Simone Passarelli, PhD ’20, is exploring how new breeds of chickens can reduce undernutrition and change the dynamics in Ethiopian farming families.
They’re known as roadrunners. The scrawny, indigenous chickens of Ethiopia produce a tough meat that’s delicious when slow-cooked in a spicy stew called doro wat—but their meat doesn’t bring farmers much profit. So an Africa-wide research collaborative stepped in to provide bigger and better local poultry varieties, bred for plumper meat or higher egg productivity. And scientists at the Harvard T.H. Chan School of Public Health are part of the research mix, focused on understanding whether the new breeds of chicken will improve women’s and children’s health—not just directly through the calories and nutrients they consume but also through changes that ripple through families and communities.
Chicken production may not seem like a natural fit for public health. For decades, many international development efforts have treated agriculture and nutrition separately, with programs to increase high-yield staple crops like wheat and rice on one side and campaigns to supplement micronutrients like iron on the other. But current thinking about how to combat undernutrition is evolving—much like it is in the rest of the nutrition field—to a focus on whole foods. Public health researchers are turning to agriculture to help ensure that people can access foods that are not just abundant but also nutritionally rich. In some parts of Africa, this means working with small household farms.
Simone Passarelli, PhD ’20, a research assistant on the School’s Agriculture to Nutrition project, wants to capture a nuanced picture of how the arrival of the new chicken breeds affects the lives of farmers and their families. She’s working with her adviser, Wafaie Fawzi, Richard Saltonstall Professor of Population Sciences; professor of nutrition, epidemiology, and global health; and chair of the Department of Global Health and Population, on a randomized trial of 2,100 households that will look not only at the direct nutritional effects of the poultry breeds, but also at how the new breeds indirectly affect household economics and family dynamics.
For a struggling family in a country like Ethiopia—where undernutrition causes roughly a third of children’s deaths—a small backyard flock can be transformative. Having a stable source of healthy protein helps children’s growing brains and bodies, and stems anemia. And the extra income from meat and egg sales—finances often controlled by women—can be a path out of poverty and a catalyst toward more equality in the household. But introducing chickens into home farms can create health risks, as well. Chickens can spread germs like the Salmonella bacterium to humans, and young children are particularly vulnerable. Poorly implemented, this innovative nutrition program could wind up harming the villagers it was intended to help.
“There are so many variables that can contribute to better or worse nutritional outcomes in agricultural settings, and sometimes they compete,” Passarelli says. “I wish it were as simple as just giving someone a magic pill.”
In a 2010 World Bank review of nutrition interventions, the authors concluded that it was not enough to ask, “What works?” Rather, researchers must dig into the details and ask, “Whom did it work for and why?”
PUSHING ALL THE BUTTONS TO FIND WHAT WORKS
While the project’s original goal was to monitor participants for changes in height, weight, diet, and anemia, Passarelli and her colleagues are taking this a step further, asking what households are buying with their expanded income and whether increased purchasing power improves women’s authority to make household decisions. In addition, Passarelli wants to know whether sanitation will prove to be a concern, and whether additional training in infection control on the farm can keep people from getting sick.
The idea is to push multiple buttons at once, Passarelli says. In the past, researchers have tended to focus on just one button at a time—vitamin supplementation, for example—but there is increasing acknowledgement that this approach can be ineffective. Iron tablets may help kids in some parts of Africa, but they contributed to severe malaria during a trial in Tanzania reported in 2006, and are currently recommended as long as malaria prevention measures are provided. Context is everything. Indeed, a 2010 World Bank review of 46 nutrition interventions conducted that decade found no clear pattern of success. The authors concluded that it was not enough to ask, “What works?” Rather, researchers must dig into the details and ask, “Whom did it work for and why?” Fawzi notes that while many programs work, adding nutrition-sensitive interventions (such as agriculture and poultry) could result in better and more sustained results.
The key is continuously gathering data through both quantitative and qualitative approaches, Passarelli says, meaning obtaining both objective measures like weight, height, and blood tests, and responses from interviews. “This approach will help us identify the barriers to adequate nutrition in this community and the types of interventions that are appropriate, useful, and desired by the population,” she says.
Introducing chickens could improve study subjects’ diets, but if the extra work causes them to spend less time cultivating their crops, they could lose out on other nutrients. Previous studies suggest that the extra income from chicken farming will encourage women to spend more money on healthy food for their children, but they—or their husbands—may choose to spend the money on other things. The hope is that the picture created by the data will be clear enough to help researchers predict whether the study’s methods can be effectively replicated elsewhere.
Passarelli brings a unique set of cross-disciplinary skills to the task. While she specializes in nutrition, her degree program in population health sciences at the Harvard Chan School encourages her to tap into four other specialties: global health, social and behavioral sciences, epidemiology, and environmental health. Add to that her previous training in economics, and she’s well equipped to understand the ways that nutrition intersects all aspects of people’s lives.
Although she smiles and laughs easily, Passarelli is serious in her determination to find new ways to make studies of nutrition interventions in developing countries more efficient and informative. By the time she leaves the School, she hopes to better grasp how technology can help. Mobile devices and social media can help researchers gather data on preferences and behavior that were previously unattainable or too expensive, she says. For example, study participants can respond to survey questions on their mobile devices, take pictures of their meals, or wear an activity tracker. Received in real time, this information can help researchers quickly correct a study’s course, if needed.
FIXING FOOD SYSTEMS AT THEIR SOURCE
Passarelli’s fascination with agriculture started in the backyard garden of her childhood home in Southborough, Massachusetts. Encouraged by her physician mother and meteorologist father, she nurtured her garden, delving into the science behind growing plants and experiencing the joy of eating food she grew herself. She worked on an organic farm as an undergraduate at Cornell, where she studied international agriculture and rural development. There, she realized that she needed to learn more about how to not just fight hunger but promote nourishment as well.
She earned a master’s degree from the Tufts Friedman School of Nutrition Science and Policy in 2014 and then took a job as a research assistant at the International Food Research Policy Institute in Washington, D.C., working on studies focused on water, nutrition, and women’s empowerment in African countries. After graduation from the Harvard Chan School, Passarelli intends to work in international policy, serving as a conduit between academic researchers and those implementing programs on the ground.
“I want to shift the traditional mindset around how we use data for measuring nutrition and health outcomes,” Passarelli says. “We don’t need to limit ourselves to collecting household survey data at the beginning and end of a project.” Public health practitioners need to look to the methods of marketers and harness the vast amounts of information that mobile technology is generating about how people behave, she says. While there is no panacea in nutrition, good data may be the next best thing, Passarelli says. “If we think more creatively, combine multiple approaches, and learn from other disciplines, I believe that we can help people get the nutrition they need not only to survive but to thrive.”
Amy Roeder is associate editor of Harvard Public Health