Symptom-Stage and Determinant Modeling

**IMPORTANT: This article contains mentions of corruption, food insecurity, and poverty. If you feel uncomfortable with these topics, please refrain from reading.

When you look at this map, what do you see? (1) What differentiates the red and orange nations from the green and blue ones?

Is it population density? How about the frequency of armed conflict? How about the prevalence of government corruption or poverty? Well, if you’ve read the title of this article, you can guess, and guess correctly, that this is a model of malnourishment. But, if you said yes to any of the other factors I presented earlier in the paragraph, you actually would not be wrong either. So what do population density, armed conflict, government corruption, and poverty have to do with hunger? Let’s explore.

This is my second article in a series focusing on “the root cause.” While I discussed this topic briefly in my article “The Root Cause. A Policy Investigation: Gun Violence and Mental Health”, the argument is simple: if politicians are attempting to truly solve an issue, they must focus on its primary cause rather than addressing how it appears superficially. (2)

In this article, I will discuss the issue of malnourishment in African nations at different levels and how approaches that attempt to rectify this issue at different levels vary in effectiveness. I will also present a graphical approach to framing this topic, the “Symptom-Stage model.” “Symptoms” refer to how an issue presents in society and “stage” refers to how many factors/determinants influence the symptoms at that level. Please remember that my frame is in itself an argument and the product of my individual research and that you may correctly disagree with my presentation of this issue.

“Chronic hunger” and malnutrition affect roughly 278 million people in Africa and in 2021, 1 in 5 (20.2%) of the African population faced hunger. (3) However, 10% of the global population faces hunger, meaning that hunger is more prevalent in African nations than elsewhere (a statistic we can also see in the map I pose at the start of this article).

So how does the symptom stage model describe hunger? Let’s start at Stage 1. Climate change has resulted in a global rise in temperatures, affecting parts of the world such as Africa. Furthermore, due to their tumultuous histories, many African nations have incomplete or poor infrastructure systems. Due to resource scarcity (with rising temperatures) and mismanagement due to a lack of infrastructure, African nations have a higher than average poverty level, resulting in overcrowded urban centers. Furthermore, urban overcrowding along with poor infrastructure and sanitation practices, makes disease spread more likely and common. These factors contribute to societal disparities (upper and lower financial classes, gender gaps, etc.) and military conflicts to secure access to especially scarce necessities. As political leaders seek to gain wealth (more resources) at the expense of African citizens, corruption grows, exacerbating the resource mismanagement crisis and resulting in hunger.

While there is very little data on previous health policy initiatives used by African nations to address hunger, I will look at some efforts taken by international organizations with the same goal.

• SOS Children’s Villages USA provides food and other resources to African children affected by hunger. (4) Referring back to the Symptom-Stage Model, this intervention targets Stage V of the Hunger Crisis, and while Children’s Villages may be successful in the short term, this intervention may run into problems long term and even cause lasting damage. Because this intervention does not target the root causes of hunger (ie. Stages 1 - 4), Children’s Villages risks African children becoming dependent on the nutritious food provided via international aid; thus, Children’s Villages must continue providing resources to achieve the same outcome. Otherwise, absent that food, it is likely that the hunger crisis will grow and civil unrest may follow as nutritious food is taken away.

• Action Against Hunger is an organization that seeks to promote policy change by advocating for nutrition and better health services. (5) This intervention targets stage IV of the Symptom-Stage Model and although policy is generally an effective tool to implement population-level reforms, corruption in African nations limits this organization’s effectiveness. If African governments recognize that it is in their best interest to acquire as many resources as possible (resulting in African citizens experiencing hunger), any proposed policy changes will have little momentum and will likely not be passed or enforced.

So what are some strategies that might work to tackle this issue? Well, looking at the framework I construct, you might guess that addressing climate change and improving infrastructure might have a positive long-lasting impact on hunger. Well, that seems to be the case: (6)

An IMF study finds that improving infrastructure (ie. financial access, agriculture subsidies, trade taxes, transport and irrigation infrastructure) tends to support low-income individuals threatened by food insecurity. This is largely because infrastructure ensures that during times of crisis, individuals get a more equitable share of the resources they need. Infrastructure may reduce civil unrest while decreasing poverty and disparity. What can African nations do to achieve these results? While reducing food insecurity may not be in the best interest of African government officials, reducing the effects of climate change and enhancing infrastructure are, and organizations with these goals will likely achieve significant progress over time.

Let’s start with climate change:

• African governments may prioritize renewable energy development, focusing on solar, wind, and water power instead of coal power to reduce greenhouse gas emissions. (7) This should reduce Africa’s carbon footprint contributing to cleaner environments and greater resource availability.

• African governments can develop strategies to tackle climate shocks, using water conservation farming and industrial techniques to make the most out of already scarce resources. (8)

• Unfortunately, addressing climate change requires global cooperation and broad multinational support, and while support appears strong in the status quo, African governments have little agency in determining policies set by nations with the largest carbon footprints.

Moving on to infrastructure:

• African governments could increase investment in key sectors of the economy, including transportation, energy, water, and communication. (9) While corruption and resource misallocation may prevent direct investment, foreign investment and private organizations could help finance these sectors.

• African governments may also use technology and improve innovation to develop novel strategies to deal with climate change, resource scarcity, and disease outbreak. (10) By stabilizing societal issues and increasing access to resources, individuals will be more able to receive the nutritious food they need to survive.

As I close this article, I realize (and I hope you do too) that this article is less about food security and more about the relationship between seemingly-disparate societal factors that dictate health. Although I will cover food insecurity and malnutrition in a future article, I hope you recognize that while we associate healthcare with clinical factors (or even social ones), we can trace the drivers of healthcare outcomes as far back as climate change and poor infrastructure.

So, my charge to you is this: the next time you encounter a health issue, try developing your own symptom-stage diagram: what political, societal, or economic issues dictate health crises? As the field of healthcare has developed, public and population health specialists have begun to recognize that analyzing a health issue involves analyzing all of its many determinants and that to achieve long-term success in reducing that issue, we must develop a model to address that issue’s root cause rather than its final stage.