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Social inequalities and household food insecurity in quilombola communities in Brazil

Desigualdades sociais e insegurança alimentar em comunidades quilombolas no Brasil

ABSTRACT

Objective

To evaluate the relationship between sociodemographic characteristics and food insecurity in quilombola communities in Brazil.

Methods

Microdata from the 2011 Quilombola Census “Assessment of the food and nutritional security situation in titled quilombola communities” were evaluated. The Brazilian household food insecurity measurement scale was used to evaluate household food insecurity status. Multinomial regression models were used to test the association between sociodemographic characteristics and food insecurity.

Results

The prevalence of food insecurity was 86.1% (mild: 30.2%; moderate/severe: 55.9%). In the final adjusted model, the factors significantly associated with moderate/severe food insecurity (p-value<0.001) were: head of household being single or divorced, head of household with 1-7 years of schooling, a larger domicile size, households with children under 5 years of age, precarious sanitation, a household income of less than the minimum wage, and being from a quilombola communities in the North of the country.

Conclusion

The results indicated that the prevalence of food insecurity among quilombola households is high, requiring the implementation of public policies to promote food and nutritional security and to mitigate the historical social injustices suffered by this population.

Keywords
Census data; Ethnic groups; Food and nutrition security; Poverty; Social vulnerability

RESUMO

Objetivo

Avaliar a relação entre características sociodemográficas e insegurança alimentar em comunidades quilombolas no Brasil.

Métodos

Os microdados do Censo Quilombola de 2011, “Avaliação da situação de segurança alimentar e nutricional nas comunidades quilombolas tituladas”, foram analisados. A Escala Brasileira de Insegurança Alimentar foi usada para avaliar o nível de insegurança alimentar dessa população. Modelos de regressão multinomial foram utilizados para testar a associação entre características sociodemográficas e insegurança alimentar.

Resultados

A prevalência de insegurança alimentar foi de 86,1% (leve: 30,2%; moderada/grave: 55,9%). No modelo final ajustado, verificou-se que as residências cujos responsáveis eram solteiros/divorciados, com escolaridade entre 1-7 anos, aquelas onde havia maior aglomeração familiar, presença de crianças menores de cinco anos, com precário saneamento básico, da macrorregião Norte do país e famílias com renda mensal familiar inferior a um salário mínimo apresentaram associação significativa com insegurança moderada/ grave (p-valor <0,001).

Conclusão

Os resultados indicaram que as famílias quilombolas apresentavam elevada prevalência de insegurança alimentar, sendo necessária a implementação de políticas públicas para promoção da segurança alimentar e nutricional e que minimizem as históricas injustiças sociais sofridas por essa população.

Palavras-chave
Coenso de população; Grupos étnicos; Segurança alimentar e nutricional; Pobreza; Vulnerabilidade social

INTRODUCTION

Quilombolas are people of African descent whose past was marked by slavery in Brazil. They have a distinct ethnic identity and define themselves as quilombolas based on their relationship with the land, the environment in which they live, and their cultural and religious traditions and practices [11 Decreto n. 4.887, de 20 de novembro de 2003 (Brasil). Regulamenta o procedimento para identificação, reconhecimento, delimitação, demarcação e titulação das terras ocupadas por remanescentes das comunidades dos quilombos de que trata o art. 68 do Ato das Disposições Constitucionais Transitórias. Decreto. (20 nov., 2003).]. They live in communities called quilombos, which are located in almost all states of Brazil, mainly in rural and geographically isolated areas where access to education, health, and infrastructure services is limited [22 Cordeiro MM, Monego ET, Martins KA. Overweight in Goiás’ quilombola students and food insecurity in their families. Rev Nutr. 2014;27(4):405-412. https://doi.org/10.1590/1415-52732014000400002
https://doi.org/10.1590/1415-52732014000...
,33 Silva EKP, Medeiros DS, Martins PC, Sousa LA, Lima GP, Rêgo MAS, et al. Food insecurity in rural communities in Northeast Brazil: does belonging to a slave-descendent community make a difference? Cad Saúde Pública. 2017;33(4):1-14. https://doi.org/10.1590/0102-311x00005716
https://doi.org/10.1590/0102-311x0000571...
]. Quilombolas were legally recognized in the Brazilian Constitution of 1988, specifically in article 68 of the transitional constitutional provisions. In 2003, a definition for these communities was established as “ethnic-racial groups, according to self-attributed criteria, with their own historical trajectory, endowed with specific relations with the land, presumed black ancestry related to resistance to the historical oppression suffered” [11 Decreto n. 4.887, de 20 de novembro de 2003 (Brasil). Regulamenta o procedimento para identificação, reconhecimento, delimitação, demarcação e titulação das terras ocupadas por remanescentes das comunidades dos quilombos de que trata o art. 68 do Ato das Disposições Constitucionais Transitórias. Decreto. (20 nov., 2003).].

Studies carried out with quilombolas have revealed a high prevalence of household Food Insecurity (FI) as measured using the Escala Brasileira de Insegurança Alimentar (EBIA, Brazilian Household Food Insecurity Measurement Scale) [33 Silva EKP, Medeiros DS, Martins PC, Sousa LA, Lima GP, Rêgo MAS, et al. Food insecurity in rural communities in Northeast Brazil: does belonging to a slave-descendent community make a difference? Cad Saúde Pública. 2017;33(4):1-14. https://doi.org/10.1590/0102-311x00005716
https://doi.org/10.1590/0102-311x0000571...

4 Monego ET, Peixoto MRG, Cordeiro MM, Costa RM. Food insecurity of Tocantins’s quilombolas communities. Seg Aliment Nutr. 2010;17(1):37-47. https://doi.org/10.20396/san.v17i1.8634798
https://doi.org/10.20396/san.v17i1.86347...

