sustainable food systems and nutrition ... systems...building sustainable food systems and healthy...

SUSTAINABLE FOOD SYSTEMS AND NUTRITION HEALTHY

DIETARY PATTERNSSome of the essential transformations needed to meet the Sustainable Development Goals (SDGs) are elaborated in the Global Sustainable Development Report (GSDR) 2019i and the political declaration of the high-level political forum 2019. These transformations are mutually reinforcing and strongly linked to the Sustainable Development Goals (SDGs). The report identifies six entry points and four levers to accelerate progress across all 17 SDGs at the global level,1 one of them being Food Systems and Nutrition Patterns.

I. SUSTAINABLE FOOD SYSTEMS AND HEALTHY NUTRITION IN ASIA AND THE PACIFIC Feeding an ever-increasing population with scarce resources and in a sustainable manner while limiting environmental pollution, lowering carbon emissions and minimizing human health risks is the persistent challenge of our times. Building sustainable food systems and healthy nutrition patterns is particularly relevant for the region where close to 489 million people remain undernourished,ii while a simultaneous rise in obesity and overweight is costing the region upwards of 0.78% of its GDP or US$166 billion annually.iii The UN Decade of Action on Nutrition offers a unique opportunity to all countries and stakeholders to unite around a common framework and to increase the visibility, coordination, efficiency and effectiveness of nutrition action at all levels across the world.iv

Strengthening sustainable food systems and healthy dietary patterns integrates SDG 2- Zero Hunger; SDG 6 - Clean water and sanitation; SDG 9 - Industry innovation and infrastructure; and SDG 12 – Sustainable consumption and production. It also has a major influence on SDG 3 – Good health and wellbeing, and links to many other SDGs.

1 Entry point 1 – Human well-being and capabilities , Entry point 2 – Sustainable and just economies, Entry point 3 – Food systems and nutrition patterns, Entry point 4 – Energy decarbonization and universal access, Entry point 5 – Urban and peri-urban development, Entry point 6 – Global environmental commons, Lever 1- Governance, Lever 2- Economy and Finance, Lever 3- Individual and Collective Action, Lever 4- Science and Technology

SUSTAINABLE FOOD SYSTEMS AND NUTRITION HEALTHY DIETARY PATTERNS

II. PROGRESS AND KEY CHALLENGES FOR ACCELERATION IN ASIA AND THE PACIFIC

In Asia and the Pacific, significant progress has been made towards eliminating hunger and malnutrition over the past years.v However, the region is still home to 490 million people suffering from chronic hunger, accounting for 62 percent of undernourished people in the world.vi The prevalence of stunting and wasting in the region remains unacceptably high, with stunting rates exceeding 22 percent in a majority of the region’s countries. An estimated 82 million children under five years of age in the region were stunted in 2018, and 34 million suffered from wasting.vii 400 million of women of reproductive age are anemic and millions of children under five suffer from micronutrient deficiencies, particularly that of iron, iodine, zinc and Vitamin A.

At the same time, most countries in the region are dealing with multiple burdens of malnutrition, whereby stunting, wasting and micronutrient deficiencies co-exist with rising rates of overweight and obesity.viii In Asia and the Pacific, an estimated 15.7 million children under five years of age were considered overweight in 2018.ix The prevalence of overweight and obesity in both adults and school-age children is rising more rapidly in Asia and the Pacific than any other region. This burden has been estimated to cost 0.78% of GDP in the region.x Nutrition related disorders can co-exist at all levels of the society from national to the households and even, within the same person.xi Recent statistics, therefore, indicate that Asia and the Pacific is facing a nutrition crisis.

Malnutrition is a global challenge with huge social and economic costs. Unhealthy diets underpin all forms of malnutrition and has become the leading risk factor for the global burden of disease.xii They play an important role that is also attributable to a lack of availability and access to nutritious foods and rising food prices. An increased intake of foods that are high in fats, salt and sugar, combined with physical inactivity due to increasingly sedentary lifestyles, rapid urbanization and changing modes of transportation are the leading causes of overweight and obesity.xiii Unhealthy diets are becoming increasingly widespread in the region and are increasingly affordable and aspirational via intense food marketing strategies. In

Figure 1: Sub-regional snapshot of progress and overall progress in Asia and the Pacific on Food Systems and Nutrition Patterns

Source: Economic and Social Commission for Asia and the Pacific (ESCAP), calculations based on methodology from Asia and the Pacific SDG Progress Report 2020 (forthcoming) and data from the ESCAP Statistical Online Database. Available at http://data.unescap.org/escap_stat/ (accessed on 10 December 2019).

