Adopting healthy eating habits in Peru’s community kitchens: The Comedores Populares experience
Author: Rocío Gálvez, José L. Avilez, Francisco Diez-Canseco, J. Jaime Miranda,
SCOPE OBESITY European Fellows
Ana wakes up at 6:00 a.m. She makes breakfast for her three grown children, cleans the house, kisses her husband goodbye, and goes to meet the other three cooks. The four women, who are neighbors and friends, go to the market: it’s only 7:30 a.m. and the sun is barely out but cooking for fifty is not a simple task. Ana, like many Peruvian women, works daily at a Comedor Popular without receiving any compensation other than five menús, the daily meal consisting of a soup plus an entrée usually made of a lot of rice, potatoes or legumes to feed her family.
She, like many others, migrated from the highlands in the 70’s and 80’s escaping from the extreme poverty and political violence that devastated that area of Peru. They pieced together urban settlements in the peripheries of big cities like Lima. Due to the lack of food and money, some women started cooking together to feed many families with fewer resources. With time, they became more organized taking turns, assigning roles, and establishing committee boards. Thus the Comedores Populares were born. (To understand more about this social phenomenon, this book from 1995, presents in detail the broader societal context and local circumstances).
Eventually, the Peruvian government recognized these organizations. It started providing them with cereals (rice, noodles), legumes (beans, lentils), fats (oil) and protein (canned fish) to counter the energy and protein deficiency this population had in the early days of migration.
Comedores are still one of the main sources of accessible food –the price is around US$ 0.75 per menú– for poor families. The problem is that after forty years they are still offering the same food while the nutritional needs of the population have changed. A common menú lacks of fruits and vegetables. Each person should eat at least 5 portions of these foods to prevent the risk of suffering from chronic diseases, according to recommendations from the World Health Organization (WHO), and it was far less the amount Comedores’ patrons were getting. And this, unhealthy eating habits, is a global problem.
The challenges are evident: a population at higher risk of developing overweight, hypertension and diabetes.
Is it possible to have a healthier Comedores’ menú?
At CRONICAS we wanted to answer this question. We designed a three-phase project whose goal was to improve the dietary habits among poor inhabitants of urban communities. The first phase of the project aimed to explore Comedores’, cooks’ and patrons’ practices and views in relation to what foods are being purchased, prepared and offered; what factors are most influential in defining the menus; and, what are the most and least valued characteristics of Comedores Populares. In the second phase, we wanted to see if patrons were prone to pay for healthier options in their menus. Thanks to these results, a third phase begun with an intervention for promoting the sales and consumption of fruits and fresh vegetables in the Comedores started. We wanted to break the myth that poor people can’t afford to eat healthily.
The intervention took place in the summer of 2014, between January and May. It had to ensure that components of the menú such as rice and soup, common staple foods in the Peruvian culinary culture, would not be removed from it, as this would have garnered resistance from the patrons, thus the addition of fruits and salads instead. It was paramount that fruit and salad prices remained equal or slightly above cost price since the goal was neither to profit nor subsidize them; instead, we aimed to show that patrons and cooks were willing and able to invest in a healthier menú. Training sessions for the cooks from 12 Comedores (four would offer fruits, four would offer salads and four would perform as controls) were planned. The topics involved were healthy diets, fruits, vegetables and their role in preventing chronic diseases, hygienic practices in the kitchen, salad cooking classes, and sales coaching sessions. Hands-on learning and retroactive feedback always remained at the heart of the matter for cooks always to feel a part of the intervention. The intervention’s plan also included a marketing campaign to inform Comedores’ patrons about it before Comedores started selling fruits and salads.
At first, cooks greeted us strangers with suspicion. Ludicrously, some of them even claimed that CRONICAS were spies hired by the municipality to study the soil and, ultimately, evict them. (The political context was not so generous either, the support to Comedores was assigned to local municipalities instead of direct support from the central government). Nevertheless, negative feelings towards the project changed over time thanks to regular visits where a forward communication prevailed. We became friends. Investing in trust building proved to be a crucial step to make companionship and interest prevail among the participants.
So what did we find out?
In nine weeks, considering only the implementation phase, almost 10 000 fruits and salads were sold. The analyses showed that patrons were prone to spend money in buying fruits and salads at the dawn of the intervention, this tendency being slightly stronger for fruits. After pondering why consumers bought the products, most alluded that fruits and salads offered in the Comedor were cheap and convenient, particularly time-saving. Others claimed that their availability at the same place they bought their menús was a huge advantage since they could buy the whole lunch at one place. Another group regarded its appealing packaging and cleanliness as a major incentive to buy them.
The burning question is: did the intervention work?
We confess that, even ourselves as researchers, we did not expect to sell as many fruits and salads in such a short period of time. Strong ideas about Comedores patrons’ unwillingness to invest money in “unfulfilling” foods prevailed. Stereotypes like that poor people would only buy foods that make them feel full were common. Clearly, it was not the case. Every day, half of the associated patrons bought at least one fruit or salad, while all cooks did the same. For every ten menús, eight fruits or four salads were sold. Comedores made an attempt to keep selling fruits and salads after the intervention was over. Patrons not only bought fruits and salads but kept inquiring about them after the end of the intervention. We can positively say the intervention was successful.
If they asked us what the fruitful features of this project were, we could probably say they were the ties we developed with the cooks, ensuring their training, and the encouragement of patrons to buy fruits and salads. Perhaps, one of the highlights was to introduce the idea that chronic diseases can happen not only because of an excessive intake of fats and sugars but also as a result of an insufficient intake of fruits and vegetables.
Nevertheless, thinking back on the experience, there are –of course– many things that can be improved. For example, we needed a better educational approach adapted to adult women with low formal schooling or knowing our participants better before training them so we could achieve a more successful tailoring.
Our friend Ana and her cook mates form a fragile structure that feels like it could crack at any minute. If she gets sick, there would be no cooking at the Comedor that day. If she argues with another cook, the Comedor could close. We were lucky that events like these did not happen. How could an intervention like this survive in such a delicate environment? How do we ensure the means to replicate the project in other Comedores? We have not answered these questions yet.
Sometimes, in public health we say habits are one of the most difficult things to change. But not only habits, communicating complex health messages are also part of the challenges to overcome. The habits Comedores’ cooks have developed allowed them to survive in a difficult environment, to sustain their operations on a day-to-day basis. This survival strategy and presence on the ground constitutes also an opportunity to introduce some needed revolution towards healthier eating habits and improved nutrition. Sometimes many barriers arise when we work with fragile but adaptive institutions like the Comedores Populares. And sometimes, companionship can be the key ingredient we need to break these barriers and fuel change.
Note: This project was supported by IDRC Canada, and conducted by the CRONICAS Center of Excellence in Chronic Diseases at Universidad Peruana Cayetano Heredia. This project was developed in collaboration with Dr Antonio Trujillo (Johns Hopkins Bloomberg School of Public Health). We are grateful to all the team that made this possible.