Medicine, Faculty of
Population and Public Health (SPPH), School of
DSpace
UBCV
Wolff, Rebecca
Master of Science - MSc
University of British Columbia
Industrialized agriculture and food security interventions have failed to eliminate global hunger, while creating complex environmental, health, and well-being challenges. The food sovereignty movement, which recognizes the power imbalances and social inequities in the global food system, presents a new lens through which to design interventions to improve how agricultural practices impact individual and community well-being. This thesis project answered the following research question: how can food sovereignty frameworks incorporate assessments of health and well-being? This research contributes to the gap in our understanding of the importance of food sovereignty practices to health and well-being through a meta-narrative literature review. Four well-being narratives (environmental, physical, cultural-spiritual, and social-political-economic) were identified from the literature and used to develop a novel framework demonstrating the relationship between food sovereignty practices and multi-dimensional well-being outcomes. A set of n=37 indicators were developed and organized into four themes of environmental, physical, cultural-spiritual, and social-political-economic wellbeing, to assess the relationship between food sovereignty practices and multiple forms of well-being. This study demonstrates how the application of food sovereignty practices can influence the well-being of individuals, their environments, and communities. As well, the results of this work emphasize the importance of defining well-being holistically, rather than viewing well-being outcomes from a purely biomedical health perspective. This framework presents a way for future researchers, farmers, and agricultural organizations to begin measuring well-being outcomes that result from their food production practices.
Improving well-being through food sovereignty: a meta-narrative literature review by Rebecca Wolff B.A.S., University of Guelph, 2015 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE in THE FACULTY OF GRADUATE AND POSTDOCTORAL STUDIES (Population and Public Health) THE UNIVERSITY OF BRITISH COLUMBIA (Vancouver) July 2021 © Rebecca Wolff, 2021 ii The following individuals certify that they have read, and recommend to the Faculty of Graduate and Postdoctoral Studies for acceptance, the thesis entitled: Improving well-being through food sovereignty: a meta-narrative literature review submitted by Rebecca Wolff in partial fulfillment of the requirements for the degree of Master of Science in Population and Public Health Examining Committee: Dr. Hannah Wittman, Institute for Resources, Environment and Sustainability, UBC Co-supervisor Dr. Annalee Yassi, School of Population and Public Health, UBC Co-supervisor Dr. Jerry Spiegel, School of Population and Public Health, UBC Supervisory Committee Member Dr. Kate Weinberger, School of Population and Public Health, UBC Additional Examiner iii Abstract Industrialized agriculture and food security interventions have failed to eliminate global hunger, while creating complex environmental, health, and well-being challenges. The food sovereignty movement, which recognizes the power imbalances and social inequities in the global food system, presents a new lens through which to design interventions to improve how agricultural practices impact individual and community well-being. This thesis project answered the following research question: how can food sovereignty frameworks incorporate assessments of health and well-being? This research contributes to the gap in our understanding of the importance of food sovereignty practices to health and well-being through a meta-narrative literature review. Four well-being narratives (environmental, physical, cultural-spiritual, and social-political-economic) were identified from the literature and used to develop a novel framework demonstrating the relationship between food sovereignty practices and multi-dimensional well-being outcomes. A set of n=37 indicators were developed and organized into four themes of environmental, physical, cultural-spiritual, and social-political-economic wellbeing, to assess the relationship between food sovereignty practices and multiple forms of well-being. This study demonstrates how the application of food sovereignty practices can influence the well-being of individuals, their environments, and communities. As well, the results of this work emphasize the importance of defining well-being holistically, rather than viewing well-being outcomes from a purely biomedical health perspective. This framework presents a way for future researchers, farmers, and agricultural organizations to begin measuring well-being outcomes that result from their food production practices. iv Lay Summary Throughout history, communities have developed strategies to effectively feed their growing populations and tackle health issues like hunger and malnutrition. However, the current agriculture system, which has a focus on technology and commercial agriculture, created challenges for the environment, culture, and well-being. The food sovereignty movement seeks to address the problems resulting from the current food system. This thesis project used a meta-narrative literature review to understand the relationship between food sovereignty practices and well-being, finding that four types of well-being (environmental, physical, cultural-spiritual, and social-political-economic) are influenced by food sovereignty practices. A novel framework and set of 37 indicators were developed to feasibly assess this relationship. This project contributes to academic knowledge on the role food sovereignty practices play in improving individual, community-level and environmental well-being. . v Preface This dissertation is original, unpublished, independent work by the author, Rebecca Wolff. The concept behind this thesis project was based on the work of Dr. Hannah Wittman at the Faculty of Land and Food Systems and the Think Eat Grow Green Globally (TEG3) project led by Dr. Jerry Spiegel and Dr. Annalee Yassi at the School of Population and Public Health. Dr. Hannah Wittman leads the Agroecological Transitions in Latin America project, which works with agroecological farming partners in five countries (Brazil, Ecuador, Paraguay, Mexico, and El Salvador) to understand the drivers and outcomes of diversified farm management decisions. It also seeks to support these organizations in measuring the impact of their agroecological farming practices, and participants had expressed interest in measuring well-wellbeing outcomes of their work in community-based research meetings in 2019. I wrote and conducted the literature review of Chapter 1 of this thesis and received edits from Dr. Yassi, Dr. Spiegel and Dr. Wittman. I wrote and created the methodology for Chapter 2 of this project under the guidance of Dr. Yassi and Dr. Wittman. With their support I designed my meta-narrative literature review thesis project on the relationship between food sovereignty practices and wellbeing based on original conversations in Ecuador with our farming partners. The results contained in Chapter 3, 4 and 5 were developed by myself and are my own original work. The work contained in Chapters 3 through 5 was reviewed by my supervisors Dr. Wittman and Dr. Yassi, as well as committee member Dr. Spiegel. vi Table of Contents Abstract ......................................................................................................................................... iii Lay Summary ................................................................................................................................ iv Preface ............................................................................................................................................ v Table of Contents .......................................................................................................................... vi List of Tables ................................................................................................................................. ix List of Figures ................................................................................................................................ x List of Abbreviations .................................................................................................................... xi Acknowledgements ...................................................................................................................... xii Chapter 1: Introduction ................................................................................................................ 1 1.1 The history of health and hunger ..................................................................................... 2 1.2 Food security and the social determinants of health ....................................................... 4 1.3 The social determinants of health .................................................................................... 6 1.4 Food sovereignty ............................................................................................................. 8 1.5 Public health and food sovereignty ............................................................................... 11 1.6 Well-being and health .................................................................................................... 15 1.7 Thesis approach and organization ................................................................................. 16 Chapter 2: Methodology ............................................................................................................. 18 2.1 Meta-narrative literature review .................................................................................... 18 2.2 Eligibility criteria ........................................................................................................... 19 2.3 Planning and search phases ........................................................................................... 20 2.4 Study selection ............................................................................................................... 21 vii 2.5 Data analysis .................................................................................................................. 23 Chapter 3: Results ....................................................................................................................... 25 3.1 Conceptual framework .................................................................................................. 27 3.2 Food sovereignty practices ............................................................................................ 29 3.2.1 Access to resources ................................................................................................ 30 3.2.2 Production model ................................................................................................... 30 3.2.3 Transformation and commercialization ................................................................. 31 3.2.4 Food security and food consumption .................................................................... 32 3.2.5 Agrarian policies ................................................................................................... 33 3.3 Environmental well-being meta-narrative ..................................................................... 34 3.3.1 Agroecology .......................................................................................................... 34 3.4 Physical well-being meta-narrative ............................................................................... 37 3.4.1 Physical health and nutrition ................................................................................. 37 3.4.2 Mental health ......................................................................................................... 40 3.5 Social, political, and economic well-being narrative .................................................... 41 3.5.1 Agency over land use ............................................................................................ 41 3.5.2 Land ownership ..................................................................................................... 43 3.5.3 Gender equity, land ownership and agency ........................................................... 44 3.5.4 Political agency ..................................................................................................... 45 3.5.5 Social well-being: farmer support ......................................................................... 46 3.6 Cultural and spiritual well-being meta-narrative ........................................................... 47 3.6.1 Cultural well-being ................................................................................................ 48 3.6.2 Spiritual well-being ............................................................................................... 50 viii 3.7 Meta-narratives by the language of publication ............................................................ 51 3.7.1 Limitations ............................................................................................................. 53 Chapter 4: Indicators .................................................................................................................. 55 4.1 Indicators of environmental well-being ......................................................................... 55 4.1.1 Biodiversity ........................................................................................................... 57 4.1.2 Agrochemical usage .............................................................................................. 58 4.1.3 Soil health .............................................................................................................. 59 4.2 Indicators of physical well-being .................................................................................. 60 4.2.1 Food security ......................................................................................................... 63 4.2.2 Nutritional status ................................................................................................... 65 4.2.3 Disease prevalence ................................................................................................ 66 4.3 Social-political-economic well-being indicators ........................................................... 68 4.3.1 Agency over land-use and land ownership ............................................................ 70 4.4 Indicators of cultural-spiritual well-being ..................................................................... 72 4.4.1 Traditional crop cultivation ................................................................................... 75 4.4.2 The well-being of mother nature/deities ................................................................ 77 4.5 Feasibility of the indicators ........................................................................................... 79 Chapter 5: Conclusion ................................................................................................................ 82 5.1 Study limitations ............................................................................................................ 84 5.2 Direction for future research ......................................................................................... 84 Bibliography ................................................................................................................................. 86 ix List of Tables Table 1: Search terms .................................................................................................................... 21 Table 2: Search results ................................................................................................................... 21 Table 3: Reviewed source type ...................................................................................................... 23 Table 4: Sources by language of publication ................................................................................ 24 Table 5: Well-being meta-narratives ............................................................................................. 26 Table 6: Meta-narratives by language of publication .................................................................... 51 Table 7: Environmental well-being indicators .............................................................................. 56 Table 8: Physical well-being indicators ........................................................................................ 62 Table 9: Social-political-economic well-being indicators ............................................................. 69 Table 10: Social-political-economic well-being indicators ........................................................... 70 Table 11: Cultural-spiritual well-being indicators ........................................................................ 74 Table 12: Most feasible indicators ................................................................................................ 80 x List of Figures Figure 1: Literature review process ............................................................................................... 22 Figure 2: Conceptual framework ................................................................................................... 27 xi List of Abbreviations AAG The American Association of Geographers AESD The Agricultural & Environmental Science Database CGSM Canadian Graduate Scholarship-Master’s Program CSDH The Commission on the Social Determinants of Health FAO The Food and Agriculture Organization GFASG The Geographies of Food and Agriculture Specialty Group of the American Association of Geographers HICs High Income Countries LMICs Low- and Middle-Income Countries MEDLINE The National Library of Medicine’s bibliographic search database OECD Organization of Economic Co-operation and Development SSHRC Social Sciences and Humanities Research Council UN The United Nations USDA The United States Department of Agriculture WHO The World Health Organization? xii Acknowledgements I wish to acknowledge that this thesis was written on traditional, ancestral, and unceded territories of the Coast Salish people, Abenaki and Wabanaki people, and the Kichwa people. As well, I acknowledge that the University of British Columbia is located on the traditional, ancestral, and unceded territory of the Musqueam people. I offer my enduring gratitude to the faculty, staff, and my fellow students at UBC, who have inspired me to continue my work in this field. I owe particular thanks to Dr. Hannah Wittman and Dr. Annalee Yassi whose guidance and support as my supervisors were invaluable and irreplaceable. I also wish to thank my committee member Dr. Jerry Spiegel for the advice, guidance, and support in carrying out my thesis. Thank you to the Social Sciences and Humanities Research Council (SSHRC), the American Association of Geographers (AAG), and the Canadian Institutes of Health Research (CIHR) under their health equity grants program, “Food systems and health equity in an era of globalization: Think, eat and grow green globally (TEG3)” (FRN 115207) for financial support for my thesis project. Thank you to my fellow lab members in the Food Sovereignty lab, especially Pedro Buss Martins, Dana James, and Evan Bowness. Pedro Buss Martins was responsible for the coding of the Portuguese language papers included in this project. Evan Bowness provided invaluable support in my application for SSHRC CGSM funding and Dana encouraged my application to the American Association of Geographer’s GFSAG graduate student award. Special thanks to my partner and parents, who provided countless hours of emotional support on my academic journey. 1 Chapter 1: Introduction Throughout history, communities and civilizations have developed strategies to effectively feed their growing populations and tackle health issues like hunger and malnutrition. However, despite the development of numerous technologies and innovations accompanying unprecedented economic expansion in a globalized world economy over the past one hundred years, the current industrialized agriculture system has failed to prevent widespread hunger and has generated additional negative consequences for human health and well-being (Harwood, 2019; Walter, 2016). Addressing this challenge in the context of Sustainable Development Goals, the goal of ending hunger was accompanied by commitments to achieve food security and improved nutrition more broadly, as well as to promote sustainable agriculture (UN, n.d.-b). The food sovereignty movement, as promoted by La Vía Campesina, seeks to address the many complex health, environmental, political, cultural and economic problems resulting from the current food system (Desmarais, 2008; Wittman, 2009) and challenge dominant power relationships. Food sovereignty practices provide a promise of possible benefits for health outcomes; however, the relationship between food sovereignty and well-being remains poorly understood. While this topic was under-investigated in public health literature, it is now receiving growing attention. This thesis project sought to explore the relationship between food sovereignty and well-being. It looks at how the concept of food sovereignty and its associated practices, such as agroecology, influence well-being, and what indicators can describe this relationship. Understanding how food sovereignty practices influence well-being is important for future public health research and interventions to prevent hunger, malnutrition, and other health issues connected related to food production and global food systems. 2 1.1 The history of health and hunger The birth of the modern industrialized agriculture system occurred in the mid 20th century when, in an increasingly globalized world economy, the United States (US) and the Global South entered a new era of food production (Patel, 2013). Termed the ‘Globalization Project’ by McMichael (2009), this agriculture period focused on industrialized food production and neoliberal trade policies (Fairbairn, 2010). Neoliberalism refers to economic models based on free and self-regulating markets (Steger & Roy, 2021). From a neoliberal perspective, the US’s modern industrialized agricultural system was touted as a symbol of economic and agricultural success, feeding a growing population through national food production and global exports, bolstering the economic power of the US, and demonstrating the so-called prowess of technology-driven agricultural practices. During this mid 20th century and onwards, agricultural production worldwide became increasingly integrated with producing for global markets. In tandem with global agricultural growth, the problem of hunger still prevailed across the world. Lower and middle income countries (LMICs) were struggling with high rates of poverty, hunger and malnutrition (Conway et al., 2012). For example, the Food and Agriculture Organization (FAO), who uses undernourishment as an indicator of hunger defined as an “estimate of the proportion of the population whose habitual food consumption is insufficient to provide the dietary energy levels that are required to maintain a normal active and healthy life” (FAO, 2021, para. 1) reported that the proportion of undernourished people in LMIC nations in 1969 was 37% (FAO, 2006b). 3 During this time, academic dialogue about the relationship between hunger and health had a narrow focus. In the late 20th century, considerations of health had a strong biomedical focus where the definition of ‘being in good health’ was the absence of sickness (De Almeida Filho, 2001). Healthcare focused on clinical interventions, and determinants of health like genetic risk factors for disease and illness. There was limited acknowledgement of the social inequities that negatively influenced health outcomes for marginalized populations (Embrett & Randall, 2014). Regarding the issue of hunger and malnutrition, public health initiatives focused on providing calories, food, and improving food production yields (Beuchelt & Virchow, 2012; Lappé et al., 2013). The idea was simple, produce more food to feed more people. The Green Revolution illustrates an important example of this health and hunger narrative. In 1968 William Gaud created the name Green Revolution (Kilby, 2019). The goal of the Green Revolution was to increase food production in LMICs using agricultural technologies like hybrid seeds, agrochemicals, and synthetic fertilizers (Hurt & Marcus, 2020). The Green Revolution technologies did dramatically increase food production and crop yields of limited crops like wheat in certain countries (Harwood, 2019). But the Green Revolution, due to its reliance on technical interventions while ignoring social relationships, also had negative consequences. In Mexico, the adoption of Green Revolution wheat seeds increased wheat production so significantly that Mexico no longer needed to import wheat into the country (Hurt & Marcus, 2020). However, small-scale farmers struggled to access the new wheat seed as they did not have the same access to economic capital, to purchase seeds, fertilizer or other agricultural products needed to take advantage of the new seed types (Hurt & Marcus, 2020). Finally, the focus on wheat production as a means to improving food production did not acknowledge the cultural 4 importance of corn and corn products for household diets (Hurt & Marcus, 2020). This example from Mexico demonstrates just a few of the many ways in which the Green Revolution technologies failed to provide equitable agricultural opportunities to peasant farmers, while attempting to displace traditional and Indigenous agricultural practices with more commercialized agriculture practices and governmental priorities (Kilby, 2019). As well, certain chemical pesticides and synthetic fertilizers introduced to farmers had detrimental impacts on soil health and contaminated local water sources (Carey, 2009). These agrochemicals also had human health impacts. Agrochemical exposure, depending on type, duration and exposure method, can cause health issues such as cancer, respiratory and gastrointestinal illnesses, and neurological disorders (A. D. Jones et al., 2015; Nicolopoulou-Stamati et al., 2016). For example, Carey (2009) reported on the health effects of the synthetic fertilizer use on Guatemalan Mayan farmers who began using the product during the Green Revolution in 1950s. Many reported perceived effects on their health, such as increased rates of disease and a feeling of weakness (Carey, 2009). 1.2 Food security and the social determinants of health In 1974 conversations around health, hunger and food production moved from a focus on agricultural technologies and food production to the concept of ‘food security’. The definition of food security is “a situation that exists when all people, at all times, have physical, social and economic access to sufficient, safe and nutritious food that meets their dietary needs and food preferences for an active and healthy life” (FAO, 2006a, p. 1). At the time of its inception, the focus of food security was on food production and food accessibility. However, the World Trade Organization and World Bank used the concept of food security to further their neoliberal trade 5 agendas (Weiler et al., 2015). The two organizations pushed the idea that free trade, market liberalization, and reducing government spending were key to global poverty reduction which would in turn reduce food insecurity. The World Trade Organization and World Bank argued that neoliberal global food production would improve access to food, through trade and global food production chains, thereby decreasing the number of hungry people across the world and improving other health outcomes such as preventing maternal and infant mortalities and decreasing the number of children suffering from malnutrition (Navarro, 2009). Over the next few decades, through dialogue at international meetings and conventions, the definition of food security changed to include issues like food accessibility, stability, and utilization. The inclusion of food accessibility was due greatly to the work of Jean Drèze and Amartya Sen (1989). They identified that hunger was dependent on one’s ability to access resources, buy food, or trade food (Clapp, 2014; Drèze & Sen, 1989). The inclusion of the work by Drèze and Sen (1989) in the definition of food security reflected an understanding by both academics and global development organizations that food production, national economic growth, and global trade alone could not eliminate issues of hunger and malnutrition (Conway et al., 2012). In the early 2000s, the FAO included activities like supporting rural small-scale farm production and ensuring land access for farmers in their food security guides (FAO, 2006a). This shift from a focus on neoliberal trade and food production to a broader recognition of the complex needs of the food insecure was in parallel with similar academic conversations in public health. 6 1.3 The social determinants of health In 2005, the World Health Organization (WHO) created the Commission on Social Determinants of Health (CSDH) (Davies & Adshead, 2009; Solar, 2010). The CSDH recognized the effect of social, political, and economic systems on health outcomes at both the population and individual levels. The WHO’s social determinants of health framework acknowledges that health and disease are socially produced, or as described by Braverman and Gottlieb that “medical care is not the only influence on health and suggests that the effects of medical care may be more limited than commonly thought, particularly in determining who becomes sick in the first place” (Braveman & Gottlieb, 2014, p. 20). Examples of social determinants include income level and socio-economic status, education, and food insecurity (WHO, 2021). Health research in high income countries (HICs) exemplifies the relationship between social determinants and health outcomes. For example, improved social position is directly correlated with improved health outcomes in the United States (Braveman & Gottlieb, 2014). The CSDH framework contains two key components: structural determinants and intermediary determinants. Structural determinants are social and economic factors which reinforce the status quo and stratification of individuals based on gender, class, and socio-economic status (Solar, 2010). Structural determinants lead to health inequities from which health outcomes can be positively or negatively impacted by intermediary determinants (Solar, 2010). According to the CSDH framework, social determinants of health “operate through a set of intermediary determinants of health to shape health outcomes” (Solar, 2010, p. 47). These intermediary determinants include issues like material and psychosocial circumstances and biological factors (Solar, 2010). 7 The new definition of food security and related food security interventions, as well as the social determinants of health framework, represented important positive shifts in discussions around the relationship between hunger and health. Interventions to alleviate global hunger no longer focused on just expanding commercial food production, but also included issues like food accessibility and affordability. The CSDH demonstrated how institutional factors and the social environment impact health outcomes and inequities. However, the definition of food security, such as that used by the FAO and WHO, was critiqued for failing to address the structural and systemic forces creating issues of social inequality, health inequity, and hunger. For example, longstanding processes of colonization via dispossession of land gave HICs the power to control global trade dialogue, dictate agricultural trends, dispossess Indigenous peoples and small-scale farmers of their land and promote neoliberalism, globalization and Westernization of food production (Desmarais, 2008; Fairbairn, 2010). Alternatively, one predominant food security discourse sees the root cause of hunger as resulting from poverty, or living on less than a certain number of dollars a day (Jarosz, 2014). This view of the relationship between poverty and hunger places great emphasis on the importance of economic activities like food production, food supply, and rural development to alleviate food insecurity, with a strong faith that increasing trade would lead to trickling down of economic and social benefits for all. These economic and trade-based activities can provide important benefits to nations and individuals; however, they fail to acknowledge the complex historical, social, and political factors that can lead to poverty and food insecurity. HICs have more power over LMICs in trade relationships and policy making, leaving LMICs economically dependent on imported goods (Lappé et al., 2013). Rural development and rural agricultural production can lead to large 8 multinational agribusinesses and corporations dispossessing small farmers and Indigenous people from their land under the guise of national food production and food security (Jarosz, 2014). While food production and economic-focused interventions can offer economic-related benefits to farmers, there is still inequitable distribution of agricultural resources to marginalized populations like women or peasant farmers (Clapp, 2014). The concept of food security has greatly contributed to academic and organizational understandings of how to alleviate hunger through food production, yet a shift is needed from viewing hunger as an issue of access to an issue of control over food system processes (Wittman, 2011). 1.4 Food sovereignty In 1993, the peasant farmer organization La Vía Campesina, a transnational social movement representing 200 million Indigenous farmers, fishers, and landless peasants, began to use the term ‘food sovereignty’ on the world stage as an alternative to the food security framing described above (Martínez-Torres & Rosset, 2014). The definition of food sovereignty is “the right of peoples to healthy and culturally appropriate food produced through ecologically sound and sustainable methods, and their right to define their food and agriculture systems” (Nyéléni, 2007, p. 1). Food sovereignty provides a framework to support the common struggles of peasant farmers and Indigenous communities with issues like neoliberal trade policies, the commercialization of agriculture, and the lack of control over the food systems. The food sovereignty movement promotes the political power of small-scale farmers and peasants to control decision-making and food production decisions (Martínez-Torres & Rosset, 2014). In 2007, La Via Campesina, alongside other organizations, organized the first World Food Sovereignty Forum. During the forum, they created the Nyéléni declaration which outlines the 9 purpose and direction of the food sovereignty movement. As stated in the declaration, the food sovereignty movement offers a strategy to resist and dismantle the current corporate trade and food regime, and directions for food, farming, pastoral, and fisheries systems determined by local producers. Food sovereignty prioritizes local and national economies and markets and empowers peasant and family farmer-driven agriculture, artisanal - fishing, pastoralist-led grazing, and food production, distribution and consumption based on environmental, social and economic sustainability (Nyéléni, 2007, p. 1) La Via Campesina was part of a growing conversation by farmers and peasant organizations around the failure of the concept of food security to address issues of hunger. As stated by Martínez-Torres and Rosset (2014), “The food security discourse was challenged in the 1990s because, while it speaks to everyone’s right to food, it says nothing about who produces what, how it is produced or where it is produced” (Martínez-Torres & Rosset, 2014, p. 983). The food sovereignty movement confronts the Green Revolution ideology that producing more food per capita is all that is needed to solve problems of global hunger. We now know that the world produces more than enough food to feed the entire global population, yet at least 690 million people still go hungry each year (FAO et al., 2020). The food sovereignty movement challenges the effectiveness of existing food security programs, calling attention to how these interventions ignore the importance of power and control in global and local food systems. There is a diversity of different food sovereignty practices, as documented in the Nyéléni declaration and by food sovereignty scholars like Ortega-Cerdà & Rivera-Ferre (2010), Badal et al. (2010), and Binimelis et al. (2014). These practices include policy activities such as the participation of peasants and small-scale farmers in politics, creating social peasant organizations, and equitable distribution of government support to farmers. Other practices 10 include promoting better access to resources for farmers, ecological farming, improved access to culturally appropriate nutritional food, and improved local food distribution and pricing. Agroecology is one of the more academically studied food sovereignty practices whose relationship to well-being and health has been explored in academia, for example studies have demonstrated links between agroecology and improved food security and nutrition (HLPE, 2019; Kangmennaang et al., 2017; Nyantakyi-Frimpong et al., 2017). Agroecological approaches to agriculture gained popularity in different social movements like food sovereignty, as ways to address power inequity in food systems (HLPE, 2019). Agroecology is a science and practice focused on integrating sustainable, ecological practices into food production (Altieri, 1989). As explained by Jones et al. (2015), agroecology “leverages the complex ecological processes inherent in agroecosystems (e.g., nutrient cycling, symbiosis, predator/prey interactions) to maximize productivity while minimizing external inputs and negative environmental impacts” (p. 3). Agroecological methods of food production include, but are not limited to, low chemical and energy output and ecologically sustainable farming (Altieri, 1999). Agroecology is seen as supporting the pathway to food sovereignty while also supporting the development of sustainable food systems (HLPE, 2019). Indigenous scholars, for example, Tabitha Robin, identified that interventions with an Indigenous food sovereignty focus can also help heal the many harms and traumas that have been inflicted on Indigenous communities for centuries. The work of Tabitha Robin (2019) and Lana Ray et al. (2019) found clear links between food sovereignty practices such as local crop production, cultural food preparation and production practices, and self-determination and improved well-11 being for Indigenous people. Thus, the food sovereignty movement presents an important lens by which to explore the relationships between food systems and well-being. There are also non-Indigenous authored studies that demonstrate relationships between certain food sovereignty practices and positive physical health outcomes. For example, agroecology, the application of ecological principles to agriculture (FAO, 2015) is linked to improved household nutrition, dietary diversity and decreased farmer exposure to pesticides (Cole et al., 2011; Deaconu et al., 2019). A study by Santoso et al. (2021) used a cluster-randomized control trial to assess whether “nutrition-sensitive agroecology intervention in rural Tanzania could improve children’s dietary diversity” (p.1). Their results found that the use of agroecological nutrition interventions significantly increased childhood dietary diversity and improved household food security (Santoso et al., 2021). 1.5 Public health and food sovereignty In public health, academics from HICs have less often recognized food sovereignty approaches, as opposed to food security interventions, as a solution to hunger and other food-system related health problems. However, important theoretical literature that addresses global issues health issues in more novel ways has come from Latin American and other Global South scholars. In the 1970s, social medicine scholars in Latin America began an academic discourse that critiqued the individualist and causational focus of traditional public health and epidemiology, and highlighted important issues with the WHO’s social determinants of health framework (Breilh, 2021; Krieger et al., 2010; Peñaranda & Rendón, 2013; Spiegel et al., 2015). As a result, they developed the critical epidemiology and social determination of health approaches. 12 Traditional epidemiology has had a strong tendency toward a relatively narrow risk factor and biological focus in its study of the relationships between disease determinants and outcomes. However, this approach can be simplistic and reductionist, and as such it has not easily allowed for a consideration of complex social factors like marginalization or colonization in the analysis which determine the prevalence of a disease or illness (Támez González, 2014). Epidemiological data can lead to pursuit of public health interventions that are focused on individual behaviors, such as campaigns to improve healthy eating by telling individuals to not eat processed or sugary foods, as opposed to addressing the food system as a whole (Támez González, 2014). Critical epidemiology, by comparison, emphasizes the interdisciplinary and intercultural study of the processes which determine the production and distribution of collective health, which encompass a set of social relations, ideas, and organized forms of practice that make up the social reproduction of human societies, as groups formed around strategic interests imposed by the political economic system, groups that are characterized by typical modes of living of its members, according to their class insertion, cultural and gender filiation and also condition the individual life strategies that are made possible (Breilh, 2015, p. 2). Critical epidemiology allows for a better understanding of how social processes and inequities impact the health of communities and societies (Breilh, 2010, 2015, 2021). For example, Latin American scholars have used critical epidemiological approaches to study the relationship between health and land dispossession, global hunger, and other complex social processes that impact human well-being (Melo Filho, 2008; Paredes Hernández, 2020). 