TAFSSA District Agrifood Systems Assessment – What Are People Eating? 1 What are people eating in Surkhet, Nepal? Food consumption, food security, food sources, and food perceptions ABOUT THIS DATA NOTE | The Transforming Agrifood Systems in South Asia (TAFSSA) district agrifood systems assessment aims to provide a reliable, accessible, and integrated evidence base that links farm production, market access, dietary patterns, climate risk responses, and natural resource management with gender as a cross-cutting issue in rural areas of Bangladesh, India, and Nepal. It is designed to be a district-level multi- year assessment. Using data collected in March-April 2023, this data note describes what people are eating, where they get their food, household food insecurity, and perceptions about food. This is one of a set of data notes that, together, provide a holistic picture of the agrifood system in the district. Figure 2. Highlights from this data note Figure 1. District location in Nepal Data Note 7 December 2023 37% & 41% Adult men and women with diverse diets 10% Adult men who consumed fruit on previous day 42% Of households purchased rather than produced foods 3.4 & 3.3 Number of times per day adult men & women ate food 73% Adolescents consumed biscuits or sweets multiple times a week TAFSSA District Agrifood Systems Assessment – What Are People Eating? 2 List of figures and tables Figure 1. District location in Nepal Figure 2. Highlights from this data note Table 1. Household and individual characteristics Figure 3A. Level of household food insecurity Figure 3B. Individual FIES items Figure 4A. Minimum dietary diversity Figure 4B. Global diet quality positive (healthy) and negative (unhealthy) scores Figure 4C. Diet related NCD risk Figure 5. Consumption of food groups on previous day Figure 6. Consumption quantity by GDQS food group Figure 7. Most commonly consumed foods in each food group Figure 8. Number of eating occasions per day Figure 9. Who eats at different eating occasions Figure 10. Frequency of consumption of sentinel foods in previous 7 days Figure 11. Food sources Figure 12. Where food is purchased Figure 13. Food perceptions (% who agree with each statement) OVERVIEW OF CONTENTS TAFSSA’s district agrifood systems assessment aimed to interview three respondents per household: a female adult (aged 20+ years), a male adult (aged 20+ years), and an adolescent (aged 10-19 years). Information on the household and respondent sampling strategy is provided at the end of this data note. In this data note, you will first find information on background characteristics of the households and individuals who were interviewed. This is followed by information on what people are eating, which was captured using several measurement methods. Respondents were asked about the foods they ate the day before the interview (24-hour recall) and about how often they ate certain foods in the past week (food frequency questionnaire). The 24-hour recall was conducted using the Global Diet Quality Score (GDQS) application, which also captured when (at what eating occasion such as breakfast, a snack between lunch and dinner, etc.) people ate each food item. In addition to what people eat, you will find information in this data note on where they get their food and, if they buy it, what types of markets or shops they buy it from. Finally, you will learn why people choose to eat certain healthy and unhealthy foods. Respondents were asked about availability, accessibility, taste, and other factors that may influence their decisions to consume certain foods. More details about the measurement methods are found on the following pages. TAFSSA District Agrifood Systems Assessment – What Are People Eating? 