5 Carvalho RRS, Alberto NSMC, Pereira TG. Insegurança alimentar em povos de terreiros. Arq Bras Ciênc Saúde. 2014;39(1):4-11. https://doi.org/10.7322/abcshs.v39i1.252
https://doi.org/10.7322/abcshs.v39i1.252...

6 Ribeiro G, Morais FMO, Pinho L. (In)Segurança alimentar de comunidade quilombola no norte de Minas Gerais. Ciênc Cuidad Saúde. 2015;14(3):1245-1250. https://doi.org/10.4025/cienccuidsaude.v14i3.21845
https://doi.org/10.4025/cienccuidsaude.v...

7 Gubert MB, Segall-Corrêa AM, Spaniol AM, Pedroso J, Coelho SEDAC, Pérez-Escamilla R. Household food insecurity in black-slaves descendant communities in Brazil: has the legacy of slavery truly ended? Public Health Nutr. 2017;20 (8):1513-1522. https://doi.org/10.1017/S1368980016003414
https://doi.org/10.1017/S136898001600341...
-88 Silva BMA, Silveira VNC, Padilha LL, Frota MTB. Situação de insegurança alimentar e nutricional em famílias quilombolas maranhenses. Demetra. 2020;15(e43636):1-14. https://doi.org/10.12957/demetra.2020.43636
https://doi.org/10.12957/demetra.2020.43...
]. However, there are still few studies with this population that evaluate the association of FI with social inequality and poverty.

Social inequality and poverty are two key determinants of FI that have serious repercussions for vulnerable population groups, such as quilombolas [99 Sperandio N, Priore SE. Prevalence of household food insecurity and associated factors among Bolsa Familia Program families with preschool children in Viçosa, Minas Gerais State, Brazil. Epidemiol Serv Saúde. 2015;24(4):739-748. https://doi.org/10.5123/S1679-49742015000400016
https://doi.org/10.5123/S1679-4974201500...
]. Research on the subject in Brazil has mainly covered local quilombola communities with a small sample of individuals [22 Cordeiro MM, Monego ET, Martins KA. Overweight in Goiás’ quilombola students and food insecurity in their families. Rev Nutr. 2014;27(4):405-412. https://doi.org/10.1590/1415-52732014000400002
https://doi.org/10.1590/1415-52732014000...
,33 Silva EKP, Medeiros DS, Martins PC, Sousa LA, Lima GP, Rêgo MAS, et al. Food insecurity in rural communities in Northeast Brazil: does belonging to a slave-descendent community make a difference? Cad Saúde Pública. 2017;33(4):1-14. https://doi.org/10.1590/0102-311x00005716
https://doi.org/10.1590/0102-311x0000571...
,66 Ribeiro G, Morais FMO, Pinho L. (In)Segurança alimentar de comunidade quilombola no norte de Minas Gerais. Ciênc Cuidad Saúde. 2015;14(3):1245-1250. https://doi.org/10.4025/cienccuidsaude.v14i3.21845
https://doi.org/10.4025/cienccuidsaude.v...
,77 Gubert MB, Segall-Corrêa AM, Spaniol AM, Pedroso J, Coelho SEDAC, Pérez-Escamilla R. Household food insecurity in black-slaves descendant communities in Brazil: has the legacy of slavery truly ended? Public Health Nutr. 2017;20 (8):1513-1522. https://doi.org/10.1017/S1368980016003414
https://doi.org/10.1017/S136898001600341...
]. Besides that, there are few studies investigating the consequences of FI on this population on a national level and using official data [77 Gubert MB, Segall-Corrêa AM, Spaniol AM, Pedroso J, Coelho SEDAC, Pérez-Escamilla R. Household food insecurity in black-slaves descendant communities in Brazil: has the legacy of slavery truly ended? Public Health Nutr. 2017;20 (8):1513-1522. https://doi.org/10.1017/S1368980016003414
https://doi.org/10.1017/S136898001600341...
]. The association between food and nutrition security and Brazilian descendants of enslaved Africans is recent. The Quilombola Census is an unprecedented survey of this population with respect both to the geographical area it covers and to its thematic scope, providing data that permits nationwide investigations and comparisons of results in different regions of Brazil. It could also be used to make an innovative assessment of the FI of quilombolas, as assessed by the EBIA, and how this interfaces with sociodemographic indicators.

This study proposes to address the gap in national research on household food insecurity and social inequalities among quilombolas. Its aim is to evaluate the relationship between sociodemographic characteristics and FI in quilombola communities in Brazil. Thus, the results of this study would contribute to the scientific debate about how social inequalities affect the food security of people living in quilombos and from different ethnic and racial segments and minorities in Brazil. These data are an important first step for the development of effective public policies for the advancement of the right to health and food and nutrition security for the quilombola population.

METHODS

This study evaluated microdata from the Quilombola Census carried out between April and November 2011, which was conceived and coordinated by the Ministério do Desenvolvimento Social e Combate à Fome (MDS, Ministry of Social Development and the Fight against Hunger), in partnership with other public agencies [1010 Ministério do Desenvolvimento Social e Combate à Fome (Brasil). Pesquisa de Avaliação da Situação de Segurança Alimentar e Nutricional em Comunidades Quilombolas Tituladas. Brasilia: Ministério; 2011 [citado 2018 jul 15]. Disponível em: https://aplicacoes.mds.gov.br/sagi/pesquisas/lista-s.php?tp=pesquisa&stk=ano&id=135
https://aplicacoes.mds.gov.br/sagi/pesqu...
-1111 Ministério do Desenvolvimento Social e Combate à Fome (Brasil). Cadernos de estudos desenvolvimento social em debate Quilombos do Brasil: Segurança alimentar e nutricional em territórios titulados. Brasília: Ministério; 2014.]. The present study used anonymized microdata from a public domain database, specifically the data collected in sociodemographic questionnaire and the EBIA [1010 Ministério do Desenvolvimento Social e Combate à Fome (Brasil). Pesquisa de Avaliação da Situação de Segurança Alimentar e Nutricional em Comunidades Quilombolas Tituladas. Brasilia: Ministério; 2011 [citado 2018 jul 15]. Disponível em: https://aplicacoes.mds.gov.br/sagi/pesquisas/lista-s.php?tp=pesquisa&stk=ano&id=135
https://aplicacoes.mds.gov.br/sagi/pesqu...
].

