Forum global sur la sécurité alimentaire et la nutrition (Forum FSN)

Note by Sylvie Avallone on “Food systems and nutrition”

SupAgro International Center for Higher Education in Agricultural Sciences

Nutripass Research unit “Food and nutrition research in the global South”

(Institut de Recherche pour le Développement / Université de Montpellier / SupAgro)

Focus on production and processing

Thanks to the HLPE steering committee for this interesting initiative on Food systems and nutrition. In the context of sustainable development, an important challenge is to find a balance between increasing agricultural productivity, environmental outcomes and human welfare. The best way of preventing nutritional disorders is to ensure consumption of a balanced diet to fullfil requirements in all essential nutrients. This is not achievable everywhere because of environmental constraints, social inequities, limited access to nutrient-rich food and dietary habits. A food system includes all stakeholders and infrastructures involved in feeding a population at a territory or national scale. As food systems greatly differ according to agroecological areas within a country, we invite the Project Team’s experts to carefully define the scale they will use to highlight the relationship between food systems and nutrition. The territorial scale is more relevant for nutrition assessment.

In the past century, agriculture has increased productivity through mechanization, fertilization, pesticides, and selective breeding. In low income countries, many agricultural projects aimed to improve food security and nutrition. However, evidence is lacking that these interventions have had an impact on the nutritional status. A decline in food nutrient content was attributed to a dilution effect due to varietal selection mainly based on yield. Furthermore, intensification of cash-crop production and conventional agriculture with chemical fertilizers and pesticides impair local resources (soil fertility, biodiversity). Meanwhile, organic farming and agroecology are attracting more interest. The Project Team’s experts should make a synthesis of the current debate on agriculture to highlight how farmers can produce more nutrient-rich-food while preserving the environment.

Depending on the type of food system, processing is done at household, small scale or industrial level. The first purpose of processing is to stabilize the food products with post harvest technology which contributes to food security. Worldwide, trends indicate an increasing contribution of processed foods to the diet diversity of consumers. Epidemiological studies have demonstrated that the consumption of ultra-processed food is associated with a higher prevalence of obesity and metabolic diseases. Food industry has the potential to improve nutrient profiles or physiological performance of processed food with reformulation, fortification, and functionalization strategies. However, most large food industries manufacture ultra-processed foods which provide nutrients which consumption should be limited (fat, salt and sugar). When consumed inappropriately or at inordinately high proportions of a total diet, ultra-processed foods are deleterious to health. Food fortification has a special place is the debate. Food fortification with vitamins and minerals was implemented on large scale because it can yield rapid nutritional and health effects on consumers. But it does not generate income and empowerment of vulnerable populations. Again, the Project Team’s experts should make a synthesis on how small processors and the food industry could contribute to build sustainable food systems more sensitive to nutrition outcomes.

To develop food systems sensitive to nutrition issues, actionable solutions have to be identified with a systemic approach and scaled up. Knowledge gaps still exist between the actions of each stakeholder and nutrition outcomes. Researches on metrics and pathways need to be further developed. According to the literature, market development of nutrient-rich food and of diversified productive systems including local smallholders is a promising strategy in terms of food security and development. In low-income countries, capacity building of farmers, cooperatives, small processors, government and civil society is still key to providing stakeholders equal opportunities to participate in the debate at national and international level. The stakeholders are interdependent and constructive discussions have to be scheduled in the political agenda to empower local communities and social groups (farmers, women) and better share the added-value of food systems.

Note from the research unit “Food and nutrition research in the global South” (Nutripass)

Institut de Recherche pour le Développement (IRD) / Université de Montpellier / SupAgro Higher School of Education in Agricultural Science, Montpellier, France

Focus on the metrics

We thank the CFS and the HLPE for this e-consultation in preparation of the report on Nutrition and Food Systems. Considering the purpose of the report, the Project Team’s experts will have to face a very heterogeneous literature with different indicators, units of analysis, outcomes and levels of representativeness. Therefore we invite the Project Team’s experts to pay special attention to metrics and carefully consider their definitions, scope, strengths and weaknesses. To illustrate our point, we will take the example of the challenge of studying nutrition outcomes at different units of analysis: household and individual-level.

