Nutrition in the Workplace is a Winning Solution During and Post-COVID-19

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The Food and Agriculture Organization of the United Nations (FAO) highlights the importance of good nutrition before, during and after an infection. While no foods or dietary supplements can prevent a COVID-19 infection, maintaining a nutritious diet is important to supporting a healthy immune system to fight infections. In addition, the World Health Organization (WHO) states that a well-balanced diet is critical to receive the essential vitamins, minerals, fiber, protein and anti-oxidants the body needs to be in good health and build a strong immune system to lower the risk of chronic illnesses and infectious diseases. Therefore, a nutritious diet is important for all age groups throughout the COVID-19 pandemic.

Diet and nutrition of the workforce during and post-COVID-19

The COVID‑19 crisis has had a dramatic impact on the world’s workforce; partial or total workplace closures have restricted business operations and have affected an estimated 80% of the global workforce. The worst-hit workers are those working in small and medium-sized enterprises, and low-wage workers in informal employment, with limited access to safety nets. For others, adjustments in the work process and arrangements to work from home have enabled them to retain their jobs during COVID‑19.

Currently, employers are facilitating a gradual return to the workplace. Workplace canteens are opening to workers if social distancing rules can be maintained or providing packaged meals to avoid fully opening staff canteens. Most workers eat at least one main meal during their working day. Workers who encounter time challenges to prepare home-cooked meals to rely on catered meals facilitated by their employer. Others bring their lunch or go to food outlets, markets, or takeaways. For many of them, it remains a daily task to obtain a diet containing all the recommended nutrients. In some labor-intensive sectors, nutrient requirements are so high that they are difficult to be obtained through the diet alone. Also pregnant or nursing women have elevated nutrient requirements that will need careful meal planning.

A survey among employees highlighted the main challenges workers face to eat healthily:
1) easiest food choices aren’t always the healthiest
2) “I don’t always have time to buy and prepare healthy food”
3) “it’s too expensive”
4) “the people I’m around don’t eat healthily.”

Cantina, workplace nutrition
Source: Pixabay

Nutrition and health at work

Nutrients, including vitamins and minerals, are critical in many functions of physical and mental health. The role of nutrition in immunity is not only to support preventing but also resolving infections that have been well established. Among other reported benefits of nutrition are increased energy and reduced fatigue, as well as enhanced alertness, cognitive and mental performance. Nutrition also plays a role in many other functions such as bone density and muscle strength and slowing progression of non-communicable diseases.

A pre-COVID-19 survey in the UK revealed that infections, musculoskeletal problems, mental health conditions, and diabetes were among the main health reasons for sick absence. However, nutrition as a direct modifiable factor for many of these health conditions is often overlooked by employers. Higher absence rates among workers can be expected post-COVID-19 due to “suspected infections” but also as a result of increased mental problems; approximately half of the young people reported anxiety or depression since the start of the pandemic. Therefore, during and post-COVID-19 pandemic, healthy eating, and nutrition programs in the workplace are important in fostering employee immunity, physical and mental health. Centrally distributed workplace nutrition provides the opportunity to reach many workers and contribute to employees’ essential nutrient requirements.

Evidence for nutrition programs at work

Workplace nutrition programs can include “education” or “coaching” programs to encourage workers to consume more nutritious foods. Access to nutrition consultation and personalized nutrition advice has a significant potential health improvement rate. Nutrition programs can also include (subsidized) nutritious food offers at work, such as healthy lunch choices or fruits, fortified lunches, or micronutrient supplements. The evidence for the health benefits of nutrition in the workplace is growing. Micronutrients provided to workers through fortified foods or supplements significantly improved workers’ nutrition status in various workplace settings. Anemia, common colds, urinary tract infections, and work absence were reduced in Bangladeshi women garment factory workers receiving multi-micronutrient-fortified rice along with iron and folic acid supplement and nutrition counseling for 10 months. Infection-related work absence was reduced by almost two-thirds in healthcare workers consuming multi-micronutrient supplements for one year. Other reported benefits of providing micronutrients in the workplace are manifold; reduced heart rate, improved body mass index scores, bone density, perceptual and cognitive functioning, improved mood, and reduced depression.

