My thoughts on Food systems for People and Planetary Health
“Profound changes in the way food is grown, processed, distributed, consumed, and wasted over the last several decades has led to increasing threats to a future of food that is sustainable, equitable, and secure… We believe in a world where healthy, sustainable and inclusive food systems, allow people and planet to thrive.…. a resilient world where no one is left behind.” – Agnes Kalibata, Special Envoy for the 2021 Food Systems Summit
Introduction:
The problem – Malnutrition and poor global health:
Malnutrition in all its forms affects most of the world’s population at some point in their lifecycle, from infancy to old age. Every country is affected, with all geographies, all age groups, rich and poor people of all genders included. In 2016, more than 1.9 billion (39%) adults were overweight. Of these over 650 million (13%) were obese, while 38 million children under the age of 5 were overweight or obese in 2019. Over 70% of those affected by overweight and obesity in the world live in low- and middle-income countries.[1] In addition, over 980 million individuals remain undernourished and about 2 billion suffer from micronutrient deficiencies. Even though stunting among children under 5 years old is declining slowly, 144 million children are still affected in 2019 and still 47 million children are wasted. Furthermore, 41 million people die of noncommunicable diseases (NCDs) each year, equivalent to 71% of all deaths globally, and this number is increasing.[2]
The contributors of malnutrition and poor global health:
A focus on efficiency has seen an increase in the availability of inexpensive, high calorie foods, often from stable cereal crops. However, it has been at the expense of diet diversity and has displaced local, often healthier, diets. Access to diverse, micronutrient rich foods (such as fresh fruits, vegetables, legumes, pulses and nuts) has not improved equally for everyone. On the other hand, food with high content of sugars, salt, saturated fats and industrially produced trans fats have become cheaper and more widely accessible. In addition, an increase in global demand for meat, dairy products, sugar sweetened drinks and processed and ultra-processed foods has contributed to making unhealthy diets the single largest driver of morbidity and mortality in the world, more than tobacco smoking and high blood pressure.[3],5 The food systems’ contribution to unhealthy diets can be linked to a variety of drivers and polices (or the lack thereof) which shape our diets. Thus, unhealthy diets and the double burden of malnutrition is the logical consequence of our present-day food system[4]. The Lancet 2019 series on the double burden of malnutrition explored how this coexistence of multiple forms of malnutrition is affecting low-income and middle-income countries. In its policy recommendations it provide double-duty actions that can be utilised to simultaneously address all dimensions of malnutrition.[5] But the issues do not end on the food that is available to make up our dietary patterns – there are major issues associated with the impact food is having on the environment.
Climate change and food system resilience:
Global food production, responsible for 17 – 24% of greenhouse gas emissions, is a major source of soil, air, and water pollution, accounting for more than 70% of freshwater use and 40% of land use, while also contributing to biodiversity loss. Today’s food systems come with many challenges, such as protection of rights of food workers, inequities in access to food; and they do not succeed at delivering nutritious, safe, affordable, and healthy sustainable diets for all at all times. Productivity and access to cheap food are priorities without consideration of the trade-offs associated with each of these needs. Moreover, transforming the global food system into context-specific healthier and more sustainable directions is necessary to achieve the global nutrition and noncommunicable diseases targets and goals, the Sustainable Development Goals (SDGs), the Paris Climate Agreement, the Convention on Biological Diversity Aichi Conservation Targets, as well as other international sustainability targets.
Sustainable food systems support national economies, trade and tourism, contribute to food and nutrition security, and underpin sustainable development. Today, the environments within which food suppliers, producers and manufacturers operate continue to evolve at an ever-increasing rate, with new hazards and pathogens regularly emerging, exacerbated by the globalization of the food supply chain. The added pressures of climate[6], urbanization and changes in consumer habits, have increased the number of people buying and eating food prepared, especially in public settings. Growing consumer demand for a wider variety of foods, has resulted in an increasingly complex and longer global food supply chain. The increasing consumer demand for “ready-to-eat” foods has fuelled the growth of quick service restaurants and fully cooked, frozen dishes that only require reheating, further expanding supply chains[7]. Further, as the world’s population grows, the intensification and industrialization of agriculture and animal production to meet increasing demand for animal source foods create both opportunities and challenges for food safety.
