the set of institutions, resources, stakeholders, and behaviors involved in the production, processing, transportation, marketing, sale, and purchase of food.
includes the three main components of availability, access, and utilization of food: Availability. For an individual or household to be food secure, food must first be available to them, either in markets or through their own production. Access. Next, they must have the economic resources to access the food. For foods available in markets, this means having the means to both reach markets and purchase the foods sold. The quality of diets is also central to food security. Food secure households must have access to not only sufficient calories, but a diversity of foods that contribute to a healthy diet. Utilization. The utilization component of food security refers to how food is distributed within households to vulnerable individuals and the ability of individuals to make the best use of the nutrients in foods. For example, the nutrients in foods may be not as easily absorbed by individuals who are ill. Finally, households and individuals are not truly food secure if they can only access diverse foods for a limited number of months per year. Therefore, the stability or consistency of food security over time—and with a minimal impact to the environment—is also important.
refers to both undernutrition (when caloric intake is not sufficient to meet dietary requirements and/or when there are deficiencies in macro- or micronutrients) and overweight or obesity.
NONCOMMUNICABLE OR CHRONIC DISEASES
medical conditions or diseases that are noninfectious (e.g., heart disease, cancer, diabetes).
The agriculture and food systems are uniquely positioned to be driving forces in overcoming malnutrition. The food system—which involves the production, processing, marketing, transformation, and purchase of food, along with the resources, institutions, and consumer practices that go along with them—lies at the heart of human health.15 It supports the livelihoods of millions, especially the rural poor in developing countries. It can provide healthy diets, which can significantly remedy malnutrition in all its forms. Yet right now, nutritious food is not as accessible and affordable as it needs to be. While many people living in poor or remote areas do not have reliable access to nutritious foods, others simply cannot afford foods that are available. And all too often, those who can access and afford nutritious foods do not eat them because of limited knowledge or time to prepare nutritious meals. The agriculture and food sectors have an essential role to play in addressing many of these challenges. Although these sectors cannot do it alone, they can and must promote nutritious diets and a healthy, productive society. They should be at the table—working alongside health-care professionals, environmentalists, businesses, entrepreneurs, donors, development practitioners, and educators—to move the needle on nutrition. The conspicuous divide between those with access to abundant quantities of safe and diverse foods and those struggling just to meet their basic dietary requirements highlights the urgent need to realign the goals of food systems with those of human health and well-being. The time to act is now. Urbanization, climate change, and scarce land and water resources are reshaping food production, distribution systems, and access. As diets shift toward highly processed foods, especially in the rapidly urbanizing regions of low- and middle-income countries, the resulting increase in diet-related noncommunicable diseases (NCDs) poses dangerously high economic and social costs. As populations and cities grow, there is less land and water for food production, which will require agriculture to become even more efficient. And climate change, if not planned for, will place additional downward pressure on agricultural production. If we don’t meet these challenges head on, they will have serious negative impacts on human health and well-being. New approaches to these challenges are desperately needed. Some experts have suggested that changes as radical as those realized during the industrial and agricultural revolutions of the past two centuries will be required along the entire food supply chain to overcome the challenges that lie ahead.16 Yet these challenges also offer an opportunity to reshape the global food system to sustainably provide nutritious foods while supporting economic growth. Building on the policy analyses put forward in previous Chicago Council studies, this report identifies ways the US government—in partnership with business, national governments, and civil society—can increase production and consumption of safe
Box 2 – A healthy diet defined
A healthy diet is primarily about dietary diversity— consuming a variety of foods across and within food groups to meet energy and essential nutrient requirements. Consumption of a wide variety of whole foods, especially vegetables, fruits, legumes, whole grains and nuts, is particularly important. In some cases, where diets are inadequate to meet normal physiologic and work demands, an additional focus on meeting energy requirements is also essential. Animal-source foods may make an important contribution to overall dietary diversity, providing a rich source of easily absorbed essential micronutrients and dietary energy. Because dietary patterns differ from place to place, foods that contribute to diet diversity must be identified based on their local availability throughout the year, their utilizable nutritional content, and the extent to which they are commonly consumed. Regional differences in food safety must also be taken into account. Food choices that are otherwise diverse are likely to adversely affect overall health if exposed to chemical or microbial contaminants through the food supply chain. Limiting consumption of highly processed foods is also important for healthy diets and prevention of chronic disease. Such foods—including sugar-sweetened beverages, snack foods, and processed meat products—are commonly high in refined sugars, salt, and saturated fat and low in dietary fiber. In addition, these foods are often energy dense (high in energy per unit weight) and may contribute to excessive calorie consumption or displace whole foods rich in dietary fiber and micronutrients. A simple approach to assessing the healthfulness of diets, therefore, is to look at the contribution of whole foods to the diet overall rather than individual food products, ingredients, or nutrients.
