Keynote Paper: Qualitative measures of food insecurity and hunger

Eileen Kennedy
International Life Sciences Institute
Washington, DC, USA

Executive summary

Increasingly, policy-makers and programme implementers have been seeking measurement techniques for food insecurity and hunger that are simple to use and easy to analyse. The present paper reviews experiences to date on qualitative measures and discusses the potential for expanded use of these methods, particularly in developing countries.

Until recently, concepts of food insecurity and hunger in many countries have been linked to clinical signs of malnutrition. There has been a clear need to provide sensitive indicators of food insufficiency and hunger that are poverty-driven and not limited to clinical definitions. Rigorous research in the 1990s led to the development of methodologically sophisticated and empirically grounded measurement scales for food insecurity and hunger. A food security module was administered in April 1995, as part of a nationally representative sample of 45 000 American households. The 18 -question module provided a means of measuring both the prevalence of food security and the severity of hunger in the United States. Validation of the food security scale found that food insecurity is significantly negatively correlated with income and household food expenditures. The qualitative food security scale also correlated significantly with the more traditional measures, such as energy intake per capita.

Many countries have moved in the direction of exploring the development and use of qualitative food security measures. These measures are well grounded in science and, once the developmental work for the methods is completed, are quick to administer and analyse. The information from these methods also provides a concept of food security that is well understood by policy-makers. A major advantage is that qualitative measures incorporate as essential elements the perceptions of food insecurity and hunger by the people most affected. Thus, many view these qualitative methods as more direct measures of food insecurity than other proxy measures.

Introduction

Food security is an essential element of overall well -being. Increasingly, in the last decade, attention has been focused on means of eliminating food insecurity and hunger world- wide. The 1992 International Conference on Nutrition and the 1996 World Food Summit both emphasized the critical need to decrease food insecurity and hunger globally. At the 1996 World Food Summit, 182 nations agreed to the definition of food security as "access by all people at all times to enough nutritionally adequate and safe food for an active and healthy life". Related to this assault on food insecurity and hunger was a call for development of appropriate methods for monitoring food security.

With renewed interest in food insecurity and hunger, policy-makers are seeking measurement methods that are simple to use and easy to analyse and interpret. To that end, this paper reviews some of the newer approaches for measuring food security - qualitative methods. These methods can be used either alone or in tandem with some of the more traditional methods for measuring food security. The main purpose of this paper is to review qualitative measures of food security, identify guidelines for development of qualitative methods and assess the potential for expanded use of these methods.

Food security measures in the United States

The United States has made a concerted effort to develop newer methods for monitoring food security at the national and subnational level (Andrews, Bickel and Carlson, 1998; Bickel, Andrews and Klein, 1996; Carlson, Andrews and Bickel, 1999). A part of this methodological development is related to the use of qualitative methods for assessing food insecurity and hunger. Many of the steps taken in the United States to develop and implement qualitative measures are now being replicated in a series of other countries. It is therefore worthwhile to examine in some detail the process used in developing a qualitative measure of food insecurity in the United States.

History

Issues related to food insecurity and hunger in the United States have had a volatile history. In the 1960s, increased attention was focused on the problem of hunger in the United States. Activities like the Ten State Nutrition Survey, the television documentary "Hunger in America "and visits by politicians to poverty-stricken areas all documented the fact that hunger and food insecurity was a problem. Leaders in government were incredulous that hunger could exist in a country with such a plentiful food supply. The 1969 White House Conference on Food, Nutrition and Health brought together research scientists, policy- makers and practitioners, and reached a clear recommendation that hunger and food insecurity needed to be eliminated.

In 1977, for the first time, a question on food security was included in the Nation- wide Food Consumption Survey conducted by the United States Department of Agriculture (USDA). This was followed in 1980 by the addition of several food security questions to the National Health and Nutrition Examination Survey, conducted by the Department of Health and Human Services (HHS) (Briefel and Woteki, 1992).

A report in 1984 by the President's Task Force on Food Assistance (1984) provided divergent views on whether and to what extent the problem of hunger existed in the United States. All agreed that hunger was simply not acceptable in the United States. However, task force members indicated that the lack of an authoritative measure of the number of hungry people precluded any firm conclusions about the magnitude of hunger and food insecurity in the country. The report concluded that there was a critical need for a reliable measure of food security to provide some degree of confidence that hunger and food insecurity were being accurately assessed.

The earlier concepts of food insecurity and hunger in the United States had been linked to clinical signs of malnutrition. This was the vision perpetuated in the media. There was a clear need to distinguish between clinically defined hunger and food insecurity, and hunger and food insecurity as commonly defined. The 1984 Task Force Report clearly stated that the clinical definition and measures of hunger do not provide sensitive indicators of food insufficiency and hunger as they are experienced in the United States context:

to many people hunger means not just symptoms that can be diagnosed by a physician, it bespeaks the existence of a social, not a medical problem: a situation in which someone cannot obtain an adequate amount of food, even if the shortage is not prolonged enough to cause health problems.

An important step was taken in the 1984 Task Force Report in articulating the need to distinguish medical definitions of hunger from poverty-driven hunger. This report catalysed the research community to develop valid and reliable measures of the prevalence and severity of hunger and food insecurity in the United States. As a result, a body of research and field survey work emerged that produced methodologically sophisticated and empirically grounded measurement scales for food security (Frongillo, 1999). Two of the most influential research studies were those of Radimer and colleagues (Radimer, Olson and Campbell, 1990) and Wehler and colleagues working on the Community Childhood Hunger Identification Project (Wehler, Scott and Anderson, 1992).

Two events in the 1990s were critical in further advancing work on food security and hunger. In 1990, the National Nutrition Monitoring and Related Research Act (US Congress, 1990) was passed and assigned USDA and HHS to:

recommend a standardized mechanism and instrument(s) for defining and obtaining data on the prevalence of "food insecurity" or "food insufficiency" in the US and methodologies that can be used across the nation and at State and local level.

Second, a national association of nutrition researchers, the American Institute of Nutrition, sponsored and published a major report on food security (Anderson, 1990). The report clarified the meaning of hunger from the scientific literature and also clarified the links between food insecurity and hunger. In essence, this report served to provide authoritative definitions of hunger and food insecurity for the first time in the United States context:

FOOD SECURITY: Access by all people at all time to enough food for an active, healthy life. Food security includes at a minimum (1) the ready availability of nutritionally adequate and safe foods and (2) an assured ability to acquire acceptable foods in socially acceptable ways (i.e. without resorting to emergency food supplies, scavenging, stealing or other coping strategies).

FOOD INSECURITY: Limited or uncertain availability of nutritionally adequate and safe foods or limited or uncertain ability to acquire foods in socially acceptable ways.

