Food, health, and complexity: towards a conceptual understanding to guide collaborative public health action

Abstract

BackgroundWhat we eat simultaneously impacts our exposure to pathogens, allergens, and contaminants, our nutritional status and body composition, our risks for and the progression of chronic diseases, and other outcomes. Furthermore, what we eat is influenced by a complex web of drivers, including culture, politics, economics, and our built and natural environments. To date, public health initiatives aimed at improving food-related population health outcomes have primarily been developed within ‘practice silos’, and the potential for complex interactions among such initiatives is not well understood. Therefore, our objective was to develop a conceptual model depicting how infectious foodborne illness, food insecurity, dietary contaminants, obesity, and food allergy can be linked via shared drivers, to illustrate potential complex interactions and support future collaboration across public health practice silos.MethodsWe developed the conceptual model by first conducting a systematic literature search to identify review articles containing schematics that depicted relationships between drivers and the issues of interest. Next, we synthesized drivers into a common model using a modified thematic synthesis approach that combined an inductive thematic analysis and mapping to synthesize findings.ResultsThe literature search yielded 83 relevant references containing 101 schematics. The conceptual model contained 49 shared drivers and 227 interconnections. Each of the five issues was connected to all others. Obesity and food insecurity shared the most drivers (n = 28). Obesity shared several drivers with food allergy (n = 11), infectious foodborne illness (n = 7), and dietary contamination (n = 6). Food insecurity shared several drivers with infectious foodborne illness (n = 9) and dietary contamination (n = 9). Infectious foodborne illness shared drivers with dietary contamination (n = 8). Fewer drivers were shared between food allergy and: food insecurity (n = 4); infectious foodborne illness (n = 2); and dietary contamination (n = 1).ConclusionsOur model explicates potential interrelationships between five population health issues for which public health interventions have historically been siloed, suggesting that interventions targeted towards these issues have the potential to interact and produce unexpected consequences. Public health practitioners working in infectious foodborne illness, food insecurity, dietary contaminants, obesity, and food allergy should actively consider how their seemingly targeted public health actions may produce unintended positive or negative population health impacts.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3142-6) contains supplementary material, which is available to authorized users.

“Highly processed, highly packaged, very unhealthy. But they are low risk”: exploring intersections between community food security and food safety

“…This concept has been previously suggested, 8 and this study provides evidence that policy disconnects can result in less effective actions by frontline practitioners, who must navigate and negotiate areas of conflict in the policy and legislative environment when delivering programs. Formal guidelines may facilitate such navigation, particularly when developed collaboratively.…”

“…6,7 Despite the historical separation of such activities in public health practice, there is emerging evidence that food insecurity and foodborne disease share upstream determinants; for example, low income is a risk factor for, and climate change can exacerbate, both food insecurity and foodborne disease in the population. 8 There is also evidence that public health actions undertaken to address one of these population health issues can inadvertently and negatively impact the other. For example, community food security programs aimed at improving access to healthy foods, such as the Farmer's Market Coupon Program, 3 increase consumption of fresh produce, which is a leading source of foodborne disease outbreaks.…”

« Très transformés, très emballés et très mauvais pour la santé... mais à faible risque » : exploration des liens entre sécurité des aliments et salubrité des aliments dans les collectivités

“…Malgré la séparation actuelle entre ces activités dans la pra tique en santé publique, des données récentes montrent que l'insécurité alimen taire et les maladies d'origine alimentaire ont en amont des déterminants communs. Le faible revenu, par exemple, est un facteur de risque d'insécurité alimentaire et de maladies d'origine alimentaire dans la population, et le changement clima tique peut exacerber ces deux situations 8 . Il s'avère aussi, d'après les données, que les mesures de santé publique prises pour résoudre l'un des deux problèmes de santé de la population peuvent avoir une incidence négative et non voulue sur l'autre problème.…”

“…Cette idée a déjà été propo sée 8 , et notre étude montre bien que des politiques disparates peuvent réduire l'effi cacité des mesures prises par les pra ticiens de première ligne, qui doivent, lors de la mise en oeuvre des programmes, naviguer en évitant les écueils des divergences entre milieu stratégique et milieu législatif. 27,36 .…”

Understanding healthy food environments in public health practice

“…health while minimizing the risks of food-borne illness (Majowicz et al, 2016). PHIs are well-positioned as front-line health promoters to begin conversations and foster relationships to facilitate the process of modifying community and consumer food environments.…”