Public Disclosure Authorized

FUTURE of FOOD
Shaping the Global Food System to
Deliver Improved Nutrition and Health
Public Disclosure Authorized
Public Disclosure Authorized
Public Disclosure Authorized

Foreword by Dr. Jim Yong Kim

© 2016 World Bank Group

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Authors
Robert F. Townsend, Steven Jaffee, Yurie Tanimichi Hoberg, and Aira Htenas, with inputs from Meera Shekar, Zia Hyder,
Madhur Gautam, Holger Kray, Loraine Ronchi, Sarwat Hussain, Leslie Elder, and Gene Moses. Overall guidance was
provided by Juergen Voegele and Ethel Sennhauser.

Images
Front cover: Neil Palmer/CIAT
Title page: Neil Palmer/CIAT
Interior: 2, Bart Verweij/World Bank
5, Danilo Pinzon
8, Kimberly L. Parent/World Bank
19, Jamie Martin/World Bank
20, Bart Verweij/World Bank
33, from left clockwise, Neil Palmer/CIAT, Kimberly L. Parent, Arne Hoel, Bart Verweij.
 FUTURE of FOOD
Shaping the Global Food System to
Deliver Improved Nutrition and Health
April 2016
FOREWORD

Every person on the planet must have a dai- system and to do this by working across
ly diet that is safe, nutritious and affordable. multiple sectors—and by helping countries
And so a vibrant, productive and resilient adapt to the perils of climate change.
food system is vital if we are to end extreme
poverty by 2030 and boost shared prosperity This report helps point the way forward by
for the poorest 40 percent of the population highlighting potentially transformative food
in developing countries. system advances. There are many good ex-
amples of individual interventions that are
Despite progress made in recent years toward being implemented in diverse settings that
reaching these goals, daunting challenges countries can adopt, adapt and apply to their
remain. Every day, 795 million people go hun- specific circumstances.
gry; one in four people in Sub-Saharan Africa
and one in six in South Asia do not consume As the report makes clear, no one-size plan
their minimum dietary energy needs. Over fits all when it comes to transforming food
165 million children under five are stunted systems. Countries need to tailor the com-
due to chronic malnutrition, which will have bination of interventions with different
life-long consequences and prevent them packages required in low-, middle- and
from achieving their full potential. For each high-income countries. Our challenge now
of them, their families, and their countries is to combine sound policies, regulations,
this is tragic; for society, it is nothing less than and knowledge with targeted investments to
a medical and an economic emergency. help shape a global food system that delivers
a nutritious, safe and affordable diet for all in
While more than 2 billion people are not get- a sustainable way.
ting all the vitamins and minerals necessary
for their growth and healthy development, This is a mission in which we must succeed
another 2 billion people are struggling if we are to end extreme poverty and boost
with the challenges of being overweight or shared prosperity in just 15 years.
obese—many of them in developing coun-
tries. These staggering numbers represent
real and growing long-term consequenc-
es for people, economies, and our collective
future.

It is clear that tackling such significant chal- Jim Yong Kim

lenges will require us to transform our food President, The World Bank Group

SHAPING THE GLOBAL FOOD SYSTEM TO DELIVER IMPROVED NUTRITION AND HEALTH 3
This paper is third in a series. The first, Ending Poverty and Hunger by 2030: An Agenda for the
Global Food System, released at the 2015 Spring Meetings of the World Bank and International
Monetary Fund, outlined the overall agenda. That paper called for action on climate-smart
agriculture, improving nutritional outcomes, strengthening value chains and creating jobs,
while improving market access for poor farmers. The second, Shaping a Climate-Smart Global
Food System, distributed at the 2015 Annual Meetings, focused on climate-smart agriculture.
This third paper focuses on how the food system can deliver improved nutrition and health
for better lives and well-being. It presents a set of nutrition-sensitive interventions that coun-
tries can adopt, adapt, and apply to their circumstances (table 1).

Key messages:
• Malnutrition and food-borne diseases impose large current and future human, economic,
fiscal, and social costs on countries. Key among these is child stunting that has life-long
consequences, reducing cognitive development and lifetime earnings of individuals, and
undermining the future competitiveness of countries.

• Reducing these costs requires multisector approaches. Governments often look to the
health sector for interventions and solutions. However, the potential of food systems to
leverage change and mitigate adverse nutrition and health impacts is frequently over-
looked. This paper focuses on measures that can be, and have been, taken in food systems
to improve nutrition and health.

• Shaping food systems to deliver improved nutrition and health requires a combination
of improved knowledge, sound policies, regulations, and investments across the produc-
tion-to-consumption continuum. The goal is to stimulate behavioral change in food pro-
ducers, post-harvest handlers, food processors, food distributors, and consumers. As the
link between food systems and household nutrition and health passes primarily through
women, greater consideration of this gender dimension is needed across all interventions.

• No one size fits all. Countries need to tailor the combination of interventions to suit their
specific needs. Moreover, different combinations of actions are needed across low- mid-
dle- and high-income countries. There is a growing body of experiential and empirical
evidence from which countries can draw to apply to their own circumstances.

The three sections of this paper focus on, respectively, why the global food system needs to
concentrate more on delivering improved nutrition and health; what types of food system
interventions can deliver improved nutrition and health; and how the agenda can best be
implemented.

4 FUTURE OF FOOD
Why does the global food system need to focus
on delivering improved nutrition and health?

Despite significant progress the world Energy and micronutrient deficiency are
continues to bear a triple burden of mal- contributors to the 165 million children
nutrition. These three burdens are related, under 5 who are stunted and cannot grow
but distinctly different, problems1: energy to achieve their full potential. Globally,
deficiencies (hunger),2 micronutrient de- this number is equivalent to approximately
ficiencies (hidden hunger),3 and excessive 1 in 4 children under 5 years, with an even
net energy intake and unhealthy diets4 more concentrated situation in Sub-Saharan
(overweight/obesity).5 Despite significant Africa and South Asia (1 in 3 children).
progress, 795 million people still are not get- Arguably child stunting is one of the biggest
ting the minimum dietary energy needs.6 The development challenges. If not addressed it
majority of these people are in Sub-Saharan will profoundly undermine our ability to end
Africa, in which 1 in 4 people are hungry; poverty and promote shared prosperity.
and in South Asia, in which 1 in 6 people are
hungry. More than 2 billion people are defi- Many factors contribute to these outcomes.
cient in key vitamins and minerals7 that are Among them, the food system—the set of
necessary for growth, development, and dis- institutions, resources, stakeholders, and
ease prevention. behaviors involved in the production, trans-
formation, delivery, sale, and consumption
Globally, over 2 billion people are overweight of food—plays a significant role. Our food
or obese, two-thirds of whom live in devel- system must shift from being part of the
oping countries.8 This issue clearly is not just problem to becoming a greater part of the
a developed country problem. solution.

