No one will disagree that diverse, nutrient-rich and safe diets support public health, provide immunity, and better intergenerational (pregnancy and birth) outcomes, crucial for a productive life-course.
The just released evidence-based Global Panel on Agriculture and Food Systems for Nutrition’s Foresight 2.0 report (https://www.glopan.org/foresight2/) offers very comprehensive policy solutions to improve the quality of diets using a food systems approach through promoting availability, accessibility, affordability, desirability, and sustainably, healthy diets for all. This one line aspiration builds on years of a credible body of evidence pouring in from around the globe on prioritizing and accelerating action on public health and nutrition. The significance of this release was amplified at least in India by the fact that we are celebrating our third National nutrition month (Rashtriyaposhanmaah 2020).
First up, some grim glaring global statistics picked from the report to highlight the gravity of the issue around poor diets being the top killer in today’s times. Sub-optimal diets are now responsible for 20 per cent of premature (disease-mediated) mortality worldwide, as well as for 20 per cent of all. About 690 million chronically undernourished people inhabit the world currently. Of these, 200 million reside in India alone. Nearly 3 billion people globally are unable to afford a healthy diet, and we are aware that poor-quality diets are linked to 11 million deaths annually.Thus no wonder that an estimated 26 per cent of the world’s population experienced hunger or did not have regular access to nutrient-rich and sufficient food in 2019. All this has huge implications on the productivity of masses, thereby impacting the economic growth of any country. Even the 2019 State of Food Insecurity and Nutrition in the World report projected that undernutrition will continue to impede economic growth across South Asia and sub-Saharan Africa, cutting GDP by up to 11 per cent per year.
The report highlights that diets, health, and environment are and will be the coming decade’s critical challenges. Current systems do not enable us to fight these multiple challenges. It urges that food systems must undergo a process of transition to deliver sustainable, healthy diets. The report also identifies several factors impeding necessary progress on policy change, namely powerful actors pulling in different directions, motivated by factors unrelated to health or food system sustainability; misaligned policy incentives distort food system goals; short-termism and siloed agendas.
The transition of food systems requires a long-term focus and a coherent set of commitments and actions. Dietary patterns, drivers of dietary choice, and sustainability of food system practices (from production through to post-retail waste) must be put at the centre of national dialogues. The key interventions in four parts of the food system have been outlined: producing the right mix of foods in sufficient quantities to deliver sustainable, healthy diets; ensuring those foods are readily accessible and also affordable to everyone; and ensuring that they are desirable to all consumers.
In terms of the complexity brought forth by the covid-19 pandemic in achieving healthy diets for all, the Food and Agriculture Organization of the United Nations (FAO) asserted that “while no foods or dietary supplements can prevent covid-19 infection, maintaining a healthy diet is an important part of supporting a strong immune system”. Several papers and analyses have suggested that the Novel Coronavirus pandemic is exacerbating all forms of malnutrition. It is also known that people who face malnutrition are also more likely to be severely affected by covid-19.
The report takes into cognizance the reality of major policy change in Low and Middle Income Countries in the form of practical considerations like the complexity of food and environmental systems in a context where policy actions on food, health, agriculture, and climate are generally managed separately; competing priorities for:
•governments who have to make difficult policy choices,
•private companies making investment choices on product portfolios or retail strategies, and
•households making food-purchase choices; uncertainty about, and mistrust in, scientific evidence.
Food systems are a major source of greenhouse gas emissions (25-30 per cent of total). It is recognized that the impact of climate change will alter the way food is produced and the quality of our diets. As the report notes “A low-income country with an annual average temperature today of 25°Ccould see a fall in national economic growth (Gross Domestic Product or GDP) of 1.2 per cent for each 1°Cincrease in temperature.” Nutritious foods are too good to waste. About 25 per cent of available calories and protein are lost globally, roughly 10–15per cent of fats, and 18–41 per cent of vitamins and minerals, including 23–33 per cent of vitamin A, folate, calcium, iron, and zinc. This must be curtailed urgently because the role of healthy diets in the future well-being of almost 10 billion people can no longer be ignored. A shift towards more sustainable, healthy diets may reduce GHG emissions by 41 – 74per cent in addition to improving productivity, growth and resilience to climate shocks.
Thus to manage the transition, we must resolve policy distortions and incoherence, establish multi-win targets attractive to multiple constituencies and leverage existing or planned food system interventions. All these pointers may appear challenging to act upon but as public health professionals, we stress that action must not be delayed on the pretext of complexity.
But every cloud has a silver lining! The suggestions in the report are absolutely doable with political engaged leadership, financial commitment, motivated human resource ready to act to make a difference, guidance from high quality evidence for timely concerted multi-sectoral action. We must recognize this as a window of opportunity to act in the interest of public health and nutrition for the 10 billion people especially the vulnerable ones.
Let us rise to this challenge and show that our passion and commitment to tackling multiple forms of malnutrition will overcome these daunting statistics.
(The author is the head, Nutrition Research and Additional Professor with Public Health Foundation of India)