HUNGER: The uneasy or painful sensation caused by lack of food. The recurrent and involuntary lack of access to food. Hunger, as the recurrent and involuntary lack of access to food, may produce malnutrition over time.

Hunger, when defined as the uneasy or painful sensation caused by lack of food, is a potential, although not necessary, consequence of food insecurity. The same applies to malnutrition.

In 1994, USDA sponsored the first ever food security measurement conference (USDA, 1995). The participants included researchers, policy-makers and advocates with experience in measurement of food insecu-rity and hunger. The conference drew heavily on the two previous research studies that had developed qualitative measures of food insecurity and hunger (Radimer, Olson and Campbell, 1990; Wehler, Scott and Anderson, 1992). The conference was an open and transparent forum in which initial consensus was reached on the most appropriate measurement of food security in the United States. A food security questionnaire was drafted and underwent additional development, testing and refinement over the next year (Hamilton et al., 1997a). The final national questionnaire was administered in April 1995.

Food security measurement scale

The objective of the food security measurement project was to develop a standard measure of food insecurity and hunger for the United States. An essential criterion was a measure that was qualitative but not subjective, i.e. correlated with other known measures of food insecurity and hunger. Of the approximately 30 food insecurity and hunger indicator questions originally tested, the final "core module "questionnaire contained a total of 18 questions for households with children and 10 questions for households without children (Appendix A). This report will concentrate primarily on the 18 -question "core module" unless otherwise specified.

The survey module needed to provide a means of measuring both the prevalence and severity of food insecurity and hunger. Individually, none of the 18 questions could provide a measure of the severity and extent of food insecurity or hunger (Hamilton et al., 1997b), but taken together, the 18 questions are able systematically to provide such a measure and have strong statistical properties. An extensive series of tests was conducted on the reliability of the food security scale (Hamilton et al., 1997b). The key findings were: (1) the scale captured multiple facets of food insecurity within a single dimension; (2) the relative severity of the questions that make up the scale conform with prior research; and (3) a relatively small percentage of the population is food insecure or hungry, as would be expected in the United States.

The questions in the food security module are intended to measure four underlying conditions or behaviours in the households: (1) anxiety about the food budget or food supply; (2) perceptions that food is inadequate in either quantity or quality; (3) reduced food intake in adults; and (4) reduced food intake in children. Taken together, the 18 questions capture a wide range of severity of food insecurity as experienced in United States households, ranging from light (worrying about running out of food) to quite severe (child going the entire day without food). The measurement scale developed subsequently from United States Census Bureau data (described below) shows that the 18 individual scale items are fairly evenly spaced across the full range of severity captured by the set of items as a whole (one characteristic of a strong measure). The scale thus enables successive ranges of food insecurity to be measured and distinguished and prevalence to be determined for each of these distinct severity levels.

The food security module was first administered in April 1995 as a supplement to an ongoing survey, the Current Population Survey (CPS), carried out by the Census Bureau on approximately 45 000 households. The CPS is a nationally representative monthly survey based on a two -stage sampling frame. The primary sampling units are counties or groups of counties within each state, and the second stage is a sample of households within each primary sampling unit. The module is interested only in food security that is income -constrained. An initial screening question is applied to ascertain a financial constraint to food security. Of the 44 730 households that completed the screen, 18 453 were administered the full battery of questions (Hamilton et al., 1997a). An adult in the household most knowledgeable about the issues was interviewed. Each of the questions in the module referred to either a 12-month or 30 -day period. For both time frames, the food security supplement was intended to measure the full range of severity of food insecurity in the United States. Results suggested that the 12-month time frame provided a more accurate picture of the extent and severity of food security within the household (Hamilton et al., 1997b).

The series of questions in the module were converted into a food security scale using a Rasch Measurement Model, a type of non-linear factor analysis that falls into the family of Item Response Theory (IRT) Models (Hamilton et al., 1997b). These IRT models are used extensively in educational research where "yes / no "types of questions must be converted into a scale. The Rasch Model was selected after reviewing use of other linear and non-linear techniques and found to have good reliability for the 12-month scale. Rasch scaling models are well suited to deal with situations where there is skewness in the distribution of the measure. The results from the scaling exercise indicated that the survey items could be described as a unidimensional construct that provides a good measure of prevalence and severity of food insecurity and hunger.

The Food Security Scale is a continuous measure ranging from a score of zero to ten. The scaling model calculates a value on the scale for each household (Figure 1); this value is based on the number of questions answered affirmatively, adjusted for the number and severity of the questions answered. These data also allow the population studied to be divided into four distinct categories of food security (Table 1) based on the differing conditions, experiences and behaviour patterns that characterize each range of severity. These four categories include:

FOOD SECURE: Little or no evidence of food insecurity.

FOOD INSECURE WITHOUT HUNGER: Food insecurity is shown by households' concern about and adjustments to food management.

FOOD INSECURE WITH MODERATE HUNGER: Food intake for adults is reduced, and adults are experiencing hunger owing to resource constraints.

FOOD INSECURE WITH SEVERE HUNGER: Households with children reduce the children's food intake to an extent that implies that the children experience hunger as a result of inadequate resources within the household, while adults show evidence of more severe hunger (e.g. going entire days with no food).

These four categories reflect increasing levels of severity as households move from food security, to food insecurity and ultimately to severe hunger. The analytic software that established the scale computes an item calibration value for each question included in the scale (Hamilton et al., 1997b). The item calibration score indicates the relative severity of the food insecurity or hunger condition that each question represents. The categorization reflects a continuum of progressively more severe levels of food insecurity from adjustment in food budget to reduced food intake in adults to the final level of reduced food intake in children. Mostly, children are protected until the severe later stages of food insecurity within the household. This progression suggests a "managed process "through successive stages of severity that is consistent with the earlier research (Basiotis, 1992; Radimer, Olson and Campbell, 1990; Wehler, Scott and Anderson, 1992).

FIGURE 1. SEVERITY RANKING OF QUESTIONS IN FOOD SECURITY SCALE

Note: Item calibrations show relative severity of questions from 0.9 (least severe) to 9.2 (most severe).

Source: Hamilton et al. (1997a).

The four categories of food security/ insecurity are bounded by threshold levels of severity that identify points of transition from one category to another (Table 1). As shown in Table 1, the first threshold point divides food secure from food insecure households. Answering "yes "to the first two questions is not sufficient to classify a household as food insecure. It is only when the first two questions are combined with an indication that the household has also experienced disruption of normal eating patterns (e.g. cannot eat balanced meals) because of insufficient resources that the household is deemed food insecure. Similarly, the cutoff point between food insecure without the experience of hunger and insecure with moderate hunger is identified by the inability of households to economize food budgets any further without adults reducing food intake or cutting meals. Hunger in this third category is characterized by reduced food intakes with the physical sensation caused by lack of food. The final category -food insecure with severe hunger -is characterized by reduced food intake and hunger in children and more severe hunger for adults.

