Dear HLPE Project Team,
I have read through your Report with interest and commend you for the great effort and amount of work carried out. I will focus my comments on the conceptual framework which I think may need to be simplified a little, and make a small comment on section 4.2.3.
I believe the conceptual framework you have developed may be a bit “heavy”- it seems to put together 3 different sets of concepts and the final outcome is a bit confusing. To specifically respond to your question # 3, I do believe that making the concept of food environment (FE) the centre piece of the framework would help make the latter simpler and clearer and would “tighten” the text a little. This is also justified on the grounds of what you write in Chapters 2 and 3. In the these you tell us: 1) that unhealthy diets account for “at least 40% of all NCD mortality” (p.33), 2) that globally speaking the world is moving towards unhealthy diets as incomes increase. This raises the question of what kind of food is becoming more available and accessible (and partially as a consequence, more desireable) worldwide. This is where I think the Food Environment framework stands at the intersection between what the food system supplies and what people actually eat.
In my view, it is important to recognize the mediating role of food environments on what people eat, and in turn the effect that various aspects of the food system have on the food environment rather than connecting the different elements of the food system directly to diets (see Figure 6.1 in the latest Glopan Report for an illustration of this). The central message should be that food systems need to make healthier food more available, accessible and acceptable – the three pillars of food environments. The question is then how do food systems, in their various aspects which you identify as “drivers” and value chains activities contribute to making healthy food more/less available, affordable and acceptable. This is what you have started to do in Section 4.1.2, which I think should be given more relevance. What I think would be needed is to transfer information that you have under 3.2 under each of the paras on page 70. For example, section 3.2.3 could feed into para 2 on page 70 thus contributing to explaining what helps/hinders healthy food becoming more affordable. And so on… I would also categorize the policies and programmes that you have under section 4.1.3 in the same way (i.e. which contributed to making healthy foods more available, etc). That would help identify whether countries are working more on one aspect (eg: availability) and not another (eg. affordability) and whether there are any trade-offs.
The NOURISHING website has some interesting examples of policies:
http://www.wcrf.org/int/policy/nourishing-framework/about-nourishing
I think the above approach I am suggesting would also help countries focus better on what needs to improve in order to help their citizens achieve a better diet and to monitor their work. In this respect, the benchmarking work of the INFORMAS team is very useful:
https://www.fmhs.auckland.ac.nz/en/soph/global-health/projects/informas.html
On the topic of Nutrition Governance, I was happy to see that you have a section on social movements. Historically social movements related to food (especially in HICs) have focused their efforts on environmental sustainability aspects- so: locavore movements, KM 0, Farmers’ markets, box delivery schemes, etc. Increasingly however the healthiness of (such) foods is entering their narrative and becoming an important topic. What this suggests is the role played by social movements in raising people’s awareness and in partially determining a shift in consumer demand (food acceptability?). In other words, “policies” “from below” need as much attention and support as those from above.
An interesting article in this respect would be:
Huang T. et al, (2015) “Mobilisation of public support for policy actions to prevent obesity”, The Lancet, vol.385
One last small thought on the structure of the report: I think that at the moment the Report is indeed a bit too long and not focused enough. I think that taking the FE concept as a categorizing tool should help avoid some repetitions and take out links between food systems and diets that are maybe a bit too indirect. As Florence has pointed out, I would also start the Report by outlining “the problem” (i.e. increases in NCDs worldwide, triple burden of malnutrition), followed by the strong role played by diets, the evidence that diets worldwide are becoming unhealthier (Section 3.1.2), the role of FE, and the contribution of the various elements of the food system in leading to this.
Thank you for the opportunity and I hope these comments are useful.
Kind regards,
Dalia
Consultant
Nutrition and Food Security Division
FAO
Ps. I have not had time to read through all the comments that have come in- just the first ones. I may thus be repeating comments already made… apologies for that!
Dalia Mattioni