This paper addresses a Food and Nutrition Security (FNS) participatory assessment developed together with community leaders and residents in Salvador city, Bahia, Brazil. Our reflection aims to analyze this research - including design, data generated, and its use - discussing the concept of FNS and its existing assessment methods. Secondary data were found to be difficult to access or of little utility to local activists. The household survey designed and used by the participants characterized the food and nutrition insecurity situation in vulnerable areas of the community, in a dialogue with national and socioeconomic indicators, evidencing robust data. First of all, the relevance of participatory approaches stood out: while the results show how much FNS is intricately embedded into a broader social vulnerability context, they show how critical it is to consider FNS research as a political instrument and the knowledge it produces as a power-related instrument. In this sense, FNS assessment is established as an emancipatory process, indissociable from the action and social change actors.

Key words
Food and nutrition security; Social vulnerability; Community-based participatory research

Introduction

The food security concept was born in the context of post-WWII shortages. It took shape at the end of the 20^th century, incorporating issues related to the economic and physical access to food, nutritional aspects, and food quality and cultural aspects, and food sovereignty-related issues, among others¹1 Valente FLS. Do combate à fome à segurança alimentar e nutricional: o direito à alimentação adequada. In: Valente FLS. Direito humano à alimentação: desafios e conquistas. São Paulo: Cortez; 2002. p. 40-43.. Hence, the United Nations Food and Agriculture Organization’s World Food Security Committee (CFS/FAO) recommends using the concept of Food and Nutrition Security (FNS), which

[...] exists when all people have, at all times, physical, social and economic access to safe food, consumed in sufficient quantity and quality, that meets their nutritional needs and food preferences, in an environment with adequate sanitation and health services, allowing a healthy and active life²2 Committee on World Food Security (CFS). Coming to terms with terminology: Food Security Nutrition Security Food Security and Nutrition Food and Nutrition Security. Rome: FAO; 2012..

With the commitment of countries to assess and ensure FNS to their populations, notably after 186 nations signed the Rome Declaration in 1996, the question arose as to how to analyze and understand better the picture of food and nutritional insecurity³3 Food and Agriculture Organization (FAO). Declaração de Roma Sobre a Segurança Alimentar Mundial e Plano de Ação da Cúpula Mundial da Alimentação. Rome: FAO; 1996.. Several FNS assessment methods have been developed in an attempt to encompass the multiple factors that imply in the framework of food and nutritional security. According to Pérez-Escamilla and Segall-Corrêa⁴4 Pérez-Escamilla R, Segall-Corrêa AM. Food insecurity measurement and indicators. Rev Nutr 2008; 21(Supl.):15-26., five evaluation methods are commonly used in national surveys: 1) FAO method of calculating the daily caloric availability per capita; 2) calculation of the minimum income for food and non-food consumption; 3) calculation of food consumption - such as the quantitative records of the last 24 hours, frequency of food consumption or the quantification of family expenses with food purchases; 4) anthropometry and; 5) family access to food psychometric scales.

In his study on the existence and type of FNS assessments in the signatory countries of the Rome Declaration, Aliaga⁵5 Aliaga MA. Segurança alimentar e nutricional no contexto do desenvolvimento humano: análise comparativa de experiências internacionais de políticas públicas e avaliação [dissertação]. Salvador: Universidade Federal da Bahia; 2013. shows the use of instruments ranging from weather forecasts, agricultural production measures and market studies, to nutritional indicators, as per the realities with which they dialogue and their corresponding needs. All countries, however, share a common point in the evaluation of the FNS: few evaluation documents that count on the participation of local civil society in its preparation are available.

In Brazil, the “Food Security” supplement of the National Household Sample Survey (PNAD) adopted the Brazilian Food Security Scale (EBIA), which is defined as a family access to food psychometric scale consisting of 14 questions measuring the perception of families concerning access to food⁶6 Instituto Brasileiro de Geografia e Estatística (IBGE). Pesquisa Nacional por Amostra de Domicílios: Segurança Alimentar 2013. Rio de Janeiro: IBGE; 2014.. The Household Budget Survey (POF), in turn, includes studies on food acquisition and consumption and nutritional assessment of the population⁷7 Instituto Brasileiro de Geografia e Estatística (IBGE). Pesquisa de Orçamentos Familiares 2008-2009: Antropometria e Estado Nutricional de Crianças, Adolescentes e Adultos no Brasil. Rio de Janeiro: IBGE; 2010.