Note: The green line represents targets to be achieved in the 2030 Agenda. If the region was on track to achieve these targets across the six areas, the red line would have been hit by 2019.


addition, poor feeding practices among infants and young children, including inadequate breastfeeding and improper complementary feeding, poor hygiene and sanitation, insufficient access to clean water and infections also compromise a child’s growth and nutritional status.xiv

The consequences of malnutrition are varied and far-reaching. Undernutrition can retard growth and development, reduce physical activity, impair resistance to infection, increase morbidity and lead to disabilities and premature death.xv It also blunts cognitive development, leading to lower school achievement and subsequent losses to incomes both at the individual level and national economic development. Overweight or obese children are at a higher risk of developing chronic health problems later in life, including type 2 diabetes, high blood pressure, sleep disorders and liver diseases among others. The high rates of these diet-related non-communicable diseases (NCDs) in the region are putting a huge strain on national healthcare budgets and causing tremendous losses in human resources and economic productivity.xvi

The Roles of Sustainable Food Systems for Healthy Diets and Improved Nutritionin Asia and the Pacific

A food system gathers all the elements (environment, people, inputs, processes, infrastructure, institutions and others) and activities that relate to the production, processing, distribution, preparation and consumption of food, and the outputs of these activities, including socio-economic and environmental outcomes.xvii, xviii Ending hunger and malnutrition requires a sustainable food system that improves dietary diversity for the consumer and also assures livelihoods to small holders, family farmers and other actors in the agri-food chain.xix, xx

Box 1: Food System

Food system: “encompass the entire range of activities involved in the production, processing, marketing, consumption and disposal of goods, which originate from agriculture, forestry or fisheries, including the inputs needed, and the outputs generated at each of these steps. Food systems also involve the people and institutions that initiate or inhibit change in the system as well as the sociopolitical, economic and technological environment in which these activities take place”.

World Bank and FAO, 2017

Malnutrition will not diminish unless action is accelerated to reshape current food systems to achieve healthier diets.Ensuring nutrition sensitivity at every stage of the supply chain being is therefore crucial. Putting in place a sustainable and nutrition sensitive food system would provide consumers easier access to affordable and nutritious choices including traditional and local foods for healthy meals all the year round and for all members of the household.xxi

Today, Asian and Pacific food systems are facing considerable challenges, mainly related to changing dietary patterns, persistent conflicts and crises, growing inequity, climate change, urbanization and globalization. These have substantial impacts on the food systems at local, national, regional and global levels.xxii Rapid socio-economic growth and urbanization, advances in food technology and food trade policy have resulted in changing dietary patterns that have increased demands on the food system.xxiii

Building a sustainable and nutrition sensitive food system as well as moving toward healthy dietary patterns

Today, far too many children are eating too little nutritious food and too much junk foods

These poor-quality diets are robbing millions of children of their health, development and lifetime prospects.


of people is becoming crucial to accelerate the reduction in all forms of malnutrition and advancement in socio-economic development for the region.

Additionally, the impact of climate-change and natural disasters on agriculture and food systems and hence, food security and nutrition cannot be understated. Climate-related disasters affect all the four dimensions of food security (availability, access, utilization and stability), as well as other drivers of malnutrition. Incidences of climate-related disasters have been rising in the region. The number of people in need of food assistance often increases after disasters, especially when vulnerable people are affected.xxiv Food-insecure people normally find themselves forced to take desperate coping measures to address their immediate needs. Often their livelihoods are compromised and their vulnerability to hunger and unhealthy diets is increased, which exposes them to further health problems. FAO warns that, “while climate change and extreme weather events are impacting the environment in many ways, agriculture and food production in Asia and the Pacific are among those hardest hit and must be first in line to defend.”xxvi Countries are urged to do more to adapt and mitigate the effects of extreme climatic events on agriculture and rural livelihoods.”xxvii

