Food systems for better nutrition: Frameworks for facilitating follow-up to the ICN2
Günter Hemrich is a Senior Strategy and Planning Officer with the FAO. The views expressed in this contribution are those of the author and do not necessarily reflect the views or policies of FAO.
Raising global attention on how to address malnutrition in all its forms was the key objective of the Second International Conference on Nutrition (ICN2), jointly organized by the Food and Agriculture Organization of the United Nations and the World Health Organization in Rome, Italy, from 19-22 November 2014. Participants included high-level representatives from more than 170 countries, as well as civil society and the business community. The Conference endorsed two main outcome documents, the Rome Declaration on Nutrition (200KB) and the Framework for Action (200KB), committing world leaders to establish national policies aimed at eradicating malnutrition and transforming food systems to make nutritious diets available to all.
This blog aims to facilitate follow-up to the ICN2 by highlighting the key linkages between food systems, agriculture, and nutrition and by pointing to some recent frameworks and resources that introduce a policy lens to addressing food systems and nutrition linkages. It calls for continued stakeholder dialogue among nutrition professionals and food and agriculture policy-makers to apply these frameworks to policy and programming for improved nutrition.
The burden of malnutrition
The multiple forms of malnutrition—including undernutrition, micronutrient deficiency, as well as obesity and overweight—and their implications are all too familiar to the readers of SecureNutrition; estimates for the global cost of the various forms of malnutrition hover around 5% of global GDP. There are still 161 million children living with chronic undernutrition, and an estimated 51 million children are acutely malnourished. In addition, about 2 billion people are subject to hidden hunger (due to a lack of micronutrients in their diets), a condition with severe health consequences.
In many developing countries, persistent undernutrition coexists with rapidly rising rates of obesity; undernourished and obese people can be found within the same communities, and sometimes even within the same households. Globally, it is estimated that more than 500 million adults are obese, with an approximately 42 million children under the age of five being overweight. Most importantly, obesity is closely associated with diet-related non-communicable diseases, such as heart disease, stroke, cancer, and diabetes.
ICN2 and linkages between food systems, agriculture, and nutrition
A crucial issue addressed by the ICN2 is how agriculture and improved food systems can help address the various dimensions of malnutrition. The Framework for Action urges countries to “Review national policies and investments and integrate nutrition objectives into food and agriculture policy, programme design and implementation, to enhance nutrition sensitive agriculture, ensure food security and enable healthy diets.”
Attempts to explore and better define linkages between nutrition and agriculture are not new, and in fact pre-date the first International Conference on Nutrition of 1992. For example, some early efforts stressed the role of agriculture in raising incomes, thus enabling households to procure sufficient calories (Kennedy, 1993). More recent publications stress the importance of making nutrient-dense, diverse foods available at household level (World Bank, 2007). What is critical for effective follow-up to the ICN2 within this context, is for decision-makers—including those not familiar with the on-going discourse within the nutrition community—to put into sharp focus the key factors that can strengthen the links between food systems, agriculture, and nutrition. Those placed to influence policy should be empowered to identify priority interventions in their specific country contexts.
Reaching nutrition through agriculture
Selected common pathways through which food and agriculture policies can influence nutrition outcomes are highlighted below:
Macro-economic and agricultural growth: At lower levels of development in particular, macro-economic growth is often seen as necessary for sustainably reducing malnutrition; agricultural policies may aim at increasing the agriculture sector’s contribution to macroeconomic growth. However, economic growth does not automatically translate into better nutrition. Country experiences vary widely1 and evidence from global studies is scarce. Agricultural growth may have a greater impact on malnutrition than non-agricultural growth, depending on the size of the sector, the extent to which food insecurity is a problem, and the extent to which agricultural growth delivers increased food availability (Headey, 2012).
Food and agricultural markets: Agricultural policies influence the markets and prices of agricultural commodities and food products, thus affecting consumption choices and nutrition outcomes. The importance of market pathways was underscored during the world food price spikes in 2008, when concern over the implications of high and volatile food prices for nutrition led to the establishment of the UN Secretary General’s High-level Task Force on the Global Food Security Crisis. Relative prices among different food commodities may also strongly impact nutrition status and obesity, and such effects need to be better understood in order to feed into appropriate policy options.