Food safety:
Globally, countries have not been investing sufficiently in food safety. For many Low and Middle-Income countries, food safety is important mainly as a trade and market access issue, while it received very little investment domestically. If we are to end malnutrition in all its forms, food safety issues need to be addressed. Unsafe food containing harmful bacteria, viruses, parasites or chemical substances, causes more than 200 diseases – ranging from diarrhoea to cancers. An estimated 600 million – almost 1 in 10 people in the world – fall ill after eating contaminated food and 420 000 die every year, resulting in the loss of 33 million healthy life years (DALYs).[8] Most of this burden (98%) falls on developing countries and on children under five years of age (40%). The results are broadly consistent with other estimates of the health burden of human disease, such as the ones produced by the Institute for Health Metrics and Evaluation (IHME) and other estimates by WHO. Many epidemics or pandemics are rooted in environmental change and ecosystem disturbances. A synthesis of literature[9] suggests that, since 1940, agricultural drivers were associated with more than 25% of all, and more than 50% of zoonotic — infectious diseases that emerged in humans, proportions that will likely increase if agriculture expands and intensifies as in the recent past. Encroachment of people and domesticated animals into natural areas can introduce a two-way process in the spreading of disease: From wildlife to humans and vice versa: spread of diseases to wildlife can devastate wild populations and create reservoirs for the disease to be transmitted back to domesticated animals and humans. “The Safe Food Imperative” argues that much of the burden of unsafe food can be avoided through practical and often low-cost behavior and infrastructure changes at different points along food value chains, including in traditional food production and distribution channels.”[10]
Under the United Nations (UN) Framework Convention on Climate Change, much investment and efforts are dedicated to research on food safety impact. The impact of climate change will likely have considerable impact on food safety, both direct and indirect, placing public health at risk[11]. Changing rainfall patterns, increase in extreme weather and an increase in annual average temperature will affect the persistence and occurrence of bacteria, viruses, parasites, harmful algae, fungi and their vectors, and the patterns of their corresponding foodborne diseases and risk of toxic contamination. Climate sensitive risk factors and illnesses will be among the largest contributors to the global burden of food-related disease and mortality, including undernutrition, communicable, noncommunicable, and diarrheal and vector borne diseases.[12]
COVID-19 and food systems:
The COVID-19 pandemic has shown that food systems are fragile. In fact, the pandemic is the most expensive externality of the current food systems in the world.
Amid the COVID-19 pandemic, maintaining the movement of food along the food chain is an essential function to which all stakeholders along the food chain need to contribute: employers need to consider what measures to put in place to protect employees by implementing practical measures to adhere to physical distancing guidance in food-processing environments. Even pre-COVID-19, foodborne viruses transmitted through contaminated food have been quite problematic with enough epidemiological evidence, and has been a challenging area to control, i.e. the multiple outbreaks of Hepatitis A in berries in many countries. Such cases make it challenging to maintain trust and consumer confidence in the safety and availability of food.
The pandemic has also resulted in major increase in food loss and waste[13] as well as anecdotal evidence on panic buying of highly processed, long shelf life food items often high in sugars, salt and unhealthy fats, alternating our diets from fresh fruits and vegetables[14]. Recent research suggests that some communities were avoiding certain foods due to rumors circulation about COVID-19 spreading through fresh food like meats and vegetables[15]. Further, when incomes fall, perishable foods are usually the first food groups that show a drop in household consumption.
The COVID-19 pandemic has also opened a window of opportunity to reshape food systems in support of people’s and planetary health. By showcasing how fragile the food system is to shocks, and at the same time how fast some governments have taken measures to halt the transmission of the virus prioritizing public health, civil society organizations and communities witness that rapid change is possible. Food system actors have come together to try to close gaps in food systems and protect the most vulnerable in society, while public authorities have taken extraordinary steps to secure the production and provisioning of food. It has also identified the importance of reducing the prevalence and risks of diseases that are attributed to unhealthy diets, such as NCDs as people suffering from NCDs are at a higher risk of falling severely ill of COVID-19. [16]
Change is needed.
The potential solution:
Under the UN Decade of Action on Nutrition (2016-2025) action is needed to build sustainable, safe, and resilient food systems. Countries are urged to undertake coherent and innovative policy actions covering the entire food system – from inputs and production, through processing, storage, transport and retailing to consumption – to ensure access to sustainable healthy diets for all and reduce food and nutrient losses and waste. Moreover, countries need to integrate food safety issues into food systems and food security and nutrition policies. Putting food systems on a sustainable path and promoting ecologically sustainable agricultural systems will contribute to meeting many SDGs, including SDG2, 3, 15 and 17, as mentioned in the 2019 Global Sustainable Development Report (GSDR). Furthermore, nutrition is central to the 2030 Agenda; SDG2.2 calls for an end to all forms of malnutrition, and good nutrition also lays the foundation for achieving all of the SDGs, as depicted in Figure 5 of the State of Food Security and Nutrition in the World, 2018[17].
Our food systems need to be transformed using a health, food safety and sustainable perspective for the health of people and the planet. Advocacy is needed for joint investment and action, highlighting the potential gains of these perspectives. Currently, recommendations on healthy diets are clear (i.e., what to consume and what not to consume) however, there is yet a narrative for what to “increase consumption of...” to promote food safety and planetary health. Thus, working on improving diets in isolation, without using a food systems approach is not reaching the full potential that is needed effective progress towards holistic health, safety and sustainability.
