Global Forum on Food Security and Nutrition (FSN Forum)

GENERAL COMMENTS ON THE HLPE REPORT ON NUTRITION AND FOOD SYSTEMS

This report is very welcome. The extensive references are very useful, there are some eye-opening data, and there is a good range of cases.  My comments are mainly on the consumer’s actual and potential role in the food system, which I feel deserves more attention, and a number of imbalances in the coverage. Specific comments are made in the notes on the attached pdf.

1.    The “education” dimension needs more prominence, coherence and specificity.  “Education” in food and nutrition now means anything (including independent insights, perceptions and actions) which results in informed food practices (the currently accepted definition of “nutrition education” is given in the comments on the text). The various schools of thought and practice (STPs) (e.g. “food and nutrition education”, “communication”, “behaviour change”, “behavioural economics”, “social marketing”) which outline, practise and test essential processes, structures and theoretical frameworks in nutrition interventions, need to be defined early in the report and the terms handled correctly and consistently. 

(a)  Specifically, the current philosophy of "nutrition education" is misrepresented as meaning information dissemination. 

(b) Generally, many of the interventions mentioned in the report (e.g. community development, service training, counseling, health promotion, social marketing, consumer education, awareness-raising, political advocacy, labeling, ENAs, conditional social protection schemes) involve consumer outlooks, understanding, attitudes, perceptions and practices, and hence some form of education. The report has a tendency to comment in passing on the effectiveness or ineffectiveness of such approaches rather than recognizing commonalities and linking them to the principles promoted by the STPs. 

(c) All STPs have inbuilt limitations and strengths, which should be acknowledged when proposing strategies (e.g. “nudges” work only in specific conditions).  A consistent stance should be taken, for example, on the effectiveness of information dissemination, community dialogue, different forms of mass media etc.

(d) A great deal is known by STP practitioners about what works and what does not. It would be desirable for a team of at least three experts from different STPs  to be invited to review the report at this stage, agree on the use of the terms and suggest clarifying detail.

2.    Socio-cultural drivers (p.57) This is the field of action of the STPs mentioned above. There is considerable evidence for a  more elaborate picture than the one presented here (see e.g. Contento,2007[1]). Socio-cultural drivers should include (among other elements) (a) the inertial power of acquired habits and skills and the time it takes to change them, (b)  household food expectations as a drag on change (change is easier for individuals), (c) time and convenience for HH cooks (major factors in the nutrition transition), (d) the social values given to specific foods (e.g. F&V not seen as a “real” food, pulses as “food of desperation”, soda drinks as young and glamorous, meat as an aspirational luxury),(e) “health beliefs”, especially the perception that what one eats makes a real difference to one’s health, (f) the practice/ understanding of prevention rather than cure in all health matters, including diet, (g) the habit of making changes, maintaining them and passing them on to the next generation, and the confidence to do it (“self-efficacy”), (h) the practice of getting information, knowing where to get it, and acting on it.   All of these are more widespread and influential than specific food taboos, which seldom have a critical effect on overall diet quality. 

3.    Access, availability and utilization: Theory of change.  The report often makes the assumption that access and availability will change dietary behaviour. For example, “Lack of affordable nutritious food can create a marked barrier to consumption” (p.70)– but so can perceptions of nutritious food and belief in its value, even in situations of scarcity. (The experience of the International Year of Pulses has highlighted some of these barriers.)The limitations of this mainly economic change model should be spelt out, exemplified and taken into consideration throughout the report.

4.    Balance and discrepancies in emphasis  Several parts of the report focus on one aspect of the issue at the expense of others – e.g. developed vs developing countries, smallholders vs industrial agriculture, high tech and low-tech solutions, obesity vs undernutrition.  In particular:

-       Environment and behaviour  A main assumption is that environments condition consumer behaviour (e.g. p.99). This is of course correct, but the influence is reciprocal, as implied in Fig. 1 (food system): environment and consumer are both conditioned and conditioning: e.g. having only fast-food restaurants in an area limits the eating-out possibilities, but if there is consumer demand for fast-food, the market is likely to supply. The trick is to work out the balance of influences in any given context.

-       Community development, consumer capacity, consumer demand are treated well, but do not get the attention that they deserve in relation to other parts of the food system.  There is evidence that supplyside actions frequently need to be reinforced by social acceptance and readiness to change.  In Fig. 27, for example, surely one of the main entry points for nutrition must be consumer demand for healthier food (as shown in the Conceptual Framework, Fig.1).

-       Agriculture’s impact on nutrition A great deal of attention is given to improvements in agriculture, PH losses, marketing etc. but the claim is also made (p.109) that there is “little empirical evidence on the role of agriculture and other nutrition-sensitive sectors on nutrition”.  Such discrepancies need to be aired.

-       Information and advice  Although the report states that information and advice alone have weak effects on changing dietary practice, much of the document assumes that information is the only “educational” strategy required - e.g. labeling and dietary guidelines figure in the model of the food system in Fig 1 as “educational” aspects of the food environment (both are likely to be ineffectual without some more diverse implementation strategy). The report proposes (near the end) to explore whether information makes a difference – however it needs only cite the existing evidence.

-       Emphasis on specific micronutrients  The report states (p.35) that "the best estimation of the relationship between diet and health consists of evaluating global dietary patterns and not in the analysis of specific foods and nutrients".  However the text goes on to look in depth at three specific micronutrient deficiencies. Should there be more on overall dietary imbalances?

-       Supplements and food-based solutions The issue of micronutrient supplements vs food-based solutions is rightly raised - needs more discussion?

-       School meals  The report claims that feeding programs - particularly school feeding - have “a direct impact on nutrition and diets”. The impact of school feeding needs a more nuanced discussion, especially in view of the relatively great length of some of the other sections in the report (e.g. on trade), the enormous sums which are spent on school meals, and the absence of evidence of nutritional impact (according to the Global School Feeding Sourcebook). Further questions about school meals are whether they have any concurrent impact on home diets, or longitudinally on children’s food choices when they become adults –i.e. whether there is any real effect on attitudes, understanding or food practices. I do not know of any studies in these areas. 

-       Policy p.69  What about examples of policies and programs aimed at improving consumer awareness and demand? 

5.    Strategy choices  How are policy-makers to choose between, balance or combine the different options for tackling national nutrition issues? Ideally governments should be able to map what is already in place, assess its cost and review models of other countries’ overall policies and plans. Cost-effectiveness and long-term, sustained impact on food practices are key criteria. The ICN2 Framework listed desirable actions, but did not supply the means for governments to arrive at workable and affordable strategy choices based on their own situations.  What guidance can this report give?

6.    Some gaps in coverage are urban agriculture, consumers’ associations, and professional training in FNE/BCC in national services.

Jane Sherman, Food and Nutrition Education consultant

Rome 26.11.2016