Interventions: Sustainable & Healthy Populations
Sustainable and healthy diets could bring widespread environmental and public health benefits. Laura Wellesley outlines the strategies and interventions required to sustainably meet the nutritional needs of a growing global population.
Aerial view of Dong people enjoying a family banquet together in Liuzhou, China. Image: Wu Lianxun/China News Service/VCG via Getty Images.
Introduction
Achieving environmental and nutrition security means that global dietary trajectories must be altered to converge around diets that are low in animal products and offer a nutritious diversity of whole grains, fruits and vegetables. Approaches to influencing food choices span a wide spectrum of intervention, from awareness campaigns to inform people to make better choices, through ‘nudging’ techniques to influence decisions at a subconscious level, to restrictions or taxation on undesirable products1. Governments have proven far more willing to employ these approaches on public-health grounds than environmental grounds so there exists considerable scope for leveraging growing public awareness and scientific evidence of the health risks associated with overconsumption of processed meat, for example.
Realizing consumption patterns that meet the nutrition needs of a growing population will also require a redistribution of resources and the targeting of nutrition-supporting initiatives among poor and marginalized communities. The World Bank estimates that every $1 spent on nutrition will yield $16 in return, supporting as it does healthy and productive individuals who will later contribute to the national economy. Nutrition-specific interventions including multi-nutrient supplements and deworming treatments can cost as little as $1 per child or woman every year2 but public funding for their rollout is lacking.
As important as the implementation of big-ticket interventions, whose value is already known, is investment in evidence and knowledge generation: numbers that justify difficult political decisions and lessons that accelerate the development of best practice so that transformative change may be realized in the shortest possible timeframe.
Below is an indicative list of interventions to: (1) expand healthy, sustainable diets, (2) deter unhealthy, unsustainable diets (3) scale up nutrition interventions and (4) build the evidence for intervention.
Expand healthy, sustainable diets
Support the setting of national guidelines for healthy and sustainable diets (HSDs). These can provide a framework for subsequent ambitious public policies such as taxes on undesirable foods and public procurement requirements and signal to industry the need for responsible supply-chain management and product reformulation. An international working group, hosted under the auspices of the World Health Organization or by an independent third party, could facilitate the exchange of lessons learned between those countries where such guidelines have already been implemented – for example, Brazil, Qatar and Sweden – and those where there is political appetite to do so.
Funding research in support of public-procurement standards based on HSD guidelines or accepted sustainability and nutrition standards. Standard setting for large-scale contracts in public services – schools, hospitals, prisons, government agencies and the military – can yield immediate results in the quality of food provision among school children, the elderly and the infirm, and can also be leveraged to generate a strong demand pull for cross-supply-chain changes among major suppliers. Philanthropic support for research to identify appropriate procurement standards, and for advocacy campaigns to put this into practice, could accelerate implementation where the impacts will be particularly great i.e. in those countries with a large public-sector spend and/or those where public procurement of unsustainable and/or unhealthy products is high.
Facilitate multi-stakeholder processes to embed HSD principles across public policy. In order to create demand for, and improve access to, healthy and sustainable foods as well as to meet this demand through sustainable production, a coordinated policy strategy grounded in HSDs is needed across agriculture, trade, health and social protection. Philanthropists can support these processes by financing national scoping studies that explore opportunities for cohesive policymaking based on HSDs, by convening national policy dialogues and by supporting peer-to-peer learning between civil society groups and policymakers in countries where such dialogues are underway.
Lead or finance investor-led initiatives to promote non-financial disclosure in the food sector of environmental and health risks. The FAIRR Initiative has spearheaded action from investors, managing a collective $4.8 trillion in assets, to enhance transparency around the use of prophylactic antibiotics in factory farming and to encourage divestment from those food companies with unacceptably high use. Investment in the establishment and championing of a CDP-modelled platform to support the standardized reporting on environmental and public-health externalities could mobilize wider investor pressure while providing key benchmarks and performance indicators against which companies and investors may be held to account.
Encourage and enable public-private research collaborations to identify big-ticket food-business interventions. Multi-stakeholder research projects involving food business as key partners, such as the WBCSD-EAT Foundation project ‘FReSH’, unlock action-orientated initiatives and industry-ready research findings from civil society.
Finance the starting up of community food networks in underserved communities with high rates of malnutrition. Teaching gardens and kitchens in schools can achieve multiple benefits, particularly when targeted in deprived communities where dependence on school feeding programmes and food banks is particularly high. Benefits from such programmes include the provision of nutritious school meals, the education of children around sustainable food production and healthy diets, the formation of healthy and sustainable eating habits, and skills development in food production and preparation. When linked with community food-distribution schemes and, during school holidays, with community kitchens and skills development programmes, such facilities can become a cornerstone of community food networks.
Schoolchildren choose their meal at a school canteen in Toulouse, France. Image: Remy Gabalda/AFP via Getty Images.
Deter unhealthy and unsustainable diets
Invest in evidence generation around the impact of pricing food to account for health and environmental costs. Several governments have used ‘sin taxes’ to discourage consumption of unhealthy products – most notably sugar-sweetened beverages – and to encourage the reformulation of products by companies. Recent analysis suggests that a carbon tax on meat could yield significant benefits in terms of both greenhouse gas emissions reductions and public health. Complementary measures, including the earmarking of associated tax revenue for nutrition-specific interventions among more vulnerable population segments, can mitigate the unintended impacts of higher consumer prices and lower producer incomes. Sin taxes are nevertheless politically risky and there is only limited evidence of their impact and of the most appropriate mechanisms for their implementation. Further funding is needed to generate additional research and to pilot their use.