3 Table 1. Household and individual characteristics Household characteristics Number 500 Female-headed, % 54 Education of head, years 5 Average household size, members 4 Involved in agriculture, % 96 Has improved toilet, % 100 Drinking water source Piped into yard or plot, % 61 Public taps/standpipe, % 12 Main source of income Crop cultivation, % 34 Remittance, % 27 Salary, % 13 Type of fuel used for cooking Wood, % 97 LPG/natural gas, % 74 Electricity, % 10 Individual characteristics Adult female Adult male Adolescent Number 505 235 500 Age, yrs. mean (range) 37 (20-88) 46 (20-84) 14 (10-19) Education, yrs. mean (range) 4 (0-17.5) 5 (0-17.5) 7 (0-11.5) Married, % 93 96 8 Employed, % 70 81 3 Primary occupation Unpaid household work, % 15 2 5 Farming, % 72 57 4 Casual non-farm labour (paid), % 3 11 0 Student, % 0 0 90 Fig 3A. Level of household food insecurity Fig 3B. Individual FIES itemsMeasuring household food insecurity Household food insecurity was measured using the Food and Agriculture Organization’s Food Insecurity Experience Scale (FIES). Respondents were asked 8 questions about their household’s experiences with food in the past 30 days. Categories of food security (none, mild, moderate, severe) were generated based on the number of questions with a positive response. 35% 28% 31% 6% None (0) Mild (1-2) Moderate (3-5) Severe (5-8) 57 43 41 4 21 9 12 2 Worried you would not have enough food to eat Unable to eat healthy and nutritious food Ate only a few kinds of foods Had to skip a meal Ate less than you thought you should Ran out of food Were hungry but did not eat Went without eating for a whole day % who said "yes" FINDINGS ✓ Slightly more than one third of the households reported experiencing moderate or severe food insecurity. TAFSSA District Agrifood Systems Assessment – What Are People Eating? 4 Diet quality scores Fig 4A. Minimum dietary diversity MEASURING WHAT PEOPLE EAT Diets were measured by asking people about everything they ate or drank on the previous day, from the time they woke up until the time they went to bed and didn’t eat or drink anything more. This includes all snacks and foods and drinks consumed at home and outside the home. To capture this information, we used the Global Diet Quality Score (GDQS) application (Bromage et al. 2021). The GDQS allows us to understand diet quality, which is associated with the risk of disease. We report the percentage of individuals with at least minimum dietary diversity (FAO and FHI 360, 2016) (Figure 4A), that is those who consume at least 5 of the following 10 food groups daily: 1) grains, white roots and tubers, and plantains, 2) pulses (beans, peas, and lentils), 3) nuts and seeds, 4) dairy, 5) meat, poultry, and fish, 6) eggs, 7) dark green leafy vegetables, 8) other vitamin A-rich fruits and vegetables, 9) other vegetables, and 10) other fruits. We also computed metrics that indicate how healthy or unhealthy diets are (Figure 4B). Higher GDQS- and GDQS+ scores indicate better diet quality. We then grouped GDQS scores into 3 categories to indicate diet related noncommunicable disease risk (Figure 4C). On the following pages, we show the percentage of individuals who consume various food groups (Figure 5), the consumption quantity by food group (Figure 6), the most commonly consumed foods (Figure 7), how many times per day people eat (Figure 8), who eats at various eating occasions (Figure 9). 41% 37% 39% 0% 10% 20% 30% 40% 50% Adult female Adult male Adolescent % who consumed at least 5 of 10 food groups Fig 4C. Diet related NCD risk 8.2 8.5 13.1 81.6 82.2 82.0 10.2 9.3 4.8 Adult female Adult male Adolescent % at risk High risk (GDQS <15) Moderate risk (GDQS 15-22.9) Low risk (GDQS 23+) Fig 4B. Global diet quality positive (healthy) and negative (unhealthy) scores 7.9 7.7 7.4 10.8 11.0 10.7 Adult female Adult male Adolescent GDQS+ GDQS- FINDINGS ✓ Dietary diversity was slightly higher among adult women than adult men or adolescents, and fewer than half of respondents consumed at least 5 of 10 food groups. ✓ Adolescents were at higher diet related NCD risk compared to adults. Note: The GDQS+ and GDQS- can be summed to give the total GDQS score, with a higher total GDQS score indicating better diet quality. TAFSSA District Agrifood Systems Assessment – What Are People Eating? 5 Figure 5. Consumption of food groups on previous day Note:. High-fat dairy and red meat are considered unhealthy when consumed in high quantities. FINDINGS ✓ Consumption of fruits was <20% for all respondent types, and adolescents are less likely to consume dark green leafy vegetables than adults. ✓ High-fat dairy was the most commonly consumed animal-source food, and around 61% of individuals consumed some animal-source foods on the previous day. ✓ Adolescents were the most likely to consume sweets & ice-cream H ea lt h y U n h ea lt h y TAFSSA District Agrifood Systems Assessment – What Are People Eating? 