Developing theory and methods for evaluating the impact of community food initiatives on NCD risk, social and economic wellbeing and the environment.

Lead Research Organisation: University of Cambridge
Department Name: MRC Epidemiology Unit

Abstract

Chronic non-communicable diseases such as diabetes, cardiovascular disease and cancer are responsible for the vast majority of deaths in all but the poorest low and middle income countries (LMICs). They are particularly rising in LMICs and are higher in many LMICs than in high income countries. A key driver of this health burden is poor quality nutrition, including diets high in energy dense and highly processed foods and low in fruit, vegetables and fibre. There are several factors that may contribute to poor diets, including poor conditions for growing, storing and transporting fruit and vegetables, and a reliance on relatively expensive food imports. In small island developing states (SIDS) the relationship between a reliance on food imports, poor nutrition and a high burden of chronic diseases is particularly apparent.

Community-based agricultural food production initiatives are one possible approach to improving food and nutritional security and to reducing the risk of chronic diseases. They can also help to improve 'food sovereignty' by increasing the ability of populations to influence their own food systems in ways that are sustainable and promote health. Such initiatives may take several forms, but are owned, organised and managed locally, and produce either fresh or minimally processed food for local consumption. While the potential contribution of such initiatives is recognised, there is very little evidence available on what their impacts actually are in terms of health, social well-being, economics or the environment. There is an urgent need for improved evidence on their impacts, and this proposal is concerned with developing and testing methods to contribute towards filling this evidence gap.

The proposal is designed to help establish a transdisciplinary research programme with the conceptual and methodological skills necessary to undertake robust evaluations of community-based food production initiatives in LMICs. The evaluation of the initiatives will include their contribution to promoting health and social wellbeing, their economic and environmental impacts, and their sustainability. The development work proposed here will be undertaken in two contrasting middle income SIDS, St Vincent and the Grenadines and Fiji. Both are actively engaged in promoting local food production for local consumption, and their well-defined geographical boundaries and relatively small size provide ideal settings to undertake development work. However, the overall goal is to develop a framework and methods that are readily adaptable and applicable to other LMIC settings in which nutritional insecurity is a major contributor to the risk of chronic diseases, including many settings in sub-Saharan African, where levels obesity and diabetes are already high and increasing.

In this project we will update and expand existing evidence reviews on community-based food initiatives in LMICs. In the two chosen settings, we will develop and test research methods to investigate the current nutritional adequacy of local diets and the contribution of community-based food production, and find out who is involved in and supports local food production. We also aim to develop methods to estimate the environmental impacts such as on local water use and carbon emissions. Finally, we aim to determine the major challenges and successes in establishing and sustaining selected initiatives, and how barriers to success might be overcome. The findings will enable us to develop an evaluation framework and refine methods to design a programme of work to robustly evaluate and compare community-based food production initiatives in Africa, the Caribbean and Pacific from the perspective of their impacts on chronic disease risk, social and economic well-being and the environment.

Technical Summary

Rates of obesity, diabetes, cardiovascular disease, and many cancers, are higher in many low and middle income countries (LMICs) than in high income countries. Poor quality diet, characterised by the consumption of energy dense and highly processed foods, low intake of fruit, vegetables and fibre is a major determinant of this increasing burden. There is an urgent need for improved evidence on the impact of agricultural interventions in LMICs on nutrition, health and other aspects of well-being. The proposal is designed to help establish a transdisciplinary research programme with the conceptual and methodological skills necessary to undertake robust evaluations in LMICs of community-based food production initiatives.

In this project we will update and expand existing systematic reviews of published and grey literature on community-based food initiatives in LMICs. In the chosen settings, St Vincent and the Grenadines and Fiji, with established community-based food production initiatives (CFPI), we will develop and test mixed methods to investigate the current nutritional adequacy of local diets and the contribution of community-based food production, and map key stakeholders and potential economic and social benefits of local food production. We also aim to develop feasible methods to estimate the environmental impacts such as on local water use. Focusing on selected CFPIs in each setting as evaluation targets, we aim to determine the major challenges and successes in establishing and sustaining such initiatives, and how barriers to success might be overcome. We will collate findings to derive an evaluation framework and refine methods to design a programme of work to robustly evaluate and compare community-based food production initiatives in the Caribbean and Pacific, and in comparable LMIC settings in Africa, including South Africa, from the perspective of their impacts on NCD risk, social and economic well-being and the environment.