13 Similar to the creation of critical epidemiology, Latin American scholars in the Global South developed the social determination of health approach, which in part critiques the WHO’s social determinants of health framework laid out in the CSDH (Támez González, 2014). While the WHO’s CSDH acknowledges the role social and economic factors play in health inequity, the framework does not call-out the historical legacy and current presence of global forces responsible for creating these major societal issues. During a workshop with Latin American and North American scholars, a key issue with the CSDH was identified as: ‘social determinants of health’ as arising from a ‘social environment,’ structured by government policies and status hierarchies, with social inequalities in health resulting from diverse groups being differentially exposed to factors that influence health, whereby ‘social determinants’, such as poverty, act as the ‘causes of causes’ (Krieger et al., 2010, p. 748) The social determination of health approach recognizes how social relations divide populations into classes and hierarchies including those of ethno-cultural and gender identity (Breilh, 2015). One of the key premises of the social determination of health is a fundamental understanding that capitalism is accelerated by activities like resource extraction, highlighting the important link between health, class and the natural environment (Breilh, 2015; Támez González, 2014). The social determination of health approach also describes four key conditions which promote health, the 4 S’s (also known as the Modos de Vivir Saludable) of sustainability, sovereignty, solidarity and bio-security (Breilh, 2011; Spiegel et al., 2015). 14 The social determination of health approach acknowledges the role of global forces and activities, like neoliberal trade policies, environmental degradation, and resource extraction, have on health. This more holistic and environmental focus also aligns well with concepts like Buen Vivir. Buen Vivir, which translates to good living in English, is in turn a Spanish translation of the Indigenous Kichwa phrase of Sumak Kawsay (Altmann, 2020). One interpretation of this term, based on the knowledge of Indigenous scholars from Ecuador, is that Sumak Kawsay is a place-based concept, that cannot be separated from its environment, which defines the relationship between the land and its inhabitants to create Sumak Allpa (a land without evil) (Altmann, 2020). However, Sumak Kawsay/Buen Vivir is an ever-changing concept. It has many different interpretations and uses across other global Indigenous cultures, such as the similar Quechua term Allin Kawsay or the Anishinaabe philosophy Mino Bimadiziiwin which also refers to ‘the good life’ (Hoover, 2017; Huambachano, 2018). In the late 20th to early 21st century Buen Vivir became part of political discourses in Latin America. President Rafael Correa made Buen Vivir a principle in the 2008 Ecuadorian constitution. The principle guaranteed the protection of Mother Nature and the natural environment, respect for the Indigenous peoples of Ecuador, and the satisfaction of basic needs of Ecuadorians, including food sovereignty and access to education, health, access to food and water, etc. (Caria & Domínguez, 2016; Sánchez & Polga-Hecimovich, 2019; Villalba, 2013). Academics such as Vanhulst and Beling (2014) and Villalba (2013) described Buen Vivir as the new 21st century alternative to sustainable development, as it proposed a form of development beyond the Western idea that nature is a commodity to be used for improved economic gain (Walsh, 2010). Although initiatives such as Ecuador’s formal adoption of Buen Vivir was 15 accompanied by specific regulations promoting food sovereignty, the use of activities which fulfill the constitution’s mandates on Buen Vivir, and food sovereignty remain limited. This has been slowed considerably by the national government’s increased accommodations to neoliberal economic development approaches (Vanhulst & Beling, 2014; Villalba, 2013). Thus, the challenge of practical implementation of food sovereignty regulations remains daunting. 1.6 Well-being and health The interpretation of Buen Vivir that is seen in the Ecuadorian constitution is complemented by Latin American theory related to critical epidemiology and the social determination of health. Together, they highlight the important contributions made by Latin American academics, scholars, and Indigenous people to discourse on the relationship between communities, their health, and the environment. The critical epidemiology and social determination approach to health are more interdisciplinary and multi-dimensional than the social determinants approach to health used by the WHO. They are also more aligned with a well-being approach to healthcare used by Indigenous scholars. As defined by Manning and Flemming (2019) “Well-being, sometimes referred to as wellness, describes the condition of an individual or group. It includes choices and activities aimed at achieving physical vitality, mental alacrity, social satisfaction, a sense of accomplishment, and personal fulfilment” (p. 1). Well-being, compared to the alternative term health, is a holistic term that allows for discussions about wellness that are not limited to just the physical body. The term well-being also encourages discussion around the complex relationships between individuals and their environment, such as the importance of land to Indigenous people. Many Indigenous peoples 16 also see their well-being as directly connected to the land and natural world. For example, the Cree people see the “concept of health and collective well-being, h[as] everything to do with connections to the land and a rich and complex past” (Kamal et al., 2015, p. 565). Indigenous scholars have documented how the legacy of colonialism, removal of Indigenous people from their land, and the loss of traditional agricultural practices and crops have had detrimental impacts on their well-being (Jonasson et al., 2019; Robin, 2019). 1.7 Thesis approach and organization This thesis project sought to develop a conceptual framework to link practices associated with the food sovereignty movement to the health and well-being of actors in local and global food systems. In pursuing this, I explore the following research question: How can food sovereignty frameworks incorporate assessments of health and well-being? Using a meta-narrative literature review, the overall goal of this research was to create a framework that explains the relationship between food sovereignty practices and multi-dimensional components of well-being. There were two specific research objectives relating to this goal. The first research objective (1) was to understand how agroecology and food sovereignty are conceptually related to well-being through their paradigms and frameworks, including (1a) Western vs. Indigenous conceptualizations of food, agriculture, and well-being, and (1b) how the food sovereignty and well-being literature differ based on the language of publication (Spanish, Portuguese, and English). The second research objective (2) was to research possible indicators to assess well-being in a food sovereignty context. This included an analysis of how contextually appropriate the possible indicators are, ways to assess the 17 indicators, and any gaps in the discussion on indicators to measuring the impact of food sovereignty practices and activities on well-being. Chapter 2 lays out the methodology used for the meta-narrative literature review and provides an explanation of the types of sources and publications reviewed. Chapter 3 then addresses research objective one, summarizing the well-being meta-narratives identified in the literature review, and the importance of their relationship to food sovereignty practices. Research objective two is addressed in Chapter 4 as a discussion on possible indicators that can assess the relationship between food sovereignty practices and well-being, organized by the meta-narrative themes identified in Chapter 3. Chapter 5 is a discussion on project limitations, future directions and concluding remarks. 18 Chapter 2: Methodology 2.1 Meta-narrative literature review A meta-narrative literature review is a qualitative and mixed-method approach to conducting literature reviews (Greenhalgh et al., 2005, 2011). It is used to understand how a research topic is interpreted across disciplines and historically over time (Greenhalgh et al., 2011). Greenhalgh et al. (2011) developed the meta-narrative methodology as an alternative or parallel review to the Cochrane Review1 commonly used in health literature. Similar to realist reviews that take an explanatory focus to understand complex programs and interventions (Pawson et al., 2005), meta-narrative reviews “were developed to help make sense of heterogeneous evidence about complex interventions applied in diverse contexts in a way that informs policy” (Greenhalgh et al., 2011, p. 2). In the context of this thesis project, a meta-narrative review aims to understand how food sovereignty practices are discussed across disciplines and languages, to inform the subsequent development of a conceptual frameworks and set of indicators linking food sovereignty to well-being. A decision was made to review literature in English, Spanish, and Portuguese to explicitly include the contributions of Global South health and food sovereignty academics in this literature review. As discussed in Chapter 1, Global South authors have greatly contributed to the topics of critical epidemology, social determination of health and literature on Buen Vivir (Breilh, 2010; Melo Filho, 2008). As well, many food sovereignty and agroecoloigcal-focused studies have 1 A Cochrane review is a systematic review of experimental and descriptive health research. While Cochrane reviews often seek to summarize statistical results like effect size or causation, meta-narratives offer a complementary perspective on how human processes lead to these outcomes (Greenhalgh et al. 2011). 19 occurred in the Global South (Altieri & Nicholls, 2010; Cini et al., 2018; HLPE, 2019). The contributions of Global South academics are often overlooked in academia from the North (Spiegel et al., 2015), thus it felt pertinent to include the voices and contributions of Global South scholars and to understand how the relationship between food sovereignty practices and well-being varied between the North vs. South. 2.2 Eligibility criteria Before beginning the literature search, I developed a set of inclusion and exclusion criteria. Literature included sources which referred to at least one component of health and/or well-being and a component of food sovereignty and/or agroecology (See Table 1 below). The term agroecology was used as both a search term and inclusion criteria to reflect that agroecology is viewed by scholars and social movements as a practice that is highly connected to the food sovereignty movement (HLPE, 2019). For example, scholars argue that “agroecology is seen as a bottom-up pathway to food sovereignty, building on traditional knowledge systems, supported rather than led by science, where small producers, their communities and organizations, rather than agrifood business, play a central role” (HLPE, 2019, p. 38). Finally, agroecology is one of the more researched food sovereignty practices, thus I felt including this search term and inclusion term would provide a more fruitful literature search. Articles were excluded if they were not accessible due to technological barriers or published in any language other than English, Spanish, and Portuguese. Literature that in no way referenced any food sovereignty practices, for example papers with no mention of practices like agroecology or the land rights of peasant farmers, that did not mention food sovereignty or that 20 did not align with food sovereignty principles (ex: discussing only food security with no mention of agroecological production or democratizing food systems) or literature that discussed soil, animal, marine health/well-being with no reference to human populations were all excluded. 2.3 Planning and search phases During this study, the meta-narrative review protocol designed by Greenhalgh et al. (2011) was followed. During the first step, or planning phase, an open-ended research question was created and meetings with academic peers and intended audiences were held, to discuss the research topic, including with farmer stakeholders in Ecuador, who sought to research the relationship between their food sovereignty practices and well-being outcomes. To carry out this work the following research question was created: how can food sovereignty frameworks incorporate assessments of health and well-being? It was agreed upon, with community partners in Ecuador, that the results of the literature review would be disseminated to them in Spanish. The search phase of the review included an initial broad search of the possible literature. During this step, the first round of papers and documents were collected through online libraries, article databases and via recommendations from local experts. A search strategy, including search terms, boolean operators, and a list of search databases, was vetted by a University of British Columbia librarian (see Table 1 and Table 2). Due to the flexibility of the meta-narrative review methodology, which acknowledges the diversity of disciplines needed to assess the interpretation of different paradigms, grey literature emerging from searches on the vetted databases was also included if inclusion criteria were met. 21 Table 1: Search terms Search terms (Food sovereignty or agroecology) AND (health* or well-being or wellness) (Food sovereignty or agroecology) AND (health* or well-being or wellness) AND (indicators OR measur* OR evaluat*) In Spanish: (Soberanía alimentaria OR agroecología) AND (salud* OR bienestar) In Spanish: (Soberanía alimentaria OR agroecología) AND (salud* OR bienestar) AND (indicadores OR evaluación* OR medid*) Table 2: Search results Search database Total documents found (duplicates included) Language of search AESD 979 English Cabi Direct 642 English Epistomonikos 2 English Ovid MEDLINE 107 English Web of Science 580 English Lilacs 65 Spanish, Portuguese Scielo 49 Spanish, Portuguese Total 2426 2.4 Study selection From completing the initial search, a total of n=2426 sources were found, including duplicates (identification stage). A set of inclusion and exclusion criteria were created (see section 2.2) and then all source titles and abstracts were reviewed. Duplicates and any sources that met the exclusion criteria based on information contained in the title and abstract were removed. This process was carried out using Covidence, a systematic review software. Using Covidence, all sources were screened for relevancy, after which there were only n=361 titles remaining. A full-text review of these 361 sources was then completed. Sources whose context did not meet the exclusion criteria as well as any remaining duplicates or sources with broken/non-functional links (such as titles which appeared in a search but no longer had live on-line PDF links) were excluded. A total of 15 sources excluded due to broken links (n=5 were Portuguese language 22 articles, n=2 were Spanish language articles, and n=8 articles were in English). After the removal of inaccessible sources n= 213 remained. The final sources were then used for retrospective snowball sampling, or searching for other relevant sources by looking at the bibliography of each selected paper (Wong et al., 2013). The snowballing process resulted in n=82 papers being added for the second round of title and abstract screening and full-text review. A total of n=35 snowballed sources were considered relevant and included in the final total. During the review process, additional n=11 papers were suggested by local experts for review of which n=6 were included in the total. After the final rounds of review, the total number of papers reviewed was n=251. An overview of the literature selection process can be seen below in Figure 1. Figure 1: Literature review process n= 2426 n= 1468 n= 361 n= 251 Snowball n= 82 Local experts n= 11 n= 35 n= 6 Identification Primary Screening Full text Review Included 23 2.5 Data analysis Following the literature collection, papers were read and coded for relevant themes. Code themes were developed inductively while the literature was reviewed. The code themes included topics and ideas related to well-being, and specific food sovereignty practices. A codebook was created to record each code and a description of the code (Braun & Clarke, 2006). During the review of each source, the reviewer recorded a reflective memo after reading it. Memos were used to record notes, comments, and reflections about the source. Due to fluency in English and Spanish, I reviewed papers in those two languages, and a Portuguese-speaking research assistant coded and reviewed all the remaining Portuguese-language papers. Qualitative data analysis software (ATLAS.ti for Mac OS X version 1) was used to facilitate data management and analysis (Birks et al., 2008). After doing a primary sorting and review of all the collected sources, it was possible to organize the sources by categories and language of publication. The predominant types of sources coded were academic articles (83%), followed by reports (6%) and book chapters (4%). Most sources were in English (82%), with 6% in Portuguese, and 12% in Spanish (see Table 3 and Table 4). Table 3: Reviewed source type Type of source Number Abstracts 1 (0.4%) Academic 208 (82.9%) Book chapters 10 (3.9%) Conference report 2 (0.8%) Dissertation 7 (2.8%) Grey literature and Magazines 8 (3.2%) Reports 15 (6%) Total 251 24 Table 4: Sources by language of publication Language of source Number English 207 (82%) Portuguese 15 (6%) Spanish 29 (12%) Total 251 After coding, I identified the meta-narrative themes and created the conceptual framework by reviewing the coding results. With set definitions applied to each meta-narrative (see Chapter 3), I tabulated how many codes on each document correlated, based on the code topic, with each meta-narrative. For example, a code labelled ‘food security’ was associated with the physical well-being meta-narrative. After tabulating the number of codes associated with each meta-narrative, I calculated the number of meta-narratives associated with each publication (see Chapter 3). In this study, I determined that to be considered linked with a meta-narrative a source had to have a minimum of two codes related to the meta-narrative. This was to ensure a result of only one code related to a meta-narrative wasn’t due to a miscount or misinterpretation of an idea presented in the text. Finally, each source could contain multiple meta-narratives, so I calculated how many sources contained multiple meta-narratives and organized these results by language of publication (see Chapter 3). A breakdown of the meta-narratives by language was also performed. To do so, I looked at the number of meta-narratives associated with each literature source based on its language of publication (see Chapter 3). This allowed for an understanding of how the diversity of meta-narratives varied by language of publication. The goal of was to understand how conceptualizations of the research question might vary by the language of publication. 25 Chapter 3: Results There were four key meta-narratives identified from this research. Each meta-narrative describes how food sovereignty practices directly relate to well-being. Table 5 describes the four meta-narratives as well as what percentage of the literature reviewed was associated with each meta-narrative. Each meta-narrative contains a list of common themes and ideas that pertain to the specific meta-narrative. 