SHAPING THE GLOBAL FOOD SYSTEM TO DELIVER IMPROVED NUTRITION AND HEALTH 5
Malnutrition imposes large human, eco- US$48 billion–66 billion annually in the
nomic, fiscal, and social costs. Malnutrition United States, and by £1.9-2 billion/
leads to maternal and child mortality, child year in the UK by 2030.15 Such costs
stunting, poor learning capacity, lost produc- would overwhelm the fiscal condition
tivity and incomes for adults, high health of most developing countries and po-
costs, and slower economic growth. It also tentially divert public spending from
can perpetuate poverty in affected popula- other productive pro-poor investments.
tions. Nevertheless, these countries are precisely
those in which obesity rates are expand-
• Higher mortality rates. Child undernu- ing, thus adding to the triple burden of
trition increases susceptibility to infec- malnutrition.
tion and chronic diseases and accounts
• Lower overall competitiveness, eco-
for approximately 45 percent of all child
nomic growth, and poverty reduction.
deaths.9 Iron and vitamin A deficiencies
Recent estimates from Africa and Asia
increase maternal morbidity and mor-
show that 11 percent of GNP is lost ev-
tality.10 Over the last several decades,
ery year due to poor nutrition.16 Analysis
overweight and obesity-linked deaths, in-
in Guatemala also shows that individuals
cluding from cardiovascular diseases and
who received nutritional care as children
diabetes, have increased significantly.11
and were not stunted at age 3 were 33
• Lower current and future labor pro- percentage points less likely to reside in
ductivity. Smallholder farmers, especial- poverty as adults.17 Stunting of children
ly women farmers, often are among the can undermine the future competitiveness
population segments with the highest of countries, an effect that may be ampli-
incidence of malnutrition. Malnourished fied with the shift to a more knowledge
farmers are less able to undertake strenu- intensive and digital world. Malnutrition
ous physical work both on and off farms, and slowed poverty reduction are inter-
thus substantially reducing current labor linked in that poverty also contributes to
productivity.12 Malnutrition can leave perpetuate malnutrition.
children stunted with life-long conse-
Contaminated food also contributes to
quences. It reduces their cognitive devel-
poor health outcomes and impacts 1 in 10
opment and learning capacity which can
people globally each year. An estimated
diminish their lifetime earnings by 10
420,000 people die each year from contami-
percent or more and substantially reduce
nated food, 30 percent of whom are children
future labor productivity.13
under 5 years, with the highest death rates
• Unaffordable health care costs. Eco- occurring in Sub-Saharan Africa and Asia. 18
nomically, obesity worldwide is associ- The many sources and forms of contaminated
ated with a total economic cost of US$2 food include poor production, post-harvest,
trillion.14 The combined medical costs and/or storage practices. Consumed in high
to treat diet-related, non-communica- doses, aflatoxins can lead to serious illness
ble diseases are projected to increase by and even death in both human beings and

6 FUTURE OF FOOD
animals. Some reports estimate that afla- temperatures. Higher global temperatures are
toxins cause 5 percent–30 percent of all projected to lower crop yields and food avail-
liver cancer in the world19 and are associated ability in the poorest countries and to shift
with growth retardation and immunosup- the composition of consumption to a pat-
pression.20 Increased human health risks tern that is associated with negative health
also are caused by the misuse of antibiot- implications, such as a disproportionately
ics in livestock and aquaculture. Evidence lower consumption of fruits and vegetables.22
is growing that animal-to-human spread of Furthermore, even in grains and pulses, ele-
microbial-resistant bacteria reduces the hu- vated atmospheric CO2 levels are shown to
man body’s responsiveness to antibiotics.21 lower the concentrations of zinc, iron,23 and
Irrigation water, which is crucial for increas- protein in some crops, making the crops
ing crop yields, also carries the potential of themselves less nutritious.24 Thus, efforts
negative health effects. Stagnant water cre- to reduce GHG emissions through a more
ates breeding sites for mosquitos and other climate-smart agriculture would support bal-
insects that transmit diseases such as malar- anced dietary intake, nutrition, and health.25
ia and schistosomiasis. Irrigation water also
can contain heavy metals and other contami- Urbanization, income growth, and other
nants, some of which result from agricultural factors are contributing to a “dietary tran-
practices. sition” in many low and middle-income
countries that is affecting opportunities
Other major factors such as HIV and AIDS and risks for human health and nutri-
and zoonotic diseases also impact human tion. The change often features a shift in
health and are intertwined with the food diet composition (with a reduced caloric
system. Given space constraints, this paper share of staple cereals and increased con-
does not explicitly address these issues and sumption of animal products, vegetable
instead focuses only on food system-relat- oils, and fruits and vegetables), increased
ed nutritional and health impacts from food consumption of processed foods, and in-
contamination and malaria. creased out-of-home consumption. With
greater intake of protein and micronutri-
Climate change, to which agriculture con- ents, this shift can contribute to improved
tributes, may worsen nutrition and health. dietary balance. However, poor eating hab-
Agriculture and land use change accounts for its also may emerge resulting in excessive
approximately 25 percent of total greenhouse consumption of foods and beverages high
gas (GHG) emissions, which contribute in saturated fat, sugar, and salt, as in many
to elevating atmospheric CO2 and global high-income countries.26

SHAPING THE GLOBAL FOOD SYSTEM TO DELIVER IMPROVED NUTRITION AND HEALTH 7
What types of interventions in the food system
can deliver improved nutrition and health?

Feeding every person, every day, every- nutrition-sensitive interventions are needed.
where, with a safe, nutritious, and afford- This includes interventions in food systems,
able diet requires interventions beyond social protection, health systems, and water
those needed to raise incomes. Ensuring and sanitation.31 The focus of this paper is
the production of sufficient quantities and making nutrition-sensitive interventions in
diversity of food remains fundamental. the food system (table 1).
Ensuring production is a necessary input for
diversified food consumption, particularly by A strategic shift that mainstreams nutri-
nutritionally vulnerable population groups, tional considerations and outcomes in
including women and children. Higher agri- agricultural and food security strategies
cultural production growth has been shown is needed. Many developing countries have
to reduce stunting when initial levels of pro- had success in reducing the incidence of hun-
duction are low.27 For the poorest countries, ger, typically through measures to increase
income growth helps reduce the prevalence production of selected staple grains and
of calorie deficiency, and in most of these manage their price volatility. Nevertheless,
countries, agricultural growth plays a key these food security strategies have contrib-
role in this income growth.28 However, as uted less to reducing child stunting and
prevalence rates decline, undernutrition be- population-wide micronutrient deficien-
comes less responsive to income growth, and cies and even have shown trending toward
impacts are much smaller for lower levels higher obesity.32 Public investment, price
of growth.29 As noted above, income gains supports, input subsidies, and stored public
alone are far from sufficient to end undernu- stocks typically have been directed to sup-
trition. Multisectoral nutrition-specific30 and port staple grains and export crops that are

8 FUTURE OF FOOD
important for their economic value and to calories, particularly in poor countries.
prevent widespread food shortages. In many Increasing adoption of improved crop and
developing countries, supporting primarily livestock technology and access to inputs,
staple grains and export crops has created an improving animal health, reducing gender
uneven playing field with most public sup- inequality, improving water management
port going to only a portion of the farming and its sustainable use, strengthening land
sector. governance and reducing land degradation,
strengthening farmer skills and knowledge,
Consequently, farmers engage less with foods and improving aquaculture production prac-
that do not benefit from large support lev- tices all can help raise productivity in poor
els, which include fish, fruits, vegetables, and countries.34 In addition, effective man-
pulses; even when consumer demand has in- agement of capture fisheries can improve
creased. A more crop/commodity-neutral sustainability. Greater investments in inter-
strategic framework is needed. Furthermore, national and national agricultural research
efforts need to be stepped up to promote the can facilitate development of a new gen-
diversity of production as well as consump- eration of climate-smart technologies for
tion33 by strengthening farmers’ knowledge, improved climate-resilience and lower GHG
advisory and regulatory services, market in- emissions.35
frastructure and connectivity, and the overall
investment enabling environment for these Reduce net taxation of agriculture, and
traditionally under-supported foods that are facilitate trade. Lowering direct and indi-
important for nutrition (table 1). In addi- rect taxation of agriculture at national and
tion, as the link between food systems and local levels strengthens the incentives to
household nutrition and health pass primar- increase production and sales, and raises
ily through women, greater consideration of purchasing power of poor farmers through
this gender dimension needs to be reflected higher incomes. As per capita incomes grow,
across all interventions. A focus on reducing countries tend to tax agriculture less. Price
both energy and micronutrient deficiencies policies vary greatly across developing coun-
in children under age two is needed to help tries and across products, offering additional
reduce stunting. With very high prevalence scope to reduce net taxation of agriculture
rates in low and middle income countries, in some countries. Improved marketing in-
food system interventions need to give this formation, infrastructure, and low tariffs and
issue greater attention. taxes can facilitate intra-national, regional,
and international trade to help that ensure
Spectrum of food system food moves from surplus to deficit areas.
interventions to reduce energy
deficiency (hunger) Reduce food loss through improved sup-
ply/demand coordination and storage. The
Increase crop, livestock, and aquaculture range of estimates for food loss varies wide-
productivity and resilience, and fishery sus- ly.36 The Food and Agriculture Organization
tainability to ensure availability of sufficient of the United Nations (FAO) estimates an

