Let food be thy medicine and medicine be thy food” – Hippocrates

Improving nutrition is crucial to the health of people and the planet, but it is an often-overlooked element of food security. It was not until the 1996 World Food Summit that the concept of nutrition was included in the definition of food security, and only in 2000 was the first European action plan for food and nutrition policy published. More recently, there is talk of a new term; Food and Nutrition Security.

The impact of failed nutrition policy is devastating. Everyone has a right to adequate food, but globally one in three people are malnourished. If current trends continue, this number will reach one in two by 2030. 795 million people are hungry, 2 billion are nutrient deficient (known as hidden hunger), and 1.9 billion are overweight and obese. This triple burden of malnutrition is associated with many health problems. Undernutrition causes child stunting and wasting, and hidden hunger causes brain damage in new born children, anaemia, blindness and weakened immune systems. Obesity is exacerbated by the nutrition transition, where populations urbanise and shift to sedentary lifestyles and diets high in fat, sugar, and salt. This in turn creates an influx of chronic and degenerative diseases. Malnutrition and poor diets are the number one driver of the global burden of disease.

Some people are locked into vicious cycles of poor health:

  • Malnutrition keeps children locked into poverty (depicted below)
  • The children of obese mothers will most likely be overweight in later life
  • Processed food is donated to food banks, so long term users risk poor nutrition
  • Poor areas in the UK have more fast food outlets than richer areas, exacerbating obesity problems in deprived areas.

malnutrition-cy_19281483_889ab1007c5ad6d0cb465970a0ae4473fc35c47a

(Original infographic by letschangefood)

This is not fair. We need to be able to help people out of these cycles so they are not destined with poor health outcomes.

Food policy has previously been made in response to crises, such as World War II and food safety scares, but why can’t we make food policy in response to the crisis of malnutrition?

The level of complexity of nutrition has hindered the policy response, especially with conflicting evidence and different stakeholders involved. The neoliberal food system places the responsibility of nutrition on the individual; because we decide what to consume. This explains why most policy responses have been ‘soft’ measures, focusing on education or labelling. However, the UK government is failing on improving nutrition, and initiatives such as change4Life are not making significant changes in obesity levels.

What we eat, and in turn our nutritional status, is influenced by many factors; friends and family, income, the food available around us, knowledge, equipment, culture, class, race, gender, taste, allergies, advertising, and health policies to name a few. How can food policy possibly navigate all these elements?

I do think that education has a role to play, and I am an advocate for making nutrition a mandatory element of medical training. Life course health services e.g. obstetrics and paediatrics should join up to provide nutrition advice and longer term help with breastfeeding. It needs to be realistic advice for specific socioeconomic situations; not just nudge techniques. Food literacy should be mandatory on the school curriculum. The UK Childhood Obesity Plan puts significant onus on schools, so food literacy should be measured as part of Ofsted. Food education is a skill for life, alongside literacy and numeracy.

But education alone is not enough; we need population level policy shift which will require hard policy measures. This becomes messy because it involves fiscal measures and changes from the food supply chain. The World Health Organisation has recently endorsed this approach. The UK government has evidence that we are consuming too much sugar and fat and not enough fruit and vegetables, so I would advocate that we progress evidence-based policy.

Improving the nutritional status of our global population will require a variety of tactics. We could start by diversifying agriculture and diets, which would need to involve subsidising fruit and vegetables instead of meat production. This would need to be combined with supporting farmers to navigate the transition in production. The Svalbard Global Seed Bank has 840,000 varieties of food crops we could choose from to reintroduce to agriculture.

seed-bank

(Inside the Svalbard Global Seed Bank. CC-BY 3.0. Available from: https://commons.wikimedia.org/wiki/File:Svalbard_Global_Seed_Vault,inside_the_vault-_panoramio.jpg)

Policy makers should work with public health professionals, who can provide evidence and expertise about their communities, including evaluating policies. We could bring in nutrient profiling for new policies, and regulate advertising (the UK will ban junk food advertising to children from July 2017). Education should focus on healthy drinking, not just healthy eating, and we need hard hitting campaigns equivalent to anti-smoking.

Eco-nutrition links up the health of people and the planet, and requires a change in diet in favour of the environment. Eating a diet which meets nutritional recommendations has been shown to reduce the Ecological Footprint. Further reductions can be made by consuming a plant based diet. If you are interested, check out the Vegan Society for advice.

I am optimistic for the future. At least 12 of the 17 Sustainable Development Goals contain indicators relevant to nutrition, and the FAO Committee on World Food Security is consulting on a Nutrition and Food Systems Report.  In the UK there is potential in the Good Food Nation Bill by Nourish Scotland, and the People’s Food Policy, which aims to provide a fairer food system for all.

Whatever the future of nutrition, it is going to change in the UK. Brexit means the food system will be significantly disturbed; 27% of what we eat is imported from the EU, and it is mostly healthy food like fruit and vegetables. Will this be an opportunity to change a broken food system, or will neoliberal policies, favouring economic efficiency, free trade and markets, take precedent over the health of people and the planet, again?