What do I need to change about my food system to improve diets and nutrition? That’s the question so many policymakers need an answer to, whether they are sitting in a low-income, largely rural country or a large city in a high-income nation. Food systems everywhere, in all their diversity, need reorienting to make healthy, nutritious diets more available, accessible, affordable and appealing.
There are many actions that can be taken to enable and incentivise food systems for better diets. That’s part of the attraction of engaging with food systems on the journey towards the as yet distant goal of ending malnutrition in all its forms. The potential is huge, whether it’s for tackling wasting, underweight, stunting, obesity, or diet-related non communicable diseases. And there are many stellar reports out there that have identified what can be done. In 2017, for example, FAO published Nutrition-sensitive agriculture and food systems in practice; options for intervention which lists scores of possible actions in different domains of the food system that can support nutrition. The report by the High Level of Panel of Experts (HLPE) of the Committee on World Food Security Nutrition and Food Systems did likewise.
These reports wisely make clear that actions should be guided by context and target population. What will enable and encourage local communities to eat more fruits and vegetables in London and New York is going to be quite different to parts of rural South Asia. We have also seen this in the wake of the coronavirus pandemic. All kinds of different solutions have been implemented to fix the functioning of the food system to get nutritious foods to people who need them which differ between contexts. This blog series alone has reported on a whole host of solutions, from community kitchens in South African townships to urban agriculture in the Philippines and e-commerce in China.
But there are some actions that are needed everywhere in order to get food systems working for healthier diets, wherever you are. Actions that no policymaker, business leader or NGO-programme committed to improving diets would ever regret taking because in whatever context, they are likely to have impact and they are feasible to implement.
So, what are these actions? This is the question we are asking ourselves in a project called “No Regrets” where we are trying to figure out if there are actions all policy makers need to take to improve diets across all dimensions of food systems, actions that are relevant and implementable everywhere. We do not expect the list to be long, but the indications from the work we have done so far is it’s going to be possible, albeit not perfect.
So what have we done so far?
Given the extensive thinking done so far on this topic, and the many recommendations out there, we started by building a long list of actions drawn from expert reports. This enabled us not only to respect and engage with the great expertise already there, but also provide a base on which to build in the future as new reports and evidence emerge – the new report due out from the Global Panel on Food Systems and Nutrition (GloPan) next week (September 29), for example.
We included reports which recommended actions specifically designed to reorient food systems towards healthier, more nutritious diets as supported by an expert, evidence-informed review. Based on these criteria, we selected 12 reports from our initial list of 47 reports on food systems. We then carefully extracted all relevant recommendations from each - well over 200 in total. On closer look, we found that the intention of the many of the recommendations was for the action to be implemented as part of a broader package. For example, a recommendation on improving transportation infrastructure to ensure perishable, nutritious foods can reach markets was made in the context of also improving storage facilities. This was because without this type of approach, it was perceived that the action would have less impact. We thus used a decision-tree to ensure we were correctly representing the more holistic spirit of most of the recommendations, producing a list of 53 actions more clearly focused on having impact on the availability, access, affordability and appeal of the relevant food groups (we were concerned with reducing the unhealthy stuff as well as increasing nutritious foods). We checked and re-checked the source material through the decision-tree, emerging with 41 actions.
The next stages were to assess if the actions were likely to have impact. So we worked through a pathway to impact for each of the 41, assessing what impact they could have, in theory, on the target populations and relevant foods through food supply systems, food environments and consumer behaviour. We also assessed what factors on the ground might undermine their ability to have impact. Throughout this process we were acutely aware that the situation on the ground can look very different to expert reports formulated in remote spaces. So next, we will be engaging with food system and nutrition practitioners out there to ask: how likely, based on your experience is this action to have impact? Does it deserve to be one of those actions we can be confident in recommending everywhere? (If you’d like to participate, please get in touch.) This will be followed by more in-depth interviews to get to questions of feasibility of implementation. We will also be incorporating the longer list into the Food Systems Dashboard to support decision-making about what actions are needed in different contexts.
We are under no illusion that identifying the technical actions needed for our food systems to work better for healthy diets is all that is needed. Overcoming barriers in political economy and governance is an even greater mountain to climb. But as we continue to navigate the challenges brought on by COVID-19, at least we can have a quick answer to that question: if I am to do something, what should it be? It’s a small piece of the puzzle but we think it will help.
Corinna Hawkes is the Director of the Centre for Food Policy, Vice Chair of the London Child Obesity Taskforce and champion of effective food policy. She is a regular advisor to governments, international agencies and NGOs, she has worked with international agencies, governments, NGOs, think tanks and universities. Her work is concerned with all forms of diet-related ill-health, including obesity, malnutrition and diet-related non-communicable diseases, with a current focus on obesity prevention. She is also a Distinguished Fellow at The George Institute for Global Health. For more information on Corinna, see her full profile.
Stephanie Walton is a Research Assistant at the Centre for Food Policy, City, University of London Stephanie is a Research Assistant, where she works on the SHEFs project (Sustainable and Healthy Food Systems) and the 'No Regrets' Actions project. She also contributed research to inform the development of England's National Food Strategy. For more information on Stephanie, see her full profile.
Lawrence Haddad is Executive Director of the Global Alliance for Improved Nutrition (GAIN). In 2018, he was awarded the World Food Prize along with David Nabarro, former Special Adviser to the UN Secretary General. Prior to this, Lawrence was the founding co-chair and lead author of the Global Nutrition Report from 2014 to 2016. From 2004 to 2014, Lawrence was the Director of the Institute of Development Studies (IDS), and from 1994-2004 he was Director of the Food Consumption and Nutrition Division at the International Food Policy Research Institute (IFPRI). See more here.
Jessica Fanzo is Bloomberg Distinguished Professor of Global Food & Agricultural Policy and Ethics at the Nitze School of Advanced International Studies (SAIS), the Berman Institute of Bioethics, and the Department of International Health of the Bloomberg School of Public Health at Johns Hopkins University. She also serves as the Director of the Global Food Ethics and Policy Program at Hopkins, and plays key advisory roles in Johns Hopkins’ Alliance for a Healthier World on the food security and nutrition theme, as well as the Bloomberg American Health Initiative on obesity and food systems. Read more.