Responding to the intersecting challenges of non-communicable diseases, food insecurity, and climate change in small island states: The Global Community Food and Health Project

Small island countries of the Caribbean, South-east Asia, and the Pacific are increasingly dependent on food imports, typically of low nutritional quality. This dependence is associated with a decline in local food production and a high burden of nutrition related non-communicable diseases. This paper outlines the rationale, settings, methodology, and theories of change (ToC) of the Global Community Food and Health Project. The project has partnered with communities and stakeholders in Fiji, Palawan (Philippines), St. Vincent and the Grenadines, and St. Lucia to address the question: how can promoting increased community-based food production (CFP) based on agroecological principles improve household diets, nutrition, and food security, while also reducing the incidence of nutrition-related diseases? A further key question being addressed is: what is the environmental, economic and social sustainability of this approach? Our approach engages local stakeholders in food system mapping and co-creation, with “Living Labs” in which setting-specific interventions and ToC with measurable outcomes are designed in each of the four settings. Stakeholders are from local communities, government, local businesses, and civil society. Systematic evidence reviews were conducted and baseline data on household diet and growing practices were collected with locally adapted quantitative and qualitative tools. Interventions, now being implemented, promote environmentally sustainable, and resilient food production based on agroecological principles, while also providing communities with the knowledge and skills to better use local produce. Interventions also include the processing and marketing of produce. The interventions are being evaluated using mixed methods, including an assessment of participant engagement. Our interdisciplinary project provides approaches to engaging with communities and stakeholders to co-create system-wide and complementary interventions that navigate the challenges of improving both population nutrition and sustainable food production. Key to the future success of this work will be learning from and responding to the evaluation of the current interventions, in particular understanding where there are synergies and trade-offs and their implications for ensuring the continuing engagement of, and ownership by, local communities and stakeholders.