evidence-based strategies to build community food security
TRANSCRIPT
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from the associationOF PROFESSIONAL INTEREST
Evidence-Based Strategies to Build Community FoodSecurity
Christine McCullum, PhD, RD; Ellen Desjardins, MHSc, RD; Vivica I. Kraak, MS, RD;
Patricia Ladipo, PhD; Helen Costello, MS, RDaas
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ver the past decade, various enti-ties within the United States (1-5), Canada (6,7), and Europe (6,8)
ave applied a food systems approacho build community food security. Thispproach to building community foodecurity requires an understanding ofow communities interact with re-ources in their social and physical en-ironments over extended periods ofime. It also uses strategies that ad-ress broad systemic issues affectingood availability, affordability, accessi-ility, and quality (1-10). The purposef this article is to provide dietetics pro-essionals with a three-stage contin-um of evidence-based strategies and
C. McCullum is an assistant pro-fessor of health promotion andbehavior sciences, University ofTexas, School of Public Health,Houston. E. Desjardins is a com-munity nutritionist, Region ofWaterloo Public Health, Ontario,Canada. V. I. Kraak is a nutri-tion consultant, Washington, DC.P. Ladipo is a breastfeedingproject coordinator, Cornell Uni-versity, Division of NutritionalSciences, Ithaca, NY. H. Costellois a food security coordinator,University of New Hampshire,Concord.
Address correspondence to:Christine McCullum, PhD, RD,Assistant Professor of Health Pro-motion and Behavioral Sciences,University of Texas, Health Sci-ence Center at Houston, School ofPublic Health, 1200 HermanPressler, RAS W910, Houston, TX77030.
E-mail: [email protected]/05/10502-0013$30.00/0
edoi: 10.1016/j.jada.2004.12.015
78 Journal of the AMERICAN DIETETIC ASSOCIATIO
ctivities that applies a food systemspproach to building community foodecurity.
NDERSTANDING KEY TERMSommunity Food Securityommunity food security is an evolv-
ng concept that emphasizes long-erm, systemic, and broad-based ap-roaches to address food insecurity1-6). Recently, Hamm and Bellowsroposed the following definition ofommunity food security: “A situationn which all community residents ob-ain a safe, culturally acceptable, nu-ritionally adequate diet through austainable food system that maxi-izes self-reliance and social justice”
5). This is the definition that will besed throughout this article. A com-ination of practical activities andolicy development is required tochieve community food security (5).
ood Systems, Sustainability, andustainable Community Food Systemsfood system is a set of interrelated
unctions that includes food produc-ion, processing, and distribution;ood access and utilization by individ-als, communities, and populations;nd food recycling, composting, andisposal (11). Food systems operatend interact at multiple levels, in-luding community, municipal, re-ional, national, and global. Sustain-bility is defined as society’s ability tohape its economic and social systemso maintain both natural resourcesnd human life (12). A sustainableommunity food system improves theealth of the community, environ-ent, and individuals over time (13),
nvolving a collaborative effort in aarticular setting to build locallyased, self-reliant food systems and
conomies (14,15). nN © 2005
VIDENCE-BASED STRATEGIES TO BUILDOMMUNITY FOOD SECURITYxamples of evidence-based strate-ies and activities that dietetics pro-essionals can use to build communityood security are arranged on a con-inuum related to the time frame ofhe expected outcome (short to longerm) (see Figure). These strategiesnd activities fall into three progres-ive stages: initial food systemshange, food systems in transition,nd food systems redesign for sus-ainability.