26 Table 5: Well-being meta-narratives Examples of the meta-narrative Prevalence of the metanarrative (Number of sources out of n=251 which contained the meta-narrative) Environmental well-being • Improved soil, land, and water quality through agroecology. • Better forest health using agroecology and agroforestry practices. • Sustainable food production using agroecological methods. • Climate change resilience and adaptation through agroecology and other environmentally sustainable agricultural techniques (permaculture, organic agriculture). • Improved agrobiodiversity, crop diversity, local biodiversity, and overall ecosystem health. • Access to local and non-GMO seeds. n= 244 sources / 97% Physical well-being • Improved nutrition, access to food, and improved dietary outcomes. • The incidence of nutrition-related diseases, mental health, and health issues like stunting, wasting, obesity, and malnutrition. • Prevalence of nutrition transitions in peasant and agriculturally focused communities. • Pesticide use, agrochemicals, and disease/poor health outcomes. • Improved food security. n= 239 sources / 95% Social-political-economic well-being • Poverty alleviation through agroecology. • Improved income or financial stability. • Improved gender equality and division of labour through agroecology. • Control over the food system, food production, and local politics and political sovereignty. • Food production and consumption as integral to community well-being. • Right to own land and access land and water. n= 236 sources / 94% Cultural-spiritual well-being • Buen Vivir or the concept of good living. • Indigenous food sovereignty. • Access to traditional foods, crops, traditional agricultural practices, and traditional land. • Access to medicinal plants and wild plants. • The well-being of Mother Nature and other entities related to the land. • Protection of Indigenous languages. • Revitalization of exchange practices (ex: Trueque). • Revitalization of traditional ecological and agricultural knowledge. n= 183 sources / 73% Total number of sources 251 27 3.1 Conceptual framework The conceptual framework, seen below in Figure 2, details the relationship between food sovereignty practices and well-being. Figure 2: Conceptual framework Figure 2 explains the relationships between the four broad themes/types of well-being identified in the meta-narrative review. The framework demonstrates how food sovereignty practices, like agroecology, can impact either an individual component of well-being or overall well-being. The inner circle containing the four well-being narratives shows how each of the narratives come together to create the outer circle which represents the over-all concept of human well-being. The framework’s bidirectional arrows imply that there is extensive interaction and no hierarchies among the four meta-narratives identified. Like how one publication could contain multiple Food sovereignty practices(e.g. agroecology)Environmental Well-beingPhysicalWell-being Cultural-spiritual Well-beingSocio-political-economic Well-beingHumanWellbeing 28 meta-narratives, this part of the conceptual framework represents the idea that each type of well-being can contribute to human well-being, and that they must all be included to understand the concept of overall well-being holistically and fully. As well, the bidirectional arrows and circular shape seek to exemplify that the relationship between well-being and food sovereignty practices is not static and can change, both can exert a negative or positive influence on the other. The conceptual framework suggests that if there is a particular area of well-being one seeks to improve, using appropriate food sovereignty practices could enhance this. For example, as discussed in section 3.4 of this chapter, if there is a desire to improve child or maternal nutrition, using agroecology as an agriculture practice may improve physical well-being outcomes such as nutrition. This dynamic relationship between food sovereignty practices and the well-being meta-narratives will be discussed further in Chapters 3 and 4. Moreover, focus and attention to these dimensions of wellbeing can serve as a basis for reflecting on the effects of food system practices, and how desires for well-being may influence the practices used. The rest of Chapter 3 provides a more detailed explanation of the framework and meta-narrative results. First, section 3.2 provides a brief explanation of the types of food sovereignty practices which are discussed in each meta-narrative. In the following sections of Chapter 3 (3.3-3.6) each well-being meta-narrative will be discussed and explained in more detail. Section 3.7 contains a discussion on how frequently each well-being meta-narrative appeared in the literature reviewed based on the language of publication. 29 3.2 Food sovereignty practices In their paper on developing indicators to assess the concept of food sovereignty, Ortega-Cerdá and Rivera-Ferre (2010) identified five broad indicator themes for the concept of food sovereignty and associated food sovereignty practices across a wide range of areas and effects, including but not limited to health. These themes are 1) access to resources: defined as the individual and community practices that support access to resources such as seeds, water, and land 2) production models: activities that support and increase local and sustainable food production 3) transformation and commercialization: activities that support landless peasants, Indigenous peoples, and farmers in selling food and feeding their local populations 4) food security and consumption: activities that support peoples’ right to safe, health, and nutritious food, and 5) agrarian policies: policies and activities that defend individuals rights and participation in politics (Ortega-Cerdà & Rivera-Ferre, 2010). The Ortega-Cerdá and Rivera-Ferre framework provides a useful explanation of the five broad categories of food sovereignty practices with a focus on food production and food systems. Many of the food sovereignty practices identified in the meta-narrative review aligned with each of the five categories of Ortega-Cerdá and Rivera-Ferre framework. However, the Ortega-Cerdá framework does not have a specific focus on health and well-being, thus the results of this thesis may offer a complementary perspective which demonstrates how food sovereignty practices impact well-being. The following are the food sovereignty practices identified through the meta-narrative literature review, organized into the five key themes identified in Ortega-Cerdá and Rivera-Ferre’s 2009 framework. 30 3.2.1 Access to resources This theme included access to environmental resources as well as human and financial capital. Access to and the use of traditional, Indigenous and local seed varieties were key practices discussed with frequency in the literature (Guerrero Lara et al., 2019; Jasso-Arriaga, 2019; Parraguez-Vergara et al., 2018). Indigenous scholars discussed the importance of being able to access the land and water in order to hunt, fish, forage, and harvest wild plants (Batal et al., 2005; Heeringa et al., 2019; Smith et al., 2019). Much of the literature highlighted economic barriers for small-scale farmers, such as sharecropping or land tenure practices (Naranjo, 2012). The ability to own land, by contrast, was a practice that improved farmer’s income and economic opportunities (Isakson, 2009). Gender equity practices were also important for household income and agricultural activities (Gartaula et al., 2017; Isakson, 2009; Siegner et al., 2020). Women are often denied land ownership and the ability to control economic decisions (Gartaula et al., 2017; Siegner et al., 2020). However, when women have the capability to make financial decisions and control household income it can greatly benefit their families (Jones et al., 2015). 3.2.2 Production model The main agricultural and production model described in the literature was agroecology. Agroecological practices are diverse and as explained in the 2019 HLPE report, Can be classified along a spectrum and qualified as more or less “agroecological”, depending on the extent to which: (i) they rely on ecological processes as opposed to the use of agrochemical inputs; (ii) they are equitable, environmentally friendly, locally adapted and controlled; and (iii) they adopt a systemic approach, rather than focusing only on specific technical assessments. (HLPE, 2019, p. 36) 31 Natural ecosystem practices mentioned in the literature included permaculture 2, organic agriculture practices, agroforestry3, and agro-silvo-pastoral systems4 (Altieri & Nicholls, 2010; Bezner Kerr, Dakishoni, et al., 2019; Boege & Carranza, 2009; Jacobi, 2016). Specific on-farm activities practiced by agroecological farmers included crop rotation, crop diversification, ecological pest management, intercropping, and livestock diversification (Bezner Kerr et al., 2016; Boege & Carranza, 2009; Nyantakyi-Frimpong et al., 2017; Ponce, 2002). The literature discussed the use of biological pesticides and herbicides, natural fertilizers and water access and management. Other concepts associated with the theme of production models included issues such as on-farm biodiversity of both crops and livestock, as well as assessing the biodiversity and ecosystem health of the surrounding or local environments. 3.2.3 Transformation and commercialization The mention of food sovereignty related transformation and commercialization practices was less common in the literature reviewed. Many of the sources discussed communities and agricultural traditions with non-economic or non-marketplace practices, such as self-consumption and subsistence farming. However, for families or producers involved in food markets and commercialization, a key topic was the importance of fair and stable crop prices. There are many drivers of international and regional food prices such as market volatility, climate change events, and the increased cost of oil and biofuels (Chappell & LaValle, 2011). Free trade agreements can also influence crop pricing and the demand for certain products 2 Permaculture is a land management practice which uses natural ecosystem processes. 3 Agroforestry is the practice of growing trees/shrubs in the same area as crops or pasture. 4 Agro-silvo-pastoral systems are a multi-land use system combining a woodland area with cattle livestock (Russo, 1996). 32 (Finnis et al., 2013). Free trade agreements enable import and export between nations with decreased tariffs or restrictions. The effects of free trade include government subsidies on certain crops, shifting priorities for export and import crops, and fluctuations in the prices of local staple crops based on global market trends. For example, due to increased import of US maize into Mexico in the 1990s the price of Mexican domestically produced maize dropped significantly (Keleman, 2010). Food sovereignty activities that can counteract the effects of free trade agreements include food procurement interventions focused on creating domestic supply chains between farms and school kitchens (FAO, 2015; Wittman & Blesh, 2017). The UN World Food Programme’s (WFP) Home-Grown School Feeding Programmes connect local farmers to school kitchens (Wittman & Blesh, 2017). The farm-to-school kitchen relationships offer farmers fair crop prices and lower transportation costs, while supplying schools with more diverse, high-quality ingredients which benefit student health and nutrition (FAO, 2015). 3.2.4 Food security and food consumption Literature sources from the meta-narrative review referenced food sovereignty practices related to community, household, and individual food consumption. The articles discussed how diversified crop production is important for household dietary and nutrient diversity (HLPE, 2019). The importance of hunting, fishing, and food gathering was linked to improved food consumption in Indigenous communities, and to improving overall diets of Indigenous people (Batal et al., 2005; Kamal et al., 2015). The production of traditional staple diet crops also played an important role in maintaining traditional knowledge and Indigenous languages 33 (Huambachano, 2019; Ray et al., 2019). Certain food production methods, such as agroecology, were linked to improved community and household food security. Agroecological practices can increase crop yield, which in turn can increase household access to food and provide more agricultural economic opportunities to sell products (HLPE, 2019). Agroecological practices also assist with climate change adaptation, enabling more stable food production in times of environmental or climatic crisis (Altieri & Nicholls, 2017). Other community food production interventions mentioned in the literature included home and community gardens, in both urban and rural marginalized communities, which were linked to improved food security (Budowle et al., 2019; HLPE, 2019). 3.2.5 Agrarian policies Regarding agrarian policy, most of the literature sources reviewed did not discuss specific policy activities or practices performed by farmers themselves. Rather, the literature highlighted the danger of the policies and political practices that do not reinforce the values of the food sovereignty movement (Abbink, 2017; Mabhaudhi et al., 2019). This included policies allowing the removal of Indigenous peoples and small-scale farmers from their land, polices that promote resource extraction and the degradation of the natural environment, and neoliberal trade policies (Abbink, 2017). Articles mentioned the importance of policy makers incorporating Indigenous peoples’ rights to their land and the importance of their culture and traditional food systems in future agrarian policy (Jennings et al., 2020; Kamal et al., 2015). Examples of policies that better align with the food sovereignty movement include changes to the Bolivian and Ecuadorian constitution that recognize the rights of the environment and Mother Nature, as well as 34 Indigenous approaches to well-being (Cecilia Rivera & Restrepo, 2014; Guardiola et al., 2014; Jacobi, 2016). In the following sections of Chapter 3 these food sovereignty practices, and how they relate to the four meta-narratives of wellbeing, will be explored in more detail. 3.3 Environmental well-being meta-narrative The first meta-narrative identified was that of environmental well-being. Environmental well-being refers to the relationship between human actions (ex: agricultural practices) and the state of the nature, such as the health of ecosystems, soil, water and air (Musa et al., 2015). This meta-narrative encompasses discussion on the intersection between food sovereignty practices and environmental well-being. In particular, the food sovereignty practice of agroecology appeared often in literature under this meta-narrative theme. This meta-narrative highlights the various ways, across disciplines and literature, that food sovereignty practices, such as agroecology, may impact the environment and natural world. This includes issues like protecting local biodiversity, encouraging crop diversity through access to non-conventional seed types, and improved water and soil health (Altieri, 1999). Literature in this meta-narrative included publications on topics like agricultural sciences, crop sciences, and food systems. 3.3.1 Agroecology Agroecology and agroecological practices were a dominant part of this meta-narrative. Many authors and articles highlighted the importance of agroecology for the well-being of the 35 environment through its impact on soil health, water quality and crop biodiversity (Botelho et al., 2016; Rosset et al., 2011). Research on agroecological practices has also demonstrated that agroecological small-scale farms have higher levels of biodiversity and productivity, and better resource management than their conventional counterparts (Altieri, 1989; Dumont et al., 2013). Agroecological practices promote increased crop diversity which can help increase the genetic diversity in the food system (Isakson, 2009; A. D. Jones et al., 2015). Crop diversity helps protect the natural environment, as it promotes the evolution and growth of naturally pest resistant, weed resistant, and less water-intensive crops (Crop Trust, n.d.). Crops also play an important role in improving soil health. For example, legumes act as important nitrogen fixers for the soil (Nyantakyi-Frimpong et al., 2017). Decreased agrochemical usage keeps important nutrients and biota in the soil making the soil more productive and healthy for future farming activities (Kangmennaang et al., 2017). Agroecological practices also include the use of natural sources of compost and manure which can further improve soil health (Bezner Kerr, Dakishoni, et al., 2019). Decreased chemical usage in agriculture also benefits local waterways by preventing contamination of nearby water sources. The same agroecological practices that improve crop and genetic diversity have also been shown to help build resilience to climate change (Bezner Kerr, Dakishoni, et al., 2019; Kangmennaang et al., 2017). Crop diversity builds resilient plant species that can withstand different climatic and environmental conditions such as flooding or drought (Isakson, 2009). Through its promotion of traditional and Indigenous agricultural knowledge, agroecology protects local seed and crop 36 biodiversity, needed practices to promote resilience and adaption to climatic changes that may impact food systems and agriculture (Bezner Kerr et al., 2016; Bezner Kerr, Kangmennaang, et al., 2019; Isakson, 2009). For example, in Malawi, Bezner Kerr et al. (2016) found that farmers who increased their crop diversity were better able to withstand periods of drought. Bezner Kerr et al. (2016) also found that agroecological biological renewal of soils can act as a buffer against extreme climatic events. Agroecological practices give farmers the ability to control the health of their soil, what crops they grow, and their ability to mitigate future climatic risks. Bezner Kerr et al. (2016) argue that this rebuilding of soils can be seen not just as reworking the metabolic rift (Wittman, 2009) but as fundamentally repairing the metabolic rift (Schneider & McMichael, 2010). Farmers’ labor in their soils, which helps to re-close the loop of organic material, nutrients, and energy within their farms, (a key principle in agroecology), also re-establishes a dependence on natural systems and breaks the dependency on industrial inputs (p. 7). From the literature review, it became clear that agroecological farming practices were directly connected to the meta-narrative of environmental well-being. By improving the health of the soil, increasing crop diversity and resilience to climate change, agroecology directly impacts the well-being of local environments. 37 3.4 Physical well-being meta-narrative The second meta-narrative is human physical well-being. Based on the guiding conceptual framework of this paper, physical well-being is related to the body and physical illnesses such as disease, nutrition, and food security (Capio et al., 2014). The physical well-being meta-narrative within the food sovereignty literature focuses predominantly on how conventional agricultural practices can negatively impact physical health and well-being, such as illness from pesticide poisoning (Huergo et al., 2018) and poor nutrition as a result of low food security and nutrition transitions (Damman et al. 2008). By contrast, agroecological practices can increase dietary diversity and improve nutritional outcomes. Academic disciplines that discussed this meta-narrative were predominantly from the field of health promotion, public health, and nutrition. 3.4.1 Physical health and nutrition From the literature review, it was clear that the effects of industrialized agriculture on human health have been very well documented. Agrochemicals are known to cause illness and health issues like headaches and nausea, and long-term exposure to agrochemicals may cause diseases and impact child development (Altieri et al., 2020; Huergo et al., 2018; Kohler & Negro, 2018; Lira et al., 2018). In a series of interviews conducted by Huergo et al. (2018), one farmer in Argentina explained how agrochemicals impacted them. “We are dying little by little because the concentration that we use or absorb is minimal but is generating cellular mutations and a lot of disorders that aren’t seen today (Huergo et al., 2018, p. 21)5.” 5 Translation of this quote was done by Rebecca Wolff. 38 Herbicides like glyphosate, specifically designed to be used alongside GMO seeds, have been deemed likely carcinogenic and harmful to humans (A. D. Jones et al., 2015). Martínez Castillo (2020) argues that modern agriculture, and its accompanying technologies like agrochemicals, care little for the health of the individuals who work in the fields, creating a damaging relationship between agriculture and health. Participating in food sovereignty practices, like agroecology, helps farmers avoid many of these occupational health risks. Agroecology uses natural, ecological methods of pest and weed control, nor are GMO seeds and related products typically used. However, Jones et al. (2015) argue that eliminating synthetic chemicals through agroecology will not prevent other forms of occupational health hazards for farmers such as inhalation of dangerous dust and gases. Conventional agriculture has also been shown to have negative impacts on local dietary diversity, food security, and nutrition (Guerrero Lara et al., 2019; Loring & Gerlach, 2015). Those most impacted by food insecurity and nutrition are often women and children. In low-income households, women are most at risk for nutritional deficiencies and the resulting health issues that can occur (A. D. Jones et al., 2015). Pregnant women who suffer from micronutrient deficiencies are at higher risk for death from childbirth and there is a higher probability their children will suffer from malnutrition such as through stunting or wasting (Freire et al., 2014). Thus the poor nutritional status of mothers can cause future generational health issues for their children (Freire et al., 2014). Decreased crop diversity and cultural shifts in diets have also led to nutrition transitions for many communities across the world, where traditional diets are replaced by other non-traditional 39 crops or processed foods (Robin, 2019; Sowerwine et al., 2019; Spurway & Soldatic, 2016). These nutrition transitions can be caused by factors such as changed agricultural practices (shifts away from subsistence food production or foraging) to poor market access or expensive pricing of foods that are healthier or have higher nutritional value (Ambikapathi et al., 2019; Jennings et al., 2020; Kamal et al., 2015). Nutrition transitions can also shift the food preferences of consumers. Individuals may desire to eat foods deemed more ‘Westernized’ and as a result, traditional crops can become undervalued and underutilized, despite their important cultural and nutritional benefits (Jennings et al., 2020; Mabhaudhi et al., 2019). These changes in the food preferences of parents and adults also influence children’s food preferences and their nutritional education (Lindsay et al., 2012). Interventions to prevent poor nutrition often focus on ‘unhealthy eating’ without truly addressing the structural and historical issues that have led to these health problems and nutritional transitions such as Westernization and globalization (Ray et al., 2019). Given many of these health issues are connected to industrialized and conventional agriculture, food sovereignty practices like agroecology present alternative ways to heal both food systems and health. By denouncing industrialized agricultural practices like monocropping and agrochemical usage, food sovereignty practices directly impact the role agriculture plays on human health and well-being. For example, agroecology promotes biodiversity through activities like mixed cropping, intercropping, and the use of Indigenous seed varieties. Increased biodiversity through agroecological farming practices has been connected to improved household nutrition and food security (Bezner Kerr, Kangmennaang, et al., 2019; A. D. Jones et al., 2015). Bezner Kerr et al. (2019) found that when farmers produced greater crop diversity, they reported 40 improved dietary diversity compared to those who did not have increased farm biodiversity. As well agroecology can encourage the consumption of wild or foraged crops which for Indigenous communities has been a historically important part of their nutritional health (Jasso-Arriaga, 2019). 