To address all forms of malnutrition, countries require a suite of bold multisectoral actions, involving all sectors and actors: health, agriculture, education, social protection, planning, economic policy sectors, local communities, civil society and the private sector. Food systems must be transformed to make nutritious foods more easily accessible, affordable and available all the year round. To that end, countries must reconsider their investment priorities and reform their food subsidy policies to promote sustainable production and to enhance the availability and affordability of a wide variety of nutritious foods for making a healthy diet possible.xxviii On the other hand, the consumption of ‘junk’ foods that are high in sugars, fats and salt, but low in micronutrients and dietary fibers need to be limited. Governments could also consider the implementation of a suite of policies and legislation by restricting the marketing and sales of such foods and beverages. These measures could include sugar taxes, restrictions on marketing of junk foods and beverages to children, front of pack labelling schemes which signpost unhealthy nutrient content and promote product reformulation such as the elimination of trans-fats as a food ingredient. To be more effective in changing consumers’ eating behaviors, their empowerment to adopt healthy eating habits must go hand in hand with the aforesaid policies and legislation. This includes promotion of healthy eating to the public, nutrition education, promotion of healthy food environments in the community, workplace and institutions, including formal and informal food vendor settings, street foods, wholesome school meal programmes and environments.

“Food systems go well BEYOND PRODUCTION: storage, transport, trade, transformation, provisioning and retail. Food systems GOVERN the safety, nutrition quality and

affordability of food”xxix

III. COUNTRY LEVEL ANALYSIS In recent decades, Thailand has come to enjoy a reputation as a Nutrition Champion. It has made great strides in improving food security with the undernourishment rate falling from 35% in 1990 to 7% in 2016.xxx Thailand has also achieved remarkable reductions in undernutrition and micronutrient deficiencies among children and women within two decades.xxxi In 1987, almost a quarter of the Thai children under five were stunted, while the rate dropped to just over 10% in 2016.xxxii The Thai experiences in nutrition achievement are widely regarded as one of the best examples of a successful country program, and its successes could provide important lessons for other countries facing hunger and malnutrition.xxxiii

Thailand’s success is due to a range of factors. Since the 1960s Thailand set the stage for accelerated progress in nutrition through building awareness and designing nutrition components of national development strategies, policies and investments. In the 1980s, nutrition was recognized not only as a development issue but as a symptom of poverty, and accordingly a multi-sectoral poverty alleviation programme was implemented in the poorest districts to improve nutrition. Among the initiatives


implemented was the setting up of a community-based nutrition programme between the 1980s to mid-1990s, which was one of the key success factors in reducing stunting. The programme involved strategic planning with community engagement, social mobilization through community activists and a local action-oriented monitoring framework. Alongside this community-based programme, other factors for success include a nutrition-sensitive agriculture system, which promoted and supported consumption of nutritious foods and supplementary and complementary foods. Increasing access to improved Water Sanitation and Hygiene (WASH) also played a significant role, as did the early adoption of universal health coverage and high rates of female secondary education. Thailand’s success story has been documented in detail elsewherexxxiv which highlights the importance of advocacy and research in elevating attention and priority for nutrition, of setting measurable targets embedded into policies, strategies and action plans, and of ensuring institutional support across sectors, including facilitation of community mobilization and actions.

The Indian Government has invested significantly in improving nutrition. The National Nutrition Mission initiated in 2017-18 aims to achieve tangible improvement in nutritional status of children from 0-6 years, adolescent girls, pregnant women and lactating mothers with time bound targets. One success factor has been in creating a strong convergence of programs and sectors and mainstreaming nutrition objectives into these, such as rural development programs. Under the National Nutrition Mission, the Government of India promotes a focus on local food systems. It follows a two-pronged strategy, which includes strengthening the knowledge about regional and local food systems and promoting social and behavior change among communities and individuals, including women and caretakers of children, in view of the benefits of what these native food systems offer to enhance diets of these individuals and their children. The mission also attempts to employ a system-wide approach by improving community linkages with the health system, public distribution system, water and sanitation system, etc.xxxv In addition, the Government of India is developing an atlas which will serve as a repository of traditional foods, crops and cultural practices associated with them, such as folk songs or theatre and arts. This repository comprises key information on the local food systems in 127 agro-climatic zones of the country. It will be made accessible to policymakers, administrators, experts and communities to inform programmes and their contribution to nutritional outcomes. The atlas will be disseminated at district level for collective use by all relevant stakeholders including farmers, retailers and consumers.xxxvi

