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Positive Deviance and the Mediterranean Diet and Sustainability
Elliot M [email protected]
1
Outline:From Food Insecurity Food Security Sustainability
Food Security – Insecurity
Global Nutrition Index –
Triple burden of <Mal>nutrition
Coping with Food Insecurity –The Sociotype
Positive Deviance
Sustainability and Sustainable Food Systems
What Policy Makers can do…
Food Security is a Fundamental Human Right
Olivier De Schutter& 250 experts
112pp
Bélanger & Pilling& >175 experts
576pp
47pp
How Positive Deviance Changed my life …
COPING:Practical Steps
LEARN FROM THE POSITIVE DEVIANTS
Positive Deviance and the Mediterranean Diet and Sustainability
Elliot M [email protected]
2
The P o w e rof Positive Deviance
Solutions before our very eyes!!
The Premise:
In every community there are certain individuals whose uncommon practices/behaviors enable them to find better solutions to problems than their neighbors who have access to the same resources
Marsh et al. BMJ 329, 1177, 2004
Indian Face or Eskimo?
Positive Deviance (PD) Approach
What enables some members of the community
(the “Positive Deviants”)
to find these better solutions?
Identifying Solutions to Community Problems Within
the Community - Today
The Key Question?
Positive Deviance and the Mediterranean Diet and Sustainability
Elliot M [email protected]
3
[Mal]nutrition in Vietnam
PD Inquiry
How are some children well-nourished??
“TBU”
“TBU”
“TBU”
Gathering vegetables
“Stealing”
Money from outside
All family thin….
Breast feeding etc
Cf AntonovskySalutogenesis
Project aim Setting PD BehaviorsChild Malnutrition
Food Nutr Bull 2002, 23 suppl 4, 36
Vietnam1999 -2000
Eating Fruits & Vegs, Shrimp snails, Breast milk, beans, peanuts
Boiling Drinking water
5-6 meals/d active feeding
Mosquito bed net
Immunization
Daily bath
Early care seeking for illness
Positive Deviance and the Mediterranean Diet and Sustainability
Elliot M [email protected]
4
PD Enables us to Act TODAY
Positive Deviants enables finding successful solutions TODAY before all the underlying causes are addressed! – Who is most Food Secure???
Although most problems have complex, underlying causes . . .
Illness
No FamilySupport
Not enough Food
The Road to Positive Deviance
Determine Deviants
Discover
Design & Do
Define Problem
Monitor & Evaluate
Community valid
Solution alreadyWORKS!!!
Positive Deviance and the Mediterranean Diet and Sustainability
Elliot M [email protected]
5
TRADITIONAL vs POSITIVE DEVIANCE PROBLEM SOLVING APPROACH
TRADITIONAL
Deficit Based:“What’s WRONG here?”
Analysis of underlying causes ofPROBLEM
Externally Driven - by outside “experts”
Top-down, Glass Half empty
POSITIVE DEVIANCE
Asset Based:“What’s RIGHT here?”
Analysis of successfulSOLUTIONS
Internally Driven - by “people like us”, same culture & resources
Bottom-up, Glass Half full
Examples???
