Intercultural models to improve nutrition and health of indigenous populations through gender-sensitive agroforestry practices in Peru

在秘鲁，特别是在偏远的土著居民中，粮食不安全和营养不良问题依然严重。秘鲁政府承诺通过包容文化多样性的包容性卫生服务来解决这种不平等现象。对于秘鲁亚马逊地区的土著人民来说，当地卫生系统往往反映了他们对世界的综合理解。许多家庭实行农林业，将树木纳入农业系统。这不仅提供了收入，支持了当地生态系统，还影响了人类的营养和健康。农林复合对人类营养和健康的潜在积极和消极影响已经有所描述，但很少有研究记录这些影响。除了从树木、作物和牲畜中获得的产品外，农林复合系统还可以支持动植物的野生生物多样性，从而在不同季节以各种方式促进粮食和营养安全。特别需要了解妇女参与农林业如何影响她们的营养状况、时间利用、照料行为和家庭饮食。我们的研究目标是与从事以咖啡和可可为基础的农林业的土著社区以及当地公共卫生、农业和林业机构合作，共同制定改善秘鲁亚马逊地区营养和健康的备选方案。我们的做法将侧重于适合当地条件和文化并对妇女的优先事项和利益作出反应的战略。我们项目的早期阶段将深入了解社会和生态环境（包括近几十年来的变化）以及社区成员对营养和健康的看法和优先事项。我们将编制一份农林业做法清单，包括男女的作用；促进粮食和营养安全的当地动植物生物多样性；以及它们在一年中不同时期对粮食和营养安全作出贡献的方式。我们还将记录妇女在农林业和其他家庭活动（包括照料和准备食物）中的作用和所花费的时间。通过对五岁以下儿童及其母亲的研究，我们将测量营养状况（包括身高、体重和贫血状况），以及在雨季和旱季饮食的营养充足性。我们将评估农林业做法、利用野生生物多样性和妇女利用时间对妇女和儿童营养状况和饮食的影响。我们的研究旨在利用收集到的信息来绘制农林业系统及其相关生物多样性与人类营养和健康之间的多种联系途径，以及这与环境可持续性的关系。我们项目的最后阶段侧重于制定有效和可接受的战略，以解决已确定的营养和健康挑战。我们将制定以食物为基础的建议，在不同文化群体的妇女中试行，并编写适合具体情况的推广材料，指导家庭遵循这些建议。在社区讲习班上，将介绍和讨论研究成果，并采用协作方法共同设计、确定优先次序和评估改善营养和健康的不同战略。该项目响应了秘鲁政府的优先事项，即更好地满足土著居民的营养和健康需要，并加强国家保健服务的整体性和包容性。通过将不同的研究专长与社区知识和兴趣相结合，以及建立对如何利用农林业系统支持营养和健康的基于证据的理解，该项目有可能利用可在秘鲁其他地区复制的方法为可持续战略提供信息。

High levels of food insecurity and malnutrition persist in Peru, particular amongst remote indigenous populations. The Government of Peru has expressed its commitment to addressing this inequity, through inclusive health services which accommodate cultural diversity. For indigenous people in the Peruvian Amazon, local health systems often reflect an integrated understanding of the world. Many households practise agroforestry, in which trees are included in agricultural systems. This not only provides income and supports local ecosystems, but also influences human nutrition and health. Potential positive and negative effects of agroforestry on human nutrition and health have been described, but there has been little research to document these impacts. Beyond the products derived from trees, crops and livestock, agroforestry systems can also support wild biodiversity of plants and animals which contribute to food and nutrition security in various ways across seasons. There is a particular need to understand how women's involvement in agroforestry affects their nutritional status, time use, care-giving behaviours and household diets. The goal of our research is to work with indigenous communities involved in coffee- and cocoa-based agroforestry, and with local public health, agriculture and forestry institutions, to co-develop options to improve nutrition and health in the Peruvian Amazon. Our approach will focus on strategies which are appropriate to local conditions and cultures, and which respond to the priorities and interests of women.The early stages of our project will build an in-depth understanding of the social and ecological setting (including how this has changed in recent decades) and community members' perceptions and priorities relating to nutrition and health. We will develop an inventory of agroforestry practices, including the roles of men and women; the spectrum of local plant and animal biodiversity which contribute to food and nutrition security; and the ways in which these contribute to food and nutrition security at different times of the year. We will also document the roles and time spent by women in agroforestry and other household activities, including care-giving and food preparation.Through a study of children under five years and their mothers, we will measure nutritional status (including height, weight and anaemia status), and the nutritional adequacy of diets during the rainy and dry seasons. We will evaluate the influence of agroforestry practices, use of wild biodiversity and women's time use on the nutritional status and diets of women and children. Our research aims to use the information collected to map the multiple pathways by which agroforestry systems, and their associated biodiversity, are linked to human nutrition and health, and how this relates to environmental sustainability. The final stages of our project focus on devising effective and acceptable strategies to address identified nutrition and health challenges. We will formulate food-based recommendations to be trialled with women of different cultural groups, and develop context-appropriate extension materials to guide households in following these recommendations. At community workshops, research findings will be presented and discussed, and collaborative approaches used to co-design, prioritise and evaluate different strategies to improve nutrition and health. This project responds to the Peruvian Government's priority to better meet the nutrition and health needs of indigenous populations, and to increase the holistic and inclusive nature of national health services. By combining diverse research expertise with community knowledge and interests, and by building an evidence-based understanding of how to harness agroforestry systems in support of nutrition and health, this project has the potential to inform sustainable strategies using approaches which may be replicated in other regions of Peru.