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Food insecurity and social determinants of health among immigrants and natives in Portugal

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Abstract

Literature is scarce on food insecurity in the context of different illnesses and intersecting social hierarchies of gender and ethnicity. This study aims to describe and compare the prevalence of food insecurity between immigrants and natives in Portugal and explore social determinants of poor health outcomes associated with food insecurity. Data were derived from the National Food, Nutrition and Physical Activity Survey 2015–2016, which is a national and regionally representative survey of the Portuguese general population which collected nationwide data on dietary habits (including food insecurity measured by the Radimer/Cornell food security questionnaire) and physical activity, among other dimensions. Demographic, socioeconomic and health factors that could help explain ethnic disparities in food insecurity were explored through complex survey data analysis. The prevalence of food insecurity was 10.7% (95% CI: 6.5–15.0) among immigrants and 10.1% (95% CI: 8.3–11.9) among natives; no significant differences were found. Low family income and low level of education were the main factors associated with food insecurity in Portugal, in both native and immigrant groups. Self-reported diseases and poor self-rated health were also associated with food insecurity. Only among natives, women, older and unmarried subjects had higher food insecurity. Therefore, inter-sectoral policies addressing the social determinants of food insecurity are needed to reduce social inequalities and particular attention should be given for Portuguese women, elderly and unmarried people which are the most vulnerable groups. Promoting equality in household food and nutrition security in Portugal including among immigrant’s populations is a public health priority.

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Abbreviations

BMI:

Body Mass Index

CI:

Confidence interval

ERS/USDA:

Economic Research Service of the United States Department of Agriculture

IAN-AF:

National Food, Nutrition and Physical Activity Survey

INSA:

National Health Institute Doutor Ricardo Jorge

NHANES:

National Health and Nutrition Examination Survey

NUTS II:

Nomenclature of territorial units for statistics; OR, Odds ratio.

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Acknowledgments

This study had institutional support from the General Directorate of Health (DGS), the Regional Health Administration Departments, the Central Administration of the Health System (ACSS), and from the European Food Safety Authority (CFT/EFSA/DCM/2012/01-C03). The researchers acknowledge all these institutions and persons involved in all phases of the Survey, as well as participants.

Funding

This Survey has received funding from the EEA Grants Program, Public Health Initiatives (PT06 - 000088SI3).

Author information

Authors and Affiliations

  1. Instituto de Medicina Preventiva e Saúde Pública, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028, Lisbon, Portugal

    Violeta Alarcão

  2. Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028, Lisbon, Portugal

    Violeta Alarcão & Sofia Guiomar

  3. Centro de Investigação e Estudos de Sociologia (CIES-IUL), Instituto Universitário de Lisboa (ISCTE-IUL), Lisbon, Portugal

    Violeta Alarcão

  4. National Health Institute Doutor Ricardo Jorge (INSA), Lisbon, Portugal

    Sofia Guiomar

  5. EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal

    Andreia Oliveira, Milton Severo, Daniela Correia, Duarte Torres & Carla Lopes

  6. Department of Public Health and Forensic Sciences, and Medical Education, Unit of Epidemiology, Faculty of Medicine, University of Porto, Porto, Portugal

    Andreia Oliveira, Milton Severo & Carla Lopes

  7. Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal

    Duarte Torres

Authors
  1. Violeta Alarcão
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  2. Sofia Guiomar
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  3. Andreia Oliveira
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  4. Milton Severo
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  6. Duarte Torres
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  7. Carla Lopes
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Corresponding author

Correspondence to Violeta Alarcão.

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Ethical approval

Ethical approval was obtained from the National Commission for Data Protection, the Ethical Committee of the Institute of Public Health of the University of Porto and from the Ethical Commissions of each one of the Regional Administrations of Health. All participants were asked to provide their written informed consent according to the Ethical Principles for Medical Research involving human subjects expressed in the Declaration of Helsinki and the national legislation.

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The authors declare that there are no conflicts of interest.

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Alarcão, V., Guiomar, S., Oliveira, A. et al. Food insecurity and social determinants of health among immigrants and natives in Portugal. Food Sec. 12, 579–589 (2020). https://doi.org/10.1007/s12571-019-01001-1

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