8 Instituto Brasileiro de Geografia e Estatística (IBGE). Pesquisa de Orçamentos Familiares 2008-2009: Aquisição alimentar domiciliar per capita Brasil e Grandes Regiões. Rio de Janeiro: IBGE; 2010.

9 Instituto Brasileiro de Geografia e Estatística (IBGE). Pesquisa de Orçamentos Familiares 2008-2009: Avaliação nutricional da disponibilidade domiciliar de alimentos no Brasil. Rio de Janeiro: IBGE; 2010.^-1010 Instituto Brasileiro de Geografia e Estatística (IBGE). Pesquisa de Orçamentos Familiares 2008-2009: Análise do Consumo Alimentar Pessoal no Brasil. Rio de Janeiro: IBGE; 2011.. Local assessments of the FNS situation are available in certain communities or a specific population group, most of them using EBIA or anthropometric assessment¹¹11 Godoy KC et al. Perfil e situação de insegurança alimentar dos usuários dos Restaurantes Populares no Brasil. Cad Saude Publica 2014; 30(6):1239-1249.

12 Lang RMF, Almeida CCB, Taddei JAAC. Segurança alimentar e nutricional de crianças menores de dois anos de famílias de trabalhadores rurais Sem Terra. Cien Saude Colet 2011; 16(7):3111-3118.

13 Oliveira JS, Israel P, Lira C, Augusta L, Sequeira DS, Filho MB. Anemia, hipovitaminose A e insegurança alimentar em crianças de municípios de Baixo Índice de Desenvolvimento Humano do Nordeste do Brasil. Rev Bras Epidemiol 2010; 13(4):651-664.

14 Pedraza DF, Gama JSFA. Segurança alimentar e nutricional de famílias com crianças menores de cinco anos do município de Campina Grande, Paraíba. Rev Bras Epidemiol 2015; 18(4):906-917.

15 Rocha EMB, Lima RT, Almeida PC. Insegurança alimentar relacionada à área de residência em município do Semiárido brasileiro. Cad Saúde Coletiva 2014; 22(2):205-211.

16 Santos LMP, Carneiro FF, Hoefel MGL, Santos W, Nogueira TQ. The precarious livelihood in waste dumps: A report on food insecurity and hunger among recyclable waste collectors. Rev Nutr 2013; 26(3):323-334.

17 Silva EKP, Medeiros DS, Martins PC, Sousa LA, Lima GP, Rêgo MAS, Silva TO, Freire AS, Silva FM. Insegurança alimentar em comunidades rurais no Nordeste brasileiro: faz diferença ser quilombola ? Cad Saude Publica 2017; 33(4):1-14.

18 Souza MM, Pedraza DF, Menezes TN. Estado nutricional de crianças assistidas em creches e situação de (in) segurança alimentar de suas famílias. Cien Saude Colet 2012; 17(12):3425-3436.

19 Vianna RPT, Segall-Corrêa AM. Insegurança alimentar das famílias residentes em municípios do interior do estado da Paraíba, Brasil. Rev Nutr 2008; 21(Supl.):111-122.^-2020 Vieira VL, Souza MP, Cervato-Mancuso AM. Insegurança alimentar, vínculo mãe-filho e desnutrição infantil em área de alta vulnerabilidade social. Rev Bras Saúde Matern Infant 2010; 10(2):199-207.. Others use focus groups or in-depth interviews²¹21 Carvalho AS, Silva DO. Perspectivas de segurança alimentar e nutricional no Quilombo de Tijuaçu, Brasil: a produção da agricultura familiar para a alimentação escolar. Interface (Botucatu) 2014; 18(50):521-532.^,2222 Silva DO, Guerrero AFH, Guerrero CH, Toledo LM. A rede de causalidade da insegurança alimentar e nutricional de comunidades quilombolas com a construção da rodovia BR-163, Pará, Brasil. Rev Nutr 2008; 21(Supl.):83-97., or secondary data to build municipal FNS assessment protocols²³23 Panelli-Martins BE, Santos SMC, Assis AMO. Segurança alimentar e nutricional: desenvolvimento de indicadores e experimentação em um município da Bahia, Brasil. Rev Nutr 2008; 21(Supl.):65-81..

