Main content

The link between human and planet health is our food system

1 in 3 people worldwide are malnourished

Since the very first beginning of agriculture, around 10,000 years ago, we have been able to increase food production in terms of calories to keep up with population growth, but we have not yet solved the challenge of feeding the (growing) global population with adequate diets. Today, two billion people lack key micronutrients like iron and vitamin A, two billion adults are overweight or obese, 150 million children are stunted, 50 million children are wasted, and nearly 40 million children are overweight. 88% of countries face a serious burden of either two or three forms of malnutrition. [1] Malnutrition in all its forms, including obesity, undernutrition, and other dietary risks, is the leading cause of poor health globally. Low-quality diets cause micronutrient deficiencies and contribute to a substantial rise in the incidence of diet-related obesity and diet-related non-communicable diseases, including coronary heart disease, stroke, and diabetes. Unhealthy diets pose a greater risk to morbidity and mortality than does unsafe sex, and alcohol, drug, and tobacco use combined, and 6 of the top 10 risk factors are diet related (see Figure 1). [2]

The world’s population is expected to grow to almost 10 billion by 2050, boosting agricultural demand – in a scenario of modest economic growth by some 50% compared to 2013. [3] Income growth in low- and middle-income countries would hasten a dietary transition towards higher consumption of meat relative to that of cereals, requiring even higher agricultural (feed) production and adding pressure on natural resources. [3]

Food system transformation for health and sustainability

The international development community has recognised these challenges. In particular, the 2030 Agenda for Sustainable Development, adopted by the international community in September 2015, provides a compelling but challenging vision on how multiple objectives can be combined to define new sustainable development pathways. The second Sustainable Development Goal (SDG 2) explicitly aims at ending hunger, achieving food security and improved nutrition, and promoting sustainable agriculture, simultaneously by 2030. Dr Lawrence Haddad, Global Alliance for Improved Nutrition (GAIN) Executive Director and World Food Prize winner 2018, formulated the challenges as follows: ‘There are two vital and interlinked questions faced by humanity. First, how do we have to eat differently to significantly reduce malnutrition? Second, what food production systems do we have to put in place to use natural resources sustainably and live within climate change targets?’ [4]

The recently published EAT-Lancet Report provides a ‘Healthy Reference Diet’ that sets ranges of intakes for food groups to ensure human health which can be sustainably produced within the boundaries of one planet. [5] To achieve the consumption of this ‘Healthy Reference Diet’ requires substantial dietary shifts, ultimately leading to an increase in consumption of fruit, vegetables, legumes and nuts, and a decrease in unhealthy foods such as added sugar, ultra-processed foods (i.e. foods high in energy and low in nutrients, and often cheaper than nutritious foods) and animal source products, especially red meat (see Figure 2). [5] However, the required changes differ greatly by region and are context-specific, e.g. many vulnerable groups in low income countries should still increase their consumption of animal-source foods in order to meet their micronutrient requirements.

In the so-called Global Syndemic of Obesity, Undernutrition and Climate Change report, the Lancet commission on Obesity argues that ‘The pandemics of obesity, undernutrition, and climate change represent three of the gravest threats to human health and survival. These pandemics constitute The Global Syndemic, consistent with their clustering in time and place, interactions at biological, psychological, or social levels, and common, large-scale societal drivers and determinants. Their interactions and the forces that sustain them emphasise the potential for major beneficial effects on planetary health that double-duty or triple-duty actions, which simultaneously act on two or all three of these pandemics, will have. [6] A system perspective is required to address the underlying drivers of The Global Syndemic within the context of achieving the Sustainable Development Goal, in particular human health and wellbeing, planetary health, social equity and economic prosperity. The major systems drivers are food and agriculture, transportation, urban design and land use. [6]

To achieve these changes in food and agriculture, a comprehensive and multi-sectoral context specific approach is required to move the dominant food system to a desired sustainable food system that provides healthy diets. This will require the buy-in of all partners, actors and especially consumers. The walls between agriculture, climate, water and sanitation, health care and nutrition will need to be breached, and nutrition-specific and nutrition-sensitive interventions (see text box) will need to be integrated.

