Accessing Healthy Diets: An Imperative for Food Security and Sustainable Development

Introduction

Despite improvement in many global health outcome trends over the last two decades, with some modest setbacks during the COVID-19 pandemic,^[1] food security still lags behind. In fact, over the last five years, it has worsened. The Food and Agriculture Organization of the United Nations (FAO) annually tracks food insecurity (also referred to as hunger), which they define as the prevalence of undernourishment. FAO estimates that 735 million people – approximately 9.2 percent of the world’s population – are undernourished. This number has increased by 122 million since the pandemic.^[2] Several regions of the world have experienced this increase, including Africa, Western Asia, and the Caribbean. In Africa alone, food insecurity has risen to a staggering 20 percent.^[3] Currently, the world is far off course to reach the Sustainable Development Goal 2 target to end hunger.^[4]

Food insecurity is primarily driven by the overall diets people have access to – meaning the types of food that are physically and economically available and accessible in their built environment. For many, accessing a healthy diet – one that meets their nutrient needs while also being health-protective to avoid malnutrition and non-communicable diseases – is elusive. Currently, 42 percent of the world’s population (an astonishing 3.1 billion people) cannot afford a healthy diet,^[5] and the cost of a healthy diet has risen by 6.7 percent compared to pre-pandemic levels in 2019. Again, Africa disproportionately suffers, with 78 percent of the population unable to afford a healthy diet. Instead, people can afford highly processed foods laden with added sugars, excess sodium, unhealthy fats, and numerous ingredients and additives that promote their shelf life, taste, and texture.^[6] These foods are inexpensive because their ingredients are cheap and easily traded around the world. For many low-income populations, a significant proportion of their diet consists of refined staple grains, roots, and tubers.^[7],[8]Because of this rampant food insecurity and poor dietary trends, nutrition outcomes, such as vitamin and mineral deficiencies, obesity, and stagnating undernutrition, remain universal issues. Every country suffers from at least one form of malnutrition.^[9]

Food systems and drivers of influence

Food systems—the dynamic processes of growing, storing, processing, packaging, selling, consuming, and wasting food—play a significant role in safeguarding food security and diets. They are influenced by a range of local, regional, and global actors as well as other factors, including poverty, urbanization, politics, globalization, trade, and environmental and planetary systems. If these systems are not instituted in fair and just ways, they can perpetuate hunger and poor access to nutritious foods. In the last few years, some have argued that food systems are reaching a polycrisis, with an increased risk of multiple breadbasket failures and tipping points.^[10],[11]

Three primary drivers continue to shock food systems and increase their fragility.^[12] The first is climate variability and change. Climate change is escalating the severity and frequency of extreme events, including heatwaves, cold spells, heavy precipitation, droughts, and wildfires. Extreme and compound eventsintensified by climate change pose systemic and disproportionate food security risks to populations already vulnerable to the impacts of climate change, particularly those living in poverty and other marginalized groups residing in low- and middle-income countries (LMICs).^[13]

The second factor is conflict. We are witnessing geopolitical shifts resulting in regional conflicts and civil wars. The Russia-Ukraine war, the Gaza-Israel conflict, and civil wars in Sudan, Somalia, Ethiopia, Yemen, Syria, and the Democratic Republic of Congo, to name just a few, perpetuate or escalate undernutrition and hunger due to poor food access, resulting in desperation, movement, and social unrest.^[14]

The third factor is the COVID-19 pandemic, which continues to have lasting impacts that we do not fully understand.^[15] However, the pandemic provided lessons about how food supply chains behaved in various geopolitical contexts and what "parts" of the chain were more vulnerable.^[16]

Political will and action for food systems

While governments are constantly dealing with trade-offs, there are several instances where they can intervene to ensure populations can access healthy diets and ensure food security. Some policy recommendations take a top-down approach, such as engaging in multilateral political processes and reorienting agricultural subsidy policies. To achieve this, much more political will is needed to integrate food into goal-committing moments, such as the Convention of Parties (COP) climate change meetings by nation-states. The role of food systems in the climate change agenda and negotiations has been sidelined at COPs.^[17] Although 89 percent of the Nationally Determined Contributions (NDCs)—commitments by each country to reduce national emissions and adapt to the impacts of climate change—recognize the role of agriculture in the climate agenda, emission reductions from food systems are often disregarded when countries define their NDCs.^[18] As such, only three percent of governments’ financial commitments and investments to address climate are directed toward food systems.^[19]

Second, global agricultural subsidy support policies account for $540 billion annually.^[20] In the US, for example, 56 percent of calories consumed by Americans originate from subsidized food commodities — corn, soy, rice, wheat, sorghum, dairy, and livestock^[21]—which is misaligned with US dietary guideline recommendations. If agriculture subsidies stay on a "business as usual" course, greenhouse gas (GHG) emissions from agriculture will increase by 58 percent by 2040.^[22] One modeling study suggests that if subsidies were reoriented to produce healthier, more sustainable foods, there would be positive multiplier effects on diets, mortality, and GHG emissions.^[23] However, changing subsidy policies is a tricky issue in food policy, with entrenched political interests making change slow if not sclerotic.^[24]

Third, there is a range of more localized policy interventions by governments and the private sector to address physical and economic access to healthy diets. Regulating the number of retailers who sell primarily unhealthy food products and partnering with local growers to offer alternative options at markets are potential opportunities to spur local economies.^[25],[26] Nevertheless, the high cost of nutrient-rich foods and overall diets, combined with climate change, conflict, and food inflation worldwide, necessitates the implementation of safety nets and other social protection measures for resource-constrained households and individuals.^[27],[28]

Conclusion

Governments must show political will and sustained commitment to advance food systems to ensure food security.^[29] The challenges facing governments and the collective citizenry could not be more frontal and acute. In these pressing times, prioritizing what matters most—food, water, and shelter—is critical to setting the world on a path toward sustainable development.

