On the Road to Better Health? Impacts of New Market Access on Food Security, Nutrition, and Well-Being in Nepal, Himalaya

The first road to be built into Humla, Nepal has connected this once-remote Himalayan region to a market in China. This dissertation research assesses the impacts of this road on villagers’ food security, diet and nutrition, and subjective well-being, and investigates the link between objective and subjective health outcomes. The primary aim of this study is to decipher whether villagers’ ‘proximity to road’ is the strongest predictor of the aforementioned health outcomes, or whether other sociocultural and economic variables play a more significant role. A mixed-methods approach and a case-control ethnographic research design were implemented in order to investigate this question. Results from the food security questionnaire indicate that due to easy accessibility and low costs, villagers now supplement their agricultural yields with enriched, processed foods obtained via the road. Although villagers perceive their current food security as being significantly higher than in years past, results indicate that food security levels do not always positively correlate with either ‘proximity to road’ or the harvest season. Nutrient composition analysis indicates that differences in both livelihood tasks and prestige ascription by gender and age yield a high variability in both dietary patterns and nutritional outcomes. These differences are also reflected in the anthropometric data, which show that while a portion of the study population is ‘underweight’, another portion is simultaneously ‘overweight’. Villagers’ subjective well-being, in addition to being defined differently from village to village, has a higher correlation with human capital levels and socioeconomic status than with ‘proximity to road’. This research illuminates the complexity involved with determining whether the introduction of a road will manifest in positive health outcomes. Using the new road in Humla District, Nepal, as a case study, this research takes advantage of a unique opportunity to study human dietary shifts as they are in the process of occurring. By assessing villagers’ decision-making patterns regarding their food consumption, the overall aim of this study is to gain an in-depth understanding of the dietary sea change that is leaving its mark on the quality of life across the globe

After the Road Came: Insights into the Nexus of Food Security and Malnutrition in Northwestern Nepal

The United Nations Decade of Action on Nutrition 2016–2025 and the 2030 Agenda for Sustainable Development call on all countries and stakeholders to work together to prevent all forms of malnutrition by 2030. In Nepal, these considerations are at the forefront of the country's Sustainable Development Goals. To aid in this effort, this article presents a case study from the mountainous Humla District, Nepal, that was designed to better understand how the arrival of the first road in this area is affecting food security and nutritional status, and how these 2 variables are interrelated. Data from participant observation, interviews, the Household Food Insecurity Access Scale questionnaire, and a region-specific food frequency questionnaire suggest that while the road provides more reliable access to market-sourced food than before, villagers' intake of many micronutrients remains below recommended levels, as most of the market-purchased foods are nutrient poor. Data also suggest that this population is experiencing the double burden of malnutrition: simultaneous cases of underweight and overweight. High food security levels among those in the malnourished/overweight group could easily mask this emerging public health concern. This study provides an analytical framework to better understand the nexus of food security and nutrition, and offers evidence-based recommendations for decreasing food insecurity and malnutrition in mountainous regions, which will help achieve the goal of preventing all forms of malnutrition by 2030