3.4.2 Mental health Mental and emotional health is an important component of overall physical well-being. Jonasson et al. (2019) found that for the Tsleil-Waututh Nation the consumption of traditional foods contributed to improved mental health. On the other hand, the “lack of cultural continuity and [of] traditional foods has also been associated with negative mental health outcomes, including addictions, substance use and suicide, among others (Oster et al., 2014)” (Jonasson et al., 2019, p. 507). Similar relationships between culture, traditional foods, and improved mental health outcomes have been noted by other scholars (Kant et al., 2013; Kuhnlein, 2017; Ray et al., 2019). In a study on urban agroecology projects in São Paulo, Brazil, participants reported that working on the land and growing food was therapeutic for their mental health (Ribeiro et al., 2015). A study by Arias (2016) noted that the food sovereignty practices of a community seed saving program, and the protection of cultural practices, influenced mental health in Antioquia, Colombia. Despite the empirical evidence of a relationship between food sovereignty practices and mental health, only n=21 papers included mentions of mental health either in their literature review or discussion sections. There were few studies that specifically examined the relationship between food sovereignty practices and mental health outcomes. There appeared to be far less research on 41 mental health than other forms of physical well-being and this area of investigation merits more attention. 3.5 Social, political, and economic well-being narrative The third meta-narrative, social, economic, and political well-being, encompasses all three of these aspects of well-being. Social wellbeing is defined as having healthy and safe relationships with others and one’s community (Sutherland & Adams, 2019). Socio-political well-being is an individual’s engagement with political culture, the popularity of political leaders and political consciousness (Nikiporets-Takigawa, 2018). This meta-narrative also included the concept of economic well-being or “having present and future financial security” (Council on Social Work Education, 2016, para 1.). In this meta-narrative income and household finances were impacted by issues such as agency over land use, the ability to own land, and the role of women in agricultural. Publications in this meta-narrative came mainly from academic disciplines of agriculture, development studies, economics, geography, and food systems. 3.5.1 Agency over land use A key concept of this meta-narrative is agency. “Personal agency can be defined as the ability to initiate and direct actions toward the achievement of defined goals (Zimmerman & Cleary, 2006)” (Frankham et al., 2020, p. 8). Agency is embedded into the concept of food sovereignty as the food sovereignty movement seeks to give farmers decision making power over their food systems (Ehlert & Voßemer, 2015; Martínez-Torres & Rosset, 2014; Nyéléni, 2007). In this meta-narrative the literature described three ways in which agency impacts the social, economic, and political well-being of farmers. 42 One key issue discussed in the literature was the relationship between agency over land use decisions and social and economic well-being. This issue was discussed in two different forms: the ability to access traditional lands, and the ability to independently use one’s farmland. In Canada, both colonization and neocolonial land-related policies have displaced Indigenous people from their traditional territories, denied Indigenous people the legal rights to be the owners of their land, or prevented them from using the land for activities like hunting, gathering, or fishing (Kamal et al., 2015). Scholars have documented clear links between improved physical and mental well-being, increased cultural practices, and the protection of Indigenous languages when Indigenous people are able to access their land and traditional territories (Donatuto et al., 2016; Huambachano, 2018; Robin, 2019). However, denying Indigenous peoples agency over their land can have determinantal effects on Indigenous peoples’ nutrition and food insecurity (Huambachano, 2018). In Canada and the United States studies have shown that the removal of Indigenous people from their land or denying them the ability to use the land can lead to a nutrition transition where the consumption of traditional foods and crops are replaced by unhealthy Westernized alternatives (Batal et al., 2005). In North America, the legacy of colonialism, and associated lack of agency over land use, has created issues of food affordability and access, with many Indigenous communities relocated to areas considered food deserts, where it is difficult to purchase and access quality food (Socha et al., 2012). The ability to access traditional territories and land is also important for the cultural-spiritual wellbeing of Indigenous people (Huambachano, 2018, 2019). This relationship between land access and cultural-spiritual well-being will be explored in more detail in section 3.6. 43 3.5.2 Land ownership Related to the concept of land access, is land ownership. In the context of food sovereignty, the right to access, use, and own land is a critical part of controlling the food system. There can be economic consequences when food producers cannot own land. Studies found that decreased land ownership is correlated with increased off-farm food purchasing and decreased income generation from farming (Isakson, 2009), whereas landowning farmers can feed their family with staple crops and not spend extra income on food (Bezner Kerr, Dakishoni, et al., 2019). Isakson (2009) found that in Guatemala families who had more land or land surpluses had more diversified livelihoods due to more economic opportunities than those without land. Unfortunately, in many countries land ownership is threatened by government land seizures or the denial of land tenure. For example, farmers in Ethiopia were greatly impacted by a 1991 federal policy that transformed traditional land into state property through land confiscation and resettlement policies (Abbink, 2017). Government land seizures can have trickle down effects. Denying land ownership prevents small-scale farmers from being able to participate in the food system as independent food producers, exaggerating the power inequality between major agribusinesses and small-scale farmers (Mabhaudhi et al., 2019). Landless farmers may enter into land-rental agreements creating cycles of debt and poverty (Jacobi, 2016; Jarosz, 2014). Some landless farmers also choose to transition to wage-based labour, such as working on a larger farm or migrating to urban regions to seek other forms of income to support their families (Naranjo, 2012). Wage-based labourers on bigger farms risk abuse, social isolation from families, and poor-working conditions in exchange for unfair wages (Misra, 2018). Migrant 44 agricultural workers may experience food insecurity, anxiety, depression, and high levels of social and workplace stress (Meyer et al., 2016; Weiler et al., 2017). 3.5.3 Gender equity, land ownership and agency Land ownership is important to decreasing gender inequity. Women experience more marginalization in agriculture, they are often not given any household finance or agricultural decision-making control, denied economic opportunities, and prevented from owning land (Bezner Kerr, Kangmennaang, et al., 2019; Nyantakyi-Frimpong et al., 2017). Yet, research has shown that income controlled by women positively benefits household food security more than that of men, and when given access to agricultural resources like land, women are more financially productive (A. D. Jones et al., 2015; Nyantakyi-Frimpong et al., 2017). Improving gender equity can improve the social, economic, and physical well-being of women and their families. When women’s health statuses improve so too does the health status of their families (A. D. Jones et al., 2015). Agroecological and food sovereignty scholars argue that the food sovereignty movement could assist in promoting gender equality through its emphasis on sharing of resources and decision-making (A. D. Jones et al., 2015). According to Jones et al. (2015) “it seems reasonable that as other priorities of the food sovereignty movement are advanced, synergistic effects on social equality are likely to appear” (p. 5). For example, participatory projects on agriculture and agroecology in Honduras appeared to increase women’s role in community agriculture (Kangmennaang et al., 2017). The project increased women’s decision-making power, leadership, and control of household income (Classen et al., 2012). Bezner Kerr et al. (2016) 45 came to similar conclusions, stating that agroecological practices, when conducted with social and gender awareness, could improve women’s physical and economic well-being, as well as improving the role they play in agriculture. 3.5.4 Political agency Indigenous people and small-scale farmers are further marginalized due to a lack of political agency, such as Indigenous people’s ability to make decisions about their own land and natural environment (Reimerson, 2013). However, certain policies that are reflective of the notions and ideas of food sovereignty can improve the social and political well-being of small-scale farmers and Indigenous peoples by respecting and protecting traditional and Indigenous land rights. For example, the Ecuadorian and Bolivian governments have put in place policies that protect farmers' rights and access to land. Bolivian President Evo Morales created a series of policies and social services to provide financial support to small-scale farmers (Jacobi, 2016). Ecuador and Bolivia also created constitutional changes that recognize the important rights of farmers, Indigenous people, and the environment (Gudynas, 2011; Jacobi, 2016). Specifically, Bolivia has a statement in its constitution that “guarantees the prioritization of food produced in Bolivia, protection of the agricultural sector, and agroecological production and commercialization” (Jacobi, 2016, p. 1). The Ecuadorian Constitution now uses the principle of Buen Vivir as a model for the future direction and development of the nation (see Chapter 1 for a definition of Buen Vivir). In the new 2008 constitution Buen Vivir is mentioned in academic articles and is explained as “the population has the right to live in a healthy environment, ecologically equitable, that guarantees 46 sustainability, Buen Vivir, and Sumak Kawsay” (Constitución de la Republica del Ecuador, 2015, p. 24). The constitution also contains many other articles describing Ecuadorians’ rights to Buen Vivir through health, social development, education, access to natural resources, etc. (Constitución de la Republica del Ecuador, 2015). 3.5.5 Social well-being: farmer support Sources in this meta-narrative theme discussed a sense of community and support networks between producers using food sovereignty practices like agroecology. The literature highlighted many different types of organizations created by farmers to support their agroecological activities, promote environmental protection of the land and water, and create more sustainable markets and supply chains. The Straight from the Countryside (Direto de Roça) program in Belo Horizonte, Brazil, provides small-scale local farms with access to low-cost farm stands in busy urban areas (Chappell et al., 2016). The program offers enables farmers to avoid market intermediaries, while giving consumers direct access high quality products (Chappell et al., 2016). In India, community irrigation cooperative programs offer farmers access to water irrigation systems, allow them to supervise water-related finances, and enable community agency over water management (Agoramoorthy & Hsu, 2015). Farmer or peasant organizations also support political agency. Peasant organizations such as Peasant Committee of the Highlands in Guatemala has fought for peasant land rights and land security since the early 2000s (Copeland, 2019). Farmer organizations, cooperatives, or community programs also offer important social support systems to their members and can be key to community resilience. Community resilience is the 47 ability of a community to cope, recover and adapt to various challenges and situations (U.S. Department of Health and Human Services, 2015). Programs such as the O-Pipon-Na-Piwin Cree Nation’s wild food program in Northern Manitoba supports community members “who are unable to access healthy, sustainable, and culturally appropriate food” (Kamal et al., 2015, p. 567). Similarly, the irrigation cooperatives in India ensure farmers have a social support system in times of hardship or personal crisis (Agoramoorthy & Hsu, 2015). This meta-narrative demonstrates the importance of agency to social, political, and economic well-being. Agency gives farmers the power to make their own decisions about land use and food production. The ability to access and own land in turn can benefit the social, economic, and physical well-being of farmers and their families. Land use and ownership is also important to improving gender equity for women. Farmer-led organizations that enable farmer agency also provide key social support systems to enhance community resilience. Finally, policies, projects, and food sovereignty activities that seek to promote the agency of farmers, and protect their land and livelihoods, can play a key role in improving social, political, and economic well-being. 3.6 Cultural and spiritual well-being meta-narrative The final meta-narrative identified in this review is on cultural and spiritual well-being. According to CRIAW (2020), cultural well-being is “the ability and freedom to practice your own culture, ability to pass on traditional knowledge and access traditional land” (para. 7). Spiritual well-being is the “freedom of spiritual practices, access to nature and connections to spiritual places” (CRIAW, 2020, para. 6). These two concepts are intertwined as spiritual belief systems and practices play an important role in many cultures and therefore intersect with 48 cultural well-being. Sources in this meta-narrative came from disciplines such as health sciences, agriculture, ethnobotany, and Indigenous people’s studies. Most literature sources associated with this theme focused on discussions around Indigenous peoples and Indigenous culture. They came from mainly Indigenous scholarly literature. It is important to note most sources in this meta-narrative focused on the cultural impacts of agroecology and other food sovereignty practices on human well-being. Some studies discussed how food sovereignty practices like agroecology influence the well-being of spiritual entities or deities connected to the natural world, or help individuals connect to their belief systems. However, this area of research is complex and merits further investigation. 3.6.1 Cultural well-being This meta-narrative encompasses the ways interactions with the land, through agriculture and agroecological practices, impacts cultural dissemination of traditional knowledge, language preservation, Indigenous food sovereignty, and the well-being of entities like Mother Nature (Guardiola & Garcia-Quero, 2014; Kamal et al., 2015; Robin, 2019). Other ways in which food sovereignty practices can positively improve cultural and spiritual well-being include helping communities maintain the production of culturally important crops and medicinal plants (Damman et al., 2008; Kuhnlein et al., 2013; Langwick, 2018; Parraguez-Vergara et al., 2018). A key theme in this meta-narrative was the importance of access to traditional land, water, and connections to land and the natural world for cultural and spiritual well-being. This was discussed by many global Indigenous scholars across different fields of academic publications (Huambachano, 2018; Ray et al., 2019; Robin, 2019). Ray et al. (2019) explained how 49 Indigenous people feel spiritually and emotionally connected to the land and environment. And Robin (2019) furthers this point by saying “land is fundamental to Indigenous ways of knowing and being…Returning to the land to nourish the body and soul is an often-overlooked component of Indigenous food sovereignty, yet it is crucial to well-being” (p. 91). Similarly, the Māori people see themselves as directly related to nature and need to keep the land and environment healthy and strong to themselves feel healthy (Shirley, 2013). As Robin (2019) summarizes, for many Indigenous people being able to be in connection with the land is essential to their cultural well-being, physical well-being, and their identity. One of the ways Indigenous people have historically, and continue to connect with the land, is through traditional agriculture and food production practices (Centers for Disease Control and Prevention, 2015). This can range from growing culturally important crops through traditional methods to practicing traditions of foraging for wild plants, hunting ,and fishing (Centers for Disease Control and Prevention, 2015; Isakson, 2009; Ray et al., 2019). The continued practice of these traditions is not just part of cultural well-being but also important for promoting self-determination and decolonization (Coté, 2016). Finally, language is also an important part of Indigenous food systems (Shirley, 2013). Sharing traditional knowledge, agricultural practices, and spending time on the land are important activities for language preservation and revitalization (Delormier & Marquis, 2019; Robin, 2019; Woodley et al., 2007). Traditional crop production and food preparation are activities linked to language preservation (Centers for Disease Control and Prevention, 2018). 50 From the literature review it became clear that food sovereignty, specifically, Indigenous food sovereignty, is a key movement that supports Indigenous peoples' control of their food systems, environment and culture (Ray et al., 2019). Kamal et al. (2015) explain that “Indigenous food sovereignty addresses ‘Indigenous’ aspirations for collective well-being and prefers to rectify inequality and acknowledge peoples’ rights to land and cultural integrity (Morrison, 2011)” (p. 565). This concept of Indigenous food sovereignty is connected to cultural and spiritual well-being. 3.6.2 Spiritual well-being The protection of traditional knowledge and Indigenous agricultural practices are also spiritually important for many Indigenous peoples. The Quechua and Māori people self-identify as descendants of Papatūānuku and Pachamama, spiritual deities often translated into English as Mother Nature or Mother Earth (Huambachano, 2018). Thus, protecting the well-being of the land and natural environment is not only culturally important but also maintains the well-being of important spiritual entities. In Ecuador and Bolivia, Pachamama, also known as Mother Earth or Mother Nature, has even been awarded constitutional rights as a federal attempt to recognize the importance of the relationships between nature, culture, spirituality and well-being (Guardiola & Garcia-Quero, 2014; Gudynas, 2011; Jacobi, 2016). While nations like Ecuador and Bolivia have pushed for federal policies or constitutional recognition of the importance of nature and land to the cultural and spiritual well-being of Indigenous people many other nations have failed to acknowledge the importance of these relationships. However, the literature reviewed in this project showed clear evidence that food 51 sovereignty practices like agroecology can still support cultural and spiritual well-being. These agricultural practices recognize and emphasize the importance of traditional agricultural knowledge in food production, as well as, supports other activities like foraging for wild plants, hunting, or fishing (Altieri, 1989). This may better help protect Indigenous knowledge and improve cultural and spiritual well-being. 