Policy & practice

Policy & practice

Riverine food environments and food security: a case study of the

Mekong River, Cambodia
Swetha Manohar,a Shauna Downs,b Sabina Shaikh,c Sithirith Mak,d Serey Sok,e Elizabeth Graham,f Lais Miachonf
& Jessica Fanzoa

Abstract Rivers are critical, but often overlooked, parts of food systems. They have multiple functions that support the food security,
nutrition, health and livelihoods of the communities surrounding them. However, given current unsustainable food system practices,
damming and climate change, the majority of the world’s largest rivers are increasingly susceptible to environmental degradation, with
negative implications for the communities that rely on them. Here we describe the dynamism and multifaceted nature of rivers as food
environments (i.e. the place within food systems where people obtain their food) and their role in securing food security including
improved diets and overall health. We also provide a conceptual framework that explain rivers as food environments within the broader
food system and describe approaches to characterizing these food environments to better inform our understanding of how they influence
food security and nutrition outcomes. Applying this framework to the Mekong River in Cambodia, we describe rivers as multifaceted wild
food environments embedded within ecosystems, sociocultural and political environments and sectors of influence. We also explain the
ways in which individual factors might influence how communities interact with this food environment. Developing and articulating
food-related, ecosystem-specific frameworks and their constructs can guide implementation of policies aimed to improve specific public
health or environmental sustainability outcomes. Our conceptual framework incorporates the multiple dimensions of rivers, which will aid
future work and public health policy framing to better describe, understand and intervene to ensure protection of rivers’ biodiversity and
ecosystems as well as food security, health and livelihoods.

than 119 million people.7 Rivers are therefore integral to food

Introduction systems and a critical resource for assuring nutritional well-
Climate change affects food security and the nutritional being and food security. Their multidimensional nature gives
well-being of populations worldwide. By 2050, an estimated them a unique position as a natural, wild food environment, a
183 million additional people will be at risk of hunger linked concept not well-characterized in the literature or in the public
directly to climate change.1 In turn, current food systems, re- health policy sphere.
sponsible for a third of total global greenhouse gas emissions, Emerging research focuses on the importance of food
hasten climate change and degradation of ecosystems leading environments as a point of convergence between food, human
to significant deforestation and biodiversity loss.2 Ecosystems beings, choice and acquisition.8,9 Environmental, economic,
are crucial components of our food system and serve as food and other shocks can affect food environments, which are dy-
environments, that is the interface at which consumers inter- namic spaces embedded in interdependent global food systems.
act with the broader food system by making choices within Characterizations of food environments have primarily focused
a physical, economic, political and sociocultural context.3 on the built food environment, such as supermarkets, corner
River ecosystems have historically provided numerous stores and kiosks. The literature remains scant on depictions
food-related benefits to humans including irrigation, livelihoods of informal and wild food environments (e.g. forests, rivers)
and as a vessel for food. Rivers can be described as nutrient as a source of food security despite the importance of these
highways across the earth’s surface, transporting sediment and environments and communities’ reliance on them, especially
water, sequestering carbon from the atmosphere, and connect- in low- and middle-income countries.10
ing and storing immense biodiversity through aquatic life. The Livelihood and income-generating activities related to riv-
flow and transportation of sediment create environments for ers are equally dynamic and include fishing, farming and trade.
cultivation (e.g. rice farming), with river deltas being one of the However, given the unsustainability of modern food systems and
world’s most agriculturally productive areas.4 Rivers support human activities coupled with climate change, 30 out of 47 of the
approximately a third of all global food production, and an es- world’s largest rivers are under threat of human water insecurity
timated 70% of freshwater from rivers is used for agriculture.5,6 and biodiversity loss ultimately linked to food productivity loss.11
In addition, in countries where consumption data is available, These unsustainable food systems have implications for food secu-
freshwater fish, primarily from inland fisheries, are estimated rity, nutrition and health for river-dependent populations. While
to be the primary animal source protein consumed by more there is broad recognition of these connections, the role of rivers

a
Global Food Ethics Policy Program, School of Advanced International Studies, 1776 Massachusetts Avenue, Washington DC, 20007, United States of America (USA).
b
Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, USA.
c
Committee on Environment, Geography and Urbanization, University of Chicago, Chicago, USA.
d
Department of Natural Resource Management, Royal University of Phnom Penh, Phnom Penh, Cambodia.
e
Research Office, Royal University of Phnom Penh, Phnom Penh, Cambodia.
f
Global Food Ethics Policy Program, Johns Hopkins School of Public Health, Washington DC, USA.
Correspondence to Swetha Manohar (email: smanoha2@​jhu​.edu).
(Submitted: 1 July 2022 – Revised version received: 14 October 2022 – Accepted: 27 November 2022 – Published online: 8 December 2022 )