Fund advocacy and piloting for public planning regulations to prevent overconsumption of undesirable foods. Successful approaches have included rules that prohibit the opening of fast-food restaurants in the vicinity of schools but have been geographically limited in scope. Support for international networks, like C40, to coordinate these localized efforts, support lesson-sharing and collate results, would greatly amplify their contribution to knowledge and evidence generation. Direct investment in advocacy for such schemes and support for local authorities in their setting up, monitoring and evaluation, could further galvanize this process while targeting food behaviours in urban centres where the triple burden of malnutrition is often most prevalent.
Scope and support big-hitting, radical awareness campaigns in major meat-consuming countries. Recent mass-audience campaigns against factory farming, most notably Cowspiracy and Farmaggedon, have arguably contributed significantly to the rapid rise in flexitarianism, vegetarianism and veganism in North America and Europe. These films are testament to the power of shock techniques in galvanizing attitudinal changes, particularly when food-safety scares and undercover journalistic exposés have already hit consumer trust. Support for equivalent campaigns in major meat-consuming countries such as Brazil – itself recently hit by corruption and food safety scandals in the meat industry – could help shift the dial towards flexitarian lifestyles. There may be opportunities to leverage celebrities alongside experts in particular countries and contexts.
Finance research into the potential impacts of lifestyle-differentiated insurance products. As the public-health burden of poor diets rises, lifestyle differentiation offers a potentially powerful means of disincentivizing unhealthy diets while lessening public payout for diet-related disease. A controversial concept, lifestyle differentiation requires in-depth analysis across geographies and sociodemographic groups to understand the benefits for public health as well as the potentially harmful unintended outcomes and how these may be managed.
Scale up nutrition interventions
Collaborate on the establishment of a new multilateral fund on nutrition-specific interventions. Interventions to improve malnutrition (e.g. micronutrient-rich food supplements, deworming treatment, salt iodization and support for early and exclusive breastfeeding) are as simple – and often considerably cheaper – than vaccines against the big-killer diseases, but the finance is lacking. Such a mechanism could be linked to innovative international financing mechanisms (as well as donor contributions) that have been explored in the past, such as airline flight levies.
Fund an independent or multilateral body to track domestic public spending on nutrition. The Global Nutrition Report collates and publishes data on domestic spending on nutrition interventions but it covers only low-income countries (with industrialized country spending tracked as donor spending) and remains targeted at the global nutrition community. The expansion of this tracking to all countries and its collation and analysis by a recognized international body such as the World Economic Forum could ramp up the pressure on finance ministers in developing countries to earmark resources for nutrition.
Support research and development in new technologies that support affordable milk pasteurization. Innovative approaches to supporting breastfeeding, such as self-guided mobile phone-based systems, can overcome the major technical and financial barriers to deployment of milk banks in those countries where they are most needed.3
Invest seed capital to kick-start public-private partnerships to fortify foods with key micronutrients – including iron, zinc and multivitamins. Public-private partnerships could harness industry innovations in product formulation to create food products tailored to the nutritional needs and food preferences of target populations – an effort particularly necessary for the design of ready-to-use therapeutic foods which are often sold or exchanged for more desirable, although likely less nutritious, foods by recipients.
Scale up investment in innovative solutions for safe drinking water. Innovations – including LifeStraw solar-based portable water distillation systems4 and bicycle-powered purification systems – offer cheap, sustainable, resource-light means of accessing safe water that could be readily deployed with investments in the up-front manufacturing and distribution costs. In addition to direct financial support for research and development, funding could target education and awareness-raising campaigns among local healthcare providers and small-scale business on their use and manufacture.
A woman using a LifeStraw filtration device at her home at Mumias in Kenya. Image: Tony Karumba/Stringer via Getty Images.
Build the evidence for intervention
Invest in pilot projects at city level to rapidly generate evidence of what works. City authorities in countries around the world have shown leadership in promoting healthy and sustainable food environments. Philanthropists can support local authorities and civil society networks as well as international city networks, like C40, to pilot many of the ideas above (public procurement standards based on health and sustainability criteria, zoning initiatives to regulate the food environment around schools, community food networks and teaching kitchens), to monitor and evaluate their impact, and to share lessons on impactful interventions and their implementation.
Support economic analysis of the contribution of interventions on nutrition and healthy and sustainable diets to meeting the Sustainable Development Goals (SDGs). Econometric modelling of the impact of interventions along the spectrum of intervention would help policymakers and civil society pinpoint win-win-win opportunities and assessing the potential multiplier effect of these investments in support of national SDG targets and commitments under the Paris accord.
Fund an international network of non-governmental organizations to collate disaggregated data on nutritional status and dietary patterns. Systematic and differentiated data collection would unlock more targeted and more impactful interventions to tackle malnutrition in all its forms and to do so within local and planetary boundaries. In industrialized countries, public-private collaborations could be supported as a means to harness big data collected by retailers and food services and to assess national and subnational dietary profiles.