However, very few studies involve members of the investigated community in the methodological design and application of the research or the analysis of its results. While the National System of Food and Nutritional Security (SISAN), created in 2006, actively invests in the social participation of Brazilian civil society to face food and nutritional insecurity²⁴24 Brasil. Lei no 11.346, de 15 de setembro de 2006. Cria o Sistema Nacional de Segurança Alimentar e Nutricional - SISAN com vistas em assegurar o direito humano à alimentação adequada e dá outras providências. Diário Oficial da União 2006; 15 set., low community participation in research about their own FNS situation seems contradictory. Indeed, this little implication does not contribute to combat the Brazilian setting of low incorporation of the FNS concept and poor recognition of the Human Right to adequate Food (HRF), both identified as essential hurdles to social participation in the FNS²⁵25 Assão TY, Cordeiro AA, Costa C, Cervato AM. Práticas e Percepções acerca da Segurança Alimentar e Nutricional entre os Representantes das Instituições Integrantes de um Centro de Referência localizado na Região do Butantã, Município de São Paulo. Saúde e Soc 2007; 16(1):102-116.

26 Burlandy L, Magalhães R, Lobato E, Florentino M. Potencialidades e limites para a implementação de sistemas locais de segurança alimentar e nutricional: estudo de caso em dois municípios do Estado do Rio de Janeiro. Brasília: MDS; 2014.

27 Costa CA, Bógus CM. Significados e Apropriações da Noção de Segurança Alimentar e Nutricional pelo Segmento da Sociedade Civil do Conselho Nacional de Segurança Alimentar e Nutricional. Saúde e Soc 2012; 21(1):12-22.

28 Gallina LS, Teo CRPA, Munaro PS, Oliveira VSH. Representações sobre Segurança Alimentar e Nutricional nos Discursos de um Conselho de Alimentação Escolar. Saúde e Soc 2012; 21(1):89-102.

29 Jacques ITO. A constitucionalização da alimentação: um direito a ser implementado adequadamente no Brasil [tese]. Porto Alegre: Pontifícia Universidade Católica do Rio Grande do Sul; 2014.^-3030 Rocha NC, Doria NG, Boia JM, Bógus CM. Organização e dinâmica do Conselho Municipal de Segurança Alimentar e Nutricional de São Paulo: implicações para a sua atuação na construção da política municipal de Segurança Alimentar e Nutricional. Rev Nutr 2012; 25(1):133-146..

This paper argues that it is necessary to put the FNS knowledge tools in the hands of the populations that suffer from food and nutritional insecurity, and leaders or civil society organizations that struggle to face social vulnerability in their communities.

The first element supporting this argument is the complex issue of measuring FNS, calling for the incorporation of research processes into the local social, political, economic, and environmental dynamics for a better understanding of the situation and the vulnerability processes in which it occurs. The second element concerns the need to situate individuals as political subjects, building their knowledge to develop coping strategies and claim their rights. This approach is consistent with the principles that founded participatory research, which seek to involve actors in the research as agents, owners of their knowledge, capable of analyzing their problems, and designing their solutions³¹31 Cornwall A, Jewkes R. What is participatory research? Soc Sci Med 1995; 41(12):1667-1676.. Within participatory research, research-action is established as placing an instrument of investigation and action available to vulnerable social groups³²32 Thiollent M. Metodologia da Pesquisa-ação. 14ª ed. São Paulo: Cortez Editora; 2005., attempting to “lay the control of knowledge in the hands of groups and communities that express collective learning both in their awareness and commitment to collective action”³³33 Zuniga RB. La recherche-action et le contrôle du savoir. Int Rev Community Dev 1981; (5):35-44..

This paper addresses one of the first actions undertaken within an FNS research-action project developed with leaders and dwellers of a region in Salvador, Bahia, Brazil. This is a household survey that aimed to assess the FNS situation in vulnerable areas of the region, based on a methodology developed by the participants in the research-action, and whose results could support their activist actions. This work aims to analyze this participatory research experience in FNS, from its design to the results generated and its use by participants, discoursing with data and other forms adopted for assessing FNS.

Assessment tools: a participatory construction

Pau da Lima is the name given to an Administrative Region, a subdivision of the municipality of Salvador, with 233,274 inhabitants in 2010³⁴34 Salvador. Sistema de Informação Municipal (SIM) [Internet]. Indicadores. [2017 Ago 28]. Disponível em: http://www.sim.salvador.ba.gov.br/indicadores/
http://www.sim.salvador.ba.gov.br/indica... . The group of the research-action participants was established from a first workshop, organized in February 2014 with community leaders and residents of an existing network of associations and churches. The workshop gathered a total of 37 participants from the community and aimed to stir a reflection on the situation of food and nutritional security in the region and the very concept of FNS, which aimed to trigger the mobilization of participants and the design of the first actions of the project.