140 Bull World Health Organ 2023;101:140–148 | doi: http://dx.doi.org/10.2471/BLT.22.288830

 Policy & practice
Swetha Manohar et al. Riverine environments and food security, Cambodia

Fig. 1. Conceptual framework for riverine food environments

River ecosystem
Biotic

Socio cultural and political

environment
Flow Abiotic

Geographic Sectors of influence Human

dominance capital

Governance Distribution Food environments Trade/markets Networks

Built (formal and informal)

Labor Industry Religion

Policies Individual factors

Social capital Tecnology Culture

Wild Preference Health Cultivated
Climate Collective Habitat
education Agriculture Planning Conflict
Beliefs and Knowledge
values and skills

Income Diets Time

Note: We adapted a schematic socioecological model of food environments13 to reflect riverine food environments.

as a crucial food environment in protecting tion rivers as food environments within are river-reliant can drive changes in river
against food insecurity and malnutrition is the broader food system and to reveal its ecosystems.
rarely described. This evidence gap can be broader ecosystem (Fig. 1). We selected We first considered the environmen-
conceivably attributed to the imbalance of this conceptual framework based on its tal and political aspects of rivers and food
research undertaken in high- versus low- grounding in the socioecological model environment attributes more broadly
resourced settings where urbanization and and theory, in which most of the food when adapting the original framework.
market-driven economies have given rise to environment literature is rooted.14 The Next, we considered how the unique
primarily built food environments versus framework emphasizes the multilevel attributes of rivers lend themselves to
a more heterogenous food environment linkages that ultimately impact individual- function as food environments. Table 1
typology.8,12 level dietary intake and nutrition, bringing expands the conceptual framework
This paper will expand on the dy- to focus the interrelated nature between by describing how factors included in
namism and multifaceted nature of riv- environments and people. Furthermore, each band in the model relate to river-
ers as food environments and their role this evidence-based framework situates its ine food environments. We generated
in securing food security. By using the conceptual thinking in low- and middle- Table 1 through an iterative approach
Mekong River in Cambodia as a case income country contexts and prominently where we assessed each factor for its
study, we will discuss how to understand features the wild food environment in ad- applicability to riverine food environ-
rivers as food environments, how rivers dition to the built food environment. The ments using peer-reviewed literature
underpin food security and their unique framework advances our understanding and relying on the authors’ collective
features and threats. Further, we offer two by demonstrating how rivers are pivotal interdisciplinary expertise. The river
conceptual frameworks. The first allows for food environments through which food ecosystem band (Fig. 1) is informed by
the conceptualization of rivers as a food security and healthy diets are secured river ecology literature as it relates to
environment, while the second establishes while also being shaped by and interact- food security.15,16 The literature search
a structure to assess rivers as food environ- ing with other factors. We have adapted was conducted with variations of the fol-
ments and highlights existing assessments the framework to reflect the entire river lowing terms: “wild food environments,”
that can be applied. Both frameworks can ecosystem and its constant interaction “natural food environment,” “river,” “food
be useful constructs in understanding how with the sociocultural and political environment,” “food security,” “Mekong
to develop and implement policies related environment, various sectors of influ- River,” “Cambodia,” “food environment,”
to improving food security, diets and public ence, food environments and ultimately “sustainable,” “river food ecology,” “low
health outcomes. individual-level factors and diets. These middle income countries.” We specifically
interactions can be bidirectional, whereby looked for studies that discuss rivers as
shifts in sectors of influence such as river- food environments or discuss wild food
Rivers as a food environment based livelihoods or unregulated market environments in riparian populations, as
We adapted a schematic socioecological activity can shape food environments as well as literature on the dependence on
model of food environments13 to posi- much as consumer food preferences that the Mekong River (and other rivers) as a

Bull World Health Organ 2023;101:140–148| doi: http://dx.doi.org/10.2471/BLT.22.288830 141

 Policy & practice
Riverine environments and food security, Cambodia Swetha Manohar et al.