3.7 Meta-narratives by the language of publication Table 6 demonstrates how many sources contained multiple meta-narratives organized by language of publication. Table 6: Meta-narratives by language of publication Meta-narrative English language sources Portuguese language sources Spanish language sources All languages Contained 4 meta-narratives 55% (113) 13% (2) 59% (17) 53% (132) Contained 3 meta-narratives 31% (65) 67% (10) 27% (8) 33% (83) Contained 2 meta-narratives 10% (20) 13% (2) 14% (4) 10% (26) Contained 1 meta-narrative 3% (7) 7% (1) 3% (8) Contained 0 meta-narratives 1% (2) 1% (2) Total 207 15 29 251 52 The literature reviewed contained mainly English language sources (n=207). 55% of the English language publications contained all four meta-narratives, 31% contained 3 meta-narratives, and 13% contained either 1 or 2 meta-narratives. The English language publications also contained two sources which only had 1 code associated with two different themes. As these publications did not meet the minimum of 2 codes to be assigned a meta-narrative they were labelled as having an association with none of the meta-narratives. These two publications contained the words “food sovereignty” and “food security” but no other related terms or ideas. They likely made it through the screening and review process as they contained these key terms and ideas, but the overall content of the publications was not strongly associated with any meta-narrative. Of the three languages, the Portuguese publications had the lowest number of publications with 4 meta-narratives at 13%, although 67% of the Portuguese language sources contained 3 meta-narratives. The Spanish language publications had the highest percentage of 4 meta-narratives at 59%. The Spanish language publications all contained a minimum of 2 meta-narratives, the highest of any of the languages. As well, neither the Portuguese nor Spanish language literature contained any publications with 0 meta-narratives. For sources with 1-3 meta-narratives, cultural well-being was most frequently the meta-narrative missing or not associated with a publication, based on number of codes. It may be possible to infer this is a result of the lack of publications written by Indigenous scholars with a focus on spiritual practices, cosmology, traditional knowledge, or other related topics. As well, while discussions on the importance of recognizing other forms of knowledge (such as traditional 53 ecological knowledge) are gaining more traction, there is still a lack of academic publications that discuss their key topic using other forms of knowledge or non-Western worldviews. Across all the languages 96% of the publications reviewed contained a minimum of 2 meta-narratives. These results demonstrate that in many fields of study food sovereignty practices are seen as multi-disciplinary and holistic, influencing many different areas of human, social, cultural, and environmental well-being. These results also reflect the relationships described in the conceptual framework (see section 3.1), the idea that food sovereignty practices can affect multiple types of well-being, and vice versa. 3.7.1 Limitations It is important to acknowledge possible limitations regarding the analysis of the literature by the language of publication. It was difficult to find Spanish and Portuguese language papers on English academic search engines. Using Spanish and Portuguese search terms with Boolean operators often yielded no results. There were far more English language search engines for academic articles than Spanish/Portuguese academic search engines. As well it appeared that some authors from the Global South published articles in multiple languages (such as English and Portuguese) and at times I ended up reviewing or finding an English language version of their work. Because literature was sorted by the language of publication and not by the location of the academic institution, it is likely many Global South scholars were included in the English category of publication. 54 From our findings it appears that food sovereignty discourses, as the main topic of a publication, are proportionately more prevalent in Spanish and Portuguese language articles than in English articles. There was n = 7/44 (15.9%) Spanish/Portuguese language articles that included the term food sovereignty in their title, or where food sovereignty practices/activities were the focus of the investigation as compared to n= 19/207 (9.2%) for the English language publications. These results mirror those of Weiler et al. (2015) who found in their meta-narrative review “a brief scan of English- and Spanish-language sources indicated that the ratio of food security (seguridad) to food sovereignty (soberanía) references is much higher in English than in Spanish” (p. 1087). 55 Chapter 4: Indicators As identified in Chapter 1, there is a gap in research on the relationship between food sovereignty practices and how these activities influence different aspects of well-being. Chapter 3 described the meta-narrative literature review results which identified four key types of well-being that are linked to food sovereignty practices. To accomplish the second research objective, to research possible indicators to assess well-being in a food sovereignty context, I identified a series of 37 indicators using the results of the meta-narrative NVivo coding: 9 associated with environmental well-being, 10 associated with physical well-being, 8 associated with social-political-economic well-being, and 10 associated with cultural-spiritual well-being. In this chapter, the indicators which best represented the meta-narrative’s relationship to different food sovereignty practices will be discussed for their feasibility, appropriateness, as well as a review of existing methodologies for assessment using the indicator. It is important to note, the assessments provided in this chapter are based on examples found in the meta-narrative literature review. If used in the field, all indicators should also be considered for their relevance/appropriateness in a local context, as well as the needs of the research team, local collaborators or local organizations seeking to use these indicators. 4.1 Indicators of environmental well-being All the indicators identified through coding for this meta-narrative theme had relationships with environmental and agricultural land management, water systems, crop and livestock health, and climate change (see Table 7). The indicators which represent each meta-narrative theme will be discussed and reviewed in more detail: biodiversity, chemical usage and soil health and quality. 56 Table 7: Environmental well-being indicators Environmental well-being indicators (n=9) Indicator Definition Assessments Access to local seeds The ability to access Indigenous seeds, save on-farm produced seeds, or access locally produced (non-GMO or conventional) seeds from other farmers. Assessments identified by the FAO for access to seeds include the quantity of seeds saved or stored by an individual or household, and the quantity of seeds accessible through social/farm networks (FAO, 2015). Agrochemical usage The extent of agrochemicals (pesticides, herbicides, etc.) used or not used by farmers. The dosage and frequency of agrochemicals used on an individual farm over a set time period (Chouaïbou et al., 2016). This can be assessed using surveys or other quantitative data collection processes. Level of on-farm agrobiodiversity and biodiversity The level of agrobiodiversity in farm fields and biodiversity of the surrounding areas. Two complementary assessments of on farm biodiversity and agrobiodiversity are species sampling (of plants and other species) and habitat mapping (Lüscher et al., 2014). Soil health The health of the soil includes biological, chemical, and physical soil properties (Lorenz & Lal, 2016). To assess soil health, soil samples must be taken. This allows for an assessment of the surface soil organic matter which includes properties like soil carbon and nitrogen fractionation (Morrow et al., 2016). Water health and quality The quality of water used for human consumption (WHO, 2020c). This includes having access to sufficient water for household and agricultural needs, as well as access to a safe source of safe drinking water. Water quality assessments include assessing fecal coliform levels, water pH, levels of organic matter, and dissolved oxygen levels. These assessments require water sampling and subsequent sample analysis (Plummer & Long, 2007). Climate change resiliency The ability of peasant farmers to remain less vulnerable to the effects of climate change such as droughts or flooding. To assess climate change resilience at a household-level Jones and Tanner (2017) recommend the use of structured surveys to assess social and financial capital as well as phycological and cultural factors of resiliency. Crop health The assessment of “harmful effects associated with plant pathogens” on crop health (Savary et al., 2017, p. 312). Assessments of crop health include documenting the crop appearance (such as the color of the foliage), crop growth, and crop yield (Nicholls et al., 2004). Livestock diversity The assessment of the “genetic diversity of animal resources” (FAO, n.d., p. 1). Assessments of livestock diversity developed by Last et al. (2014) include “livestock species richness (the number of species per farm) and breed diversity (the average number of species breeds per farm)” (p. 9). Forest and land conservation The percent of deforestation and land conservation/protection happening on the farm and surrounding land. Assessments of deforestation are the quantity of deforested land at a particular point in time, and rates of deforestation in km2/year (Ferraz et al., 2009). Land-use maps from different time periods can also be compared to understand current and historical land-use and land conservation trends (Koglo et al., 2018). 57 4.1.1 Biodiversity The most prevalent indicator, identified from the literature, for environmental well-being was biodiversity and agrobiodiversity. Agricultural biodiversity or agrobiodiversity is “the variety and variability of animals, plants and micro-organisms that are used directly or indirectly for food and agriculture” (Dulloo, 2019, p.54) . It describes all the genetic resources, soil organisms, livestock, crops, plants, insects, fungi, bacteria, etc. contained within a farm and includes the members of surrounding natural ecosystems such as wild animals, wild plants, predators and pollinators (Thrupp, 2002). It has been demonstrated that agroecological practices can greatly increase agrobiodiversity making agrobiodiversity an important indicator of environmental well-being (Altieri & Manuel Toledo, 2011; Thrupp, 2002; Wittman & Blesh, 2017). In previous studies, agrobiodiversity had been assessed through questionnaires that ask farmers to list crop species grown, variety of species or types of livestock (Mburu et al., 2016; Santoro et al., 2020). Statistical analyses can be done with the questionnaire data to determine number of crops grown, nutritional diversity of crops and surrounding diversity of regional areas of farm property (Mburu et al., 2016; Santoro et al., 2020). International organizations such as Biodiversity International use agrobiodiversity as an indicator of the diversity of local and global food systems in their organizations' reports (Biodiversity International, 2018). The methodology for this indicator seems feasible within specific contexts, such as the use by academics and NGOs in the field. However, it requires significant effort by either a research team or individuals to conduct surveys, questionnaires or documents different aspects of crop and natural biodiversity. Thus, collecting data for this indicator means investing significant 58 energy to gather and analyze the data. This may prevent certain individuals or farmers from having the personal capacity, available time, or financial means to hire others to assess agrobiodiversity. 4.1.2 Agrochemical usage The literature sources reviewed frequently discussed the usage of agrochemicals such as pesticides, herbicides, and fungicides as indicators for health and environmental outcomes. Agrochemical usage has been linked to poor health outcomes such as disease, cancer, headaches and neurological problems (Araújo-Pinto, 2011; Huergo et al., 2018). Whereas, the alternative options of agroecological farming practices, which promote more natural non-agrochemical farming practices, have been associated with improved health outcomes for farmers, as well as for consumers of all-natural products (Carneiro et al., 2015; A. D. Jones et al., 2015). Agrochemicals can also leak into nearby water sources and soil and “can kill other non-target and beneficial organisms” (Mabhaudhi et al., 2019, p. 8). This can impact soil health and quality as well as the overall health of the ecosystem (Mabhaudhi et al., 2019). Certain studies have developed methods to assess agrochemical usage and its impact on the environment and human health (Sellare et al., 2020; Sheahan et al., 2017). Sellare et al. (2020) interviewed farmers and used quantitative questionnaires to record data on agrochemical usage such as the type and quantities of products. They then created a statistical model that used the environmental impact quotient (EIQ) and hazard quotient (HQ) of the pesticides to calculate the impact on human health and the environment (Sellare et al., 2020). The study by Sheahan et al. (2017) on the relationship between pesticide use and health in Sub-Saharan Africa developed statistical models to identify possible associations between pesticide use, crop productivity and human health. 59 Assessing the impact on the soil or water from agrochemical usage may require sampling of the soil and water. Sampling allows for an analysis of agrochemical residue. Bhandari et al. (2020) used soil samples to conduct a pesticide residue analysis from farms in Nepal. They compared the samples to the predicted environmental concentrations (PECs) of pesticides, they also compared pesticide levels by field type (Bhandari et al., 2020). There are many other types of statistical and soil analyses that can assess the impact of agrochemical usage on soil, water, and human health. Alternatively, it is possible to also use basic survey data to understand the quantity and type of pesticides used by farmers on a monthly or annual basis. The type of analysis done for this indicator will depend greatly on the needs of the farmer or organization, the data they wish to collect, and if they have physical/geographical and financial assess to laboratory testing services. 4.1.3 Soil health Soil health is defined as “the capacity of soil to function as a vital living system, within the ecosystem and land-use boundaries, to sustain plant and animal productivity, maintain or enhance water and air quality, and promote plant and animal health” (Doran & Zeiss, 2000, p. 3). Many literature sources mentioned soil health as an indicator of overall environmental health as it implies that the land is productive and fertile for farming and other activities. Strong soil health (and the related term soil quality) is directly linked to sustainable farming practices (Doran & Zeiss, 2000). Agroecological practices have been shown to greatly improve soil health (A. D. Jones et al., 2018; Kangmennaang et al., 2017; Thrupp, 2002). Agroecological practices increase the biodiversity of local organisms and ecosystems, as well farmers often use animal and plant residues in their soil and botanical pesticides which improve soil health (Kangmennaang et al., 60 2017; Mabhaudhi et al., 2019). Better soil can lead to higher crop productivity, improving yields and requiring less chemical inputs (Kangmennaang et al., 2017; Mabhaudhi et al., 2019). Other agroecological practices like mixed cropping and intercropping have been shown to improve soil fertility and soil water retention (Parraguez-Vergara et al., 2018). Thus, soil health is a strong indicator of the impact of agroecological practices on environmental well-being. As discussed by Doran & Zeiss (2000) and Griffiths et al. (2018), existing biological indicators to assess soil health include earthworm, nematode, fungi or bacterial population in the soil, field water infiltration rates, and level of agrochemicals in a soil sample. However, Griffiths et al. (2018) highlight many key issues with measuring soil health. Firstly that there is a lack of standardization across the many possible biological indicators that can be used, secondly it is important to recognize that many tests require laboratory access and may not be cost-effective for certain groups or individuals (Griffiths et al., 2018). Given there is such a range of indicators that can be assessed to understand soil health, stakeholders may have different needs and thus a more diverse but standardized set of indicators of soil health may be needed to meet stakeholder demands (Griffiths et al., 2018). More research is needed on how to assess soil health as an overall concept and to standardize these assessments. 4.2 Indicators of physical well-being From the literature review, most discussions around physical well-being included indicators related to food, nutrition, and disease/illness. The concept of food security featured prominently in many academic articles despite it being critiqued as not-aligned with the food sovereignty movement (Jarosz, 2014). Nutrition and nutrition transitions towards more Westernized diets 61 were issues of concern in many of the articles reviewed (Damman et al., 2008; Kamal et al., 2015). As well discussions around disease prevalence such as heart disease, cancer, and diabetes were also highlighted in the literature (Borras & Mohamed, 2020). Thus, the key indicators selected for this discussion (see Table 7) were the ones which best encompassed this meta-narrative: food security, nutritional status, and disease prevalence. 62 Table 8: Physical well-being indicators Physical Well-being Indicators n=10 Indicators Definition Assessment The following indicators are based on the FAO’s definition of food security (Ward, 2013). Food quality The perceived quality of food by the consumer (perceptions like taste) and the nutritional quality of the food (Wezel & Peeters, 2014). To assess consumer-perceived food quality, sensory testing, where participants use sliding scales to rate the taste, appearance, and texture of food products, can be used (Kilcast, 2013). To assess the nutritional quality of foods requires a laboratory analysis for different nutrients, vitamins or food properties (Southgate & Greenfield, 2003). Food accessibility The assessment of physical and economic access to food at a household level (FAO, 2008). Food accessibility can be assessed through self-reported questionnaires, focus groups, or other qualitative methodologies like semi-structured interviews and talking circles (Gebremariam et al., 2017; Jennings et al., 2020). Participants should be asked questions about what foods they can afford and regularly have access to. Food utilization The assessment of the biological use of food to ensure proper nutrition based on household knowledge of food storage and preparation, as well as access to safe drinking water and sanitation (FAO, 2008). Food utilization can be assessed using quantitative surveys and statistical analysis of variables impacting food utilization (access to clean water, sanitation, etc.), as well as through qualitative interview results (Abdoellah et al., 2020; Jasso-Arriaga, 2019). Food stability An assessment of the stability of food prices and supply (FAO, 2008). Food stability can be calculated using multi-variate statistical analysis with variables such as national import dependency, variability of consumer price index, and the variability of food production price indexes (all based on a local context) (Napoli et al., 2011). Nutritional status – The following indicators are based on (FAO, 2008). Nutritional status of children The nutritional status of children is calculated using assessments of stunting, wasting, overweight, and underweight (WHO, 2020a). Stunting, wasting, overweight, and underweight are calculated using a Z-score standardization system to compare children’s scores to a chosen reference population. Stunting is low-height-for-age that is 2> standard deviations lower than reference population. Wasting is a low-weight for-height 2 > standard deviations lower than the reference population. Overweight is weight-for-height that is 2 > standard deviation greater than the reference population. Underweight is when weight-for-height is 2 > standard deviations lower than the reference population (WHO, 2020a). 