SHAPING THE GLOBAL FOOD SYSTEM TO DELIVER IMPROVED NUTRITION AND HEALTH 9
TABLE 1: Spectrum of Interventions in the Food System to Deliver Improved Nutrition and Health
Post-harvest
handlers, processors,
Objectives Producers and distributors Consumers
Reduce ¾¾ Increase crop, livestock, and fisheries ¾¾ Reduce food loss ¾¾ Support home-grown school
energy productivity and resilience to ensure through improved feeding programs (K, I, R)
deficiency availability of sufficient calories, supply/demand ¾¾ Ensure policy consistency to
(hunger) particularly in poor countries (K, I, P) coordination and reduce food price volatility (P)
¾¾ Reduce net taxation of agriculture, storage (K, I) ¾¾ Support public campaigns to
and facilitate trade (P, K, R, I) reduce food waste (K)
Reduce ¾¾ Align producer price and production ¾¾ Promote food ¾¾ Expand nutrition education
micro- policies to shifting consumer fortification (R) and demonstration in
nutrient demand (P, R) schools (K)
deficiency ¾¾ Promote more diversified crop/ ¾¾ Expand home-grown school
(hidden farm enterprise production systems, feeding designed to deliver
hunger) including through homestead micronutrients (K, I)
gardens (K, P, R, I) ¾¾ Promote the dissemination of
¾¾ Integrate balanced diet and nutrition dietary guidelines (to combat
modules in agricultural extension (K, I) micronutrient deficiency) (K)
¾¾ Increase discretionary income-
earning opportunities and promote
labor saving technologies for
women (K, I)
¾¾ Increase research and development
on more nutrient-rich crops (I)
¾¾ Support development of biofortified
crops (I)
¾¾ Promote micronutrient fortified
fertilizers (K, P)
Reduce ¾¾ Improve food ¾¾ Seek and support
excessive labeling (R) consumer engagement in
net energy ¾¾ Restrict food and regulatory and program
intake and beverage advertising, development (K, I)
unhealthy especially to ¾¾ Tailor dietary guidelines
diets children (R) (specifically to combat
(over- ¾¾ Limit specific dietary overweigth and obesity) (K, R)
weight/ factors (such as ¾¾ Reduce subsidy biases for
obesity) trans fats) (R) foods high in salt, oil, and
¾¾ Reduce subsidy biases sugar; consider the use of
for processed foods (P) taxes to influence consumer
behavior (P)
Improve ¾¾ Apply regulatory knowledge and ¾¾ Control aflatoxin
food enhance measures to address the (K, R, I)
safety misuse of pesticides (K, R, I) ¾¾ Modernize food
(health) ¾¾ Control and reduce antibiotic use in safety regulations
livestock and aquaculture (K, R, I) and oversight (K, R, I)
¾¾ Mitigate any negative impacts ¾¾ Support private
on human health from irrigation operator food safety
infrastructure (K, I, R) management (R, K)
¾¾ Upgrade hygiene
and management of
informal markets (I, K)
Note: Public policy and investment levers are notated in the parentheses. Explanation: K = Knowledge, including
education and training; P = Fiscal and/or trade policy; R = Regulations; I = Investment. Table 1 is not intended to be
exhaustive but indicative of entry points.

10 FUTURE OF FOOD
8 percent post-harvest handling and storage enterprises. It also is important to establish
loss of cereals in Africa, whereas self-report- nutritional guidelines outlining the nutrient
ed post-harvest losses for maize show lower requirements for meals to ensure that the
estimates of 1.4−5.9 percent.37 Losses for feeding program adequately addresses the
more perishable products are higher. FAO goals of the program.
estimates milk losses ranging from 7 per-
cent to 21 percent in Ethiopia, Tanzania, Ensure policy consistency to reduce food
and Uganda.38 price volatility. Policy uncertainty or un-
timely food market interventions by gov-
In some contexts, losses are very significant, ernments exacerbate the price effects of
especially quality losses. Reducing these seasonal differences in production. As has
losses requires more attention. Food losses been observed in many developing coun-
occur throughout the value chain, including tries, these interventions can dampen farm
during production, harvest, handling, stor- production, investment, and private sector
age, processing, and logistics. Food losses storage; and negatively affect consumers. At
result from multiple factors, and the mix of the global level, food price volatility peri-
interventions needed will vary depending on odically has been exacerbated by sudden ad
local circumstances. In low-income coun- hoc restrictions on exports among import-
tries, losses can be reduced—sometimes ant global suppliers, as well as by ad hoc re-
substantially—through better timing of ductions in import tariffs in net importing
planting and harvesting; improved post-har- countries. In 2006–08, these types of mea-
vest techniques; upgrading storage facilities sures accounted for 45 percent of the sharp
and their management; and investments in increase in world rice prices and 30 percent
rural infrastructure, market linkages, cold of the increase in world wheat prices.40
chains, and other logistical services.
Support public campaigns to reduce food
Support home-grown school feeding pro- waste. High levels of food waste occur, par-
grams. School feeding programs in devel- ticularly in high income, and to a lesser
oping countries––both school meals and extent in middle income, countries due to
take-home rations––are popular and wide- excess supply and/or the behavior of con-
spread. The objectives of these programs sumers and retailers.41 According to FAO,
are to encourage children’s school enroll- every year, consumers in rich countries
ment, attendance, and educational perfor- waste almost as much food (222 million
mance. Use of crops and livestock products tons) as the entire net food production of
procured from smallholder farmers who live Sub-Saharan Africa (230 million tons).42
near schools should be encouraged to serve Significant gains in rich countries can be
as a market outlet and strengthen the lo- made through influencing consumer behav-
cal economy.39 For example, Brazil’s school ior, reducing portion sizes at home and in
feeding program is mandated by law to pro- restaurants, and developing markets for pro-
cure at least 30 percent of its food directly duce that is discarded because the products
from local family farmers and rural family do not meet grade standards on size, shape,

SHAPING THE GLOBAL FOOD SYSTEM TO DELIVER IMPROVED NUTRITION AND HEALTH 11
or appearance.43 Recently, France passed in Nigeria shows that production diversity
legislation that bans supermarkets from dis- had a larger effect on dietary diversity than
carding unsold foods and instead requires income gains.48 A combination of interven-
them to donate unsold foods to charities tions are needed to improve food production
and food banks. and consumption diversity: improve nutri-
tion literacy; remove land use restrictions
Spectrum of food system and price policy biases toward cereal crops;
interventions to reduce promote homestead gardens; and promote
micronutrient deficiency higher productivity of nutrient dense crops,
(hidden hunger) fish farming, and livestock.49, 50