The Lancet introduced the terminology ‘nutrition sensitive’ and ‘nutrition specific’ in its Maternal and Child nutrition series in 2013.[7] Nutrition sensitive interventions and approaches comprise those that indirectly impact nutrition: agriculture and food security; social safety nets; early child development; maternal mental health; women’s empowerment; child protection; classroom education; water and sanitation; health and family planning services. Nutrition specific interventions and programmes include: adolescent health and preconception nutrition; maternal dietary supplementation; micronutrient supplementation or fortification; breastfeeding and complementary feeding; dietary supplementation for children; dietary diversification; feeding behaviours and stimulation; treatment of severe acute malnutrition; disease prevention and management; nutrition interventions in emergencies.

Policy inertia

Governments, supported by civil society and knowledge institutes, will need to lead the governance of the development and implementation of evidence-based policies beneficial for society, health and planet, without vested commercial bias. ‘Policy inertia, a collective term for the combined effects of inadequate political leadership and governance to enact policies to respond to The Global Syndemic, strong opposition to those policies by powerful commercial interests, and a lack of demand for policy action by the public governments and civil society […] prevent change to the existing systems’, argue the authors of the Global Syndemic report. [6] Last, but not least, the private sector needs to be encouraged to be part of the solution by developing sustainable and health-promoting business models and shifting business outcomes from a short-term profit focus only, to sustainable, profitable models that explicitly include benefits to consumers, society and the environment.

The role of health professionals

So why is this relevant for global health professionals? First of all, as unhealthy diets pose by far the largest risk factor to morbidity and mortality, every medical professional should at least have a good understanding of current diets and desired dietary shifts, taking into account that the changes needed differ greatly by region and are context-specific. Secondly, as a comprehensive and multi-sectoral context specific approach is required to move the dominant food system to a desired sustainable food system that provides healthy diets, global health professionals need to be part of the design and implementation of double- and triple-duty actions. Ironically, one of the least used settings to promote better nutrition is the healthcare system. [8] And lastly, being aware of the enormous risk and burden that a failure to change our food system would put on the shoulders of our children and grandchildren, we need everyone to advocate for breaking down ‘policy inertia’ and make their small but important contributions. Or, as Professor Wangari Maathai, founder of the Green Belt Movement and Nobel Peace Prize laureate tells us: ‘I will be a hummingbird; I will do the best I can’. [9]

References

  1. Development Initiatives. 2018 Global Nutrition Report: Shining a light to spur action on nutrition. 2018. https://globalnutritionreport.org/reports/global-nutrition-report-2018/
  2. Institute for Health Metrics and Evaluation (IHME), University of Washington. GBD Compare Data Visualization. 2018. http://vizhub.healthdata.org/gbd-compare. [Accessed 26 August 2019]
  3. FAO. The future of food and agriculture – Trends and challenges. 2017. http://www.fao.org/3/a-i6583e.pdf
  4. Haddad L. The EAT Lancet Report: landmarks, signposts and omissions. 2019. https://www.gainhealth.org/media/news/eat-lancet-report-landmarks-signposts-and-omissions [Accessed 26 August 2019]
  5. Willett W, Rockström J, Loken B, et al. Food in the Anthropocene: the EAT-Lancet Commission on healthy diets from sustainable food systems. Lancet. 2019;393:447-92. https://doi.org/10.1016/S0140-6736(18)31788-4
  6. Swinburn BA, Kraak VI, Allender S, et al. The global syndemic of obesity, undernutrition, and climate change. Lancet Commission report. Lancet. 2019:393:791-846. https://www.thelancet.com/commissions/global-syndemic [Accessed 26 August 2019]
  7. The Lancet. Maternal and Child Nutrition Series. 2013. https://www.thelancet.com/series/maternal-and-child-nutrition [Accessed 26 August 2019]
  8. Mozarffarian D, Angell S, Lang T, et al. Role of government policy in nutrition – barriers to and opportunities for healthier eating. BMJ. 2018; 361:k2426. https://www.bmj.com/content/361/bmj.k2426 [Accessed 26 August 2019]
  9. Maathai W. Be a hummingbird. http://www.greenbeltmovement.org/get-involved/be-a-hummingbird [Accessed 26 August 2019]