What are the benefits for the worker and employer?

Employers bear many of the costs related to absenteeism and presenteeism. On average, employees cost businesses the equivalent of three months per year in lost productivityUnhealthy eating (too much salt, sugar, saturated fat), as well as inadequate essential nutrient intake, raises the risk of low productivity. By optimizing workplace nutrition, workers receive the nutrition needed to stay alert and focused while employers benefit from reduced absenteeism and less presenteeism or unproductive use of time. Better nutrition also equates to improved resilience to infections and stress – other potential pathways to better work performance.

Workplace Nutrition Graphic

Employers’ social responsibility for the nutrition of own employees

Employers have an essential role to play during the COVID-19 crisis to provide good nutrition, especially for the most vulnerable in society. It is important that work environments facilitate good nutrition to support the physical and mental health of their workers. Investing in workplace nutrition is a high return on investment for the employer and can increase workers’ health, work attendance, morale, efficiency, and productivity. A recent report by GAIN-SUN-Eat Well demonstrated that “workforce nutrition” is a win-win for employers looking to improve both employee health and business outcomes. Moreover, it can contribute to the nutrition targets of the United Nations Sustainable Development Goals (SDGs), specifically SDG 2 (zero hunger), SDG 3 (good health and wellbeing), and SDG 8 (decent work and economic growth).

IMPact4Nutrition, Workplace nutrition, India
Nutrition awareness session for female garment workers at Arvind Ltd, an IMPAct4Nutrition private sector partner.

There is a growing awareness among the public and private sectors that workplace nutrition can benefit both employees and businesses. IMPAct4Nutrition (read more in our Action in Brief on IMPact4Nutrition) is an example of a public-private engagement that aims to bring together the diverse private sector interested in contributing to the Indian Government’s social movement named POSHAN Abhiyaan or National Nutrition Mission. Diverse partners are engaged including UNICEF, Sight and Life, CSRBox, Tata Trusts, and the Confederation of Indian Industries. The priority by IMPAct4Nutrition is promoting nutrition in the workplace by targeting key nutrition behaviors in the workplace in three areas; assets and core business for nutrition, cash/corporate social responsibility for nutrition, and employee engagement for nutrition. During COVID-19, IMPAct4Nutrition has developed digital training modules to support companies in promoting good nutrition across their business ecosystem with practical, easy to follow tips on how employees can maintain an appropriate nutritional status. Through these modules, the platform is reaching 10 million employees, their families, and communities in 51 companies across India.

In June 2020, IMPact4Nutrition was honored with a UNICEF global INSPIRE Award in the category ‘Best Multistakeholder Engagement’. Nearly 100 campaigns from 50 countries were nominated and voted on by UNICEF staff worldwide. 

The reward is high

A successful workplace nutrition program can be part of a broader organization’s framework tailored toward health and wellness. A successful program requires buy-in from leadership as well as a dedicated coordinator and resources for implementation. Quantitative data such as surveys, nutrition, and health data will help to evaluate if the program was a success. Besides the employer, trade unions, foodservice operators, and incentives by insurance companies can further contribute to a positive nutrition environment at work.

Nutrition programs in the workplace offer a direct opportunity to workers and employers; they have the potential to improve workers’ physical and mental health, and loyalty and thereby improve work attendance, productivity, and employer reputation. The potential return on investment of investing in workplace nutrition is high. Therefore, proper nutrition in the workplace is a win-win proposition for employers and employees. Investing in workers’ nutrition should be a goal if organizations are to thrive.