Align producer price and production pol- Integrate balanced diet and nutrition mod-
icies with shifting consumer demand. ules in agricultural extension. Agriculture
Aligning farmer incentives to respond to extension workers need to strengthen mes-
changing market demands can spur a respec- sages regarding production and consumption
tive supply response and help raise incomes of nutritious foods,51 informed by improved
of poor farmers. Aligning incentives includes: knowledge of dietary requirements at various
(a) removing price policies that are biased stages of the life cycle. Simple nutrition mes-
against production of high-value non-cereal sages around specific crops can be effective
crops in favor of cereals. Such policies dis- if they are targeted to the farmers who grow
incentivize farmers to produce non-cereal the crops, and are packaged with seed deliv-
crops. These disincentives can lead to elevat- ery or other pertinent information about the
ed prices for non-cereal foods and result in crop.52 Improving the gender balance among
poor dietary diversity; and (b) removing re- agricultural extension workers will help im-
strictions on land use tied to specific crops. prove the delivery of services that meet the
needs of women farmers. As demonstrated in
Promote a more diversified crop/farm en- Mozambique,53 close coordination between
terprise production systems, including agriculture and health sector staff at all levels
through homestead gardens. Many small- can be effective. In India,54 communicating
scale farmers engage in monocropping, messages from multiple sources—agricul-
including of staple grains. The resulting tural extension workers, health workers, and
household diet often lacks sufficient nutrient village-level workers—helped enhance the
diversity and contributes to poor nutritional impacts on consumption and nutrition. The
outcomes. When small farm households pro- range of channels available to expand cov-
duce a more diverse set of foods (for example, erage include radio, print media, television
fruits and vegetables, legumes, milk, eggs, shows, and information-and-communica-
and fish) and receive nutrition awareness tion-technology-(ICT)-enabled tools such
training, the result often is greater dietary di- as cell phones and videos.55
versity,44 higher micronutrient intake,45 and
positive impacts on the nutritional status Increase discretionary income earning
of children in the household.46, 47 Analysis opportunities and promote labor saving

12 FUTURE OF FOOD
technologies for women. Making educa- will have significant impacts. For example,
tion, labor markets, and civil engagement the Nigerian national agricultural research
as accessible to women as men is partic- system and the CGIAR’s International
ularly important to improve nutrition of Crops Research Institute for the Semi-Arid
the women themselves and their children. Tropics (ICRISAT) jointly developed a sor-
The most relevant aspects of women’s em- ghum variety that has triple the amount of
powerment for nutrition are (a) increasing iron compared to average values while exhib-
women’s access to and control over re- iting high yields and drought resilience.59
sources––primarily incomes, (b) increasing
women’s decision-making power related to Support the development of biofortified
food purchase and preparation; and (c) re- crops (use nutrient content as the main cri-
ducing time and labor constraints. Decision terion for plant breeding). Biofortification
making on household income and expendi- is a purposeful effort to breed plants to
ture controlled by women has a significantly improve the nutrient content while not
greater positive effect on child nutrition and compromising on traditionally valued traits
household food security than income con- such as yields, resilience, and taste. Efforts
trolled by men.56 Additionally, labor saving are underway to add nutrient-dense traits to
technologies are needed to enable women to traditional staple crops including maize, rice,
earn more income without compromising on millet, beans, and cassava. In case studies,
breastfeeding and meal preparation time.57 consumption of biofortified Vitamin A-rich
orange sweet potato increased Vitamin A in-
Increase research and development on take and dietary diversity among children;60
more nutrient-rich crops (use nutrient con- yellow or golden cassava with high levels of
tent as one of the criteria in plant breeding). beta-carotene increased Vitamin A intake
The nutrient content varies greatly across in children;61 biofortified orange maize in
varieties of the same crops. For example, cer- Zambia increased serum B-carotene con-
tain varieties of rice contain 2.5 times more centrations in children aged 4–8 years;62 and
iron than the average variety––enough to iron-biofortified millet improved the iron
make a significant nutritional contribution.58 status of adolescent girls.63 Biofortification
Increasing nutrient content has not been a offers a promising approach to help address
commonly used criterion for plant breeding micro-nutrient deficiencies, especially for
except in very special cases such as biofor- people currently consuming an undiversified
tification. The traditional focus of plant cereal-based diet.
breeding research has been on increasing the
yield of staple crops—mainly rice, wheat and Promote micronutrient fortified fertil-
maize—and their resistance to pests and dis- izers. Supplementing fertilizers with zinc,
eases, and tolerance to droughts, and floods. iodine, and selenium can increase the nutri-
Breeding needs to be expanded to include ent content of food grown in soils that are
a focus on nutrient content to improve ac- low in these micronutrients.  In Turkey, ap-
cess to nutrient-rich foods and to a broader plying zinc as a fertilizer to the soils doubled
set of crops. Expanded breeding research or tripled the zinc content of cereal grains.64

SHAPING THE GLOBAL FOOD SYSTEM TO DELIVER IMPROVED NUTRITION AND HEALTH 13
Finland’s supplementation of fertilizers with life. School-based nutrition education must
selenium increased selenium levels of the be culturally appropriate.69 The effectiveness
food produced, enhancing the selenium sta- of these programs is related to (a) quality of
tus in children and adults who consumed implementation, (b) educational rigor of the
these crops.65 In China, adding iodine to ir- program and its integration within main-
rigation water decreased iodine deficiency stream curricula (for example, reading, and
and lowered infant mortality.66 Improving science), and (c) positioning of school-based
farmer and consumer knowledge, reducing efforts within the context of broader edu-
tax or import tariffs on micronutrient forti- cational and community efforts. Successful
fied fertilizers, and including these fertilizers programs tend to involve family and the rest
in ongoing input-subsidy programs in areas of the community. These programs also ex-
with micronutrient-deficient soils can in- tend to issues beyond food preparation,
crease their use. preservation, and storage to cover social and
cultural dimensions of food and eating; as
Promote food fortification. Food (or indus- well as self-esteem and body image messag-
trial) fortification—adding micronutrients es––all of which affect food choices.70
(vitamins and minerals) to foods, including
to milk, during processing—can help reduce Expand home-grown school feeding pro-
malnutrition.67 Food fortification has a long grams designed to deliver micronutrients.
history of use in industrialized countries, and Some school feeding programs are designed
its use is growing in a number of developing intentionally to deliver micronutrients
countries.68 Fortification has taken numer- to help solidify early childhood develop-
ous forms including universal fortification ment gains and deliver important nutrients
mandated by law, targeted fortification for to a population that does not readily con-
vulnerable groups, and market-driven vol- sume them elsewhere. Some programs use
untary fortification. Food fortification premixed packages of micronutrients that
regulations are necessary as part of nation- enhance the nutritional value of meals, and
al food safety and public health policies to fortified products or biofortified produce that
ensure the benefits of fortification. In most are enriched with essential nutrients such as
countries, the Ministry of Health leads in- Vitamin A or iron.71 Some school meals also
dustrial food fortification. However, because are designed to add dietary diversity.
it relates to the processing of food, fortifi-
cation typically also requires the cooperation Promote the dissemination of dietary
of the Ministry of Agriculture or food safe- guidelines (to combat micronutrient de-
ty agencies. ficiency). FAO and World Health Organiza-
tion (WHO) promote the use of balanced
Expand nutrition education and demon- dietary guidelines. Over 100 countries have
stration in schools. The purpose of nutrition developed dietary guidelines, including
education in schools is to help students ob- 5 countries in Sub-Saharan Africa. Most
tain nutrition-related knowledge and skills guidelines encourage variety and increased
and to develop healthy dietary habits for intake of plant foods, especially vegetables