In stage 1, participants create smallut significant changes to existing foodystems. Data collected at this stagean be used to inform the work under-aken in subsequent stages. In stage 2,ood systems change is progressing,nd efforts are directed toward facili-ating and stabilizing that change. Intage 3, efforts are made to institution-lize food systems change through ad-ocacy and policy instruments that in-egrate different policy fields. Dataollection, monitoring, and evaluationre conducted at all stages. A detailediscussion of the strategies and activi-ies outlined in the three-stage commu-ity food security continuum followsnd is summarized in the Figure.
tage 1: Initial Food Systems Changetage 1 of the community food secu-ity continuum focuses on strategiesnd activities that create small butignificant changes to existing foodystems. Data collected at this stagean be used to inform the work that isndertaken in subsequent stages. Anxample of a strategy that dieteticsrofessionals can use to facilitate ini-ial food systems change (6) is clientounseling to maximize access to ex-sting programs providing food and
utrition assistance, social services,by the American Dietetic Association
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nd job training (16). Furthermore,ietetics professionals can collectata on the nutritional adequacy ofoods served in emergency food pro-rams (5) because there is evidencehat people who rely regularly onuch sources may have inadequateutritional intake (17,18). There islso some evidence that people whoive in low-income neighborhoods
ay not have easy access to food re-ail outlets that sell a variety of af-ordable and healthful foods (19).herefore, it is valuable to determinehether pricing and food quality in-quities exist in food stores located inow-income neighborhoods (6,20).verall, this type of research and doc-mentation is a useful early step tonsure that all community residentsave access to nutritionally adequate
Stage ofcontinuum
Stage 1: Initial food syschange
Strategies andactivities
Counsel clients to maximto existing programs pfood and nutrition assisocial services, and jo
Document the nutritionalemergency foods.
Identify food quality andinequities in low-incomneighborhoods.
Educate consumers andabout the benefits of lseasonal, and organic
Time frame Short term
Evaluation Data collection, monitorin
igure. Evidence-based strategies and activitiriginally developed by MacRae (10). aSustainaesources and human life (12). bFair Trade iseveloping countries gain direct access to intearketplace. In the United States, TransFair US
nformation, see: www.transfairusa.org.
nd affordable foods. a
Dietetics professionals can also fa-ilitate initial food systems change byducating consumers and institutionsbout the benefits of purchasing lo-ally grown, seasonally available, andrganically produced food. When con-umers purchase foods that haveeen produced locally, a greater pro-ortion of the profits remain with lo-al farmers, providing them with aivable income and supporting localconomies (21). Purchasing locally-roduced foods protects the environ-ent by reducing the use of fossil fuel
nd packaging materials (22,23). Theenefits of organic farming systemsxtend to farmers, consumers, andhe environment. The results of a
ashington state study showed thatrganic apple production providedimilar yields, better-tasting fruit,
sStage 2: Food systems in transit
accessidingce,
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Connect emergency food programslocal urban agriculture projects.
Create multi-sector partnerships annetworks.
Facilitate participatory decision-maand policy development throughserving on food policy councilsorganizing community-mappingprocesses and multistakeholderworkshops.
Medium term
nd evaluation are conducted at all stages of
associated with a three-stage community foody is defined as society’s ability to shape its eco
innovative, market-based approach to sustational markets, as well as to develop the businlaces the “Fair Trade Certified” label on coffee
nd higher profitability, and was a
February 2005 ● Journa
ore environmentally sound and en-rgy efficient than apples produced byonventional practices (24). Otherenefits of organic farming practicesnclude reduced groundwater pollu-ion from nitrogen and phosphorusertilizers, improved soil fertility, andeduced occupational exposure to pes-icides (25), which has been associ-ted with acute and chronic humanllnesses (26-28). Dietetics profession-ls in California, Iowa, Minnesota,ew York, Pennsylvania (15,22,29),ichigan (Ruth Blackburn, MPH,D, personal communication, April004), and Canada (eg, Ontario, Brit-sh Columbia) (30,31) are working toducate consumers and institutionsegarding the advantages of purchas-ng locally-grown, seasonally-avail-
Stage 3: Food systems redesign forsustainabilitya
th Advocate for minimum wage increaseand more affordable housing.
Advocate for food labeling standardsabout product history (eg, place oforigin, organic certified, Fair Tradecertifiedb).