Planned Impact

Relevance: Chronic non-communicable diseases (NCDs) are responsible for the vast majority of deaths, and age-standardised prevalence rates of obesity and diabetes and mortality rates from cardiovascular disease and many cancers are higher in many low and middle income countries (LMICs) than in high income countries. The burden of NCDs is an urgent concern beyond the public health field for governments, society at large, and regional and international organisations. The UN high-level declaration on the prevention of chronic non-communicable diseases (NCDs), for example, has committed governments around the world to taking concerted action, recognising the direct impact of NCDs on the economic and social development in particular for LMICs and calling for a multi-sectoral response. Food security and sovereignty are central upstream determinants of NCDs and community-based food production a poignant example of such multi-sectoral effort required.

Who will benefit: While a multi-sectoral ('whole of government' and 'whole of society') response has been identified as playing a vital part in comprehensive approach to prevent and control NCDs, multi-sectoral collaborations require evidence and guidance to develop, implement, evaluate and sustainably support their initiatives. Direct beneficiaries of this project will be civil society organisation as organisers of community-based food production initiatives. Further direct beneficiaries will be governmental and non-governmental organisation as initiators and supporters of such initiatives. This includes governments in the selected countries but also regional policy-makers as both in the Caribbean and the Pacific setting intergovernmental regional collaborations are established to pool resources and expertise. Furthermore, policy-makers of governments in regions that are similarly vulnerable can benefit from the findings of this project. For example, our South African partners have a strong interest in this research programme and see relevance for policy-making in their setting. Finally, research partners will directly benefit from this project. There is an increasing interest in natural experimental studies to evaluate policy responses and 'real life' initiatives that tackle upstream determinants of health. As a relatively novel research field, this project will contribute to further develop methods for such evaluations, with strong guidance within the MRC Epidemiology Unit who contributed to the MRC guidance on evaluating natural experiments.

How will they benefit: As a development project, the short term benefit will be to identify specific needs to support the development and maintenance of community-based food production initiatives, particularly for relevant key organisation in the two identified regions. The impact plan outlines how these will be engaged.
In more medium term, with the successful establishment of a comprehensive programme of research, we can cumulate robust evidence for their complex impact, including potential unintended consequences for the settings such as the potential negative environmental impact in terms of water pollution or carbon emission. With robust evidence beneficiaries across sectors will be able to make a case for further support of such initiatives and identify concrete factors that might need addressing to reduce negative impacts. The researchers directly involved in the project, at the University of Cambridge, the University of the West Indies, the University of the South Pacific and the University of Witwatersrand will be involved in highly innovative methods development work; this will include local colleagues and postdoctoral researchers. Researchers beyond the direct collaboration will benefit will be access to tools, conceptual framework and related guidance made publically available (see academic beneficiaries).

Publications

10 25 50
 
Description IDRC: Food, Environment and Health
Amount £201,000,000 (JMD)
Organisation International Development Research Centre 
Sector Public
Country Canada
Start 04/2018 
End 03/2022
 
Description Intervention Co-creation to Improve Community-based Food Production and Household Nutrition in Small Island Developing States (ICoFaN)
Amount £990,000 (GBP)
Funding ID BB/T008857/1 
Organisation Biotechnology and Biological Sciences Research Council (BBSRC) 
Sector Public
Country United Kingdom
Start 02/2020 
End 02/2023
 
Description Collaboration with Dr Alafia Samuels, Director of the Chronic Disease Research Centre, University of the West Indies 
Organisation University of West Indies
Country Jamaica 
Sector Academic/University 
PI Contribution The link with the Director of the Chronic Disease Research Centre (CDRC) was made by me. The project concerns informing policy for the prevention of type 2 diabetes in the Caribbean. This is something of direct interest to CDRC, which is regularly asked to advise the Chief Medical Officers and the Ministers of Health of the Caribbean Community (CARICOM).
Collaborator Contribution Dr Samuels has a long history of advising, and excellent contacts with, health policy makers in CARICOM. Her collaboration has greatly facilitated engagement with policy makers in the three project countries: Belize, Jamaica and St Vincent & the Grenadines.
Impact The project is a multi-disciplinary project. Dr Samuels has a background in public health with a particular interest in guiding and evaluating public policy interventions for the prevention and control of chronic non-communicable diseases. Other skills on the project include simulation modelling, systematic review methodology, bio-statistics, and qualitative research methods.
Start Year 2016
 