14 FUTURE OF FOOD
and fruit, and reduced consumption of solid salt, and/or fat by requiring warnings on the
fats, salt and sugar. Recently, some countries front of packages. Many countries, including
have included considerations to promote and Singapore, have supported “healthy choice”
protect traditional food or promote diets that symbols on packaged food labels and restau-
are considered to be more environmental- rant menus.
ly sustainable.72 Evidence on the impacts of
implementing these guidelines is still limit- Restrict food and beverage advertising, es-
ed. Measures need to be taken to ensure that pecially to children. To combat the rising
balanced dietary guidelines are disseminated rates of obesity among children and the wider
via multiple channels to increase uptake and population, over the past decade, a growing
adherence by the consumers. number of countries have undertaken mea-
sures to curb the commercial promotion of
Spectrum of food system foods high in salt, sugar, and fat, especially to
interventions to reduce excessive children.77 The United States Federal Trade
net-energy intake and unhealthy Commission reports that, in 2006, the food
diets (overweight/obesity)73 industry spent approximately $870 million
on marketing to children under the age of
Improve food labeling. Food labels, partic- 12 and over $1 billion on marketing to ad-
ularly on packaged and processed foods, play olescents.78 The majority of advertising (63
an important role in consumer protection by percent) was spent to promote carbonated
conveying safety information and nutritional beverages, breakfast cereals, and restaurant
content. Over time, breadth and visibility of foods. Some countries, including Denmark,
labeled content has evolved in parallel with Latvia, and Mexico, have worked with in-
improved scientific understanding, chang- dustry to develop codes for “responsible”
ing societal attitudes, and commercial needs. marketing to children. Other countries have
International labeling guidelines are pro- adopted laws that prohibit various forms of
vided under the Codex Alimentarius.74 food product advertising to children through
Nevertheless, significant differences among television, internet, videogames, and prod-
national food labeling requirements re- uct placements. France has taken a different
main, especially with regard to nutritional approach. It requires that all television ad-
content.75 Whether nutritional labeling can vertising of foods high in salt, sugar, and fat
influence dietary habits and behavior76 de- include messages about good dietary habits,
pends on the clarity of the information and including what to eat and what to avoid.
consumers’ awareness. In Thailand, consid-
erable effort has gone into raising consumer Limit specific dietary factors (such as trans
knowledge. Research there has experiment- fat). Over concerns about food-related
ed with the use of symbols and color codes non-communicable diseases, as of 2014,
to convey positive and negative nutrient con- 6 European Union countries (Austria,
tent. Some countries, including Chile, have Denmark, Hungary, Iceland, Norway, and
sought to actively discourage consumption Switzerland) limited trans fatty acids through
of products with a high content of sugar, regulation, while others (for example, the

SHAPING THE GLOBAL FOOD SYSTEM TO DELIVER IMPROVED NUTRITION AND HEALTH 15
Netherlands) use voluntary, self-regula- Seek and support consumer engagement
tion measures.79 In 2014 the U.S. Food and in regulatory and program development.
Drug Administration determined that par- Effective consumer engagement and rep-
tially hydrogenated oils, the primary dietary resentation plays a very important role in
source for trans fat in processed food, are not identifying food-related problems and solu-
“Generally Recognized as Safe” (GRAS)80 in tions and ensuring the development of
human food.81 In 2014, as part of its Food competitive and safe food systems. Consumer
Code, Argentina enacted a law that limits engagement and representation can take
trans fatty acids in processed foods to 2 per- multiple forms, including regular consumer
cent of the total of vegetable oils and marga- research, appointment of consumer repre-
rines for direct consumption, and 5 percent sentatives to scientific or other committees,
of other foods.82 Across multiple countries, holding public hearings on proposed reg-
policies aimed at reducing trans fatty acids ulations, and interactions with/support for
in food have been associated with signifi- formal consumer organizations. Influential
cant reductions in trans fatty acid levels in consumer organizations and consumer repre-
the food supply with likely positive public sentation in scientific committees are much
health effects.83 more common in North America and among
EU Member States than in developing
Reduce subsidy biases for processed foods. countries, although this pattern is emerging
From 1995 to 2013, the United States gov- elsewhere, including in Brazil and India.
ernment provided US$19.2 billion in
subsidies for corn sweeteners, corn starch, Tailor dietary guidelines specifically to
and soy oils—common ingredients in pro- combat overweight and obesity. The gener-
cessed foods, while subsidies for apples, the al advice seen in most dietary guidelines is
only fresh fruit or vegetable that received an to encourage variety and increased intake of
appreciable subsidy, was only US$0.7 bil- plant foods, especially vegetables and fruit;
lion.84 These differences, along with other and to reduce consumption of solid fats,
factors, contribute to reduce the consum- salt, and sugar, This advice is valid whether a
er price of corn sweeteners, corn starch, and country suffers mainly from undernutrition
soy oils relative to fresh fruits and vegetables. issues or overnutrition. However, in societ-
In the U.S., fruits and vegetables represent ies in which overweight and obesity are the
41 percent of the total recommended dietary predominant nutritional concerns, dietary
consumption. Nevertheless, in 2011–13, guidelines need to be adjusted to specifically
public spending on fruits and vegetables–– target obesity. For the first time, the 2015–
subsidies; research, education, and extension; 20 dietary guidelines for the U.S. included a
nutrition assistance programs; and ad- specific target to reduce sugar intake to less
ministration––was approximately only 15 than 10 percent of an individual’s daily cal-
percent of total food group spending.85 ories. The 2014 Brazilian dietary guideline
Correspondingly, the average U.S. resident target the country’s increasing obesity lev-
consumed less than 50 percent of the recom- els. It has moved away from the traditional
mended amount of fruits and vegetables. approach of daily recommended portions of

16 FUTURE OF FOOD
basic food groups to instead espouse 10 evi- contain pest populations and improve crop
dence-based principles. They include limiting yields, quality, and storability. The misuse
consumption of processed foods; avoiding of pesticides—including improper mixing,
consumption of ultraprocessed foods; devel- dosing and timing; unsafe application, han-
oping culinary skills so that consumers can dling, and storage; and the use of highly
prepare meals with fresh ingredients without toxic or persistent chemicals—can harm
having to rely on quick and convenient pro- environmental, human, and animal health.
cessed foods; and eating in clean, quiet, and A combination of approaches can lead to
comfortable environments; whenever possi- more judicious use of pesticides. These ap-
ble in the company of others.86 proaches include (a) training farmers in the
techniques of integrated pest management
Reduce subsidy biases for foods high in in which natural control measures are em-
salt, oil, and sugar; and consider the use phasized; (b) making technical changes in
of taxes to influence consumer behavior. how pesticides are formulated or applied (for
Large consumer subsidies of cooking oil and example, pesticide-coated seeds); (c) remov-
sugar in the Middle East and North Africa ing existing pesticide subsidies and support
likely have contributed to high levels of obe- the development of markets for organical-
sity in the Region. These programs are major ly grown produce; and (d) strengthening the
pillars of the countries’ social protection pol- enforcement of national regulatory systems
icies. Thus, any reforms face huge political for pesticide use and distribution.
challenges even when these subsidies are
known to be a heavy burden on public fi- Control and reduce antibiotic use in live-
nance, are largely untargeted, and likely are stock and aquaculture. The extensive use
linked to negative nutrition consequences. of antimicrobial drugs has become a threat
However, in some countries, incremental re- to public health from the overuse and mis-
forms are happening. Mexico introduced a use of antibiotics, including in food animals.
10 percent tax on sugar-sweetened drinks, Human beings are at risk due both to the
which reduced sales by 12 percent after one potential presence of superbugs in meat and
year.87 The long-term comsumption impact fish, and to the general migration of super-
of this policy is not yet clear. Nevertheless, bugs into the environment, where they can
encouraged by the Mexican experience, oth- transmit their genetic antibiotic immunity
er countries including South Africa and to other bacteria, including those that make
United Kingdom are following suit. people sick. There is great variability across
countries in antibiotic use in food animals.
Spectrum of interventions to For example, in 2008, Chile used significantly
improve food safety (health) more antibiotics than Norway per kilogram
of salmon produced.88 WHO’s 2015 Global
Apply regulatory and knowledge-en- Action Plan on Antimicrobial Resistance
hancing measures to address the misuse spells out the country-level actions needed to
of pesticides. When used correctly, pesti- improve awareness and understanding of an-
cides are a labor-saving technology that can timicrobial resistance, strengthen knowledge

SHAPING THE GLOBAL FOOD SYSTEM TO DELIVER IMPROVED NUTRITION AND HEALTH 17
and the evidence base, reduce the incidence consistently was reduced by 80 percent–90
of infection, optimize the use of antimicro- percent. Native atoxigenic strains have been
bial medicines in human and animal health, isolated from Kenya and are ready for further
and corresponding investment.89 evaluation to be developed into a product.