Thus, working groups were set, one of which was responsible for defining the method for assessing the FNS situation in the community and its organization. The group meetings were held weekly, between May and October 2014, with the participation of 5 people from the community, including two male residents, one female resident, and two community leaders, all aged 29 to 61 years. The following points were discussed: (1) protocol of indicators based on public domain secondary data; (2) municipal databases that break down data by neighborhood or district; (3) developed methodologies and collection instruments used in the PNAD, the different parts of the POF, and discussion about qualitative methods; and (4) discussion and debate about the FNS situation in the community, about information collection methods and challenges faced by research in the community.

Two instruments were developed to assess FNS in the community. First, a protocol for municipal FNS indicators that uses secondary data was adapted for the local level²³23 Panelli-Martins BE, Santos SMC, Assis AMO. Segurança alimentar e nutricional: desenvolvimento de indicadores e experimentação em um município da Bahia, Brasil. Rev Nutr 2008; 21(Supl.):65-81.^,3535 Pereira MHQ. Avaliação da segurança alimentar e nutricional: contribuições em âmbito municipal [dissertação]. Salvador: Universidade Federal da Bahia; 2014., with indicators or similar indicators broken down by Region, Health District, or, if not found, neighborhoods. The data were mainly collected in the databases of the Municipal Information System of Salvador³⁴34 Salvador. Sistema de Informação Municipal (SIM) [Internet]. Indicadores. [2017 Ago 28]. Disponível em: http://www.sim.salvador.ba.gov.br/indicadores/
http://www.sim.salvador.ba.gov.br/indica... , and the “TabNet” System of the Municipal Health Secretariat of Salvador³⁶36 Salvador. Secretaria Municipal de Saúde (SMS) [Internet]. TABNET - Salvador. [acessado 2017 Ago 28]. Disponível em: http://www.tabnet.saude.salvador.ba.gov.br
http://www.tabnet.saude.salvador.ba.gov.... .

The first observation at this stage of the work concerns the intricate nature of multiple databases, which are not easily accessible to community members with no mastery of such tools. Moreover, several local indicators are not available on the online databases, and when they are, they apply to different geographical delimitations (administrative region, health district, neighborhoods), often with a level of aggregation that does not account for the situation found in the most vulnerable areas. Finally, some of the identified indicators’ most recent values were collected in 2000.

In general, some dissonance between outdated, incomplete, and aggregated indicators was identified, and, on the other hand, a highly complex reality, within the same neighborhood or in the same region, and highly dynamic, with exponential population growth and high population mobility in recent decades. More current and complementary data, such as nutritional indicators or the number of families registered in the single registry, can, in theory, be accessible on request to the Health District or the sub-municipality. These data were requested from local authorities by leaders throughout the project, which led them to face hardships to obtain them, even though some of them work in the sub-municipality or as community health workers. This shows the difficulty of access to public, current, user-friendly and quality data for residents or community leaders, contributing, in part, to the low participation of the participants in this work stage.

Second, a household survey to assess the FNS was designed and applied, with the following objectives: (1) to assess the FNS situation in a more vulnerable area of the community, as a basis for formulating projects and claiming the guarantee of HRF by the leaderships; (2) to provide an anthropometric nutritional assessment for residents of this area; and (3) to inform about FNS and HRF, mobilize to claim HRF and invite to participate in the project.

A closed-ended questionnaire was applied to one of the guardians in all households, focusing on the respondent’s perception, both concerning their access to food and their consumption. The group’s choice was to focus on these two dimensions as they are the most problematic in the community. The focus on the respondent’s perception was, first of all, motivated by the understanding that it would be relevant to conduct a household survey that would not only confirm the situation of food and nutritional insecurity, but also approach the residents’ understanding of the subject, and, not least, try to arouse interest in the issue of promoting FNS and claiming HRF by the surveyed residents, involving them in reflecting on the topic.

Thus, the questionnaire was complemented by open-ended questions in 10% of the households, focusing, first, on the reason for food shortage in the past and the concern about lacking food in the future and, second, on the meaning of healthy eating and the reasons that lead residents to have or not, in their opinion, healthy food at home. The questionnaires were accompanied by the nutritional assessment of the residents and a discussion about FNS and HRF in each household, with an invitation to participate in the project.