The Quilombola Census investigated 169 quilombola communities (9,193 households) with titled lands in Brazil. Titling is the legal recognition of the collective use of land, and its absence can have negative repercussions on the socioeconomic and health status of the quilombola population [1212 Nascimento GAR, Batista MRR, Nascimento MAR. Panorama atual de proteção do direito à terra das comunidades quilombolas e desafios futuros. Interações. 2016;17(3):432-447. https://doi.org/10.20435/1984-042X-2016
https://doi.org/10.20435/1984-042X-2016...
]. This study did not include households with a member who did not self-identify as a quilombola (n=251; 2.7%), that did not live in titled land (n=75; 0.9%), whose head of household was less than 15 years old (n=3; 0.03%), or about which some data was missing (n=121; 1.3%). After applying these exclusion criteria, the final study sample consisted of 8,743 quilombola households who answered the Quilombola Census (95.1%). These households were not in every state of the country, but did cover each of its five regions. More details about the census and its methodology can be accessed in the report published in 2014 [1111 Ministério do Desenvolvimento Social e Combate à Fome (Brasil). Cadernos de estudos desenvolvimento social em debate Quilombos do Brasil: Segurança alimentar e nutricional em territórios titulados. Brasília: Ministério; 2014.].

FI was evaluated using EBIA, which was established in 2003 for use in national surveys after a process of adaptation and validation of the US Household Food Security Survey Module (HFSSM) for the Brazilian population [1313 Segall-Corrêa AM, Marin-León L, Melgar-Quiñonez H, Pérez-Escamilla R. Refinement of the Brazilian household food insecurity measurement scale: recommendation for a 14-item EBIA. Rev Nutr. 2014;27(2):241-251. https://doi.org/10.1590/1415-52732014000200010
https://doi.org/10.1590/1415-52732014000...
,1414 Reichenheim ME, Interlenghi GS, Moraes CL, Segall-Corrêa AM, Pérez-Escamilla R, Salles-Costa R. A model-based approach to identify classes and respective cutoffs of the Brazilian household food insecurity measurement scale. J Nutr. 2016;146(7):1356-1364. https://doi.org/10.3945/jn.116.231845
https://doi.org/10.3945/jn.116.231845...
]. The EBIA contains 14 dichotomous items (yes/no) covering information related to food deprivation within a recall period of three months [1313 Segall-Corrêa AM, Marin-León L, Melgar-Quiñonez H, Pérez-Escamilla R. Refinement of the Brazilian household food insecurity measurement scale: recommendation for a 14-item EBIA. Rev Nutr. 2014;27(2):241-251. https://doi.org/10.1590/1415-52732014000200010
https://doi.org/10.1590/1415-52732014000...
]. In the EBIA, eight of these questions are administered to domiciles composed of only adults, while all 14 are administered to those with at least one under-eighteen member.

The EBIA takes the household as the unit of study. FI was classified into four categories according to the sum of affirmative answers: (i) food security (absence of food restrictions, no concerns about food shortages in the future); (ii) mild FI (concern or uncertainty about access to food, compromising quality of diet and posing a risk to the subsistence of the domicile members); (iii) moderate FI (quantitative restrictions, especially among adults); and (iv) severe FI (significant reduction in the amount of food available for both adults and children, with a clear interruption of regular dietary intake and a high likelihood of hunger) [1515 Instituto Brasileiro de Geografia e Estatística. Pesquisa de orçamentos familiares: análise da segurança alimentar no Brasil. Rio de Janeiro: Instituto; 2020.].

In this study, moderate and severe FI were grouped together in view of the interest in identifying the prevalence of the most serious levels of FI, and because they have similar characteristics, following the methodology used elsewhere [1616 Domingos TB, Pereira AF, Yokoo EM, Salles-Costa R. Low fruit consumption and omission of daily meals as risk factors for increased blood pressure in adults. Br J Nutr. 2016;116(4):683-691. https://doi.org/10.1017/S0007114516002397
https://doi.org/10.1017/S000711451600239...
]. This combination of moderate and severe FI into a single group was adopted recently in the 2019 report from Food and Agriculture Organization (FAO) [1717 Food and Agriculture Organization. The state of food security and nutrition in the world 2019. Rome: Organization; 2019.]. Details of the EBIA classifications are available in the literature [1313 Segall-Corrêa AM, Marin-León L, Melgar-Quiñonez H, Pérez-Escamilla R. Refinement of the Brazilian household food insecurity measurement scale: recommendation for a 14-item EBIA. Rev Nutr. 2014;27(2):241-251. https://doi.org/10.1590/1415-52732014000200010
https://doi.org/10.1590/1415-52732014000...
,1414 Reichenheim ME, Interlenghi GS, Moraes CL, Segall-Corrêa AM, Pérez-Escamilla R, Salles-Costa R. A model-based approach to identify classes and respective cutoffs of the Brazilian household food insecurity measurement scale. J Nutr. 2016;146(7):1356-1364. https://doi.org/10.3945/jn.116.231845
https://doi.org/10.3945/jn.116.231845...
,1818 Palmeira PA, Bem-Lignani J, Maresi VA, Mattos RA, Interlenghi GS, Salles-Costa R. Temporal changes in the association between food insecurity and socioeconomic status in two population-based surveys in Rio de Janeiro, Brazil. Soc Indic Res. 2019;144(3):1349-1365. https://doi.org/10.1007/s11205-019-02085-0
https://doi.org/10.1007/s11205-019-02085...
].

