Sustaining healthy diets: The role of capture fisheries and aquaculture for improving nutrition in the post-2015 era

The Sustainable Development Goals (SDGs) agenda makes achieving food security and ending malnutrition a global priority. Within this framework, the importance of fisheries in local and global food systems and its contribution to nutrition and health, particularly for the poor are overlooked and undervalued. This paper reviews current fish production and consumption from capture fisheries and aquaculture, highlights opportunities for enhancing healthy diets and outlines key multi-sectoral policy solutions. Mirroring the call for a diversification of agricultural research and investment beyond a few staple grains, it is anticipated that productivity gains for a few farmed aquatic species will not suffice. Capture fisheries and aquaculture have a complementary role to play in increasing fish availability and access, and must be promoted in ways that support measurable nutrition and health gains. This paper argues that the lack of a nutrition-sensitive policy focus on capture fisheries and aquaculture represents an untapped opportunity that must be realised for ensuring sustainable healthy diets for all.     

Sustainable food systems for healthy diets in Europe and Central Asia: Introduction to the special issue

This Special Issue highlights various good practices and food policy discussion in relation to the transformation of current food systems toward their social, environmental and economical sustainability. The papers describe policies, programmes and initiatives in developing and advanced economies of Europe and Central Asia that refer to the core elements of food systems, such as food supply, food environments, and consumers. The shared opinions, analyses, studies and approaches, experiences and insights contribute to a better understanding of regional specificities and support the efforts to guide the complex food systems’ transformation for their improved capacity to deliver healthy diets.     

The system-wide impact of healthy eating: Assessing emissions and economic impacts at the regional level

Encouraging consumers to shift their diets towards a lower meat/lower calorie alternative has been the focus of food and health policies across the world. The economic impacts of such changes on regions have been less widely examined, but are likely to be significant, especially where agricultural and food production activities are important for the region. In this study we use a multi-sectoral modelling framework to examine the environmental and economic impacts of such a dietary change, and illustrate this using a detailed model for Scotland. We find that if household food and drink consumption follows healthy eating guidelines, it would reduce both Scotland’s “footprint” and “territorial” emissions, and yet may be associated with positive economic impacts, generating a “double dividend” for both the environment and the economy. The economic impact however depends critically upon how households use the income previously spent on higher meat/higher calorie diets. Furthermore, the likely (but not modelled) benefits to health suggest the potential for a “triple dividend”.     

Integrating climate change,food prices and population health

The inter-related nature of food, health and climate change requires a better understanding of the linkages and a greater alignment of policy across these issues to be able to adequately meet the pressing social and health challenges arising from climate change. Food price is one way through which climate change may affect health. The aim of this study of the global and Australian food systems is to provide a whole-of-system analysis of food price vulnerabilities, highlighting the key pressure points across the food system through which climate change could potentially have the greatest impact on consumer food prices and the implications for population health. We outline areas where there are particular vulnerabilities for food systems and food prices arising from climate change, particularly global commodity prices; agricultural productivity; short term supply shocks; and less direct factors such as input costs and government policies. We use Australia as a high-income country case study to consider these issues in more detail. The complex and dynamic nature of pricing mechanisms makes it difficult to predict precisely how prices will be impacted. Should prices rise disproportionately among healthy foodstuffs compared to less healthy foods there may be adverse health outcomes if less expensive and less healthy foods are substituted. Higher prices will also have equity implications with lower socio-economic groups most impacted given these households currently spend proportionately more of their weekly income on food. The ultimate objective of this research is to identify the pathways through the food system via which climate change may affect food prices and ultimately population health, thereby providing evidence for food policy which takes into account environmental and health considerations.     

Targeting population nutrition through municipal health and food policy: Implications of New York City’s experiences in regulatory obesity prevention

