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Policy relevant food research for improving urban populations diets
1. Policy relevant food research for
improving urban populations diets
Manuel Franco MD, PhD
Associate Professor
School of Medicine, University of Alcala, Spain
Adjunct Associate Professor
Department of Epidemiology
Johns Hopkins Bloomberg School of Public Health, Baltimore
Food 2030 October 16th. 2017
2. http://hhhproject.eu
• Diet is a chronic disease risk factor
highly influenced by the local food
environment.
• Urban health relevance:
• 2050 2/3 of world population
• Chronic diseases and aging
• Health inequalities
• Urban food environment is an
example of a mass influence on
population diets and health.
Franco M. et al. (2016). Food Environment.
Encyclopedia of Food and Health.
Academic Press, Oxford
Urban Food Environment
3. Social and Physical Urban
Environment and Cardiovascular Health:
The Much Needed Population Approach
Manuel Franco MD, PhD
Starting Grant 2013
5. http://hhhproject.eu
To provide scientific evidence to researchers, general
population and policy makers to intervene at the
population level preventing 1ST cause of death in Europe
R&I impact: Methods, articles, conferences.
Social impact: Participation, communication, policy making
HHH overarching objective
Policy and research implications
6. http://hhhproject.eu
Kick off meeting Sept 2014
Interdisciplinary team
PI: Social Epidemiology
Geography
Sociology
Primary Health Care
Epidemiology
Health Policy
Photography
Communication
8. http://hhhproject.eu
Urban food environments
Mediterranean urban food environments
share unique characteristics:
1. Diversity
(Types of food stores)
2. Compactness
(Shorter distance)
Diez J, Bilal U and Franco M,
EJCN, 2017, accepted.
9. http://hhhproject.eu
1. Analyse
data context
2. Collect
on-field data
3. Collect
municipal
data
4. Validate
municipal
data
5. Rate
healthy food
access
6. Translate
results for
government &
stakeholders
AIM
• To examine whether municipal data are a valid source to characterize
the retail food environment in the whole city of Madrid.
• To test whether indicators of validity differed by area-level deprivation.
Diez J, Bilal U and Franco M, AJPM 2017, Under review.
Measuring MED food environments
10. http://hhhproject.eu
Table. Validity of municipal data sources as compared with ground-truthed
data (n=117) for the location of food stores in the city of Madrid, Spain.
MUNICIPAL DATASET
Type of store Sensitivity 95% CI PPV 95% CI
Supermarkets 100.0% 83.9% , 100.0% 91.3% 72.0% , 98.9%
Small grocery 86.7% 73.2% , 94.9% 59.1% 46.3% , 71.0%
Convenience 100.0% 87.0% , 100.0% 100.0% 87.0% , 100.0%
Specialized 87.5% 74.8% , 95.3% 42.9% 32.9% , 53.3%
95% CI: Confidence Interval; Est. = Validity Statistic Estimate
Diez J, Bilal U and Franco M, EJCN, 2017, accepted.
Measuring MED food environments
11. http://hhhproject.eu
• Our step-wise approach allows other cities to asses an entire city
• For effective food policies, governments and stakeholders need accurate
information on the retail food environment to:
1. Evaluate availability and access of healthy/unhealthy food
2. Compare between cities, regions or countries
3. Identify and track changes over time
4. Evaluate the impact of the RFE on health outcomes
Mediterranean food environments
R&I and Policy conclusions
13. Research
• Cross-cities comparisons are
needed to promote healthier diets
• Relying exclusively on supermarkets
underestimates healthy food
availability in MED cities
Policy
• Supporting more compact and
diverse urban environments
R&I and Policy conclusions
14. Manuel Franco MD, PhD
School of Medicine, University of Alcala, Spain
Department of Epidemiology
Johns Hopkins Bloomberg School of Public Health
A Participatory Action Research project to
understand the food environment in Madrid
PHOTOVOICE VILLAVERDE PROJECT
15. http://hhhproject.eu
What is Photovoice?
• Photovoice is a participatory-action research method.
• Enables participants to identify, capture, and reflect their community´s
strengths and concerns through group discussions and photography
• Informs policy makers to persue relevant public policies
16. http://hhhproject.eu
• 24 participants took 163 photographs, and identified 30
categories emerging from the photographs and discussions
• Final categories were then organized around five themes of the
food environment related to dietary behaviors:
1. Eating in moderation
2. Cultural diversity
3. Food stores
4. Social relationships
5. Economic crisis and poverty
Results
Diez. J. and Franco M. Health and Place 2016
26. http://hhhproject.eu
Photovoice a succesful story
• Citizen science, participatory-action research method.
• Five methodological workshops in Spain and the US
• Four research articles
• Direct policy dialogue
• Bilingual and multifacetic communication strategy:
• Photobook, video, exhibitions, media
27. http://hhhproject.eu
Further R&I work in Food 2030
1) Support for interdisciplinary teams and mixed methods
2) Citizen science and participatory-action research
3) Well-designed urban food interventions and evaluations
from a Public Health Nutrition perspective
A. Collaborative policy-research teams and designs
B. State of the art nutrition and health measurements
28. http://hhhproject.eu
• HHH participants
• HHH team and international collaborators
• Funding agencies:
• European Research Council
• Ayuntamiento y Comunidad de Madrid
• Fondo de Investigación Sanitaria
• Plan Nacional de Investigación
• Plan Nacional Sobre Drogas
• Fundación Mapfre
• Center for a Livable Future, Johns Hopkins
Acknowledgements
el logo arriba y abajo queda repetido. Propongo quitar la chapa y centrar el título
Hacer un poco más pequeña la imagen para dejar márgenes
Repasar animacion! Porque al final sale el titulo de la diapo...valorar si el tñitulo sale desde el principio
Incluso en el comité asesor nacional e internacional INTERDISCIPLINARIDAD
DECIR SOBRE ESTA DIAPO:
Sensitivity:
The municipal dataset showed good sensitivity values and moderately reliable PPV values - almost perfect for supermarkets; lowest for specialized stores
We found no systematic bias across area-level deprivation
First study to compare accuracy of data from a municipal source to the gold-standard of ground-truth data in a large whole Southern-European city
Figure 1 shows the pedestrian access to high-healthy food stores in both areas. In Madrid
77% of the residents lived within a walkable distance of less than 200m to a food store with high healthy food availability. The remaining 23% lived within a walkable distance of 200 to 400m.
A different trend was evident in Baltimore, with only 1% of the residents located within less than 200m from a food store with high healthy food availability, and where most residents lived at a distance of 400 to 800m (13%) or further than 800m (82%) from them.
Manuel, si quieres modificar esta imagen, la tienes en la siguiente diapo que está oculta.
Lo importante que yo diría aquí:
En base a los resultados obtenidos en el Photovoice se han generado unas recomendaciones (etapa 4) y actualmente estamos trabajando en la etapa 5 y 6 con la idea de que se llegue a una etapa 7, que ya depende de los políticos.
Los participantes (community) han estado involucrados en el proceso de manera activa desde etapas tempranas.
Los políticos no serán “únicamente” informados con nuestro proyecto, si no que se les ha involucrado de manera activa en la difusión (Ayuntamiento, expo, fotolibro)
Incluso en el comité asesor nacional e internacional INTERDISCIPLINARIDAD
