title: From income to well-being? (An analysis of stakeholder and community perceptions of the efficacy of horticultural programmes in Kerala and their effects on access to fruits and vegetables)
Creators: name: David, DM
Publisher: name: London School of Hygiene & Tropical Medicine
Year: 2020

description: Background: The effect of horticulture programmes – which can potentially contribute to higher supply, distribution and access to micronutrient-rich fruits and vegetables — in communities experiencing high rates of non-communicable diseases remains underexplored. Research questions: This study analyses stakeholder and community perceptions of the contextual and historical factors that shaped the horticulture programmes in Kerala, India (between 1993 and 2012), and stakeholder and community perceptions of impacts of horticulture programmes on fruit and vegetable access in the food environment. It also suggests implications for future policies and research. Methods: A qualitative study was conducted in Kerala, India. Fieldwork done between April and September 2012 included a witness seminar with 27 stakeholders, 30 semi-structured oral history interviews, and focus group discussions with parents and teachers in 12 school sites selected as a proxy for socio-economic status in four panchayats of Alappuzha and Pathanamthitta districts. Analysis and interpretation of data involved transcription, translation and analysis through coding with NVivo 10 software. Findings: My findings showed that rationales offered by stakeholders about maximizing both income and human development generated a creative tension that ushered in a wave of agricultural revival intensifying and expanding fruit and vegetable farming and improving marketing. This agricultural revival may have arrested declining fruit and vegetable availability. However, there is little evidence that horticulture programmes have increased dietary diversity in Kerala. My findings also showed that the local food environment — how and what food was grown, distributed and marketed — determined what was available, affordable and desirable. Nutrition-sensitive and equity-oriented horticulture programmes that prioritized consumption rather than those that emphasized income may have facilitated fruit and vegetable access. Low socio-economic groups mostly considered fruits a luxury. Investments in subsidy-enabled interventions, such as the market intervention to control price rise, increased affordability. Additionally, these effects showed heterogeneity of equity impact across groups. Crosscutting issues included democratization (including focus on women’s empowerment), responsive and participatory governance and gender bias. My research suggests that gender bias hampered access to resources, obstructed nutrition input in food-system decisions, and limited the role of nutrition professionals in policy making and academic institutions. Effective horticulture programmes valued collaboration, co-ordination, and convergence. They were led by empathetic leaders who advocated for policies that improved the lives of marginalized people. The findings of the witness seminar and interviews suggest that silo-like structures, leadership changes, inexperience in public health nutrition combined with resistance and technocratic pride may have negatively impacted the food environment. Interpretation: This study, while confirming the key role of horticulture programmes to nourish people and improve the food environment, also draws attention to the fact that availability, affordability, and equitable access to nutrition-rich fruits and vegetables depends on an enabling environment that encompasses discourses and programme models. It supports the view that increasing production, without attention to barriers to access, affordability and acceptability, may not achieve nutrition security. While enabling environments have spread farmer-centric agriculture reforms, Kerala’s nutrition status may have been negatively impacted by gender and socio-economic inequalities. However, my research showed that a discourse that fosters a movement for food sovereignty has the potential to herald a more nutrition-sensitive form of agriculture.