A structured sociodemographic questionnaire was administered to build up a profile of the head of household (gender, age, marital status, and years of schooling) and the household (number of residents, number of children under 5 years, number of rooms, electricity, adequate sanitation, adequate water supply, region, and total monthly household income). Sanitation was considered adequate if there was sewage and garbage collection. The regions were classified using the geopolitical divisions (North, Northeast, South/ Southeast, and Central-West). The South and Southeast regions were combined as they both have fewer quilombola communities and are sociodemographically similar. Total monthly household income was estimated by summing the income of all the residents (government benefits, paid work, pensions, sale or breeding of animals, and sale of handicrafts), categorized according to the 2011 monthly minimum wage (R$545.00) and converted to dollars using the dollar-real exchange rate of July 1, 2011 ($349.31).

A descriptive analysis was performed estimating the prevalence and confidence intervals (95%CI) of the categories of FI and the sociodemographic characteristics. Then a multinomial logistic regression model was designed to estimate the odds ratios (OR) and respective 95%CI, considering three categories of FI: food security (reference level); mild FI, and moderate/severe FI. The multinomial logistic regression model was used, in which the estimated OR and 95% CI of each variable were adjusted for the effect of the other sociodemographic variables studied. Associations with a p-value of less than 0.05 in the unadjusted multinomial logistic regression model were included in the final model at a significance level of 5% (p<0.05). All the variables were included in the final model except gender (p>0.05). Inconsistent or incomplete data were excluded. Analyses were performed using the statistical software Stata 13.0 [1919 Stata 13.0. Data analysis and statistical software. [software]. College Station: Stata Corporation; 2011.].

According to Brazilian Health Council resolution 510/2016, surveys that use information from a public domain database do not need to be registered with or evaluated by the National Research Ethics Committee [2020 Ministério da Saúde (Brasil). Resolução no 510, de 7 de abril de 2016. Brasília: Ministério; 2016 [citado 2019 ago 14]. Disponível em: http://conselho.saude.gov.br/resolucoes/2016/Reso510.pdf
http://conselho.saude.gov.br/resolucoes/...
]. Thus, ethical approval was not required for this paper.

RESULTS

Of the 8,743 domiciles investigated, 86.1% reported FI, with 55.9% having moderate/severe FI. Most of the domiciles were headed by men aged ≥51, either married or cohabiting, with 1-7 years in formal education. The majority of the domiciles had 3-5 members, had no children under 5 years, and lived in residences with 1-4 rooms. While 81.9% reported having electricity, only 5.2% had adequate sanitation. Most of the quilombola population lived in the North region and most of the households had a monthly income of half to one monthly minimum wage (Table 1).

Table 1
Prevalence and respective confidence interval of household food insecurity and sociodemographic characteristics of quilombolas communities in Brazil. Quilombola Census, 2011.

In the multinomial logistic regression analysis (Table 2), after adjusting for all the variables (except gender) and taking food security as a reference category, it was observed that the chances of moderate/severe FI were 50% lower when the household was headed by an adult aged ≥51 vis-a-vis households headed by adults aged 31-40. When the head of household was single/divorced, the chance of moderate/severe FI was 1.5 times higher than in those headed by a couple (married or cohabiting). A lower educational level of the head of household was also statistically associated with a higher chance of moderate/severe FI.

Table 2
Unadjusted and adjusted odds ratio and confidence intervals of the relationship between sociodemographic characteristics and household food insecurity of quilombolas communities in Brazil. Quilombola Census, 2011.

Turning to the domicile variables, household size was the variable most strongly related to moderate/severe FI, with households of 3-5 individuals having an almost 40 times higher likelihood of experiencing moderate/severe FI. Households with children younger than 5 years and with fewer rooms were also significantly more exposed to moderate/severe FI. The absence of electricity and adequate sanitation in the domiciles was positively related to moderate/severe FI. The North region was the region most negatively associated with the most severe levels of FI, especially when compared to the South/Southeast. Regarding income, the quilombola households whose combined income was between half and one minimum wage were three times more likely to suffer moderate/severe FI than those who received more than one minimum wage (Table 2).

DISCUSSION

Data from the government’s nationwide demographic and socioeconomic survey of 2013 showed a significant reduction of FI in Brazil [2121 Instituto Brasileiro de Geografia e Estatística. Pesquisa Nacional por amostra de domicílios: segurança alimentar 2013. Rio de Janeiro: Instituto; 2014.]. However, the data analyzed here, from the 2011 survey of quilombola households, found the FI of this population group to be almost four times higher than the estimated level for the Brazilian population in 2013 (86.1% versus 22.6%). It should be noted that even when we consider the skin color/race classification of heads of household in the 2013 survey, the proportion of moderate/severe FI among black and brown-skinned individuals was still lower than that observed among quilombola households (11.1% versus 55.9%) [2121 Instituto Brasileiro de Geografia e Estatística. Pesquisa Nacional por amostra de domicílios: segurança alimentar 2013. Rio de Janeiro: Instituto; 2014.].