The pathway between household and individual-level is complex and may vary according to the region, composition of the household and food insecurity level. For example, in Northern Ghana where extended households are comprised of several nuclear family units, it was found that distribution of food was more favorable for children of the head of the extended household than for children of other family units (1). In South Asia, numerous studies found that male family members received more nutritious food than women (2). Due to this risk of asymmetric intrahousehold distribution of food, household-level dietary outcomes cannot adequately reflect nutritional status of household members and great caution should be taken when interpreting studies with household and/or individual-level data.

A first example relates to a publication by our group where we studied the relationship between the use of supermarkets in the Greater Tunis and diet quality as measured by the Diet Quality Index-International (3). We found an improved diet quality among regular supermarket users but, as only the diet quality of the person in charge of food shopping was assessed and linked to the household food supply, it would have been inappropriate to generalize our results to all household members.

Another example relates to the metrics of dietary diversity which are defined as the number of food items or food groups consumed by an individual or household in a given period. Indicators of dietary diversity were developed because simple measures of access to food or dietary quality were lacking. The indicators were validated (4-6) and WHO (6), FANTA (7) and FAO (8) published guidelines to help standardize these metrics. An indicator of women’s dietary diversity was validated recently (9). In the global debate on nutrition-sensitive agriculture, a growing literature addresses the complex linkages between agriculture and nutrition in rural areas of developing countries (10-16). These studies use metrics of dietary diversity at either household or individual level but some of them confuse these different levels (12,13). While both these levels of dietary diversity are assessed in a somewhat similar way, their significance differs notably. The household-level dietary diversity is a proxy indicator of household economic access to food whereas the individual-level dietary diversity is a proxy indicator of micronutrient adequacy of the diet (4-9). Because of potential asymmetric intrahousehold distribution of foods, the household-level dietary diversity cannot be used as an indicator of individual food consumption and even less as an indicator of the nutritional status of household members.

Once again, we invite the Project Team’s experts to be especially cautious when reviewing studies that address linkages between any element of food systems (e.g. supermarket use or agriculture) and nutrition. Appropriate use of the metrics should be rigorously evaluated, and separate analysis of the results and conclusions should be considered according to whether the household or the individual-level were studied. Moreover, beyond the question of the unit of analysis, the Project Team’s experts should consider issues of the type of dietary assessment method used, the relevance of the metrics chosen, and their comparability and standardization.

References

(1) Leroy JL, Razak AA, Habicht JP (2008) Only children of the head of household benefit from increased household food diversity in northern Ghana. J Nutr 138(11):2258-63.

(2) Haddad L, Pena C, Nishida C, Quisumbing A, Slack A (1996) Food security and nutrition implications of intrahousehold bias: a review of literature. FCND Discussion paper 19. Washington, DC: International Food Policy Research Institute.

(3) Tessier S, Traissac P, Maire B, Bricas N, Eymard-Duvernay S, El Ati J, Delpeuch F (2008) Regular users of supermarkets in Greater Tunis have a slightly improved diet quality. J Nutr 138(4):768-74.

(4) Hoddinott J, Yohannes Y (2002) Dietary Diversity as a Household Food Security Indicator: Technical Appendix. Washington, D.C.: FHI 360/Food and Nutrition Technical Assistance project.

(5) Arimond M, Wiesmann D, Becquey E, Carriquiry A, Daniels MC, et al. (2010) Simple food group diversity indicators predict micronutrient adequacy of women’s diets in 5 diverse, resource-poor settings. J Nutr 140(11): 2059S–2069S.