63 Physical Well-being Indicators n=10 Indicators Definition Assessment Nutritional status of mothers An assessment of the nutritional status of mothers using BMI, nutrient levels, or vitamin deficiencies (WHO, 2010). BMI is a weight-to-height assessment. When a woman has a BMI < 18.5 she is underweight (WHO, 2010). To assess nutrient and vitamin levels, blood samples must be collected and analyzed to determine possible deficiencies. General nutritional status An individual’s health as influenced by their diet. This includes the intake and utilization of nutrients (National Research Council Committee on Diet and Health., 1989). To assess general nutritional status nutritional screening tools should be used, such as measuring BMI and recent food intake (Reber et al., 2019). Food literacy and food and nutrition education An individual’s level of food literacy and understanding of nutrition. An example food literacy assessment tool, used nationally in countries like Norway and the US, is a Nutritional Literacy Scale. It is a survey which can be given to youth to assess their answers to a series of nutrition literacy questions (Guttersrud et al., 2014; Yuen et al., 2018). *Access to health services *This indicator overlaps with the indicator access to culturally appropriate care in the cultural well-being category. An assessment of an individual or household’s ability to access health services at a local, regional, or national level. This includes assessments of barriers to accessing care such as transportation, geographic location, and culturally appropriate care. Health services access can be assessed using qualitative semi-structured interviews or quantitative surveys. Participants should be asked about financial, geographic, cultural, structural and other barriers to receiving health services (Spurway & Soldatic, 2016; Zegeye et al., 2021). Prevalence of illness, disease, and mental health illnesses This is an epidemiological assessment of the number of cases of a disease or illness in a particular population at a given period (Ward, 2013). This also includes the prevalence of mental health illnesses such as depression, anxiety, etc. To calculate prevalence of a specific illness/disease, rigorous quantitative data collection from a clear study population should be used. Following data collection, the prevalence can be determined using statistical analysis (Ward, 2013). 4.2.1 Food security Food security is defined by the FAO as “ensuring that all people at all times have both physical and economic access to the basic food that they need” (FAO, 2008, p. 1). According to the 64 WHO, food security has three main components: food availability, food access, food utilization and food stability (WHO, 2020b). However food security definitions have expanded to now also include food quality and cultural appropriateness (Jarosz, 2014). Food security has been used for many years as an indicator of hunger and nutrition levels (FAO, 2008). The concept of food security as an indicator appeared often in the literature reviewed as part of this project. To assess food security, the FAO developed the Food Insecurity Experience Scale (FIES) which uses participants' responses to eight questions about where they sit on a food insecurity experience scale (FAO, 2017). Other existing ways to assess food insecurity include the USDA's ‘Guide to Measuring Household Food Security’ which uses a standardized questionnaire to determine levels of household food security on a points scale that contains four categories of food security: food secure, food insecure without hunger, food insecure with hunger moderate, food insecure with hunger severe (Bickel et al., 2000). The link between agroecology, food sovereignty, and improved food security has been well documented. In particular, papers emphasized that agroecology and food sovereignty improve crop diversity thereby increasing dietary diversity and improving local nutrition (Jonasson et al., 2019; A. D. Jones et al., 2015). As well, food sovereignty and agroecology promote the use of traditional crops and foods which can improve local dietary outcomes, preventing high consumption of western diet foods that may be high in fat and salts (Jonasson et al., 2019). However, food sovereignty scholars also critiqued the concept of food security in that it does not adequately address the complex socio-economic, structural, and political issues that can impact issues like hunger and nutrition. For example, food security does not necessarily reflect how individuals or communities are impacted by a lack of control of the food system, legacies of 65 colonization, or structural violence and racism. Scholars argue that food security exists in a capitalist and neoliberal sphere, where solutions come from top-down forms of aid to address hunger and not the underlying greater issues at play (Jarosz, 2014). The usefulness of food security as an indicator for physical well-being in an agroecological and food sovereignty context may be specific to the needs of each organization or group. A desire to use this indicator may depend greatly on what groups seek to assess. For example, if there is a need to only understand experiences with hunger and poverty, with a focus on nutrition or physical health (FAO, 2008), then food security may be a strong indicator. However, there is also no global standard for how to assess food security, especially since the economic, political, and cultural contexts may differ greatly depending on location (Pérez-Escamilla & Segall-Corrêa, 2008). For example, Pérez-Escamilla and Segall-Corrêa (2008) recommended “the Latin American and Caribbean Region to work towards the adoption of a single regional module that can be adapted to the local contexts” (p.1). The lack of standardization could give groups the flexibility to assess food security in a way that they feel better reflects their own experience. This could present issues when seeking to compare food security experiences across different regions or areas. The concept of food security as an indicator of physical well-being is a topic that requires more research and investigation to address these conflicting benefits and issues. 4.2.2 Nutritional status An alternate approach to using food security as an indicator of hunger and physical well-being could be to focus on nutritional status indicators. In children, indicators for nutritional status (or malnutrition) are assessments of stunting (height for age), wasting (weight for height), 66 underweight (weight for age), and overweight (weight for height) (WHO, 2010). Using the WHO system, children are assessed in each category for how many standard deviations under or above the median they are (WHO, 2010). The WHO also suggests measuring the prevalence of each status in children to determine the public health significance of these nutritional indicators for the total population or community (WHO, 2010). To assess the nutritional status of women the WHO suggests using BMI calculations to determine if an individual is over or underweight (WHO, 2010). Finally, assessing levels of vitamin and mineral deficiencies in the population can also be used as indicators of nutritional status, for example, assessments of anemia, vitamin A deficiency, or iodine deficiency are common (WHO, 2010). It is important to note that measuring a child's nutritional status can be done using simple instruments to note the weight, height, and age of a child, whereas vitamin deficiency tests may require more invasive blood sampling. If this data has already been gathered using regional censuses or Ministry of Health data, it may be possible for communities or organizations to use existing health data and assessments to assess the nutritional status of women and children in their region or state/province. It may not be feasible for smaller organizations or communities to get consent or have the means to run laboratory analysis of blood samples. 4.2.3 Disease prevalence A final indicator of physical well-being identified during the literature review was the prevalence of disease. It has been well documented that communities struggling with food insecurity and the legacies of colonization are more likely to have a higher burden of disease. In Canada and the US food insecure individuals were more likely to suffer from diseases and chronic illnesses like 67 diabetes, hypertension, heart disease, asthma, etc. (WHO, 2010). However, food sovereignty and agroecological practices may alleviate food insecurity and in turn improve health outcomes and disease prevalence in certain communities. As previously discussed, agroecological farming practices require fewer agrochemicals and lower agrochemical use has been linked to decreased rates of diseases and illnesses from chemical exposure (Kangmennaang et al., 2017). As well, the production of traditional or Indigenous staple crops have been linked to improved health outcomes in Indigenous communities (Jonasson et al., 2019; Robin, 2019). Food sovereignty also promotes gender equality, and improving gender equality has been shown to improve health outcomes for women (A. D. Jones et al., 2015; Kuhnlein, 2017). Assessing the prevalence of specific diseases, not to be confused with measuring nutritional status specifically, might help communities or organizations understand the impact of their agroecological practices on the long-term physical well-being of their local populations. This may require survey questionnaires and quantitative data collection, as well as epidemiological analysis of this data to determine the prevalence, morbidity rates, or other values of importance. Alternatively, groups could study regional data over time or use qualitative research to understand perceived changes in physical health as opposed to measuring the incidence or prevalence of a specific disease. It is important to acknowledge that definitions and interpretations of physical well-being may vary across cultures (Sutherland & Adams, 2019; Valadeau et al., 2010), so indicators of 68 physical well-being and disease should be inclusive of local belief systems and interpretations of this concept. Consultation with local communities must be part of designing disease prevalence indicators, to ensure that lived experiences and perceived health status are not excluded from possibly being assessed. 4.3 Social-political-economic well-being indicators From the literature review, indicators were identified that aligned with social-political-economic well-being meta-narrative. These indicators looked at concepts from crop pricing to social support for farmers. However, the two strongest indicators that seemed to encompass and best represent this meta-narrative were the ideas of agency over land access and ownership. These concepts, as indicators, present opportunities to understand the political, social, and economic experiences of small-scale farmers. They also allow for an understanding of the relationship between Indigenous people, their land, and how this impacts well-being (Coté, 2016; Kamal et al., 2015; Robin, 2019), as well as an opportunity to assess the impact of land ownership on gender equity and well-being (Bezner Kerr, Dakishoni, et al., 2019; Nyantakyi-Frimpong et al., 2017). For a full list of the indicators see Table 9 below. 69 Table 9: Social-political-economic well-being indicators Social-political-economic well-being indicators n=10 Indicator Definition Example assessment Social indicators Support for farmers The existence of programs and organizations that support farmers and their activities. This may include NGO programs, trainings, credit programs, cash-transfer programs, food insecurity programs, etc. Surveys or interviews can be used to ask farmers about their membership to group organizations or cooperatives, and their use or knowledge of government support programs or other types of support (Agarwal & Agrawal, 2017). Community resilience The ability of a community to cope, recover, and adapt to various challenges and situations (U.S. Department of Health and Human Services, 2015). There is an existing tool to assess community resilience, the Conjoint Community Resilience Assessment Measurement Tool (CCRAM). It involves the use of a self-reported survey and checklist to assess social ties, access to infrastructure, demographic details, and other components of community resilience (Cohen et al., 2013). Farmer working conditions The existence of fair and healthy working conditions for farmworkers. There are multiple temporal periods in which to assess farmer working conditions such as weekly or at the end of the season. Farm managers or leaders can conduct surveys on farm work conditions and experiences with all laborers and farmers to understand their experiences (Gaddis et al., 2020). Gender equity The ability of individuals to have the same equal rights, opportunities, and not face discrimination based on gender identity (UN, n.d.-a). Gender empowerment and equity indicators must be reflective of local contexts and experiences (Adjei, 2015). Measurements of gender equity can include rates of violence against women, protection of women’s rights, and a woman’s decision making ability (Adjei, 2015). Economic indicators Crop prices The stability and fairness of crop prices and the ability of farmers to deal with market fluctuations in crop prices. There are different levels of crop price assessment: international, domestic, and regional pricing. The FAO developed an international food price index which assesses monthly changes in international food pricing (FAO, 2021a). Market Access Access to markets and areas to sell crops and produce. Surveys can be used to assess market access. The surveys should contain questions on distance to roads and infrastructure, distance to markets, means of transportation, types of trade conducted, and access to institutional services that support market access and agriculture (Chamberlin & Jayne, 2013). Income The income status/level of a farmer and/or their household. Household income data can be collected using household surveys with each income earning individual (OECD, 2013). Political indicators Land ownership The ability of an individual to buy and own land. An assessment for land ownership is the proportion of the population of interest with tenured land rights, secure land rights, and/or who have documentation of land ownership (FAO et al., 2019). 70 Social-political-economic well-being indicators n=10 Indicator Definition Example assessment Political indicator Land use agency The ability of an individual to make decisions and control what occurs on their land or traditional territories. Mixed-methods can be used to assess agency over land-use decision making and control. A combination of qualitative interviews with individuals and surveys can be used to assess land-based activities, infrastructure and other variables of interest (Bouchard et al., 2020). Decision-making control (political sovereignty) with the food system The ability of communities or individuals to govern and control their food systems and land (Damman et al., 2008). Open-ended interviews with farmers can be conducted to understand agricultural decision-making practices and experiences (Finnis et al., 2013). 4.3.1 Agency over land-use and land ownership An important part of agroecological practices and food sovereignty is “responsible and effective governance to support the transition to just, equitable, and sustainable food and farming systems” (Siegner et al., 2020, p. 586). The ability of an individual to use their land and traditional territories or to own land is an essential part of democratic and equitable food systems. The literature on this topic demonstrated improved well-being with the agency over land use and poor well-being when denied access to land ownership and usage (Huambachano, 2018). From an economic perspective, the amount of land small-scale farmers own can limit their income and what they can grow and produce both to sell and for self-consumption (Isakson, 2009). There have also been economic consequences to the entire food system due to large-scale land acquisitions by the government or companies for resource extraction projects (Jacobi, 2016). This type of land acquisition takes land away from small-scale farmers which not only impacts their income but food security for those who rely on self-produced crops to feed their families (Jacobi, 2016). Colonial and neo-colonial forces have also stolen land from Indigenous peoples and put legal limitations on their ability to fish, hunt, forage, and grow on the remaining land Table 10: Social-political-economic well-being indicators 71 they have access to (Kamal et al., 2015). It has been well documented that removing Indigenous people from their land has dire consequences on their well-being, culture, and identity (Kamal et al., 2015; Robin, 2019). Finally, peasant farmers who cannot own land of their own often enter into tenure or sharecropping agreements with larger landowners. These relationships can indenture landless farmers into debt-filled relationships greatly impacting their income and socio-economic status (Naranjo, 2012). Research demonstrates that individual land ownership can indicate improved economic well-being, providing better opportunities to grow crops for sale and self-sufficiency (Isakson, 2009). Having the ability to use traditional territories and make land use decisions is also important for the social well-being of Indigenous communities, as well as it allows for political sovereignty over how land is used (Coté, 2016; Kamal et al., 2015). Finally, land ownership can also impact gender equity. Providing women with the right to own land, as opposed to land-use decisions being made by a husband or other male family figures, can improve gender equity and gender empowerment (Bezner Kerr, Dakishoni, et al., 2019). Kuhnlein et al. (2013) discussed the right to land as an indicator of food sovereignty in their work on Indigenous people’s food sovereignty and food security. It has also been the subject of investigation in many studies in similar fields of agroecology, sociology, and peasant studies (Copeland, 2019; Isakson, 2009; Jacobi, 2016; Kamal et al., 2015). It is possible to assess through qualitative or quantitative interviews, questionaries, or surveys. For this indicator, there must be a differentiation between Indigenous individuals still living on the traditional territory or unceded land, Indigenous people forcibly removed from their land, non-Indigenous peasants 72 seeking land ownership, and non-Indigenous peasants forcibly removed or disposed of their land. Historical, legal, and political structures that prevent marginalized people from using their land or owning land should also be considered. This indicator also offers an opportunity to explore the issue of land rights and ownership from a gender-based lens (Bezner Kerr, Dakishoni, et al., 2019), and this should be considered in the design of assessment tools. In conclusion, the right to land and land ownership is an indicator of social-political-economic well-being that provides an opportunity to understand and explore many complex issues from historical and political oppression, gender equity and the economic status of small-scale farmers. 4.4 Indicators of cultural-spiritual well-being Many of the articles in the literature review discussed the importance of agroecology and food sovereignty for Indigenous peoples for whom attachment to land remains important. Agroecology can help promote the production of traditional crops and protect traditional farming practices and knowledge, while food sovereignty practices may better support the decolonization of food systems (Coté, 2016; Robin, 2019). It is important to note, discussions around cultural indicators related to Indigenous peoples' agroecological systems was discussed during the 1st Indigenous Peoples’ Global Consultation on the Right to Food in Sololá, Guatemala, on the 17-19 April 2002 (Woodley et al., 2007). The indicators identified in this section align with the priorities for indicators as identified by Indigenous people themselves in the report written by Woodley et al. (2007) following the 2002 Sololá consultation. In particular, the indicators identified in this project align with cultural indicators 1 and 3 of the report: “1. Access to, security for and integrity of lands, territories, natural resources, sacred sites, and ceremonial 73 areas used for traditional food production, harvesting and/or gathering and related cultural and ceremonial purposes” and “3. Use and transmission of methods, knowledge, language, ceremonies, dances, prayers, oral histories, stories, and songs related to traditional foods and subsistence practices, and the continued use of traditional foods in daily diet as well as in relevant cultural/ceremonial practices” (Woodley et al., 2007, p. ix). In this section, two indicators which best represented and encompassed this meta-narrative will be discussed in further detail: traditional crop production and the well-being of Mother Nature/the natural world. 