Healthy food, good health for all

The global population is struggling with malnutrition in unprecedented ways. Co-existing problems of underweight, overweight and micro-nutrient deficiences are interacting with climate-change, conflicts and other human and planetary factors that challenge health. A transformative change of our food environment is urgently needed to improve human and planetary health and well-being and to meet the Sustainable Development Goals (SDGs)^1-3. In particular the SDGs directly related to nutrition include zero hunger (SDG2), good health and well-being (SDG3), gender equality (SDG5), planetary health and revitalize the global partnership for sustainable development (SDG4, SDG17)⁴. Food environments are of vital importance to achieve these SDGs. This brief aims to assist technical staff, such as programme developers and managers working on reaching the SDG goals.

Food environment refers to “the interface that mediates people’s food acquisition and consumption within the wider food system. It encompasses external dimensions such as the availability, prices, vendor and product properties, and promotional information; and personal dimensions such as the accessibility, affordability, convenience and desirability of food sources and products”⁵

Currently, 1 in 9 people – 820 million worldwide – are hungry or undernourished⁶ and simultaneously one-third of the world’s adult population is overweight or obese⁷. In addition, there exists an unequal burden in terms of disease incidence, morbidity, mortality, survival, and quality of life between subgroups related to the food environment.

Persons at risk are those with diets that are high in unhealthy fats, low in fruits, vegetables, and whole grains; and high in salt. Combining nutritional adequacy with planetary health has been on the global health agenda for some time now, as emphasized by the EAT-Lancet Commission on Food, Planet and Health. However, whether such a planet healthy diet “the universal healthy reference diet” is affordable⁸ for the poorest across the globe or whether it is even nutritionally adequate⁹, especially with respect to animal-source foods for the under-nourished populations are some of the controversial questions that have been considered in this framework. These issues call for equity-focused action with respect to diets and food environments to ensure that the needs of the most vulnerable are explicitly considered.

Food environments are intricately related to the health and economic development of countries¹⁰. Investing in interventions to improve food environments for human health can therefore yield co-benefits for sustainable development¹¹; for example, providing free, healthy lunches to school children may support their educational performance, which in turn leads to better future employment opportunities and stronger workforce. Transforming local food environments with such actions contributes to the food system transformation needed for improved planetary (e.g. climate change and pollution) and human health globally. A key success factor in this transformation is identifying the agents and factors with the greatest relative impact on facilitating change premised on sustainable and equitable practices in local contexts ¹².

Why is food environment transformation an equity issue?

The food that people consume, particularly amongst the most vulnerable, is primarily determined by their food environments and not by ‘choice’¹³. Food environments have differential impacts on the health of populations, both positive and negative. Some groups are more exposed to unhealthy food environments, for example lack of financial resources decrease access to fresh fruits and vegetables, while inexpensive, low-nutrient, energy-dense food may be perceived as more attractive, placing them at higher risk of diet-related diseases.

The right to equitable health and nutrition is grounded in a human rights framework that recognizes each person has the right to adequate and nutritious food. This involves access to the resources necessary to produce, earn and purchase food, not only to prevent hunger but also to ensure good health and well-being. Food security policies and programmes require major paradigm shifts to elevate agency and sustainability as essential dimensions of food for all, together with availability, access, utilization and stability¹⁴ Health equity is the notion that all people should have a fair opportunity to attain their full health potential, and that no one should be prevented from achieving this potential. Differences in health and nutrition status between groups are socially produced, systematic in their unequal distribution, avoidable and unfair.

“Policies that promote a radical transformation of food systems need to be empowering, equitable, regenerative, productive, prosperous and must boldly reshape the underlying principles from production to consumption. These include stronger measures to promote equity among food system participants by promoting agency and the right to food, especially for vulnerable and marginalized people.¹⁵”

Promoting equity is therefore essential to delivering on the SDG promise of ‘leaving no one behind’. Equity in health refers to fair access to resources and opportunities to achieve the best possible physical, emotional, and social well-being¹⁶. This translates to addressing the needs of vulnerable groups through actions that consider and evaluate equity^{17, 18}. It also means involving representatives from vulnerable communities in the decision-making process to improve their food environments for better health and nutrition for all¹⁹.

References

1. EAT-Lancet Commission on Food, Planet, Health. Summary Report of the EAT-Lancet Commission. Healthy Diets from Sustainable Food Systems: Food, Planet, Health. Available at: https://eatforum.org/eat-lancet-commission/
   
2. The Sustainable Development Goals: https://sdgs.un.org/goals
   
3. Willet et al. Food in the Anthropocene: the EAT–Lancet Commission on healthy diets from sustainable food systems. The Lancet 2019;393;10170:447-492.
   
4. Kraef et al. Primary Health Care and Nutrition. Bull World Health Organ 2020;98:886–893.
   
5. Turner et al. Concepts and critical perspectives for food environment research: A global framework with implications for action in low- and middle-income countries. Global Food Security. 2018; 18: 93-101.
   
6. Ng et al., 2014. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. The Lancet 2014; 384(9945):766-781.
   
7. FAO, IFAD, UNICEF, WFP and WHO. The State of Food Security and Nutrition in the World 2021. Transforming food systems for food security, improved nutrition and affordable healthy diets for all. 2021. Available at: https://doi.org/10.4060/cb4474en
   
8. Hirvonen et al. Affordability of the EAT-Lancet reference diet: a global analysis. Lancet Glob Health. 2020;1:e59-e66. doi: 10.1016/S2214-109X(19)30447-4.
   
9. Adesogan A et al. Animal source foods: Sustainability problem or malnutrition and sustainability solution? Perspective matters. Global Food Security 2020; 25:100325.
   
10. Perez-Escamilla et al. Nutrition disparities and the global burden of malnutrition, BMJ 2018; 36: k2252
    
11. United Nations Development Programme (UNDP). Case studies of sustainable development in practice. Triple Wins for Sustainable Development. UNDP, 2021.
    
12. Pereira et al. Food System Transformation: Integrating a Political-Economy and Social-Ecological Approach to Regime Shifts. Int J Environ Res Public Health. 2020;17(4):1313. doi: 10.3390/ijerph17041313.
    
13. Popkin et al. The Lancet 395/10217 (2020), 65-74. https://doi.org/10.1016/S0140-6736(19)32497-3
    
14. FAO. Food security and nutrition: building a global narrative towards 2030. 2020. Available at: https://www.fao.org/3/ca9731en/ca9731en.pdf
    
15. HLPE. Summary and Recommendations of the 15th report by the High Level Panel of Experts on Food Security and Nutrition (HLPE), page 14. 2020. Available at: https://www.unscn.org/en/news-events/recent-news?idnews=2091
    
16. Peterson, Charles, Yeun, Coyle. The Health Equity Framework: A Science- and Justice-Based Model for Public Health Researchers and Practitioners. Health Promotion Practice. August 2020. doi:10.1177/1524839920950730
    
17. Food systems and nutrition equity. Global Nutrition Report, Chapter 4. Available at: https://globalnutritionreport.org/reports/2020-global-nutrition-report/food-systems-and-nutrition-equity/
    
18. Bamberg et al. How to design and manage equity-focused evaluations. UNICEF. Available at: https://evalpartners.org/sites/default/files/EWP5_Equity_focused_evaluations.pdf
    
19. Pomeroy-Stevens. Participatory Systems Mapping: Implications for Improving Urban Maternal and Childhood Outcomes. Webinar presentation, December 2020. Available at. https://www.childhealthtaskforce.org/sites/default/files/2020-12/BHC%20Webinar_12.1.2020_shared.pdf