The household survey was carried out from November 2014 to January 2015, in a random sample of 450 households selected within the study cohort of the Gonçalo Muniz Research Center of the Oswaldo Cruz Foundation, Bahia (CPqGM-Fiocruz), which has been developing projects in this territory since 2001.

Descriptive statistics of socioeconomic variables, food access and consumption, and nutritional assessment were used for the analysis of quantitative data. Subsequently, the relationship between socioeconomic variables and FNS indicators was analyzed from a trend analysis and Chi-square and trend Chi-square tests. The analyses were performed using Epi-Info version 7. The answers to the open-ended questions were recorded, transcribed, and analyzed through the creation of analytical categories emerging from the residents’ narratives. Field notebooks were written to record and systematize the observations of the research team.

The household survey was approved by the Ethics Committee of the research institution responsible for the survey and was funded by the National Council for Scientific and Technological Development (CNPq) with the Ministry of Social Development (MDS).

The results of the evaluation: expressions of food and nutritional insecurity

The household survey showed that 31% of household heads consulted said they were concerned about food shortage in the month before to the survey, and 17% said they lacked food, including 14% of households where a quantitative food reduction was reported. By way of comparison, the state of Bahia had 15.9% of households with moderate or severe food insecurity in 2013, pointing to a substantial food reduction or food pattern disruption resulting from food shortage in the three months before the research⁶6 Instituto Brasileiro de Geografia e Estatística (IBGE). Pesquisa Nacional por Amostra de Domicílios: Segurança Alimentar 2013. Rio de Janeiro: IBGE; 2014.. In other words, in the community surveyed, the proportion of households reporting a significant food reduction was, in one month, close to the proportion reached in the state in three months, bearing in mind that the state showed worrying food and nutritional insecurity rates. It should also be noted that 273 (80%) of those in charge, often with emphasis, said that they were concerned about food shortage in the next generations. It is understood that the concern for the future factor plays a vital role in the daily lives of community residents, mirroring a situation of high social and economic insecurity.

Both the residents’ reports and the analysis of the socioeconomic data identified low income and unemployment as the main reasons for food shortage and concern about the future lack of food. The analysis confirms a statistically significant association between these variables. Some statements indicate another point of interest: women’s dependence on men. Food shortage was attributed several times by the mother of the family to the unemployment of her husband or son. The analyzed data confirmed the significant difference in access to food between households headed by women and those headed by men, with a statistically significant association between the gender of the head of the household and its report of the concern about future food shortage, or the current lack of food.

The results show that the community’s food and nutritional insecurity is part of a broader context of social vulnerability, in line with the results of scholars on the topic⁶6 Instituto Brasileiro de Geografia e Estatística (IBGE). Pesquisa Nacional por Amostra de Domicílios: Segurança Alimentar 2013. Rio de Janeiro: IBGE; 2014.^,3737 Pereira DDA, Vieira VL, Fiore EG, Cervato-Mancuso AM. Insegurança Alimentar em Região de Alta Vulnerabilidade Social da Cidade de São Paulo. Segurança Aliment e Nutr 2006; 13(2):34-42.^,3838 Hoffmann R. Determinantes da Insegurança Alimentar no Brasil: Análise dos Dados da PNAD de 2004. Segurança Aliment e Nutr 2008; 15(1):49-61.. The food insecurity-affected groups are also those exposed to several other factors that characterize a situation or a state of vulnerability, among which are deficient socioeconomic conditions, degrading environment, low schooling, urban suburbs’ residents, unemployment, among others. Thus, households that are most exposed to food insecurity are also those who live with several other social vulnerability indicators³⁹39 Pedraza DF. Grupos vulnerables y su caracterización como criterio de discriminación de la seguridad alimentaria y nutricional en Brasil. Rev Bras Saúde Matern Infant 2005; 5(3):367-375..

