Gesunde Ernährung und Nachhaltige Lebensmittelproduktion Nationales Forschungsprogramm NFP 69

Alimentation Saine et Production Alimentaire Durable Programme National de Recherche PNR 69

Healthy Nutrition and Sustainable Food Production National Research Programme NRP 69

www.nrp69.ch Wildhainweg 3, P.O. Box 8232, CH-3001 Berne Swiss National Science Foundation Programmes Division National Research Programmes

Pre-proposal

NRP “Healthy Nutrition and sustainable food production” Responsible applicant

Name, First name,

Mattig Thomas

Project title

The potential of family urban agriculture for health promotion and sustainable cities in french-speaking Switzerland: identifying obstacles, leveraging opportunities

Type of involvement

Lead coordinator

Please indicate to which of the following research modules your project belongs to (see Implementation Plan for more details, multiple answers possible):

X

Research module 1: Examining and influencing consumer behaviours and nutrition patterns in Switzerland Research module 2: Evaluating the sustainability of food and nutrition systems

X

Research module 3: Optimisation of food and nutrition systems

Please list five publications from third parties (not yours) considered relevant as stepping stones for the research envisaged: 1. McCormack LA et al. (2010) Review of the nutritional implications of farmers' markets and community gardens: a call for evaluation and research efforts. J Am Diet Assoc. 110(3):399-408. 2. Friel S et al. (2011) Urban Health Inequities and the Added Pressure of Climate Change: An Action-Oriented Research Agenda. Journal of Urban Health: Bulletin of the New York Academy of Medicine 88(5):886-895 3. van den Berg A et al. (2010) Allotment gardening and health: a comparative survey among allotment gardeners and their neighbors without an allotment. Environmental Health 9:74 4. Leake JR et al. (2009) Health benefits of „grow your own‟ food in urban areas: implications for contaminated land risk assessment and risk management? Environ Health 8(Suppl 1):56 5. Frauenfelder A et al. "Joindre l'utile à l'agréable. Le jardin familial et la culture populaire". Gigon V "Etude de la productivité des jardins familiaux". HETS et HEPIA, Genève, février 2011 http://www.ies-geneve.ch/Manifestations/ceres/110215Jardins_familiaux.pdf

Please list the most important publications of your team (not more than five): al, St-Denis, Paris

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user Verlag, Basel.

3. Thomas Mattig, Gesundheit braucht Freiheit, Norderstedt 2012 4. Soguel L, Revelly JP, Schaller MD, Longchamp C, Berger MM. Energy deficit and length of hospital stay can be reduced by a two-step quality improvement of nutrition therapy: the intensive care unit dietitian can make the difference. Crit Care Med 2012;40(2):412-9 (Impact factor 2010 : 6.254) 5. Chastonay P, Moretti R, Zesiger V, Cremaschini M, Bailey R, Pariyo G, Mpinga EK. Health Workforce Development: a needs assessment study in French-speaking African countries. Advances in Health Sciences Education 2012; DOI10.1007/s10459-0129369-9

Please develop the following points:

1.

Research topic and objective of the project

The general aim is to foster a HiAP1 agenda catering to the needs of urban vulnerable groups and improving urban sustainability and resilience, using the public’s growing interest in family urban agriculture as an entry point. The specific aims are: - To map the key regional actors, interests and needs influencing policies and outcomes for family urban agriculture - To identify the regional obstacles and opportunities to realize the full potential of family urban agriculture as a health promoting and active learning activity in Switzerland - To gather local data on selected health, nutrition and behaviour effects of the practice of family urban agriculture - To provide policymakers and civil society with a palette of tailored options and problem solving tools. - To set the concepts base and implementation network for relevant future health promotion activities - To educate public health actors and other relays about key issues, findings, and opportunities for health promotion

2.

State of research

The on-going rapid succession of systemic crises and alerts has fuelled public interest in the various dimensions, effects and specific needs of family urban agriculture2 in developed countries. At the core of those preoccupations is the quest for innovative solutions to improve urban health gradients, well-being, food security, social integration, active learning, liveability, social/environmental justice and sustainability3. The latter also includes supporting the necessary re-orientation of the food system, mitigating the emerging risks related to climate change, and fostering biodiversity. According to the European Quality of Life Survey, between 5 to 22% of the population of Western European countries is involved in some degree of self-provisioning of food in Western European countries, and this proportion amounts to 30 to 60% in Eastern European countries, across all social groups. (Jehlicka et al. 2012). In both cases, people engage in self-production for multiple reasons. While survival strategies or economical benefits are not currently among the main ones (Clarke et al. 2000, Ries 2009, Jehlichka et al. 2011), they cannot be entirely discounted. Other authors stress the possible effect of high uncertainty about incomes, markets and jobs (Southworth 2006). Personal regeneration from life stresses, social activities and access to fresh, self grown vegetables appear most frequently in the narratives. Western populations appear to be catching up with their Eastern counterparts, with a trebling demand for allotment gardens: between 2009 and 2010, the waiting lists grew 20% in the UK, for a total of 94‟124 people, and only 483 plots in new allotment sites brought in use by local authorities (Campbell and Campbell, 2010). Coming mainly from archives and historical data, there is substantial, policy-level evidence for the key role of urban agriculture in cushioning severe systemic shocks in industrial4 countries. Conversely, decades of anthropological, sociological, economic and observational studies consistently point to significant added value to key family and social functions. There is a long history of therapeutic uses of horticulture, especially in the mental health domain (Detweiler et al. 2012), with some reliable evidence of the effectiveness and appropriateness of natureassisted therapy (Annerstedt and Währborg 2011) and some evidence that activity in a natural environment compared to a different environment can have a positive impact on mental well-being (Bowler et al. 2010). There 1 2

See: Adelaide Statement on Health in All Policies (2010) http://www.who.int/social_determinants/hiap_statement_who_sa_final.pdf

Defined in contrast to “Professional Urban Agriculture” (“farmers and market gardeners of low, middle and high income, farmer‟s cooperatives, private or public firms including agro business and family business gardeners”), “Family Urban Agriculture” encompasses the concepts of “kitchen gardens, collective gardens, allotment gardens, community gardens, urban family gardening” with the production mostly intended for self consumption (Boukharaeva and Marloie, 2006). Significant parallels may be drawn between the acknowledgement of the persistent importance of those activities in industrial and post-industrial countries (see for example Weber 1996) with the recognition of the “user-led” (Von Hippel 2005) or “produsage” (Bruns 2007) key roles in innovation. 3 See for example WHO (2001), Small (2007), Duchemin et al. (2008) 4 WWI, WWII “liberty gardens”, 1930s “relief gardens”. See Acton (2011), Van Molle & Segers (2008) for historical perspectives; more recently: 1990s former USSR and Cuba. Surprisingly, this “hard evidence from History” and its rich policies background is often overlooked in current systematic reviews focused on RCTs, leading to remarks such as “we are faced with a dearth of research or evaluation that adequately demonstrates the efficacy of urban agriculture initiatives in preventing or alleviating food insecurity” and “limited literature presenting high level evidence has been located” (Montague 2011)

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is high level evidence of a protective effect of fruit and vegetables consumption for hypertension, coronary heart disease and stroke (Boeing et al. 2012) and probable evidence that the risk of several major types of cancer is inversely associated with the consumption of vegetables and fruit (Boeing et al. 2012, Riboli and Norat, 2003). There is possible evidence that an increased consumption of vegetables and fruit may prevent body weight gain (Boeing et al. 2012). However, other specific health and behaviour benefits for individuals have been less subject to close scrutiny. Overall, a recent mixed methods study shows that quality and quantity of greenspace in residential areas are positively correlated to health. That relationship might be partly mediated by reduced stress and increased social cohesion (Groenewegen PP et al. 2012). Data from developing and transitional countries shows a “fairly consistent evidence of a positive statistical association between engagement in urban agriculture and dietary adequacy indicators” (Zezza and Tasciotti, 2010). In Michigan, adults with a household member who participated in a community garden consumed fruits and vegetables 1.4 more times per day than those who did not participate, and they were 3.5 times more likely to consume fruits and vegetables at least 5 times daily (Alaimo et al. 2008). A small British study detects higher vegetable intake and increased physical activity in gardeners compared to the general population (Hunt 2010). A recent review of the nutritional implications of farmers‟ markets and community gardens stresses the need of well-designed nutritional studies (McCormack 2010). A recent study compares allotment gardeners to their neighbours, showing significantly higher levels of physical activity, health and well being, especially for the older gardeners (van den Berg et al. 2010). Allotment gardeners report significant less perceived stress than participants of indoor exercise classes (Hawkins et al 2011), and gardening has been shown to promote neuroendocrine and affective restoration from acute stress (Van Den Berg 2011). A garden-enhanced nutrition curriculum improves school children‟s knowledge of nutrition and preferences for some vegetables, as compared with nutrition classes alone (Morris and Zindenberg-Cherr 2002). A review of garden-based nutrition intervention programs suggests that those programs may have the potential to promote increased fruit and vegetable intake among youth and increased willingness to taste fruits and vegetables among younger children, but there is a lack of well designed studies (Robinson-O‟Brien et al. 2009). In Switzerland, the fruit and vegetables (FV) intake in the general population does not meet the recommended values5. A study made in the Swiss national program against cancer in 2005 showed that in the French speaking part of Switzerland 15% of the people interviewed consumed ≤ 2 servings of fruits and vegetables per day, 41% 2 - 4servings per day, 25% 4-5 servings and only 15% ≥ 5 servings per day. To our knowledge, there are no specific data for FV intake in the gardeners‟ population available in our country. Such data may contribute to a better understanding of FV intake in order to propose strategies to increase it and promote health. Local (Canton de Fribourg 2012; Chabbey 2012) and international (Alloway 2004) data show a range of problems with soil contamination with heavy metals and over-fertilization in private, allotment and community gardens alike. While the actual bioavailability of pollutants is subject to many factors (Islam et al. 2007) and does not always compromise for the safety of vegetables (Leake et al. 2009), the long term fertility of some soils might be at risk, and wide site-specific effects on contaminants are to be expected in urban areas (Saümel et al. 2012). It has been suggested that wider health and societal benefits should be taken into account in current risk assessment methodologies (Leake et al. 2009). Many of the gardener‟s practices can be amended with appropriate information, education and support services. Among others, soil testing has been recommended (Sterrett et al. 1996, Finster et al. 2004). Several offices offer some degree of information services for gardeners such as brochures, but the transfer of this information into safe practices does not appear to have been evaluated. Actual ecological practices and knowledge in allotment gardens are retained and transmitted by imitation of practices, oral communication and collective rituals and habits, as well as by the physical gardens, artifacts, metaphors and rules-in-use (Barthel et al. 2010). Several countries are taking account the multifunctional roles of family urban agriculture, among them the U.K., the U.S. and Canada. Not unlike what happened in former communist countries6, grassroots pressure and community action may play an important role in the adoption of favourable country and city-level regulations7. 5 6

3 servings (360g) of vegetables and 2 servings (240g) of fruits per person per day (Société Suisse de Nutrition, Swiss Food Pyramid, 2011)

In Russia, negotiating with mostly reluctant authorities, the long quest for access to comparatively large land parcels adjacent to high density cities, then to the right to build and sojourn there, is considered by some authors as an important democratic conquest with an universal meaning. (Boukaraeva and Marloie, 2010). Others might observe that opportune conciliatory measures on garden plots may have kept the malcontent off the streets and reduced public scrutiny pressure on authorities during a period of critical reforms and deals. 7 See for example: van der Schanz (2010)

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Where political will exists, local/municipal institutions may facilitate placing the food system on the urban agenda (Pothukuchi and Kaufman, 1999) and promote the availability of locally grown, healthy food (WHO 2001). For example, cities may engage in substantial revisions of zoning code laws, opening the way to community and commercial urban agriculture activities in diversified neighbourhoods, while simultaneously pre-empting potential nuisances8. At a higher (country) policy level, UK‟s „Food 2030‟ strategy takes account of the third sector and explicitly considers making land available for community food growing, and funding school food growing programs, to enable and encourage people to eat a healthy, sustainable diet with a low carbon footprint (Defra 210, Hunt 2010). However, practices such as allotment gardening are still affected by a poor, marginalized, sometimes discriminatory image9 (Cérézuelle 2003). There is some evidence that this group might have been sidelined in the collaborative management of ecosystem services by better connected proponents of more passive uses of greenspaces (Ernstson et al. 2008). In Switzerland family urban agriculture, in spite of a sustained unsatisfied demand10 especially from vulnerable groups11, has yet to be recognized as a valuable HiAP target, and may be eclipsed by colliding forces such as conservationist land use planning, a chronically dry housing market, and commercial land pressures. On the other hand, according to some models, the long term convergence of the Swiss agricultural policy with the UE‟s CAP is expected to result in a reduction of the return rate of agricultural land (Müller and Grether 2002) opening a potential to innovative policy options. A more flexible allocation of land uses would be in line with recommended policies for adaptation to and mitigation of climate change effects (Olesen and Bindi 2002).

