Determinants of food insecurity in occupied Palestinian territory: a cross-sectional survey

Abstract

BackgroundFood insecurity is a major issue facing Palestinians. According to the latest statistics (from 2014), 1·6 million people in Palestinian territory are food insecure. Specifically, 20% of the population of the West Bank and over 50% of the population of the Gaza Strip live in food insecurity. High rates of poverty, high food prices, and economic shocks influence food insecurity. The objective of this study was to explore the major determinants of food insecurity in Palestinian territory. MethodsData from the Gallup World Poll (GWP) from 2014 to 2017 were used (n=1000 per year). The target population in the GWP is the entire civilian non-institutionalised population aged 15 years and older. All sample selection is probability based and nationally representative. The GWP surveys an average of 1000 sample individuals per country. The Food Insecurity Experience Scale (FIES) was used as the dependent variable. The FIES measures individuals' food security status, and it is composed of eight questions with simple dichotomous responses (1=yes, 0=no). Respondents are asked whether, at any time during a certain reference period, they have worried about their ability to obtain enough food, their household has run out of food, or they have been forced to compromise the quality or quantity of the food that they ate owing to limited availability of money or other resources to obtain food. Sociodemographic, economic-related, and health factors were used as the independent variables. Different statistical analyses, such as descriptive, unadjusted, and adjusted binary logistic regression were carried out. FindingsResults from descriptive analysis showed significant differences in the frequency of severe food insecurity status on the FIES scale between 2014 and 2017 (2014, 27·3%; 2015, 26·0%; 2016, 22·1%; 2017, 24·6%). In terms of economy-related factors, more than 50% of the sample reported no confidence in national government, and more than three-quarters of the sample reported low local job opportunities. Approximately 55% of the sample reported having poor personal health. Findings from unadjusted logistic regression indicated that food insecurity was highest among the poorest 20% (odds ratio [OR] 25·64; p<0·0001), those with low education (completed elementary education; 3·802; p<0·0001), those with unemployed status (3·192; p<0·0001), and those living in a household with more than seven people (1·576; p<0·0001). Furthermore, food insecurity status increased with low local job opportunities (2·932; p<0·0001). Results of adjusted logistic regression analysis showed that females were more food insecure (1·335; p<0·0001) than their male counterparts. Among people aged 26–49 years, food insecurity was high (2·244; p<0·0001) compared with other age groups. The probability of being food insecure was higher in people with low education (3·943; p<0·0001). Importantly, Financial Life Index index was strongly related to food security. This index measures respondents' personal economic situations and the economics of the community in which they live. People with a low Financial Life Index were more food insecure (OR 24·27; p<0·0001). Probability of being food insecure was high among people with poor personal health status (2·546; p<0·0001). In conclusion, this study found food insecurity to be associated with different sociodemographic, health-related, and economy-related factors. InterpretationVery strong linkage was observed between food security status and Financial Life Index. In fact, macroeconomic conditions contribute to people's food security status through influence on job opportunities. Consistent with this, job status and employment opportunities affect income directly, and are found to be significantly related to food security in Palestinians. Food security status reflects individuals' health and wellbeing. In this study, a strong association was observed between Palestinians' poor health and their food security status. In developed countries, education can help to promote a healthy lifestyle by increasing nutritional knowledge. However, in developing countries, education can—through providing better job opportunities—directly influence income, which affects food security status. In this study, Palestinians with low education reported being food insecure. Palestinians living in rural areas were food secure and females were found to be more food insecure than their male counterparts. FundingNone.