Mitigate any negative impacts on hu- Modernize food safety regulations and
man health from irrigation infrastructure. oversight. A modern set of food safety laws,
Irrigation infrastructure helps boost agricul- regulations, and compliance enforcement
tural productivity, especially in areas such as mechanisms is critical to protect consum-
Africa, where expanding irrigation has the ers, develop local food markets, and facilitate
potential to increase production by more trade.93 Food laws should lay out respon-
than 50 percent.90 However, irrigation also sibilities of different agencies within the
can facilitate water-borne diseases, includ- government, and of the private sector in the
ing malaria. In some cases, the prevalence event of an emergency, core principles for
of malaria has increased as a consequence ensuring safe food, and the penalties for infrac-
of increased standing water from irrigation tions. These laws need to be supplemented by
schemes.91 Poor canal water management a range of regulations that provide implemen-
can increase malaria transmission, and mit- tation guidance for inspectors and for private
igating measures should be put in place.92 In operators; and specific rules on cross-cutting
addition, including water quality consider- issues, such as additives, chemical contami-
ations in decisions on irrigation placement nants, and packaging, or in relation to certain
and design, and improved agricultural prac- types of products, such as fortified and or-
tices can help avoid heavy metals and other ganic foods. Food safety regulatory reforms
contaminants in irrigation water. are trending toward emphasizing preventive
measures and promoting behavioral chang-
Control aflatoxin. There is no single solu- es and away from resorting to end-product
tion to the aflatoxin problem. A holistic and compliance enforcement. Although nation-
integrated approach is required based on al standards are trending toward equivalence
creating awareness, providing training and with CODEX and other established interna-
education, and mainstreaming good prac- tional standards, challenges remain around
tice and technologies into value chains and small enterprises that cannot pay the high
regulatory and policy frameworks/capabil- compliance costs and ensuring that such costs
ities. CGIAR’s International Institute of do not position high-nutrient foods out of
Tropical Agriculture (IITA), in partnership reach for poor consumers.94
with the U.S. Department of Agriculture
(USDA), is introducing an adapted biocon- Support private operator food safety man-
trol product called aflasafe™ in Kenya and agement. There is growing recognition—in
Nigeria through using native micro-flo- both developed and developing countries—
ra. Field testing of aflasafe™ in Nigeria has that the primary responsibility for ensuring
produced highly positive results: aflatox- safe food lies with the private sector, includ-
in contamination of maize and groundnut ing farmers, post-harvest handlers, processors,

18 FUTURE OF FOOD
food distributors, and restaurants.95 Still, gov- sanitary conditions can mitigate the risks
ernments can use various instruments to faced by lower income consumers.97
guide and support changes in behavior and
practices that impact how well food safety Upgrade hygiene and management of in-
hazards are addressed. Regulations prescribe formal markets. In much of Africa and Asia,
or restrict certain practices (for example, in informal (“wet”) markets continue to be
relation to food facilities, record-keeping, the most important source of animal prod-
and use of chemicals or additives).96 Formal ucts and fresh fruit and vegetables for poor
training and certification programs targeting people.98 Maintaining these markets—or
small and medium enterprises (SMEs) im- upgrading them with improved infrastruc-
part knowledge about safe food handling and ture and sanitary conditions—needs to be an
build a professional identity and ethic that can integral part of any food retail moderniza-
be instrumental in changing the behavior of tion effort. A recent study shows that policy
individuals employed in firms, even in the ab- approaches aiming to suppress the informal
sence of public scrutiny. For food companies sector generally are ineffective; in some cas-
that come into direct contact with consum- es, these approaches actually decrease the
ers, the public disclosure of risk profiles can quality and safety of food. Similarly, food
be a powerful means to influence behavior. and nutrition policies that simply ignore
An example is to visibly post the food safety the informal sector may fail to have effects
inspection grades of restaurants, as do many for low-income populations. Thus, there is a
cities, including Singapore, Shanghai, and need to upgrade based on introducing mod-
New York. For informal sector operators, such ern equipment such as upgraded counters,
as street food vendors or informal market sell- installing sanitation facilities, training on
ers, programs involving food safety awareness food safety and hygiene standards and on
raising and/or the upgrading of marketplace promoting behavioral change.99

SHAPING THE GLOBAL FOOD SYSTEM TO DELIVER IMPROVED NUTRITION AND HEALTH 19
How can the food system agenda for improved
nutrition and health best be implemented?

Countries need to implement a set of ac- 38 percent of children under 5 are stunted
tions tailored to their needs. Policies need to caused partly by both energy and micro-
target food producers, post-harvest handlers, nutrient deficiencies; and almost 5 per-
processors, food distributors, and consumers cent of the total population are obese. In
across low- middle- and high-income coun- these countries, efforts are required most
tries to address the specific challenges of at the food producer and processor levels
energy deficiency, nutrient deficiency, exces- (table 2). In extremely poor countries with
sive net-energy intake and unhealthy diets, low initial levels of food production, in-
and food safety issues that each country fac- come gains and food production growth
es (figure 1). The overall objective across all will be vitally important to reduce energy
countries is the same: to feed every person, deficiency and child stunting. Reducing
every day, everywhere with a safe, nutritious, policy uncertainty and/or avoiding poor-
and affordable diet. Achieving this objective ly-timed food market interventions can
will require a tailored set of policies and in- help reduce food price volatility benefiting
vestments by country. both producers and consumers. Increasing
diversity of crop and farm enterprise pro-
• Low-income countries. Forty-seven per- duction patterns, expanded use of home-
cent of the total population in low- stead gardens, development and adoption
income countries lives below the US$1.90 of labor-saving technologies for women,
per day poverty line; 27 percent of the to- biofortification, and the use of micronu-
tal population are food energy deficient; trient fortified fertilizers all can help.

