Main areas of action (health)

This chapter focuses on actions which help to reduce/eradicate negative health outcomes from food systems. For this purpose, a non-exhaustive list of key actions along different food system features (Food Environment, Consumer Behaviour, Supply chains, Regulatory and Policy Framework) will be described. Furthermore, the chapter will highlight some action related to health systems and briefly address gender and sustainability. The following graph summarises key actions described below.

Food environment

Key areas of action include the promotion of conducive product properties such as food quality and safety allowing consumers to purchase healthy and safe food items and the marketing of food products.

• Facilitating the compliance with food safety regulations by food companies along the supply chain to avoid health risks from the consumption of unsafe food. It includes the recognition of food safety standards and the collaboration with authorities for food inspections. It might also involve the facilitation of certification processes, e.g. certification with ISO 22000 for food safety management. In addition, in order to meet food safety requirements food safety management systems can be promoted which could include setting-up Traceability Systems and preventive controls, e.g. Good Hygiene Practices (GHPs) and Hazard Analysis and Critical Control Point (HACCP) systems.
• Promoting safe food handling at individual level and for retailers. It refers to the promotion of key safe food handling practices such as those proposed by WHO or good food hygiene practices as part of nutrition-sensitive WASH.
• Supporting efforts by food processors to fortify food products in order to increase the nutritional quality of the product and/or to address micro-nutrient deficiencies. The best known example is iodised salt which helped to eradicate iodine deficiency in large parts of Europa. As a sub-set of fortification biofortification can be promoted. Biofortification refers to the process by which the nutrient density of food crops is increased through conventional plant breeding, and/or improved agronomic practices and/or modern biotechnology without sacrificing any characteristic that is preferred by consumers or most importantly to farmers.
• Supporting the reformulation of food and drinks for healthier food items reducing contents of sugar, salt and harmful fats. This action has become more relevant in recent years due to the rise of cheap highly-processed and energy-dense food on the markets. Those products have often high amounts of salt/sodium, free sugars, saturated fats and industrially produced trans fats potentially contributing to negative health outcomes such as being overweight, obese and suffering from diet-related noncommunicable diseases (NCDs).
• Supporting intuitive and easy understandable nutrition labelling as part of product development by food-companies. Clear and accurate nutrition labelling is considered a key element for consumers to make healthier food choices. It is important that the nutritional information is presented in a way which is visually appealing and quickly to grasp. For instance, providing detailed information on the back of a product is less helpful.
• Supporting any efforts to restrict the marketing of unhealthy foods. Often a particular focus is on unhealthy foods targeting children and adolescent. It is known that marketing strongly shapes preferences and that exposure to marketing for foods high in fats, sugars and salt/sodium increases the likelihood that children and adolescents request, buy and consume those foods. However, measures can be taken to prevent this. For instance, Chile introduced a new law limiting child-direct marketing of unhealthy foods. According to it black, octagonal warning labels are mandatory for any product high in sugar, calories, sodium and/ or saturated fat. Secondly, advertising for those products during child-focused TV and digital media, at cinemas and in locations that attract a high proportion of children is prohibited. Thirdly, it is not allowed to use intentionally child-directed advertising methods, such as cartoon characters or mascots. (see: Chile’s Comprehensive Food Policy Offers Global Lesson in Tackling Unhealthy Foods - Health Policy Watch)

Consumer Behaviour

Redirecting consumer choice for healthier food items is another strategy to increase the uptake of those.

• Enhancing the knowledge of people on healthy food items and stimulating a desire for healthy food items. Social behaviour change communication (SBCCs) is a widely used approach to reach those objectives. SBCC can be described as a process of interactively communicating with individuals, institutions, communities and societies as part of an overall programme of information dissemination, motivation, problem solving and planning. It is crucial to understand all the positive and negative behaviours linked to food including food-related practices which are potentially health threatening. If well understood nutrition, adequate nutrition messages can be formulated and inform the process.
• Supporting the application of smart nudges by private or public entities. A nudge describes an intervention that gently steers individuals towards a desired action without forbidding any options or changing their economic incentives. It includes behavioural nudges, e.g. placing a bowl of nuts and fruits for “grab and go” and cognitive nudges, e.g. placing healthier food options at eye-level and different colourful stickers for “healthy” and “unhealthy” products.

Supply chains

Supporting the spread of alternative agricultural production models which support ecosystem processes, organic inputs and nature-based solutions. It reduces/avoids the contamination of natural resources with harmful substances which pose a health risk to anyone involved in agricultural production. Alternative agricultural production models include agriculture based on agroecological principles and organic agriculture.

Regulatory and Policy Framework

A third set of actions covers political measures aiming to incentivise healthy food items and to disincentivise unhealthy food items.