Table 1. Conceptual description of factors outlined in the conceptual frameworks direct source of food in low- and middle-
income countries. While the table is not
Layer, factora Relevance of factors to rivers as food environments exhaustive, its relevance is supported by
the evidence reviewed to help expound
River ecosystem
factors captured and depicted in the
Biotic Living plants (algae) and creatures (fish, frogs, crocodiles, shrimp,
dolphins, geckos), soil, sediment
conceptual framework in a way that is
Abiotic Chemical and physical elements such as water, dirt, rocks, sunlight, illustrative.5,10,13,17–19 The identification,
oxygen, temperature, sand, pH organization and assessment of this in-
Climate Droughts, floods, climate change exacerbations (and detractions) of formation serve to bolster research and
extreme events, water temperature change, cyclical seasonal patterns policy considerations on river systems as
Flow Flow paths, watershed hydrology, river connectivity, flood pulse unique food environments.
ecosystem Food environments can be char-
Habitat Riparian zone, biodiverse ecological communities, human settlements acterized as built or natural, the latter
Sociocultural and political environment comprising both cultivated and wild
Collective Non-traditional knowledge, ecosystem-related traditional indigenous
food environments. Cultivated natural
education knowledge, conservation practices
Policies Energy (hydropower), conservation, environmental, water, economic, food environments make a significant
microfinance, agriculture and fishery, resettlement contribution to the diets of subsistence
Governance Transboundary cooperation, resource management, Mekong River farmers and rural communities through
Commission the production of staple crops, supple-
Geographical GDP, economic power, political power mental gardens that produce fruits and
dominance vegetables, and the rearing of livestock
Human capital Employment in fisheries, aquaculture, and all river-related activity and aquaculture, and utilization of their
(trade, processing, boat builders and maintenance, etc.), within country
by-products, such as eggs and milk.
migration away from rural areas (to cities for factory and construction
work) Cultivated food environments are often
Networks Intergovernmental organizations (Mekong River Commission), dependent and intrinsically linked with
conservation groups, community fishery groups, worker groups and wild natural food environments, which
unions, agriculture cooperatives, rural-urban migration networks include forests, jungles, rivers and lakes.
Religion Sacred areas, ritual space and practices (e.g. Hinduism, Buddhism, These environments are particularly im-
Animism) portant for increasing access to nutrient-
Culture Folk narratives, river-related place-based identities, principles, norms rich foods, including animal source
and values, indigenous meaning-making related to rivers, origins of
foods, leafy greens and other vegetables
civilizations (Khmer civilizations of 800 AD), recreation
Conflict Drug trade, land ownership, illegal fishing, damming, water access rights and fruits,19 and can increase resilience
Sectors of influence of households to shocks.20,21 Rivers act
Agriculture Fisheries and aquaculture, staple crop (rice), irrigation as wild food environments from which
Labour Labour migration away from rural fishing-related economies or river- food (fish and edible aquatic plants) is
based livelihoods procured,22 but also as cultivated food
Distribution River transportation of commodities including food, medicine environments where staple crops are
Trade/markets River trade of goods and services, barter of river-related products grown. The riverbanks can serve as in-
Industry Construction, milling and/or processing, hydroelectric power, food formal built food environments (habitual
processing, food safety wet markets and mobile fish vendors) as
Technology Satellite imagery for river planning, agriculture and aquaculture
well as formal built food environments
technology
Planning Urban planning, river basin planning where restaurants are situated. But river
Food environments bodies also serve as a space for selling
Wild River, such as fish, river plants and other animals foods and allow for trade and transporta-
Built (formal) Riverside restaurants and kiosks tion of food. As such, they cut across the
Built (informal) Kiosks and food stalls along riverbanks, floating markets, river vendors different food environment types and the
Cultivated Horticulture, such as home gardens, rice paddies, fisheries, aquaculture, food system itself. From a public health
irrigation for cultivation policy standpoint, understanding the dy-
Individual factors namic role of rivers as food environments
Income Employment in agriculture, fisheries, aquaculture, forestry and other river- is critically important in determining
based jobs and livelihoods
where, when and how to act to not only
Beliefs and values Intergenerational river communities, sense of place and identity with
land, indigenous value systems related to rivers, water purity protect food security and diets, but to
Preferences Personal taste and preferences for aquatic plants and animals instil resilience of the rivers themselves
Social capital Place-based social networks that allow reciprocity and exchanges as important food sources.
Health Human health, access to clean water and sanitation, morbidities
Knowledge and Formal and informal training, skills for using and/or managing river
skills systems and resources, culinary skills The case study
Time Time allocation, restrictions and burdens The Mekong River traverses south-east
Diets Contribution of river plants and creatures to diets and nutrition, macro- Asia and is shared by six countries –
and micronutrient content of river plants and creatures
Cambodia, China, Lao People's Demo-
GDP: gross domestic product. cratic Republic, Myanmar, Thailand
a
Layers are illustrated in Fig. 1 and listed from distal to proximate.
and Viet Nam – where approximately

142 Bull World Health Organ 2023;101:140–148| doi: http://dx.doi.org/10.2471/BLT.22.288830

 Policy & practice
Swetha Manohar et al. Riverine environments and food security, Cambodia