(6) WHO (2010). Indicators for assessing infant and young child feeding practices. Part 2: measurement. World Health Organization, Geneva.

(7) Swindale A, Bilinsky P (2006) Household Dietary Diversity Score (HDDS) for Measurement of Household Food Access: Indicator Guide (v.2). Washington, D.C.: FHI 360/Food and Nutrition Technical Assistance project.

(8) FAO (2011) Guidelines for Measuring Household and Individual Dietary Diversity (Food and Agriculture Organization of the United Nations, Rome).

(9) Martin-Prével Y, Allemand P, Wiesmann D, Arimond M, Ballard T, et al. (2015) Moving forward on choosing a standard operational indicator of women’s dietary diversity (Food and Agriculture Organization of the United Nations, Rome).

(10) Zezza A, Tasciotti L (2010) Urban agriculture, poverty, and food security: Empirical evidence from a sample of developing countries. Food Policy 35: 265–73.

(11) Jones AD, Shrinivas A, Bezner-Kerr R (2014) Farm production diversity is associated with greater household dietary diversity in Malawi: Findings from nationally representative data. Food Policy 46:1–12.

(12) Leonardo WJ, Florin MJ, van de Ven GWJ, Udo H, Giller KE (2015) Which smallholder farmers benefit most from biomass production for food and biofuel? The case of Gondola district, central Mozambique. Biomass and Bioenergy 83: 257-68.

(13) Sibhatu KT, Krishna VV, Qaim M (2015) Production diversity and dietary diversity in smallholder farm households. Proc Natl Acad Sci U S A 112(34):10657-62.

(14) Herforth A (2010). Promotion of traditional African vegetables in Kenya and Tanzania: A case study of an intervention representing emerging imperatives in global nutrition. PhD Thesis, Cornell University.

(15) Keding G, Msuya J, Maass B, Krawinkel M (2012) Relating dietary diversity and food variety scores to vegetable production and socio-economic status of women in rural Tanzania. Food Security 4(1): 129–40.

(16) Kumar N, Harris J, Rawat R (2015) If They Grow It, Will They Eat and Grow? Evidence from Zambia on Agricultural Diversity and Child Undernutrition, The Journal of Development Studies, 51:8, 1060-1077.

On behalf of the Swiss Federal Office for Agriculture FOAG, I would like to thank the HLPE for this opportunity to comment on this timely and important initiative.

We are very pleased to see that the report will adopt a food systems approach to look at nutrition, from farm to fork. In fact, Switzerland plays an active role in promoting sustainability all along the food chain at global, regional and national level. Switzerland is co-leading the Sustainable Food Systems (SFS) Programme of the 10 Year Framework of Programmes on Sustainable Consumption and Production (10YFP), a global multi-stakeholder initiative that aims to accelerate the shift towards sustainable food systems by adopting such a systemic approach. This Programme addresses several of the elements presented in the Issues Note (e.g. sustainable diets) and we believe that it could be highly valuable to build on these interlinkages and make best use of synergies between the work of the 10YFP SFS Programme and the HLPE report.

Regarding the main elements as presented in the Issues Note, we would like to underline that they are very relevant and overall they capture the main issues in the context of nutrition and food systems very adequately. In the first paragraph on page 1, we would propose to highlight also SDG 12 on sustainable consumption and production, in addition to Goals 2 and 13. Further, it could be valuable for the report to highlight some existing case studies on sustainable diets (e.g. Mediterranean diet).

We agree with the importance of the proposed questions to be addressed by the report, and in this regards, we would like to suggest to take into account the following core questions:

- What are the main factors determining nutritional outcomes, along the different stages of the food chain and in different regional and national contexts? Consequently, where lies the largest potential to act upon food systems in order to achieve better nutritional outcomes?

- Which are the food systems and/or elements of certain food systems that have the most positive impact on nutrition?

