Achieving equitable diets for all: The long and winding road

Our journey to improve food systems for healthy, equitable, and sustainable diets by 2050 will be long winding. There might bumps along the way, but there also exist maps signposts guide us. A fellowship of political commitment realism, science data, incentives, collectivism help us successfully reach our targeted destination achieve global goals. Food. It is lifeline—the highway, so speak—that has historically spurred nations’ economic growth allowed world population grow almost eight billion. links society as a patchwork feeder roads through cultures, traditions, histories. Food fundamental development because it touches on many sometimes contentious issues, such equity, climate change, globalization, technology.1Fracassi P. Siekmans K. Baker Galvanizing in UN Decade Action Nutrition: assessing member-countries Scaling Up Nutrition (SUN) Movement.Food Policy. 2019; 90: 101788Crossref Scopus (7) Google Scholar moved manipulated hands, transactions, decisions, culminating an extensive system that shapes better or worse. In all their intricacies, have become incredibly efficient some parts unbelievably ineffective others. The result, following centuries human manipulation, generates much at significant environmental cost. This would, perhaps, understandable if Earth’s nearly billion citizens were well fed nourished, they are not. Not only environmentally unsustainable generating massive amounts waste plastic end up oceans atmosphere, not providing healthy diet everyone. For individuals families, getting access nutritious foods entirely out reach. As we look ahead approaching ten billion, must navigate this winding road with final mind—one does destroy planet ourselves. fragile inadequate often reflect society’s inequities—both between within countries. reality situation doing what need do—that is, provide nourish everyone and, same time, ensure its natural resources sustained future generations. Worldwide, 9% people still cannot get enough daily table,2FAOWFPUNICEFWHOIFADThe state insecurity 2020.http://www.fao.org/publications/sofi/2020/en/Date: 2020Google where available, healthiest, safest, sustainable. Often, most easily accessible those calorie rich nutrient poor shelf lives. due influenced rapid technological advances, trade, market transnational beverage companies pervasive advertising, branding, formulation based flavor convenience.3Moss M. Hooked. Random House, 2021Google Policies protect consumers from unhealthy been insufficient largely ineffective.4Baker Machado Santos T. Sievert Backholer Hadjikakou Russell C. Huse O. Bell Scrinis G. et al.Ultra-processed nutrition transition: Global, regional national trends, transformations economy drivers.Obes. Rev. 2020; 21: e13126Crossref PubMed (151) These increasingly dominating consume, these sub-optimal now account 11 million adult deaths annually, which non-communicable disease (NCD) kind—where cardiovascular tops list.5Afshin A. Sur P.J. Fay K.A. Cornaby L. Ferrara Salama J.S. Mullany E.C. Abate K.H. Abbafati Abebe Z. al.GBD 2017 Diet CollaboratorsHealth effects dietary risks 195 countries, 1990-2017: systematic analysis Global Burden Disease Study 2017.Lancet. 393: 1958-1972Abstract Full Text PDF (1691) Undernutrition, food, far behind second leading cause death countries.6Murray C.J.L. Aravkin A.Y. Zheng GBD 2019 Risk Factors CollaboratorsGlobal burden 87 risk factors 204 countries territories, 1990-2019: 2019.Lancet. 396: 1223-1249Abstract (1221) Even South, diet-related NCDs increasing highly processed packaged creeping into deeply rural markets fast-food restaurants infiltrating expanding urban centers sub-Saharan Africa South Southeast Asia. some, impoverished world, supply chains infrastructure limit available local purchase affordable. example, although increase availability nutrient-rich animal-source since 1970, these, fruits vegetables, require cold-chain storage transport absence technologies, spoil long, dusty roads.7Headey D.D. Alderman H.H. relative caloric prices differ systematically across income levels continents.J. Nutr. 149: 2020-2033Crossref (119) costly produce, transport, thus types. spend 60%–80% entire feed reach.2FAOWFPUNICEFWHOIFADThe estimated three people, whom 57% Africans Asians, afford constitutes nationally recommended diet.2FAOWFPUNICEFWHOIFADThe When poorest struggle vital sources protein, micronutrients, other health-promoting properties, both universally seems way down road. though halfway United Nations (UN) Nutrition, aims eliminate malnutrition forms, everywhere, burdens contributors overall morbidity globally.8Kharas H. McArthur J.W. Ohno I. Leave No One Behind: Time Specifics Sustainable Development Goals. Brookings Institution Press, 2019Google Although slight improvement reducing compared child mortality, Agriculture Organization estimates 691 suffer hunger 21% children under age 5 years chronic undernutrition.2FAOWFPUNICEFWHOIFADThe Unsurprisingly, who higher tend lower socioeconomic status, poverty strongly associated households struggling undernutrition overweight women.9Perez-Escamilla R. Bermudez Buccini G.S. Kumanyika S. Lutter C.K. Monsivais Victora disparities malnutrition.BMJ. 2018; 361: k2252Crossref (108) Low- middle-income particularly hard hit double health challenge (Figure 1).10Popkin B.M. Corvalan Grummer-Strawn L.M. Dynamics changing reality.Lancet. 