Recently, the National Family Expenditure Study, based on data collected in 2017 and 2018, pointed to an increase in all levels of FI in the Brazilian population [1515 Instituto Brasileiro de Geografia e Estatística. Pesquisa de orçamentos familiares: análise da segurança alimentar no Brasil. Rio de Janeiro: Instituto; 2020.]. This data reflects the setback in advances in social policies to promote food and nutrition security and a return of hunger in the country [2222 Grupo de Trabalho da Sociedade Civil para a Agenda 2030. IV Relatório luz da sociedade civil da agenda 2030 de desenvolvimento sustentável. Brasil: Grupo de Trabalho da Sociedade Civil para a Agenda 2030; 2020 [citado 2018 jul 15]. Disponível em: https://brasilnaagenda2030.files.wordpress.com/2020/08/por_rl_2020_web-1.pdf
https://brasilnaagenda2030.files.wordpre...
]. In that study, it was observed that severe FI was more prevalent among those whose self-reported skin color was black or brown than among those who were white-skinned [1515 Instituto Brasileiro de Geografia e Estatística. Pesquisa de orçamentos familiares: análise da segurança alimentar no Brasil. Rio de Janeiro: Instituto; 2020.]. Although the National Family Expenditure Study does not provide any specific analysis of the country’s quilombola population, data on the greatest increase in all forms of FI among black and brown-skinned people is indicative of the continued entrenchment of racial inequality in access to adequate food in the country.

Other studies that have investigated the prevalence of FI in quilombolas corroborate our findings [22 Cordeiro MM, Monego ET, Martins KA. Overweight in Goiás’ quilombola students and food insecurity in their families. Rev Nutr. 2014;27(4):405-412. https://doi.org/10.1590/1415-52732014000400002
https://doi.org/10.1590/1415-52732014000...
,33 Silva EKP, Medeiros DS, Martins PC, Sousa LA, Lima GP, Rêgo MAS, et al. Food insecurity in rural communities in Northeast Brazil: does belonging to a slave-descendent community make a difference? Cad Saúde Pública. 2017;33(4):1-14. https://doi.org/10.1590/0102-311x00005716
https://doi.org/10.1590/0102-311x0000571...
,77 Gubert MB, Segall-Corrêa AM, Spaniol AM, Pedroso J, Coelho SEDAC, Pérez-Escamilla R. Household food insecurity in black-slaves descendant communities in Brazil: has the legacy of slavery truly ended? Public Health Nutr. 2017;20 (8):1513-1522. https://doi.org/10.1017/S1368980016003414
https://doi.org/10.1017/S136898001600341...
,88 Silva BMA, Silveira VNC, Padilha LL, Frota MTB. Situação de insegurança alimentar e nutricional em famílias quilombolas maranhenses. Demetra. 2020;15(e43636):1-14. https://doi.org/10.12957/demetra.2020.43636
https://doi.org/10.12957/demetra.2020.43...
,2323 Sousa LA, Medeiro DS, Lima GP, Santos LM. Insegurança alimentar de famílias residentes numa comunidade de zona rural de Vitória da Conquista, BA. Rev Saúde. 2016;12(1):444-453.]. Indeed, Carvalho et al. [55 Carvalho RRS, Alberto NSMC, Pereira TG. Insegurança alimentar em povos de terreiros. Arq Bras Ciênc Saúde. 2014;39(1):4-11. https://doi.org/10.7322/abcshs.v39i1.252
https://doi.org/10.7322/abcshs.v39i1.252...
] and Ribeiro et al. [66 Ribeiro G, Morais FMO, Pinho L. (In)Segurança alimentar de comunidade quilombola no norte de Minas Gerais. Ciênc Cuidad Saúde. 2015;14(3):1245-1250. https://doi.org/10.4025/cienccuidsaude.v14i3.21845
https://doi.org/10.4025/cienccuidsaude.v...
] observed FI to affect about 80% of the quilombola population. It should be noted that these surveys evaluated communities within a single region and small samples, unlike the national footprint of the Quilombola Census analyzed here.

Household income is pivotal in enabling access to adequate food and reducing FI, since it mediates the relationship between social and economic indicators and FI [2424 Lignani JB, Palmeira PA, Antunes MML, Salles-Costa R. Relationship between social indicators and food insecurity: a systematic review. Rev Bras Epidemiol. 2020;23(e200068):1-15. https://doi.org/10.1590/1980-549720200068
https://doi.org/10.1590/1980-54972020006...
]. The association between food security and income is well documented in the literature [2525 Bezerra TA, Olinda RA, Peraza DF. Food insecurity in Brazil in accordance with different socio-demographic scenarios. Ciênc Saúde Coletiva. 2017;22(2):637-651. https://doi.org/10.1590/1413-81232017222.19952015
https://doi.org/10.1590/1413-81232017222...
,2626 Sousa LRM, Segall-Corrêa AM, Ville AS, Melgar-Quiñonez H. Food security status in times of financial and political crisis in Brazil. Cad Saúde Pública. 2019;35(7):e00084118. https://doi.org/10.1590/0102-311x00084118
https://doi.org/10.1590/0102-311x0008411...
]. In this study, the lowest monthly income was also a determining factor for moderate/severe FI, since 82.5% of the quilombola domiciles earned up to one minimum wage at the time of the research. Income is a prerequisite for the purchase of food and reduction of FI.

According to Rêgo and Castro [2727 Rêgo LS, Castro MS. Inclusão produtiva e etnodesenvolvimento para as comunidades quilombolas: parte IV. In: Pinto AR, Borges JC, Novo MP, Pires PS. Cadernos do Brasil: segurança alimentar e nutricional em territórios titulados. Brasília: Ministério do Desenvolvimento Social e Combate à Fome; 2014.] based on census microdata, the economy of the former quilombos was based on the use of available natural resources (e.g., medicinal plants and wild animals) in association with subsistence agriculture. When investigating the data from the 2011 census, they observed that quilombola households still engaged in subsistence farming, and that 30.4% of the investigated population sold part of their produce or bred animals for sale [1111 Ministério do Desenvolvimento Social e Combate à Fome (Brasil). Cadernos de estudos desenvolvimento social em debate Quilombos do Brasil: Segurança alimentar e nutricional em territórios titulados. Brasília: Ministério; 2014.].