Reference Links:
http://www.fao.org/3/ca8380en/ca8380en.pdf
http://www.emro.who.int/images/stories/nutrition/documents/en_flyer_nutrition_adults_covid_19.pdf?ua=1
https://www.who.int/docs/default-source/searo/india/covid-19/food-donation-guidelines-22nd-may
https://www.ilo.org/wcmsp5/groups/public/—dgreports/—dcomm/documents/briefingnote/wcms_740877.pdf
https://www.ilo.org/wcmsp5/groups/public/—dgreports/—dcomm/documents/briefingnote/wcms_740877.pdf
https://news.un.org/en/story/2020/04/1061322
https://ilostat.ilo.org/topics/covid-19/
https://www.ilo.org/safework/areasofwork/WCMS_118393/lang–en/index.htm
https://www.ilo.org/wcmsp5/groups/public/—dgreports/—dcomm/—publ/documents/publication/wcms_publ_9221170152_en.pdf
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https://meetzipongo.com/blog/top-4-challenges/
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https://www.ons.gov.uk/employmentandlabourmarket/peopleinwork/labourproductivity/articles/sicknessabsenceinthelabourmarket/2016
https://ilostat.ilo.org/topics/covid-19/
https://warwick.ac.uk/fac/sci/med/research/platform/wemwbs/
https://www.nutraingredients-usa.com/Article/2020/02/17/Public-health-expert-ringing-the-alarm-on-workplace-nutrition#
https://gccmarketing.blob.core.windows.net/marketing-site/marketo/resources/presenteeism/us-presenteeism-whitepaper.pdf
https://www.liebertpub.com/doi/10.1089/pop.2012.0003
https://www.who.int/news-room/fact-sheets/detail/malnutrition
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https://nutritionconnect.org/nutrition-at-work
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https://www.ilo.org/safework/areasofwork/WCMS_118393/lang–en/index.htm

Culture is a Road to Improved Nutrition

Discovering the Mayan ways

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Edward (Ted) Fischer is Professor of Anthropology and Director of the Center for Latin American Studies and the Institute for Coffee Studies at Vanderbilt University. Prof Fischer is also the founder of Maní+, a social enterprise in Guatemala that develops and produces locally-sourced complementary foods to fight malnutrition, and serves as an advisor to the World Health Organization on Wellbeing and the Cultural Contexts of Health.

Prof Fischer posits that food is about much more than macro- and micronutrients, arguing that it is instead intimately linked to identity and social relations in his article, ‘Beyond Nutrition: Eating, Innovation, and Cultures of Possibility’ published in the Sight and Life magazine. In his opinion, food is an integral part of our identity, and any attempts to change diets need to take this into account. The composition also explains why culture should not be seen as an obstacle to health, but as a source of potential. In addition, he says that public health and nutritional interventions should work with, rather than against, this dynamism, and beneficiaries should be treated as clients, customers, and collaborators, and as sources of inspiration and innovation, as well as mouths to feed.

Here at Sight and Life we had an opportunity to talk with Prof Fischer and discuss his continual fascination with the Maya way of life. During our interview, he shared how it led to a realization that, far from being a hindrance, culture is an aid to improving nutrition.

Sight and Life (SAL): What inspired your passion for the topic of eating, innovation, and the cultures of possibility?

Prof Edward Fischer (EF): As a cultural anthropologist, I have spent the better part of my life and career (the last 25 years) working with the Maya people of highland Guatemala. I have cumulatively lived and worked there for several years, I visit several times a year, and I have deep personal as well as professional ties. Maya culture and traditions are endlessly fascinating to me, and I have spent countless hours in the fields of maize, beans, and squash and around the hearth watching women make tortillas and slow-cook black beans. Maya families tend to have a close sense of kinship and community; while most Maya are very poor in material and economic terms, they have a richness of social ties that we have lost.

The beauty of Maya culture is in contrast to their history of colonization, marginalization, and violence. Half the population of Guatemala is Maya, and yet they are largely excluded from national economic and political life. There is also still the palpable legacy of the violence of the 1970s and 1980s, when Maya communities were intentionally targeted for extermination by the US-backed military.