Obesity remains a major public health challenge across OECD countries and policy-makers globally require successful policy precedents. This paper analyzes New York City’s innovative experiences in regulatory approaches to nutrition. We combined a systematic documentary review and key informant interviews (n = 9) with individuals directly involved in nutrition policy development and decision-making. Thematic analysis was guided by Kingdon’s three-streams-model and the International Obesity Task Force’s evidence-based decision-making framework. Our findings indicate that decisive mayoral leadership spearheaded initial agenda-change and built executive capacity to support evidence-driven policy. Policy-makers in the executive branch recognized the dearth of evidence for concrete policy interventions, and made contributing to the evidence base an explicit goal. Their approach preferred decision-making through executive action and rules passed by the Board of Health that successfully banned trans-fats from food outlets, set institutional food standards, introduced menu labeling requirements for chain restaurants, and improved access to healthy foods for disadvantaged populations. Although the Health Department collaborated with the legislature on legal and programmatic food access measures, there was limited engagement with elected representatives and the community on regulatory obesity prevention. Our analysis suggests that this hurt the administration’s ability to successfully communicate the public health messages motivating these contentious proposals; contributing to unexpected opposition from food access and minority advocates, and fueling charges of executive overreach. Overall, NYC presents a case of expert-driven policy change, underpinned by evidence-based environmental approaches. The city’s experience demonstrates that there is scope to redefine municipal responsibilities for public health and that incremental change and contentious public discussion can impact social norms around nutrition.     

Healthy,sustainable and plant-based eating: Perceived (mis)match and involvement-based consumer segments as targets for future policy

Given the inseparable environmental and health impact of dietary habits, integrating health and sustainability goals has become a highly topical issue in policy development and communication to encourage consumers to adopt healthier and more sustainable diets. Increasing evidence indicates that it is possible to develop diets that are both environmentally sustainable and healthy, but their potential success largely depends on consumers’ willingness and ability to change their behavior. This study investigates consumer perceptions of the match, or mismatch, between healthy and sustainable diets, and gives insight into consumers’ motivation to eat healthily and sustainably, as measured by involvement. Data were collected in Spring 2014 through a cross-sectional quantitative online survey with samples representative for age, gender and region in four European Union (EU) countries (United Kingdom, Germany, Belgium, and the Netherlands) (n = 2783). The images of a healthy diet, a sustainable diet and a plant-based diet were found to be highly compatible based on a strongly observed match between European consumers’ perceptions of these concepts. Half of the participants were highly involved in healthy eating and one third in both healthy and sustainable eating. Informational food policy actions targeting both healthy and sustainable food consumption behavior are recommended to address issues relevant to the target segments, taking into account their levels of involvement. Increasing consumers’ motivation and involvement in health and sustainability emerges as a key trigger for increasing healthy and sustainable eating.     

Assessing nutritional status and nutrition-related knowledge,attitudes and practices of Albanian schoolchildren to support school food and nutrition policies and programmes

In Albania, many children exhibit poor nutritional status, have unhealthy diets and inadequate physical activity. Yet, comprehensive studies on the nutritional status, food and nutrition knowledge, attitudes and practices (KAP) are largely non-existent for Albanian school-age children.To fill these important gaps, a nationwide survey was conducted in Albania in 2017–2018 to assess the nutritional status and the nutrition-related KAP of Albanian school-aged children.The study consisted of a nationally representative sample of 7578 Albanian schoolchildren from all regions of the country. In addition, 6810 parent questionnaires were collected, along with interviews with the directors of all involved schools, 311 teachers and 53 key informants representing local authorities in all districts of Albania. Data collection consisted of anthropometric measurements of children and structured questionnaires administered to children, their parents, teachers, school directors, and key informants.The survey is unique in both the scope of the respondents involved, and in the breadth of content area covered, and as such, makes an important contribution not only to Albania, but also to the field of research in food, health and nutrition for school-age children.This paper presents the preliminary findings from the KAP survey that will help influence policies for actionable advancement on the commitments and priorities of Albania to improve food security and nutrition. In particular, the study findings will support the development of a national school food and nutrition programme in Albania embedded into the local food system and the design of food and nutrition educational materials and campaigns to promote healthy diets and practices among both school-age children and the Albanian population.     

The economics and nutritional impacts of food assistance policies and programs

Recent evidence on malnutrition and poverty raise important questions on the role of food assistance policies and programs. In this review article, we examine evidence on the economic and nutritional impacts of international food assistance programs (FAPs) and policies. The returns on investments in FAPs are, on average, high but depend considerably on the targeting and cost structures as well as on food quality and role of complementary activities. We disaggregate findings into four classes of recipients. Returns to FAPs are highest for children under two. But, FAPs oriented towards early childhood interventions are less well funded than are interventions aimed at school-age children or at the broader, largely adult population even though available evidence indicates that these latter classes of interventions offer considerably lower average returns in economic, health, and nutrition terms. Nonetheless, FAP effectiveness in achieving any of several objectives varies with a range of key factors, including targeting, additionality, seasonality, timeliness, incentive effects, social acceptability and political economy considerations.     

