I arrived in Guatemala in 1973 as a Peace Corps Volunteer assigned to school gardens. The idea was straightforward: help children grow food and improve nutrition.
But it didn’t take long to see the limits of that approach.
The children were often sick—diarrhea, parasites, malaria. Even when food was available, their bodies couldn’t fully use it. It became clear that nutrition wasn’t just about food. It was about health, environment, and daily living conditions.
That realization stayed with me. It led me to study nutrition and public health, to spend months in the National Agricultural Library and the National Library of Medicine reviewing Peace Corps, USAID, and World Bank programs, and to work across Asia, Africa, and the Americas. I was looking for one thing:
What actually works—consistently, at the community level?
Over time, a pattern emerged.
Most programs treat problems. Far fewer remove their causes.
We treat diarrhea in clinics but don’t prevent it at the household level. We distribute malaria tools but don’t eliminate everyday exposure. We support nutrition programs without addressing the infections that undermine them.
The result is familiar to many of us: high effort, real goodwill—and limited, short-lived impact.
But in the communities where root causes are addressed together, the results are different.
The most effective approach I’ve seen is not complicated, but it is integrated:
-Universal sanitation and hygiene
-Reliable access to safe water, plus household water treatment
-Practical, consistent malaria prevention
-Women-led savings and loan groups to build financial resilience
When these come together, change accelerates.
Families spend less time caring for illness and more time on productive work. Household expenses drop. Children attend school more regularly. Nutrition improves—not just because food is available, but because illness no longer blocks its benefits. Savings begin to grow, and families start investing in education, assets, and small businesses.
But there is another layer that determines whether these gains last.
Communities also need access to resources, basic education, and the confidence to act.
Reading, writing, and numeracy allow people to understand instructions, manage finances, and make informed decisions. Access to practical information and tools makes action possible. And self-confidence—the belief that “we can do this ourselves”—turns knowledge into sustained progress.
Without these, even strong programs stall. With them, communities move forward on their own.
In recent work in rural Uganda, I’ve seen this combination—health, infrastructure, and human capability—lead to sharp reductions in diarrheal disease and malaria, while freeing time and increasing household economic activity. What stands out is not just the health impact, but the shift in outlook: communities begin to see themselves as capable of solving their own problems.
For Returned Peace Corps Volunteers, there is something important here.
Our service gave us more than memories. It gave us direct exposure to how change actually happens—or doesn’t—on the ground. That experience is a kind of long-term dataset. It allows us to see patterns that aren’t obvious from reports alone.
The opportunity now is to build on that insight.
To move beyond isolated efforts toward models that can be replicated, adapted, and sustained by communities themselves. To ask not only “What did we do?” but “What removes root causes?” and “What lasts?”
After more than 50 years, my conclusion is simple:
When communities are supported to eliminate the causes of disease—and are equipped with the knowledge, skills, and confidence to act—they don’t remain dependent. They become self-sufficient.
That lesson began for me in highland school vegetable gardens in Guatemala.
It has held true ever since.
Short author bio
Chris Roesel served as a Peace Corps Volunteer in Guatemala (1973–75) in school gardens and nutrition. He later earned graduate degrees in nutrition and public health and has worked for over five decades in community-based health, WASH, and development programs across Asia, Africa, and the Americas. He is President of P2P Inc., a nonprofit focused on low-cost, community-led systems for sustainable health improvement.