#PHTwitJC 14 *Sun 27 May*: Sustainable Food Systems in Europe

 * This #PHTwitJC chat rescheduled   due to lack of participants, to Sunday  27th May at 8.00-9.00 pm (UK time). We’ll be discussing this paper:

Rayner, Barling and Lang (2008) Sustainable food systems in Europe: policies, realities and futures. Full text available here.

Join in by signing into Twitter and searching for the #PHTwitJC  hashtag – remember to use it if you want to contribute (further instructions for joining a Twitter chat are available at the ‘About’ tab, above).

This is the first time that PHTwitJC has selected a review-type article to discuss, as opposed to a primary research study/ systematic review.We hope to have an interesting discussion on policies for achieving food security and sustainability in Europe and beyond.

About the paper

The authors review food and agriculture policy in the European Union (EU) over a number of decades. A tension is identified beteween the EU ‘s commitment to sustainable development on the one hand, and competitiveness/ economic growth on the other.

The authors present a framework for doing an ecological public health* analysis of policy-making, which is applied to food policy. They suggest that the framework is a ‘simplifying mechanism’ that ensures analytic emphasis on all four domains  that influence human existence; whilst acknowledging complexity.   The four domains identified are:

1.    Material /physical world

2.    Physiological world

3.    Social world

4.    Cognitive world (lifeworld)

Environmental, cultural and health ‘frontlines’ of the struggles relating to food policy in the EU are discussed. Marked transitions are identifiable  in the economics of food and its place in culture(s).   These are related to nutrition  and health transitions: the shift towards diets dominated more by processed foods, saturated fats and sugars; and towards a non-communicable disease burden.

Tensions are highlighted, for example, between the types of food production and distribution  that are supported; and the EU’s declared position on human health and nutrition, and on sustainable environmental policies. Voluntary self-regulation by producers and retailers of food (in the areas of marketing and labelling, for example) has had mixed results.

The authors argue for integrated food-related policy that  must address all the above domains, in order to resolve some of the tensions, and develop in a sustainable way.

Areas for discussion in #PHTwitJC  include:

• Is the analytic framework presented clear? Is it applied appropriately?
• Is the argument logically developed and supported with valid evidence/examples?
• What is the main contribution of the article: what new knowledge/ understanding is achieved of the issue?
• What lessons can we take from the article, for public health policy/practice development?
•  What developments have their been since the article’s publication in 2008, that might reinforce or challenge the article’s assertions?

__________________________

* Rayner and Lang’s recently published book on Ecological Public Health (Routledge, 2012) sets out this framework and argument in much more detail.

#PHTwitJC 14: Sustainable Food Systems in Europe

Next #PHTwitJC live Twitter discussion will be on Sunday 20th May at 8.00pm UK time. We will be discussing the following paper:

Rayner, G., Barling, D. & Lang, T. (2008) Sustainable Food Systems in Europe: policies, realities and futures. Journal of Hunger and Environmental Nutrition, 3: 2-3. Available: http://www.tandfonline.com/doi/abs/10.1080/19320240802243209

A paper summary and questions for discussion will be posted in due course. All are welcome to join the chat.

 

#PHTwitJC 14: 20 May 2012 – Food security 2 – vote

 Next #PHTwitJC chat will be on Sun 20 May 2012 (8.00 pm UK time).

We will continue the theme of food /food security, this time looking at a paper that is not     restricted to the UK context (see the previous PHTwitJC for the UK paper we discussed).  Papers included in the poll (below) include conceptual /review papers as well as primary research studies. Help us choose a study!

Vote to determine the paper /focus of Sunday’s chat:

Voting will close on Friday 18 May.

#PHTwitJC 13: “Mental Health Context of Food Insecurity” – Summary are Discussion Points

This week’s PHTwitJC we will be discussing the following paper:

Mental Health Context of Food Insecurity: a Representative Cohort of Families With Young Children, Maria Melchior, Avshalom Caspi, Louise M. Howard, Antony P. Ambler, Heather Bolton, Nicky Mountain and Terrie E. Moffitt

Pediatrics 2009;124;e564; originally published online September 28, 2009

What is Food Insecurity?

The WHO state that food security involves having food available (sufficienct amounts on a consistent basis), food accessible (sufficient resources to obtain food) and food use (based on knowledge of nutrition and care, as well as water and sanitation).

The authors of this study have defined food insecurity as “families that lack access to sufficient, safe and nutritious food that meets individuals’ dietary needs and  preferences for an active and healthy life” (p.e565)

 

Why is Food Insecurity a Public Health concern?

Food insecurity has been shown to impact upon children’s behaviour and development.  As the authors of this study summarise: “food insecurity… occurs most frequently in families with low socioeconomic position and low income; however, interventions that supplement families’ income or diet have not eradicated food insecurity.” (p.e564)

More widely there is a great deal of debate around food security with some arguing that:

• There is enough food in the world to feed everyone adequately; the problem is distribution.
• Future food needs can – or cannot – be met by current levels of production.
• National food security is paramount – or no longer necessary because of global trade.
• Globalization may – or may not – lead to the persistence of food insecurity and poverty in rural communities. (Source: WHO)

 

Paper Summary:

Aim: the study aimed to test the hypothesis that low socio-economic status families are more vulnerable to be food insecure when the mother experiences depression, alcohol and/or drug abuse, psychosis spectrum disorders or domestic violence.