This original food security module has undergone refinements between 1995 and 1999 but the basic 18 core module questions have remained constant. In addition, a shorter six- question version of the module has been developed that imposes a smaller interview burden on the participant (Appendix B). The 18 - item survey provides a greater precision and reliability (Nord and Fogarty, 2000); the six- item approach measures food insecurity up through the mid-range of severity, as experienced in United States households, but does not measure the more severe levels of child and adult hunger.

Results of United States surveys using the food security module

The Food Security Core Module has been administrated every year (either in April or August/September) since 1995 as part of the CPS. The prevalence of food security and food insecurity is shown in Table 2 for the years 1995 -1999. Over this time period, the vast majority of households in the United States were food secure; the prevalence of food security varied from 89.7 percent to 91.3 percent of the population (Andrews et al., 2000). The prevalence of food insecurity ranged from 8.7 percent to 10.4 percent over the period, with the largest percentage among households that were food insecure without hunger. Between 1995 and 1999, the number of food insecure households fell by 12 percent (Andrews et al., 2000), and the number of food insecure households with hunger fell by 24 percent during the same time period. As the authors note, despite a strong United States economy in the mid-to later 1990s and the existence of a United States nutrition safety net, many American families and individuals still struggled to meet basic food needs (USDA, 1999).

Food insecurity and income are related, as shown in Table 3. Food insecurity is nine times more prevalent and hunger is 12 times more prevalent in households with incomes below the poverty line compared to households with incomes 1.85 times greater than the poverty line, where only 4 percent are classified as food insecure. Among households where income is less than half that of the national poverty line, 39 percent are classified as having some kind of food insecurity within the past year, with five percent falling into the most severe hunger category (data not shown). However, two -thirds of all households with income below the official poverty line remain food secure. Food insecurity also varies by household type. Hunger is more prevalent in single, female -headed households (8.1 percent), and Black and Hispanic households (6.4 percent and 5.5 percent) (Table 3). The prevalence of food insecurity in households with children is twice that of households without children 14.8 vs. 7.4 percent); 42 percent of children in low-income households live in food insecure families (Andrews et al., 2000).

Given the manner in which the data were collected, it has also been possible to provide state -by-state estimates for food security averaged for 1995 -1999. The rates of food insecurity vary from 4.6 percent to 15.1 percent across the 50 states. During the three -year period of 1996 -1998, 9.7 percent of all households were food insecure, with 3.5 percent of these households experiencing hunger (Nord, Jemison, and Bickel, 1999). The state -level food insecurity rate is linked to poverty, although the association is not perfect; for the three -year period, the average poverty rate for the United States was 13.6 percent compared with the 9.7 percent prevalence rate of food insecurity. The rates of food insecurity in the United States follow a geographic pattern, with areas in the Pacific West and South having prevalences above the national average and states in the mid-West having rates lower than the national average. The reasons for this geographic pattern are unclear, and further research is under way to try to explain the differences.

Relationship of the food security scale to other measures

In its early development, the food security scale was compared with other related measures of food security. As researchers indicated during this scale development, there was no "gold standard "against which the food security measure could be compared (Hamilton et al., 1997b). In the absence of such a gold standard, the relationship between the food security measure and other measures known to affect food security were compared; these included household food expenditures, absolute income and income relative to poverty, and household report of food sufficiency.

Food insecurity is correlated negatively to household income as shown in Tables 3 and 4. One also expects to see an association between household food expenditures and both the quantity and quality of food. The correlation coefficients for the association between weekly food expenditures and the food security scale, as shown in Table 4, are however smaller than for the two income variables. Nevertheless, the data do show an inverse relationship - the lower the level of food expenditures, the more will likely a household be classified as food insecure.

It should be noted that the 12-months periods over which income is calculated and the food security survey covers are not identical. The income measure is a categorical variable converted to a continuous variable; in-kind income from food assistance programmes such as Food Stamps is not included in the income measure and the food expenditure variable does not include in-kind programme benefits like Food Stamps or home-grown food.

The food security scale was also compared with the food sufficiency question that has been included since 1977 in all USDA-conducted national food surveys (Table 4B). The standard food sufficiency question asks: "Which best describes the food eaten in your household?(1) enough of the kinds of food we want to eat; (2) enough but not always the kinds of food we want to eat; (3) sometimes not enough to eat; (4) of ten not enough to eat." The food sufficiency question is not time -bounded and is thus different from the food security measure that is time -bounded. As shown in the second part of Table 4, the single -question version of the food sufficiency question shows a strong, positive relationship to food security status as measured by the 12-month variable. Altogether, eighty-four percent of the households reporting "of ten not enough to eat" were classified as food insecure: 29 percent were food insecure without hunger and 55 percent were food insecure with moderate to severe hunger (37 percent with severe hunger). (Hamilton et al., 1997b).

These analyses provided evidence that the food security measure correlated with the more traditional measures of food security. In addition, several literature reviews were carried out to ascertain the reliability of subjective measures of hunger as measures of food deprivation (De Castro and Elmore, 1988; Harris and Wardle, 1987; Lappalainen et al., 1990; Mattes and Friedman, 1993; Rolls, 1996; Sepple and Read, 1989). These reviews showed strong support for subjective reporting on the sensation of hunger, without necessarily clinical signs of malnutrition.

However, as stated earlier, none of these relationships were conclusive. Fortunately, additional research validating the relationship of qualitative measures of food security to more concrete measures of nutritional status has been conducted since 1995. Murphy et al. (1998) used a qualitative food security measure (similar to that used by Wehler, Scott and Anderson, 1992) to examine the relationship between food insufficiency and school functioning: 204 children and their parents in four schools in low-income areas as well as teachers were surveyed. Results indicated that intermittent experiences of food insecurity and hunger were associated with impaired school performance, tardiness, absenteeism and higher levels of hyperactivity in children. Additional research in Pittsburgh and the surrounding areas on 4 638 families indicated that children from food insecure households are more likely to show behavioural, emotional and academic problems on standardized measures of psycho-social function (Kleinman et al., 1998). The authors conclude that

... whether hunger is a cause or a correlate of aggressive behaviour and emotional problems in poor children, the fact that these problems are far more prevalent in children whose families report multiple experiences of hunger suggests both the possibility of and the need for intervention. (Kleinman et al., 1998)

Research in Canada also provides evidence of strong links between food insecurity and dietary inadequacy in adult women (Tarasuk and Beaton, 1998). A study of 153 low-income women showed significantly lower intakes of energy, protein, vitamin A, iron, magnesium and zinc in women who reported hunger in their households over the previous 30 days. A 30 -day time frame and food security module developed by USDA was used in this research with minimal modifications.

