Abstract
This year marks the midterm of the UN Decade of Action on Nutrition 2016-2025 and the start of the Decade of Action to deliver the Sustainable Development Goals by 2030. The world is off track for achieving many of the Sustainable Development Goal (SDG) targets, with the COVID-19 pandemic further disrupting implementation of action toward achieving the SDGs. The pandemic is affecting the world’s poorest and most vulnerable people the most, exposing harsh and profound inequalities in our societies and further exacerbating existing disparities within and among countries.
Even before the COVID-19 pandemic, the world was not on track to achieve the global nutrition targets, including those on child stunting, wasting, and overweight by 2030. 1 Almost 690 million people were undernourished in 2019, up by nearly 60 million from 2014, and an estimated 2 billion people in the world did not have regular access to safe, nutritious, and sufficient food. At the same time, 2 billion adults were overweight in 2016, with adult obesity rates rising in all regions. Preliminary projections suggest that the COVID-19 pandemic may add an additional 83 to 132 million people to the ranks of the undernourished in 2020. 1 The Standing Together for Nutrition Consortium analysis indicates that COVID-19 lockdown measures and accompanying disruptions in essential nutrition services in low- and middle-income countries could increase the prevalence of wasting in children younger than 5 years by 14.3%, equivalent to an additional 6.7 million children wasted in 2020. 2 Moreover, obesity and diabetes are among the largest risk factors for illness and death from COVID-19.
A key reason why millions of people around the world suffer from hunger and malnutrition in all its forms is because they cannot afford healthy diets, especially the poor in every region of the world. The cost of a healthy diet exceeds the international poverty line, established at US$1.90 purchasing power parity per day. This puts healthy diets beyond the reach of those living in poverty or just above the poverty line. Estimates suggest that even the least cost healthy diet is unaffordable for more than 3 billion people in the world. 1
If current food consumption patterns continue, diet-related health costs linked to mortality and diet-related noncommunicable diseases are projected to exceed US$1.3 trillion per year by 2030, and this does not include the costs associated with undernutrition. The diet-related social cost of greenhouse gas emissions associated with current dietary patterns is estimated to reach more than US$1.7 trillion per year by 2030. 1
A transformation of current food systems is urgently needed. At the Second International Conference on Nutrition (ICN2), member states committed to enhance sustainable food systems (SFS) to promote safe and diversified healthy diet. 3 Actions for SFS promoting healthy diets are also one of the focus action areas of the work programme of the UN Decade of Action on Nutrition 2016-2025, 4 which are based on the ICN2 Framework for Action. 5
The need to act urgently was called for by the UN Secretary-General António Guterres’ message on World Food Day and 75th Anniversary of the Food and Agriculture Organization of the United Nations (FAO), 2020, where he said, “We need to make food systems more resistant to volatility and climate shocks. We need to ensure sustainable and healthy diets for all, and to minimize food waste. And we need food systems that provide decent, safe livelihoods for workers.” 6
Recognizing the urgent need to promote diets that are healthy and have low environmental impacts while at the same time are socioculturally acceptable and economically accessible for all, FAO and the World Health Organization (WHO) organized an expert consultation from July 1, 2019, to July 3, 2019, in Rome, Italy. Prior to the consultation, 5 background papers were commissioned, covering (1) the elements and definitions of healthy diets; (2) the role of healthy diets in environmentally SFS; (3) the role of culture, economics, and food environment in shaping choices for sustainable diets; (4) territorial diets; and (5) food safety implications of Sustainable Healthy Diets. Thirty-three experts knowledgeable in the various dimensions of healthy diets and aspects of sustainability, representing low-, middle-, and high-income countries, participated in the consultation and/or contributed to drafting the background papers. The experts agreed on guiding principles for sustainable healthy diets, describing these as being: “dietary patterns that promote all dimensions of individuals’ health and well-being; have low environmental pressure and impact; are accessible, affordable, safe and equitable; and are culturally acceptable.” 7
The 6 papers presented in this Supplement are the product of the work done before, during, and after the consultation, culminating in an in-depth peer review process. The original paper on the role of culture, economics, and food environments was split into 2 shorter papers in recognition of the need to devote sufficient space for each of the important topics covered in it.