PD Focus on Practice Rather than Knowledge
“It’s easier to ACT your way
into a new way of THINKING, than to
THINK your way into a new way of ACTING”
Positive Deviance and the Mediterranean Diet and Sustainability
Elliot M [email protected]
6
Current Applications of Positive Deviance
Program context Countries
Childhood development & Malnutrition
> 40 countries throughout the world
HIV/AIDS risk reduction: use of Condoms…
Myanmar, Indonesia, Viet Nam
Antenatal care, Maternal & Newborn Care, Breastfeeding
Egypt, PakistanViet Nam
Female Genital Mutilation (FGM)
Egypt
Girl Trafficking Indonesia, Nepal
Education Issues Argentina, US
Empowerment in The Philippines
Positive Deviance
approach to
FGM – Egypt
And Use of
Pregnancy Banks
Empowerment Micro financing in Nepal
Positive Deviance and the Mediterranean Diet and Sustainability
Elliot M [email protected]
7
Q: How could we apply PD to the following
Public Health problems….????:
Childhood Obesity
Compliance to the Mediterranean Diet
Better Diabetic control
Road Traffic Accidents
Smoking / alcohol cessation
Regular physical activity
Immigrant workers’ conditions
Health of Lower socio-economic classes
Violence in Schools Etc, etc
Major NUTRITION &HEALTH Benefits
Long-term Safety and FOOD SECURITY
Low ENVIRONMENTALImpact
Protect Biodiversity, Ecosystems
Positive ECONOMICReturn Regionally,
Economically Fair & Affordable
High SOCIAL and CULTURAL
Value of Food, and Acceptability
SUSTAINABLE DIETS
Berry & Dernini, 2015Optimize Natural & Human Resources
Sustainable Diets incorporate the three dimensions of Sustainability with Food Security
Case Study:MediterraneanDiet
Positive Deviance and the Mediterranean Diet and Sustainability
Elliot M [email protected]
8
Why the Mediterranean Diet???: the BEST diet with strong scientific evidence
for health benefits
• Decreased Overall Mortality (-9%)
• Decreased Cardiovascular Mortality (-9%)
• Decreased Incidence & Mortality Cancer (-6%)
• Decreased incidence Parkinson’s disease (-13%)
• Decreased Incidence Alzheimer's disease (-13%)
Sofi F, Cesari F, Abbate R, Gensini GF, Casini A. Adherence to Mediterranean diet and health status: meta-analysis. BMJ. 2008; 337:a1344
Bach-Faig A, Berry EM, Lairon D et al. Mediterranean Diet Pyramid Today. Science and Cultural Updates. Public Health Nutrition. 14 (12A): 2274-2284, 2011
Berry et al. Mediterranean diet pyramid today. Science and cultural updates. Public Health Nutrition 2011; 14: 2274-84.
Every Main Meal
Every Week
CulturalElements
MODERATION
Every Day
Positive Deviance and the Mediterranean Diet and Sustainability
Elliot M [email protected]
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EVERY MAIN MEAL contains 3 basic elements:
Cereals: 1-2s, preferably whole grain (processing removes fiber
and nutrients such as Mg, Fe, vitamins).
Vegetables: ≥2s, at least 1 serving consumed raw.
Fruit: 1-2s, as dessert.
Also - Olive oil: central, principal source of lipids.
Emphasis on variety in colors & textures.
The pyramid “core” – plant-origin foods – for prevention of many chronic diseases and for weight control.
Berry et al. Mediterranean diet pyramid today. Science and cultural updates. Public Health Nutrition 2011; 14: 2274-84.
0
10
20
30
40
50
14 0 16 0 16 1 18 0 18 1 18 2 18 3
Israel
America
Ethiopia
Oleic acid is the MAJOR storage
adipose tissue fatty acid ?!
Fatty Acid
%composition
A Rubinstein
*
*
Positive Deviance and the Mediterranean Diet and Sustainability
Elliot M [email protected]
10
Homo sapiens
Who-ever you are
Where-ever you live
What-everyou eat
The main storage fatty acid in
the human body
is
OLEIC ACID
Olive Oil, Almonds, Avocado,
Canola Oil
Berry, 1997
Oleic Acid is the link between the Socio-Biology and Culture of the
Mediterranean Diet
Mediterranean DietAVAILABLE
Mediterranean FoodEATEN
“Bottle Neck”ECONOMIC
SOCIO-CULTURAL
ChallengesToo Many Food Choices
Food PricesNO Time For Cooking
Women's Roles…EDUCATION