- What actions should be taken and/or what policies should be promoted in relation to food systems, in order to achieve better nutritional outcomes? How important is the cultural dimension with regard to the success of such actions and/or policies?

- Are there trade-offs between nutritional outcomes and the sustainability of food systems, or does better nutrition reinforce more sustainable food systems?

Thank you and we remain at your disposition for any additional information regarding the 10YFP SFS Programme.

Please find attached a submission from the UK Food Group network on the Issues Note for the forthcoming HLPE report on 'Nutrition and food systems'. We look forward to continuing to engage on this throughout the process.

Sustainable and resilient global food security and nutrition systems must provide consumers access to diverse diets with adequate amounts of nutritious foods that are safe and affordable on a regular basis. Each of these components are essential in their own right, but no single component is sufficient to overcome food insecurity.The HLPE report should address these inter-linkages. 

The HLPE report should address the nexus of nutrition in global food security systems. It should underscore the long neglected recognition of nutrition and the necessity to embed nutrition specific interventions and nutrition sensitive policies, program and initiatives throughout food systems-- from production to consumption.

The value test of global food systems will not be whether more food is produced for the already well fed, but whether critical deficiencies in food systems can be reshaped from farm to fork to eliminate poverty and provide vulnerable populations sustainable, regular access to nutritious, affordable, safe and wholesome food products. Until this goal is achieved, hunger and malnutrition will likely remain the number one global health and national security threat, killing more people every year than HIV/AIDs, malaria and tuberculosis combined. While some progress has taken place, the current status of malnutrition in the world remains unacceptable.

The report should point to the need for cooperation with related disciplines, in particular within the following areas: health, agriculture, education, environment, finance, gender, diversity, and development studies. The report should also address the need to implement nutrition-specific interventions and to embed nutrition in multi-sectoral nutrition-sensitive strategies within national and local government plans and initiatives.

The PSM believes that key considerations are:

·       Effective nutrition policies must be developed using evidence-based science in order to address all forms of malnutrition

·       Effective and efficient nutrition policies require coordination across government ministries with input from the research community, private sector and civil society

·       Food systems should place emphasis on food safety, quality, and assurance across the food supply chain

·       Protection and conservation of natural resources to sustainably continue to grow healthy and nutritious food is necessary, in particular considering the impacts of changing climates on nutrition

·       Emphasis should be put on the empowerment of women and girls as they health is directly linked to the health and nutrition of future generations

·       Nutrition education is fundamental in triggering changes in nutrition, cultural practices and diets over the long term as such programs increase public awareness of the important of eating well for good health.

·       The private sector as a producer, processor and provider of food has a fundamental role to play to achieve a more nutrition-enhancing food system by innovating and investing in the food and agricultural sector

·       Addressing issues that impact a community/s or population’s ability to thrive economically such as poverty, gender equality, water access, and sustainable agriculture. 

·       The private sector would welcome the opportunity to share good practices and case studies to demonstrate the private sector’s contribution to improving nutrition at all points along the food supply chain

Sustainability, Access, and Civil Society Engagement

Humane Society International (HSI) is one of the world’s largest animal protection organizations working to protect all animals. HSI’s farm animal welfare initiatives engage stakeholders at every stage in the supply chain for eggs, milk, and meat—including farmers, governments, food retailers, financial institutions, and consumers—to improve animal welfare and stem the unsustainable rise in meat consumption globally. We appreciate the opportunity to provide input to the Issues Note: Nutrition and Food Systems. Our key comments relate to 1) specific metrics to be used when evaluating sustainability, 2) the need for more specificity and detail when assessing food access, and 3) engagement with civil society organizations that are already working to promote healthier, more humane, and sustainable diets.

Sustainability

Those food products that require the most water and land resources, and that are the greatest contributors to climate change, pose serious threats to long-term food security. Metrics, including protein or caloric availability per kilogram of grain, or per liter of water, should play a key role in evaluating the sustainability of different food products, as should the sustainability of complete diets (e.g. Scarborough et al. 2014. Dietary greenhouse gas emissions of meat-eaters, fish-eaters, vegetarians and vegans in the UK. Climatic Change 125(2):179-192).