 

SAL: How do you explore this through your research?

EF: My work looks at these paradoxes: How the Maya adapt and co-opt the globalized economy for their own ends (by growing broccoli for export to the US, for example), and how we can understand wellbeing in the context of material poverty.

When I was in graduate school, we learned that the Maya were especially short because of some local evolutionary adaptation or a genetic bottleneck. If you have ever been to Guatemala, you will have noted the heights: Maya men average just 1.59 meters (5.21 feet) and Maya women 1.47 meters (4.82 feet). They were thought to be the ‘pygmies of Central America.’ However, research by anthropologist Barry Bogin has shown that this is not genetic; the difference in height is virtually all nutritional and environmental.

I saw in development programs a lot of distribution of imported malnutrition products, which struck me as odd and counterproductive in a predominately agricultural country, with a majority of those suffering from malnutrition being rural farmers. For that reason, I started looking into malnutrition, and how to develop something locally that would support farmers.

SAL: Were there any unexpected findings?

EF: We discovered a number of surprising things. First, there is an epidemic of early childhood malnutrition, but also of adolescent and adult obesity: This is the dual burden of malnutrition. Thus, it is very important that interventions be targeted at specific at-risk children within families.

Second, I was surprised to see, behind the scenes of the malnutrition world, that well-intentioned humanitarian workers often saw Maya culture as a problem, not something to be celebrated and nourished. Many want to “overcome” traditional beliefs to get people to eat well in specific ways (such as a certain number of calories, the amount of protein, and so on).

In view of that, I wrote this article largely as a response — to show how culture can be used to improve nutrition, and that it is more than an obstacle. Also, to underline the important subjective, affective, and emotional aspects to food that are real and important (even if they are not measured in neat numbers of grams or RDA), and that we who are fighting malnutrition need to engage, rather than fight.

SAL: Did your work present any unexpected challenges?

EF: Fieldwork in difficult places always presents an endless string of challenges, logistical, cultural, and intellectual. This is even more so when doing interventions. As we were developing the Mani+ project in Guatemala, we encountered one obstacle after another, not least in the food science of developing a new product. The peanut oils interact with plastics in ways I could not anticipate. Packaging solids and liquids is straightforward, but getting pastes into little sachets is almost impossible because of the consistency. Therefore, when students ask what being a successful social entrepreneur requires, I tell them that it takes naïve optimism. I saw a problem with malnutrition in Guatemala, and what I thought was a relatively simple solution. Had I known all of the reasons my ‘relatively simple’ solution was not so simple, all of the reasons that it should not work, I probably would not have started. However, I was naively optimistic. Hence, when the problems started coming, I dealt with them one by one as they arose, thinking each one would be the last one to solve and then we would end up with our product. However, had I know at the start the string of obstacles we would face, I would not have begun.

In addition, taking culture seriously means working in local languages and local communities. In Guatemala alone, there are 23 Mayan languages spoken. The easy fix is to do all programming in Spanish, the country’s official language. That works fine in urban areas, but in the rural villages, where malnutrition is most prevalent, many do not speak Spanish well and women are the least likely to speak Spanish in Maya communities. Therefore, we have had to go through the hard work of translating materials, and training native speakers to do educational sessions with our program. It is not easy, but it makes all the difference.

Here is a photo gallery of typical Mayan meals captured during Ted Fischer’s time in Guatemala:

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Why Ethnographic Research?

Insight behind gathering research data from a cultural perspective

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Dr Eva C Monterrosa is the senior scientific manager at Sight and Life and the co-author, with Prof Gretel H Pelto, graduate professor at Cornell University, Ithaca, of “The Mother-Child Food Relationship in the Study of Infant and Young Child Feeding Practices”, published in the ‘Focus on Food Culture’ edition of Sight and Life magazine. This article shines a light on how biology and culture come together at the level of the diet by reviewing infant and young child feeding (IYCF) practices. Far from ‘story-telling’, Dr Monterrosa says research that incorporates a cultural perspective achieves two objectives: First, to generate explanatory frameworks that help us understand and generate hypotheses about health behaviors; and, second, to design programs to improve behaviors.