In Indonesia, the Ministry of National Development Planning (BAPPENAS), in the new 5-Year National Development Plan (RPJMN 2020-24), has recognized the need to develop strategies that will rework food systems in the country to ameliorate food insecurity and combat all forms of malnutrition without compromising robust economic growth both in rural and urban areas. In addition, the Food Law (18/2012) foresees the establishment of a national Food Agency, which is yet to be set up. In 2018, BAPPENAS took the initiative to address the gaps in implementation of the Food Law and the process of policy and institutional change is underway. A new inter-institutional mechanism of governance and oversight that addresses food systems in a holistic way and convenes all the relevant sectors and agencies is being put in place. This is the result of a change in mindset at a high level which will result in policies and regulations governing agriculture production, food chains and the food environment being streamlined and integrated to achieve sustainable outcomes for nutrition as well as the climate.

Pakistan has one of the highest malnutrition burdens in the world including the world’s third largest population of stunted children.xxxvii It also faces the complex problem of the double burden of malnutrition. Despite Pakistan being a large producer of rice and wheat, around 67% of the population is unable to afford a minimum nutritious diet.xxxviii The country is losing an estimated USD 7.6 billion or 3% of its GDP per year due to its high burden of malnutrition.xxxix The major challenge in relation to food systems is a lack of adoption of coherent approaches towards nutrition sensitive and sustainable models which could facilitate access to healthy diets. Other challenges that the country experiencing are food safety, lack of commercially available nutritious foods that are affordable and accessible to young children, poor implementation of regulations and standards and weak linkages from farm to market.


IV. POLICY RECOMMENDATIONS FOR ACCELERATION ON SUSTAINABLE FOOD SYSTEMS AND IMPROVED NUTRITION

1. Governments can help reduce hunger, improve nutrition and transform food systems by reviewing national policies and investments and integrate nutrition objectives into food and agriculture policy and programming to ensure food security and healthy diets.

2. Strengthen local food production and processing, especially by smallholders and family farmers, giving special attention to youth and women’s empowerment, while recognizing that efficient and effective trade is one of the keys to achieving nutrition objectives.

3. Improve food storage, preservation, transport and distribution technologies and infrastructure to reduce food and nutrient losses and waste and seasonal food insecurity.

4. Encourage product reformulation by the reduction of saturated fat, sugars and salt/sodium in foods and beverages, as well as elimination of trans-fats in food products to improve food and nutrition quality and prevent excessive intakes.

5. Establish and strengthen institutions, policies, programmes and services to enhance the resilience of the food supply in crisis-prone areas, including areas affected by climate change.

6. Establish food and nutrient-based standards to guide healthy diets and safe drinking water accessible

at home, workplace, school and public facilities.

7. Improve maternal and child nutrition by encouraging breastfeeding and providing adequate facilities for breastfeeding, addressing nutritional quality of complementary foods targeting mothers and young children, and improving supplementary feeding programmes for infants and young children.

8. Invest in nutrition sensitive social protection and WASH programmes to improve child and maternal health and nutrition.