• Support the introduction of food taxes and food-related subsidies/fiscal policies, e.g. increasing the price of unhealthy options and lowering the price of healthy foods. Taxing unhealthy food items has gained momentum mainly to fight overnutrition such as obesity and as part of a larger effort to reduce public health costs. The most concrete example is the taxation of sugar-sweetened beverages which is supported by a corresponding WHO recommendation to do so. So far over 50 countries have introduced taxes on sugar-sweetened beverages (SSBs) and data shows that those taxes succeeded in reducing the sugar consumption from SSBs. (see: Taxes on sugar-sweetened beverages (SSBs) | Obesity Evidence Hub)
• Supporting the introduction and/or strengthening of public food procurement and service policies for healthy diets. Public food procurement offers huge potential as it covers a wide of institutions such as schools and hospitals reaching a large part of the population. For instance, school feeding menus can prioritise healthy food items ensuring a high nutritional value of the food consumed. Public canteens can be directed to increase healthy canteen food so that people can explore healthy food choices at low prices.
• Supporting the development of food-based dietary guidelines guiding consumers and institutions towards the consumption of healthy sustainable diets. In the past it mostly referred to food pyramids though in many cases those have been replaced by other designs such as in the form of a plate. In recent years many countries have published such guidelines heavily supported by FAO. Those guidelines are needed for measurements to assess malnutrition and for designing healthy menus, e.g. as part of school feeding programmes.
• Facilitating the coherence of trade policies with nutrition and food safety. Strengthening coherence can improve the availability and diversity of nutritious foods. There are interesting examples of special trade policies to enhance the availability of healthy food items. For instance, Fiji improved access to vegetables by cutting the customs duty and excise tax on imported vegetables.
• Promoting participatory and coherent food governance. For the realisation of functional food systems, it is essential that sectors collaborate and food system stakeholders at multiple levels can raise their voice and are heard. Sectoral silo-thinking and weak/a lack of participatory mechanisms pose obstacles to it. The establishment of multi-stakeholder platforms including food councils, food labs, multi-sectorial committees, is often used as the primary solution for tackling both obstacles. For instance, as part of the Scaling Up Nutrition Movement in various countries Nutrition-related multi sectorial committees at different levels made up by a diverse membership of government, civil society, private sector and development partners were established.

Health-system-related actions

• Targeting obesity comprehensively. In recent years obesity has been attracting more and more attention due to rising obesity figures across the globe independently of income levels. Actually, it has been known for quite a while that often over- and undernutrition coexist but it has taken time that this is reflected in actions taken. Some of the actions above of course help such as a reduction of intake of sugar. However, for those suffering from obesity other forms of support such as nutrition counselling in medical institutions and adequate therapeutic offers are needed.
• Strengthening Public Health Nutrition (PHN) as a scientific discipline and increasing the visibility and application of its findings. Public health nutrition can be described as the promotion and maintenance of nutrition-related health and wellbeing of populations through the organised efforts and informed choices of society. It aims to promote and maintain the nutritional health of populations and argues for a multi-disciplinary perspective.
• Another possible action mentioned is capture by the phrase “food is medicine” or “food as medicine”. “Food is medicine” works towards an increased integration of specific food and nutrition interventions in—or closely coordinated with—the healthcare system. This includes but is not limited to medically tailored meals, medically tailored groceries, and prescription programmes. For instance, trials using healthy food prescriptions typically providing either financial subsidies or direct provisions for fruits and vegetables as a treatment for patients who were experiencing food insecurity as well as cardiometabolic disease have shown positive results.
• Strengthening Integrated Management of Acute Malnutrition (IMAM) and Community Management of Acute Malnutrition (CMAM) in order to detect malnutrition and for treatment. Key principles include maximum coverage and access up to the community level, timeliness of service delivery, appropriate medical care and nutritional rehabilitation. Potential components are community Outreach/mobilisation, outpatient treatment of SAM without and with complication and management of Moderate Acute Malnutrition.

see also: Publications and key learnings from the RUNRES

Cross-cutting aspects

• Consider gender-related aspects particularly affecting women in pregnant and lactating age. Unhealthy diets, e.g. an insufficient intake of zinc, have been linked with an increased risk for pregnancy complications, including gross structural birth defects, prematurity, low birth weight, and an increased risk for neurobehavioural and immunological abnormalities after birth. Furthermore, it is statistically proven that prevalence of food insecurity has been consistently higher among women than among men, globally and in all regions. In literature prevailing gender norms and women’s limited access to resources are mentioned as key factors causing it .
• Promoting the double impact of the consumption of healthy diets. Healthy sustainable diets have a huge potential to address both environmental sustainability and positive health outcomes due to their lower environmental impacts compared to the consumption of unhealthy diets. Therefore, acting on healthier food is not only beneficial for the individual health and reduces public health costs but also has a positive impact on the environment.

• Brief case study: Best practices of the Leadership to ensure adequate nutrition project in Lao PDR

  The “Leadership to Ensure Adequate Nutrition” (LEAN) project operated in the remote Chattogram Hill Tracts in Bangladesh from September 2018 to February 2024. Co-financed by the European Union, this 11 million Euro undertaking was implemented by a consortium of United Purpose, Global Alliance for Improved Nutrition and Helvetas Swiss Intercooperation in collaboration with three local partners.

  The overall objective was to contribute to improved maternal and child nutrition in the Chattogram Hill Tracts. It fits very well with the content provided because it not only explicitly addressed local food systems for achieving food and nutrition security for all but also included health interventions strengthening access to health services in remote areas.

  The key vehicle to support increased awareness of healthy sustainable diets and increased access to health services were the Women Business Centers (WBCs). The WBCs are managed by a group of local women selling snacks, direct nutrition products such a fortified food items and sanitary pads to members of the local community. In addition, WBCs offer a digital healthy advisory service. It functions as follows: The patient is checked for a fee at the WBC where some basic medical equipment is available to collect basic health data, such as blood pressure. This data is then digitally shared via an app called “klick health” with a contracted doctor. The doctor assesses the information and then formulates the medical recommendation. The doctor advises on next steps to take which is re-shared with the patient. Key advantages include the ability to decide on the stop and saving time and money which would be required for travelling to a far away local health station.

  In addition to the service provision at the shop members of the WBC were trained to deliver nutrition trainings to communities nearby thereby offering a door-step service with the objective to increase the nutrition awareness among the rural population. Recipients of this service confirmed that this service made a difference and allowed them to understand the importance of consuming a health sustainably diet for them themselves and family members.