Further, the conceptual framework must allow for an in-depth look at the impact of different production systems on the surrounding environment and public health. For example, agricultural production systems that propagate antimicrobial resistance, release noxious odors into the surrounding community, or otherwise pollute the environment with dangerous chemical or biological contaminants must be rated for their potential dangers. The current list in the Issues Note does not adequately reflect the need for a detailed evaluation of food security and nutrition in relation to sustainability, including different production systems’ environmental and public health impacts.

Access

Assessing food security also requires an in-depth analysis of access to resources, including the disaggregation of data relating to food access and nutritional deficiencies amongst different socio-economic groups within a country. Tremendous nutritional disparities exist, not only amongst countries, but within countries as well. Developing countries with high levels of hunger and undernutrition now simultaneously bear the burden of an obesity-related public health crisis, with the number of overweight women exceeding the number of underweight women in most developing countries. In countries that bear the double burden of under-nutrition and obesity, under-nutrition is frequently greater in rural areas. The availability of disaggregated data would allow for a more nuanced approach to the growth and development of food systems. For example, the production and consumption of environmentally costly foods, including animal source foods, can be be limited and specifically targeted towards populations with relevant nutritional deficiencies. On this issue, we offer our report, The impact of industrial farm animal production on food security in the developing world (http://www.hsi.org/assets/pdfs/hsi-fa-white-papers/factory_farming_and_food.pdf), as guidance.

Further, detailed attention must be paid to the underlying social and economic causes of malnutrition in women, children, and other vulnerable or marginalized populations. Age at first pregnancy, the status of women in the household, and the availability of sanitation or health care services all play a critical role in nutritional outcomes. The conceptual framework employed must allow for detailed and in-depth analysis of barriers to accessing food, health, economic, and other resources necessary to achieve food security at household and individual levels.

Thus, the Issues Note should more comprehensively evaluate access to resources, including disaggregated data on different socio-economic groups within and amongst countries. And it should include underlying causes of malnutrition.

Engagement with Civil Society

In both industrialized and developing countries, a variety of public health, environmental and animal protection groups have launched campaigns and programs to shift consumer choice towards healthier, more humane, and ecologically sustainable food choices. A tremendous wealth of knowledge is being generated within these circles relating to the drivers of consumer choice, behavioral change (as it relates to dietary practices), and effective policy, educational, and marketing tools for promoting more plant-based eating. For example, Humane Society International is successfully promoting Meatless Monday and Green Monday throughout Asia, Latin America, and in South Africa. The Humane Society of the United States has convinced major food companies, and entire school districts in the United States to adopt Meatless Monday and similar initiatives. Leaders in the public health sphere, including the Johns Hopkins School of Public Health, also promote Meatless Monday. The CFS would benefit from tapping into this knowledge base, and drawing more of these civil society actors into the dialogue. Therefore, the Issues Note must go beyond vaguely identifying stakeholder actions and also evaluate current and past actions and successes amongst stakeholder groups, including lessons learned, opportunities to buoy and scale actions, and areas in need of further research.

Further, as evidenced by the examples above, the discussion on the need for reduced meat consumption rapidly gaining momentum across the world. It is no longer politically necessary to side-step the issue. The need for the reduced consumption of meat, egg, and milk products – particularly by consumers in industrialized countries, and mid- and high income consumers in developing and emerging economies – must be stated openly in the Issues Note.

We hope these comments are useful and look forward to discussing any questions the Panel may have.

CARE welcomes the opportunity to submit feedback here and in the attachment on the Issues Note regarding the focus of the forthcoming High Level Panel of Experts report on Nutrition and Food Systems. CARE is pleased that the Committee on World Food Security has taken up the critical issue of nutrition and the role the CFS can play.  CARE appreciates the focus of the report on food systems and all aspects of sustainability. In particular, CARE welcomes the reference in the Issues Note to Global Goal 13, on climate change.

