Food, health, and complexity: towards a conceptual understanding to guide collaborative public health action.
What we eat simultaneously impacts our exposure to pathogens, allergens, and contaminants, our nutritional status and body composition, our risks for and the progression of chronic diseases, and other outcomes. Furthermore, what we eat is influenced by a complex web of drivers, including culture, politics, economics, and our built and natural environments. To date, public health initiatives aimed at improving food-related population health outcomes have primarily been developed within 'practice silos', and the potential for complex interactions among such initiatives is not well understood. Therefore, our objective was to develop a conceptual model depicting how infectious foodborne illness, food insecurity, dietary contaminants, obesity, and food allergy can be linked via shared drivers, to illustrate potential complex interactions and support future collaboration across public health practice silos.



We developed the conceptual model by first conducting a systematic literature search to identify review articles containing schematics that depicted relationships between drivers and the issues of interest. Next, we synthesized drivers into a common model using a modified thematic synthesis approach that combined an inductive thematic analysis and mapping to synthesize findings.



The literature search yielded 83 relevant references containing 101 schematics. The conceptual model contained 49 shared drivers and 227 interconnections. Each of the five issues was connected to all others. Obesity and food insecurity shared the most drivers (n = 28). Obesity shared several drivers with food allergy (n = 11), infectious foodborne illness (n = 7), and dietary contamination (n = 6). Food insecurity shared several drivers with infectious foodborne illness (n = 9) and dietary contamination (n = 9). Infectious foodborne illness shared drivers with dietary contamination (n = 8). Fewer drivers were shared between food allergy and: food insecurity (n = 4); infectious foodborne illness (n = 2); and dietary contamination (n = 1).



Our model explicates potential interrelationships between five population health issues for which public health interventions have historically been siloed, suggesting that interventions targeted towards these issues have the potential to interact and produce unexpected consequences. Public health practitioners working in infectious foodborne illness, food insecurity, dietary contaminants, obesity, and food allergy should actively consider how their seemingly targeted public health actions may produce unintended positive or negative population health impacts.
School of Public Health and Health Systems, University of Waterloo, 200 University Ave. West, Waterloo, N2L 3G1, ON, Canada. smajowicz@uwaterloo.ca.
Shannon E
SE
Majowicz
School of Public Health and Health Systems, University of Waterloo, 200 University Ave. West, Waterloo, N2L 3G1, ON, Canada.
Samantha B
SB
Meyer
School of Public Health and Health Systems, University of Waterloo, 200 University Ave. West, Waterloo, N2L 3G1, ON, Canada.
Sharon I
SI
Kirkpatrick
School of Public Health and Health Systems, University of Waterloo, 200 University Ave. West, Waterloo, N2L 3G1, ON, Canada.
Julianne L
JL
Graham
Social Development Studies, Renison University College-University of Waterloo, 240 Westmount Road North, Waterloo, N2L 3G4, ON, Canada.
Arshi
A
Shaikh
School of Public Health and Health Systems, University of Waterloo, 200 University Ave. West, Waterloo, N2L 3G1, ON, Canada.|Department of Geography & Environmental Management, University of Waterloo, 200 University Ave. West, Waterloo, N2L 3G1, ON, Canada.
Susan J
SJ
Elliott
Propel Centre for Population Health Impact, University of Waterloo, 200 University Ave. West, Waterloo, N2L 3G1, ON, Canada.
Leia M
LM
Minaker
Department of Geography & Environmental Management, University of Waterloo, 200 University Ave. West, Waterloo, N2L 3G1, ON, Canada.
Steffanie
S
Scott
School of Public Health and Health Systems, University of Waterloo, 200 University Ave. West, Waterloo, N2L 3G1, ON, Canada.
Brian
B
Laird
D001823:Body Composition; D002908:Chronic Disease; D003210:Concept Formation; D004032:Diet; D005506:Food Contamination; D005512:Food Hypersensitivity / Q000453:epidemiology*; D005523:Food Supply; D005517:Foodborne Diseases / Q000453:epidemiology*; D006801:Humans; D007239:Infections; D008954:Models, Biological; D009765:Obesity / Q000453:epidemiology*; D011634:Public Health; D015980:Public Health Practice
Dietary contamination; Food allergy; Food insecurity; Foodborne diseases; Health policy; Obesity; Population-based planning; Public health; Public policy