Food systems, human health and nutrition1
In spite of rapidly increasing food production and large global food stocks, a large share of the world’s population still suffers from micronutrient deficiencies. While food is plentiful, much of it is rich in dietary energy and poor in nutrients, particularly vitamins and minerals such as iron, zinc and vitamin-A but also in some cases essential amino acids and fatty acids such as Omega 3. A focus on producing calories rather than the nutrients that are in short supply, has resulted in expensive micronutrients and inexpensive calories, primarily from carbohydrates. It is, therefore, not surprising that the prevalence of chronic diseases associated with overweight and obesity is increasing rapidly while deficiencies in certain nutrients continue to be widespread. A large proportion of the world’s population does not consume a healthy diet, either by choice or because they do not have access. Thus, efforts to improve nutrition and associated health should aim to change consumer behavior and enhance access to a healthy diet.
While direct nutrition interventions, such as health and nutrition education and targeted food distribution programs as well as primary health care, play important roles, nutrition-related interventions in the existing food systems offer underutilized opportunities for improvements in health and nutrition. The specific interventions should be tailored to each context but the following are likely to be relevant in most contexts. Agricultural research has been very successful to expand production and reduce unit-costs of production of cereals. Lower consumer prices, increasing consumption and reduced deficiencies in dietary energy resulted. Given the successes in reducing energy deficiencies, it is now time to refocus agricultural research towards expanded production and reduced unit-costs of food commodities rich in the nutrients that people are short of, including vegetables, legumes, fruits, fish, dairy products and meats. This could help reduce the price of the nutrients needed and contribute to a more diversified and nutritious diet. Instead of measuring crop yields in tons of food per ha., it would be useful to move towards a measure of the amount of scarce nutrients per ha. In addition, fish whether from marine fisheries or aquaculture; provide a very important source of micronutrients that could be expanded.
A number of other interventions to reduce the price of scarce nutrients could be pursued. Government support of improved varieties of micronutrient-rich food commodities, fertilizer subsidies targeted to such commodities, enhanced extension and advisory services to producers, and infrastructure support to facilitate private investment in aquaculture, are examples. Public and private investments in value chains for micronutrient-rich food commodities could reduce marketing costs and consumer prices. Commodity-specific subsidies and taxes such as the elimination of VAT on micronutrient-rich foods and taxes on foods and beverages with high content of sweeteners and sugar may be effective in certain contexts. However, the impact will depend on consumer preferences and behavior. For example, a tax on beverages with high content of sweeteners among people with a strong preference for such beverages may in fact reduce the consumption of micronutrient-rich foods in order to maintain the beverage consumption at the higher prices. Similarly, consumer savings from the elimination of value added taxes on vegetables may be spent on consuming more empty calories.
A refocus of food processing from inexpensive, ultra-processed foods with high content of sugar, sweeteners and fat towards inexpensive micronutrient-rich foods, associated with nutrition education and an advertising campaign to promote such foods would help slow down the trend towards an obese, nutrient-deficient population. Post-harvest fortification of foods short of essential nutrients has been effective in reaching some urban populations although most rural poor have been missed. Biofortification, which is still in its infancy, although it has already been successful in sweet potatoes, offers very promising opportunities for reaching nutrient-deficient rural and urban populations, particularly those whose diet consist of one or two basic stables such as maize and cassava, high in calories but low in micronutrients.
Interventions to reduce poverty should be a goal in itself but the impact on nutrition and associated health may be positive or negative, depending on the context. The additional incomes may be spent on excessive intake of dietary energy resulting in obesity and chronic diseases, while micronutrient deficiencies and associated health problems may continue to exist. Unfortunately, that appears to be rather common in environment with access to cheap calories. Widespread iron deficiency in low-income obese women is a case in point. Poverty alleviation is most likely to result in nutrition improvements when accompanied by access to inexpensive micronutrients and education and in the absence of advertising campaigns for ultra-processed foods.
The nutrition effects of food systems, which include smallholder farmers in low-income countries, may be improved by alleviating the pressure on women’s time, through productivity-increasing, time-saving innovations and redistribution of intra-household responsibilities, making more time available for the production of micronutrient-rich foods in home gardens or farmers’ fields, food preparation and storage, child care and participation in food and nutrition deliberations and technical advice.
Assuring good health and nutrition during the pregnancy period and the first 2 years of a child’s life, currently referred to as the “1000 days after conception” is of particular importance because of the risk of irreversible damage to the child during that period. A large share of low-income pregnant and lactating women is in semi-subsistence farming. Many are deficient in essential nutrients. Iron deficiency is particularly prevalent. Changes in the portfolio of the crops and livestock produced and consumed by these women towards more diversity is likely to lead to a more diversified diet, with a higher content of micronutrients. Changes in food systems towards the production of a diversified portfolio of foods, with lower unit-costs of micronutrients, would also help replace weaning foods consisting mostly of sugar water and other empty calories, with a more nutritious food.
In a market system, the behavior of farmers, processors and others in the food system must be guided by what is demanded at a price sufficient to assure a reasonable economic return. Nutrition goals will change their behavior only if such changes are compatible with consumer preferences, economic goals and government policy. That is an important but often overlooked consideration in the current well-meaning but sometimes naïve debate about more nutrition-friendly food systems. The challenge is to design the above suggestions so that economic goals are achieved as well. We need win-win solutions.
1 Prepared for Nestle Foundation’s special 50th anniversary Annual Report, 2016
2 Graduate School Professor and Professor Emeritus, Cornell University and Adjunct Professor, University of Copenhagen