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 <Mal>nutrition Coping with Food Insecurity – Bélanger & Pilling The Sociotype & >175 experts 576pp Positive Deviance Olivier De Schutter & 250 experts Sustainability and Sustainable Food 112pp Systems What Policy Makers can do… Food Security is a Fundamental Human Right 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.