Positive Deviance and the Mediterranean Elliot M Berry Diet and Sustainability [email protected]
Outline: From Food Insecurity Food Security Sustainability Food Security – Insecurity 47pp Global Nutrition Index – Triple burden of
How Positive Deviance Changed my life …
COPING: Practical Steps LEARN FROM THE POSITIVE DEVIANTS
1 Positive Deviance and the Mediterranean Elliot M Berry Diet and Sustainability [email protected]
The P o w e r of Positive Deviance
Solutions before our very eyes!!
The Premise: Indian Face or Eskimo?
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
Positive Deviance (PD) Approach Identifying Solutions to Community Problems Within the Community - Today
The Key Question?
What enables some members of the community (the “Positive Deviants”) to find these better solutions?
2 Positive Deviance and the Mediterranean Elliot M Berry Diet and Sustainability [email protected]
[Mal]nutrition in Vietnam
PD Inquiry How are some children well-nourished??
Gathering vegetables “Stealing” “TBU” Money from outside “TBU” All family thin…. “TBU” Cf Antonovsky Breast feeding etc Salutogenesis
Project aim Setting PD Behaviors Child Vietnam Eating Fruits & Vegs, Shrimp Malnutrition 1999 - snails, Breast milk, beans, 2000 peanuts
Boiling Drinking water
5-6 meals/d active feeding
Mosquito bed net
Immunization Food Nutr Bull 2002, Daily bath 23 suppl 4, 36 Early care seeking for illness
3 Positive Deviance and the Mediterranean Elliot M Berry Diet and Sustainability [email protected]
AlthoughPD most Enables problems have complex, us to underlying Act causes TODAY . . .
Not enough Food No Family Support
Illness
Positive Deviants enables finding successful solutions TODAY before all the underlying causes are addressed! – Who is most Food Secure???
The Road to Positive Deviance
Design & Do
Discover
Determine Deviants Monitor & Evaluate
Community valid Define Problem Solution already WORKS!!!
4 Positive Deviance and the Mediterranean Elliot M Berry Diet and Sustainability [email protected]
TRADITIONAL vs POSITIVE DEVIANCE PROBLEM SOLVING APPROACH TRADITIONAL POSITIVE DEVIANCE
Deficit Based: Asset Based: “What’s WRONG here?” “What’s RIGHT here?”
Analysis of underlying causes of Analysis of successful PROBLEM SOLUTIONS
Externally Driven - by outside Internally Driven - by “people “experts” like us”, same culture & resources Examples Top-down, Bottom-up, Glass Half empty Glass Half full ???
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”
5 Positive Deviance and the Mediterranean Elliot M Berry Diet and Sustainability [email protected]
Current Applications of Positive Deviance Program context Countries Childhood development & > 40 countries throughout Malnutrition the world HIV/AIDS risk reduction: use Myanmar, Indonesia, of Condoms… Viet Nam Antenatal care, Maternal & Egypt, Pakistan Newborn Care, Viet Nam Breastfeeding Female Genital Mutilation Egypt (FGM) 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
6 Positive Deviance and the Mediterranean Elliot M Berry Diet and Sustainability [email protected]
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
Sustainable Diets incorporate the three dimensions of Sustainability with Food Security
Major NUTRITION & HEALTH Benefits Low ENVIRONMENTAL Impact Long-term Safety and Protect Biodiversity, FOOD SECURITY Ecosystems SUSTAINABLE Case Study: DIETS Mediterranean Diet Positive ECONOMIC High SOCIAL and Return Regionally, CULTURAL Economically Fair & Value of Food, and Affordable Acceptability
Optimize Natural & Human Resources Berry & Dernini, 2015
7 Positive Deviance and the Mediterranean Elliot M Berry Diet and Sustainability [email protected]
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
Every MODERATION Week
Every Main Meal Cultural Every Day Elements Berry et al. Mediterranean diet pyramid today. Science and cultural updates. Public Health Nutrition 2011; 14: 2274-84.
8 Positive Deviance and the Mediterranean Elliot M Berry Diet and Sustainability [email protected]
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.