Description Technical Centre for Agricultural and Rural Cooperation ACP-EU (CTA) 
Organisation Technical Centre for Agricultural and Rural Cooperation ACP-EU
Country Netherlands 
Sector Public 
PI Contribution We worked with CTA to adapt the data collections tools (quantitative and qualitative) developed by us, and to plan and implement data collection to contribute to the evaluation of two CTA projects in the Pacific. The team in the UK (Cambridge and Exeter) were largely responsible for modifying the data collection tools, and along with the team in the Caribbean they designed the REDCap tablet based data collection system. The team in the Pacific planned and implemented the data collection. The UK team analysed the quantitative data, and assisted the Pacific team in the analysis of the qualitative data. Pacific and UK teams prepared presentations for a workshop in the Pacific, organised by CTA.
Collaborator Contribution The CTA provided funding to carry out the evaluation of two of their projects, all of which went to the University of the South Pacific. They worked closely with the research team, which provided valuable learning on CTA's activities to support increased local food production in the Pacific. The CTA organised and hosted the two webinars (described under 'engagement') which provided the research team with access to interested policy makers and practitioners in the Pacific.
Impact Presentations to members of the 8 projects that are part of Innov4AGPacific; two webinars on improving nutrition in the Pacific through local food production; policy brief based on this work. The collaboration is multidisciplinary: CTA largely provides technical support on agriculture, colleagues at University of the South Pacific are environmental scientists and predominantly qualitative researchers; most colleagues in the UK have backgrounds in public health, epidemiology and nutrition.
Start Year 2019
 
Description Community Food and Health Workshop 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact This multidisciplinary workshop, held in Cambridge in September 2017, brought together researchers from the Caribbean (University of the West Indies, Ministry of Health in St Vincent and the Grenadines, Caribbean Farmers Network) and Pacific (University of the South Pacific and Secretariat of the Pacific Community).
Year(s) Of Engagement Activity 2017
 
Description Food Systems in Latin America and the Caribbean 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact This workshop was designed to review research currently underway in Latin America and the Caribbean related to food systems and health and to set priorities for future research, and research collaborations.
Year(s) Of Engagement Activity 2017
 
Description Presentation on current activities and future plans for Global Public Health Research 
Form Of Engagement Activity Participation in an open day or visit at my research institution
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact The presentation was designed to communicate our current research agenda for Global Public Health to the whole of the MRC Epidemiology Unit.
Year(s) Of Engagement Activity 2017
 
Description Public Lecture 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Postgraduate students
Results and Impact Public lecture given at the University of the South Pacific, Fiji, by Co-Investigator Cornelia Guell (University of Exeter) and Research Associate Catherine Brown (University of the West Indies) to an interdisciplinary academic, policy (e.g. National Food and Nutrition Centre, Fiji), and lay audience. We provided an overview of the project aims, introduced the Caribbean partner field site St Vincent and the Grenadines to the Fijian audience, and presented preliminary findings of the systematic scoping review.
Year(s) Of Engagement Activity 2018
URL https://pace.usp.ac.fj/event/dr-cornelia-guell-ms-catherine-brown-understanding-community-food-produ...
 
Description Webinar organised by Technical Centre for Agricultural and Rural Cooperation ACP-EU (CTA) on addressing the burden of malnutrition in Pacific Island States 
Form Of Engagement Activity A broadcast e.g. TV/radio/film/podcast (other than news/press)
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact This activity was the culmination of a collaboration with the Technical Centre for Agricultural and Rural Cooperation (CTA). The research team, through Nigel Unwin, had been approached by CTA to assist with the evaluation of their Innov4AGPacific projects. The lead project officer at CTA, Judith Francis, had learnt about the Community Food and Health Project (CFaH) through her links with the University of the South Pacific and our collaborators there (led by Dr Morgan Wairiu). We worked with Judith to adapt the CFaH data collection tools to help evaluate two of CTA's 8 Pacific projects, aiming to improve local food production and nutrition. The two webinars were delivered in February 2020, and included presentations on the burden of malnutrition and related diseases in the Pacific, the aim and methods developed by CFaH, findings from the two CTA projects that were evaluated using CFaH's tools (this work was carried out in July through September 2019), and policy implications and responses. The webinars were held in real time, and are now available on YouTube and through the CTA website.
Year(s) Of Engagement Activity 2020
URL https://www.youtube.com/watch?v=yOU9I2-Nn8k