Ribeiro et al. [2828 Ribeiro KA, Moreira ES, Rodrigues MA, Souza AR. Associações e o fortalecimento da agricultura familiar: um olhar sobre Brasileira, uma comunidade remanescente de quilombo. Rev Desenvol Soc. 2017[citado 2019 ago 14];20(1):121-149. Disponível em: https://www.periodicos.unimontes.br/index.php/rds/article/view/1866
https://www.periodicos.unimontes.br/inde...
] found that quilombos in Bahia, northeastern Brazil, had difficulty in producing and marketing their food because of a lack of union amongst the farmers and a lack of associations and trade unions to stimulate production. This reinforces the importance of public policies for rural development designed to stimulate family farming in traditional communities, resulting in income generation. It is hoped that by increasing the food production in their lands, they could boost their income by selling the surplus produce, thereby reducing their social vulnerability and FI, and encouraging autonomy and an improved standard of living [2929 Sibhatu KT, Qaim M. Rural food security, subsistence agriculture, and seasonality. Plos One. 2017;12(10):e0186406. https://doi.org/10.1371/journal.pone.0186406
https://doi.org/10.1371/journal.pone.018...
,3030 Heling CA, Oliveira ER, Almeida RA, Gabriel AMA, Magalhães AM, Souza AG, et al. Food acquisition program in Mato Grosso do Sul: food sovereignty, crisis and prospects for overcoming the crisis. Realização. 2017[citado 2020 jun 25];7(4):51-78. Disponível em: http://ojs.ufgd.edu.br/index.php/realizacao/article/view/7252
http://ojs.ufgd.edu.br/index.php/realiza...
].

The present study investigated quilombola households who have the title to their lands, which means the legal right to occupy their territories. Land is important for cultural and physical reproduction, food production, and subsistence, making it an essential aspect of this population’s livelihood [3131 Silva LB. Constituição de comunidades negras rurais na América Latina: impactos externos nas atividades econômicas e territorialidades nos Quilombos Cangume (Brasil) e Palenque (Colômbia). Av Investig. 2018[citado 2020 ago 29];8:223-232. Disponível em: http://cartografiasdelsur.undav.edu.ar/index.php/CdS/article/view/114/120
http://cartografiasdelsur.undav.edu.ar/i...
]. Titling is therefore indirectly responsible for improving socioeconomic conditions and reducing FI. When a community lacks guarantees and protections for their lands, this hinders their cultural expression, autonomy, and agro-ecological development, with direct consequences on their livelihoods [1212 Nascimento GAR, Batista MRR, Nascimento MAR. Panorama atual de proteção do direito à terra das comunidades quilombolas e desafios futuros. Interações. 2016;17(3):432-447. https://doi.org/10.20435/1984-042X-2016
https://doi.org/10.20435/1984-042X-2016...
].

Silva [3131 Silva LB. Constituição de comunidades negras rurais na América Latina: impactos externos nas atividades econômicas e territorialidades nos Quilombos Cangume (Brasil) e Palenque (Colômbia). Av Investig. 2018[citado 2020 ago 29];8:223-232. Disponível em: http://cartografiasdelsur.undav.edu.ar/index.php/CdS/article/view/114/120
http://cartografiasdelsur.undav.edu.ar/i...
] investigated rural black-skinned communities in Colombia and found that issues related to soil degradation for crops and restrictions against water use due to the intervention of land grabbers and farmers were factors behind FI in this population. He also reinforced the importance of such communities to have land for growing food, promoting food and nutritional security.

Another factor that can influence food production is the climate. This is a particular concern in the drought-prone Northeast region of Brazil, where advanced techniques are required to maintain production [2828 Ribeiro KA, Moreira ES, Rodrigues MA, Souza AR. Associações e o fortalecimento da agricultura familiar: um olhar sobre Brasileira, uma comunidade remanescente de quilombo. Rev Desenvol Soc. 2017[citado 2019 ago 14];20(1):121-149. Disponível em: https://www.periodicos.unimontes.br/index.php/rds/article/view/1866
https://www.periodicos.unimontes.br/inde...
]. The FAO cites climate change as a major cause of increased hunger in the world and relates it to key factors affecting food security, such as the production, sale, and access to food [1717 Food and Agriculture Organization. The state of food security and nutrition in the world 2019. Rome: Organization; 2019.,3232 Lei n. 11.346, de 15 de setembro de 2006. (Brasil). Cria o Sistema Nacional de Segurança Alimentar e Nutricional, SISAN com vistas em assegurar o direito humano à alimentação adequada e dá outras providências. Lei Pública. (15 set., 2006).,3333 Food and Agriculture Organization. The state of food security and nutrition in the world: transforming food systems for affordable healthy diets. Rome: Organization; 2020.].

We observed in our study that the higher the age group of the heads of household, the lower the proportion of moderate/severe FI, which could be down to contributions by older people to family income [3434 Prince MJ, Lloyd-Sherlock P, Guerra M, Huang Y, Sosa AL, Uwakwe R, et al. The economic status of older people’s households in urban and rural settings in Peru, Mexico and China: a 10/66 INDEP study cross-sectional survey. Springerplus. 2016;5(258):1-16. https://doi.org/10.1186/s40064-016-1913-2
https://doi.org/10.1186/s40064-016-1913-...
]. Data from the National Family Expenditure Study indicated that FI was less prevalent in households that included older people [1515 Instituto Brasileiro de Geografia e Estatística. Pesquisa de orçamentos familiares: análise da segurança alimentar no Brasil. Rio de Janeiro: Instituto; 2020.]. Pensions make up a large portion of older people’s income, even those with a low income are eligible to receive benefits from social welfare income transfer programs [3535 Cardoso E, Dietrich TP, Souza AP. Envelhecimento da população e desigualdade. São Paulo: Fundação Getúlio Vargas; 2019 [citado 1 out 2020]. Disponível em: https://bibliotecadigital.fgv.br/dspace/bitstream/handle/10438/27425/TD%20501%20-%20Envelhecimento%20da%20Popila%C3%A7%C3%A3o%20e%20Desigualdade.pdf?sequence=1&isAllowed=y
https://bibliotecadigital.fgv.br/dspace...
]. Such benefits help boost the income of these households, and may help reduce their FI.