Positive Deviance and the Mediterranean Diet and Sustainability
Elliot M [email protected]
11
Promoting the Mediterranean Diet
Lifestyle:Interventions in Kindergartens &Junior Schools
Ronit Jakobovich, Asia Levita & Elliot M Berry in preparation, 2015
Maha Nubani PhD 2015. M Donchin, Ziad Abdeen & E M Berry
Changing Behaviours in EARLY CHILDHOOD – relevance for preventing Obesity and promoting the Mediterranean lifestyle
1890 Kindergarten CHILDREN aged 4-6 years
74 KINDERGARTEN TEACHERS
52 hour training Program
Intervention group: 1048 Children
42 Kindergarten teachers
Control group: 842 Children32 Kindergarten teachers
Evaluation after 9 months Intervention
Positive Deviance and the Mediterranean Diet and Sustainability
Elliot M [email protected]
12
Changes in Eating Habits
44
26
59
41
34
27
35
26
0
10
20
30
40
50
60
70
FRUITS VEGS
Pre Int Post Int
N Intervention 1048Control 842
19
39
7
74
18
47
19
45
0
10
20
30
40
50
60
70
80
SWEETS WATER
PRE INT POST INT
If a child can say to himself /herself:
“If I eat healthy food and do my physical exercises, then I’ll stay healthy”
Then, we have achieved our goal…
Conclusion:
It is possible to change behaviours towards a Mediterranean Lifestyle –
even in Kindergartens
Positive Deviance and the Mediterranean Diet and Sustainability
Elliot M [email protected]
13
An Intervention Program for Promoting Healthy Eating & Physical Activity among Palestinian Girls in Grades 4 & 5
Needs Assessment in 7 Intervention & 7 Control Schools
897 Pupils,
373 Teachers &
744 Mothers 2 Interventions of 10 months
Maha Nubani PhD 2015. M Donchin, Ziad Abdeen & E M Berry
Changes in Behavior: Nutrition and Activity
38.5
29.8
53.1 54.7
34.6
25.5
31.7
21
0
10
20
30
40
50
60
BREAKFAST F & V
PRE INT POST INT
16.5
34.7
61.2
28.9
13.6
31.9
13.1
30
0
10
20
30
40
50
60
70
PA TV
PRE INT POST INT
Positive Deviance and the Mediterranean Diet and Sustainability
Elliot M [email protected]
14
S
At 2 years follow-up, the programme is still running in 6 / 7 of the intervention schools, is being implemented in 5 / 7 of the control schools.
Additionally, several other schools are requesting to start the programme too…
SUSTAINABILITYof
PROJECT
Food Pyramid vs Environment Pyramid
Barilla CFN
Positive Deviance and the Mediterranean Diet and Sustainability
Elliot M [email protected]
15
UN Sustainable Development Goals 2015How many involved with Food Security??
Sustainable Development Goals 1 (adapted from FAO)
1. No Poverty – c80% of poor people live in rural areas
2. Zero Hunger – Enough food for all, but c800 million go hungry…
3. Good Health & Well-being – Good Health starts with Nutrition ( -9 months)
4. Quality Education – Nutritious food is critical for Learning
5. Gender Equality – Women produce ½ world’s food, but lack access to land
6. Clean Water & Sanitation – Sustainable agriculture and re-cycling addresses water scarcity
7. Affordable & Clean Energy – Modern food systems rely heavily on fossil fuels
8. Decent Work & Economic Growth – Agricultural growth in low-income economies can reduce poverty by half
9. Industry, Innovation & Infrastructure – Agriculture accounts for 25% of GDP in Developing Countries
Positive Deviance and the Mediterranean Diet and Sustainability
Elliot M [email protected]
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Sustainable Development Goals 2
10. Reduced Inequalities – Land reforms can give fairer access to rural land
11. Sustainable Cities and Commodities – Rural investment can deter unmanageable urbanization
12. Responsible Consumption & Production – 1/3 the food produced is lost or wasted
13. Climate Action – Agriculture is key to responding to climate change
14. Life below Water – Fish give 3bn people 20% of daily animal protein
15. Life on Land – Forests contain >80% of terrestrial biodiversity
16. Peace, Justice & Strong Institutions – Ending hunger can contribute to greater stability and peace
17. Partnerships for the Goals – To raise the voices of the hungry
