Shaping Sustainable Food Systems

for Healthy Diets and Improved Nutrition:

Implementing the ICN2

Framework for Action Recommendations

Patrick Webb

Friedman School of Nutrition Science and Policy

Tufts University

United States of America

1990 2015

Poverty

Mortality

Illiteracy

Malnutrition

Communicable diseases

Famine deaths

Many improvements in human well-being

Today

30% people

affected by

malnutrition

By 2035

Malnutrition

could affect

50% people

Source: Global Panel (2016) Foresight Report

Malnutrition now found in 193 countries.

790 million undernourished, c.2 billion have

micronutrient deficiencies, 2 billion overweight/obese.

Most malnutrition not in low income countries!

Malnutrition pervasive and increasing

Source: IFPRI (2015) Global Poverty Report 2014/15. Washington, D.C.

Most malnourished people live in Middle Income Countries

Top Risk Factors for Global Burden of Disease

Source: Mozaffarian (2016) Circulation

China: 32% overweight & obese adults in 2012; likely rise to 51% by 2030.

Nigeria: adults with diabetes could double by 2030 to reach 3 million.

Ethiopia: adults with diabetes could double by 2030 to reach >6 million.

Bangladesh: more adults with diabetes by 2030 than Mexico or Indonesia.

Business as usual will generate a

catastrophic health crisis

Malnutrition is rising globally.

Low diet quality is common to all malnutrition.

Business as usual will bring huge nutrition and health crisis – its already started...

Tweaking at the margins won’t suffice. We need

a radical transformation of our food systems –to nourish not just feed 9 billion.

Summary so far…

ICN2 framework is good starting point

Develop, cost national plans - [R2]

Increase domestic finance for nutrition - [R4]

Develop guidelines for healthy diets - [R13]

A voluntary framework, addressed mainly to

government leaders.

Strengthen local food production - [R9]

Promote farm diversification - [R10]

Build capacity of frontline workers - [R20]

Needs specificity on how, and more ambition!

Go big…or go home!We need to be more demanding and aspirational

1. Fully implement known evidence-based actions

2. Re-direct agricultural subsidies

3. Re-focus agriculture research priorities

4. Re-think global food trade for year-round access

5. Industry incentives/taxes for healthier products

6. Consumer incentives for healthier choices

7. Dietary guidelines to guide policy

8. Metrics and data on global diet quality needed

9. Game-changing climate change opportunities

1. Fully implement evidence-based actions

1,000 days are key. In utero nutrition/health!

Small for Gestational Age accounts for 30%

of stunting age 3y.

10 targeted interventions can cut 20% of

child stunting in high burden countries.

US$7 billion/year to achieve 2025 targets

for stunting, anemia, exclusive breastfeeding,

severe wasting (not obesity, MN deficiencies):

The cost of targeted actions?

50 countries spent US$585 billion annually to

support agricultural production since 2013, plus

US$87 billion on services supporting the sector.

Almost 70% provided as market price support.

“Little support provided directly addresses the

recognized challenges…of the sector.”

2. Agricultural subsidies

Source: http://www.oecd.org/tad/agricultural-

policies/producerandconsumersupportestimatesdatabase.htm

Total government support to agriculture (% GDP 2015)

Direct subsidies for animal products and feed

Source: Global Panel on Agriculture and Food Systems (2016)

3. Focus of agriculture research must change!

The evidence for

policy decisionsNew studies do support hypothesis that

agriculture can be correlated with better

diets and nutrition.

Homestead gardens, farm diversification and

production of fruits, vegetables, aquaculture

“can potentially improve nutrient intake.”

But…we have to go beyond home gardens

and single nutrients to system-wide change.

Exports from India of processed

foods FY16 (US$ million)

4. Global food trade to support access to

nutrient-rich foods

622.1 566.4Among broad sectors of the U.S. economy,

agriculture and food would see greatest

gain; output would rise $10 billion by 2032.

Trans-Pacific Partnership would benefit

trade in fresh fruits, vegetables and nuts

which is currently hampered by sanitary

and phytosanitary restrictions.

Global food retail industry valued at >US$4 trillion

(2015); rising to US$7.5 trillion by 2020.

Source: https://www.ers.usda.gov/topics/international-markets-trade/global-food-markets/global-food-industry.aspx; http://www.reportlinker.com/p03549658-summary/Analyzing-the-Global-Food-Retail-Industry.html;

5. Incentives for food industry must change

6. Consumer incentives for healthy choices?

Stuckler D, McKee M, Ebrahim S, Basu S (2012) Manufacturing Epidemics: The Role of Global Producers in Increased Consumption of Unhealthy

Commodities Including Processed Foods, Alcohol, and Tobacco. PLOS Medicine 9(6): e1001235. doi:10.1371/journal.pmed.1001235

http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001235

Average Annual Price Change since

1990 for middle-high income countries

(China, Mexico, Brazil, Korea, UK)

Source: Wiggins and Keats (2015) ODI

7. Dietary guidelines to frame policy actions

Food-based dietary guidelines missing from low-

income countries (present only in 2 out of 31)

Need dietary guidelines, but to guide food policy

decisions, not just to inform consumers

8. Metrics and data (for accountability

and transparency)

Urgent need for better data and metrics

for diet quality and the food system.

Diet is No. 1 risk factor for global

burden of disease…but

UN has no global database on diets

Not an SDG target!

Policymakers should demand much more of their food systems – as vehicles to protect health, productivity.

What needs to happen right away?

Start with nutrition/diet quality problems, and work

backwards to modify food systems to be fit-for-purpose.

Quantify complex trade-offs and synergies among diet

quality, sustainable agriculture, GHG emissions. Climate

change is a major challenge, but also opportunity.

Malnutrition has re-emerged as a global public health issue, not just in low income countries. Low quality diets contribute to all forms of malnutrition.

Diet is a modifiable risk factor for ill health – so modify!

Healthy food systems must nourish us, not just feed us.

Needs policy, investment and behaviour shifts throughout the food system – i.e. a radical transformation. Requires huge commitment on scale of HIV/AIDS, tobacco, malaria.

Take-Away Messages

Thank-you.