65 million people live in its basin.23 In cultivated and informal built food en- social incoherence.34 Globally, maternal
Cambodia, the river splits the country, vironment. Total fisheries production is education is positively associated with
flowing over 500 km, and comprises 39 estimated at 9.5 million metric tonnes of both the mother’s own and her child’s
river basins. Nearly 80% of the country’s fish in 2018 which include capture fish- dietary intake, a relationship that can be
16.7 million people rely on the basin for eries and aquaculture products.27 These modified with food availability.35 Time
their livelihoods and other resources.23 yields support an average annual con- allocation, especially women’s time and
The Mekong River connects with the sumption of approximately 63 kg/capita restrictions placed on their time, have
Tonle Sap Lake which, with its unique in Cambodia in contrast to 20 kg/capita been associated with poor child feeding
flood pulse hydrology, functions as the worldwide.28 The distinctive flood pulse practices and the mother’s own quality of
largest inland fishery in the world. 17 system of the Mekong River and Tonle diet.36 In recent decades, the dramatic in-
Currently, Cambodia’s food systems Sap Lake is responsible for production of crease in migration of women from rural
are transitioning – they are expanding three quarters of the country’s dominant areas to cities has affected both women’s
and transforming, moving away from agricultural product, rice.29 and children’s diets. Ultimately, these
smallholder self-sufficiency agriculture Wild foods frequently harvested individual factors can shape Cambodian
to more significant commercial produc- for consumption include snails, frogs, diets, which are usually comprised of
tion. However, with 75% (12.7 million) prawns, crabs, insects, waterbirds and rice and fish as a primary protein source,
of the Cambodian population still living aquatic plants.30 The proportion to which both of which are river dependent. White
in rural areas, the Mekong River and its river wild foods contribute to the overall fish (trey riel) commonly used to make
tributaries remain crucial to ensuring caloric and nutrient intake of the Cambo- fish paste (prahok) creates an affordable
the country’s food security. dian population is not well characterized, animal protein with a longer shelf life.
The downstream impacts of hy- however, an estimated >90% of house- These interactions of individual factors
dropower dam construction on the hold catch of aquatic plants and animals with riverine food environments to sup-
Mekong River include altered water (besides fish) is consumed by household port food acquisition are important in a
and sediment flow to the delta.24 The members.30 Beyond cultivation, the sale of context where the burden of malnutri-
alterations to the biophysical and hydro- food harvested from the river along with tion and food insecurity is high.37 For
logical system have significant effects other types of food items (including pro- example, in 2021, during the coronavi-
on agricultural and fishery production, cessed foods) are sold on and around the rus disease 2019 pandemic, estimates
particularly for small-scale operators river in both informal and formal markets. of household food security revealed
who are already constrained by the lack Individual factors that interact with that 32% of households experienced
of resources and political agency, and both the river as a food environment and moderate and/or severe food insecurity,
threaten their livelihoods and agricul- dietary intake include values and beliefs, with the poorest households carrying
tural ways of life.24 income, social capital, health, knowledge, a disproportionate burden. Among the
The Mekong River Commission, es- skills and time. Cultural practices and poorest households, an estimated 55%
tablished in 1995, provides a framework celebrations, including the Water Festival experienced such food insecurity.38
to promote cooperation in the region, and other religious customs, reflect belief When considering the more distal
including through data collection to and value systems at the individual and layers of the conceptual framework, the
facilitate river management.25 However, broader community level. literature shows evidence of different con-
the commission is limited in its capacity The reliance of the rural Cambo- textual factors in Cambodia influencing
due to the lack of membership of key up- dian population on the Mekong River the Mekong River and its tributaries as a
stream countries, including China, and for their livelihood and food security is food environment. Sectors of influence,
the mode of cooperation is not legally high: approximately 80% of river com- given their relationship with the Mekong
binding. Thus, governments may ignore munities directly rely on the river and River, are the agricultural, labour, markets,
the commission’s recommendations if lake for food and livelihoods and 45% of distribution, industry and technology
they impede governmental plans. For its households undertake fishing-related sectors in Cambodia. Rice farming and
example, not all Mekong River Com- income activities.31 Increasingly, Tonle fisheries livelihoods have been critical
missions’ member states have been Sap Lake communities have experienced contributors to gross domestic product
transparent about dam development.26 reductions in catch quantity due to over- growth since the 1990s.39
Further, other regional cooperation fishing and ecological threats, but have The sociocultural and, especially,
agreements, such as the frameworks limited access to resources for adapting the political environment of the Mekong
of the Mekong-Lancang Cooperation to the situation.32 Opportunities exist River, is complex. There are currently an
and Mekong-Republic of Korea Coop- to assess the sustainability attributes of estimated 132 hydropower dams built,
eration, are at times at odds with the riverine food environments that reflect under construction or planned on the
commission and undermine its efforts.25 adaptive practices to climate and liveli- tributaries of the lower Mekong River.40
hood changes. Other individual factors While electrification is critical for Me-
Applying the framework
include social capital; the links between kong River populations, there are ques-
We expand our evaluation of the Mekong social capital and food security are tions of how to reconcile electrification
River as a food environment, starting well-established,33 but there is limited projects with trade-offs of sustainable
at the band of food environments itself evidence in the Cambodian context. development, displacement and other
(Fig. 1), and discuss its interaction with Of note, low accessibility to both social risks to populations living downstream
individual factors and the diets of the and human assets among lower Mekong of the dams. The construction of up-
Cambodian population. As described River communities has impeded liveli- stream dams in both China and Lao
earlier, the river functions as a wild, hood strategies, which has resulted in People's Democratic Republic has di-