For more comprehensive policy recommendations on improving food systems for healthy diets and improved nutrition, please refer to the following publications:-

FAO & WHO, 2014. Second International Conference on Nutrition. Report of the joint FAO/WHO secretariat on the Conference. Rome, FAO, and Geneva, WHO. Available at www.fao.org/3/a-i4436e.pdf

FAO & WHO, 2018. Strengthening Nutrition Action – a resource guide for countries based on the policy recommendations of the 2nd International Conference on Nutrition (ICN2). FAO/WHO. Rome. FAO & WHO. 2018. http://www.fao.org/in-action/fsn-caucasus-asia/resources/detail/en/c/1157372/ Global Panel, 2016. Food systems and diets: facing the challenges of the 21st century. https://www.glopan.org/foresight

ACKNOWLEDGEMENTSThis entry point profile has been developed by the Food and Agriculture Organization of the United Nations (FAO), the United Nations International Children’s Emergency Fund (UNICEF) and, the United Nations World Food Programme (WFP), under the guidance of the United Nations Economic and Social Commission for Asia and the Pacific (ESCAP).


END NOTES i https://sustainabledevelopment.un.org/content/documents/24797GSDR_report_2019.pdfii Source http://data.unescap.org/escap_stat/, accessed 10 December, 2019iii ADB,UNDP,ESCAP Partnership report 2020iv FAO et al., (2016). UN Decade of Action on Nutrition 2016 – 2025 http://www.fao.org/3/a-i6130e.pdfv FAO et al., 2019. Regional Overview of Food Security and Nutrition, Asia and the Pacific 2019. Bangkok, FAO. Available at

www.fao.org/documents/card/en/c/ca7062en/vi FAO, 2017. Future Smart Food: Unlocking hidden treasures in Asia and the Paci¬fic. Available at http://www.fao.org/3/

I8907EN/i8907en.pdfvii FAO et al., 2019. The State of Food Security and Nutrition in the World 2019. Safeguarding against economic slowdowns

and downturns. Rome, FAO. Available at www.fao.org/3/ca5162en/ca5162en.pdfviii Gillespie. S and Bold. M, 2017. Agriculture, Food Systems, and Nutrition: Meeting the Challenge, Global Challenge.

https://onlinelibrary.wiley.com/doi/full/10.1002/gch2.201600002ix FAO et al., 2019. Regional Overview of Food Security and Nutrition, Asia and the Pacific 2019. Bangkok, FAO. Available at

www.fao.org/documents/card/en/c/ca7062en/x FAO et al., 2019. Regional Overview of Food Security and Nutrition, Asia and the Pacific 2019. Bangkok, FAO. Available at www.

fao.org/documents/card/en/c/ca7062en/xi FAO et al., 2019. Regional Overview of Food Security and Nutrition, Asia and the Pacific 2019. Bangkok, FAO. Available at

www.fao.org/documents/card/en/c/ca7062en/xii Gillespie. S and Bold. M, 2017. Agriculture, Food Systems, and Nutrition: Meeting the Challenge, Global Challenge.

https://onlinelibrary.wiley.com/doi/full/10.1002/gch2.201600002xiii WHO, 2018. Obesity and overweight. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight)xiv UNICEF et al, 2010. Facts for Life. http://www.factsforlifeglobal.org/resources/factsforlife-en-full.pdfxv FAO and WHO, 1992. International Conference, Nutrition and development - a global assessment. Available at www.

fao.org/3/z9550e/z9550e.pdfxvi FAO et al., 2019. Regional Overview of Food Security and Nutrition, Asia and the Pacific 2019. Bangkok, FAO. Available at

www.fao.org/documents/card/en/c/ca7062en/xvii Global Panel, 2016. Food systems and diets: Facing the challenges of the 21stcentury. https://www.ifpri.org/publication/

food-systems-and-diets-facing-challenges-21st-centuryxviii HLPE, 2017. Nutrition and food systems. A report by The High Level Panel of Experts on Food Security and Nutrition:

http://www.fao.org/3/a-i7846e.pdfxix FAO, 2013. The state of food and agriculture 2013: Food System for Better Nutrition. Rome, FAO. Available at www.fao.

org/3/i3300e/i3300e00.htmxx World Bank and FAO, 2017. Food Systems for an Urbanizing world. Available at http://documents.worldbank.org/

curated/en/454961511210702794/pdf/Food-Systems-for-an-Urbanizing-World.pdfxxi FAO, 2018. Strengthening Sector Policies for Better Food Security and Nutrition Results. Food Systems for Healthy