Towards a food and nutrition policy for Australia,an environmentalist view

The state government of Victoria, Australia, recently prepared a discussion paper towards a regional food and nutrition policy. This evaluation finds it deficient in various ways. The critique contains recommendations for the building of a national food policy. The commission report displays a lack of a systems view of the problem of nutrition, which would recognize a diversity of influences on eating (e.g. social frameworks and frameworks by which we think and know). Linear causality is not an adequate concept. Agribusiness impacts heavily on the environment. In the case of meat production, inputs to production far exceed food energy outputs. Disposal of the by-products of meat production is also more problematic. The way to impact on these wasteful and destructive industrial practices is to consume less meat. Additives in food are a serious problem not well enough addressed. This and other processing increase the cultural perception of foodstuffs as human artifacts. Awareness of the cultural role of foods would allow Australians to cope with industry campaigns promoting meat and processed foodstuffs. There should be more attention to mutual impacts of environment, consumptiuon, and additives and processing. Food from low in the food chain (cereals, seafood) should be promoted not as substitutes but as foods in their own right. Commission recommendations should deal with questions such as nutritional information labeling of foods, and especially an attempt to foster consciousness of the environmental impact of food consumption: Government policy should be mindful to the extent possible of the impact on poor areas of the world of wasteful food consumption in Australia. Proposals for action should benefit from the impact of several fields of expertise beyond health, agriculture, consumer affairs and others; for instance, anthropology or environmental science.     

Exploring dietary guidelines based on ecological and nutritional values: A comparison of six dietary patterns

The objective of this study was to explore the synergies between nutritionally healthy and ecologically sustainable diets. The aim was to explore the possibilities for future integrated dietary guidelines that support consumers to make informed dietary choices based on both ecological and nutritional values. We developed a score system for health and sustainability. Subsequently, we tested six different diets: current average Dutch, official ’recommended’ Dutch, semi-vegetarian, vegetarian, vegan and Mediterranean. For the sustainability rating, we used the Life Cycle Assessment, measuring the impacts on greenhouse gas emissions (GHG) and land use (LU). For the health rating, we used ten nutritional indicators. By comparing the overall scores we found that the consumption of meat, dairy products, extras, such as snacks, sweets, pastries, and beverages, in that order, are largely responsible for low sustainability scores. Simultaneously, these food groups contribute to low health scores. We developed a matrix that illustrates that the health and sustainability scores of all six diets go largely hand in hand. Fig. 1 provides a visualisation of the position of the six diets in the full health and sustainability spectrum. This matrix with scores can be considered a first step in the development of a tool to measure both sustainability and health issues of specific food patterns. In selecting the diets, we examined two directions: health focus diets and the animal protein reduction diets. The Mediterranean diet is generally the health focus option with a high sustainability score. We conclude that guidelines oriented in between the two directions (i.e., semi- and pesco-vegetarian) are the option with the optimal synergy between health and sustainability.     

Viewpoint: Future of food safety and nutrition - Seeking win-wins,coping with trade-offs

The possible implications of global trends such as climate change and resource scarcity on food security are high on the political agendas. While the food sufficiency aspect of food security takes centre-stage, the future of food safety and nutritional quality of diets often seems to be taken for granted. This paper builds on the results of a foresight study on EU food safety and nutrition towards 2050 to discuss potential future points of tension for food policy. Increasing food production while using fewer resources and reducing food waste while ensuring food safety are just two examples. Innovation at different levels in the food system will be needed to address future challenges. Fast technology uptake and the launch of new food-related products can put pressure on the ability to deliver timely risk assessments, the scope of which might also need to cover other legitimate factors. Future food policies need to be more sensitive to impacts on food safety and nutrition and health aspects. A holistic food systems approach must be taken to identify and discuss in advance possible tensions and trade-offs and to address them upfront in a systematic and transparent manner.     

