www.publichealth.ie lessons from the decent food for all (dffa) intervention kevin p balanda...
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Lessons from the Decent Food for All (DFfA) intervention
Kevin P Balanda (presenter),Audrey Hochart, Steve Barron, Lorraine Fahy
Tackling Food Poverty
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Institute of Public Health in Ireland
All-Ireland body: North-South co-operation Inequalities in health
Broad view of health and its determinants
Three work strands: Capacity building Policy support Information and intelligence
2008/2009 – 10 year anniversary
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Armagh and Dungannon
Health Action Zone
Newry and Mourne Health and Social
Services Trust
Armagh and Dungannon Health Action Zone
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Part of the jigsaw
• “Food poverty: Fact or Fiction” – NI (PHAII)• “Food Poverty and Policy” – RoI (Friel and Conlon)
• Fit Futures Strategy – NI (2005)• Report of National Taskforce on Obesity – RoI (2005)• Lifetime Opportunities – NI (2006)• National Action Plan for Social Inclusion 2007-2016 – RoI
(2007)
What’s the role of community interventions?
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What is DFfA?
A four year (initially three year) community intervention 2003-2007
Mission to “improve the provision and
consumption of an affordable, safe and healthy diet
in order to protect and improve public health,
particularly amongst the disadvantaged and
vulnerable in the ADHAZ”
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What is DFfA?
Practical community-based focused help & advice:
• Physical access• Financial access• Information access
DFfA aims to reduce inequalities by having a positive impact:
• across the whole of the intervention area• target wards (rural, border, “deprived”) and disadvantaged groups (unemployed, less educated)
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How it was evaluated?
• Evaluated by IPH, commissioned by safefood
• Programme Logic Approach (PLA)
•A non-random matched comparison area
• Pre-test & post-test measures
• Process evaluation (Local Evaluation Group)
• Ethnographic studies to explore the food culture
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Key indicators of success (via PLA)
Local Regeneration:• Physical and financial access• Stronger local food production & supply
economies
Individual, Household & Community Change:• Awareness and knowledge• Demand for safe health affordable food• Improved health behaviours• Greater social inclusion• Greater individual development
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Key data collections
Attendance at core activities (2003-2007)
370 core activities involving 3,100 residents
One in 8 residents participated in at least one core activity
0
20
40
60
80
100
120
140
160
Border Non-borderTarget group
Att
end
ance
rat
e p
er 1
,000
po
p
0
20
40
60
80
100
120
140
160
180
200
Least deprived Deprived Most deprived
Target groupA
tten
dan
ce r
ate
per
1,0
00 p
op
95% of participants in the Cook It! workshops said it had changed their ideas about healthy eating:
I always thought eating healthier would take a lot of time, now I know it doesn’t
It showed me how to cook the things I normally cook but in a healthier wayI’m more inclined to use lots of fresh
vegetables in my cooking. I see how recipes can be healthy and very tasty!
I was surprised at how much fat and sugar are in some foods that I thought were healthy, I hope to change my diet’.
What participants said
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Individual, household and community change
Significant improvements in :• Confidence in knowledge and abilities • Consumption of fruit and vegetables• Consumption of foods high in fat or sugar
(marginal)• Safe food practices• Levels of physical activity
No associated improvements in: • Awareness and knowledge• Levels of obesity/overweight
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Understanding of the term “healthy eating”
0
0.5
1
1.5
2
2.5
3
3.5
Pre-test
Post-test
Pre-test
Post-test
Pre-test
Post-test
Pre-test
Post-test
Highly affluentp<0.0001
Affluent p=NS Deprived p=NS Highlydeprived
p=NS
Ave
rag
e n
um
ber
of
ind
icat
ive
item
s m
enti
on
ed
Comparison Intervention
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Adults consuming foods high in fat or sugar 3+ times a day
0
1 0
2 0
3 0
4 0
5 0
6 0
P r e - t e s t p = N S P o s t - t e s t % w
ho
co
nsu
me
foo
d a
nd
d
rin
ks h
igh
in f
at a
nd
/or
sug
ar t
hre
e o
r m
ore
tim
es a
d
ay
C o m p a r i s o n I n t e r v e n t i o n
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Average portions of fruit & vegetable consumed daily
0
0.5
1
1.5
2
2.5
3
3.5
Pre-test
Post-test
Pre-test
Post-test
Pre-test
Post-test
Pre-test
Post-test
18-29 years p=NS 30-44 years p=NS 45-59 years p=NS 60+ yearsp=0.0007
Comparison Intervention
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Local Regeneration
Average number of available food items in ADHAZ increased:• Increase was not restricted to healthier foods• Changes in availability did not vary with shop type
Average price of food basket in the ADHAZ increased:• Increase was not restricted to less healthy foods• Increased observed in all shop types except larger
multiple and discounter/freezer shops where it decreased significantly
The “bottom line”
2003 2007
Most commonly available products
Product % of shops Product % of shops
Jam 81 Jam 90
Sausages 80 Sausages 85
Coke 79 Crisps 85
Milk (full and semi-skimmed)
79 Bacon(leanback)
85
White bread 79 Milk (full and semi-skimmed)
85
Baked beans 79 Potatoes 85
Coke 84
2003 2007
Least commonly available products
Product % of shops Product % of shops
Wholemealpasta
4 Wholemealpasta
11
Frozen cod(battered)
13 Beef (mince) 13
Cottage cheese 15 Low-fatcheddarcheese
19
Beef (mince) 19 Mandarinoranges
20
Brown rice 20 Cottagecheese
20
Lean steak (mince)
32 Frozen cod (battered)
24
Low-fat cheddar cheese
35
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Adults who had recently cut their weekly food in order to pay other household bills
0
5
1 0
1 5
2 0
2 5
3 0
P r e - t e s t P o s t - t e s t P r e - t e s t P o s t - t e s t
R u r a l p <0 . 0 0 0 1 U r b a n p =0 . 0 0 3 8
C o m p a r i s o n I n t e r v e n t i o n
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Summary
Powerful impacts on participants in core activities
“Programme reach” relative low
Impact at the community-level was mixed:
• Some positive individual, household and
community change
• Little evidence of local regeneration
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Some challenges
• A very complex intervention • Shifting goal posts • Blurred geographical boundaries • High local demand• Chasing funds & frequent staff changes
• Dilution of the contrast between study areas
• Representativeness of the study areas
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Recommendations
1. Local action is essential - it should be properly supported
2. It must also be properly embedded into a more comprehensive approach
3. Co-ordinate the work of researchers, practitioners, policy makers and the community
4. An all-Ireland approach is necessary and possible
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THANK YOU FOR YOUR ATTENTION