A rationale for investing in the healthy, sustainable and safe diet agendas is needed in order to develop a new food system vision. Country case studies are needed to share real-world experience on integrated policy approaches in different contexts. This could encourage governments and other food system actors to reshape the food system by making new policy commitments. The following actions can be a starting point and valuable contributions to the health action track of the UN SG Food Systems Summit.
The re-assessment and analysis of the evidence,
evaluation of policy packages,
case studies of food system transformation in different contexts and regions,
dissemination of the findings,
building the new narrative collectively,
working with decision makers on defining new SMART commitments, and
ensuring stakeholders who are contributing to better food systems are visible internationally at the 2021 UN Food System Summit, COP 26, CBD COP15, Nutrition for Growth Summit and other fora.
These actions can help decision-makers decide where to invest with greatest policy impact across food value chains with the understanding that it is not an “either/or” choice between economy and health; but a balanced investment based on science and evidence for improved wellbeing.
[1] Obesity: Health and Economic Consequences of an Impending Global Challenge. World Bank; 2020 (https://openknowledge.worldbank.org/handle/10986/32383, accessed 19 May 2020) [2] Noncommunicable diseases. Key facts. World Health Organization; 2018 (https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases, accessed 19 May 2020). [3] Institute for Health Metrics and Evaluation (IHME) Global Burden of Disease 2017 Study Highlights: Risk Factors. IHME; 2020 (http://www.healthdata.org/node/6775, accessed 19 May 2020). [4] The double burden of malnutrition: aetiological pathways and consequences for health. The Lancet; 2019 (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32472-9/fulltext, accessed 19 May 2020) [5] Series from the Lancet journals. The Double Burden of Malnutrition. The Lancet; 2019 (https://www.thelancet.com/series/double-burden-malnutrition, accessed 19 May 2020). [6] The Critical Role of Food Safety in Ensuring Food Security (https://www.karger.com/Article/PDF/452395, accessed 19 May 2020). [7] Hueston W, McLeod A. OVERVIEW OF THE GLOBAL FOOD SYSTEM: CHANGES OVER TIME/SPACE AND LESSONS FOR FUTURE FOOD SAFETY. In: Institute of Medicine (US). Improving Food Safety Through a One Health Approach: Workshop Summary. Washington (DC): National Academies Press (US); 2012. A5. Available from: https://www.ncbi.nlm.nih.gov/books/NBK114491/ [8] Havelaar AH, Kirk MD, Torgerson PR, et al. World Health Organization Global Estimates and Regional Comparisons of the Burden of Foodborne Disease in 2010. PLoS Med. 2015;12(12):e1001923. Published 2015 Dec 3. doi:10.1371/journal.pmed.1001923 [9][9] Jason R. Rohr, Christopher B. Barrett, David J. Civitello, Meggan E. Craft, Bryan Delius, Giulio A. DeLeo, Peter J. Hudson, Nicolas Jouanard, Karena H. Nguyen, Richard S. Ostfeld, Justin V. Remais, Gilles Riveau, Susanne H. Sokolow and David Tilman. 2019. Emerging human infectious diseases and the links to global food production. Available on https://www.nature.com/articles/s41893-019-0293-3.pdf [10] World Bank, 2019 https://openknowledge.worldbank.org/bitstream/handle/10986/30568/211345ov.pdf?sequence=3&isAllowed=y [11] The 2019 report of The Lancet Countdown on health and climate change: ensuring that the health of a child born today is not defined by a changing climate : https://www.lancetcountdown.org/2019-report/ [12] Food Safety, climate change and the role of WHO. World Health Organization; 2019 (https://www.who.int/foodsafety/publications/all/Climate_Change_Document.pdf?ua=1, accessed 19 May 2020). [13] Jribi, S., Ben Ismail, H., Doggui, D., & Debbabi, H. (2020). COVID-19 virus outbreak lockdown: What impacts on household food wastage?. Environment, Development and Sustainability, 1–17. Advance online publication. https://doi.org/10.1007/s10668-020-00740-y [14] Tan Monique, He Feng J, MacGregor Graham A. Obesity and covid-19: the role of the food industry BMJ 2020; 369 :m2237 - bmj.com/content/369/bmj.m2237 [15] Food and nutrition security in Addis Ababa, Ethiopia during COVID-19 pandemic: May 2020 report [16] Prevention and control of non-communicable disease in the COVID-19 response. The Lancet; 2020 (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31067-9/fulltext, accessed 19 May 2020). [17] FAO, IFAD, UNICEF, WFP and WHO. 2018. The State of Food Security and Nutrition in the World 2018. Building climate resilience for food security and nutrition. Rome, FAO.