What happens to diet and child health when migration splits households? Evidence from a migration lottery program

The impact of migration on food security and child health is likely to differ depending on whether children themselves migrate or whether they remain behind while other household members migrate. However, existing studies have not been able to examine how impacts differ in these two scenarios because parallel data are required for both the sending and receiving country. Moreover, self-selection into migration makes unbiased estimation of either impact difficult. We overcome these problems by using a unique survey of Tongan households that applied to migrate to New Zealand through a migrant quota which selects households through a random ballot. This survey covers both migrant children in New Zealand and non-migrant children in Tonga, with the migration policy rules providing a source of exogenous variation for identifying impacts. Our estimates of short-run impacts show that diets diverge upon migration: children who migrate experience improvements, while diets worsen for children who remain. There is also suggestive evidence of a divergence in health outcomes, with increases in weight-for-age and height-for-age found for migrant children, and decreases found for children who remain behind while other household members migrate.     

Integrating fisheries,food and nutrition – Insights from people and policies in Timor-Leste

The important role of fish in food and nutrition security is becoming more widely acknowledged by the fishery sector and within food policy. Integration of fish and food policy, at national, regional or global levels, is required to ensure the contribution of fisheries and aquaculture to human health is supported through governance arrangements. We explore this aspect of food policy integration in Timor-Leste, where malnutrition is a critical health problem. Consumption of fish is low by international standards and only a small proportion of the population engages in fishing. We used a mixed method approach involving desktop policy analysis, interviews and social network analysis to explore interactions among sectoral instruments and organisations. Our results show generally good integration of food security into fisheries policies, but a lack of integration of fish into food policies. Policy network analysis revealed evidence of collaboration and cooperation between sectors, however, consideration of fish and food concerns was not well embedded across all organisations. We discuss challenges and options for future integration of fisheries into sustainable food systems in Timor-Leste and more broadly, including the need for greater political will and resources, combined with clearer targets and actions within instruments.     

A ‘Common Food Policy’ for Europe: How governance reforms can spark a shift to healthy diets and sustainable food systems

More than half of adults in the European Union (EU) are now either overweight or obese (53%). Non-communicable diseases (NCDs), many of which are diet-related, account for 70% of mortality in Europe and a growing share of healthcare costs. While eating habits have an important role to play in NCD prevention, consumption patterns across the EU are diverging significantly from recommended diets. There is growing consensus on the solution: a series of coordinated and wide-ranging policy interventions to build healthy ‘food environments’.This article argues that EU governance structures remain ill-adapted to the systemic nature of this and other challenges in food systems (e.g. climate change, biodiversity loss, food poverty): conflicting objectives and missed synergies are identified between different policy areas (agriculture, trade, health, environment, etc.) and between different levels of governance (EU, national, local). An integrated food policy framework – a ‘Common Food Policy’ – is therefore required to meet the EU’s public health and sustainability objectives. It identifies four distinct aspects of the governance shift required to promote healthy diets and build sustainable food systems in Europe: (i) coherence across policy areas; (ii) coherence across governance levels; (iii) governance for transition; and (iv) food democracy. Blueprints for a Common Food Policy are already emerging, and are ripe for consideration, development, and implementation by the European institutions.     

Issues and strategies in ex-post evaluation of intervention against animal disease outbreaks and spread

Animal disease outbreaks pose a significant threat in terms of potential economic losses, reduced productivity, and negative impacts on public health, food security and nutrition. This paper considers four issues in ex-post evaluation of animal disease interventions: firstly, a counterfactual involves simulating disease trajectories without the intervention. But some diseases can become endemic or become dormant after an outbreak, making it a challenge to know the true trajectory without the intervention. Secondly, without adequate design of controls and treatments, how can the estimated impacts be attributed to a given intervention? Thirdly, how do we assess costs saved by the intervention? Fourthly, given data uncertainty, would a stochastic simulation give better estimates than a deterministic one in solving for key variables? This paper addresses these issues and proposes solutions that bridge the gap between household level analysis and macro-level simulations in modelling the impact of animal diseases outbreaks.     

A consumer segmentation of nutrition information use and its relation to food consumption behaviour

Consumers need information such as nutrition tables to assess the nutritional value of a food product. Although a broad range of studies has examined consumers’ attention, perception and use of nutrition tables, relatively little is known about what types of consumers use what kind of nutrition information. Therefore, using data from the Swiss Food Panel, we conducted a cluster analysis of nutrition information usage and health and nutrition interest to determine whether consumers could be segmented into specific groups. We identified four segments, which we labelled Official Information Users, Internet Users, Moderate Users and Uninterested. We then determined the segments’ demographics, food frequencies and perception of food. Based on our findings, we provide suggestions for targeted interventions that stimulate healthy food choices among these four segments. Our findings imply that nutrition education or the improvement of nutrition labels is unlikely tostimulate nutrition information usage among all consumer types; some consumers may rather benefit more from environmental cues that prime healthy food choices.     

