Assessing the impact of the food system on poverty, nutrition and health, and environmental sustainability in urban Ethiopia

Abstract

Food systems have enormous implications for human health and wellbeing and planetary health. They involve a complex set of factors from farm to table. A greater understanding of the effects of food systems on nutrition, health, poverty, and the environment is necessary to inform the development of optimal food systems that can improve human nutrition and health, promote sustainable environments, and support livelihoods. The intersection of these areas is particularly crucial in fragile states where food security plays an important role in poverty alleviation, social cohesion, and national security. Understanding how food systems can be optimized to improve food security, nutrition, and livelihoods may have important implications for transitioning countries and populations toward greater stability.

We propose to conduct an assessment of a developing country food system and its effects on nutrition, health, and the environment, in the context of rapid urbanization and fragile governance structures. Food security, including both quantity and quality of diets, is an important determinant of poverty and economic development. While food security has been a priority for many developing countries, policies aimed at increasing crop yields have rarely been aligned with nutritional and health needs. Malnutrition is responsible for nearly half of all child deaths. At the same time, obesity and noncommunicable diseases like heart disease, diabetes, and cancer, are increasing-often in the same communities where undernutrition remains prevalent. This double burden of malnutrition is increasing in much of sub-Saharan Africa and is exacerbated by rapid rates of urbanization.

Food systems are both impacted by the natural environment and also a cause of its degradation. Agricultural production is placing increased pressure on the environment as it struggles to keep pace with population growth and shifts. Current trends of unsustainable resource consumption are harming our planetary health, threatening food security, and impacting our wellbeing.

There is little evidence connecting food systems, poverty, human health, and the natural environment. The complexity of these issues has hindered research in this area and existing dietary data does not comprehensively capture relevant food system factors.
The proposed study will look at production, access, and consumption of protein source foods, including both animal-source and plant-based sources. Protein is essential for human health, and different sources offer varying nutritional and health benefits. The production of these foods also has enormous impacts on the environment, such as greenhouse gas emissions and water pollution.

We propose mixed methods including a quantitative household survey and qualitative value chain analysis to assess the food system for protein source foods among an urban population in Addis Ababa, Ethiopia. Review (and updating where necessary) of systematic reviews and meta-analyses will be used to estimate etiological effect sizes on health and environmental outcomes. Results will be used to develop a conceptual model that will allow us to test interventions toward optimal planetary health. Ultimately, we will form recommendations for immediate action and future research that will be of relevance for a wide range of stakeholders in Ethiopia and other sub-Saharan African countries.

The relationships between food systems, the environment, and health in sub-Saharan Africa are exceedingly complex and have not been studied in detail. A clear understanding of these dynamics will allow us to develop potentially groundbreaking, long term solutions. There is perhaps no issue more pressing for global populations than the establishment of resilient food systems that promote health, nutrition and sustainable environments.

