Researchers warn that poor diet quality is now the number one risk factor killing more people than several other diseases combined. Even the ones who have enough to eat are not eating the right types of diverse foods, in optimal amount or time. The Global Nutrition Report 2018 documents that while more than four in 10 children drink sugary drinks daily, one in three does not eat fruits every day. There’s not one income group that’s eating enough healthy foods, like vegetables, whole grains or legumes. While 821 million people sleep hungry each day, two billion of us are overweight-obese on this planet. This poses a double whammy to public health, because low birth-weight or stunted children are more vulnerable to obesity and non-communicable diseases— diabetes, heart problems, hypertension and more. The food environment doesn’t help either if they live in a country where the market for unhealthy, processed foods is expanding rapidly. Recently published analysis of over 23,000 packaged food products found the vast majority (69 per cent) were of relatively poor nutrient quality (high in added sugar, sodium and unhealthy fats) especially in two most populous countries India and China. Diet diversity is plummeting and the frequency of eating out is increasing multi-fold—reveal national surveys and research studies.
The past decade has been illuminating and exciting for nutrition advocates like me. A lot of attention is being rightfully given to eradication of malnutrition in all its forms. In fact, sustainable, resilient food systems for healthy diets have been identified as the first of the six pillars for action during the UN Decade of Action on Nutrition (2015-2025). A sustainable food system is defined as the one “that ensures food security and nutrition for all in such a way that the economic, social and environmental bases to generate food security and nutrition of future generations are not compromised”. A sustainable global food system by 2050 means sufficiently healthy food for all, with no additional land use conversion for food, protection of biodiversity, reduced water use, decreased nitrogen and phosphorus loss to waterways, net zero carbon dioxide emissions, and significantly lower levels of methane and nitrous oxide emissions.
Climate change is being recognised as a more active adversary for nutrition than previously contemplated. Every one degree rise in temperature results in about 10 per cent loss in production of staples. This small rise also translates to big nutrient losses in the form of dilution of water soluble vitamins and minerals, especially in fruits and vegetables. Additionally, climate change results in more floods, famines and other adverse situations which make disadvantaged people even more food insecure. Climate change can have an impact on environmental health issues, such as sanitation, water availability, access and quality and the transmission of waterborne, food-borne, vector-borne, and other diseases. Such diseases, in turn, reduce the body’s absorption and utilisation of essential nutrients, effectively increasing overall nutritional needs. The linkages between agriculture, public health, environment and nutrition are being discussed but the pace and quantum of discussion urgently need to be accelerated across all possible platforms.
Thus during this Poshan Maah celebration in India, we present five key strategies which may guide action to tackle multiple forms of malnutrition from a multi-sectoral (especially, environment) lens.
1.EVIDENCE SYNTHESIS
Generate and/or collate (as required) evidence and action plan. Lucid Statement of Purpose are urgently required. Use the knowledge pool of experts globally, best practices, case studies. Example: Sustainable agri-models like agro-ecology may be able to feed the world better and longer. Agro-ecology utilises local knowledge and know-hows of farming and improves smallholder farmers’ yield, income, resilience to climate change and helps meet the challenges of climate adaptation and mitigation. The recently released EAT-Lancet Commission this year outlines a planetary health diet and targets for sustainable food production that, when combined, can prevent 11 million premature adult deaths per year and help us move towards a sustainable global food system by 2050. This planetary health diet chart emphasises increasing the consumption of local, healthy, diverse diets with fresh fruits, vegetables, nuts and legumes and small portions of meat and dairy. Developing guidelines based on the planetary health diet incorporating all above-mentioned domains, and supporting the implementation of these guidelines through regulatory efforts must be prioritised.
2.STRENGTHEN POLICIES AND PROGRAMMES FOR CONVERGED ROBUST ACTION
Attaining and sustaining food and nutrition security in a changing climate requires a multi-sectoral approach involving public nutrition, agriculture, health, and social protection. There are also important links to education (especially women and children), water supply, and sanitation, as well as to cross-cutting issues like gender equality, governance etc. Leverage existing policies and strategies to advocate for greater integration and inform joint planning, objective setting and monitoring. Using appropriate financial levers and fiscal policies, people must be empowered to access healthy foods and reduce food waste and food loss. Policies should have a greater emphasis on the nutritional quality and dietary diversity of agricultural food production for local consumption. Policies must also be gender-sensitive to allow women farmers to balance their child-care responsibilities and farming.