6 Animal-source foods 9% of adult women and 4% of adult men consumed eggs on the day before the survey Photo credit: Abdul Momin TAFSSA District Agrifood Systems Assessment – What Are People Eating? 7 0% 50% 100% Citrus fruits Deep orange fruits Other fruits Dark green leafy vegetables Cruciferous vegetables Deep orange vegetables Other vegetables Legumes Deep orange tubers Nuts & seeds Whole grains Liquid oils Fish & shellfish Poultry & game meat Low-fat dairy Eggs High-fat dairy Red meat Processed meat Refined grains/baked goods Sweets & ice-cream Sugar-sweetened beverages Juice White roots & tubers Purchased deep fried foods HighFemale adult Male adult Adolescent Figure 6. Consumption quantity1 by GDQS food group 1 “Low”, “medium”, and “high” describe consumption levels that predict noncommunicable disease risk in studies from Africa, Asia, and the Americas (Bromage et al. 2021). Disease risk is minimized when healthy foods are consumed in “high” quantities and unhealthy foods are consumed in “low” quantities. H ea lt h y U n h ea lt h y FINDINGS ✓ Few individuals consumed “high” quantities of healthy foods except legumes and liquid oils; in contrast, few individuals consumed “low/none” quantities of unhealthy foods. ✓ To reduce the risk of developing noncommunicable diseases, consumption of healthy foods such as fruits and whole grains should increase and consumption of unhealthy foods such as refined grains/baked goods, and white roots & tubers should decrease. 0% 50% 100% Medium 0% 50% 100% Low/None TAFSSA District Agrifood Systems Assessment – What Are People Eating? 8 Top 3 foods consumed in each food group % who consumed food group 1st most common 2nd most common 3rd most common Citrus fruits 1 N/A1 N/A1 N/A1 Deep orange fruits 3 Papaya N/A1 N/A1 Other fruits 14 Banana Grapes Apple Dark green leafy vegetables 32 Coriander leaves Saag Garlic leaves Cruciferous vegetables 55 Cabbage Gundruk Cauliflower Deep orange vegetables 2 Tyamattar (tree tomato) N/A1 N/A1 Other vegetables 76 Tomato Onion Ginger Legumes 88 Masoor dal Maas dal Simi dal Deep orange tubers 3 Potatoes (OFSP2) N/A1 N/A1 Nuts & seeds 13 Sesame paste N/A1 N/A1 Whole grains 19 Roti N/A1 N/A1 Liquid oils 95 Oil N/A1 N/A1 Fish & shellfish 2 N/A1 N/A1 N/A1 Poultry & game meat 22 Chicken Poultry N/A1 Low fat dairy 8 Yogurt Whey liquid Milk Eggs 7 Eggs N/A1 N/A1 High fat dairy 25 Milk Yogurt Water buffalo milk Red meat 8 Mutton Pork Buffalo Processed meat 1 N/A1 N/A1 N/A1 Refined grains/baked goods 100 Rice Roti Wai Wai instant noodles Sweets & ice-cream 44 Sugar Biscuit Chocolate Sugar-sweetened beverages 4 Mountain Dew N/A1 N/A1 Juice 1 N/A1 N/A1 N/A1 White roots and tubers 74 Potatoes N/A1 N/A1 Purchased deep fried foods 5 Potatoes Maida Cabbage Deep fried foods at home 4 N/A1 N/A1 N/A1 Figure 8. Number of eating occasions per day (mean) Figure 9. Who eats at different eating occasions 0% 20% 40% 60% 80% 100% Pre-breakfast Breakfast Mid-morning Lunch Afternoon Dinner Post-dinner 3.3 3.4 3.4 Adult female Adult male Adolescent FINDINGS ✓ Individuals consumed similar number of eating occasions per day. ✓ More than 90% of respondents ate at the 2 out of 3 main eating occasions (lunch and dinner), less than 76% of respondents consumed breakfast. ✓ Very few adult males and females consumed food at the post-dinner eating occasion. Figure 7. Most commonly consumed foods in each food group (adult male, adult female, and adolescent combined) H ea lt h y U n h ea lt h y 1Not applicable (N/A): Foods consumed by less that 2% of the respondents have not been displayed. 2OFSP refers to orange fleshed sweet potato. TAFSSA District Agrifood Systems Assessment – What Are People Eating? 