 

Jessica Fanzo, Ph.D., is a Professor of Climate and the Director of the Food for Humanity Initiative at Columbia University’s Climate School in New York City. She also serves as the Interim Director for the International Research Institute for Climate and Society, also known as IRI. 

 

 

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[1] Roser EOOA. "Global Health." Published online at Ourworldindata.org. Published online 2016. https://ourworldindata.org/health-meta

[2] FAO. The State of Food Security and Nutrition in the World 2023. Urbanization, Agrifood Systems Transformation and Healthy Diets across the Rural–Urban Continuum. FAO; 2023. doi:10.4060/cc3017en

[3] Ibid.

[4] Gertz, G., Zoubek, S., Daly, J. and Hlavaty, H. Prospects for Accelerating Progress Toward SDG2. Duke Sanford World Food Policy Center and Global Economy and Development at Brookings Institution; 2020.

[5] FAO. The State of Food Security and Nutrition in the World 2023. Urbanization, Agrifood Systems Transformation and Healthy Diets across the Rural–Urban Continuum. FAO; 2023. doi:10.4060/cc3017en

[6] Monteiro CA, Cannon GJ. The role of the transnational ultra-processed food industry in the pandemic of obesity and its associated diseases: problems and solutions. World nutr. 2019;10(1):89-99.

[7] Milani P, Torres-Aguilar P, Hamaker B, et al. The whole grain manifesto: From Green Revolution to Grain Evolution. Global Food Security. 2022;34:100649.

[8] Food and Agriculture Organization of the United Nations (FAO). FAOSTAT. Accessed October 25, 2022. https://www.fao.org/faostat/en/

[9] Phelps NH, Singleton RK, Zhou B, et al. Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults. Lancet. 2024;403(10431):1027-1050.

[10] Søgaard Jørgensen P, Jansen REV, Avila Ortega DI, et al. Evolution of the polycrisis: Anthropocene traps that challenge global sustainability. Philos Trans R Soc Lond B Biol Sci. 2024;379(1893):20220261.

[11] World Economic Forum. The Global Risks Report 2023. Accessed February 21, 2023. https://www3.weforum.org/docs/WEF_Global_Risks_Report_2023.pdf

[12] Hendriks SL, Montgomery H, Benton T, et al. Global environmental climate change, covid-19, and conflict threaten food security and nutrition. BMJ. 2022;378:e071534.

[13] Fanzo J, Davis C, McLaren R, Choufani J. The effect of climate change across food systems: Implications for nutrition outcomes. Global food security. Published online 2018. https://www.sciencedirect.com/science/article/pii/S2211912418300063

[14] Kuemmerle T, Baumann M. Shocks to food systems in times of conflict. Nat Food. 2021;2(12):922-923.

[15] Barrett CB, Fanzo J, Herrero M, et al. COVID-19 pandemic lessons for agri-food systems innovation. Environ Res Lett. Published online September 10, 2021. doi:10.1088/1748-9326/ac25b9

[16] Brands H, Gavin FJ. COVID-19 and World Order: The Future of Conflict, Competition, and Cooperation. JHU Press; 2020.

[17] Food and Agriculture Organization of the United Nations. Linking Nationally Determined Contributions and the Sustainable Development Goals through Agriculture: A Methodological Framework. Food & Agriculture Org.; 2019.

[18] Ingrid Schulte, Haseeb Bakhtary, Simon Siantidis, Franziska Haupt, Martina Fleckenstein, Clementine O’Connor. Enhancing NCDs for Food Systems: Recommendations for Decision-Makers. World Wildlife Fund; 2020.

[19] Global Alliance for the Future of Food. Untapped Opportunities: Climate Financing for Food Systems Transformation.; 2022. https://futureoffood.org/wp-content/uploads/2022/10/climatefinancereport-english.pdf

[20] Fanzo J, Miachon L. Harnessing the connectivity of climate change, food systems and diets: Taking action to improve human and planetary health. Anthropocene. Published online April 10, 2023:100381.

[21] Ibid. 

[22] Gautam M, Laborde D, Mamun A, Martin W, Pineiro V, Vos R. Repurposing Agricultural Policies and Support: Options to Transform Agriculture and Food Systems to Better Serve the Health of People, Economies, and the Planet. World Bank; 2022.

[23] Springmann M, Freund F. Options for reforming agricultural subsidies from health, climate, and economic perspectives. Nat Commun. 2022;13(1):82.

[24] Fanzo J, Miachon L. Harnessing the connectivity of climate change, food systems and diets: Taking action to improve human and planetary health. Anthropocene. Published online April 10, 2023:100381.

[25] Freedman DA, Vaudrin N, Schneider C, et al. Systematic Review of Factors Influencing Farmers’ Market Use Overall and among Low-Income Populations. Journal of the Academy of Nutrition and Dietetics. 2016;116(7):1136-1155. doi:10.1016/j.jand.2016.02.010

[26] Chenarides L, Cho C, Nayga RM, Thomsen MR. Dollar stores and food deserts. Appl Geogr. 2021;134:102497.

[27] International Food Policy Research Institute (IFPRI). 2021 Global Food Policy Report: Transforming Food Systems after COVID-19. Intl Food Policy Res Inst; 2021

[28] Raza A, Others. Ensuring healthier diets, better nutrition and strengthened food systems: the role of social protection policies and programmes. UNSCN News. 2017;(42):49-51.

[29] Schneider KR, Fanzo J, Haddad L, et al. The state of food systems worldwide in the countdown to 2030. Nat Food. 2023;4(12):1090-1110.