A larger body of research corroborates the finding that household food insecurity and hunger have a significant, negative impact on individual caloric and nutrient intake (Cristofar and Basiotis, 1992; Kendall, Olson and Frongillo, 1995; Rose and Oliveria, 1997). Unfortunately, most of the research on qualitative measures of food security and dietary or nutritional status have, to date, emerged primarily from industrialized countries. As more developing countries craft context-specific food security measures, one would anticipate that this type of research on food security and nutrition would also emerge.

Qualitative measures of food security in developing countries

The concept of food and nutrition monitoring and surveillance is not new. Indeed, much attention was focused on method development af ter the 1974 World Food Conference. However, most of the methods developed were quantitative. Since the mid - 1990s, there has been a proliferation of activity worldwide to develop country -specific qualitative food security measurements. Research under way in a number of developing countries builds on other approaches for understanding food insecurity. Techniques such as Rapid Rural Appraisal (RRA) and Participatory Rural Appraisal (PRA) were an attempt to build simpler tools for assessing communities; both RRA and PRA relied heavily on focus groups and in -depth interviews of a limited number of individuals living in a given community. Maxwell (1995) and colleagues at IFPRI used indirect measures of food coping strategies to rank food security status. Few of these approaches, however, provided the necessary basic understanding of food security in order to construct a valid and reliable qualitative measure. The work of the Food Security Measurement Project in the United States provided a model of steps that could be taken to produce a country -specific measurement of food security/insecurity. An essential component is understanding the concept of food and hunger from the perspective of those who have actually experienced the condition.

A number of countries are now in the process of developing and/or implementing a qualitative food security module. Patrick Webb and colleagues from Tufts University (Webb, Coates and Houser, 2001) are working with World Vision staff in Bangladesh to design a food security measurement scale. Unlike in the United States, it appears that several distinct scales will be needed to address the complexity of the food insecurity situation sufficiently in this developing country. Four main concepts underlie the development of the measure in Bangladesh: quantity of food, quality of food, security of predictability and acceptability in acquisition (Webb, Coates and Houser, 2001). The team in Bangladesh has systematically developed the measurement instrument through a series of in-depth interviews with low-income women. These interviews have led to the identification of the overall framework for the questionnaire design and through an iterative process with World Vision staff, USAID Bangladesh and colleagues from a local research institution, the survey instrument was developed. Extensive training and testing of the food security survey ensued. In summary, the process included (1) establishing concepts, (2) testing and adapting terminology to Bangladesh, (3) developing and refining questionnaires, and (4) establishing a large -scale survey capability (Webb, Coates and Houser, 2001).

Some parallel activities are occurring in other developing countries. In-depth research similar to that in Bangladesh is being conducted in Burkina Faso by a Cornell University and Africare team (Nanama and Frongillo, 2001). The work is being carried out at a subnational level, in the Zondoma province. A key objective of this work is to develop a household food security measurement tool using in-depth interviews in the local area. Similarly, related efforts are ongoing in Guatemala (Save the Children, UK), Kenya and Ethiopia (CARE). For most of these projects, initial results should be available within the year.

Between 1992 and 1994, CARE US used the Radimer Index in Russia to assess the prevalence of hunger through interviews with 800 mothers at six study sites (Welch, Mock and Netrebenko, 1998). Results indicate that 77 percent of the women surveyed, 70 percent of the households and 32 percent of children in the households were classified as hungry. The levels of hunger correlated significantly with household income. Only 3 percent of the children surveyed had weight-for-age below -2 Z-scores, but 25 percent were anaemic, as measured by a haemoglobin level of less than 11 g/dl in under-two -year-olds. The authors interpret these findings to indicate that children's energy needs were being met while the high level of anaemia showed that food quality was deteriorating. These researchers also conclude that the Radimer type index might provide a useful early warning for diet quality before child growth is affected.

It is likely that an increasing number of countries will move in the direction of exploring the development and use of qualitative food security measurements. What is the applicability of the United States Food Security Module, or any other country module for that matter, to other countries or locations? Given what is known, it cannot be claimed that the United States food security measure can validly be applied untested in quite different cultural and developmental contexts (although at least two instances of that already have been reported, one in Mateveleland, Zimbabwe and one in rural areas of Orissa State, India) (Holben, 2000; Satpathy, 2001). Moreover, given the highly context-specific and linguistically dependent nature of this type of measure, it may never be possible to develop a usable common or "universal" set of indicator items capable of capturing the successive stages of severity of the food-insecurity/hunger experience validly and consistently across highly diverse regions and peoples. However, research to date has helped to identify the necessary series of steps required for rigorous development of valid and reliable food security scales within a consistent conceptual and methodological framework. As soon as a number of such conceptually and methodologically similar scales have been developed and tested in their own right, the possibilities for identifying potential common indicator items among them will be greatly enhanced. At that stage, if a number of indicator questions are found to be the same or very similar in apparent conceptual content across diverse scales, and are shown analytically to capture similar levels of relative severity in their separate scale locations, then the subsequent development of a common or "universal" scale, drawing upon such common items from diverse country settings, may indeed be achievable. The advantages of such a common scale in providing a consistent basis for measuring food insecurity and hunger prevalence at well -defined levels or ranges of severity, across varied cultural contexts and levels of economic development, are apparent.

Advantages and disadvantages of qualitative measures of food security

The increased worldwide attention focused on food insecurity and hunger is appropriate and long overdue. The increased attention has also led to the realization that newer methods for monitoring the prevalence and severity of hunger and food insecurity are needed and that such methods need to be developed in a manner that reflects the perception of food security and hunger by those affected, e.g. the poor. Policy-makers and programme implementers are looking for methods that are direct, and simple to administer, analyse and interpret. The emerging qualitative measures of food security offer enormous potential for use at the international, national and subnational level. There are clearly, however, advantages and disadvantages with these newer methods compared with others.

Advantages

(1) The qualitative measures that have been developed thus far are well grounded in science. The United States Food Security Module, for example, was based on solid science, with input from a wide range of knowledgeable people, and has been refined and updated over the past four years to become even more rigorous than originally designed.

(2) Once the developmental work for the qualitative measures has been carried out, a major advantage of these approaches is that they are quick to administer and analyse, and they provide a concept of food security that is well understood by policy-makers.

(3) The food security modules that have been drafted can be easily incorporated into almost any ongoing survey. This offers a major advantage in terms of costs and logistics.

(4) Respondent burden tends to be low; this is a clear advantage when one is inserting a food security module into a longer survey. For the United States module, the average response time is less than 4 minutes for the 18 -question module.