and nutritious foods. It assesses the unique role of the agriculture and food sectors in confronting both undernutrition and obesity and offers policy recommendations to achieve triple wins for nutrition, economic, and environmental goals. In the face of global pressures on agricultural productivity from climate change and rapidly changing food demands, achieving these goals will require collaboration and strong leadership. Historically, the US government has played a leading role in supporting the sustainable development of agriculture and food systems throughout the globe. The recommendations proposed in this report will strengthen current US leadership in this arena and support systems that are productive, sustainable, and rich in nutritious foods. To achieve triple wins for health, economic, and environmental goals, the recommendations are to: > strengthen policies to support nutrition-sensitive food systems, > expand the research agenda for nutrition-sensitive food systems, > prepare the next generation of leaders in food and nutrition security, > develop public-private partnerships to support nutrition-sensitive food systems. A global double burden of malnutrition is imperiling health and hampering economies Despite tremendous progress over the past 25 years in reducing hunger and severe undernutrition, millions of people across the globe still suffer from food insecurity, and billions more lack access to essential vitamins and minerals and otherwise healthy diets. Chronic disease, caused in large part by unhealthy diets, has become the main cause of illness and death worldwide.17 Malnutrition is also responsible for costly losses to economic productivity.18 The agriculture and food sectors are uniquely positioned to address the factors that underlie these global health concerns. Global patterns of diet and disease are rapidly changing Unprecedented changes are taking place in the way food is produced, distributed, and consumed around the world. Driven by urbanization, increased foreign direct investment in raw and processed foods, and income growth, a “nutrition transition” is taking hold in many low- and middle-income countries (LMICs). This transition is characterized by increased consumption of vegetable oils, refined and processed foods, sugar-sweetened beverages such as soda and fruit drinks, and more sedentary lifestyles and has been linked to a sharp increase in obesity and diet-related NCDs in LMICs over the past three decades.19 As a result, many LMICs are now facing a “double burden” of malnutrition.20 These countries are simultaneously confronting both high rates of obesity and undernutrition without the resources, infrastructure, or support of strong institutions needed to combat them. In Nigeria, for example, more than one-third (37 percent) of children under the age of five are stunted.21 Almost no progress has been made in reducing this percentage over the past 10 years (38 percent of children were stunted in 2003). Yet one-quarter of adult women of reproductive age (15 to 49 years) are now overweight or obese—a 25 percent increase over the past 10 years.
Box 3 – The nutrition transition
The ways that human diets and physical activity have shifted over time and the effects on health is known as the “nutrition transition.” Modernization, urbanization, and economic growth have contributed to the latest changes in diet, activity levels, and health and nutrition. This transition is reflected in the shift from infectious diseases associated with famine and malnutrition to the prevalence of diet-related chronic disease. The nutrition transition is divided into five patterns: Pattern 1: Hunter Gatherer—Active lifestyles and diets based on foraged food such as plants and wild animals Pattern 2: Early Agriculture—Diet becomes less diverse; famine is common Pattern 3: End of Famine—Incomes rise and nutrition improves Pattern 4: Overeating, Obesity-Related Diseases— Continued rise in income leads to increased access to abundant, high-calorie foods and decreased physical activity; leads to obesity and related chronic diseases Pattern 5: Behavior Change—Individuals change their behavior and communities promote behavior change to prevent obesity and related chronic disease Today, many low- and middle-income countries find themselves at the end of famine and in a pattern of overeating due to the accessibility of highly processed foods, while urban areas tend to be further along the nutrition transition than rural areas. Countries like India are moving rapidly through the nutrition transition, as rapid economic growth and urbanization alter diets and activity levels, with significant ramifications for health.