395: 65-74Abstract (364) Since every country suffered rising rates obesity NCDs, inequalities increased primarily low- countries.11Bell W. Lividini Masters W.A. convergence 1970 2010 altered inequality agriculture, health.Nat 2021; 2: 156-165Crossref (8) coronavirus (COVID-19) pandemic laid bare consequences inequities. Those being hospitalized dying COVID-19,12Popkin Du Green W.D. Beck M.A. Algaith Herbst C.H. Alsukait R.F. Alluhidan Alazemi N. Shekar Individuals COVID-19: perspective epidemiology biological relationships.Obes. e13128Crossref (445) projected among women significantly result downturn.13Osendarp Akuoku J. Black Headey D. Ruel Scott Walker Flory Haddad al.The potential impacts COVID-19 crisis maternal low middle countries.Research Square. https://doi.org/10.21203/rs.3.rs-123716/v1Crossref Avoiding future, potentially deadlier zoonotic spillover events—in encroachment habitats directly implicated—will key over next decade two. urgency address challenges understated. Goal (SDG) 2—end hunger, security improved nutrition, promote agriculture—leans endgame, relevant SDG. Unfortunately, projections show SDG 2 2030,8Kharas analyses suggest meeting SDGs 2030 “demand pace progress no achieved recent past.”15Lozano Fullman Abay S.M. CollaboratorsMeasuring 1990 projecting attainment health-related Goals territories: 392: 2091-2138Abstract (231) examine globalization demand diets, story happy ending. consumption unhealthy, processed, intensive 2070. COVID-19, continued could offer further setbacks reaching 2030. So then beyond 2050, away, even 2070, like? Right now, sit precise return “normal”—if ever was thing—in sight, tell. We history formulating grand goals putting markers sand, day, made sand rather than concrete, quickly move onto set very little hindsight accountability went wrong adjust. 2000 Millennium Goals, agreed cut half, one example. Perhaps modus operandi—a survival mechanism closer order—but approach longer sufficient, change barrels profound increases inequities blindingly visible poor, marginalized, living South. presently To prevent Agenda becoming yet another faded, washed-out mark least firm foundations targets toward action needed. Secretary-General called Systems Summit year spur attention systems, food-related can summit critical moment back track steered right direction destination. likely winding, difficult navigate, road, map, how traverse beyond. us—the citizenry. People driver’s seat want function whom. already produce everyone, technology needed producing more exists. make easier produced stays planetary boundaries—conserving biodiversity watersheds, halting deforestation, minimizing greenhouse gas emissions. Much done multitude actors making decisions operates delivers constitute diets. Consumers, too, powerful shaping system’s directionality when supportive systemic policies them, banning junk-food provision easy-to-read labels, food-safety surveillance, promotion investments incentivize production practices. map vast amount evidence, knowledge accumulated last 50 years. always data gaps, information solid head take any good understand topography, features, size, scale hand. bolus food-system Dashboard brings aid decision making.14Fanzo McLaren Marshall Q. Davis Herforth Jones Beal Tschirley Bellows new tool inform policy.Nat. 1: 243-246Crossref (55) real-time learnings pandemic. First, something genuinely threatening humanity, governments act swiftly. How optimal, do. Governments realize threats. What community generates, shares, provides evidence policy real time. Do underestimate ingenuity. speed scientists developed vaccine shows scientific cooperation, accumulating research, funding, goods impact. know tremendous about action. source innovation opportunity, opportunity highlight this. Innovations regenerative reformulated foods, lab-grown meats, ready-to-use acute treatment, seed vaults, homegrown school meals, digital technologies consumer information, front-of-the-pack name just handful, tried tested world. Multilateral cooperation essential. exemplified pandemic, modern-day including interconnected issues. efforts tackle issues impaired without cooperation. Because traded commodities globally, country’s “fix” healthier, sustainable, safe, affordable requires fixing trade system. crucial garnering ensuring inclusivity, signaling power asymmetries actors, holding account. Collectivism social critical. Over few years, resurgence movements, similar fashion late 1960s, highlighted injustices profoundly affect government policies. past year, smack dab seen Lives Matter importance highlighting swept rug too long. Prior saw millions streets participate events demanding change. transcend time ripe food-justice movement. incentives. understanding each actor naive. “it thing do” enough. Examining incentives trade-offs certain inroads fair Navigating equitable 10 difficult. But sufficient coordinated action, remains roll sleeves work. roaming 2050. should define are, go, robust hold J.F. editor-in-chief Security Journal associate editor American Clinical Nutrition.