Kigezi Healthcare Foundation – Official Blog

KIHEFO promotes local initiated solutions to fight disease, ignorance and poverty in southwestern Uganda

Undernourishment in Uganda vs. USA

Vegetable production in raised beds in Kabale, Uganda.

Vegetable production in raised beds in Kabale, Uganda.

By Katherine Crabtree

Vegetables are relatively expensive per calorie everywhere. But in Uganda, even if you have no money to buy them, you at least have the skill to farm and provide them for yourselves.

My grandparents lived in a similar way. During much of their lives, growing and canning their own vegetables provided the bulk of the produce they ate. That has become harder as people don’t have the land or really the knowledge of gardening and farming needed to be able to provide vegetables in large enough quantities to be a meaningful portion of their diets. Where before, the number of vegetables consumed didn’t rely on veggies being cheap to buy in the grocery store, now it makes more of a difference for people.

In the US, the bulk of our food comes from large-scale farming and most carbohydrate crops are subsidized. So as far as calories go, we’re pretty set. Considering that The Grapes of Wrath is in living memory for many Americans, it’s hard to fault the policymakers who set American farming on its current path.

What is harder to swallow is the lack of innovation in adapting policy as its downstream effects for later generations have become obvious. We’ve made it so cheap for the food industry to shove calorie-dense, nutrition-poor food into our faces that we’ve ended up with an epidemic of people who suffer from this strange combination of macronutrient overnutrition and micronutrient undernutrition. And because the overnutrition makes people look “well fed,” we’ve masked the problem and, deluded, pat ourselves on the back for being a nation that can nourish the populace. Replacing the word “nourish” with “fatten” would be more accurate.

At our clinic for homeless patients in Sacramento, there are of course some very thin, hungry people, and during a survey on food insecurity there I had one emaciated patient tell me that he sometimes would go without food for three days at a time. But for the most part our patients are not wasting away. Many are overweight or obese, and at first glance you wouldn’t guess how inconsistent their access to food can be–25% report going without food for a full day at times.

Here in Uganda, when people are undernourished, it is much easier to see the problem. They look cachectic, or kids have the big swollen bellies, edematous limbs and light hair of kwashiorkor. Health care providers who worry about poor nutrition here have a very obvious problem to tackle, and they can tackle it with easily measurable outcomes, like changes in arm circumference.

But just because we can’t see it as easily in the US doesn’t mean that we don’t know the problem exists. We have the National Health and Nutrition Examination Survey, which gives us a ton of data on the situation, and largely because of that food insecurity has been linked unequivocally to the development of obesity and diabetes, two of our biggest contributors to morbidity and mortality.

The obesity epidemic only became an issue during the past 30-40 years, but carbohydrate crops have been subsidized since 1933. Clearly some of it is due to food industry practices, but that is only a problem because of our increased reliance on the industry because of the decrease in small scale farming that we have seen during the same time period.

So nutrition-wise, where would you rather have a low income? America or Uganda?

Katherine Crabtree is a recent graduate from medical school at UC Davis School of Medicine. In April-May, Katherine participated in a 4-week internship with KIHEFO in Kabale, Uganda, focusing on food security and nutrition via the Child Family Health International (CFHI) partnership.

Read more about her experiences in Uganda – click here.

Inspired to get involved with KIHEFO? Please visit our official website – click here. 


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