Low and middle-income countries (LMICs) are experiencing a nutritional shift from a predominance of problems of undernutrition, including micronutrient deficiencies, stunting and wasting, to a more complex situation characterized by a rapid increase in health problems associated with over-nutrition, such as obesity, diabetes mellitus (DM), hypertensive disease and other non-communicable diseases, (NCDs). There are no examples of countries which have started into this transition and then reversed it. Overweight, diabetes and other NCDs continue to rise and there is no known public health strategy to halt this. In Ecuador, the rural populations, in particular indigenous women, are disproportionately affected by nutrition-related NCDs. A key part of the decline in health is transformation to a food system dominated by ultra-processed food. Our project considers the potential of “Alternative Food Networks” (AFNs) to promote healthy changes to the Ecuadorian food system.

Objectives

We aim to examine the impact of AFNs on the underlying risk factors for diabetes and hypertension, to discern the specific attributes of AFNs that most efficiently prevent disease, and to explore how the endogenous scaling up of AFNs can be directed to generate a stronger impact on health among vulnerable populations in Ecuador and elsewhere. Specifically, our research objectives are:

1. To understand the pathways by which AFNs enable healthier local food environments and act on social determinants of health to reduce risk for diabetes and hypertension among farmers.
2. To evaluate the efficiency of strengthening and scaling up of specific AFN attributes in affecting dietary practice for diabetes and hypertension prevention.
3. To assess the impact of AFNs on physiological risk factors and biomarkers for diabetes and hypertension.
4. To synthesize findings into strategic intervention design for refining, intensifying and amplifying positive health impacts of AFNs in a broad range of geographic, cultural and economic settings.
5. Based on findings, to promote the institutionalization of more effective nutrition and NCD prevention programmes.

Health system impacts: By investing in upstream health promotion and disease prevention, the project has strong potential to reduce the long term burden of NCDs on the public health care system. Additionally, this study will support the health system by contributing to the proper screening for diabetes and hypertension in a marginalized rural population in Ecuador’s Sierra and Coastal regions. We expect this multisectoral collaboration to influence Ecuador’s health system by exemplifying how health imperatives closely integrate with environmental, economic and social aspects of sustainable development, and that these are best addressed through coherent practices and policy, and through self-organization and grassroots initiatives.

Capacity-building and upscaling: Our research contributes to the scale-up of health sensitivity within AFNs. This project provides the specific evidence-based foundation to ensure that (1) effective strategies are implemented to achieve health impacts; and, (2) implementation is appropriate and effective for achieving uptake and scale-up.

Knowledge translation and communication: Collaboration with the Ecuadorian food-focused initiative “Que Rico Es!” will facilitate knowledge translation and communication activities through their established media, networks and audiences. These include weekly national radio programs, website (www.quericoes.org) and lively social media platforms.