(5) The qualitative measures incorporate as essential elements the perceptions of food insecurity and hunger by the people most affected, those who have directly experienced these conditions. They are more direct measures of food insecurity than other proxy measures.

Disadvantages

(1) Time and costs for the development of food security modules.

(2) It is not clear that only one food security scale will measure the complexity of hunger in any given locale. This is an ongoing debate that can be answered only by additional research.

Future challenges

There is a clear demand worldwide for direct, simple and rigorous methods to measure food insecurity and hunger. The emerging science devoted to developing context-specific, qualitative measures of food insecurity is responding to this demand. There are some issues that should be considered further.

Given the time -consuming nature of developing these newer techniques, it would be worth while to identify core items that might be part of any food security module. At this point, it is not clear whether these exist or not, and if so, what they are. The development and identification of these core elements would ease the burden of designing future modules and facilitate cross-country comparisons of the data. Some researchers have taken existing modules and applied them without modification in other countries. While this is a time -saving approach, without the in-depth research that would be location- specific, it is not possible to ascertain that this provides a valid measure of food security.

In developing food security scales for a particular country, more clarification is needed on issues such as the time frame of the survey period (one month, one year, more), the number of appropriate questions, and the cutoff points to define food secure and food insecure persons. FAO is well positioned to facilitate an international forum for discussing these and other issues related to design and implementation.

Costs

Estimates for the cost of designing and implementing a qualitative food security scale are very imprecise. In the United States example, substantial costs went into the development of the current food security measurement. For example, the United States Food Security Module was guided by existing research (Radimer, Olson and Campbell, 1990; Wehler, Scott and Anderson, 1992). The conceptual work defining food security, food insecurity and hunger in the United States was available when the development of the module commenced. A large amount of pro bono time from academic, government and private sector staff was devoted in the early stages of developing the core module. These talents may not be available to the same extent or without charge in developing countries. It would be a mistake to underestimate the amount of time needed to craft and implement an appropriate food security module effectively.

With this as a caveat, the direct cost of work in Bangladesh and Burkina Faso is approximately US$100 000 to US$150 000 per year for each of three years (Cogill, personal communication, 2001). In contrast, the United States Food Security Module costs US$500 000 per year for the Census Bureau to administer as part of the Current Population Survey. This is the direct cost of 1 500 interviewers for 40 000 households, plus an unknown but probably large share of overhead or institutional costs.

The costs of conducting the food security measures will increase substantially if an on- going survey cannot be used to carry out the module.

Lessons learned

The phenomenon of hunger is universal, but the experiences leading to hunger and food insecurity are not. The qualitative food security measures that have already been or are currently being developed are appealing because they provide a simple, direct measure of food insecurity and hunger that is country -and context-specific. The development of food security scales worldwide relies on different metaphors for expressing the concepts of hunger and food deprivation. The extent to which these may be found to be roughly comparable across diverse cultural contexts remains to be seen. Success in designing and implementing the qualitative measures, thus far, appears to be related to a number of factors:

(1) Effective qualitative measures have been well grounded in science. These are classic examples of research linked to action. In addition, efforts at national and subnational levels have methodically brought together key actors to build consensus on the most appropriate measures.

(2) Mechanisms have been incorporated that allow the food security measures to be modified and refined over time. Thus, the measures have been improved, based on newer knowledge.

(3) The food security modules have been developed in a manner that they can be integrated into ongoing surveys, making the implementation easier. Indeed, in the United States, an increasing number of surveys are including either the core or short version of the food security module.

(4) The qualitative measures can be used at many levels, thus allowing community level data to be collected and easily compared with the national level statistics.

(5) The development and use of the qualitative measures will be institutionalized further by creating working groups on food security. In the United States, for example, an interagency working group on food security - with representatives from key parts of government interacting closely with private sector experts - was created to oversee ongoing work on the food security and hunger monitoring in the country.

(6) The results from the qualitative food security modules are easy to understand. These data can be a tremendous asset for advocacy.

Sponsored, targeted research by FAO would allow for the development of a global database that can document types of qualitative measures, range of uses and ultimately mechanisms for cross-country comparisons. These qualitative measures of food insecurity and hunger may take on increasing importance as the worldwide demographic transition proceeds.

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Appendix A

Eighteen-Question, Core Food Security Module (all questions answered often true, sometimes true, never true, don't know/refused)

I worried whether my food would run out before I got money to buy more.

The food that I bought just didn't last and I didn't have money to get more.

I couldn't afford to eat balanced meals.

I relied on only a few kinds of low-cost food to feed the children because I was running out of money to by food.

I couldn't feed my children a balanced meal because I couldn't afford that.

My children were not eating enough because I just couldn't afford enough food.

In the last 12 months, since last (name of current month), did you ever cut the size of your meals or skip meals because there wasn't enough money for food?

How often did this happen - almost every month, some months, but not every month, or in only 1 or 2 months?

In the last 12 months, did you ever eat less than you felt you should because there wasn't enough money to buy food?

In the last 12 months, were you very hungry but didn't eat because you couldn't afford enough food?

In the last 12 months, did you lose weight because you didn't have enough money for food?

(If affirmative response to any one of these questions, continue, otherwise skip to end.)

In the last 12 months did you ever not eat for a whole day because there wasn't enough money for food?

(If affirmative response to above)

How often did this happen - almost every month, some months but not every month, or in only 1 or 2 months?

(If there are children under 18 years old in the household, ask the next questions, otherwise skip to end.)

The next questions are about children living in the household who are under 18 years old. In the last 12 months, since (current month) of last year, did you ever cut the size of your child's meals because there wasn't enough money for food?

In the last 12 months did (child's name) ever skip meals because there wasn't enough money for food?

(If affirmative response to above)

How often did this happen - almost every month, some months but not every month, or in only 1 or 2 months?

In the last 12 months, was your child ever hungry but you just couldn't afford more food?

In the last 12 months, did your child ever not eat for a whole day because there wasn't enough money for food?

Appendix B

Six-item, short form of the 12-month Food Security Scale (all questions are answered often, sometimes or never)

The first statement is, "The food that I bought just didn't last and I didn't have the money to get more." Was that often, sometimes or never true?

I couldn't afford to eat balanced meals.

In the last 12 months since (date 12 months ago) did you ever cut the size of your meals or skip meals because there wasn't enough money for food?

(If any of these three questions are answered affirmatively, proceed to next question.)

(Referring to previous question) How often did this happen - almost every month, some months but not every month, or in only 1 or 2 months?

In the last 12 months, did you ever eat less than you felt you should because there wasn't enough money to buy food?