Consistent with the reported lack of access to adequate food, the results of anthropometric assessments show that the community suffers from the so-called dual burden⁴⁰40 Kepple AW. O estado da segurança alimentar e nutricional no brasil: um retrato multidimensional. Brasília: FAO; 2014., living with both malnutrition and overweight. Among adults, 6.2% of the sample showed weight deficit, whereas, in urban areas in the Northeast, the prevalence found was 2.3% for men and 4.5% for women in 2008-2009⁷7 Instituto Brasileiro de Geografia e Estatística (IBGE). Pesquisa de Orçamentos Familiares 2008-2009: Antropometria e Estado Nutricional de Crianças, Adolescentes e Adultos no Brasil. Rio de Janeiro: IBGE; 2010.. In the same way, a prevalence of 20.9% of weight deficit was found among older adults in the community, while the estimated prevalence is between 2.1% and 4.4% in this age group for the whole of Brazil, in 2008-2009⁷7 Instituto Brasileiro de Geografia e Estatística (IBGE). Pesquisa de Orçamentos Familiares 2008-2009: Antropometria e Estado Nutricional de Crianças, Adolescentes e Adultos no Brasil. Rio de Janeiro: IBGE; 2010..At the same time, while the prevalence of obesity was estimated at 11.5% for men and 15.6% for women in urban areas of the region⁷7 Instituto Brasileiro de Geografia e Estatística (IBGE). Pesquisa de Orçamentos Familiares 2008-2009: Antropometria e Estado Nutricional de Crianças, Adolescentes e Adultos no Brasil. Rio de Janeiro: IBGE; 2010., in the researched community, the results show a prevalence of 22% of obesity, including cases of grade III obesity in adults. In the end, only 35% of the adult and elderly residents assessed had the ideal weight, showing a worrying picture of weight deficit and obesity.

The nutritional assessment results show the lack of indicators of chronic malnutrition in children under five years of age in the community. However, acute malnutrition indicators are identified, revealing a more recent or specific situation: weight-for-height data points to wasting in 7% of children, with severe wasting in 5%. The National Survey of Demography and Health of Children and Women (PNDS)⁴¹41 Brasil. Ministério da Saúde (MS). PNDS 2006: Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher. Brasília: MS; 2008. shows that weight-for-height deficits are indicative of acute malnutrition cases when their frequency exceeds 2 to 3%. As a comparison, in 2006, the PNDS results showed a weight-for-height deficit in only 1.9% of Brazilian children under five years of age, not exceeding 3% in any stratum of the population⁴¹41 Brasil. Ministério da Saúde (MS). PNDS 2006: Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher. Brasília: MS; 2008.. In the same age group, the prevalence of 7% overweight and 1% obesity as per this same nutritional indicator stands out, for a total of 8% overweight according to the PNDS criteria, which showed a prevalence of 6.6% in Brazil in 2006⁴¹41 Brasil. Ministério da Saúde (MS). PNDS 2006: Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher. Brasília: MS; 2008.. Overall, the data show a picture of wasting and obesity of concern in community children and adolescents, with particular attention to data on acute malnutrition in children under five years of age and adolescents aged 10-18 years.

It is essential to point out that the households’ survival strategies do not include resorting to the State or Institutions: even among households that reported lack of food or were concerned about future food shortage, few people resort to food donations from family, neighbors or institutions, with no mention to the Government or any other institution when addressing the issue of assuring food at home.

In the meantime, there have been several references to God, who appears as the one who decides about tomorrow and protects against food shortage. When respondents point to someone being responsible for assuring food, that someone is themselves: It’s my fault! (E.3, Question 1); Only when I die! There will be no shortage as long as I have arms to work! Because I’m always going to strive to provide it! (E.3, Question 2); I am not retired, so I have to work, get by in order to be able to support myself (E.12, Question 2). The spontaneous self-acceptance and self-responsibility to ensure the food at home seem to predominate as indicated in sentences such as “we manage”, “we have toget by”.

We also observed in the respondents some discomfort when talking about food shortage, especially in households where such a situation has already occurred, pointing to a stigma that persists insofar as food is not recognized as a right, in the residents’ discourse. Thus, accountability becomes individual and penalizes the household head: food shortage would be evidencing the failure of those responsible for providing food in the household. This process, by which the subjects are to blame for their health problems, which originate or are influenced by social, cultural and financial factors, is widespread, and is described by Vasconcelos⁴²42 Vasconcelos EM. Educação popular e atenção à saúde da família. São Paulo: Hucitec; 1999. as “blaming the victim”. Since food is a basic necessity for survival, its shortage is a violation of human dignity⁴³43 Valente FLS. Fome, desnutrição e cidadania: inclusão social e direitos humanos. Saude e Soc 2003; 12(1):51-60., feeding shame and guilt in the respondents’ discourse, and inhibiting social mobilization where it is most needed.

