The EAT Lancet Report: landmarks, signposts and omissions

London, 18 February 2019 - 

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?

The EAT Lancet Report is a landmark because it answers these two questions simultaneously.

In doing so the report produces a global target for food consumption, the “Healthy Reference Diet”. The diet sets ranges of intakes for food groups to ensure human health and is also consistent with planetary health, given assumptions on improvements in food production practices and reductions in food loss and waste. In other words this diet satisfies two key objectives: were it consumed it would prevent approximately 20% of all premature adult deaths and it would operate within safe planetary boundaries for climate change, biodiversity loss, land system change, freshwater use and Nitrogen and Phosphorous cycling.

So how distant is the healthy reference diet from actual consumption intakes? Well, it depends where one resides in this world. From Figure 1 in the Report, it is clear that some regions of the world are consuming less than the reference diet in most of the food groups. For example South Asia is below the reference diet for every one of the 11 groups except “starchy vegetables” (which I think are refined cereals and roots and tubers). Sub-Saharan Africa is below in every category except starchy vegetables and is at the limit of red meat. Latin America, the Middle East and North Africa are above the limits in red meat, starchy vegetables, eggs and poultry, but below in the other food groups. East Asia and the Pacific are above in red meat, starchy vegetables, eggs and fish. North America and Europe and Central Asia are above in red meat, starchy vegetables, eggs, poultry, and total dairy. All regions are below in the categories of vegetables, fruit, legumes, whole grains and, especially, nuts.

Little African girl with a spoon in her mouth

Little African girl smiles to the camera while holding a spoon with her mouth. © GAIN

How far from reality is this reference diet, especially for high-income populations who operate well above many of the limits? The Report points out that the Reference diet includes ranges for many of the food groups and that different regions, countries and cultures feature different aspects of the Reference diet. The Report notes the “special considerations” that are demanded by certain groups, namely young children and adolescents and women during pregnancy and lactation (although I understand under twos are not included in the reference diet). The Report also has a panel on Sub Saharan Africa which concludes with “Achieving healthy diets from sustainable food systems for everyone on the planet is possible; however to accomplish this goal, local and regional realities needs to be carefully considered”.

How easy will it be to achieve these diets? Not easy, says the Report, but possible. The Report calls for a “Great Food Transformation” and points out that there are plenty of “reasons to be cheerful” about achieving this transformation because there are examples of successful systemic action and change, drawing on positive experiences of energy shifts trans-fatty acid use, tobacco use and HIV/AIDS containment.

The Report draws several lessons from these examples. First, is it important work in a systems manner—with all actors, all sectors working to shared goals. Second, research and monitoring is vital to guide action and promote accountability. Third, the full range of policy levers need to be deployed both soft (e.g. consumer behaviour change) and hard (e.g. laws, fiscal policy, trade policy).

What does the Great Food Transformation consist of? Five strategies are outlined.

First, seek international and national commitment towards healthy diets (e.g. make public procurement reflect human and planetary health concerns). Second, reorient agricultural policies from the focus on quantity and calories to quality and all nutrients (e.g. promote agricultural diversity and focus agricultural research more on healthy diets). Third, sustainably intensify food production (e.g. precision agriculture, low tillage, recycling, more appropriate use of fertiliser, better land use policies). Fourth, build strong and coordinated governance of land and oceans (e.g. land use zoning, the promotion of collective action and better certification of seafood harvesting). Fifth, at least halve food loss and waste (e.g. infrastructure innovations, orientate extension services towards minimising in field and post and public campaigns around waste).

The Report then outlines several evidence based tools and institutions it would like to see to champion and monitor the transformation of food systems. Most prominent of these (and one I support) is an IPCC (Intergovernmental Panel on Climate Change) type mechanism for healthy diets from sustainable food systems.

So what are my views on the Report?

I should note that I am on the EAT Advisory Board although I did not have any input into this Report.

My first reaction is one of admiration. I admire the ambition of the Report, bringing these two worlds of health and environment together in the context of food systems. This requires surveying and linking a great many disparate literatures. It also requires some creative modelling and lots of trawling through and sifting of data.

The boldness of laying out a Healthy Reference Diet is also welcome. As the Report says, this serves as a starting point for national debates (and controversies) on appropriate diets that are healthy and do not require food systems that are unsustainable.