In the last 12 months, were you ever hungry but didn't eat because you couldn't afford enough food?

Discussion opener - qualitative measures of food insecurity and hunger

Helen H. Jensen
Iowa State University
Ames, IA, USA

During the last decade, measurement of the phenomenon of hunger and food insecurity has become possible in the United States through efforts of the US Department of Agriculture and others to develop a set of survey questions (the Food Security Module) that estimate the prevalence and severity of food insecurity (e.g. Bickel et al., 2000; Hamilton et al., 1997). The resulting qualitative measure or index is correlated with other, known measures of food insecurity and hunger. From my own work and review of studies that have applied the Food Security Module across time, across populations and subpopulations, and in targeted special surveys, the similar ranking of questions and hence observation of a common phenomenon or process indicates that scientifically grounded qualitative measures offer a potentially valuable addition to the more commonly applied quantitative measures of hunger and food insecurity.

The common set of 18 questions in the United States Food Security Module measures four underlying conditions or behaviours in the households: anxiety about the food budget or food supply, perceptions that food is inadequate in quality or quantity, reduced food intake by adults and reduced food intake by children. The 18 -question set was converted into a food security scale from which national -and state -level estimates of prevalence and severity of poverty-linked food insecurity and hunger in the United States can be estimated. In addition, the 18 -question scale can be used to identify groups in the population at greatest risk of hunger and food insecurity, or can be included in other types of surveys. Currently, work is under way in several developing countries to develop qualitative food security measures. Based on experience in the United States and from parallel efforts in developing countries, Kennedy raises the important question of whether such measures can be developed with sufficiently common metric of the experience of hunger and food security to be used for meaningful cross-country comparisons.

I raise four issues with respect to the qualitative measurement approach, detailed below.

Will it be possible to develop qualitative scales to enable comparisons across a large range in severity of food insecurity?

The 18 questions from the United States Food Security Module were converted into a food security scale using an analytical model that scales responses to rank questions in order of severity. Ordering of the questions and degree of severity were used to identify and interpret associated food insecurity categories. Using the scale, it was observed that in 1999, 10.1 percent of all United States households and 36.7 percent of households falling below the poverty income level experienced some food insecurity in the previous year (see table 2 in the E. Kennedy paper in this series). In terms of the 18 questions, if the households answered all questions, the food insecure households answered at least three questions in the affirmative. Similar methods can be applied to specific subpopulations of interest. Three recent studies estimated food insecurity in households that had participated in the Food Stamp Program (FSP), the major food assistance programme in the United States. The studies were in three very different states -Arizona, Illinois and Iowa -and all used the 18 -question module. In the three states, with similarly defined food assistance populations (FSP leavers), the rates are remarkably similar, as shown in Table 1. Food insecurity was experienced in 54 percent of food stamp leaver households in Arizona, 54 percent in Illinois and 50 percent in Iowa. The common food security scale allows comparison of a similar phenomenon across the three locations and comparison with the average rate in the United States of 10 percent, or the rate among poor households of 37 percent. These examples all come from the United States. The next issue relates to whether the basic understanding of the process of food insecurity and hunger as experienced by households can bridge cultural differences.

How comparable are the concepts of hunger and food deprivation across cultures?

The ability of measures to take account of similar phenomena is important to comparisons cross-country and across subpopulations within country or region. The evidence from the United States indicates that the qualitative measure of food insecurity does, for the most part, measure the same experience. This has been shown for rural residents, for the elderly, for households with and without children and for households in other subpopulations or programme categories likely to be at higher risk of hunger. However, extensive work by Derrickson et al. (2001) in Hawaii cautions that cultural differences are evident in the interpretation of specific questions related to food security. They found differences in modal response patterns, especially related to the experience of children's hunger. In our work with the Current Population Survey data, we analysed the 18 questions using generalized linear mixed models that allowed evaluation of question interaction with demographic variables. We found that the overall fit of the Rasch (Item Response Theory) model was supported, although there was some evidence of significant interaction between questions and some demographic variables (e.g. minority status), indicating the possibility of differences in question interpretation for minority groups compared with others. These findings suggest the need for testing and validation of the questions used to measure food insecurity, as the measures are applied to diverse populations. That said, the results to date are encouraging that the processes and phenomenon experienced have many common elements across cultures.

What is the appropriate time frame of reference?

The United States Food Security Module includes questions covering both the previous 12-month period and the previous 30 days. In the United States context, both measures are useful. Food insecurity is a relatively uncommon occurrence and, for most low-income households, an infrequent event. The longer time period allows observation of the infrequent events. However, it then becomes more difficult to associate precipitating events and the dynamics of the food insecurity phenomenon. The reference time period may also be very different in countries where seasonal effects, for example, may be quite important. If the shorter period of reference were to be used, for example, the rate of food insecurity among all households in the United States would fall significantly.

Will the qualitative measures be useful for policy analysis and as measures to guide policy decision processes?

As Kennedy points out, there are many advantages to the qualitative measures: grounding in science; once developed, ease of administration; low respondent burden and direct measurement of the phenomenon of interest. However, to be useful for educating the public and policy-makers, the measures will need to be easily interpretable. In part, that is why the establishment of clear cutoff points and the interpretation of question ordering in the scaled measures become an important part of the process. Establishing external validity with other dietary or income measures is critical. Ultimately, the qualitative measures will be most useful and interpretable if they can be sensitive to the dynamics of household food insecurity and can facilitate the identification of subpopulations at greatest risk of food insecurity and deprivation.

A solid research base is vital to the development and use of qualitative measures and has guided the development and application of measures used in the United States, as well as those in other countries. External validation has been established in the general United States context. In other countries where the development of qualitative measures is under way, the research base comprises a series of intensive, local studies. Those lessons are applicable to extensions of the method for cross-country comparisons. As Kennedy notes, the creation of working groups on food security and sponsored, targeted research by FAO would help facilitate the development of a global database and more extensive use of qualitative measures in a cross - country context.

References

Bickel, G., Nord, M., Price, C., Hamilton, W. & Cook, J. 2000. Guide to measuring food security, revised 2000. Washington, DC, United States Department of Agriculture.

Derrickson, J.P., Fisher, A.G., Anderson J.E. & Brown, A.C. 2001. An assessment of various household food security measures in Hawaii has implications for national food security research and monitoring. J. Nutr., 131: 749 -757.

Hamilton, W.L., Cook, J., Thompson, W.W., Buron, L.F., Frongillo, E.A., Olson, C.M. & Wehler, C.A. 1997. Household food security in the United States in 1995. Summary report of the food security measurement project. Washington, DC, United States Department of Agriculture.