Bull World Health Organ 2023;101:140–148| doi: http://dx.doi.org/10.2471/BLT.22.288830 143

 Policy & practice
Riverine environments and food security, Cambodia Swetha Manohar et al.

rectly affected water levels by restricting regional cooperation are the major chal- while significant increases in popula-
water flow, removing the anticipated lenges in the transboundary Mekong tions living in the lower Mekong area has
seasonality of the rise and fall of water River basin governance.42 put pressure on natural resources in the
levels and blocking fish from upstream Finally, the river ecosystem com- region. A shift has begun, moving away
movement and sediment flow.24,41 Pro- prises factors that reflect biotic, abiotic, from smallholder farming towards more
jected production loss alone on capture climate, flow and habitat features of this industrialized, specialized agriculture
fisheries in Cambodia is between 40% ecosystem. Climate change is altering the and cash crop systems, and farmers mov-
and 57% by 2030.28 This loss would im- Mekong ecosystem in various ways in- ing towards off-farm livelihoods.48 Geo-
ply anywhere between 6.4 million and cluding its hydro-ecological conditions, physical and anthropogenic forces have
21.1 million people losing their main sediment and nutrient flux, and vegeta- altered the agro-ecological landscapes
protein source.28 Without reliable river tion growth43,44 as well as the ability to of the basin, which has seen increasing
flows, seasonal food insecurity and a harvest and grow food in and around the deforestation due to forest-cover change
decline in agricultural productivity can Mekong River.45 Extreme droughts and and land-use conversion from forests to
affect an estimated 70% of inhabitants floods have devastating consequences farmland.49 Unsustainable agricultural
of river communities that rely on the on the ecology of the river with future practices have also been linked to dra-
river for fisheries livelihoods and food scenarios projecting increased risks of matic habitat loss over the past 10 years
cultivation.40 Conflict over water rights, both.46,47 Human activities in and along (2300 km2 of seasonally flooded habitat
illegal fishing practices and inconsistent the river have affected flow dynamics, was lost to agriculture, with another

Fig. 2. Key elements of multidimensional riverine food environments

Informal food
vendors on the
Quantity of fresh river (no. Food
vs. farmed fish and type) imports
Annual food from the river in transported
production markets on river

Natural food
Attributes of environment
availability (rivers) Attributes of
convenience

Food
environments Cost of
Attributes of Attributes of locally
promotion affordability produced
Labeling crops
(fresh vs.
farmed) Time burden
of catch during
Attributes of Attributes of peak fishing
sustainability quality Cost of river season
User rights fish relative to
to common farmed fish
goods

Nutritional
Average Biodiversity
quality of
Governance of annual of the river
river fish
rivers (overfishing rainfall
practicies, hydro
dams) River
River water salinity
level average in
Functional relation to long
community term average
fisheries

144 Bull World Health Organ 2023;101:140–148| doi: http://dx.doi.org/10.2471/BLT.22.288830

 Policy & practice
Swetha Manohar et al. Riverine environments and food security, Cambodia