Setting: British cohort “Environmental Risk Logitudinal Study” which had recruited 1116 families in 1999 and were followed until 2006.

Method: a number of validated measures were used to assess family socio-demographic factors (assessed in 1999-2000), maternal mental health and domestic violence (assessed 2001-2002), children behavioural outcomes at age 10 (assessed 2005-2006) and food insecurity (assessed twice: 2001-2002, and 2005-2006).  Mothers provided the information to trained interviewers.

Result: 9.7% of families (n=108) were reported to be food insecure.  When socio-economic status was controlled (as a known confounder) – multiple regression analyses reported food insecurity was correlated with maternal depression, psychosis and domestic violence.

 

Discussion Points for Journal Club

1. Were the aims of the study clear?
2. Were the parameters used clear, relevant and valid?
3. Are the findings justifiable considering the information inputted ?
4. Could anything else explain the results (chance, bias, confounders?)
5. What implications do the findings have for public health practice & policy?

#PHTwitJC 13: Mental Health Context of Food Insecurity

The following paper got the most votes in the poll, and will be discussed in the next Public Health Twitter Journal Club, on Sunday 29th April at 8.00 pm UK time:

M. Melchior et al (2009) Mental Health Context of Food Insecurity: a Representative Cohort of Families With Young Children, Pediatrics  October 2009; 124:4 e564-e572; Full text link: http://www.pediatricsdigest.mobi/content/124/4/e564.full 

An overview and set of questions for discussion will be posted in the next day or two.

#PHTwitJC 12: Ecological Study on Income Inequality and Population Health: Discussion

On Sunday 9th April we discussed this paper:

Richard G. Wilkinson and Kate E. Pickett (2007) Income Inequality and Socioeconomic Gradients in Mortality, American Journal of Public Health, April 2008, Vol 98, No. 4.  Accessible online via:   http://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.2007.109637

This paper is part of a wider project, the findings of which are accessible by the book The Spirit Level, which expands upon the theme of ecological comparisons and indicates that inequalities are problematic, even to those well-off in society.  These ideas are still largely debated.

A full transcript can be obtained here and will be stored in our Archive, also.

Summary of #PHTwitJC Discussion

1 – Were the aims of the study clear?

Overall it was felt the aims were ‘hard to digest’ and ‘complex’ – dispite some participants acknowledging familiarity with the topic and major concepts.  It was suggested that as this paper is part of the larger ‘Spirit Level’ project, a level of prior knowledge was assumed.

2 – Were the parameters used clear, relevant and valid?

It was noted that the study used US geographical parameters.  These are conveniently well collected, with good coverage and high inter-region equality differences.  The general consensus was that the population parameters were sensible, although more depth and detail would have been useful.

3 – Are the findings justifiable considering the information inputted ?

Some interesting critiques resulted from this question, for example one participant felt the findings were justified but noted:

“The authors were careful not to suggest the causal process – wouldve made it more debatable.” @duncautumnstore

Another participant queried why the statistical significance level differed from convention:

“Not sure why interaction sig was set at 0.1″ @riyadhonline

“@riyadhonline agree the 0.1 signif not justified /explained, quite a low threshold?” @KateT_health

Furthermore, it was noted that the identification and elimination of outliers was not made apparent by the authors.  One participant suggested that graphs with data points would be a useful addition to the paper in order for readers to consider the effect of outliers, although it was acknowledged that frequently in scientific journals space is limited.

Further critique included no reported attempt model for other confounders that may vary across counties/states (such as ethnicity, crime rate and smoking prevalence).

4 – What implications do the findings have for public health practice & policy?

” it’s the classic question of how much evidence is enough evidence.” @duncautumnstore

In general it was felt that possible confounding variables were not explored, and participants felt it would be useful to compare the strength of correlation with other relevant factors.

It was also queried whether an ecological study design is innappropriate to understand the processes underlying population health inequalities – as ecological study designs can only infer association, not causal processes.

@michaelgrayer suggested that a cohort design tracking theorised causal variables, with a view to compare outcomes & covariates in individuals could help develop these ideas into evidence-based policy.

Overall there was no clear policy or practical implication as participants found it difficult to translate the findings as many queries remained, and a wider debate on the political nature of public health.

#PHTwitJC 13, 29th April: Food (in)security – Choose a study

Next #PHTwitJC live chat will take place on Sunday 29th April 2012, at 8.00pm BST (UK time).

Up to now we have selected studies as examplars of particular study designs. We reckon we have now ‘done’ most study designs (if you can think of one we omitted, do let us know!) For the next phase of journal club we are reversing the focus/ choice by first selecting a topic area. Articles included in the poll may have different study designs or areas of focus. As well as primary research studies, there is the opportunity to include reviews or conceptual discussions for appraisal.

The first topic area chosen is food security. There is a wealth of literature that touches upon the issue; for this week we have selected articles that focus on the UK context. Vote to select your preferred article. The poll will close on the evening of Thursday 26th: