Www.publichealth.ie Lessons from the Decent Food for All (DFfA) intervention Kevin P Balanda (presenter), Audrey Hochart, Steve Barron, Lorraine Fahy Tackling.

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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

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20

40

60

80

100

120

140

160

180

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Least deprived Deprived Most deprived

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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

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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