Changing food systems for improved health: Seeking win-wins
Food systems have much greater impact on our health and wellbeing than they are getting credit for by the popular press and in the general debate. In spite of economically well-functioning food systems, nutrition-related health problems are huge both in the United States and worldwide. These problems could be significantly reduced if health goals are explicitly considered in the decisions made in the food systems. Such decisions influence diets in a variety of ways, some positive and others negative. Unhealthy diets contribute to nutrient deficiencies and overweight, obesity and related illness. Every third non-pregnant woman worldwide is iron deficient and the number is increasing and one fourth of the world’s preschool children do not grow to their full potential, primarily because of unhealthy diets leading to malnutrition. About 15 % of the world population is obese; close to 10 % has diabetes and many more are added every day. Between 40 and 45 million Americans are food insecure, while one-third of the total population is obese and another third is overweight but not (yet) obese. Thirty million Americans are diabetic, 86 million have prediabetes and the numbers are going up. The costs of malnutrition and related illness, including those mentioned above, are huge, whether measured in monetary costs to societies or in welfare terms for the individuals affected.
So how can food systems be changed to improve health and nutrition? The obvious answer would be to assure that food systems are driven solely by health goals rather than economic goals. That is also a naïve and unworkable answer. Failure to take into account basic economic factors would lead to inefficient and unsustainable systems. A better answer is to find ways to achieve both health and economic goals. The specific win-win solutions will depend on the context and the nature of the health problem. The following may serve as illustrations:
1) Joint efforts by the food processing industry, consumer-oriented non-government organizations and government to simultaneously change consumer preferences and the content of processed foods towards a more healthy diet, e.g. more micronutrients and fiber and less sugar, sweeteners and fat, while maintaining or increasing profits in the food processing industry . Such efforts, which would be relevant in communities where obesity is the most important diet-related problem, might include nutrition education, advertising and changes in government regulations, subsidies and other policies, including those that influence relative prices of various food commodities. There is an urgent need for the interested parties to get together to design and implement a mutually beneficial solution to the obesity problem caused by the current unhealthy diet.
2) Fortification of basic food staples with nutrients that are deficient in the diet. While industrial fortification is widespread in the United States, benefitting both the processing industry and consumers, it is much less common in developing countries. Biofortification offers opportunities for higher incomes for farmers and better diets for consumers.
3) Expanded publicly and privately funded research to increase the productivity and reduce unit-costs of production of fruit and vegetables to change diets towards increased micronutrient consumption and decreased intake of dietary energy while increasing incomes to farmers, a win-win opportunity waiting to be exploited.
4) Investments in rural infrastructure, such as roads, electricity and market facilities, in low-income countries. This would reduce the post-harvest losses and marketing costs for the benefit of farmers, consumers and traders.
Many other illustrations of potential win-wins could be mentioned. The key point is that efforts to achieve health goals that are compatible with economic goals pursued by the agents in the food system, will succeed. Those that are incompatible will fail.
 Prepared for blog for Harvest2050.
 Professor Emeritus, Cornell University