By way of final considerations: rethinking the FNS assessment

The research carried out with leaders and residents of the investigated community allowed characterizing the picture of food and nutritional insecurity in vulnerable areas of the community, dialoguing with the national indicators and social determinants of FNS observed in other studies. This shows certain robustness of the data obtained. Despite using a non-standardized assessment instrument, the household survey managed to capture an event, that of food and nutritional insecurity as conceived by the participants of the project, that dialogues with the social reality in which it is embedded.

Placing food and nutritional insecurity in the broader context of social vulnerability, as suggested by the research results, allows us to understand it in its individual-collective duality, apprehending its historical, social, environmental, and political dimensions. This type of approach has two main implications when it comes to assessing the FNS situation.

The first implication concerns the phenomenon of food and nutritional insecurity, its complexity and scope, pointing to the need to rethink the methodologies for its analysis. Food and nutritional insecurity overly transcends its biological expressions, encompassing economic, social, environmental, and cultural issues that end up establishing links between the individual and community life of subjects⁴⁴44 Freitas MCS, Pena PGL. Segurança alimentar e nutricional: A produção do conhecimento com ênfase nos aspectos da cultura. Rev Nutr 2007; 20(1):69-81.. In their proposed political epistemology, Porto et al.⁴⁵45 Porto MFS, Rocha DF, Finamore R. Saúde coletiva, território e conflitos ambientais: bases para um enfoque socioambiental crítico. Cien Saude Colet 2014; 19(10):4071-4080. point to the need for knowledge production forms that recognize health problems and their socio-environmental determination as multidimensional and intricate, and that question vulnerabilization processes before situations of vulnerability, and socio-environmental determination before socio-environmental determinants.

In particular, in the social determination of health, the “gap between the macro-structural and collective plan, and the conditions and potentialities of the subjects in more personal and community plans linked to daily life and place” is problematic⁴⁵45 Porto MFS, Rocha DF, Finamore R. Saúde coletiva, território e conflitos ambientais: bases para um enfoque socioambiental crítico. Cien Saude Colet 2014; 19(10):4071-4080., because the authors believe:

The biomedical and epidemiological perspective produced rationality for the interventions of society and the State along the lines of normal science, restricting the social dimension in determining the health-disease process to the instrumental level of attributes, and society is understood as a group of individuals with quantifiable features. Such rationality does not prioritize or articulate improvements in living and working conditions with the social structures of society [...]⁴⁵45 Porto MFS, Rocha DF, Finamore R. Saúde coletiva, território e conflitos ambientais: bases para um enfoque socioambiental crítico. Cien Saude Colet 2014; 19(10):4071-4080.

In the social determination of food and nutritional insecurity and of health, it is necessary to build “critical and transforming” analysis approaches, the authors said. As a basis for this reflection, we recognize the limits of FNS assessment methods that focus on the individual or household dimension, that favor quantifiable physiological or biological aspects, or that do not address food and nutritional insecurity as a process - which can last for months or years - and reveal a subject who is already ill.

In Brazil, FNS is now mainly measured through instruments and indicators that focus on the household dimension, such as EBIA and the household budget survey, and the individual dimension, such as the anthropometric assessment of individuals, and these indicators are often associated with socioeconomic variables equally individual or household-related. In this process, there is a risk of shifting the subject or assessed group from a context of relationships in which it is inserted, reinforcing the discourse based on the subject’s accountability and issues relating only to its individual practices. Political issues are found in these relationships, including those linked to actions of the State’s responsibility regarding FNS as an object of human rights. In particular, it is crucial to note that food insecurity/security is directly related to access to services that are, to a large extent, dependent on State action (sanitation, treated water supply, appropriate sewage, health services, among others)³⁸38 Hoffmann R. Determinantes da Insegurança Alimentar no Brasil: Análise dos Dados da PNAD de 2004. Segurança Aliment e Nutr 2008; 15(1):49-61..

We should value approaches that build beyond individual or household indicators, and create a space, both in the academia and the communities themselves, to discuss the place of FNS in the relationships between individuals and the community, and reflect on the responsibility of the State.

This household survey intervened at the onset of the research-action, when the meanings associated with FNS by the participants were still guided by the subject’s accountability, with weak recognition of food as a right, which undoubtedly influenced the choice and construction of research instruments. The early familiarization of participants with both the concept and participatory research methodologies certainly contributed to the design of the household survey, giving a place of importance to the instruments already being used in Brazil. Even so, the involvement of residents and leaders in the methodological construction and the analysis of the results provided a fertile reflection on the State’s responsibility, and on how the community’s food and nutritional insecurity fits into a broader historical, socioeconomic and political context. As a result, the household survey allowed the construction of meanings associated with FNS as an object of right and provided the argumentative basis for community actions aimed at the public sector.