9 SENTINEL FOODS | In addition to the GDQS, which provided information about all foods consumed in the previous 24 hours, we selected a set of 25 “sentinel foods” to better understand how frequently these foods are consumed, food sources, where people buy food, and their perceptions about food. Respondents were asked how frequently they consumed these foods in the past 7 days (Figure 10). They were also asked about where their household gets each food (purchased from outside, own production, received from others, received from government, gather/forage) (Figure 11). If they said their household purchases the food, we asked them where it is purchased (haat, retail shop, farm, government ration shop, or other market type) (Figure 12). For a few foods, we dug deeper to understand people’s food perceptions, or what they think about the foods. This included whether they know of a vendor who sells the food, if the food is safe to eat, easy to acquire near where they spend most of their time, is not too expensive, is fast and easy to prepare, tastes good, fills their stomach, is nutritious, and if their family enjoys eating it (Figure 13). Understanding these perceptions provides insights into drivers or barriers of consumption of healthy and unhealthy foods. Sentinel food list 1. Rice 2. Wheat 3. Maize 4. Millets 5. Moong dal 6. Masoor dal 7. Chana dal 8. Chickpeas and beans 9. Potato 10. Poultry (chicken, ducks, pigeons, etc.) 11. Fish 12. Other meat (e.g., mutton) 13. Eggs 14. Milk (e.g., cow, buffalo, goat) 15. Orange vegetables (e.g., pumpkin, carrots) 16. Green leafy veg. (e.g., spinach, mustard, taro, pumpkin leaves, red amaranth leaves) 17. Onions 18. Tomatoes 19. Fruits (e.g., guava, banana, apple, mango) 20. Instant noodles (e.g., Maggi, Wai Wai) 21. Chips (e.g., Lays, Kurkure) 22. Biscuits and baked sweets (e.g., cakes and cookies, mithai) 23. Deep fried food (e.g., samosa, pakora) 24. Soda/soft drinks and packaged juices (e.g., Coke, Sprite, Fanta, Maaza) 25. Tea/coffee with sugar TAFSSA District Agrifood Systems Assessment – What Are People Eating? 10 0 50 100 Rice Wheat Maize Millets Potato Moong dal Masoor dal Chana dal Chickpeas and beans Poultry Fish Other meat Eggs Milk Orange vegetables Green leafy vegetables Onions Tomatoes Fruits Instant noodles Chips Biscuits and baked sweets Deep fried food Soft drinks, packaged juices Tea/coffee with sugar % 0 50 100 % 0 50 100 % Figure 10. Frequency of consumption of sentinel foods in previous 7 days FINDINGS ✓ Rice, potatoes, onions, and tomatoes were consumed daily by nearly all respondents. ✓ Animal-source foods were typically consumed a once a week or never consumed. ✓ Adult women consumed unhealthy foods less frequently than adult men or adolescents. Daily Few times a week Once a week Never Adult female AdolescentAdult male Daily Few times a week Once a week Never Daily Few times a week Once a week Never G ra in s & T u b er s P u ls es A n im al fo o d s F ru it s & V eg U n h ea lt h y TAFSSA District Agrifood Systems Assessment – What Are People Eating? 11 Figure 11. Food sources G ra in s & T u b er s P u ls es A n im al fo o d s F ru it s & V eg U n h ea lt h y 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Rice Wheat Maize Millets Potato Moong dal Masoor dal Chana dal Chickpeas and beans Poultry Fish Other meat Eggs Milk Orange vegetables Green leafy vegetables Onions Tomatoes Fruits Instant noodles Chips Biscuits and baked sweets Deep fried food Soft drinks, packaged juices Tea/coffee with sugar Total Purchased outside Own production Received from others Received from govt Gather/forage Never consume FINDINGS ✓ Most households purchased their food rather than producing it themselves. ✓ Households commonly produced rice, wheat, maize, potato, green leafy vegetables, and onion. ✓ Receiving food from the government or gathering/foraging food was not a common food source. TAFSSA District Agrifood Systems Assessment – What Are People Eating? 