Incomes of those working in food and agriculture and in the broader rural sector: A common objective of agricultural policies is to increase the incomes of those living off agriculture and the rural economy. Income from agricultural and non-agricultural activities is an important determinant of food access. However, the income pathway for improving nutrition is not necessarily linear, as the effect of income on diet, health, and nutrition is modified by market characteristics, nutritional knowledge, gender roles, and social norms.
Composition of household diets: Household production for own consumption is the most direct pathway influencing the composition of the diet consumed in agricultural households (World Bank, 2007). Beyond subsistence, economic determinants of food choice include the availability of a variety of food products, their cost, and the income of a household—factors already mentioned above. Food policies may shift the incentives and consumption patterns and agricultural programmes may have direct implications for dietary diversity.
The role of women: Gender roles and the role of women in particular are important determinants of nutritional outcomes. There is ample of evidence that when women have greater control of household income and assets, the food and nutrition status of their children tends to improve (Haddad et al., 1997). Gender-sensitive agricultural policies may alter women’s social status, access, and control of resources with direct nutritional outcomes. Policies and programmes that improve women’s rights to land, their access to knowledge and inputs, and bring about institutional and technological innovations that save women’s energy and time can therefore be instrumental for improving nutrition.
In recent years, the linkages between nutrition and agriculture are increasingly being analysed using a food systems lens. FAO’s SOFA 2013 Report: Food Systems for Better Nutrition, for example, focuses on how diverse and rapidly changing food systems around the world—having become more industrial, commercial, and global—affect agriculture and nutrition links.
Practical guides and conceptual frameworks: Getting from research to programming
Putting the above-mentioned pathways to work requires political commitment, research, evidence, and concepts that help plan policies and actions, and monitor their outcomes. A plethora of new guides and frameworks exist that highlight particular aspects of food system-nutrition linkages and help to identify interventions in specific policy areas. Recent examples, some developed in preparation of the ICN2, include the following:
- Agriculture and Nutrition - A Common Future: This joint framework, signed by the FAO, European Commission, Technical Centre for Agricultural and Rural Development, and World Bank Group, identifies interventions in specific policy areas, highlighting a range of possible actions in the domains of nutrition-sensitive design, access to nutritious food, resilience, and equity. The framework is also a tool for co-coordination and joint action across agencies.
- Making Agriculture Work for Nutrition: Synthesis of Guiding Principles: Published by the FAO, this synthesis covers aspects of policy, planning, and implementation for improving nutrition impact through agriculture, based on a review of materials produced by multilateral, bilateral, and civil society organizations.
- How can Agriculture and Food System Policies Improve Nutrition?: This technical brief from the Global Panel on Agriculture and Food Systems for Nutrition focuses on action areas in the domains of agricultural production, consumer purchasing power, food transformation, consumer demand, and markets and trade.
- Changing Food Systems for Better Nutrition (4MB): Issue 40 of the UN’s Standing Committee Nutrition News report includes a review of country programming experiences in nutrition and agriculture, with recommendations for improving nutrition through agriculture and ample country case studies.
- SOFA 2013 Report: Food Systems for Better Nutrition: As noted above, this annual FAO report provides an overview of food system interventions for better nutrition (Figure 1, p. 8), outlining opportunities for improving nutritional outcomes through measures related to agricultural production, management of the post-harvest supply chain, and consumer protection.
The above examples highlight the multitude and diversity of frameworks for strengthening the links between food systems and nutrition. The scope of available resources ranges from providing conceptual maps for policy and programme choices, to identifying research needs, harvesting experiences and lessons from programme implementation, and proposing principles for interventions. Further analysis and synopsis of extant frameworks and dialogue across stakeholders and actors will enable policy-makers to apply them purposefully in policy, programming, and in monitoring of impact.
The frameworks and pathways introduced above also illustrate that there are many questions warranting further debate: How suitable are extant frameworks and pathways for analyzing the multiple dimensions of malnutrition simultaneously? Which are better suited to dealing with specific issues of undernutrition, micronutrient deficiency, or obesity? What are some major gaps in existing frameworks? How well are human rights aspects, and issues of governance and regulation—which featured prominently in the ICN2—covered in the frameworks presented above?
Tools to foster ICN2 follow-up
The ICN2 has provided an opportunity for countries and partners to intensify their commitment to addressing malnutrition in all its forms. FAO is committed to support members in mainstreaming nutrition into food and agricultural policies, increase technical assistance, and strengthen capacity for nutrition-enhancing food systems. It will also further support partners in mainstreaming nutrition into large-scale agricultural investment programmes, as it has done in supporting the Comprehensive African Agricultural Development Programme (CAADP).