Oleic acid is the MAJOR storage % adipose tissue fatty acid ?! c 50 o m40 p o 30 Israel s i America t 20 *Ethiopia i o 10 n 0 14 0 16 0 16 1 18 0 18 1 18 2 18 3 Fatty Acid *A Rubinstein
9 Positive Deviance and the Mediterranean Elliot M Berry Diet and Sustainability [email protected]
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 Oleic Acid is the link between the Socio-Biology and Culture of the
Mediterranean Diet Berry, 1997
Mediterranean Diet AVAILABLE
“Bottle Neck” Challenges Too Many Food Choices ECONOMIC Food Prices SOCIO-CULTURAL NO Time For Cooking Women's Roles… EDUCATION
Mediterranean Food EATEN
10 Positive Deviance and the Mediterranean Elliot M Berry Diet and Sustainability [email protected]
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 Children 32 Kindergarten teachers
Evaluation after 9 months Intervention
11 Positive Deviance and the Mediterranean Elliot M Berry Diet and Sustainability [email protected]
Changes in Eating Habits
70 80 PRE INT POST INT Pre Int Post Int 74 60 70 59 N Intervention 1048 60 50 Control 842 50 40 44 41 47 40 45 30 34 35 39 30 26 27 26 20 20 19 18 19 10 10 7 0 0 FRUITS VEGS SWEETS WATER
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
12 Positive Deviance and the Mediterranean Elliot M Berry Diet and Sustainability [email protected]
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
60 PRE INT POST INT 70 PRE INT POST INT
54.7 60 50 53.1 61.2 50 40 38.5 40 34.6 30 31.7 29.8 30 34.7 31.9 25.5 30 20 28.9 21 20 16.5 10 10 13.6 13.1 0 0 BREAKFAST F & V PA TV
13 Positive Deviance and the Mediterranean Elliot M Berry Diet and Sustainability [email protected]
S SUSTAINABILITY of PROJECT
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…
Food Pyramid vs Environment Pyramid
Barilla CFN
14 Positive Deviance and the Mediterranean Elliot M Berry Diet and Sustainability [email protected]
UN Sustainable Development Goals 2015 How 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
15 Positive Deviance and the Mediterranean Elliot M Berry Diet and Sustainability [email protected]
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
Sustainable Food Systems and the SDG Goals SDG 12 SDG 14 Responsible Life Below Aquaculture Production & Availability Water Consumption Agriculture Loss Imports National SDG 15 Life on Land Accessibility SDG 3 Physical Household SDG 1 Health & Waste Economic No Poverty Well-being SDG 6 Quality / Safety SDG 2 Clean water Quantity Zero Utilization Individual & Sanitation Hunger Health Food Secure Stability Vulnerability “Short term” Food Systems SDG 7 Affordable & Activities Clean Energy SUSTAINABILITY GENERATIONS “Long Term”
National Policy after Berry et al, 2015, 2017
16 Positive Deviance and the Mediterranean Elliot M Berry Diet and Sustainability [email protected]
Food SystemsDrivers • Natural Resources, Biodiversity • Education, Income Distribution, Environment Socio-Cultural • Ecosystem Services, Climate change Health, Market opportunities Economic • Social values, Traditn knowledge • International Trade Geopolitics • Political Stability • R & D, Innovation Science Technology • Population Growth • Information Demographics • Urbanization Infrastructures • Roads, Ports, Transport, Energy Grids • Taxes and Subsidies Policy Regulations Institutions • Government, Companies, NGOs, Civil Soc • Land Rights Food Systems Activities
Growth Process Market Food SystemsOutcomes Transport Consume Waste Harvest Package Street Food
• Resource Efficiency, Ecosystem Services; Conservation and Environment Sustainable Biodiversity, Climate change Mitigation • Availability Accessibility Utilization Food Security & Nutrition • Stability Sustainability • Human Capital Health • Productivity • Livelihoods living wages, Social Justice, Advocacy, EQUITY Socio-economic • Poverty alleviation, Resilience, TRUST
World's food supply under 'severe threat' from loss of biodiversity 91 countries 576 pages Since 2000, c20% of the earth’s vegetation undergone “debilitating” loss of 2019 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.
17 Positive Deviance and the Mediterranean Elliot M Berry Diet and Sustainability [email protected]
Equality – highest Average levels of a
Recommendations for Policy Makers - 3 years Sustainable Food Systems : The “HOW” - 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 + Political Commitment to 5 Put Trade in the Service of Sustainable National Sustainable Development Food Systems…
18 Positive Deviance and the Mediterranean Elliot M Berry Diet and Sustainability [email protected]
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. What have Countries been doing…? 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.EatingPromote is not accessa list of ofdo ’healthys and don foods’ts butin rather restaurants, a pleasurable public, social places, and tasty hospitals, experience. Univ … Traditional and cultural preferences in food choices should be respected. Berry et al, FAO 2017
13 Dietary Guidance Recommendations for Sustainability in 11 countries
1. More Plant Foods [9] Countries Australia [6] Recommendations 2. Reduce Food Waste [7] Brazil [3] 3. Less Meat [5] Denmark [2] 4. More Sustainable Food Estonia [5] 5. Minimally Processed Foods Finland [6] 6. Less Animal Foods 7. Meal Plan / Store Germany [6] 8. Eat Enough calories for Energy Balance Netherlands [3] 9. Eat Seasonally Qatar [5] 10. Focus on Local Foods Sweden [5] 11. Eat Fish from Sustainable Sources UK [6] 12. Eat Diverse Diet Uruguay [2] 13. Foods with minimal / no packing But not so simple…. Rose, Heller, Roberto. J Nutr Educ Behav 2019; 51: 3 - 15
19 Positive Deviance and the Mediterranean Elliot M Berry Diet and Sustainability [email protected]
Same Changes in Eating Patterns may have variable Environmental Impacts
• Healthy Diet, Healthy Caloric Intake, BUT • Moderate Meat • High in Dairy • High in Fruit and Vegetables grown in HIGHER GREEN HOUSE or AIR FREIGHTED Eco roof garden IMPACT • High in Fruit and Vegetables grown in Portland WATER STRESSED regions
• Healthy Diet, Healthy Caloric Intake, LOWER AND IMPACT • Low Meat • Moderate Dairy • High in Legumes and Pulses • High in SEASONAL Fruit and Vegetables Urban Garden Machu Picchu Lima
ANSWER: Reduce / Replace “Everything in Moderation including Moderation (David Berry)” If World’s 2 Billion High Consumers of Meat and Dairy reduced consumption by 40%...
World Resource Institute Farmed Beef Lab Grown Beef INSECT PROTEIN…
Energy Use GHG emissions Land Use
20 Positive Deviance and the Mediterranean Elliot M Berry Diet and Sustainability [email protected]
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…
“ Be the Change you wish to bring about” M.K. Gandhi
Be a POSITIVE DEVIANT….
Life is in your hands….
42
21 Positive Deviance and the Mediterranean Elliot M Berry Diet and Sustainability [email protected]
22