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

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.

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.