I am really appreciative of the drawing together of six environmental literatures (from climate to Nitrogen recycling)—this is an enormous job and goes way beyond the greenhouse gas emission literature that often serves as a proxy for environmental footprints. This takes us away from an overreliance on the narrative around red meat being bad for greenhouse gas emission. For example, there are other crops that have much higher footprints than animal products when it comes to the use of cropland, freshwater and nitrogen application (see Figure 5 in the Report).

I admire the ambition of the Report, bringing these two worlds of health and environment together in the context of food systems

Lawrence Haddad, Executive Director, GAIN

I also like the fact that the Report is constructive. It suggests lessons, strategies and literally hundreds of actions that can be undertaken to achieve the great food transformation.

Finally, the Report is very well written, with a clear story, good graphics and unfussy tables—this is not easy when there are 37 researchers involved over 3 years.

There are, however, some omissions that need to be addressed and several issues that I would have liked to seen more discussion of.

First, the equity story behind the transformation does not come through strongly (the word equity only appears once). As in climate mitigation, it is the high-income countries that need to change (their diets and food systems) the most. They are best able to do this and it is their food systems that are causing the greatest problems for planetary boundaries and to the global burden of disease. In particular declines in red meat need to come mainly from North America and Europe with many countries and population subgroups actually needing to consume more animal source foods because their intakes are so low.

Second, I would have liked to see more discussion of the heterogeneity of contexts. There is a panel that discusses Sub-Saharan Africa (why not South Asia?) but the Report’s heart is not really in it when it comes to analysing the differentiated needs and responsibilities. This is unfortunate, because it may affect how well the Report lands in countries in Africa, Asia and Latin America.

Third, issues of affordability and livelihoods are not discussed enough. The transition from one diet to another will entail costs to some groups, whether it means more expensive foods or lost livelihoods. What is the magnitude and distribution of such costs? In many ways this is the third “public good” we want food systems to deliver – income growth and affordable nutritious food—and the Report is not nearly vocal enough on this.

Fourth, I would have liked to have a better sense of the decomposition of drivers of the healthy reference diet. For example, what is the main shaper of the diet recommendation on low consumption of eggs? I assume it is environmental, not health-related, but for some other diet components the decomposition may not be so straightforward to read.

Fifth, the modelling –both health and environment–is based primarily on non-processed foods. For example, the nutrient composition effects of food processing are not addressed in the healthy reference diet and the processing of food significantly affects the environmental footprints of different foods. This omission no doubt reflects a lack of available data, but I would have liked to see a panel with data from one or two countries with data that would give us a sense of how robust the conclusions are from their omission.

Sixth, I would have liked more sensitivity analyses to be shown. Even the best evidence is open to interpretation and it would have been good to see more of the kind of “what-if” analyses we saw around food loss and waste and their impacts on food production shifts in Figure 8.

Seventh, the recommendations on institutional changes tend to focus on building new constructs rather than building on existing institutions. The former might be easier than the latter, but may lead to needless fragmentation. For example if we have a Global Nutrition Report, do we also need a Global Food Systems Report? Maybe, but it would be good to suggest exploring synergies and opportunities for mergers.

Eighth, the issues around the true cost of food are not well highlighted. This seems absolutely fundamental to generate the kind of transitions we all want to see. This is, in the Report’s own words, the ultimate “hard” policy change and an approach that is foundational in climate policy. I wanted to see more on the technicalities and the realpolitik of adopting such an approach.

Finally, even though there is a repeated and absolutely correct refrain around the urgency of making changes to diets and food systems, the necessary timeframe for changes is unclear in the Report. Every country will move at its own pace, but a greater sense of the timing of some of these changes out to 2050, even at the global level, would have been helpful.

But rather than see these as points as a stern critique of the Report, they should be seen as a challenge to all of us who care about these issues. After all there is only so much material and so many issues that can be crammed into 39 pages.

There is much work to be done and this Report represents a fantastic opportunity for all of us to step forward and do better–together. For example, we at GAIN, working with our partners, will do more to consider the environmental consequences of the programmatic choices we make.

This is such an important Report that GAIN is pleased to be supporting EAT/Lancet by helping to organise national convenings to discuss it in Bangladesh, India, Mozambique and Nigeria and I have also asked all my colleagues to contribute their own reflections – stimulating public debate is a priority we should all now support.

Ultimately transformation is not for other people and other organisations, it is for each and every one of us to transform our own thinking and actions. This Report gives us new signposts as to the choices we need to make and puts additional wind in our sails. Bravo!