400 km2 recently burnt), almost twice policies. Such policies can improve
what was predicted (1300 km2) to occur those attributes to promote healthy
Conclusion
between 2010–2040.50 In addition, Cam- and sustainable dietary choices and If we are to understand how to produce,
bodia faces the highest forest loss and options for populations. For example, acquire and consume food within plan-
deforestation rates among all countries the attributes of quality shows how bio- etary boundaries to support nutritional
in the Mekong basin, due to illegal log- diversity is crucial for rivers to be fully well-being, we cannot do so without
ging, with significant negative impacts functional food environments. Public characterizing and protecting ecosys-
on floodplain productivity.49 health policy-makers can inform and tems-based food environments that serve
collaborate with agriculture and fisher- as a critical interface for food acquisition
ies ministries to ensure biodiversity of within larger systems. Rivers contribute
Assessing river food rivers; this protection and promotion of in multiple ways to food security, diets
environments biodiversity can positively affect health. and nutrition outcomes. In some areas
The dynamic nature of these riverine of the world, such as the Mekong River
Policy-makers need new tools to under- food environments adds an additional basin, rivers are critical for food security
stand how riverine food environments challenge in that they are kinetic, they and the livelihoods of millions of people.
are changing, the impacts on food change markedly based on the season While rivers have been deeply
security and diets, and how and where and they are heavily influenced by cli- studied, we know much less about
to intervene in the context of climate mate variability and change.13,19,42 This rivers when framed as dynamic food
change. The framework in Fig. 2 illus- variability makes measuring aspects of environments. What we do know is that
trates the types of interdisciplinary as- sustainability and temporal features of key attributes of rivers provide critical
sessments that exist to evaluate riverine these environments even more critical. contributions to multiple sustainable
food environments.10,13 We highlight the Fig. 1 and Fig. 2 recognize the rela- development outcomes. When framing
six main attributes of food environments tionships, effects and trade-offs across rivers as food environments, assessments
typically used for food environment as- the full riverine food environment need to be multilevel, multisectoral and
sessment: (i) availability; (ii) affordabil- system, and all the domains and dimen- interdisciplinary to adequately describe,
ity; (iii) convenience; (iv) promotion; sions of those relationships. Without understand and identify points of policy
(v) quality; and (vi) sustainability, and a clear framing of those relationships and programmatic interventions. This
illustrate the corresponding measure- and a conceptual understanding of framing is to ensure that biodiversity
ments.3,13,21,51 While tools may exist to where to intervene, it is challenging to and ecosystems of rivers are protected,
assess certain (not all) attributes, these account for the system dynamics and as well as to improve human food secu-
assessments have not been conducted complexities and act across a range rity and livelihoods. To undertake such
in a holistic manner for riverine food of policy interventions. Despite the assessments, more tailored information,
environments.13 This lack of assessment existence of many food system frame- approaches and tools are needed to
may relate to the complexity and breadth works for policy-makers, very few have assess their dynamic nature. The as-
of such assessments. Given the unique- incorporated ecosystems into them, sessment should include not only their
ness of riverine food environments, their and even fewer incorporate the role of contributions to healthy diets, but to
assessment requires a multitude of tools rivers, which are crucial ecosystems for environmental sustainability and resil-
from various disciplines not limited to food security.31 The application of the ience and the overall management of
ecology, hydrology, economics, food sci- frameworks presented here allows for an this critical natural resource relied upon
ence, public health and nutrition. These approach to monitoring rivers and ad- by communities living near or in these
attributes are influenced by macrolevel vocating their protection, management environments. Further, articulating the
factors (Fig. 1) and river ecosystems and utilization with greater purpose for pathways by which economic, social and
themselves that respond to climatic food security and nutritional well-being. environmental policy interventions affect
change and other stressors. Understand- Further policy implications include pay- riverine food environments is important
ing the availability, quality, affordability, ing greater attention to the downstream for assessment refinement and for course
convenience, promotion, and sustain- effects of energy planning including the corrections to ensure trade-offs that cre-
ability attributes of food environments pathways by which dam construction ate adverse impacts on rivers and riverine
(Fig. 2) can help public health policy- and land use decisions alter hydrology communities are minimized. ■
makers and practitioners in developing, and drive food insecurity across borders
prioritizing and implementing localized and jurisdictions. Competing interests: None declared.

‫ملخص‬
‫ كمبوديا‬،‫ دراسة حالة لنهر ميكونج‬:‫البيئات الغذائية النهرية واألمن الغذائي‬
‫ مع ما يرتتب عىل ذلك من آثار سلبية عىل‬،‫متزايد للتدهور البيئي‬ ‫ ولكن غال ًبا ما يتم‬،‫متثل األهنار أجزا ًء مهمة من النظم الغذائية‬
‫ نحن هنا نصف الديناميكية والطبيعة‬.‫املجتمعات التي تعتمد عليها‬ ،‫ فيوجد لدهيا وظائف متعددة تدعم األمن الغذائي‬.‫جتاهلها‬
‫املتعددة األوجه لألهنار كبيئات غذائية (أي املكان املوجود يف النظم‬ .‫ وسبل العيش يف املجتمعات املحيطة هبا‬،‫ والصحة‬،‫والتغذية‬
‫ ودورها يف تأمني‬،)‫الغذائية حيث حيصل الناس منه عىل طعامهم‬ ‫ وبناء‬،‫نظرا ملامرسات النظام الغذائي غري املستدامة احلالية‬
ً ‫إال أنه‬
.‫ والصحة العامة‬،‫األمن الغذائي بام يف ذلك النظم الغذائية املحسنة‬ ‫ فإن غالبية أكرب أهنار العامل معرضة بشكل‬،‫ وتغري املناخ‬،‫السدود‬

Bull World Health Organ 2023;101:140–148| doi: http://dx.doi.org/10.2471/BLT.22.288830 145

 Policy & practice
Riverine environments and food security, Cambodia Swetha Manohar et al.

