1. www.publichealth.ie Lessons from the Decent Food for All (DFfA) intervention Kevin P Balanda (presenter), Audrey Hochart, Steve Barron, Lorraine Fahy Tackling Food Poverty

2. www.publichealth.ie Institute of Public Health in Ireland All-Ireland body:  North-South co-operation  Inequalities in health Broad view of health and its determinants Three work strands:  Capacity building  Policy support  Information and intelligence 2008/2009 – 10 year anniversary

3. www.publichealth.ie Armagh and Dungannon Health Action Zone Newry and Mourne Health and Social Services Trust Armagh and Dungannon Health Action Zone

4. www.publichealth.ie Part of the jigsaw “Food poverty: Fact or Fiction” – NI (PHAII) “Food Poverty and Policy” – RoI (Friel and Conlon) Fit Futures Strategy – NI (2005) Report of National Taskforce on Obesity – RoI (2005) Lifetime Opportunities – NI (2006) National Action Plan for Social Inclusion 2007-2016 – RoI (2007) What’s the role of community interventions?

5. www.publichealth.ie What is DFfA? A four year (initially three year) community intervention 2003-2007 Mission to “ improve the provision and consumption of an affordable, safe and healthy diet in order to protect and improve public health, particularly amongst the disadvantaged and vulnerable in the ADHAZ”

6. www.publichealth.ie What is DFfA? Practical community-based focused help & advice: Physical access Financial access Information access DFfA aims to reduce inequalities by having a positive impact: across the whole of the intervention area target wards (rural, border, “deprived”) and disadvantaged groups (unemployed, less educated)

7. www.publichealth.ie How it was evaluated? Evaluated by IPH, commissioned by safefood Programme Logic Approach (PLA) A non-random matched comparison area Pre-test & post-test measures Process evaluation (Local Evaluation Group) Ethnographic studies to explore the food culture

8. www.publichealth.ie Key indicators of success (via PLA) Local Regeneration: Physical and financial access Stronger local food production & supply economies Individual, Household & Community Change: Awareness and knowledge Demand for safe health affordable food Improved health behaviours Greater social inclusion Greater individual development

9. www.publichealth.ie Key data collections

10. Attendance at core activities (2003-2007) 370 core activities involving 3,100 residents One in 8 residents participated in at least one core activity

11. 95% of participants in the Cook It! workshops said it had changed their ideas about healthy eating: I always thought eating healthier would take a lot of time, now I know it doesn’t It showed me how to cook the things I normally cook but in a healthier way I’m more inclined to use lots of fresh vegetables in my cooking. I see how recipes can be healthy and very tasty! I was surprised at how much fat and sugar are in some foods that I thought were healthy, I hope to change my diet’. What participants said

12. www.publichealth.ie Individual, household and community change Significant improvements in : Confidence in knowledge and abilities Consumption of fruit and vegetables Consumption of foods high in fat or sugar (marginal) Safe food practices Levels of physical activity No associated improvements in: Awareness and knowledge Levels of obesity/overweight

13. www.publichealth.ie Understanding of the term “healthy eating”

14. www.publichealth.ie Adults consuming foods high in fat or sugar 3+ times a day

15. www.publichealth.ie Average portions of fruit & vegetable consumed daily

16. www.publichealth.ie Local Regeneration Average number of available food items in ADHAZ increased: Increase was not restricted to healthier foods Changes in availability did not vary with shop type Average price of food basket in the ADHAZ increased: Increase was not restricted to less healthy foods Increased observed in all shop types except larger multiple and discounter/freezer shops where it decreased significantly

17. The “bottom line” 20032007 Most commonly available products Product% of shopsProduct% of shops Jam81Jam90 Sausages80Sausages85 Coke79Crisps85 Milk (full and semi- skimmed) 79Bacon (leanback) 85 White bread79Milk (full and semi- skimmed) 85 Baked beans79Potatoes85 Coke84 20032007 Least commonly available products Product% of shopsProduct% of shops Wholemeal pasta 4Wholemeal pasta 11 Frozen cod (battered) 13Beef (mince)13 Cottage cheese15Low-fat cheddar cheese 19 Beef (mince)19Mandarin oranges 20 Brown rice20Cottage cheese 20 Lean steak (mince) 32Frozen cod (battered) 24 Low-fat cheddar cheese 35

18. www.publichealth.ie Adults who had recently cut their weekly food in order to pay other household bills

19. www.publichealth.ie Summary Powerful impacts on participants in core activities “Programme reach” relative low Impact at the community-level was mixed: Some positive individual, household and community change Little evidence of local regeneration

20. www.publichealth.ie Some challenges A very complex intervention Shifting goal posts Blurred geographical boundaries High local demand Chasing funds & frequent staff changes Dilution of the contrast between study areas Representativeness of the study areas

21. www.publichealth.ie Recommendations 1.Local action is essential - it should be properly supported 2.It must also be properly embedded into a more comprehensive approach 3.Co-ordinate the work of researchers, practitioners, policy makers and the community 4.An all-Ireland approach is necessary and possible

22. www.publichealth.ie THANK YOU FOR YOUR ATTENTION