Dalla Lana School of Public Health

The COVID-19 pandemic has amplified existing nutritional challenges. It has put into focus unsustainable food and nutrition policies and practices that are not only non-resilient to shocks, but also increase the likelihood of future shocks. The impacts of unsustainable food policies and practices on natural systems (e.g., forests, climate) feed back to affect food production and ultimately food and nutrition security. To break the feedback loop, recovery from the COVID-19 crisis should be designed to “build back better”¹. That is, doing more than getting livelihoods back to normal by designing policies or interventions that reduce the likelihood of future shocks, strengthen resilience to them when they occur, and address pre-existing structural inequities². This can be achieved by integrating environmental, food and nutrition interventions to ensure that nutritional outcomes are not delivered at the expense of the environment. Forest conservation interventions offer a unique opportunity as nutrition-sensitive interventions.

Alignment of nutrition and environment co-benefits

Forests provide ecosystem services that support resilience of vulnerable forest dependent households to shocks, meaning the ability of these households to withstand and bounce back from shocks. Examples of such services include the provision of forest foods and livelihoods from forest products³. Other forest ecosystem services reduce the risks of future shocks (e.g., climate change mitigation and regulation of zoonotic and vector-borne diseases)⁴⁵. However, forests are under threat in large part due to agricultural expansion driven by increasing food demand⁶. There is thus a need to develop interventions that safeguard forests while meeting human nutritional needs.

Forest conservation is a potential nutrition-sensitive intervention that can deliver conservation and nutritional co-benefits. Forest conservation can address several underlying determinants of undernutrition lying on the pathways between forests and nutritional status, including the supply of forest food products, income, habitat for pollinators, diarrheal disease, dietary diversity, and women’s time allocation to forest-related livelihood activities (e.g., firewood collection) that in turn affects their time for nutrition-related activities (e.g., food preparation, child feeding behavior)⁷. Forests have been associated with reduced prevalence of stunting and anemia⁸⁹. Forest conservation interventions are often located where rates of undernutrition are high¹⁰. Increasing the nutrition sensitivity of forest conservation will therefore provide nutritional benefits for some of the world’s vulnerable communities.

Relevant conceptual theories, methodological tools, frameworks, approaches, gender and equity considerations

Spotlight on references:

Ruel MT,  Alderman H. Nutrition-sensitive interventions and programmes: how can they help to accelerate progress in improving maternal and child nutrition? Lancet 2013;382:536–551.

Rasolofoson RA et al. Forest conservation: a potential nutrition-sensitive intervention in low- and middle-income countries. Frontiers in Sustainable Food Systems 2020;4,20.

To increase their nutrition sensitivity, nutrition-sensitive interventions are used as delivery platforms for nutrition specific interventions (e.g., food supplements, fortification) that address the immediate causes of undernutrition (e.g., nutrient intake)¹¹. I propose to use community forest management, a widespread forest conservation intervention in developing countries¹², as a platform to deliver community nutrition programs. Both community forest management and community nutrition programs involve local communities. By offering a community-based delivery platform to nutrition programs, community forest management will increase the likelihood of success of nutrition programs at delivering nutritional outcomes. Community forest management, in turn, can leverage nutrition benefits provided by nutrition programs to improve its local acceptability.

Community nutrition activities will target undernourished women and children in community managed forest sites in Madagascar. Women and children are often vulnerable to undernutrition in low- and middle-income countries¹³. In these countries, women are also primary caregivers and prepare food for their families. Community nutrition activities will focus on community kitchens, which are community nutrition programs that not only address food and nutrition insecurity but also empower women by the varieties of activities that the programs can accommodate, such as nutrition education, development of health eating habits, cooking, agricultural and budgeting skills¹⁴¹⁵¹⁶.

Measurement of impact

Spotlight on references:

Iacovou M, Pattieson DC, Truby H, Palermo C. Social health and nutrition impacts of community kitchens: a systematic review. Public Health Nutrition 2012;16:535 – 543

Metrics:

• Nutritional outcomes: anthropometric measurement (e.g., height, weight, age) and blood sampling will be undertaken.
• Nutrition-related intermediary outcomes: women will be interviewed to detect any change in intermediary outcomes, such as income, nutritious food intake, healthy child feeding behavior, food security, and dietary diversity.
• Conservation outcomes: forest cover, restoration or degradation will be monitored
• Conservation-related intermediary outcomes: household surveys will be carried out to examine conservation behavior and the attitude and perception of communities toward community forest management, its activities, and contribution to the well-being of the communities.

The idea proposed here is intended to influence conservation and public health practitioners and scholars. The innovative solution integrating community forest management and community nutrition programs I propose will demonstrate to conservation and public health practitioners the potential synergy between forest conservation and public health nutrition. It will catalyze closer collaboration between these practitioners as such collaboration has the potential to better deliver conservation and nutrition co-benefits than either of these practitioners working on their own.

The serious challenges to global health and nutrition posed by the rapid human transformation of ecosystems has led to increasing number of studies examining the links between ecosystems and human health and nutrition. By testing a solution that integrates environmental and nutrition interventions, the idea presented here can serve as an example that will inspire scholars to go beyond linking ecosystem and human health to developing interventions that safeguard both ecosystem and human health.

Challenges/barriers and knowledge gaps impeding shifts towards healthier and sustainable food systems and barriers

Spotlight on references:

Houghton RA. Carbon emissions and the drivers of deforestation and forest degradation in the tropics. Current Opinion in Environmental Sustainability 2012;4:597–603.

It is only recently that conservation and public health sectors have started to interact given the public health threats posed by ecosystem degradation. Conservation and public health have evolved separately without much interaction. Consequently, scholars and practitioners in both disciplines have developed different perspectives and approaches that can present challenges in collaborative efforts to address the public health threats posed by ecosystem degradation. The innovative solution integrating forest conservation and nutrition interventions proposed here will provide a platform for close interaction between conservation and public health that will promote mutual understanding and thus improve collaboration between the two disciplines. A challenge observed in the rare conservation initiatives that intentionally consider human health is the establishment of links between conservation activities and activities designed to improve human health. To link community nutrition programs to community forest management, some specific activities of the nutrition programs will be limited to the women that are members of community forest management associations, while other activities will be open to all target women and children from the wider communities. Activities limited to members of community forest management associations are intended to incentivize these members to continue actively in the associations and non-members to join the associations and its conservation activities. Activities open to women and children from the wider communities are intended to improve their food security and nutritional status and to change or improve the community’s attitude toward community forest management.