Box 4 – Stunting up close—a story from Ethiopia
Stunted. It is a harsh, ugly word. Often spoken of in detached, clinical, analytic terms—“below standard deviations” of height and weight, “suboptimal” brain development—stunting is the result of malnutrition early in life. It leads to diminished physical and cognitive capacity. But what does it really mean to be stunted? What does it look like? What does it feel like? In 2003 during a great famine, an Ethiopian boy named Hagirso was carried by his father, Tesfaye, to an emergency feeding tent on the Boricha plateau. Hagirso was five years old and weighed just 27 pounds. He was severely malnourished, on the verge of starvation. The nurses and doctors didn’t know if he would survive. Thankfully, miraculously, he did. But the consequences of the hunger and malnutrition were painfully clear. Ten years later, as a teenager, Hagirso was barely four feet tall. Tesfaye said his son was often sick and wasn’t strong enough to do much work on the small family farm. He was certainly physically stunted. Hagirso proudly announced that he was in school. It is true, Tesfaye said, adding that he had just started. Hagirso was in first grade. He and his classmates were studying the alphabet. In his tattered notebook, Hagirso had written some consonant-vowel combinations: ba, be, bi, bo, bu. Fifteen years old, in first grade, learning the alphabet. Clearly, Hagirso was cognitively stunted as well. Tesfaye doubted that Hagirso would ever learn enough to get a job off the farm that would earn more money. Hagirso was the embodiment of all the statistics on the cost of malnutrition and stunting: lost health, lost education, lost work, lost wages, lost opportunity. Stunted. What does it mean? It means a life of diminished potential, dashed dreams, underachievement. It is the life of Hagirso. It is the life of one of every four children in the world.
These trends are common in many LMICs. The prevalence of diet-related NCDs in low-income countries in particular is increasing faster than the decline in disability and mortality from infectious diseases. The health and economic costs are significant. The global decline in productivity due to illness and death from diet-related NCDs may in fact reach $35 trillion by 2030—seven times the current level of global health spending. Malnutrition leads to poor health and weakens economies Unhealthy diets are the leading risk factor for disease and disability in both developed and developing countries. Malnutrition—both undernutrition and obesity—contributes to poor health in a variety of ways across different populations. Undernutrition is linked to infection, which impairs children’s growth and development. Undernourished children are more susceptible to illness and are more likely to experience severe infections and longer bouts of illness. More than three million children die each year due to undernutrition. Micronutrient deficiencies in particular can lead to serious health risks such as anemia from iron deficiency or blindness from severe vitamin A deficiency. Obesity has also dramatically increased, according to new World Health Organization (WHO) statistics released in January 2015.30 It has adverse effects on nearly every aspect of health, including cardiovascular, reproductive, respiratory, and mental health.
Beyond the individual health impacts, malnutrition weakens economies through decreased productivity, diminished educational achievement and income-earning potential, and increased health-care costs. Undernutrition in early life is associated with permanent IQ loss, impaired cognitive function, and decreased lifelong earning potential. In some countries of Sub-Saharan Africa, child undernutrition may be responsible for losses as high as 16 percent of GDP.Poorly nourished or unhealthy workers are less productive, less likely to innovate, and more likely to leave agriculture due to poor health. At the same time, health-care expenditures on obesity-related medical problems have risen sharply over the past 20 years in the United States and in many developed countries. In China, for example, in 2002 obesity led to a nearly 3.6 percent decline in GNP, a percentage that is expected to more than double by 2025 (8.7%)