Planned Impact

Findings from the proposed research and the new thinking it inspires will benefit vulnerable populations in rapidly growing developing countries, promoting improved environments, health and wellbeing. Poverty and development, diets and nutrition, and planetary health are all intertwined, and complicated by fragile states and rapid urbanization. Identifying means to optimize food systems in a way that will improve not only food security, but dietary quality and health, while also addressing livelihoods and ensuring environmental sustainability, presents a significant challenge with enormous consequences. Successful solutions to these new and pressing issues have the potential to promote quality of life, health and wellbeing on a large scale.
This research team has significant experience conducting research with partners in Ethiopia. We have experience working in agriculture and nutrition programs that has enabled us to identify key challenges related to food systems, poverty, and environmental sustainability. In particular, a lack of measurement tools has precluded the generation of an evidence base on which to build strong research programs. Our team brings together the interdisciplinary expertise needed to develop a scientifically robust study of the food system that promote more interest and research in this area. Through deliberations with communities, academic partners, and government institutions, we have identified the intersection of the food system, nutrition, health, and the environment as a growing area of importance for Ethiopia as well as other fragile and/or rapidly urbanizing developing countries.
The primary users of this research will include local and regional decision-makers in Ethiopia, academia, civil society, and community leaders. Outreach at the start of the program and a stakeholder workshop at its conclusion will therefore include key representatives from these spheres.
Findings and recommendations from this research will produce data that will be made publicly available. This data could possibly be used for evidence-based policy making at local, regional, and national levels. The most direct beneficiaries include local and regional decision makers in agriculture and health in Ethiopia. Evidence from Addis may also be useful for other countries or cities looking for solutions to address environmental degradation, persistent undernutrition, and rising rates of noncommunicable diseases. While the translation of evidence into action becomes more complex at national levels, especially in fragile states, cities like Addis Ababa are in a better position to quickly adopt progressive social measures. Numerous examples of cities on the forefront of positive social change exist in both developed and developing countries, such as taxes on sugar sweetened beverages in Philadelphia in the United States or urban planning for climate change in Maputo, Mozambique.
We also aim to increase awareness of food systems, nutrition and health, and environmental sustainability among civil society and the public in Ethiopia. Civil society can play an important role in advocating for evidence-based policies and programs and promoting a culture of scientific engagement. The food system has profound impacts on people's everyday lives. Greater awareness and understanding of these issues will help to empower the public to make informed decisions.
Longer term impacts of this research may have significant impacts on environmental sustainability. Currently, food systems have negative effects on planetary health in the form of land use, soil degradation, water pollution and shortages, over use of pesticides and other chemicals, and carbon emissions throughout the value chain. New evidence on how to create sustainable food systems that promote planetary health over the long term is urgently needed. We expect this research to generate information that will be consequential for the future of interdisciplinary study in this area.

Publications

10 25 50
 
Description This project has provided promising results toward advancing our understanding of how to improve food systems to limit negative environmental impacts, while improving nutrition and health. Using data from this project, we created a model to estimate the effects of protein source food consumption in Addis Ababa, Ethiopia. We quantified the impact of eliminating protein deficiency on childhood and adult deaths and years of life gained in Addis Ababa under eight scenarios of sufficient protein intake using various combinations of plant-source and animal-source foods. Our data suggest that a large increase in life expectancy could be gained if protein deficiency is eliminated from the population of Addis Ababa, but that the protein sources used to achieve this may have a wide range of environmental impacts. Meeting the recommended protein intake with plant-source foods for adults and animal source foods for children is estimated to have the largest absolute gain in presenting disability-adjusted life years (DALYs). Protein from beans and legumes appear to confer the smallest environmental strain. We have submitted a manuscript to a peer-reviewed journal to disseminate these findings.

Qualitative data from the current project has been analyzed to examine animal-source food production, availability and consumption in order to identify whether and what type of supply-side policies and interventions may be necessary to support urban animal source food market vendors. The main challenges vendors perceived concerned food supply, religious fasting, consumer demand, price increases and fluctuations, transportation, market infrastructure, and government policies. We identified several potential supply-side interventions and policies that can help optimize animal-source food markets and eliminate market inefficiencies: improving storage facilities to reduce vendor dependability on seasonality; improving road infrastructure to reduce transportation costs and difficulties; stabilizing input costs; improving the physical infrastructure of markets to ensure opportunities for business growth; and enhancing policies to protect vendors from macroeconomic events related to foreign exchange. A manuscript reporting these results titled "Changes and challenges in markets for animal source foods: a qualitative study among market vendors in Addis Ababa, Ethiopia" has recently been published in the journal Food Security.
Exploitation Route The design of this research and development of study instruments have taken into consideration input received from government stakeholders regarding priorities for nutrition, food, agriculture, and the environment in Ethiopia. The research goals of this project are aligned with government policy and therefore findings will be able to influence policy and practice in the country for greatest impact.
Sectors Agriculture, Food and Drink,Communities and Social Services/Policy,Environment,Healthcare

URL https://link.springer.com/article/10.1007/s12571-020-01103-1
 
Description 2018 Dean's Fund for Scientific Advancement: Incubation Award
Amount $49,879 (USD)
Organisation Harvard University 
Department Harvard T.H. Chan School of Public Health
Sector Academic/University
Country United States
Start 06/2018 
End 06/2019
 