The head of household’s education level was also found to be inversely associated with moderate/severe FI. This underlines the importance of basic education in the acquisition of knowledge and information and improved access to job opportunities and a higher income, yielding a reduction in the poverty cycle and FI [3636 Salinas RC, Rivera R, Seperak R. Impacto de composición familiar en los niveles de pobreza de Perú. Cult Hombre Soc. 2017;27(2):69-88. https://doi.org/10.7770/cuhso-v27n2-art1229
https://doi.org/10.7770/cuhso-v27n2-art1...
].

As to household characteristics, moderate/severe FI was higher in the domiciles with over six residents. A higher domicile density increases the need for resources to buy food, while a larger domicile does not always tally with a higher family income [3636 Salinas RC, Rivera R, Seperak R. Impacto de composición familiar en los niveles de pobreza de Perú. Cult Hombre Soc. 2017;27(2):69-88. https://doi.org/10.7770/cuhso-v27n2-art1229
https://doi.org/10.7770/cuhso-v27n2-art1...
,3737 Cabral CS, Lopes AG, Lopes JM, Vianna RPT. Food security, income, and the Bolsa Família program: a cohort study of municipalities in Paraíba State, Brazil, 2005-2011. Cad Saúde Pública. 2014;30(2):393-402. https://doi.org/10.1590/0102-311X00140112
https://doi.org/10.1590/0102-311X0014011...
]. The association between food security and domicile density is well documented [1111 Ministério do Desenvolvimento Social e Combate à Fome (Brasil). Cadernos de estudos desenvolvimento social em debate Quilombos do Brasil: Segurança alimentar e nutricional em territórios titulados. Brasília: Ministério; 2014.,2525 Bezerra TA, Olinda RA, Peraza DF. Food insecurity in Brazil in accordance with different socio-demographic scenarios. Ciênc Saúde Coletiva. 2017;22(2):637-651. https://doi.org/10.1590/1413-81232017222.19952015
https://doi.org/10.1590/1413-81232017222...
,3838 Gubert MB, Spaniol AM, Bortolini GA, Pérez-Escamilla R. Household food insecurity, nutritional status and morbidity in Brazilian children. Public Health Nutr. 2016;19(12):2240-2245. https://doi.org/10.1017/S1368980016000239
https://doi.org/10.1017/S136898001600023...
,3939 Santos TG, Silveira JAC, Longo-Sila G, Ramires EKNM, Menezes RCE. Trends and factors associated with food insecurity in Brazil: the National Household Sample Survey, 2004, 2009, and 2013. Cad Saúde Pública. 2018;34(4):e00066917. https://doi.org/10.1590/0102-311X00066917
https://doi.org/10.1590/0102-311X0006691...
]. A high prevalence of quilombola households without adequate sanitation was also found, which indicates social vulnerability and deficient hygienic and sanitary conditions and infrastructure, which could compromise health due to infectious diseases [4040 Teixeira JC, Oliveira GS, Viali AM, Muniz SS. Study of the impact of deficiencies of sanitation on public health in Brazil from 2001 to 2009. Eng Sanit Ambient. 2015;19(1):87-96. https://doi.org/10.1590/S1413-41522014000100010
https://doi.org/10.1590/S1413-4152201400...
]. An association between inadequate sanitation and FI in population-based studies has also been found by Santos et al. [4141 Santos TG, Silveira JAC, Longo-Silva G, Ramires EKNM, Menezes RCE. Trends and factors associated with food insecurity in Brazil: the National Household Sample Survey, 2004, 2009, and 2013. Cad Saúde Pública. 2018;34(4):1-17. https://doi.org/10.1590/0102-311x00066917
https://doi.org/10.1590/0102-311x0006691...
] and Araújo et al. [4242 Araújo ML, Nascimento DR, Lopes MS, Passos CM, Lopes ACS. Condições de vida de famílias brasileiras: estimativa da insegurança alimentar. Rev Bras Est Popul. 2020;37(e0110):1-17. https://doi.org/10.20947/s0102-3098a0110
https://doi.org/10.20947/s0102-3098a0110...
]. This lack of basic sanitation is another indication of social inequalities and precarious living conditions, compromising the health of citizens by making them more susceptible to diseases attributable to inadequate sanitation. Another factor that was related to the presence of moderate/severe FI was the absence of electricity, indicating its importance for the maintenance and storage of food, and the reduction of FI.

Regarding the region of residence, the households from the North and Northeast were more likely to experience moderate/severe FI. These regions have a higher proportion of rural areas and have historically been marked by poverty and worse socioeconomic and health indicators, which are reflected in the quilombola population [2121 Instituto Brasileiro de Geografia e Estatística. Pesquisa Nacional por amostra de domicílios: segurança alimentar 2013. Rio de Janeiro: Instituto; 2014.,4141 Santos TG, Silveira JAC, Longo-Silva G, Ramires EKNM, Menezes RCE. Trends and factors associated with food insecurity in Brazil: the National Household Sample Survey, 2004, 2009, and 2013. Cad Saúde Pública. 2018;34(4):1-17. https://doi.org/10.1590/0102-311x00066917
https://doi.org/10.1590/0102-311x0006691...
,4343 Ministério da Saúde (Brasil). Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher (PNDS) 2006: dimensões do processo reprodutivo e da saúde da criança. Brasília: Ministério; 2009.