12 Figure 12. Where food is purchased Note: Data shown are for the subset of households who purchase the food from outside (Figure 11). “Others” includes weekly markets, haats, wholesale markets, mobile vendors, government shops, and any other purchase source. Haats are wholesale markets where foods are sold in bulk directly by manufacturers/ farmers/ artisans at a fair price, in permanent or semi- permanent infrastructure. Retail shops means fixed or mobile individual shops where foods are sold directly to the consumers, including local grocery stores, specialized shops, vegetable/fruit shops, restaurants, and tea stalls. G ra in s & T u b er s P u ls es A n im al fo o d s F ru it s & V eg U n h ea lt h y FINDINGS ✓ Food was predominantly purchased from retail shops. ✓ Milk, millets, and other meat was often directly purchased from the farmer/producer rather than through a market. ✓ Unhealthy foods were mainly purchased from retail shops. 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Rice Wheat Maize Millets Moong dal Masoor dal Chana dal Chickpeas and beans Potato Poultry Fish Other meat Eggs Milk Orange vegetables Green leafy vegetables Onions Tomatoes Fruits Instant noodles Chips Biscuits and baked sweets Deep fried food Soft drinks, packaged juices Tea/coffee with sugar Total Retail Farm City market Road market Other TAFSSA District Agrifood Systems Assessment – What Are People Eating? 13 Figure 13. Food perceptions (% who agree with each statement) 100% 0% FINDINGS ✓ Nearly all respondents knew a shop that sold the different foods. ✓ Green leafy vegetables were perceived as more affordable than dal. ✓ Few respondents considered fried foods and noodles safe to eat or nutritious. Note: GLVs = green leafy vegetables. Dal GLV Eggs Banana Biscuits Deep fried food Noodles Vendor is nearby Adult female (F) 97 83 95 95 98 87 99 Adult male (M) 97 92 98 95 100 93 100 Adolescent (A) 91 79 94 89 99 87 99 Safe to eat F 93 98 90 93 23 20 14 M 97 96 92 95 35 29 26 A 97 99 94 96 27 29 14 Easy to acquire F 75 77 84 67 95 53 95 M 89 83 91 73 96 62 94 A 81 79 86 69 93 61 94 Affordable F 11 42 14 22 50 16 38 M 27 73 42 43 74 34 71 A 24 66 45 44 74 32 65 Easy to prepare F 82 98 96 89 95 63 96 M 82 96 94 87 81 66 94 A 73 92 91 82 84 61 88 Tastes good F 83 98 92 98 60 71 68 M 98 100 93 98 67 66 64 A 90 87 95 94 71 84 85 Fills stomach F 65 64 53 83 43 65 59 M 58 59 46 79 40 68 57 A 61 61 45 70 46 74 63 Is nutritious F 96 99 96 96 28 28 14 M 95 100 97 96 36 37 26 A 94 99 97 95 27 33 18 Family enjoys F 93 91 95 99 81 83 84 M 97 100 96 99 76 76 75 A 92 95 94 97 59 75 64 TAFSSA District Agrifood Systems Assessment – What Are People Eating? 14 KEY TAKEAWAYS 1. There is room for improvement in diet quality. • Consumption of healthy food groups such as whole grains, nuts & seeds, animal-source foods, fruits, and deep orange vegetables is low. • Consumption of unhealthy food groups such as refined grains/baked goods, biscuits, sweets and ice-cream is high. • Consumption of starchy foods with low nutrient density (rice, potatoes) is high. • Compared to adults, adolescents are more likely to be at “high” diet related NCDs risk. 2. Most households purchase food from markets rather than producing it themselves. 3. Food purchases are predominantly from retail shops. KEY QUESTIONS FOR ACTION 1. What are the key barriers to improving diet quality in the district? 2. What are a few potential solutions to overcome these barriers? What is needed from decision-makers and from program teams to implement these solutions? 3. How can understanding eating patterns throughout the day and perceptions about healthy and unhealthy foods help inform strategies to influence consumption of these foods? 4. What additional information is needed to facilitate actions to improve diets in the district? Photo credit: Abdul Momin TAFSSA District Agrifood Systems Assessment – What Are People Eating? 15 SURVEY METHODOLOGY Ward and household sampling We selected 25 wards in the district with a probability proportional to the number of households that reside in each ward. Within each ward, we conducted a household listing to identify eligible households, that is, those with adolescents (10-19 years old). From the households with adolescents, we randomly invited 20 households to participate in the survey. If a household refused, we replaced that household with another randomly selected eligible household, to retain a total of 500 households in the district. Thus, the findings reported in this data note are representative of rural households from this district that include an adolescent. Respondent selection Within households, one adult female