Remembering and acting on 'Malnutrition': A Latin American Network to Foster Deep Learning on Nutrition Interventions Past and Present

这项提议将把人类学家、历史学家、公共卫生和营养专家以及流行病学家的不同群体聚集在一起，创建一个研究网络，以应对拉丁美洲营养不良的挑战。该网络的中心目标是改变未来营养方案的方法，考虑到过去什么起作用或没有起作用的“遗失”学习，以及根据最常作为营养干预目标的社区的观点考虑什么起作用或没有起作用。该网络将是英国研究机构与秘鲁、哥伦比亚和尼加拉瓜的研究人员、公共卫生专家和活动人士之间的合作伙伴关系，并将重点放在这些拉美国家。在最新的全球营养数据中，这三个国家都被确定为“双重负担”的地方，这意味着肥胖和糖尿病的发生率很高，同时贫血和营养不良等微量营养素缺乏症的发生率也很高。最令人不安的是，秘鲁、哥伦比亚和尼加拉瓜存在这些复杂和重叠的营养不良形式，尽管该地区的营养干预历史悠久。很明显，我们需要一种新的‘营养’方式。拟议网络的成员尤其关切的是，由于国家和全球一级公共卫生和营养优先事项的变化，社区经历了过去和现在的多层次营养干预。我们希望通过更深入地了解这些过去和现在缓解营养不良的尝试从目标社区的角度来看是什么样子，以及从历史的角度来看这些尝试是什么样子，从而更好地了解影响营养干预成功(或失败)的复杂因素。例如，我们知道，“目标社区”如何接受和应对与食品准备、母乳喂养、食品生产和改善卫生条件有关的行为改变信息可能有很大差异。我们还知道，“营养不良”问题以及如何在地方一级加以补救，往往是种族、性别、族裔和社会经济地位等复杂政治问题的一部分。我们不知道的是，那些最有针对性的“营养”变化的社区是如何在很长一段时间里经历了对他们的饮食、育儿、烹饪和农业实践的干预的不同循环；他们的经历与国家一级的营养政策变化有多大的脱节(或没有)。通过参与一个直接关注这样的社区体验的网络，来自这些国家的研究人员、政策制定者和实践者将提高他们的能力，以了解这些领域的过去、现在和未来的干预措施如何作为互补层发挥作用，而不是潜在的不协调的方法和信息的混乱。我们的网络将植根于一种实践的“相互学习”，这意味着我们在整个网络中寻求一种平等的关系，在那里，不同形式的知识和对营养研究中什么是重要的问题的不同观点将受到欢迎。我们打算分享我们所学到的知识，并从更传统的营养来源扩展到包括对基层营养干预措施的历史、政治和文化解释，以及通过分析国家营养政策制定过程。对于我们的方法，我们将使用探索性民族志研究(通过与公共卫生学校和当地接触者协商选择地点进行参与者观察)、口述历史方法(深入的一对一访谈和集体口述历史访谈，或‘证人研讨会’)和基于档案的历史研究。

This proposal will bring together a diverse group of anthropologists, historians, public health and nutrition specialists, and epidemiologists to create a research network to tackle the challenge of malnutrition in Latin America. The central objective of this network is to change the approach of future nutrition programmes by taking into account 'lost' learning on what has, or has not worked in the past; as well as taking into account what has, or has not worked, according to the perspectives of those communities most commonly targeted for nutrition interventions. The network will be a partnership between UK research institutions and researchers, public health experts and activists in Peru, Colombia and Nicaragua and will focus on these Latin American countries. All three countries have been identified in the most recent global nutrition data as places of 'double burden', which means that there are high rates of obesity and diabetes, alongside high rates of micronutrient deficiencies such as anaemia and undernutrition. Most troubling is that these complex and overlapping forms of malnutrition in Peru, Colombia and Nicaragua exist despite a long history of nutrition interventions in the region. It is clear that a new way of 'doing nutrition' is needed. The members of the proposed network are particularly concerned with the multiple layers of past and present nutrition interventions experienced by communities a result of changing public health and nutrition priorities at national and global level. We want to better understand the complex factors that shape the success (or failure) of nutrition interventions through a deeper understanding of what these past and present attempts to mitigate malnutrition have looked like from the standpoint of the 'target community', and what these attempts look like when viewed through the lens of history. We know, for example that how 'target communities' receive and react to behaviour change messages related to food preparation, breastfeeding, food production, and improved sanitation can vary widely. We also know that the question of 'poor nutrition' and how to remedy it at the local level is often part of complex politics of race, gender, ethnicity and socio-economic status. What we do not know is how those communities most targeted for 'nutrition' change have lived these distinct cycles of intervention into their eating, parenting, cooking and agricultural practices over long periods of time; and how disconnected (or not) their experience has been from nutrition policy change at the national level. By participating in a network focusing directly on such community experience, researchers from these countries, policy makers and practitioners will increase their capacity to understand how past, present and future interventions in these areas might work as complementary layers rather than a potentially uncoordinated mess of approaches and messaging.Our network will be grounded in a practice of 'mutual learning', which means to say that we seek a relationship of equals across the network where distinct forms of knowledge and diverse perspectives on what matters in nutrition research will be welcomed. We intend to share what we learn and expand outwards from more traditional sources of nutrition 'expertise' to include historical, political and cultural interpretations of nutrition interventions at grassroots levels, as well as through analysis of national nutrition policy-making processes. For our methods we will use exploratory ethnographic research (participant observation in sites selected through consultation with the public health schools and local contacts); oral history methods (in-depth one-to-one interviews and group oral history interviews, or 'witness seminars'); and archives-based historical research.