Through participatory decision-making and policy development,mobilize governments andcommunities to institutionalize:
(1) land use policies that facilitatelarge-scale urban agriculture;
(2) market promotion and subsidiesas a way to increase acommunity’s food self-reliance andachieve nutrition goals; and
(3) tax incentives and financingmechanisms to attract local foodbusinesses to low-incomeneighborhoods.
Long term
community food security continuum.
curity continuum. Adapted from a frameworkic and social systems to maintain both naturalle development that helps family farmers incapacity necessary to compete in the global
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tage 2: Food Systems in Transitiontage 2 of the community food secu-ity continuum focuses on strategiesnd activities that support food sys-ems in transition toward initiativeshat have not traditionally been uti-ized by the current food systems. Inhis stage, the social infrastructureeeded to connect various food systemrocesses is established or strength-ned through capacity building andultisector partnerships and net-orks. Stage 2 involves shifting foodistribution activities from privateeg, food banks) to public spaces (eg,ommunity gardens and community-upported agriculture [CSA] farms)nd promoting economic renewalrojects and job creation througharmers’ markets and small-scaleood businesses. Strategies and activ-ties in this stage also encourageroader civic participation througharticipatory decision-making pro-esses and initial policy development4,6,7,32,33), which may serve as ex-mples and set precedent for changehat can be accomplished at a largerevel over time. Several types of tran-ition strategies and activities are de-cribed below.onnecting emergency food programs withrban agriculture projects. Urban agri-ulture involves producing food closero where most consumers live and is anncreasingly important strategy forchieving food security in the 21st Cen-ury as the world becomes more urban-zed (9,34). It offers many potentialenefits such as reducing energy costsnd pollution from food transportationnd storage, absorbing greenhouse gasmissions, offering a viable use for ur-an waste as compost, and creatingmployment and economic develop-ent opportunities (34-36).An example of a successful effort to
ink urban agriculture projects withmergency food programs is the Mich-gan Food Bank Garden Project, whichdministers 18 community gardens inhe Lansing area. All garden partici-ants receive supplies and training,hich enable them to grow and pre-
erve their own fresh vegetables. A sec-nd initiative of this project organizesolunteers to harvest surplus fruitsnd vegetables from local farms thatre distributed to residents of low-in-ome housing projects (9).
Another successful example in-
olves linking emergency food pro- C80 February 2005 Volume 105 Number 2
rams with CSA farms (37), an inno-ative strategy designed to connectocal farmers with local consumers,evelop a regional food supply,trengthen a local economy, maintainsense of community, encourage land
tewardship, and honor the knowl-dge and experience of local food pro-ucers (38). CSA members pay a feer volunteer their time in exchangeor a share of the CSA farm’s produceach week during the harvest season38). In the state of New York, dietet-cs professionals are involved with ef-orts linking emergency food pro-rams with urban agriculturerojects, including community gar-ens (39) and CSA initiatives (37).reating multisector partnerships and net-orks. Dietetics professionals canupport food systems in transition byreating or joining multisector part-erships and networks that result inutually beneficial programs and
rojects. For example, partnershipsnd networks are created by provid-ng nutrition education at farmers’
arkets (15) and conducting researchn enablers of and barriers to estab-ishing, accessing, and participatingn farmers’ markets within low-in-ome communities (40,41). Farmers’arkets improve consumers’ access
o fresh produce through reducedrices while stimulating the vitalitynd sustainability of the local econ-my (42,43).Two US federal assistance programs
xpand low-income populations’ accesso fresh produce at farmers’ markets:he Special Supplemental Nutritionrogram for Women, Infants, and Chil-ren (WIC) Farmers’ Market Nutritionrogram (FMNP) (44) and the Seniorsarmers’ Market Nutrition Program
SFMNP) (45). Research in Michiganevealed that the maximum positivempact on fruit and vegetable consump-ion was achieved among WIC FMNParticipants when nutrition educationccompanied the coupons that wereistributed as incentives to improve af-ordability (46). Evaluation of con-umer participation in the SFMNP inouth Carolina suggested that partici-ants receiving vouchers reported anntention to eat more fruits and vege-ables year round (47).