When we spoke with Dr Monterrosa about how she came to this topic of research, she had some stimulating answers:

Sight and Life magazine (SAL): Why did you choose this topic – what inspired it?

Eva Monterrosa (EM): In my opinion, public health nutrition research design is focused on getting the results we want – often at the expense of understanding ‘how’ results were achieved. But it is precisely the ‘how’ (or the ‘black box’) that can help us design programs that achieve our goals. A successful outcome in one setting might not lead to success when it is replicated in a different context. By context, I don’t just mean a different country. Even replication in the the same type of institution, such as a hospital or clinic, can be a challenge. In essence, we must understand the context to know what factors are driving our results, and how to adapt interventions to fit our context. Ethnographic research gives us the tools to do this.

Guatemala research
Dr Monterrosa and colleague researcher watching mothers in Guatemala make pap food for their young children. Photo credit Eva Monterrosa

 

SAL: What challenges do you face when doing this type of research?

EM: I think my greatest challenge is people telling me, often not in a nice way, that my research is ‘story telling’, or worse yet saying that what I do is ‘not research’. This however, speaks to another predisposition in nutrition science: That research is only valid if it uses a randomized trial design , or uses complex statistical procedures. Don’t get me wrong – I can hold my weight when it comes to running a complex analysis of longitudinal data, but I understand this work’s limitations. Moreover, when you deal with food and eating habits, these are complex social phenomena that cannot be reducible simply to numbers.

In the research Prof Pelto and I share in the article, we use ethnographic methods, such as observations, interviews, and other cognitive elicitation techniques, including free listing, and card-sorting exercises. The selection of the methods is always guided by a research question. One must skillfully apply interviewing techniques, including careful wording of questions and precise ordering to reduce reporting bias. Lastly, a rigorous analysis of the text data is necessary to elicit solid insights based on the data.

SAL: What has been the most surprising result or outcome from your research?

EM: When study participants ask clarifying questions – their questions lead to all sorts of wonderful discoveries. I recall from my Mexico work that I asked one of my first participants: ‘What meals do you prepare at home?’ And she asked, ‘Meals for whom? My family or my children?’ and this was an unexpected answer that led to a wonderful discovery of child-appropriate meals, which added another dimension to our data analysis. We went from just describing complementary feeding practices to understanding how mothers and children inhabit the same ‘eating space’. It was fascinating!

SAL: Why is applied ethnographic research for nutrition science important?

EM: Two pieces are featured in this issue of Sight and Life magazine, because I want our readers to understand the explanatory power of ethnographic methods, and how this work can help their scientific inquiries or programs. It is not about the biological perspective versus the cultural perspective. That is counterproductive. We need a holistic view of nutrition science.

SAL: Do you think people will listen?

EM: I hope so! Prof Pelto developed the biocultural framework in the late 1970s as a framework to examine the different domains that in interaction determine dietary and eating practices. Today, there is a new generation of scientists seeking to address the complexity of eating practices. We are seeing a rise in training on mixed-method designs, excellent research question(s), solid training in ethnographic methods, and the analytical procedures to elucidate patterns in the data.

Guatemala
As a guest, people are always curious as to why you visit their communities. This bright, young girl didn’t leave my side the whole time we were conducting focus group discussions in her village. Photo credit Eva Monterrosa

SAL: How is your research used?

EM: Much of the work that we do is used to develop programs. A lot of the nutrition research that draws on the biological perspective has an impact on the policy sphere, for example, in helping to set recommendations of vitamin A or calcium. As for the ‘how’ to develop programs for administering vitamin A or calcium? That is a whole different research phase, but it is the space that our research inhabits.

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