20 FUTURE OF FOOD
 As the distance between producers and Producer-level aspects relevant for
consumers widens, and the food value low-income countries also apply to mid-
chain becomes more complex, action also dle-income countries. As per capita in-
is needed beyond the farm. Maintaining come rises, producer price and produc-
food quality and reducing quantity loss tion policies need to align with shifting
across the value chain, food fortification, consumer demand. Growth in animal
and improving storage to preserve nutri- product consumption intensifies livestock
ent value become increasingly important. production and heightens risks such as
Food safety and health can be improved the misuse of antibiotics and contami-
through using pesticides more optimal- nation of foods at farm level. Urbaniza-
ly, designing and managing irrigation tion and industrialization bring increased
schemes that do not cause an increase risk from environmental sources such as
in water-borne diseases like malaria, and contaminated soil and water. The scope
putting in place basic post-harvest food of food safety laws needs to be expand-
safety standards and regulations that ad- ed; public food safety monitoring, inspec-
dress risks associated with staple foods tion, surveillance, and laboratory testing
(such as aflatoxin in cereals and ground- need to be strengthened; input subsidies
nuts) and improving hygienic conditions that induce soil and groundwater pollu-
and practices in informal markets. tion need to be realigned to minimize the
negative impact on both plant and animal
• Middle-income countries. Approxi- health; private sector food safety systems
mately 12 percent of the total population need to be strengthened, including facility
in middle-income countries live below and management system upgrades; and
the $1.90 per day poverty line; 12 per- traceability and recall systems need to
cent of the total population are food en- be developed to help identify and isolate
ergy deficient; 24 percent of children un- food-borne disease outbreaks. Better in-
der 5 are stunted; and almost 8 percent of formation on dietary choices, and health
the total population are obese. Variation awareness can move social norms on eat-
across middle-income countries is large. ing in a healthier direction. Finally, reduc-
For example, in Egypt less than 5 percent ing subsidies for oils, sugar, and salt can
of the population are food energy defi- help address the rising obesity challenge
cient, whereas 22 percent of the children many middle-income countries face.
under 5 are stunted, and approximately
28 percent of the population are obese. • High-income countries. No aggregate
In India, the respective incidences are data exist for the share of the total popu-
15 percent, 40 percent, and 3 percent. lation living below the $1.90 per day pov-
A context-specific customized set of ac- erty line in high-income countries, but
tions is needed to address the different extreme poverty rates likely are very small.
situations although, in most cases, a bal- Fewer than 5 percent of the population
anced focus is needed across all three sets are energy deficient; 3 percent of chil-
of actors (table 2). dren under 5 are stunted; while almost 19

SHAPING THE GLOBAL FOOD SYSTEM TO DELIVER IMPROVED NUTRITION AND HEALTH 21
FIGURE 1: Challenges of Ending Poverty, Undernourishment, Stunting, and Obesity Vary Across
Low-, Middle-, and High-Income Countries (%)

47.2

37.6

27.0
24.3
18.8
12.5 12.0
7.5
4.6 3.3

Low Income Middle Income High Income

Poverty headcount at $1.90 a day (% of total population) Undernourishment (% of total population)

Stunting of children < 5 (%) Obesity (% of total population)

Source: World Development Indicators; Ng and others. “Global, Regional, and National Prevalence of Overweight and
Obesity in Children and Adults during 1980–2013: A Systematic Analysis for the Global Burden of Disease Study
2013.” Lancet 384 (2014): 766–81; UN Population Division data.
Note: For each developing country, the respective obesity data from Ng and others are weighted by the share of the popu-
lation above and below 20 years old; and, within regions, by the population of each country. There is no data available on
poverty headcount and undernourishment for high-income countries.

TABLE 2: Different Attention Is Needed at Food Producer, Processor/Distributor, and Consumer

Levels across Low-, Middle-, and High-Income Countries

Low income Middle income High income

countries countries countries

Producers *** ** *
Post-harvest handlers,
processors, distributors ** ** **

Consumers * ** ***
Note: Asterisks indicate the relative priorities for attention; 6 asterisks are assigned to each country group.

percent of the total population are obese. ations of safety, wellness, and ethical con-
Most attention is needed at processor, siderations that go beyond nutrition and
distributor, and consumer levels (table health to encompass concerns like the
2) to address the increasing challenge of environmental impact of diets and ani-
obesity. In high-income countries, con- mal welfare. Food regulatory provisions
sumer awareness is generally higher and are more refined in these countries, re-
consumer advocacy combines consider- flecting both scientific advancement and

22 FUTURE OF FOOD
 strong corporate interests from large food combination of multisectoral interventions,
companies. Food safety responsibility is some of which have proved successful.
placed largely on the private sector—with
performance and compliance motivated Increase the focus on women. The con-
by technical, professional, commercial nection from food systems to nutrition and
(such as brand reputation) and legal/reg- health outcomes passes primarily through
ulatory factors. Labeling and other trans- women. Yet, women have less access to and
parency measures are important tools to control over assets, inputs, services, and fi-
help consumers make their food choices. nance than do men. As the child bearers and
Restricting specific dietary factors (for child care providers, women play the criti-
example, trans fat) can improve food nu- cal role in the health of infants, and are often
trient content. Reducing subsidies biased responsible for producing the food, purchas-
to processed foods relative to fresh foods ing it, processing it, and preparing the meals.
can change relative prices and influence Thus, any effective program to improve
dietary choice. Seeking and supporting household nutrition and health must address
consumer engagement in regulatory and gender inequalities. This issue cuts across the
program development processes can help actions in table 1 beyond the specific action
to identify food-related problems and listed (i.e. increasing discretionary income
solutions, and ensure the development earning opportunities and promoting labor
of competitive and safe food systems. saving technologies for women). Policies and
Restricting advertising of non-nutritious/ programs need to abandon a gender-blind
unhealthy food and beverages, especially approach and instead expand women’s role
to children, is another important tool in and engagement in areas around (a) decisions
the fight against obesity. about agricultural production, (b) access to
and decision making power over produc-
Leadership and governance. Shaping coun- tive resources, (c) control over use of income,
try food systems for improved nutrition and (d) leadership in the community, and (e)
health requires strong leadership. Some lead- time use.
ers have emerged from their direct exposure
to the realities of malnutrition, and oth- Facilitate multiagency and multisectoral
ers through capacity building and training collaboration. Implementing the food sys-
courses.100 Effectiveness requires thinking tem linked nutrition and health agenda re-
multisectorally to ensure alignment of sec- quires collaboration across government min-
toral actions with common nutrition and istries, such as the Ministries of Agriculture,
health objectives.101 Bangladesh, Brazil, Health, Industries, Education, Rural De-
Chile, China, and Thailand are examples of velopment, and Women Affairs. It requires
countries that have made significant prog- cross-sectoral collaboration within and
ress in improving nutrition and health across development partners; civil society;
outcomes. Some of their progress was driv- research institutions; and private sector food
en by rapid economic growth, but countries producers, post-harvest handlers, processors,
also experimented with and implemented a distributors, and consumers. Following an

SHAPING THE GLOBAL FOOD SYSTEM TO DELIVER IMPROVED NUTRITION AND HEALTH 23
institutional review,102 Tanzania established In addition, to avoid conflicts of interest,
a High-Level Committee on Nutrition food regulatory agencies, which become in-
chaired by the Prime Minister’s Office. The creasingly important as per capita incomes
committee comprised nine key ministries, increase, should be public entities fund-
development partners, nongovernmen- ed by government, and not rely on private
tal organizations, faith-based organizations, company user fees. Clear dietary guidelines
private sector, and tertiary educational insti- drawing on nationally recognized nutri-
tutions. In Brazil, both the National Council tion and medical researchers, academics, and
on Food and Nutrition Security and the practitioners can help guide the regulato-
Inter-ministerial Chamber on Food and ry agencies. Dietary guidelines vary across
Nutrition Security are multistakeholder en- countries (and over time). Given the grow-
tities. The multisectoral nature of nutrition ing concern about rising obesity,103 perhaps a
and health, and the ability of the food system global guideline on healthy diets could help
to contribute need to be reflected in nation- develop a clearer consensus to inform subse-
al and local institutional structures, and in quent national regulations on certain foods.
complementary development plans to better
inform public budget allocations. Monitor and evaluate. Continually build-
ing the evidence base on the impact of food
Better understand and address political system actions on nutrition and health out-
economy factors. Shifting biased consumer comes is necessary. New survey data that
food policies and production subsidies away collect both farm-level production and nu-
from traditional staples in low- and mid- trition-related data are providing more
dle-income countries, and from processing opportunities to build the evidence base, as
ingredients such as corn sweeteners, corn reflected in the recent special issue of the
starch, and soy oils in high-income countries, Journal of Development Studies on “Farm-
to a more crop-neutral policy and subsidy Level Pathways to Improved Nutritional
system has both winners and losers. Entry Status.”104 Government programs, par-
points for moving forward include (a) bet- ticularly those financed by development
ter understanding the nutrition and health partners, need to increasingly use more com-
costs of current policies and the gap between mon sets of metrics to measure nutritional
a country’s agricultural and nutrition/health and health-related outcomes through food
policy objectives, (b) increasing the voice system interventions, such as dietary diver-
of broader stakeholder groups (for exam- sity. A larger knowledge stock of impacts can
ple, consumers, nutritionists, researchers) in help inform future government budget and
agricultural policy dialogue; and (c) under- donor fund allocations, and the design of
standing who will be the winners and losers programs for higher future impacts.
from policy shifts, and creating options for
bargained compromises (such as compensa- Strengthen partnerships. Global partner-
tion or adjustment support for losers). ships such as the UN Zero Hunger Challenge;