Dietetics professionals can also cre-te multisector partnerships that in-olve urban agriculture projects (eg,
SA farms and community gardens) snd farm-to-school programs. For ex-mple, one urban agricultural part-ership in Colorado connected CSAarms with the WIC program to pro-ote both fruit and vegetable con-
umption and physical activity forIC participants (48). Urban agricul-
ural partnership projects such asommunity gardening exemplify anntegrated approach to health promo-ion by increasing community net-orks, expanding green space, lower-
ng urban-neighborhood crime rates,nd providing employment opportu-ities (9,49,50). Farm-to-school part-erships provide local markets forarmers and integrate educationbout local food and farming issuesith local foods served in school cafe-
erias. These partnerships may alsoead to arranging special events withocal farm organizations, creating nu-rition curricula around school gar-ens, and providing opportunities foreld trips to local farms. Farm-to-chool programs have been shown toroduce positive outcomes such asromoting greater fruit and vegetableonsumption (51). Dietetics profes-ionals have been actively involved intarting up farm-to-school programsn Alabama (22), New York (22),ennsylvania (30), California (Mar-aret Haase, MPH, RD, personal com-unication, April 2004), and Newampshire (Helen Costello, MS, RD,ersonal communication, April 2004).acilitating participatory decision-makingrocesses and policy development. Com-unity residents must participate in
ecision-making processes and policyevelopment to increase their accesso resources (8,52,53). Participatoryecision-making and policy develop-ent can promote social cohesion and
educe inequities by building connec-ions between local food productionnd consumption (4,8,53,54). Partici-atory community food security strat-gies and activities such as food policyouncils, community-mapping pro-esses, and multistakeholder work-hops offer a planning framework andools to involve local residents in de-ning and analyzing their communi-y’s issues and mobilizing communityction around a range of food systemroblems (4,53,54). Each of thesetrategies and activities is describedn more detail below.
A food policy council is an officially
anctioned body representing various
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egments of a state, city, or local foodystem and is composed of diversetakeholders representing a wideange of interests related to agricul-ure, food, nutrition, and health. Theoal of a food policy council is to fostercomprehensive and systematic ex-
mination of agriculture, food, nutri-ion, and health policies (32). A foodolicy council may also bridge diversenterests toward a common goal32,55). Several statewide food policyouncils are active in Arizona, Con-ecticut, Illinois, Iowa, New Mexico,orth Carolina, Oklahoma, Utah,nd Washington (32,55). Municipalood policy councils operate in Berke-ey, CA (56), Knoxville, TN; Los An-eles, CA; Portland, OR; Salina, KS;oronto, Ontario, Canada (57); Min-eapolis-St Paul, MN (58); and Van-ouver, British Columbia, CanadaCorinne Eisler, RD, personal com-unication, March 2004). Dietetics
rofessionals are serving on food pol-cy councils in Iowa (58); Portland,R (59); Knoxville, TN (Betsy Haugh-
on, EdD, RD, personal communica-ion, February 2004); and Vancouver,ritish Columbia, Canada (Corinneisler, RD, personal communication,arch 2004).The Toronto food policy council has
een instrumental in placing commu-ity food security and food policy de-elopment on the municipal agenda.mong its notable accomplishmentsre conducting research for the Cityf Toronto and Food Share Toronto,hich led to the construction of an
ncubator kitchen; working with theconomic Development Committee,oard of Health, and Parks and Rec-
eation to develop strategies for fea-uring farmers’ markets at variousivic centers; and chairing the Schoolarden and Compost Committee at
he Toronto Board of Education,hich included conducting 25 garden-
ng workshops and developing a man-al for school garden and compostrojects (57).Dietetics professionals can also fa-
ilitate participatory decision-makingrocesses and policy developmenthrough organizing community-map-ing processes and multistakeholderorkshops. A community-mappingrocess involves analyzing the com-unity environment, examining the