3.

Research plan: approaches and methods

We will carry on a literature review on urban agriculture and sustainable development, education, health and public policies. As there is a substantial potential for synergy with some ongoing research projects being carried on with NRP 65 “New Urban Quality”12, specific inputs from those groups will be sought. After actors mapping (Aligica 2006) and stakeholder analysis (Schmeer 1999), we will carry on qualitative research (interviews and/or focus groups) (Winch et al. 2000, Crosby et al. 2006) aiming to elucidate the various actors‟ concerns, needs and obstacles. Fresh local data on the nutritional status, mental health and well-being of gardeners and controls (Yanagawa 1979) will be collected. Fruit and vegetable intake will be repeatedly assessed in quantity, variety13 and origin by trained dieticians using nationally validated methods (multi pass 24 hours dietary recall), during a full year cycle. The various results will be input to a Health Impact Assessment process (Plateforme EIS 2010) engaging all of the identified most significant actors. Health impact assessment (HIA) is most commonly defined as “a combination of procedures, methods and tools by which a policy, a program or project may be judged as to its potential effects on the health of a population and the distribution of effects within the population” (WHO, 1999). HIA attempts to predict the consequences of a decision before it has been implemented (Kemm et al, 2004). Its main purpose is to influence decision-making process, so that policies, projects, and programmes in all areas lead to improved population health or, at least, do not damage population health (Kemm et al, 2004). HIA is built upon the health determinants approach, which considers that health is mostly determined by a spectrum of factors from physical, social and economic environments and emphasizes the relatively small role played by health services in influencing the health of the population. Despite differences shaped by a diverse origin (i.e. environ8 9

See for example: Bureau of Planning and Sustainability (2012)

Evidence of patronizing and prejudices is relatively abundant, ranging from the press (see for example: Spiegel Online International 2006) to some researches descriptions (see: Callenge 2007). 10 Characterized by very long waiting lists. In Geneva, in 1994 the waiting list was 500 persons long (Joye 1994), currently 700 persons for about 2‟200 allotment parcels. Also observed is a sharp reduction of the surface of the proposed lots, raising questions on some aspects of the potential for sustainability. The picture is similar in UK surveys. 11 Eight out of ten users of allotment gardens in Switzerland are classified as members of the “popular classes” (factory workers and lower rank employees) (Frauenfelder et al. 2011). In the main employment basins, a combination of high prices, high rent substitution taxation and restrictive policies have reserved access to individual housing to the substantially well-off. The allotment gardener‟s shack, nicknamed “the poor man’s cottage” typically represents the only possibility of “access to land” with a minimum of privacy for those categories. 12 http://www.nfp65.ch/E/Pages/home.aspx 13 We formulate the hypothesis is that gardeners, as compared to non gardeners, have a better knowledge of fruits and vegetables, and tend to eat a wider variety of them.

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mental health, social view of health and health equity, Harris-Roxas, Harris, 2010), HIA methodologies share the same procedural steps, namely screening, scoping, appraisal, recommendations for decision-making and followup (Harris et al. 2007). Table 1: Activities, targets, deliverables and expected resulting process Activities Literature review public health experts consultation exchanges with NRP 65 projects

Actors mapping Stakeholder analysis Mixed methods research

Nutrition surveys

Targets biodiversity and natural capital risks mitigation non-renewable resources conservation re-engineering the food system environmental services from/for FUA school & educational activities health effects food security public policy, land use, zoning codes international framework changes and expected effects grassroots aspirations and motivations monetary and nonmonetary evaluation all of the identified actors

Deliverables literature reviews report

all of the identified actors

influence map

most significant actors special emphasis on policymakers, grassroots organisations and educational institutions gardeners vs. controls

Synthesis of qualitative research: obstacles, opportunities, specific needs Synthesis of nutrition surveys HIA report

Health Impact Assessment of family urban agriculture General synthesis

most significant actors

Final dissemination of results

all of the actors general public public health students

4.