Choosing effective pathways requires a solid understanding of country contexts and policy objectives and a strong commitment to strengthening information, data, and evidence. A contribution in this direction is a new FAO Pocket Book, Food and Nutrition in Numbers 2014, a reference for policy makers, which provides an overview of nutrition aspects at country, regional, and global levels.
In order to translate the ICN2 commitments into concrete actions, FAO has established an Action for Nutrition Trust Fund. The fund focuses on assisting governments and partners in policy-making and programming, capacity development, information systems and knowledge management, so as to ensure that investments in food systems are leveraged for better nutrition.
For the food and agriculture sectors to effectively address the multiple forms of malnutrition, integrated action across sectors, including public health and education as well as broader policy domains, is imperative. Furthermore intense dialogue and collaboration between public actors, the private sector, and civil society--constituents that may have different views on which pathways to prioritise for improved nutrition--is critical.
 According to Webb and Block (2012) and Ruel and Alderman (2013), quoted in SPRING (2014), a doubling of agriculture Gross Domestic Product (GDP) has shown to yield, on average, a reduction of between 15% and 60% in undernutrition, and is highly variable by country. A doubling of GDP results in approximately a 70% gain in obesity (Ruel and Alderman 2013 cited in SPRING 2014), and obesity is more highly correlated with agricultural growth than with overall economic growth (Webb and Block 2012, cited in SPRING 2014).
EC, FAO, CTA, WB (2014): “Agriculture and Nutrition: A Common Future”: A framework for Joint Action by the European Commission, the Food and Agriculture Organization of the United Nations, The Technical Centre for Agricultural and Rural Cooperation (CTA) and the World Bank Group.
Global Panel on Agriculture and Food Systems for Nutrition (2014): How can Agriculture and Food Systems Policies improve Nutrition? A Technical Brief. Global Panel on Agriculture and Food Systems for Nutrition. London, U. K.
UN SCN (2013): Changing Food Systems for Better Nutrition. SCN News No 40. United Nations Standing Committtee on Nutrition. (PDF, 4MB)
FAO (2013): The State of Food and Agriculture: Food Systems for Better Nutrition. FAO. Rome, Italy.
The World Bank (2007): From Agriculture to Nutrition, Pathways, Synergies and Outcomes. The World Bank, Washington, D. C.
Haddad, Lawrence, John Hoddinott and Harold Alderman (eds.)(1997): Intrahousehold Resource Allocation in Developing Countries: Models, Methods, and Policy. International Food Policy Research Institute. Washington, D. C.
Headey, Derek (2012): Turning Economic Growth into Nutrition-Sensitive Growth. In Shenggen Fan and Rajul Pandya-Lorch (eds.) (2012): Reshaping agriculture for Nutrition and Health. An IFPRI 2020.Book. International Food Policy Research Institute. Washington, D.C.
Herforth, Anna and Jody Harris (2014): Understanding and Applying Primary Pathways and Principles. Brief #1. Improving Nutrition through Agriculture Technical Brief Series. USAID/Strengthening Partnerships, Results, and Innovations in Nutrition Globally (SPRING) Project. Arlington, VA.
Kennedy, Eileen and Howarth E Bouis (1993): Linkages between Agriculture and Nutrition: Implications for Policy and Research. International Food Policy Research Institute. Washington, D. C.
Ruel, Marie T., and Harold Alderman (2013): Nutrition-Sensitive Interventions and Programmes: How Can They Help to Accelerate Progress in Improving Maternal and Child Nutrition? The Lancet, 382:536–551.
Shenggen Fan and Rajul Pandya-Lorch (eds.) (2012): Reshaping agriculture for Nutrition and Health. An IFPRI 2020.Book. International Food Policy Research Institute. Washington, D.C.
SPRING (2014): Understanding the Agricultural Income Pathway. Brief #3. Improving Nutrition through Agriculture Technical Brief Series. USAID/Strengthening Partnerships, Results, and Innovations in Nutrition Globally (SPRING) Project. Arlington, VA.
Webb, Patrick (2013): Impact pathways from Agricultural Research to Improved Nutrition and Health: Literature Analysis and Research Priorities. FAO and WHO. Rome, Italy. (PDF, 1.3MB)
Webb, Patrick, and Steven Block (2012): Support for Agriculture during Economic Transformation: Impacts on Poverty and Undernutrition. Proceedings of the National Academy of Sciences of the United States of America.