In the first paper, Kumanyika and coauthors set the scene by characterizing healthy diets and their implications for food system sustainability. 8 They compare 3 complementary approaches to defining healthy diets: WHO guidelines and recommendations developed between 1996 and 2019; 2017 Global Burden of Disease risk factor study estimates of diet-related risk–outcome associations; and analyses associating indices of whole dietary patterns with health outcomes in population studies and clinical trials. The authors identify many general points of agreement across the different approaches reviewed, and note that sustainability discussions will require harmonization of specific risk factor definitions and dietary pattern indices. The authors conclude that shifts toward plant foods and away from animal foods (excepting fish and seafood, moderate amounts of dairy, and small amounts of red meat) would be necessary when considering the human health perspective together with sustainability considerations.
In the second paper, Clark and others look at the issue of environmental sustainability by discussing the role of healthy diets in SFS. 9 They summarize current global knowledge and present case studies on 4 countries that differ in their social, economic, political, and dietary contexts, highlighting how the difficulties and solutions of transitioning toward healthier dietary patterns vary across countries. They identify how simultaneous, coordinated and multisectoral actions by the public sector, private sector, and governments is needed, emphasizing how context specific solutions will be required to account for the unique challenges, food cultures, dietary preferences, and institutional structures present in each country.
In the third paper, Monterrosa and others highlight the need to examine sociocultural influences on food choices and practices as precursors to food policy decisions. 10 An analysis of the sociocultural influences is needed to assess the acceptability and desirability for sustainable healthy diets so that food policy fully aligns with society and culture. The authors present frameworks and concepts for sociocultural analysis, which can be combined with empirical data collected through in-depth qualitative methods and surveys.
The forth paper focuses on the food environment, defined as the interface between the wider food system and consumer’s food acquisition and consumption, is critical for ensuring access to sustainable healthy diets. Gross inequities in access currently exist, with sustainable nutrient-rich foods being generally less available and affordable than those that are less sustainable and nutritious. Drewnowski and coauthors discuss various actions in the physical, economic, and policy components of the food environment to address affordability and to enable access to sustainable nutrient-rich foods. 11
In the fifth paper, Hachem et al look at 2 territorial diets, the Mediterranean Diet and the New Nordic Diet, to learn how these diets have managed to strike a balance between health and nutrition and the different dimensions of sustainability (environmental, economic, and cultural). 12 They review the contribution of these 2 diets to health and nutrition and to environmental, sociocultural, and economic sustainability, proposing pertinent indicators. They conclude that achieving diets that deliver better health and sustainability outcomes will require building on the sociocultural appropriation of diets, having the proper tools and indicators, investing in cross-sector collaboration and policy coherence and having the necessary political support to push the agenda of sustainability forward.
The sixth paper highlights food safety as a prerequisite to ensuring food security globally. Pires and coauthors consider the implications on food safety of transforming food systems to promote sustainable healthy diets, by exploring the food safety dimensions of the topics discussed in the companion papers. 13 They summarize current knowledge on the global burden of foodborne diseases, and then examine the potential impacts of current and predicted dietary transitions from a food safety angle to allow for holistically approaching the issue of sustainable healthy diets. The potential dilemmas associated with choices between safe, healthy, sustainable, affordable, and accessible food products are discussed. They conclude that several synergies between public health, environmental, and food safety strategies can be identified to support dietary transitions.
The information contained in this Supplement adds meaningful contributions toward the evidence base on how to transform toward more SFS while taking into consideration context-specific barriers and managing trade-offs. This comes at a critical moment, where countries and other stakeholders prepare for the forthcoming Nutrition for Growth Summit and the UN Food System Summit in 2021. We hope that this scientific work will feed into the dialogues and further inspire and strengthen country-level action toward SFS enabling healthy diets over the second half of the UN Decade of Action on Nutrition.
This series of papers also contributes to the Sustainable Food Systems Programme of the One Planet network (previously known as the 10-Year Framework of Programmes on Sustainable Consumption and Production Patterns). 14 With its focus on diets, this work inscribes well into the knowledge production arm of the SFS Programme core initiative on “Sustainable Diets within the Context of Sustainable Food Systems.”
We take this opportunity to acknowledge the following for their immense support during the preparation of the articles for publication—Ramani Wijesinha-Bettoni (FAO) who consistently liaised with all the authors during the peer review process until the final publication. We would like to acknowledge the contribution of Nancy Aburto, Jessica Mathewson, Alan AlorSoto all of FAO, and Marzella Wüstefeld and Fabienne Maertens of WHO. Valuable reviews were received on the draft papers from Tim Lang and Gretel Pelto, and FAO staff Markus Lipp, Alice Green, and Kang Zhou.