Jensen, H.H., Garasky, S., Wessman, C. & Nusser S. 2002. A study of households in Iowa that left the food stamp program. CARD Staff Report 02-97. Ames, IA, Center for Agricultural and Rural Development, Iowa State University (available at http://www.card.iastate.edu/publications/texts/02sr97.pdf). Also available as Jensen, H.H., Garasky, S., Wessman, C. &

Nusser S. 2002, July. Iowa Food Stamp Leavers Survey: Final Report. E-FAN-02-014 -1. Washington, DC, Economic Research Service, US Department of Agriculture (available at http://www.ers.usda.gov/publications/efan02014-1/efan02014-1.pdf).

Mills, G. & Kornfeld, R. 2000, December. Study of Arizona adults leaving the food stamp program. Final Report E-FANRR, No. 01-001. Report prepared by Abt Assoc.

Rangarajan, A & Gleason, P.M. January 2001. Food stamp leavers in Illionois -how are they doing two years later? E-FANRR No. 01-002. Report prepared by Mathematica Policy Research (available at http://www.mathematica-mpr.com/3rdLevel/illfoodrelease.htm).

Discussion opener - qualitative measures of food insecurity and hunger

Stephen Devereux
University of Sussex
Brighton, UK

Introduction

Eileen Kennedy's paper starts by providing an overview of evolving conceptualizations of food security in the United States, followed by a detailed description of, and commentary on, the "Food Security Measurement Scale", developed in the early 1990s and first administered in 1995. I have a few comments to make on this methodology but some more substantive remarks about the section of the paper that deals with "Qualitative measures of food security in developing countries "because this Symposium's focus on methodologies for monitoring food security is ultimately concerned with the World Food Summit target of halving, and ultimately eradicating, "hunger", which is concentrated in poor countries.

United States food security measurement scale

This paper emphasizes an important point, that the United States approach to assessing "hunger" or food insecurity is "deliberately" qualitative, i.e. the questions in the food security module that encourage respondents to articulate their "anxiety" about food access and "perceptions" about dietary adequacy reflect a view that hunger is "a social, not a medical problem ". This argument provides a general justification for qualitative approaches to food security assessment: perceptions and anxieties cannot be estimated in household expenditure surveys nor quantified in anthropometric outcomes, but they tell us something about vulnerability, an important and often neglected dimension of food insecurity.

This raises a related point. The linkages between the "Food Security Measurement Scale "and conventional measures of poverty are mentioned a few times in the paper, but it would be instructive to see a direct presentation of this correlation, perhaps in a 2 × 2 matrix ("food secure "and "food insecure" versus "poor "and "not poor") where the sensitivity and specificity "errors "would be quantified. This comparison would serve two purposes: it would "validate "the use of qualitative approaches, and it would highlight the important conceptual differences between "subjective "and "objective "measures of related phenomena. It appears, for example, that a significant proportion of American households fall into the "food insecure but not poor "category, which might be an indicator of the different conceptual bases of the two approaches -food insecurity being a broader concept than income or consumption poverty. If a similar validation exercise were conducted against nutritional outcomes, that would be equally revealing.

Qualitative measures of food security in developing countries

Kennedy argues that the "Food Security Measurement Scale "is not directly transferable to developing countries but that it can be adapted to local context specificity, though this would require investing resources to test and refine the questionnaire in each country. Kennedy also discusses some related efforts to implement qualitative food security measurement methodologies in developing countries. However, there are many additional methodologies, some of them quite promising, that are not discussed in this paper. I will briefly discuss four: the food economy approach, group ratings, dietary diversity and coping strategies indices. All of these have been developed and tested at the local level, using participatory methods.

Food economy approach

Developed by Save the Children Fund (UK) with support from the European Union, this approach divides a geographic area into food economy zones, each representing a common livelihood system. Next, communities are stratified into three to six wealth groups in terms of locally defined characteristics (asset ownership, months of self-provisioning, etc.), and households are allocated to these wealth groups, which can then be used to generate estimates of food insecure populations for targeting purposes. The methods used are qualitative and participatory: proportional piling, wealth ranking, focus group discussions. Critics argue that this raises the "scaling up "problem common to all participatory research methods, but in fact entire countries (e.g. Mozambique) and food insecure regions (e.g. the Ethiopian highlands) have been mapped using this method. The food economy approach is most powerful as a diagnostic tool rather than as a source of precise statistics (food economy analysts prefer to present data in ranges rather than point estimates, so 30 to 40 percent of households in a given Food Economy Zone are severely food insecure -rather than 34.7 percent). Disadvantages of the methodology include: (1) it is very resource -and time - intensive; (2) it generates relative proportions rather than absolute numbers; and (3) it has not yet been validated against conventional measures of poverty and food insecurity. This point leads on to the next approach.

Group ratings

This methodology evolved out of wealth ranking, so it shares a basic similarity with the Food Economy Approach. It has been tested recently for reliability by IFPRI in several countries including Honduras and Malawi. Essentially, single -sex or mixed-sex groups assign members of their community to one of three categories -"food secure", "intermittently insecure "and "food insecure" -and the results of different groups are compared. Unfortunately, the conclusion from Honduras was disappointing: "The consistency of responses between sets of raters was alarmingly low "(Bergeron, Morris and Banegas, 1998, p. 1897). Further work is under way to reduce the suspected sources of error.

Dietary diversity

This is an extremely simple method, again pioneered by IFPRI, which claims to provide a single indicator of household food insecurity. The method is to generate a list of locally consumed foods (about 30 to 40 items) and then ask households if they have consumed each item in the past week. The numbers of the different items consumed are simply added -not even weighted, for instance scoring meat higher than cereals, as most dietary assessments do -and the higher the number, the more diverse the diet and the more food secure the household. Lisa Smith refers favourably to this method in her paper on household expenditure surveys for this Symposium. According to Hoddinott and Yisehac Yohannes (2001), it is surprisingly robust when validated against conventional measurement indicators.

Coping strategies index

This was proposed by Dan Maxwell (of IFPRI, now CARE) and subsequently tested in Accra, Ghana. Interestingly, Maxwell claims that his "food consumption-related coping strategies indicator "shares methodological and conceptual overlaps with the USDA food security index that Kennedy's paper elaborates and endorses. In fact, Maxwell's approach is mentioned in the Kennedy paper but is dismissed in a sentence - "these approaches [do not] provide the necessary basic understanding of food security to construct a valid and reliable qualitative measure". However, Maxwell et al. (1999, p. 412) argue that their measure is superior to conventional proxies for food security, such as poverty, consumption and malnutrition, because those measurements do not "get at the crucial issue of vulnerability". They also argue that "food security is probably too complex to even be adequately captured by a single indicator", which suggests a sophisticated understanding of the multidimensional nature of food security. Maxwell's methodology is qualitative: nine coping strategies were identified by focus groups in urban Accra, individual households were scored by frequency of adoption of these strategies, then composite indices were constructed to rank households by degree of food insecurity. The advantages of this method are that it is quick, cheap and simple to administer, yet complex in terms of its conceptualization and the information it generates about household behaviour under stress. But coping strategies are locally specific - urban and rural "coping" options are very different -and scaling up to the national level presents formidable challenges. The method also shares a limitation with the group ratings approach: Maxwell et al. compare the coping strategies indices against "benchmark indicators "-poverty, food consumption, food shares in the household budget -and find some inconsistencies: few false negatives but many false positives.