74 Table 11: Cultural-spiritual well-being indicators Cultural-spiritual well-being indicators n=8 Indicators Definitions Example assessment Cultural well-being Ability to hunt, fish, and forage on land (and traditional territories) The ability of individuals and communities to practice traditional food production and gathering methods like hunting, fishing, foraging, and harvesting on their traditional land or the land they currently inhabit. Quantitative surveys, qualitative interviews, or Indigenous research methodologies can be used to understand the frequency by which households or individuals hunt or participate in other activities, as well as, to understand barriers to these practices (Addis et al., 2013; Noreen et al., 2018; Socha et al., 2012). Access to traditional foods The ability of individuals or household to consume, grow, or use traditional foods and crops. Quantitative surveys, qualitative interviews, or Indigenous research methodologies can be used to understand access to traditional foods, and frequency of consumption (Addis et al., 2013; Socha et al., 2012). Traditional agricultural practices in use The assessment of traditional agricultural practices used by an individual or a community. This includes practices like trade and exchange events (ex: trueque) and traditional agricultural methods like a milpa. Semi-structured interviews, or other qualitative or Indigenous research methodologies can be used to document the types of traditional agricultural practices and traditional knowledge used by farmers. Access to culturally appropriate healthcare The ability to access healthcare that is culturally appropriate, extending beyond Western medical practices. Semi-structured interviews, or other qualitative or Indigenous research methodologies can be used to understand the barriers to receiving culturally appropriate healthcare. Traditional language preservation The conservation and preservation of Indigenous languages and language speakers. Semi-structured interviews, surveys, or other qualitative or Indigenous research methodologies can be used to record the number of individuals who can speak their Indigenous language, as well as level of fluency and types of language preservation practices. 75 Cultural-spiritual well-being Indicators n=8 Indicators Definitions Example assessment Spiritual well-being An * indicator that aligns with multiple meta-narrative themes. *Well-being/health of the natural world or Mother Nature *This indicator is also associated with environmental well-being indicators. The perceived well-being of Mother Nature or the natural environment (also known as Mother Earth and by many other names across cultures and languages). This is a diverse concept with many forms of assessment. Some assessments include the rates of resource extraction and deforestation or the level of contamination and pollution of the soil and water. These can be assessed in similar ways to the forest health and soil and water health indicators in Table 7 (environmental well-being indicators). Mystical, ceremonial, medicinal, or religious plant use and access The ability of an individual to harvest and use culturally important mystical, religious, or medicinal plants. Plant usage information can be collected through ethnopharmacological studies, field walks, or semi-structured interviews on plants and their properties and uses (Odonne et al., 2013). Practice of ceremonies The ability of an individual or community to practice spiritually and culturally important ceremonies and events. Ceremonial practices and access to ceremonial spaces can be assessed through surveys, or Indigenous research methodologies, and qualitative methods like interviews. Possible questions to participants might include information on the types of ceremonies they participate in, the frequency, and their ability to access ceremonial spaces (Woodley et al., 2007). 4.4.1 Traditional crop cultivation In the literature on Indigenous peoples and food sovereignty, there was a clear theme regarding the link between Indigenous or traditional crops and cultural identity (Huambachano, 2019; Kamal et al., 2015; Levkoe et al., 2019; Mabhaudhi et al., 2019; Robin, 2019). Traditional crops and crop production practices represent spiritually and culturally meaningful forms of food production (Isakson, 2009). Crops, like Andean tubers for example, are important parts of the culture and identity of Andean people, and the traditional milpa growing system promotes community identity and social bonds for Mayan people (Isakson, 2009; Parraguez-Vergara et al., 2018). The consumption of traditional crops and the preparation of traditional foods are 76 important for cultural values and have been linked to improved mental health and a sense of Indigenous identity (Jonasson et al., 2019; Robin, 2019). Kamal et al. (2015) and Robin (2019) also noted that Indigenous gardening and food production helps disseminate Indigenous teachings and knowledge to future generations. From the literature, it is clear there are many important values and contributions that Indigenous or traditional crops play in the cultural and spiritual well-being of Indigenous peoples (Huambachano, 2019; Ray et al., 2019; Robin, 2019). Thus, traditional crop production could be an important indicator of how food sovereignty and agroecological practices impact well-being, specifically cultural and spiritual well-being. Several academic studies have already tried to document traditional food consumption using questionnaires and survey data (Batal et al., 2005; Noreen et al., 2018; Quave & Pieroni, 2014). Woodley et al. (2007) also proposed to use indicators such as the continued use of traditional crops at home and in ceremony, continued practice of traditions related to traditional crops and foods, and preservation of language related to food and food uses. Indigenous peoples may already be doing this work in their communities and have existing systems and indicators not discussed or recognized yet in academic literature. It is important Indigenous people are consulted and included in the design of this indicator. It is also important to note that this indicator should not be confused with crop diversity in general. In choosing to assess traditional crop production there could be options to also assess traditional food production, practice of ceremonies related to food, and the consumption of traditional vs. Western foods. These assessments are very different and explain different 77 relationships than crop diversity and its importance for the natural environment. In developing future indicators for this topic, it will be important to make this distinction clear. 4.4.2 The well-being of mother nature/deities One aspect of spiritual and cultural well-being discussed in the reviewed literature was the concept of spiritual connections to the land and natural environment. This connection exists in many diverse ways for Indigenous groups. I could not explore the complexities and individualities of these spiritual beliefs as part of this project. However, work by Indigenous scholars in Peru, New Zealand, Canada, and the USA highlighted an important spiritual connection between Indigenous people and the land (Batal et al., 2005; Coté, 2016; Huambachano, 2018, 2019; Robin, 2019). Huambachano (2018) explained that for the Quechua people of Peru the concept of Allin Kawsay, which is extremely similar to the Kichwa phrase Sumak Kawsay in Ecuador or Buen Vivir, is their ancestral principle and ideology for sustainable living where there is a state of equilibrium between Pachamama (Mother Earth) and all human and living beings (Huambachano, 2018). The Māori people in New Zealand have a similar concept of Mauri Ora which describes the life-supporting capacity of air, water and soil (Huambachano, 2018). For Māori, “shifts in Mauri (life force, life spirit) of any part of the environment, for example through use, would cause changes in the Mauri of immediately related components. As a result, the whole system is eventually affected” (Huambachano, 2018, p. 1012). During interviews with Quechua participants, Huambachano (2018) noted that one individual explained this cultural-nature connection as: How we work and nurture our land influences greatly on our food, and food security. I love my seeds and I cry when my potatoes do not grow, and I know it is because my 78 mother –Pachamama is unwell. Therefore, our Andean thinking is different from other people such as mestizos (Huambachano, 2018, p. 1015). Huambachano and other Indigenous scholars documented how the well-being of the environment and spiritual deities, such as Pachamama or Mother Earth, is extremely important to Indigenous conceptualizations of well-being. Physical changes to the environment will also impact Pachamama and Mauri Ora in different ways (Huambachano, 2019). In anecdotal conversations with both Indigenous and mestizo agroecological farming partners in Ecuador, understanding the impact of their farming practices on spiritual well-being and these spiritual-nature connections were important concepts they sought to assess. However, there was little academic work that showcased indicators that might assess the spiritual well-being or a spiritual-nature connection. The First Nation’s Community Health Indicators Toolkit, used in a report by Kathleen Heggie (2018) on Indigenous wellness indicators, contains a spiritual activities indicator which measures the number of spiritual activities, participation level, and number of visits to a spiritual practitioner (Heggie, 2018; Jeffery et al., 2006). However, there were no other indicators for spiritual well-being or any which explored a spiritual-nature connection. Woodley et al.’s (2007) report titled “Cultural Indicators of Indigenous Peoples' Food and Agro-Ecological Systems” contained indicators on ceremonial practices and the existence of sacred sites but had no spiritually specific indicators or indicators that used language related to spirituality and spiritual well-being. The lack of academic articles on spiritual indicators of well-being may be due to the existing disconnect between Western knowledge and traditional knowledge (Huambachano, 2018) and a 79 lack of appreciation and acknowledgement of the need for traditional knowledge indicators in scholarly work. However, Indigenous people themselves likely have ideas and existing knowledge on how to assess the impact of food sovereignty and agroecological practices on the spiritual well-being of nature. This is an area of work that should be explored by raising the voices of Indigenous scholars and knowledge keepers. There is a gap in academic documentation of the impacts of food sovereignty and agroecology on spiritual well-being, but these are important concepts to appreciate and understand. 4.5 Feasibility of the indicators From the total n=37 indicators identified through this project, 11 were selected as the most feasible. Feasibility in this context means that the data may already be available or require minimal time or financial investment to access it. The indicators listed below in Table 11 can be assessed using data that is typically publicly available through national censuses or international databases such as those of the World Bank or other major NGOs or intergovernmental organizations (IGOs). However, in countries where census data and other data is not publicly available these indicators may no longer be feasible. 80 Table 12: Most feasible indicators Indicator Reason for feasibility Environmental well-being Water and soil quality Some governments or agencies may offer publicly accessible data on local and regional water quality testing of different water bodies. Similarly, some governments or regional/national environmental agencies may have databases on historic soil quality. Water and soil data may be available through other studies done by researchers, institutions, or NGOs. Forest and land conservation Data on designated conservation areas may be available through government environmental agencies, institutions, or NGOs. Physical well-being Nutritional status This data (by age, gender, or other demographic) may be available through national censuses, research/databases by NGOs like the WHO, or through a local Ministry of Health or similar government department. Access to health services It may be possible to assess aspects of this indicator by looking at the geographical location of available health services (and level of health services) and distance to communities, as well as the ratio of doctors/health practitioners per 1000 people. At a national or regional level some of these statistics may be available through national censuses, research/databases by NGOs like the WHO, or through a local Ministry of Health or similar government department. Prevalence of illness, disease, and mental health illnesses This data may be available through national censuses, research by institutions like the Institute for Health Metrics and Evaluation, or databases from NGOs like the WHO, or through a Ministry of Health or similar government department. Socio-political-economic Gender equity Gender-related statistics, such as maternal health conditions, rates of gender-based employment and annual income, number of women who own land, or other statistics needed to understand gender equity may be available (at a national level) through censuses, databases from NGOs or IGOs like the UN, or through research studies and data collected by other institutions. Crop prices Historic crop prices may be available through the appropriate government agency, NGOs, or a research institution. Income This data may be available through national censuses, research/databases by NGOs or IGOs like the World Bank, or through a governmental department. Land ownership If publicly available, it may be possible to get access to national or regional data on registered landowners and property-tax payers where applicable. Cultural-spiritual well-being Traditional language preservation Databases on the number of Indigenous languages spoken in a region or nation may be available through government agencies, institutions, or NGOs. Census data or databases may have information on number of documented speakers of each language. Communities may keep record of language speakers as well. Ability to access land/traditional territories If traditional territory is legally designated by a nation’s government, a list of designated land may be publicly available. Indigenous nations may have their own maps and lists/databases on accessible traditional land. 81 The remaining 29 indicators may require further research and testing in the field to determine the best ways to collect the data as many of the indicators identified in this project are quantitative in nature. They require extensive time spent surveying farmers on topics such as the number of crops grown, experiences with farming, or physical health issues, etc. Carrying out surveys, depending on sample population size, can be a time intensive task that may require help through paid or voluntary means. The indicators discussed were not designed for a particular type of user. The resources accessible, such as financial and human capital, and time available may vary greatly between academic researchers, local vs. international NGOs, farmer cooperative groups, and other groups seeking to use these indicators for their own research agendas. As well, traditional research-like assessments may not be welcome or well received in certain communities with a history of colonial, harmful, and non-consensual research experiences. Thus, it is important to recognize that these indicators are not all inclusive, they exist to further conversations about what a practical framework to assess the impacts of food sovereignty on well-being could look like. When implementing this framework in the field, the indicators may need to be adapted, or new indicators created, to represent local contexts, cultures, and experiences. 82 Chapter 5: Conclusion This thesis project sought to answer the question: how can food sovereignty frameworks incorporate assessments of health and well-being? Using a meta-narrative literature review methodology, this project created a novel framework which demonstrates the relationship between four themes of well-being and food sovereignty practices; thereby providing evidence that this research question is possible to answer. The results of the meta-narrative literature analysis found considerable literature with each of the four key themes of well-being associated with food sovereignty practices: environmental well-being, physical well-being, cultural-spiritual well-being, and social-political-economic well-being. This grouping bears certain similarity to existing health frameworks such as the 4 S’s Modos de Vivir Saludable (Breilh, 2011; Spiegel et al., 2015). The 4 S’s are sovereignty, solidarity, bio-security, and sustainability and parallel the physical, environmental, and social-political-economic well-being themes identified in this thesis (Spiegel et al., 2015). As well, the cultural-spiritual and environment well-being themes identified in this project reflects the work by Indigenous scholars to develop Indigenous health indicators, theory, and frameworks (Heeringa et al., 2019; Ray et al., 2019). This work also reflects the results of Elizabeth Hoover’s work documenting how Indigenous individuals define food sovereignty (2017). Participants discussed themes such as health, culturally appropriate foods, independence, seed use, and control (Hoover, 2017), many of which mirror concepts in the meta-narratives identified in this project. There are also important correlations between the well-being themes identified in this project and Indigenous concepts and their political representation, such as Buen Vivir. These 83 similarities between theories and frameworks further emphasize the importance of the relationships between the environment, culture and health for many communities and cultures around the world. The framework and set of indicators developed for this project are novel in that they specifically explore how food sovereignty practices impact well-being from a multi-dimensional and holistic health perspective. Discussing well-being instead of the bio-medically focused term health is less common in English-language public health literature despite the critiques form Global South and Indigenous scholars on the failure of public health theory and interventions to adequately address the complex social and systematic issues found in global food systems (Breilh, 2015; Cidro et al., 2015; Támez González, 2014). This thesis project addressed the gap in literature on the relationship between the concept of food sovereignty and health, while recognizing the failures of previous public health and bio-medical and approaches to similar research in this field. The increased emphasis on social determinants of health has shed light on the need to understand the processes and interactions that impact the physical health of individuals and their communities. The well-being narratives identified in this study present ways to understand how interactions with food production, nutrition, and the natural environment can influence health outcomes at an individual and population level. The meta-narratives also offer avenues to observe and analyze the positive and negative impacts of food sovereignty and food-system related activities on health, while offering ways to address these issues in a more holistic and multi-dimensional manner. Finally, this framework provides a 84 way for farmers and other stakeholders to assess the value of their farming activities on the well-being of their own families, communities, and the natural environment. 5.1 Study limitations This study used a set of key Boolean operator terms to find literature to review (see Chapter 2 Table 1 for the full list of terms). It is possible there were not enough terms, or the terms chosen were not effective enough for finding all possible relevant literature. As well, literature had to be published in English, Spanish, or Portuguese to be included, and no grey-literature specific search engine was used (such as Google, etc.). Thus, other articles and sources of value may not have been found or included in this literature review. Time was also a constraint for the number of sources reviewed a longer-term project may have been able to review more sources. 5.2 Direction for future research This framework and its corresponding set of indicators lay the groundwork for future experimental studies in the fields of public health and agriculture. Future studies can put these indicators into practice, assessing how they function in the field, as well as their appropriateness for diverse contexts where food sovereignty activities occur. It will be important to discuss these indicators with different stakeholders, such as farmers, to understand if they feel the indicators are representative of the concepts they seek to assess, as well as their experiences and needs as food producers or actors in the food system. This project had no specific locational or contextual focus, thus the indicators identified may not be reflective of all cultures, or of all food production or food sovereignty practices. As well, this project only looked at literature in English, Spanish, and Portuguese, it is likely there is much more valuable literature both academic and grey, 85 published in other languages which could expand upon the well-being themes and indicators identified in this thesis. Future research that reviews other literature that was outside of the scope of this project could greatly advance the findings contained in this thesis. 86 Bibliography Abbink, J. (2017). 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Thesis/Dissertation
eng
Population and Public Health
Vancouver : University of British Columbia Library
Attribution-NonCommercial-NoDerivatives 4.0 International
Graduate
Wittman, Hannah
Yassi, Annalee
Improving well-being through food sovereignty : a meta-narrative literature review
Text