In this study, we evaluated the relationship between perceptions of social cohesion among individuals in a neighborhood and the level of food insecurity among adult individuals living in a healthcare region in the city of Porto Alegre/RS. The results showed that half of the study population was in a state of FI. In addition, social cohesion was associated with the outcome, and those individuals who reported more positive perceptions of social cohesion in their neighborhood were less likely to experience FI than were those who did not report such perceptions.
The level of prevalence of FI in the study sample (51.2%) was higher than that found in the 2017–2018 Household Budget Survey (36.7%) (4) but was similar to that found in the 2nd National Survey on Food Insecurity in the Context of the Covid-19 Pandemic in Brazil, the prevalence rates of which were 58.7% in Brazil in general and 47.6% in the state of Rio Grande do Sul in 2022 (5, 6). The fact that FI is more prevalent in women, in the youngest individuals, in those individuals with lower income and education levels, and in larger families is in agreement with the observations in the scientific literature, which has consistently demonstrated that these sociodemographic and economic factors are present in relation to FI in several countries around the world (5, 32, 33). Brazil is a country with high rates of social inequalities and whose processes result in the asymmetric distribution of resources and opportunities, limiting the right to access adequate and healthy food among different societal groups. It is estimated that 6 out of 10 households whose head of household is a woman, for example, experience some degree of FI in Brazil (5). In this sense, income, poverty, family composition and low levels of education are the determining factors and drivers of FI (34). The chances of individuals or population groups experiencing FI are reduced when there is an increase in the amount of monetary resources, with education being a factor that allows for an increase in the average income of individuals, while the presence of a larger number of individuals in the household favors a greater commitment of resources than does the presence of a smaller number of individuals in the household (35).
As in our study, individuals with lower income and education levels experience a greater degree of FI in Brazil (5). Younger individuals and households with children under 18 years of age seem to experience a higher degree of FI in studies conducted in different regions of the country (36–38). These data reinforce the idea that larger families with children and adolescents who do not yet contribute financially to household expenses have limited resources for the acquisition of basic items for survival. Thus, for individuals, receiving a social benefit may contribute to weaker fluctuations in household income, being a factor protecting against FI, expanding access to food, and favoring an improvement in the quality of the diets of individuals (37–39).
We also found that individuals with more positive perceptions of social cohesion in the neighborhood were less likely to experience FI. In a study conducted with women in California, Denney et al. (2017) showed that those women with low-level perceptions of social cohesion in the neighborhood were approximately 50% more likely to experience FI than were other women (15). Additionally, in a longitudinal study conducted in rural areas of South Carolina, a 24% higher risk of FI was identified in those individuals with lower-level perceptions of social cohesion in the neighborhood (16). Thus, social cohesion can be considered an important factor protecting against FI because, as in the present study, the data in the literature confirm the inverse association between these elements.
The inverse relationship between social cohesion and FI has been explained through multiple and complex social interactions. Cohesive communities result in greater amounts of social capital, that is, resources to prevent, face, and overcome situations of vulnerability (40, 41). These resources translate into cooperative behaviors among individuals, strengthening informal networks of credit, support, and social leverage and expanding empowerment and problem-solving skills, which can act as important strategies for coping with FI (15, 16, 42).
A greater degree of social cohesion may favor the sharing of supplies among peers and the construction of resource-generating spaces, such as community gardens, which are maintained and strengthened through small efforts by each participant in the relationship network. In addition, facilitating access to food through informal help, either by sharing financial resources or by direct food donations, allows for a greater degree of stability in terms of permanent food security (43).
Some studies have also indicated that the relationship between social cohesion and FI may be associated, even partially, with mental health issues (44, 45). Systematic review and meta-analysis studies have shown that FI is associated with several negative mental health outcomes, including the enhanced risk of depression and stress (46, 47). This effect seems to be activated by mental distress, anticipated stigma, shame, strategies for purchasing food considered to be socially unacceptable and uncertainty about the ability of individuals to meet their own food needs and those of their families (48–50). In addition, the poor nutrient profile of the diets of individuals experiencing FI may contribute to the greater degree of prevalence of mental disorders in this population (51) through several biological mechanisms, such as, for example, the processes of inflammation, oxidative stress, tryptophan availability and metabolism (52). Thus, social cohesion can act positively by decreasing the likelihood of individuals experiencing FI and favoring collective transformations in the physical and social spaces of neighborhoods.
In our study, we also found that older individuals who received some type of social benefit, such as retirement, pension, or CPB, perceived a greater degree of cohesion in their neighborhood. This result may indicate that the older portion of the population has more established socioeconomic conditions than does the younger population, as well as the fact that the individuals in this population receive social benefits, whether transitory or fixed, a factor that contributes to the financial stability of families. When investigating the contribution of social cohesion to individual well-being considering income inequality, Delhey and Dragolov (2016) showed that income inequality weakens social cohesion among individuals (53). Furthermore, Child et al. (2020) showed that compared to lower-income individuals, those individuals with higher income levels reported a greater degree of social cohesion among their neighbors and that they received greater social support from them (54).
Individuals with higher education and income levels seem to have greater access to connections with people from different professions, expanding their possibilities for problem solving and social leverage (54). These results agree with the data of our study, which, although not significant, showed that individuals with higher income levels had more positive perceptions of social cohesion in their neighborhood. Thus, there is inequality in access to social cohesion based on socioeconomic status, which may favor lower-income individuals in terms of living in more vulnerable neighborhoods with a larger number of social conflicts, hindering the construction of strong social bonds (14–17).
The present study has some limitations. First, the temporality between exposure and outcome cannot be guaranteed because this is a cross-sectional study. In addition, despite the care taken to mitigate selection bias by alternating the sexes in each household, women are represented in greater numbers in the final sample than are men. In addition, we use the measure of individual perception of neighborhood aspects, which may differ from reality in this community. However, the associations found can be generalized to other population groups, given the presence of similar causal mechanisms between exposure and outcome.
To the best of our knowledge, this study is unprecedented, as it is a pioneer in Brazil in attempting to understand the relationship between the community social environment and FI while contemplating individuals' self-perceptions of social cohesion. This study reinforces the hypothesis that processes now considered strongly related to the individual component are also a reflection of the community component. We suggest future investigations relating these elements to a better understanding of the factors involved, including other population groups. In addition, the effectiveness of actions to strengthen social cohesion, for example, in the community construct, is a topic that should be further explored.
This study finds an independent association between individuals' perceptions of the degree of social cohesion in the community and FI in a population with a high prevalence of food insecurity. These findings reinforce the importance of considering aspects of the environment when designing programs and public policies to combat FI. In addition, projects that expand and strengthen social ties between individuals and groups, favoring trust, a sense of belonging, cooperation, and tolerance among its members and expanding action in the face of social injustice and the engagement of organized civil society are essential for overcoming FI and building spaces that promote both health and citizenship.