DiabetesScale Up SU10, 2019 – 2024

Evaluating and bringing to scale alternative food networks to address diabetes mellitus and hypertension


Globally, a growing double burden of malnutrition leaves many people, and particularly rural people, exposed to the health problems associated with simultaneous undernutrition and overnutrition, including diabetes mellitus (DM) and hypertension (HTN)

Life course evidence suggests that people who experience nutrient inadequacies in early life are more likely to develop DM and HTN. In Ecuador, rates of DM and HTN are a growing national concern, and rural people are particularly vulnerable due to such life course impacts. This project aims to use an evidence-based approach to implement health-sensitivity for DM and HTN upstream prevention into Ecuador’s expanding Alternative Food Networks (AFN).

These are initiatives that connect rural farmers with clients through equitable, direct-purchase markets, such as farmers’ markets. AFNs hold promise for implementation scale-up because there is a growing and well-organized movement toward AFN creation in Ecuador and globally, thus providing a strategic point of access for health promotion among the most marginalized people. Our objective is thus to examine the impact of AFNs on the underlying risk factors for DM and HTN, to discern the specific attributes of AFNs that most efficiently prevent disease, and to explore how the endogenous scaling up of AFNs can be directed to generate a stronger impact on health among vulnerable populations in Ecuador and elsewhere. To achieve this, we propose five complementary studies, namely (i) participatory exploration on the relationship between AFNs and health, (ii) engagement of public institutions in pro-health implementation, (iii) a cross-sectional comparative study on social, dietary and health risk factors; (iv) assessment of AFN efficiency for translating knowledge into practice, and (v) evaluation of AFN food environment contributions. We deploy mixed qualitative and quantitative methods, with the former including participant observation, ethnography, key informant interviews and focus groups, and the latter involving dietary instruments, anthropometric measurements, clinical and biochemical assessment (blood pressure, glycated hemoglobin, hemoglobin and ferritin), socio-economic inquiry, food environment assessment and social network topology instruments.

This project aligns with the third Sustainable Development Goal on healthy lives and well-being, which emphasizes the need to address chronic disease in the most vulnerable of populations. By scaling nutrition sensitivity into the ongoing expansion of AFNs and into public policy, we aim to enhance programs and policies that reduce upstream risk factors for DM and HTN. Because AFNs already have a focus on ecological, social and economic sustainability, by promoting AFNs as a resource for health, we will enhance sustainability at a systemic level. Finally, as AFNs continue to expand globally, this innovative research will provide valuable recommendations to translate findings to other countries.

Programme Team

  • Malek Batal University of Montreal
  • Kate Zinszer University of Montreal
  • Virginia Vallejo Rojas Ministry of Agriculture and Livestock, Ecuador
  • Peter Berti HealthBridge
  • Donald Cole University of Toronto
  • Pablo López Proaño Pontificia Universidad Católica del Ecuador
  • Myriam Paredes Facultad Latinoamericana de Ciencias Sociales – FLACSO
  • Stephen Sherwood Ekorural
  • Gabriela Rivas Mariño Ministry of Public Health
  • Eliana Estrella Cobo Ekorural

Funding organisations

  • DiabetesScale Up SU10
  • Ecuador
  • 2019 – 2024

Programme contact
Malek Batal