We face a greater challenge than ever before: ending hunger and malnutrition in the face of climate change and natural resource scarcity. While much of the global dialogue on ending hunger focuses – overemphasizes, in fact – the need to increase yields, it is vital that the global community acknowledge that lack of food is not the sole cause of hunger. Inequality shapes who has access to food and the resources to grow it and buy it. It governs who eats first and who eats worst. When food is scarce, often because of extreme weather or disasters, women and girls are less likely or the last of the family to eat.  And even without crisis, cultural tradition often dictates that women and girls eat last, after men and children have eaten.  If we are to achieve the new Sustainable Development goal of ending hunger and malnutrition by 2030, particularly in the face of climate change, we must address these underlying inequalities in food systems.

Acknowledging that this focus for the HLPE report is important and complex, CARE also recognizes the role of inequality as a driver of hunger, malnutrition, and poverty, and believes strongly that issues of gender inequality and power dynamics (from household to global level, as it impacts the ability of different populations to access adequate nutritious food) must also be included. These issues should, in fact, serve as the lens through which all the questions are examined.

By beginning with questions of power and inequality, particularly through a gender lens, and examining growing threats to nutrition like climate change, the HLPE report can contribute to policy approaches, actionable solutions, and research that target underlying causes of malnutrition and contribute to sustainable, positive impact. We offer additional reflections on and recommendations for the focus of the HLPE report on Nutrition and Food Systems.

Please find attached the joint submission to the HLPE e-consultation on nutrition and food systems by World Cancer Research Fund International and the NCD Alliance.

§  Globalisation and trade : evaluate food purchasing capacity among different income level groups, role of stakeholders (agriculture producers, processors, consumers etc)

The above points would cover some of the issues highlighted by the HLPE Steering Committee as mentioned in the Issues note.

References

M Story, KM Kaphingst, R Robinson-O'Brien and K Glanz (2008) Creating Healthy Food and Eating Environments: Policy and Environmental Approaches. Annual Review of Public Health. Vol. 29: 253- 272.

FAO Report (2015). The State of Food Insecurity in the World 2015. 1-62. http://www.fao.org/3/a-  i4646e.pdf

Federation of organic development «Bio-KG», Kyrgyzstan, promote the agriculture, sensitive to nutrition, since 2012.  We support a list of issues that HLPE report will be addressed, as well as the proposals made by our colleagues from different countries. Particularly important we consider conducting qualitative research and assessments using participatory approach. This kind of studies will be a reliable source of facts in order to understand people’s situation and decide what should be done. Currently, nutrition researches in Kyrgyzstan are fragmentary.  It is difficult to understand the whole scene and identify priorities on the basis of these studies. Voices of the inhabitants of remote mountain villages, poor people, people with certain medical conditions are almost inaudible. Based on our experience in cooperation with the residents of the mountain villages, we believe that special attention should be paid:

• on the cultural specificity of the diets, the description of traditional diets and changes that occur in the power of traditional communities nowadays;

• the extensive mythology, spontaneously formed around diets, and uncontrolled flow of inadequate, incomplete and false information on nutrition;

• the social stratification of consumers and the selection of particularly vulnerable groups, which must be addressed first by efforts to improve access to healthy food;

• to the context, which includes access to other options of a healthy lifestyle, such as healthy movement, a roof over people’s heads, distress level, and so on.

• the relationship between food safety and stability of fragile agro eco-systems;

• political, economic and legal aspects of the formation of a "product package" caused by intense cross-border trade and its impact on local producers (in particular for the poorest countries, with more economically developed neighbors);

• the analysis of the effectiveness of existing civil, governmental and international initiatives in the field of nutrition, their coordination and transparency.