all of the actors

Process flow input to the HIA and policy actors

SWOT with experts

actors list

base to stakeholder analysis strategy to engage actors input to the HIA input to the HIA

input to the HIA Policy-level recommendations adapted to the local context

Recommendations manual (organized by stakeholders) A public health event (thematic week at the Master of Advanced Studies in Public Health, Geneva University)

input for a health promotion operational plan

Q5

Q8

Adoption / adaptation of relevant healthy public policies Input to communication strategy Input to implementation network

Timeframe and milestones

Quarter Coordination & steering Experts consultation Litt. reviews Actors mapping & Stakeholder analysis Mixed methods research Nutrition survey HIA General synthesis Recommendations manual Dissemination of results

Q1

Q2

Q3

Q4

Q6

Q7

Q9

Q10

Q11

Q12

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5.

Expected benefits and possible application of results

We expect the process to facilitate connexions and exchanges between policymakers and grassroots organizations in problem-solving networks (Gillies 1998), clearing obstacles to progress along the lines of WHO’s Urban and peri-urban food and nutrition action plan (WHO 2001). The data collected will directly inform the Health Impact Assessment and policy process, extend our knowledge of the local links between nutrition and gardening, and reinforce the evidence basis for innovative health promotion activities. The expected long term outcomes include improved, fairer access to fresh, safe foods and the culture of land, increased physical activity and mental health, reinforced social nets and a greater understanding of sustainable food cycle issues. The gardeners might provide and be the target of a wide range of environmental, educational and social services. Current and potential home gardeners should also be targets of future activities, helping mainstreaming family urban agriculture and exploring opportunities to enhance the sustainability of suburbs (Holmgreen 2005, Ghosh and Head 2009, Ghosh 2010). A large urban population involved in hands-on gardening and “grow your own” activities might raise awareness14 and kick-start the much needed social consensus for re-engineering the city towards improved sustainability with reduced carbon footprint, shortened Phosphorus, Nitrogen and organic matter cycles, rooftop and façade greening, local rainwater capture and re-use, fostering biodiversity, etc. Fine-tuning this secular transformation will need significant multisectorial engagement. The foundation Health Promotion Switzerland has recently launched the Healthy3 initiative, with the aim to bring together actors of sustainable development and health promotion. This project might ideally fit with its framework and focus key actors on practical policy problem-solving questions. A high level of synergy and exchanges is expected, among others, with the upcoming development of an Urban Agriculture chair at HEPIA in Geneva, and at an international level with TUD COST action TU120115. Exchanges and dissemination of results at the international level will be carried on in collaboration with the WHO European Healthy Cities Network. Specific risks to be considered Risk event

Probability of occurrence

Estimated project impact

Mitigation strategy and contingency plan

The project may fall behind schedule

Low

Medium

Control: the team’s partners are recognized and experienced players in their own domains and in network collaboration; allocated resources are realistically proportionate to ends. Multi-stakeholder meetings include progress assessment and early correction measures

Key stakeholders unwilling to participate or opposed to project development

Low

High

Control: The combination of a growing public interest, project visibility and participation of grassroots organizations make it unlikely that public sector actors will defect. Promote dialogue/negotiation between parties and stress prospects related to innovation and new opportunities

Unforeseen risks emerge

Low

High

Ongoing contingencies assessment during project allowing for early action.

The project outputs may not stay focused on the specific needs and demands of users, raising questions of adequacy

Low

High

Users (gardeners) are included all along from the very early stages of planning and design of the project’s activities.

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This idea is making headways into recent UK parliamentary hearings: “CPRE believed that it was important to involve increasing numbers of people in food growing, not only so that they could produce their own food, but also so that they could understand the environmental issues surrounding food production. Transfer of knowledge in this way contributed to creating a more informed body of consumers which could in turn help to increase people's commitment to buying more sustainable produce from established food retail outlets.” (Environmental Audit Committee 2012). The Committee‟s recommendations include, among others, “food skills, such as cooking and gardening, should be part of the curriculum in all schools. new national planning policy for Local Authorities should ensure communities have access to healthy food and land to grow their own produce”. However, support for community initiatives seems to be in jeopardy currently, due to the difficult economic situation in the UK. 15 http://www.cost.eu/domains_actions/tud/Actions/TU1201