Modern malnutrition?

Geneva, 23 April 2018 - 

Last week the Food and Agriculture Organization (FAO) hosted the launch of a new report by the Global Panel – “Improving diets in an era of food market transformation – challenges and opportunities for engagement between the public and private sector”.

Its main point: market forces are remaking the world food system at lightning speed, what should we do to make sure this reduces, not adds to, malnutrition?

It paints a compelling picture of rapidly changing diets and how many countries now face undernutrition, vitamin and mineral deficiencies and overweight/obesity simultaneously – a short but comprehensive report, co-chaired by President Kufuor and John Beddington. Plaudits all round, including to FAO for helping promote this debate. If you need any persuading, it demonstrates that food systems are far from “broken” (as is often said) they are dynamic. Transformation almost feels too understated a term for a helter skelter of change hard to keep up with. Most importantly the locus of the action is the market – where businesses and entrepreneurs meet consumers, with government often sitting somewhat uneasily or even idly on the side-lines. We need to change this.

Modern malnutrition? Tom Arnold, a Global Panel member, introduced this characterisation. It reminds us that we are not on a course of slowly but surely grinding down malnutrition, instead it is mutating and challenging us!  Of the three big malnutrition challenges in the SDGs, he argued, we broadly know what and how to address two – undernutrition, and vitamin and mineral deficiencies (although both are very much work in progress and certainly underinvested). But on the third, overweight and obesity, we know too little.

Hand picking up a copy of the new report

Global Panel on Agriculture and Food Systems for Nutrition. Improving diets in an era of food market transformation: Challenges and opportunities for engagement between the public and private sectors. FAO headquarters (Sheikh Zayed Centre). © FAO

Worldwide obesity has nearly tripled since 1975 and in 2016, more than 1.9 billion adults were overweight, 650 million obese. Over 340 million children and adolescents aged 5-19 were overweight or obese in 2016 – yet obesity is preventable.

We might add that tackling all three types of malnutrition at the same time – the actual challenge facing most countries – adds further layer of complexity.

The trends here are clearly linked to stunningly rapid changes in diets, for example the growth of ultra-processed foods in diets – in Latin America over 13 years to 2013, there was a 48% rise in consumption of highly or ultra-processed foods. What we do know is that unchecked, these market forces will continue to drive these trends – the report reemphasises that poor diet is a bigger risk to global health than air pollution, alcohol, drug and tobacco use combined. Rates of conditions such as diabetes, hypertension and obesity are sky rocketing, notably in poorer countries.

For me, if we accept that business is at the centre of food system, the event in FAO raised three big challenges on the back of this excellent report.

First, what is the right balance right between incentives (investment, recognition or reward) and control/regulation of business? To date most energy around quality of diet has gone into how to protect public health agendas from private interests, and via disincentives such as the taxes on sugary drinks, codes to limit influence, labelling schemes. But how about governments leading better eating campaigns, supporting investment and credit schemes for healthy foods? Of course, we need both, but to date there has been almost no focus on doing good, almost everything on “do no harm”. You can read more about this thinking in Lawrence Haddad’s recent article in Nature. The report suggests that an effort is needed to encourage new investment in food sector Small Medium Enterprises (SME) via new lending mechanisms. GAIN itself has proved its own SME funding mechanism the Marketplace for Nutritious Foods can change consumption of these nutritious foods. In East Africa, for example for tilapia, via milk vending machines, meat production. There is huge untapped potential of national food systems which can be activated to improve diets, but the policy and lending instruments are missing.

Second, what level of intervention should be expected of government? There were some powerful examples of government leadership: Chile’s food labelling scheme, the recent UK soft drink sugar levy – but this is a contentious field. Difficult choices for politicians. But it is hard to see how any government is going to be able to stand aside for too long – the social and economic costs of malnutrition represent almost strategic threats to economies.

Global subsidies for cereal crops top USD 1 billion per day, what about spending some of that on cutting the cost of key parts of the World Health Organization (WHO) recommended healthy diets – fruit, vegetables, pulses and adequate animal sources proteins? In many countries there is huge power imbalance, governments find it hard to manage powerful companies, and there is little practical support for then from the global community. The report argues that government has to take the lead in promoting healthy diets – companies sell individual products only government can shift consumer preferences for whole groups of products. The meeting noted that so much enterprise and potential exist at national level, but indigenous business needs guidance and policy direction from government – a framework and leadership. Hear hear!

Third, given its defining role in food, does our development sector honestly know enough about business? It’s no monolith, the report captures a “system of entrepreneurs” from small farmers, traders, transporters, marketeers, national and global companies, all different and often competing. Even global companies are made up of people with divergent views and values, and internal policy debates (just like governments and NGOs!). Perhaps we are too fixated on Multi National Corporations (MCN), which do wield big market power but make up less than 25% of the food sector? The role of big food companies was a hot topic, the only question which all six panellists, including me, wanted to answer! There is plenty of evidence that measures to improve accountability, transparency and public scrutiny such as ATNI help. But face to face dialogue is also fundamental. The report calls for greater trust, which is fair enough, but you can only trust when you know, and the development and business sectors still operate largely in isolation.

The report is a good contribution to describing the dynamics of modern malnutrition. Its bigger point is that we need more ambition and innovation to find modern solutions to address it.



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