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

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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.