‫باألغذية واخلاصة بالنظم اإليكولوجية وبنياهتا إىل توجيه تنفيذ‬ ‫أيضا إطار عمل مفاهيمي يرشح األهنار عىل أهنا بيئات‬ً ‫نحن نقدم‬
‫السياسات اهلادفة إىل حتسني نتائج حمددة تتعلق بالصحة العامة أو‬ ‫ ويرشح أساليب لتوصيف هذه‬،‫غذائية ضمن نظام غذائي أوسع‬
‫ يشتمل إطار العمل املفاهيمي لدينا عىل األبعاد‬.‫االستدامة البيئية‬ ‫البيئات الغذائية لتوعية فهمنا بشكل أفضل لكيفية تأثريها عىل‬
‫ والتي سوف تساعد العمل املستقبيل وتأطري‬،‫املتعددة لألهنار‬ ‫ بتطبيق إطار العمل هذا عىل هنر‬.‫األمن الغذائي ونتائج التغذية‬
،‫سياسات الصحة العامة من أجل وصف وفهم وتدخل أفضل‬ ‫ نحن نصف األهنار عىل أهنا بيئات غذائية‬،‫ميكونج يف كمبوديا‬
‫ وكذلك‬،‫لضامن محاية التنوع البيولوجي والنظم البيئية لألهنار‬ ‫ والبيئات االجتامعية‬،‫ مدجمة يف النظم البيئية‬،‫برية متعددة األوجه‬
.‫ وسبل العيش‬،‫ والصحة‬،‫األمن الغذائي‬ ‫أيضا الطرق‬ً ‫ نحن نوضح‬.‫ وقطاعات التأثري‬،‫والثقافية والسياسية‬
‫التي قد تؤثر هبا العوامل الفردية عىل كيفية تفاعل املجتمعات مع‬
‫ يمكن أن يؤدي تطوير وتوضيح األطر املتعلقة‬.‫هذه البيئة الغذائية‬

摘要
河流流域的食物环境与食物安全问题 ：一项柬埔寨湄公河的案例研究
河流是食物系统的重要组成部分，但往往被人们忽视。 此框架应用于柬埔寨的湄公河流域，我们将河流定义
它们具有维持周围社区的食物安全、营养、健康和生 为嵌入生态系统、社会文化和政治环境及其所影响部
计的多种功能。然而，鉴于目前不可持续的食物系统 门的多面性野生食物环境。我们还解释了个别因素可
实践、筑坝和气候变化，世界上大多数大河越来越容 能如何影响社区与食物环境相互作用的方式。制定和
易受到环境退化的影响，对依赖这些河流的社区产生 阐明与食物相关的特定生态系统框架及其结构，可以
了负面的影响。在这里，我们介绍了河流作为食物环 指导旨在改善特定公共卫生或环境可持续发展状况的
境（即食物系统中人们获取食物的地方）的活力和多 实践。我们的概念框架纳入了河流的多个维度，这将
方面性，以及它们在确保食物安全（包括改善人们饮 有助于未来开展工作和制定公共卫生政策的框架，以
食和总体健康）方面所起的作用。我们还提供了一个 便更好地描述、理解和实施干预，确保河流的生物多
概念框架，解释了河流在更广泛的食物系统中作为食 样性和生态系统以及食物安全、人类的健康和生计得
物环境的作用，并介绍了描述这些食物环境的方法， 到保护。
以更好地了解它们如何影响食物安全和营养状况。将

Résumé
Environnements alimentaires fluviaux et sécurité alimentaire: étude de cas portant sur le fleuve Mékong, au Cambodge
Souvent négligés, les cours d'eau jouent pourtant un rôle vital dans que nous puissions mieux comprendre l'influence qu'ils exercent sur
les systèmes alimentaires. Ils remplissent de nombreuses fonctions la sécurité alimentaire et la nutrition. En appliquant ce cadre au fleuve
qui contribuent à la sécurité alimentaire, à la nutrition, à la santé et aux Mékong, au Cambodge, nous dévoilons les multiples facettes de ces
moyens de subsistance des communautés avoisinantes. Toutefois, en environnements alimentaires naturels variés qui font partie intégrante
raison d'un système alimentaire actuel aux pratiques non durables, de des écosystèmes, des milieux politiques et socioculturels, mais aussi des
la construction de barrages et du changement climatique, la plupart sphères d'influence. Nous expliquons en outre la façon dont certains
des grands fleuves et rivières du monde sont de plus en plus exposés facteurs individuels sont susceptibles d'interférer dans les interactions
aux dégradations environnementales, avec des conséquences néfastes que les communautés entretiennent avec cet environnement
pour les communautés qui en dépendent. Dans le présent document, alimentaire. Développer et formuler des cadres et structures liés à
nous évoquons le dynamisme et les multiples facettes des cours d'eau l'alimentation, propres à chaque écosystème, peut orienter la mise en
en tant qu'environnements alimentaires (c'est-à-dire l'endroit où les gens œuvre de mesures visant à améliorer des résultats spécifiques dans le
se procurent de la nourriture au sein d'un système alimentaire), ainsi que domaine de la santé publique ou de la préservation de l'environnement.
la manière dont ils favorisent la sécurité alimentaire, notamment par le Notre cadre conceptuel inclut les différents aspects des cours d'eau, ce
biais d'un régime plus équilibré et d'une meilleure santé en général. qui aidera à mener de futurs travaux et à élaborer des politiques de santé
Nous fournissons également un cadre conceptuel qui définit les cours publique pour mieux les qualifier, les appréhender et intervenir en vue
d'eau comme environnements alimentaires au sein d'un système plus d'assurer la protection de la biodiversité et des écosystèmes fluviaux
vaste et décrit les approches caractérisant ces environnements, afin ainsi que la sécurité alimentaire, la santé et les moyens de subsistance.

