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

除最贫穷的低收入和中等收入国家外，所有国家的绝大多数死亡都是由糖尿病、心血管疾病和癌症等慢性非传染性疾病造成的。低收入和中等收入国家的失业率上升尤为明显，许多低收入和中等收入国家的失业率高于高收入国家。造成这种健康负担的一个关键因素是营养质量差，包括高能量密度和高度加工食品的饮食，以及低水果、蔬菜和纤维的饮食。有几个因素可能导致饮食不良，包括种植、储存和运输水果和蔬菜的条件恶劣，以及对相对昂贵的进口食品的依赖。在小岛屿发展中国家，依赖粮食进口、营养不良和慢性病负担高之间的关系尤为明显。以社区为基础的农业粮食生产举措是改善粮食和营养安全以及减少慢性病风险的一种可能办法。它们还可以通过提高人民以可持续和促进健康的方式影响自己的粮食系统的能力，帮助改善“粮食主权”。这些举措可以采取多种形式，但都是由当地拥有、组织和管理的，并为当地消费生产新鲜或加工程度最低的食品。虽然认识到这些举措的潜在贡献，但很少有证据表明它们在健康、社会福祉、经济或环境方面的实际影响。迫切需要改进其影响的证据，本提案涉及开发和测试方法，以有助于填补这一证据空白。该提案旨在帮助建立一个跨学科研究方案，具备必要的概念和方法技能，以便对中低收入国家的社区粮食生产倡议进行强有力的评估。对这些举措的评价将包括它们对促进健康和社会福祉的贡献、它们的经济和环境影响以及它们的可持续性。这里提出的发展工作将在两个不同的中等收入小岛屿发展中国家，圣文森特和格林纳丁斯和斐济进行。这两个国家都积极促进当地粮食生产以供当地消费，其地理边界明确，面积较小，为开展发展工作提供了理想的环境。然而，总体目标是制定一个易于适应和适用于其他低收入和中等收入国家的框架和方法，在这些国家，营养不安全是慢性病风险的主要因素，包括撒哈拉以南非洲的许多环境，那里的肥胖和糖尿病水平已经很高，而且还在不断增加。在这个项目中，我们将更新和扩大对中低收入国家社区粮食倡议的现有证据审查。在两个选定的环境中，我们将开发和测试研究方法，以调查当前当地饮食的营养充足性和社区粮食生产的贡献，并找出谁参与和支持当地粮食生产。我们还致力于开发评估环境影响的方法，例如对当地用水和碳排放的影响。最后，我们的目标是确定在建立和维持选定的倡议方面的主要挑战和成功，以及如何克服成功的障碍。这些研究结果将使我们能够制定一个评估框架并改进设计工作方案的方法，以便从对慢性病风险、社会和经济福祉以及环境的影响的角度对非洲、加勒比和太平洋地区的社区粮食生产举措进行有力的评估和比较。

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.