Food Secure Vulnerability
Utilization
Stability
Individual
Household
National
“Short term”
Accessibility
Availability
Sustainable Food Systems and the SDG Goals
Waste
Loss
PhysicalEconomic
AquacultureAgriculture
Imports
Quality / SafetyQuantityHealth
SUSTAINABILITY GENERATIONS“Long Term”
National Policyafter Berry et al, 2015, 2017
SDG 3Health &
Well-beingSDG 6
Clean water & Sanitation
SDG 12Responsible
Production & Consumption
SDG 15Life on Land
SDG 1No Poverty
SDG 14Life Below
Water
SDG 2Zero
Hunger
SDG 7Affordable & Clean Energy
Food SystemsActivities
Positive Deviance and the Mediterranean Diet and Sustainability
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Growth Harvest
Process Package
TransportMarket
Street FoodConsume Waste
Food Systems Activities
Foo
d System
s Ou
tcom
es
Foo
d System
s Drivers
• Natural Resources, Biodiversity
• Ecosystem Services, Climate changeEnvironment
• International Trade
• Political StabilityGeopolitics
• Population Growth
• UrbanizationDemographics
• Taxes and Subsidies
• Land RightsPolicy Regulations
Socio-Cultural Economic
• R & D, Innovation
• InformationScience Technology
• Roads, Ports, Transport, Energy Grids
• Government, Companies, NGOs, Civil SocInfrastructures
Institutions
• Resource Efficiency, Ecosystem Services; Conservation and Sustainable Biodiversity, Climate change MitigationEnvironment
• Availability Accessibility Utilization
• Stability SustainabilityFood Security & Nutrition
• Human Capital
• ProductivityHealth• Livelihoods living wages, Social Justice, Advocacy, EQUITY
• Poverty alleviation, Resilience, TRUSTSocio-economic
• Education, Income Distribution, Health, Market opportunities
• Social values, Traditn knowledge
91 countries576 pages
2019Since 2000, c20% of the earth’s vegetation undergone “debilitating” loss of biodiversity, forests, grasslands, coral reefs, mangroves, seagrass beds & genetic diversity in crop and livestock species.
In the oceans, 1/3 of fishing areas are being overharvested.2/3rds of crop production comes from 9 species out of 6,000 (!!!) cultivated
plant species - SUGAR CANE, MAIZE, RICE, WHEAT, POTATOES, SOYBEANS,OIL-PALM FRUIT, SUGAR BEET and CASSAVA - monoculture uniformity.
Most threatened: plants, birds, and fish and fungi. 17% of vertebrate pollinators – bats, birds and especially bees face extinction.
Causes: land-use conversion; forests farm fields; soil over-exploitation; use of pesticides, herbicides and other chemicals; over-harvesting; spread of invasive species; Increased URBANIZATION & infrastructure; over-exploitation of water supplies, pollution, and climate change.
Supermarkets full of imported food; less resilient food production; reliance on few species increases susceptibility to disease and climate change.
World's food supply under 'severe threat' from loss of biodiversity
Positive Deviance and the Mediterranean Diet and Sustainability
Elliot M [email protected]
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Equality – highest Average levels of a <Good>Equity – Socially Just allocation of a <Good>
Priorities for Equity Agenda Nutritional Implications
1 Providing Fair Access to universal Public Services
• Maternal and Infant Health• Immunization and Sanitation
2 Action for Vulnerable Food Insecure Groups
• Socio-cultural: (ethnicity, gender), immigrants…. • Nutritional: Pregnancy, children, adolescence, elderly
3 Social Protection • Nutritional Safety Net – cash, stamps, food• ?Conditional on compliance with public health goals
4 Redistribution • Land reform women’s empowerment, sovereignty• Fiscal trade policies for affordable nutritious foods• Tax of “unhealthy” foods re-invested in food system
5 Challenging imbalances of Power via Civil Society and independent media
• Multinationals vs. small farmers• Food Producers vs. Consumers• Accountability & Demand from Civil Society, Consumers
after Harris J & Nisbett N. UNSCN news. 2018; 43: 57
So what should Policy Makers do…?