Резюме
Реки как продовольственная среда и продовольственная безопасность: исследование на примере реки
Меконг, Камбоджа
Реки являются важнейшей, но часто упускаемой из виду зарегулирования стока плотинами и изменения климата
частью продовольственных систем. Они выполняют множество экологическое состояние большинства крупнейших рек мира
функций, способствующих обеспечению продовольственной постоянно ухудшается, что негативно сказывается на зависящих
безопасности, питания, здоровья и средств к существованию от них сообществах. В этой статье описывается динамизм
окружающих их сообществ. Однако в условиях существующих и многогранность рек как продовольственной среды (то
неэкологичных практик в продовольственной системе, есть как места в продовольственных системах, откуда люди

146 Bull World Health Organ 2023;101:140–148| doi: http://dx.doi.org/10.2471/BLT.22.288830

 Policy & practice
Swetha Manohar et al. Riverine environments and food security, Cambodia

получают пищу) и их роль в обеспечении продовольственной то, как сообщества взаимодействуют с этой продовольственной
безопасности, включая улучшение рациона питания и общего средой. Разработка и разъяснение схем и концепций, связанных с
состояния здоровья. Также представлена концептуальная схема, продуктами питания в конкретных экосистемах, могут определять
в которой реки рассматриваются как продовольственная среда реализацию политики, направленной на улучшение конкретных
в рамках более широкой продовольственной системы, и описаны результатов в области общественного здравоохранения или
подходы к определению характеристик этой продовольственной экологической устойчивости. Разработанная концептуальная
среды для лучшего понимания ее влияния на продовольственную схема включает в себя многочисленные показатели состояния
безопасность и результаты в сфере питания. Применяя эту рек, что поможет в ходе дальнейшей работы и разработки
схему к реке Меконг в Камбодже, авторы описывают реки как политики в области общественного здравоохранения добиться
многогранную среду обитания диких продовольственных лучшего описания, понимания и вмешательства в целях
ресурсов, встроенную в экосистемы, социокультурную обеспечения защиты биоразнообразия и экосистем рек, а также
и политическую среду и секторы влияния. Авторы также обеспечения продовольственной безопасности, здоровья
объясняют, каким образом отдельные факторы могут влиять на и средств к существованию.

Resumen
Entornos alimentarios ribereños y seguridad alimentaria: estudio de caso del río Mekong en Camboya
Los ríos son partes fundamentales de los sistemas alimentarios, pero mejor cómo influyen en los resultados de la seguridad alimentaria y
con frecuencia se ignoran. Tienen múltiples funciones que favorecen la la nutrición. Mediante la aplicación de este marco al río Mekong en
seguridad alimentaria, la nutrición, la salud y los medios de vida de las Camboya, se describen los ríos como entornos alimentarios silvestres
comunidades que los rodean. Sin embargo, dadas las actuales prácticas multifacéticos integrados en ecosistemas, entornos socioculturales y
insostenibles del sistema alimentario, la construcción de embalses y políticos y sectores de influencia. Además, se explican cómo los factores
el cambio climático, la mayoría de los ríos más grandes del mundo individuales pueden influir en la interacción de las comunidades con este
son cada vez más susceptibles a la degradación medioambiental, con entorno alimentario. El desarrollo y la articulación de marcos específicos
implicaciones negativas para las comunidades que dependen de ellos. de los ecosistemas relacionados con la alimentación y sus constructos
En este documento, se describe el dinamismo y la naturaleza polifacética pueden orientar la aplicación de políticas destinadas a mejorar
de los ríos como entornos alimentarios (es decir, el lugar dentro de los determinados resultados en materia de salud pública o sostenibilidad
sistemas alimentarios donde las personas obtienen sus alimentos) y su medioambiental. El marco conceptual que se presenta incorpora las
función para garantizar la seguridad alimentaria, incluida la mejora de múltiples dimensiones de los ríos, lo que ayudará en futuros trabajos y
los hábitos alimentarios y la salud en general. Asimismo, se proporciona en la formulación de políticas de salud pública a describir, comprender
un marco conceptual que explica los ríos como entornos alimentarios e intervenir mejor para asegurar la protección de la biodiversidad y los
dentro del sistema alimentario en su conjunto y se describen enfoques ecosistemas fluviales, así como la seguridad alimentaria, la salud y los
para caracterizar estos entornos alimentarios con el fin de comprender medios de subsistencia.

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