Diets. Policy Guidance Note /12. Available at www.fao.org/3/CA2797EN/ca2797en.pdfxxii Asia and the Pacific Policy Forum, 2019. The intersection between climate change, food, and migration: Transforming

agri-food systems for human and planetary health. https://www.policyforum.net/the-intersection-between-climate-change-food-and-migration/

xxiii Asia and the Pacific Policy Forum, 2019. The intersection between climate change, food, and migration: Transforming agri-food systems for human and planetary health. https://www.policyforum.net/the-intersection-between-climate-change-food-and-migration/

xxiv FAO, 2018. The impact of disasters and crises on agriculture and food security 2017. Rome, FAO. Available at www.fao.org/3/I8656EN/i8656en.pdf

xxv FAO, 2018. The impact of disasters and crises on agriculture and food security 2017. Rome, FAO. Available at www.fao.org/3/I8656EN/i8656en.pdf

xxvi FAO, 2018. FAO warns that protecting agriculture from extreme weather and climate change must become a priority in Asia and the Pacific www.fao.org/asiapacific/news/detail-events/en/c/1106925/


xxvii FAO, 2019. UN partners warn of disproportional impacts from climate change on land use and food security in Asia-Pacific www.fao.org/asiapacific/news/detail-events/en/c/1241960/

xxviii Asia and the Pacific Policy Forum, 2019. The intersection between climate change, food, and migration: Transforming agri-food systems for human and planetary health. https://www.policyforum.net/the-intersection-between-climate-change-food-and-migration/

xxix Lee. W. T.K, 2019. Moving Towards Nutrition-Sensitive Food Systems for Healthy Diets- A challenge for the 21st Century, Bangkok FAO https://eatrightinternational.org/2019/03/21/moving-towards-a-nutrition-sensitive-food-systems-for-healthy-diets-a-challenge-for-the-21st-century/v

xxx Winichagoon P, 2013. Thailand nutrition in transition: situation and challenges of maternal and child nutrition. Asia Pac J Clin Nutr 2013;22 (1):6-15

xxxi FAO, 2017. FAOSTAT. Accessed May 2017 http://faostat3.fao.org/download/Q/QC/E.xxxii UNICEF, 2016. UNICEF MICS survey 2015-16. Available at https://www.unicef.org/thailand/sites/unicef.org.thailand/

files/2018-06/Thailand_MICS_Full_Report_EN_0.pdfxxxiii Gillespie, Tontisirin, and Zseleczky, 2016. Local to National: Thailand’s Integrated Nutrition program, Available at https://

www.ifpri.org/publication/local-national-thailands-integrated-nutrition-programxxxiv Tontisirin et al., 2013. Country Policy Analysis: Nutrition Impacts of Agriculture and Food Systems, Thailand 2013.

UNSCN- Available at https://www.unscn.org/files/Publications/Country_Case_Studies/Thailand_case_study_FINAL.pdfxxxv Transforming Food Systems for a Rising India. Available at https://tci.cornell.edu/wp-content/uploads/2019/05/Pingali.

etal2019_Book_TransformingFoodSystemsForARisingIndia.pdfxxxvi IFPRI, 2018. Increasing Food System Resilience for Nutrition Sensitivity and Sustainability: A Decentralized

Analysis for India. Available at http://www.indiaenvironmentportal.org.in/files/file/Increasing%20food%20system%20resilience%20for%20nutrition%20sensitivity%20and%20sustainability.pdf

xxxvii UNICEF, 2018. Pakistan National Nutrition Survey 2018. Available at https://www.unicef.org/pakistan/reports/national-nutrition-survey-2018-key-findings-report

xxxviii Government of Pakistan & WFP, 2016. Minimum Cost of the Diet Pakistan 2016. Available at-https://reliefweb.int/sites/reliefweb.int/files/resources/mcod_pakistan_july_2016.pdf

xxxix WFP, 2017. Economic Consequences of Undernutrition in Pakistan: An Assessment of Losses, Available at https://sunpc.org.pk/wp-content/uploads/2019/06/Economic-Consequences-of-Undernutrition-An-Assessment-of-Losses-Final-AK_170414_electronic-copy.pdf

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