Stories of change in nutrition: lessons from a new generation of studies from Africa, Asia and Europe

Abstract

How does nutrition improve? We need to understand better what drives both positive and negative change in different contexts, and what more can be done to reduce malnutrition. Since 2015, the Stories of Change in Nutrition studies have analysed and documented experiences in many different African and Asian countries, to foster empirically-grounded experiential learning across contexts. This article provides an overview of findings from 14 studies undertaken in nine countries in South Asia, sub-Saharan Africa, and Europe between 2017 and 2021. The studies used a combination of methods, including regression-decomposition analyses of national datasets to assess determinants of nutritional change; policy process and food environment analyses; and community-level research assessing attitudes to change. This article takes a narrative synthesis approach to identify key themes across the studies, paying particular attention to multisectoral determinants, changes in the food environment, the role of structural factors (including longstanding social inequities), and changes in political commitment, cross-sectoral coherence and capacity. Given the inherent multisectoral nature of nutrition, many countries are experimenting with different models of ensuring coherence across sectors that are captured in this body of work. The relative immaturity of the policy sector in dealing with issues such as obesity and overweight, and associated influences in the wider food environment, adds a further challenge. To address these interrelated issues, policy must simultaneously tackle nutrition’s upstream (social/economic/equity) and downstream (health and dietary) determinants. Studies synthesised here provide empirically-driven inspiration for action.

Plant-Based Diets versus the Mediterranean Dietary Pattern and Their Socio-Demographic Determinants in the Spanish Population: Influence on Health and Lifestyle Habits

“…Another possible explanation for the lack of dependence found between dietary pattern choice and socio-demographic determinants could be that, in recent decades, particularly in Western countries, there has been a significant change in attitudes towards food and health in general. This has led to a greater awareness of different types of diets and a more widespread adoption of healthy lifestyles across the population, regardless of gender, age, educational level, income level, or place of residence [48,49].…”

Applying the ‘Candidacy’ Model to understand access to key nutrition, food & health services in LMIC contexts: a qualitative study in Odisha, India

“…Odisha has an estimated poverty rate of 33% (vs. 22% for the whole of India) with considerable social and spatial variation across the state; rural poverty rate in the most backward districts is 68% vs. 46.9% for the state rural average (Thomas et al, 2015). ST and SC populations are the most marginalised and the poorest in India (Diwaker, 2014;Mosse, 2018) who are therefore expected to experience worse health and nutrition outcomes than the rest of the population (Barros et al, 2010;Nisbett et al, 2022).…”