Title: NIHR Global Health Research Group on Community Food for Human Nutrition and Planetary Health in Small Islands (Global CFaH)
Funder: Department of Health and Social Care

Abstract: Research question: _x000D_ _x000D_ What is the potential for improving household diet, nutrition, and food security, and reducing the burden of nutrition related diseases by promoting increased community-based food production (CFP) based on agroecological principles in small island countries?_x000D_ _x000D_ Background: _x000D_ _x000D_ Small island countries of the Caribbean, South East Asia and the Pacific are increasingly dependent on food imports (most of low nutritional density), accounting for around two thirds of food consumed. This trend has been associated with a decline in local food production, compounded by the vulnerability to increasingly frequent extreme weather events associated with climate change. All have high burdens of malnutrition: micronutrient deficiencies and overweight /obesity related non-communicable diseases. Anaemia in women of reproductive age ranges from 15.7% (Philippines) to 31% (Fiji) and obesity (BMI > 30kg/m2) from 5.2% (men in Philippines) to 35.3% (women in Fiji). In the Philippines 3 in 10 children aged <5 suffer from stunting. The UN Food and Agriculture Organization’s ten elements of agroecology set out a framework for creating sustainable and resilient CFP for improved human and ecosystem health._x000D_ _x000D_ Methods: _x000D_ _x000D_ Our interdisciplinary research group will work in four countries, Fiji, the Philippines, Dominica and St. Lucia, on the following interrelated work packages (WPs). _x000D_ _x000D_ WP1 - Systematic review and critical appraisal of evidence for small island countries on dietary quality, nutrition-related diseases, where and why food is sourced, and the extent to which current CFP conforms to an agroecological approach. _x000D_ WP2 - New quantitative and qualitative data collection, guided by evidence gaps identified by WP1, on: population and household diet and nutritional status; contribution of food sources, including CFP, to diets; socio-cultural, historical and economic contexts; enabling factors (e.g. local and national governance and policy frameworks)._x000D_ WP3 - Co-innovation for improved diets and nutrition. We will work with local communities and local food producers to assess their needs, develop ‘living labs’ to codesign, deliver and evaluate interventions to increase local sustainable food production for better household nutrition and health._x000D_ WP4 - Impact modelling of long-term human and ecosystem health benefits, guided by agri-food system maps derived with local stakeholders in group model building exercises, comparing ‘business as usual’ and scaling up interventions developed in WP3 to inform national and regional policies._x000D_ _x000D_ Timelines of delivery: _x000D_ _x000D_ Yr1: Agreements, protocols and ethics, identification of project settings, community engagement activities (for WP2 new data collection and WP3 establish communities of practice), evidence synthesis (WP1); Yr2: new data collection (WP2); Yr2-4: intervention co-creation and living labs (WP3); Yr4 modelling (WP4); Yr1-4: engagement, dissemination and developing of web resources._x000D_ _x000D_ Anticipated impact: _x000D_ _x000D_ We will 1) develop a web-based repository of materials and guidance to support dissemination and further development of applied research beyond project completion, 2) provide policymakers with well-defined, evaluated, interventions designed to improve household nutrition, 3) enhance learning, collaboration and strengthen capacity across academic institutions, 4) build and strengthen relationships between researchers, local NGOs and governments.

Lay abstract: Background to the research:_x000D_ _x000D_ In small island countries of the Caribbean, South East Asia and the Pacific, around two thirds of the food consumed is imported. Most imported food is of low nutritional value. At the same time, local food production has been steadily declining, made worse by increasingly frequent extreme weather events associated with climate change. All of these countries have high burdens of malnutrition, such as overweight and obesity related non-communicable diseases such as diabetes and heart disease, and deficiencies of some nutrients, such as iron. _x000D_ _x000D_ Aims of the research:_x000D_ _x000D_ We are public health, agricultural and social scientists who aim to improve the nutrition, health, social and economic well-being of populations in low- and middle-income small island countries by applying approaches that develop healthy, resilient and environmentally sustainable community-based food production. _x000D_ _x000D_ Design and methods used:_x000D_ _x000D_ We will work in four countries, Fiji, the Philippines, Dominica and St. Lucia, to provide evidence on how to improve human and ecosystem health for better nutrition, guided by the UN Food and Agriculture Organization’s 10 elements of agroecology. We will work with local communities to assess their needs and develop ‘living labs’ to work together to increase local food production and household nutrition. The project will inform national and regional policy goals of developing sustainable and healthy food systems as outlined in the following 4 interrelated work packages (WP)._x000D_ WP1 - Review of current evidence for populations in small island countries on dietary quality, nutrition-related diseases, where and why food is sourced, and the extent to which current community food production conforms to an agroecological approach. _x000D_ WP2 - Guided by WP1, we will fill evidence gaps by conducting new data collection in participating countries on dietary intake and its relationship to food sources, and socio-economic and cultural contexts shaping food access and choice. We will also map existing community food production and its sustainability, resilience and potential for conforming to an agroecological approach which contributes to healthy local diets._x000D_ WP3 - Co-innovation for improved diets and nutrition. This will involve the creation of a ‘community of practice’ in each of the four countries, working with community food producers and other stakeholders through the development of ‘Living Labs’. _x000D_ WP4 - Impact modelling. This will assess potential long-term human and ecosystem health benefits. _x000D_ _x000D_ Community engagement and involvement:_x000D_ _x000D_ Involving community members and organisations will guide our work throughout the research, taking their experiences, traditions and knowledge seriously and responding to their needs. Networks of local stakeholders will also be involved for expert consultation, including policymakers, food producers and other actors across the food value chain. _x000D_ _x000D_ Dissemination:_x000D_ _x000D_ This research will enhance learning and collaboration across academic institutions, and between researchers and local NGOs working with small food producers in participating communities. It will provide policymakers with well-defined and evaluated interventions designed to improve household nutrition. For continued use beyond the project, a website will house materials, including case studies and guidance based on lessons learned for improving local food systems and diets using an agroecological approach.

Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health categories: GENERIC HEALTH RELEVANCE