44 Almeida JA, Santos AS, Nascimento MAO, Oliveira JVC, Silva DG, Mendes-Netto RS. Factors associated with food insecurity risk and nutrition in rural settlements of families. Ciênc Saúde Coletiva. 2017;22(2):479-488. https://doi.org/10.1590/1413-81232017222.27102015
https://doi.org/10.1590/1413-81232017222...

45 Gubert MB, Perez-Escamilla R. Severe food insecurity in Brazilian municipalities, 2013. Ciênc Saúde Coletiva. 2018;23(10):3433-3444. https://doi.org/10.1590/1413-812320182310.26512016
https://doi.org/10.1590/1413-81232018231...
-4646 Trivellato PT, Morais DC, Lopes SO, Miguel ES, Franceschini SCC, Priore SE. Food and nutritional insecurity in families in the Brazilian rural environment: a systematic review. Ciênc Saúde Coletiva. 2019;24(3):865-874. https://doi.org/10.1590/1413-81232018243.05352017%0A
https://doi.org/10.1590/1413-81232018243...
]. Due to the historical process of land occupation, these regions were more populated by ethnically different groups and have a higher proportion of communities certified and recognized as descendants of quilombolas [4747 Coimbra CEA, Tavares FG, Ferreira AA, Welch JR, Horta BL, Cardoso AM, Santos RV. Socioeconomic determinants of excess weight and obesity among Indigenous women: findings from the First National Survey of Indigenous People’s Health and Nutrition in Brazil. Public Health Nutrition. 2020;1:1-11. https://doi.org/10.1017/S1368980020000610
https://doi.org/10.1017/S136898002000061...
].

The current study has some limitations. EBIA is a validated instrument for both urban and rural populations, but not specifically for quilombolas, which may be a possible limitation to estimating FI among this population group. However, because it is a subjective measure that evaluates access to an adequate quality and quantity of food, it may be assumed that EBIA can be used to identify FI in this group as well, as other studies have observed [22 Cordeiro MM, Monego ET, Martins KA. Overweight in Goiás’ quilombola students and food insecurity in their families. Rev Nutr. 2014;27(4):405-412. https://doi.org/10.1590/1415-52732014000400002
https://doi.org/10.1590/1415-52732014000...
,33 Silva EKP, Medeiros DS, Martins PC, Sousa LA, Lima GP, Rêgo MAS, et al. Food insecurity in rural communities in Northeast Brazil: does belonging to a slave-descendent community make a difference? Cad Saúde Pública. 2017;33(4):1-14. https://doi.org/10.1590/0102-311x00005716
https://doi.org/10.1590/0102-311x0000571...
,55 Carvalho RRS, Alberto NSMC, Pereira TG. Insegurança alimentar em povos de terreiros. Arq Bras Ciênc Saúde. 2014;39(1):4-11. https://doi.org/10.7322/abcshs.v39i1.252
https://doi.org/10.7322/abcshs.v39i1.252...

6 Ribeiro G, Morais FMO, Pinho L. (In)Segurança alimentar de comunidade quilombola no norte de Minas Gerais. Ciênc Cuidad Saúde. 2015;14(3):1245-1250. https://doi.org/10.4025/cienccuidsaude.v14i3.21845
https://doi.org/10.4025/cienccuidsaude.v...

7 Gubert MB, Segall-Corrêa AM, Spaniol AM, Pedroso J, Coelho SEDAC, Pérez-Escamilla R. Household food insecurity in black-slaves descendant communities in Brazil: has the legacy of slavery truly ended? Public Health Nutr. 2017;20 (8):1513-1522. https://doi.org/10.1017/S1368980016003414
https://doi.org/10.1017/S136898001600341...
-88 Silva BMA, Silveira VNC, Padilha LL, Frota MTB. Situação de insegurança alimentar e nutricional em famílias quilombolas maranhenses. Demetra. 2020;15(e43636):1-14. https://doi.org/10.12957/demetra.2020.43636
https://doi.org/10.12957/demetra.2020.43...
,2121 Instituto Brasileiro de Geografia e Estatística. Pesquisa Nacional por amostra de domicílios: segurança alimentar 2013. Rio de Janeiro: Instituto; 2014.]. Also, as it was not part of the objective, the association between food production and FI was not investigated, which prevents us from stating whether the quilombola households investigated were food producers and whether or not this production was sufficient to cover their needs and if there was any excess production for sale.

CONCLUSION

Although Brazil is a pioneer in tackling FI and in its efforts to revert its great historical debt to its descendants of black slaves, the findings of this study indicate that inequalities of access to adequate food and hunger still persist alongside low education levels, low income, and poor sanitation in quilombola communities. There is a pressing need for food security monitoring and evaluation indicators not only in quilombos, but also in other ethnic and racial segments and minorities in Brazil, such as indigenous people. In addition, efforts to plan and implement social programs to fight hunger and encourage rural development must be maintained to minimize FI and boost the economic autonomy of these most underprivileged communities.

How to cite this article

  • Cherol CCS, Ferreira AA, Sales-Costa R. Social inequalities and household food insecurity in quilombola communities in Brazil. Rev Nutr. 2021;34:e200173. https://doi.org/10.1590/1678-9865202134e200173
  • Support: Conselho Nacional Brasileiro de Desenvolvimento Científico e Tecnológico (CNPq, Brazilian National Council for Scientific and Technological Development) (Process n. 371250/2017-0); Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES, Coordination of Superior Level Staff Improvement).
  • Article elaborated from dissertation by CCS CHEROL, entitled “Insegurança alimentar e acesso aos programas sociais em comunidades quilombolas tituladas do Brasil”. Universidade Federal do Rio de Janeiro; 2018.

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Publication Dates

  • Publication in this collection
    02 June 2021
  • Date of issue
    2021

History

  • Received
    06 June 2020
  • Reviewed
    15 Dec 2020
  • Accepted
    03 Feb 2021
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