Conclusion

From this brief review of alternative participatory approaches to food security assessment, it appears that self-reported or "subjective" methodologies tend to share a systematic bias towards overestimation of food insecure households when compared against head- counts derived from standard quantitative methods. However, as mentioned above, this could reflect conceptual differences rather than methodological errors; indeed, this could be a strength of qualitative approaches in general, as Kennedy argues for the "Food Security Measurement Scale". Further refinement and validation of all these qualitative methods could be extremely rewarding in terms of providing complementary data for national and global food security monitoring. Whether these methods have the potential to be scaled up to the national level at reasonable cost, and whether robust, generalizable indicators can be found that allow cross - country comparability, is an open question.

References

Bergeron, G., Morris, S. & Banegas, J. 1998, How reliable are group informant ratings? A test of food security ratings in Honduras. World Dev., 26(10): 1893 -1902.

Hoddinott, J. & Yisehac Yohannes, Y. 2001, Dietary diversity as a food security indicator. Washington, DC, IFPRI (mimeo).

Maxwell, D., Ahiadeke, C., Levin, C., Armar - Klemesu, M., Zakariah, S. & Lamptey, G.M. 1999. Alternative food security indicators: revisiting the frequency and severity of 'coping strategies'. Food Policy, 24(4): 411 -430.

Discussion groups report - qualitative measures of food insecurity and hunger

Sean Kennedy
IFAD
Rome, Italy

Opening discussion

The Chair and the two discussion openers established a tone of balanced optimism that carried into the general discussion. Both of the discussion openers emphasized the potential contributions of qualitative measures and highlighted the need for continuing research and development.

From ... review of studies that have applied the Food Security Module across time, across populations and subpopulations and in targeted special surveys, the similar ranking of questions and hence obser vation of common phenomenon or process indicates that scientifically grounded qualitative measures offer a potentially valuable addition to the more commonly applied measures of hunger and food insecurity. (H. Jensen)

Further refinement of these qualitative methodologies could be extremely rewarding in ter ms of providing complementary data for national and global food security monitoring. Whether these methods have the potential to be scaled up to the national level at reasonable cost and whether robust, generalizable indicators can be found that allow cross-country comparability is an open question. (S. Devereux)

General discussion

Some of the initial dialogue reflected differing expectations among the participants regarding the scope of the discussion. Essentially, the question was whether the group should consider qualitative measures in general (including the household economy approach, group rankings, etc.) or focus on the keynote paper presented in plenary by Eileen Kennedy. The outcome was an open discussion of both, touching on the range of qualitative methodologies available and addressing specific questions related to the keynote paper. It also became clear during the exercise that the term "qualitative" was problematic, which is revisited below in the recommendations.

Key Points on the Keynote Paper

VALIDATION

A specific qualitative instrument (the USDA Food Security Module) has now been extensively tested and proven robust in the context of the United States. Similar instruments are currently being field-tested in other country contexts, notably Bangladesh, Burkina Faso, India and Uganda (see contributed papers by Webb, Coates and Houser; Frongillo and Nanama; Nord et al. in this series). Case studies from these countries were presented during the parallel contributed papers sessions of the Symposium.

MEASUREMENT

These measures contribute important dimensions of how households actually experience hunger and food insecurity. Experiential dimensions include emotional effects such as anxiety over not being able to meet the basic needs of the household, as well as behaviour changes such as reducing the number of meals or going a day without eating. In practical terms, once the measures have been developed, they are relatively easy to administer and have a low time burden for respondents.

USEFULNESS

The results generated by the Food Security Module are potentially informative at multiple levels:

At the policy level, they are relatively uncomplicated to interpret and understand, which can be critical in policy analysis and presenting resonant messages to policy makers.

At the programme or project level, they can be effective in targeting interventions (specifically for identifying populations or geographic areas, but not for identifying households or individuals) and in monitoring changes in food insecurity and hunger.

COMPARABILITY

Is the methodology comparable across different cultures and countries?

Experience from other countries indicates that, in general, the United States module should not be simply translated for use in other contexts. However, there was at least one case (Russia) where the United States module was applied with limited adaptation and still produced interesting results.

Significant development and pretesting is needed to determine core elements in most country and subcountry settings.

As field trials become available from an increasing variety of settings, some relatively "universal" dimensions of food insecurity and hunger may or may not materialize.

Even where a scale works well, it can and should be periodically updated according to social acceptability (for example, in a culture where it is currently expected that adult men will eat before women or children, the social acceptability of those attitudes and practices may change over time).

Recommendations for action

Two recommendations emerged from the discussion regarding actions that could further the development and use of qualitative methodologies.

Refine the terminology

A number of speakers noted that the US Food Security Module and equivalent methodologies should not be termed "qualitative "when the results are quantified in a statistically rigorous manner (as opposed to classic qualitative research techniques such as focus group discussions, key informant interviews, direct observation, etc.). Although consensus was not reached concerning more appropriate terminology, several options were suggested, including "direct", "experience -based "or "experiential "measures of food insecurity and hunger.

Need for a clearinghouse

FAO or FIVIMS should initiate a clearinghouse for new developments in "qualitative measures "of food insecurity and hunger, such as a subsite under www.fivims.org where researchers and practitioners post or access instruments, experiences and results from ongoing field tests. An early activity of the clearinghouse could be to host an online dialogue to resolve the issue of appropriate terminology.

Conclusion

The discussion group recognized promising aspects of the Food Security Module and similar modules being adapted for various countries or cultural settings, and acknowledged positive points regarding the validity, relevance and usefulness of the methodology. The prospects for eventual comparability of findings across countries and cultures were actively debated, and there was clearly a sense of optimism that significant progress is feasible. Participants effectively agreed on the need for continuing the process of refining and field-testing the instruments.

The fundamental complementarity of qualitative and quantitative measures was an unambiguous point of consensus. Qualitative measures are designed to add vital information, such as the experiential dimensions of food insecurity and hunger, and are in no way intended to replace or substitute widely accepted quantitative indicators such as anthropometric survey data, household expenditure surveys, dietary intake assessment or the FAO methodology.