In a society that still does not recognize food as a human right, it is necessary to see FNS research beyond the generation of knowledge, as a space for building FNS as an object of right, and for the establishment of political subjects who recognize themselves as carriers of social rights.

This is when the second implication of thinking about food and nutritional insecurity within the approach of social vulnerability steps in, as this approach also concerns the coping possibilities. In particular, the social vulnerability analysis model proposed by Kaztman⁴⁶46 Kaztman R. Notas sobre la medicion de la vulnerabilidad social. In: Kaztman R. Taller regional, la medicina de la pobreza, metodos y aplicaciones Borrador para discusión. México: BID, Birf, Cepal; 2000. p. 275-301. incorporates the set of resources and strategies that individuals and families can mobilize to improve their well-being situation, avoid the deterioration of their living conditions or reduce their vulnerability. The confrontation of social vulnerability goes beyond the individual framework, as Porto points out when the author draws attention to “the importance of the so-called vulnerable populations to assume their role as active collective subjects to transform their condition of vulnerability”⁴⁷47 Porto MFS. Complexidade, processos de vulnerabilização e justiça ambiental: um ensaio de epistemologia política. Rev Crit Cienc Sociais 2011; 93:31-58.. Thinking about social vulnerability implies thinking about the political and institutional participation of individuals⁴⁸48 Muñoz Sánchez AI, Bertolozzi MR. Pode o conceito de vulnerabilidade apoiar a construção do conhecimento em Saúde Coletiva? Cien Saude Colet 2007; 12(2):319-324., just as it requires placing them as political subjects because according to Porto et al.⁴⁵45 Porto MFS, Rocha DF, Finamore R. Saúde coletiva, território e conflitos ambientais: bases para um enfoque socioambiental crítico. Cien Saude Colet 2014; 19(10):4071-4080., it is necessary to:

[...] think of complexity and concepts such as vulnerability under a critical and emancipatory perspective. More than attributes that define people and groups most threatened or prone to health problems, due to their inability to fend for themselves, it is crucial to analyze and intervene in the processes that make subjects vulnerable, which means overcoming the tendency to consider such populations as passive and abstract in order to situate them as political, historical, culturally situated and rights-holding subjects.

In this sense, any research that encompasses the situation of vulnerability becomes a potential instrument for the political participation of the subjects who are in the situation in question.

The study showed that public access to data of interest for assessing the situation of food and nutritional insecurity is difficult because the information is outdated and incomplete, indicators are complex and inconsistent, and data are aggregated and do not allow capturing the situation in smaller areas. Project participants, community leaders, campaign without having actual data in hand that can sustain their arguments. The incorporation of these leaders into councils, among them the district health council and the council of sub-municipality residents, did not facilitate, as one might expect, access to such data.

Participating in research in some quality other than that of an informant was not the practice of community members. The incorporation into the research design processes, organization, analysis, and use of the results was a brand new experience to the participants, as they reported. Despite the difficulties represented by the novelty of this experience, the participants were involved in the research design and its organization, and used its results to formulate guidelines for action, including the establishment of a regional food and nutrition security council, the demand for the implementation of a Popular Restaurant in the region, and a community garden project. Thus, informants became creators and users of the research, which already is a significant step towards the control of resources to face the community’s social vulnerability.

Above all, the experience showed the relevance of thinking about research in FNS as an emancipatory process, inseparable from the action and stakeholders of social change. This perspective recognizes and dialogues with the need for local and qualitative approaches that seek to understand food and nutritional insecurity in its cultural dimension, as a process embedded in the social relationships and daily lives of individuals, bringing their local specificities and the need to get closer from the subjectivity of the social groups involved. However, besides the local and qualitative, the relevance of participatory approaches stands out most in this reflection, as understanding and acting are intrinsically linked.

In the same movement in which the research results show how much the issue of FNS is embedded in the issue of social vulnerability, they show how necessary it is to think about FNS research as a political instrument and about the resulting knowledge as a power instrument. In the line of the research-action thinkers, the assessment of the FNS situation is an emancipatory process in itself, based on the need for the participation of community members in the construction of knowledge about their vulnerability in order to face it.

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