24 FUTURE OF FOOD
the Scaling Up Nutrition initiative; the South A Call for Action. The human and eco-
Asia Food and Nutrition Security Initiative, nomic costs of malnutrition and foodborne
the Global Agriculture and Food Security diseases are large and disproportionately
Program; the Global Panel on Agriculture impact poor people. Child stunting is un-
and Food Systems for Nutrition; and the conscionably high. Concerted multisectoral
Nutrition for Growth Summit, which was actions are needed to combat malnutrition
held in conjunction with the London in all its forms. The urgency is reflected in
Olympics and will be continued at the Rio the Sustainable Development Goals with
Olympics in 2016, increasingly are paying at- their call to end hunger by 2030. The food
tention to nutrition and health outcomes. system provides energy and nutrients that
people require to advance economically and
There is growing attention to these issues. socially. It has a key role to play in glob-
Civil society has been an early supporter al efforts to improve nutrition and health.
and implementer of this agenda. Building on Our food system must shift from being
growing interest, there are efforts to mobilize part of the problem to becoming a great-
a Global Chef ’s Network to help drive change er part of the solution. The world needs a
in the food system. Multilateral development food system that can feed every person, ev-
banks, bilateral agencies, and foundations in- ery day, everywhere with a safe, nutritious,
creasingly are integrating nutrition and food and affordable diet. Progress will require
safety aspects into the agriculture programs behavioral change by all actors from food
they support. The World Bank has increased producers to consumers.
the share of agriculture projects with an ex-
plicit focus on nutrition from 12 percent in The paper outlines the spectrum of actions
2012 to 27 percent in 2015. Improving food that countries can take in the food system
and nutrition security is one of CGIAR’s to improve nutrition and health through a
three system level outcomes, and the focus combination of improved knowledge, sound
of its global research programs on agriculture policies, regulation, and investments (table
for nutrition and health, and on livestock 1). There are many tested solutions, but no
and fish, which provide new data, evidence, one size fits all. Countries need to tailor
and technologies. More support is needed to the combination and form of interventions
strengthen country level planning and pri- to their own circumstances. Doing so
oritization of nutrition aspects in country will require leadership, a greater focus on
agricultural development plans, and ensure the needs of women, more collaboration
that global efforts consolidate, rather than between institutions and sectors, learning
fragment, efforts and financing. Growing in- and innovation, and broad partnerships.
terest and partnerships need to be sustained Working together we can help shape the
and deepened, and this paper provides po- global food system to deliver improved
tential entry points for action to help jointly nutrition and health for the benefit of both
shape the global food system to deliver im- current and future generations.
proved nutrition and health.

SHAPING THE GLOBAL FOOD SYSTEM TO DELIVER IMPROVED NUTRITION AND HEALTH 25
Endnotes

1 As described by P. Pinstrup-Andersen, 9 R. Black, C. Victora, S. Walker, Z. Bhutta,

“Agricultural Research and Policy for P. Christian, M. de Onis, M. Ezzati, S.
Better Health and Nutrition in Developing Grantham-McGregor, J. Katz, R. Martorell,
Countries: A Food System Approach,” and R. Uauy, “Maternal and Child
Agricultural Economics 37 (2008): 187–98. Undernutrition and Overweight in Low-
Income and Middle-Income Countries,”
2 Below the minimum level of dietary energy
Lancet 382 (2013): 427–51.
consumption, as defined by FAO.
10 Ibid.
3 Insufficient micronutrients such as iron, zinc,
and Vitamin A. 11 WHO, Global Burden of Disease (WHO,
Geneva), http://www.who.int/topics/global_
4 D. Mozaffarian, T. Hao, E. Rimm, W. Willett,
burden_of_disease/en/.
and F. Hu, “Changes in Diet and Lifestyle
and Long-Term Weight Gain in Women and 12 D. Sahn, “The Impact of Poor Health and
Men,” New England Journal of Medicine 364 Nutrition on Labor Productivity, Poverty, and
(2011): 2392–404. Economic Growth in Sub-Saharan Africa” in
The African Food System and Its Interaction with
5 Using a body mass index of a person’s weight
Human Health and Nutrition, ed. P. Pinstrup-
in kilograms divided by the square of her/
Andersen (Ithaca: Cornell University Press/
his height in meters (kg/m2), the World
UNU Press, 2010).
Health Organization (WHO) defines being
overweight or obese as a person whose body 13 World Bank, Repositioning Nutrition As
mass index is greater than or equal to 25 or 30, Central to Development (Washington, DC:
respectively. World Bank, 2006).

6 FAO (Food and Agriculture Organization 14 McKinsey Global Institute, Overcoming

of the United Nations), The State of Food Obesity: An Initial Economic Analysis (2014),
Insecurity in the World 2015 (Rome, 2015). http://www.mckinsey.com/industries/
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7 FAO, The State of Food and Agriculture: Food
how-the-world-could-better-fight-obesity.
Systems for Better Nutrition 2013 (Rome. 2013).
15 C. Wang, K. McPherson, T. March, S.
8 M. Ng, T. Fleming, M. Robinson, B. Thomson,
Gortmaker, and M. Brown, “Health and
N. Graetz, C. Margono, E. Mullany, and
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others, “Global, Regional, and National
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(9793) (2011): 815–25.
Children and Adults during 1980–2013: A
Systematic Analysis for the Global Burden 16 S. Horton and R. Steckel, “Global Economic
of Disease Study 2013,” Lancet 384 (2014): Losses Attributable to Malnutrition
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Economics of Human Challenges, B. Lomborg
(Cambridge: Cambridge University Press,
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17 J. Hoddinott, J. Maluccio, J. Behrman, R. 24 E. Lin, W. Xiong, H. Ju, Y. Li, L. Bai, and L.
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21 B. Marshall and S. Levy, “Food Animals and 28 O. Ecker, C. Breisinger, and K. Pauw,
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30 Comprises salt iodization, multiple 38 FAO, Milk and Dairy Products, Post-Harvest
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pregnancy (includes iron-folate), calcium and the Near East (Rome: FAO, 2005).
supplementation during pregnancy, energy- 39 When linking with local agriculture, a
protein supplementation during pregnancy, potential trade-off is that foods bought
Vitamin A supplementation during childhood, locally, especially from smaller vendors, could
zinc supplementation during childhood, be more diverse and potentially fresher but
breastfeeding promotion, complementary most likely would not be fortified, from WFP
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food supplementation, severe and acute Worldwide (WFP, Rome, 2013).
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35 World Bank, Future of Food: Shaping 45 M. Demment, M. Youngy, and R. Sensenig,

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32 FUTURE OF FOOD
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