auses and consequences of food inse-urity, and implementing strategies
or improving local community food tecurity (33,53). Diverse food systemtakeholders—including urban plan-ers, food producers and retailers,olunteers in food access projects,ood-insecure individuals, and otheroncerned citizens—convene to en-age in a process that examines how aocal community food system can
eet household and communityeeds by identifying available localood resources, food prices, transpor-ation options, and employment op-ortunities. For example, the Port-and-Multnomah County food policyouncil has partnered with the re-ional government to create a geo-raphic information system map ofrocery stores, farmers’ markets,mergency food locations, and com-unity gardens in the county (59).ommunity mapping is also used to
nform multistakeholder workshopst which views are exchangedhrough interactive processes to sup-ort project planning and policy for-ulation (53).The purpose of a multistakeholderorkshop is to provide a common visionnd a platform for building consensusmong diverse participants who mayave divergent or competing interests55). One evaluation in upstate Nework suggests that, to build community
ood security, practitioners may benefitrom skills in facilitation, negotiation,nd conflict resolution to transformonflict into greater capacity, equity,nd justice (4,60).
tage 3: Food Systems Redesign forustainabilitytage 3 of the community food securityontinuum provides examples of strat-gies and activities in which citizensnd government institutions play aarger role in building community foodecurity. This stage involves advocacynd public policies that integrate differ-nt policy fields (eg, education, labor,conomic development, agriculture,ood, social welfare, health) to increase
community’s food self-reliance andchieve nutritional goals (6) (see Fig-re). Integrated policies should ensurehat all community members have theapacity to buy healthful foods ratherhan rely regularly on charitable foodources. As well, it is important thathe proportion of the locally-based foodupply increases over time for the en-ire population, which may be achieved
hrough land-use policies, market pro- BFebruary 2005 ● Journa
otion, and subsidies, tax incentives,nd financing mechanisms.Norway is an example of a country
hat has used integrated policy in-truments to redesign its food system.orwegians aspired to increase theiromestic food self-reliance from 39%o 52% of total calories and to achieveacronutrient intakes appropriate
or a healthful diet using policy toolsuch as production and consumerubsidies, market promotion, con-umer education, and food labelingnd penalties for unhealthful foods61). By 1988, Norway had reached0% food self-reliance and increasedhole-grain consumption and theuality of locally-produced grains andotatoes. Greater improvements wereimited by the lack of human and fi-ancial resources (62).
UMMARYhis article provides dietetics profes-ionals with a three-stage continuum ofvidence-based strategies and activi-ies that applies a food systems ap-roach to building community food se-urity. Stage 1 creates small butignificant changes to existing food sys-ems through such strategies as identi-ying food quality and pricing inequi-ies in low-income neighborhoods andducating consumers regarding bothhe need and the possibilities for alter-ative food systems. Stage 2 stabilizesnd augments change for food systemsn transition by developing social infra-tructure through multisector partner-hips and networks and fostering par-icipatory decision-making and initialolicy development. Based on thesehanges, stage 3 involves advocacy andntegrated policy instruments to rede-ign food systems for sustainability. Dataollection, monitoring, and evaluationre key components of all stages of theommunity food security continuum.
upport for this article was providedy National Institute of Health grantR25CA57712-06, Behavioral Scienceducation Cancer Prevention andontrol, National Cancer Institute.he authors thank the following indi-iduals for providing comments on anarlier version of this paper: Sarahollins Couch, PhD, RD; Jenniferilkins, PhD, RD; Caroline Baumebber, MPH, RD; Rod MacRae,
hD; Trevor Hancock, MB, MHSc,
S; and Ronald Labonte, PhD.l of the AMERICAN DIETETIC ASSOCIATION 281
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