How can policy processes remove barriers to sustainable food systems in Europe? Contributing to a policy framework for agri-food transitions

A new food policy coherent with the goal of achieving sustainable food systems implies changing visions and radically revising the understanding of the system on which agricultural and food-related policies act. This paper identifies and discusses policy processes that contribute to sustainable food systems in Europe. Based on a conceptual framework that links the policy cycle approach to transition theories, we (i) assess the evolution of policy cycles of the Common Agricultural Policy (CAP) to highlight how the food and nutrition concepts have evolved and been reframed throughout the five phases of the CAP, (ii) map and classify available policy instruments to assess potential synergies and gaps in view of their reorganization and (iii) indicate and discuss strategic tools for sustainable food policies. This contribution goes beyond the current literature highlighting the obstacles which hinder the transition to a policy regime that embodies the nexus among food and nutrition security, natural capital preservation and climatic and social justice, and proposing new avenues for food policy studies.     

Food distribution systems: Evolution in Latin America and the Middle East

The author describes the characteristics of food distribution systems and practices in developing countries, with particular reference to Latin America and the Middle East. He also examines the characteristics of the environmental factors which have an influence on food distribution, and explores the relationship between the environmental factors and the specific characteristics of food distribution systems of developing countries. The intention is to show how structural and operational changes can be induced in the distribution systems of developing countries.     

Food and health research in Europe: Structures,gaps and futures

BackgroundFood and health research is concerned with production, marketing, choice, regulation and policy for food as it affects health, and the mechanisms and control of diet-related diseases, nutrition and obesity. It covers positive and negative impacts of food on health, as well as issues related to under and over consumption of food. The European Union-funded study FAHRE (Food and Health Research in Europe) has described structures and identified gaps and needs for food and health research across Europe.MethodsFAHRE was conducted by a consortium of partners in 7 European countries, including private and public research organisations, university-based researchers and civil society organisations. National advisers in 32 European countries made reports on the structures of food and health research, and nine experts made reports on food and health research themes. At the end of this phase, a stakeholder conference was held to review and discuss the findings, and from this a Strategic Document was developed and distributed electronically for wider consultation at national level. This report presents the findings of the Strategic Document.ResultsFAHRE proposed that future research using public funding should address the global issue of unhealthy eating, including obesity, which causes preventable disability and disease, reduced working life and increased healthcare costs. FAHRE suggests a move of the focus of research from healthy food to healthy eating, and to overcome the existing separation between food research and health research through a shift of research towards food for health.EU member states have widely differing national systems for research management, and information is poorly standardised for comparisons. There are many research programmes in both food and health, usually managed by ministries of science, but rarely in collaboration with ministries of health. Industry mainly contributes ‘near product’ research: few industry small and medium enterprises are engaged with food and health research, nor are civil society organisations. EU food and health research has been focused within the agriculture research theme, and not sufficiently linked to health research.FAHRE recommends coordination of food and health research through an EU-level Coordinating Agency, with budget and representation from the three EU directorates Agriculture, Health and Research, the member states, and wider stakeholders including civil society and industry. There should be corresponding ‘food and health research agencies’ in the member states bringing together national policy-makers and stakeholders, and directing research funding. Food safety agencies may provide a model for this joint approach. Further proposals include strengthening social and policy research, accessing Structural Funds for research programmes, and more strategic approaches to determining research programmes and funding.ConclusionFood and health research in Europe should move from ‘healthy food’, which concentrates on food as a product, to research for ‘healthy eating’ which is concerned with appropriate intake and reducing disease. Coordination of research on this theme, at European level, and between member states, could deliver major economic and social returns.     

Food product composition,consumer health,and public policy: Introduction and overview of special section

As efforts to improve diets in high income countries intensify, attention has turned to how policies may influence diet composition. The case studies in this special issue contribute to our understanding of how two main types of policies have influenced food product composition and dietary outcomes: (1) policies affecting food manufacturers’ input costs and (2) information policy affecting competition. Research on the first type of policy is relatively new, but suggests that US commodity policies would not be good policy instruments to influence diets, except through the long run impacts of agricultural research. Research on the impacts of information policy continues to demonstrate that it can spur food industry competition to introduce healthier products, but may not result in healthier diets. International comparisons show where the US experience may have relevance for other high income countries.