Evidence suggests that climate-resilient agriculture can contribute to improving dietary diversity and nutrition by; integrated traditional agroforestry systems which promote the sustainable exploitation of nutrient-rich forest products; integrated farming systems exploiting the synergies of horticulture, aquaculture, and small livestock rearing to reduce waste and expenses on agricultural inputs and increase food production diversity. The Aid for Trade programme, initiated in 2005, is a positive example of several global institutions (e.g. WHO, FAO and the World Bank) collaborating to ensure that the health and trade sectors enhance health and development by fostering policy coherence across sectors. International trade agreements may have considerable impact on domestic food environments. Multiple sectors, ministries, departments need to talk the same language and have common vision. Leverage work done and existing resources, plan for collaborative work.
For instance, across the tribal-dominated districts of Chhattisgarh, the government has launched the Poshan Vatika scheme to raise the nutrition levels of people, especially women and children. In the same state, a new scheme - Narva (watershed management and revitalising the water table and water resources) Guruva (livestock management), Ghurva (composting and creating biogas) and Baadi (nutri-garden for home consumption) programme is being implemented through convergence between various departments such as Horticulture, Agriculture and Livestock, Panchayati Raj and Rural Development and the Forest Department. Another successful multi-sectoral project SWAN (Safe Water and Nutrition) focused on both talking about and showing communities in Vietnam that safe water and safer, more nutritious food would improve their children’s health.
3.LEADERSHIP AND ACCOUNTABILITY
Demonstrate political leadership in setting national food-system strategies and initiatives with attainable time bound measurable targets. Policymakers and practitioners should capitalise upon existing knowledge, synthesised high quality evidence in form of best practices and promote positive local risk management and coping holistic strategies. Accountability must be set a priori and empowered committees should monitor periodic progress including challenges and achievements. Leaders must demonstrate practices which ensure transparency, accountability, citizen participation and inclusion, and the minimisation of conflicts of interest in policy development.
4.ACCELERATE CAPACITY BUILDING EFFORTS
India has poor capacity to manage public health and nutrition sectors. Whether its short training programs or integrated curricula with pooled knowledge, we need to invest in awareness building, imparting relevant skill, strengthening capacity to deliver required interventions etc. Use of media and technology should be harnessed to amplify the effect. Education, communication and social advocacy around strengthening local food systems, promoting cultivation and consumption of local micronutrient-rich foods should be emphasised. Better research and development programmes to improve post-harvest management (food storage, transformation, handling, and processing) to reduce losses in quantity and nutrient content may also contribute to nutrition security. School-based approaches (school feeding programs, school gardens, nutrition education, etc.) can support child nutrition through improved WASH practices, diverse plant based diets and practical nutrition education. These early exposures help to provide a platform for sensitising both children and parents/caregivers, creating young ambassadors and future leaders.
5.PERIODIC MONITORING, SUPPORT AND FEEDBACK LOOP
Government action is essential to increase the healthiness of food environments, reduce all forms of malnutrition and their related inequalities. Create stringent systems to check growing influence of commercial interests on public policy development. Using technology and multiple communication channels, we must strengthen support systems, grievance redressal and provide unconditional hand holding as and when required. Designing or strengthening social protection systems to protect vulnerable population groups is also an essential component of this. Innovative example of climate risk management is the Livelihoods, Early Assessment and Protection (LEAP) project, in which the World Food Programme, supported by the World Bank, has assisted the Government of Ethiopia in the development of a comprehensive national weather risk management framework. LEAP links Ethiopia’s Productive Safety Net Program to a contingency fund.
Every 1 per cent decrease in the poverty rate achieves a 0.25 per cent reduction in the malnutrition rate, a reduction of 1 per cent in undernutrition eventually yields a 4 per cent decrease in poverty. Therefore, nutritional interventions are essential to speed up the reduction in poverty. However, even if good progress is made in tackling undernutrition, those efforts could very well be neutralised by climate change if the impacts and threats of climate change to nutrition security are not properly addressed. So far, current climate change-related policies and practices have not considered agriculture, food security, social protection, health, and nutrition contexts, when in fact a more integrated approach and coherence are needed. Suposhit, Swastha, Swachh Bharat vision needs to act cohesively and urgently, especially from the sustainable environment and resilient food systems perspective.
Dr Shweta Khandelwal is Head of Nutrition Research and Additional Professor of Public Health Foundation of India
(Picture Credit: Photograph by Aron Visuals, Unsplash Photo Community)