Title Group-based simulation model to optimize protein intake by plant and animal sourced foods and examine impact on human and planetary health in Addis-Ababa, Ethiopia 
Description Quantitative data from women of reproductive age 18-49, children 6-59 months of age and adult men 18-49 years of age in Addis Ababa, Ethiopia were used to create a model to examine different patterns of protein-source food consumption and their effects on life expectancy and environmental outcomes such as greenhouse gas emissions, land use and water use. 
Type Of Material Computer model/algorithm 
Year Produced 2020 
Provided To Others? No  
Impact Using this model, we quantified the impact of eliminating protein deficiency on childhood and adult deaths and years of life gained in Addis Ababa under scenarios of sufficient protein intake using various combinations of plant-source and animal-source foods. Our model suggests that a large increase in life expectancy could be gained if protein deficiency is eliminated from the population of Addis Ababa, but that the protein sources used to achieve this may have a wide range of environmental impacts. 
 
Description Collaboration between HSPH and ACIPH 
Organisation Addis Continental Institute of Public Health
Country Ethiopia 
Sector Academic/University 
PI Contribution This project is a collaboration between Harvard T.H. Chan School of Public Health and Addis Continental Institute of Public Health in Ethiopia. HSPH and ACIPH are jointly designing, evaluating, and interpreting results for this project. HSPH is responsible for administrative oversight of the project as well as ensuring robust scientific methodology.
Collaborator Contribution ACIPH is leading the implementation of the project in Ethiopia, including data collection and management, and data quality. ACIPH and HSPH jointly contribute to the study design, analysis, and development of research outputs.
Impact The analysis of data and development of outcomes is currently in progress. We expect all outputs to be jointly produced by HSPH and ACIPH.
Start Year 2018
 
Description ARISE Ethiopia workshop 2018 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Schools
Results and Impact Partners from ACIPH led a workshop session in Ethiopia in October 2018 focused on food environments, dietary intake, and health outcomes. This workshop was attended by 14 researchers from seven countries in sub-Saharan Africa (Burkina Faso, Ethiopia, Ghana, Nigeria, South Africa, Tanzania, and Uganda). Partners at ACIPH and HSPH on this project are members of the Africa Research, Implementation Science, and Education (ARISE) Network, a collaboration between over a dozen institutions from eight countries in sub-Saharan Africa. This project benefits all members of ARISE who learn from each other's experiences and jointly build capacity to conduct research on poverty, development, and public health. The experience and preliminary findings from this project have provided valuable development opportunities for ARISE members in the region with similar challenges and research interests.
Year(s) Of Engagement Activity 2018
URL https://blogs.plos.org/globalhealth/2018/11/global-health-collaboration-in-action-the-arise-adolesce...
 
Description Dubai workshop 2018 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Schools
Results and Impact Our research team contributed to capacity building efforts among early career researchers from Tanzania, Uganda, Ghana, and India at the Harvard Medical School Center in Dubai, UAE in February 2018 at a workshop entitled, "Advancing Global Nutrition for Adolescent and Family Health: Innovations in Research and Training." During this workshop, participants highlighted innovations in nutrition-related research and identified promising areas for intervention. Our project team, including Wafaie Fawzi, Yemane Berhane, Nega Assefa, Chelsey Canavan, and Alexandra Bellows, presented the objectives and methods of this project, contributing to capacity building of Southern researchers at the workshop.
Year(s) Of Engagement Activity 2018
URL https://ghd-dubai.hms.harvard.edu/files/ghd_dubai/files/advancingglobalnutritionforadolescent.pdf
 
Description Dubai workshop 2019 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Schools
Results and Impact In 2019, the Africa Research, Implementation Science, and Education (ARISE) Network- comprised of 21 institutions from nine countries in sub-Saharan Africa- brought together an interdisciplinary group of researchers and scientists for a two day workshop in Dubai to review scientific evidence on nutrition and health globally and develop intervention programs. Partners at ACIPH and HSPH on this project are members of this Network, and we used this opportunity to discuss methods and preliminary findings from the project. ACIPH and HSPH investigators on this project led sections of the workshop, which was attended by ARISE researchers from seven countries in sub-Saharan Africa (Burkina Faso, Ethiopia, Ghana, Nigeria, South Africa, Tanzania, and Uganda). Findings from this project are being considered in development of interventions through ARISE, and this project benefits all members of ARISE who learn from each other's experiences and jointly build capacity to conduct research on poverty, development, and public health.
Year(s) Of Engagement Activity 2019