aged 20+ years, one adult male aged 20+ years, and one adolescent aged 10-19 years were selected as the respondents for the survey. When multiple adolescents were living in a household, the oldest adolescent was selected. In some households, an adult male was not available (often due to migration for work). In such households, the female was the only adult respondent (see Table 1 for respondent sample sizes). At the beginning of the interview, the adult in the household primarily involved in agriculture (either male or female) and the adult primarily responsible for food purchasing (either male or female) were identified as the primary respondents. INDICATOR DEFINITIONS Indicator Definition GDQS+ The Global Diet Quality Score positive sub-metric is composed of the summed score of the 16 healthy food groups and ranges from 0-32 points, with a higher score indicating higher diet quality. GDQS- The Global Diet Quality Score negative sub-metric is composed of the summed score of the 7 unhealthy food groups and the 2 food groups that are unhealthy when consumed in excess amounts (high-fat dairy and red meat), with a higher score indicating lower diet quality. The GDQS negative score has a possible range of 0-17. REFERENCES Bromage, S., C. Batis, S.N. Bhupathiraju, et al. 2021. “Development and Validation of a Novel Food-Based Global Diet Quality Score (GDQS).” Journal of Nutrition 151,(10S), Supp. 2. FAO and FHI 360. 2016. Minimum Dietary Diversity for Women: A Guide for Measurement. Rome: FAO. TAFSSA District Agrifood Systems Assessment – What Are People Eating? 16 AUTHORS Samuel Scott, Research Fellow, IFPRI Sharvari Patwardhan, Research Analyst, IFPRI Suman Chakrabarti, Associate Research Fellow, IFPRI Alka Chauhan, Research Analyst, IFPRI Archis Banerjee, Research Analyst, IFPRI Sumanta Neupane, Program Manager, IFPRI Aklima Parvin, Program Manager, IFPRI Sabrina Rasheed, Scientist, icddr,b Kaosar Afsana, Professor, James P Grant School of Public Health, BRAC University Nazma Shaheen, Professor, University of Dhaka Christine Blake, Associate Professor, University of South Carolina Purnima Menon, Senior Director for Food and Nutrition Policy, CGIAR & IFPRI Avinash Kishore, Senior Research Fellow, IFPRI REFERENCES Bromage, S., C. Batis, S.N. Bhupathiraju, et al. 2021. “Development and Validation of a Novel Food-Based Global Diet Quality Score (GDQS).” Journal of Nutrition 151,(10S), Supp. 2. FAO and FHI 360. 2016. Minimum Dietary Diversity for Women: A Guide for Measurement. Rome: FAO. SUGGESTED CITATION Scott S, Patwardhan S, Chakrabarti S, Chauhan A, Banerjee A, Neupane S, Parvin A, Rasheed S, Afsana K, Shaheen N, Blake C, Menon P, Kishore A. 2023. What are people eating in Surkhet, Nepal? TAFSSA Data Note 7. New Delhi, India: Transforming Agrifood Systems in South Asia (TAFSSA). FUNDING ACKNOWLEDGEMENT We would like to thank all funders who supported this research through their contributions to the CGIAR Trust Fund: https://www.cgiar.org/funders/ To learn more, contact: a.kishore@cgiar.org To learn more about TAFSSA, contact: t.krupnik@cgiar.org; p.menon@cgiar.org ABOUT TAFSSA TAFSSA (Transforming Agrifood Sys tems in South Asia) is a CGIAR Regional Integrated Initiative that supports actions improving equitable access to sustainable healthy diets, that boosts farmers’ livelihoods and resilience, and that conserves land, air, and water resources in a climate crisis. ABOUT CGIAR CGIAR is a global research partnership for a food secure future. Visit https://www.cgiar.org/ research/cgiar-portfolio to learn more about the initiatives in the CGIAR research portfolio DISCLAIMER The views and opinions expressed in this publication are those of the author(s) and are not necessarily representative of or endorsed by CGIAR, centers, our partner institutions, or donors. This data note has not been peer reviewed. https://www.cgiar.org/funders/ mailto:a.kishore@cgiar.org mailto:t.krupnik@cgiar.org mailto:p.menon@cgiar.org https://www.cgiar.org/research/cgiar-portfolio https://www.cgiar.org/research/cgiar-portfolio Slide 1 Slide 2 Slide 3 Slide 4 Slide 5 Slide 6 Slide 7 Slide 8 Slide 9 Slide 10 Slide 11 Slide 12 Slide 13 Slide 14 Slide 15 Slide 16