- 3 years- 250 Food System “Actors” - Published 2019
Tools for Common Food Policy
1 Ensure Access to Land, Water & Healthy Soils
2 Rebuild Climate-Resilient, Healthy Agro-Ecosystems
3 Promote Sufficient, Healthy, Affordable & Sustainable Diets for ALL
4 Build Fairer, Shorter & Cleaner Supply Chains. Engage with Business - SMEs
5 Put Trade in the Service of Sustainable Development
Recommendations for Policy Makers Sustainable Food Systems : The “HOW”
+ Political Commitment toNational Sustainable
Food Systems…
Positive Deviance and the Mediterranean Diet and Sustainability
Elliot M [email protected]
19
Recommendations for Policy Makers Sustainable Food Systems : The “WHAT”
1. Make Food System Sustainable along the entire food chain – from Production to Consumption; reduce food losses and waste. MULTISTAKEHOLDER PARTNERS
2. Strengthen Agriculture towards the best Sustainable Ecosystem practices.
3. Protect the Right of All to healthful, nutritious, adequate & affordable food.
4. Monitor the safety of the food supply to be environmentally friendly and free of pathogens.
5. Legislate (& incentivize) Food Industry to produce healthy, (minimally processed foods), with less added sugars, salt and additives. Informative Labelling, Production & Marketing - honest and transparent. No junk food adverts to children
6. School and Community Education on healthy life styles, nutrition, cooking (Mediterranean Diet Pattern), and EXERCISE
7. Promote access of healthy foods in restaurants, public places, hospitals, Univ…Eating is not a list of do’s and don’ts but rather a pleasurable, social and tasty experience.
Traditional and cultural preferences in food choices should be respected.
Berry et al, FAO 2017
What have Countries been doing…?
13 Dietary Guidance Recommendations for Sustainability in 11 countries
Australia [6] Recommendations
Brazil [3]
Denmark [2]
Estonia [5]
Finland [6]
Germany [6]
Netherlands [3]
Qatar [5]
Sweden [5]
UK [6]
Uruguay [2]
1. More Plant Foods [9] Countries
2. Reduce Food Waste [7]
3. Less Meat [5]
4. More Sustainable Food
5. Minimally Processed Foods
6. Less Animal Foods
7. Meal Plan / Store
8. Eat Enough calories for Energy Balance
9. Eat Seasonally
10. Focus on Local Foods
11. Eat Fish from Sustainable Sources
12. Eat Diverse Diet
13. Foods with minimal / no packing But not so simple….Rose, Heller, Roberto. J Nutr Educ Behav 2019; 51: 3 - 15
Positive Deviance and the Mediterranean Diet and Sustainability
Elliot M [email protected]
20
HIGHER IMPACT
• Healthy Diet, Healthy Caloric Intake, BUT
• Moderate Meat
• High in Dairy
• High in Fruit and Vegetables grown in GREEN HOUSE or AIR FREIGHTED
• High in Fruit and Vegetables grown in WATER STRESSED regions
LOWER IMPACT
• Healthy Diet, Healthy Caloric Intake,AND
• Low Meat
• Moderate Dairy
• High in Legumes and Pulses
• High in SEASONAL Fruit and Vegetables
Same Changes in Eating Patterns may have variable Environmental Impacts
Eco roof gardenPortland
Urban GardenMachu Picchu Lima
ANSWER: Reduce / Replace “Everything in Moderation including Moderation (David Berry)”
World Resource Institute
If World’s 2 Billion High Consumers of Meat and Dairy reduced consumption by 40%...
Farmed Beef Lab Grown Beef
Energy Use GHG emissions Land Use
INSECT PROTEIN…
Positive Deviance and the Mediterranean Diet and Sustainability
Elliot M [email protected]
21
Summary & Conclusions:Food Insecurity, Social “Inequity” and Sustainability
Every country has problems of Food Insecurity – and a double / treble burden of Malnutrition
The Global Nutrition Index (1990-2015) shows improvement world-wide and particularly in African LMIC
There must be Political Will & Trust to make equitable policies for Affordable, Healthy and Sustainable Diets for all - Forks >> Knives
Sustainable Food Systems are good for You, your Country and your Planet - EVERYONE must ENGAGE with the ENVIRONMENT – No Waste
A well-fed, Food Secure Nation is a Healthy Nation, is a Productive and Sustainable Nation…
42
Life is in your hands….
“ Be the Change you wish to bring about”
M.K. Gandhi
Be a POSITIVE DEVIANT….