Food Security is a Fundamental Human Right · Eating Fruits & Vegs, Shrimp snails, Breast milk, beans, peanuts ... FRUITS VEGS Pre Int Post Int N Intervention 1048 Control 842 19

Positive Deviance and the Mediterranean Diet and Sustainability

Elliot M [email protected]

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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



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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?



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[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



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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!!!



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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”



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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



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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



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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



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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

*

*



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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



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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



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Changes in Eating Habits

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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



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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

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29.8

53.1 54.7

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PA TV

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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



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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



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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



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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



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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…



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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



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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…



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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…

[email protected]

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Life is in your hands….

“ Be the Change you wish to bring about”

M.K. Gandhi

Be a POSITIVE DEVIANT….



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Documents

Food Security is a Fundamental Human Right · Eating Fruits & Vegs, Shrimp snails, Breast milk, beans, peanuts ... FRUITS VEGS Pre Int Post Int N Intervention 1048 Control 842 19