Reshaping dysfunctional food systems

A new report by the UN Special Rapporteur on the Right to Food has drawn attention to the need to reshape the current food systems to meet the twin challenges of global hunger and malnutrition. Kanaga Raja summarises its findings and recommendations.

THE current food systems are deeply dysfunctional, with the world paying an exorbitant price for the failure to consider the health impacts in designing food systems, and a change of course is needed as a matter of urgency, a United Nations Special Rapporteur has recommended.

This is the main conclusion of the UN Special Rapporteur on the Right to Food in his report to the 19th regular session of the UN Human Rights Council, due to take place on 27 February-23 March.

In his report, Olivier De Schutter noted that in OECD countries (rich member states of the Organisation for Economic Cooperation and Development) in particular, where farm subsidies remain at high levels, the current system is one in which taxpayers pay three times for a system that is a recipe for unhealthy lives.

'Taxpayers pay for misguided subsidies that encourage the agrifood industry to sell heavily processed foods at the expense of making fruits and vegetables available at lower prices; they pay for the marketing efforts of the same industry to sell unhealthy foods, which are deducted from taxable profits; and they pay for health-care systems for which non-communicable diseases today represent an unsustainable burden,' he said.

In developing countries, he added, the main burdens remain under-nutrition and micro-nutrient deficiency, but these countries, too, are victims of these failed policies. They are witnessing a rapid shift to processed foods, which are often imported, and the abandonment by the local population of traditional diets. This shift has reduced the opportunities for local farmers to live decently from farming.

'Combating the different faces of malnutrition requires adopting a life-course approach guaranteeing the right to adequate diets for all, and reforming agricultural and food policies, including taxation, in order to reshape food systems for the promotion of sustainable diets. Strong political will, a sustained effort across a number of years, and collaboration across different sectors, including agriculture, finance, health, education and trade, are necessary for such a transition.'

According to the Special Rapporteur's report, 'The right to food cannot be reduced to a right not to starve. It is an inclusive right to an adequate diet providing all the nutritional elements an individual requires to live a healthy and active life, and the means to access them. States have a duty to protect the right to an adequate diet, in particular by regulating the food system, and to fulfil the right to adequate food by proactively strengthening people's access to resources, allowing them to have adequate diets.'

Agrifood companies also have a responsibility to respect the right to adequate food. They must avoid infringing upon this right, and seek to prevent any adverse impact their activities might have on the enjoyment of this right. And the United Nations system itself must ensure that nutrition is taken into account in all relevant policy areas, the report adds.

The report, prepared through a range of expert meetings and consultations, says that since the 1960s, food security has been linked largely to production, while the links to nutrition were often neglected. Hunger and malnutrition were equated with a lack of calorie intake.

In the face of widespread global hunger, this focus was perhaps understandable, says the Special Rapporteur. But this prompted an overemphasis on increasing agricultural outputs and lowering food prices, while scant attention was paid to ensuring the availability of and accessibility to a wide range of diverse foods containing the micro-nutrients necessary for the full physical and mental development of children, and for adults to lead healthy and productive lives.

'In other words, because addressing protein-calorie malnutrition was seen as the major challenge, the requirement of dietary adequacy was neglected. In addition, beyond making foodstuffs available at low prices, the other functions of agriculture - to ensure decent incomes to food producers and to maintain the ecosystems - were not considered.'

This is changing, the report notes, pointing out that experts now agree that food systems must ensure the access of all to 'sustainable diets', defined as 'diets with low environmental impacts which contribute to food and nutrition security and to healthy life for present and future generations. Sustainable diets are protective and respectful of biodiversity and ecosystems, culturally acceptable, accessible, economically fair and affordable; nutritionally adequate, safe and healthy; while optimising natural and human resources.'

This definition recognises the need to gear agrifood systems away from an exclusive focus on boosting production and towards integrating the requirements of the adequacy of diets, social equity and environmental sustainability. All these components are essential to achieving durable success in combating hunger and malnutrition, as emphasised by the Special Rapporteur in past reports.

Challenges of malnutrition

According to the report, the world is now paying a high price for having focused almost exclusively on increasing production over the past half-century. Under-nutrition remains considerable, largely because agrifood systems have not contributed to the alleviation of rural poverty. One in seven people on a global level are still hungry. About 34% of children in developing countries, 186 million children in total, have a low height for age, the most common symptom of chronic under-nutrition.

Additionally, a large number of people (with children and women being affected disproportionately) suffer from micro-nutrient deficiencies. Vitamin A deficiency affects at least 100 million children, limiting their growth, weakening their immunity and, in cases of acute deficiency, leading to blindness and to increased mortality. Between four billion and five billion people suffer from iron deficiency, including half of the pregnant women and children under 5 in developing countries, and an estimated two billion are anaemic.

Like under-nutrition, the Special Rapporteur stresses, micro-nutrient deficiency or 'hidden hunger' is a violation of a child's right to a standard of living adequate for the child's physical and mental development, and to the enjoyment of the highest attainable standard of health, recognised under Article 6, paragraph 2, and Article 24, paragraph 2 (c), of the Convention on the Rights of the Child.

The report highlights that an additional nutritional challenge concerns people whose caloric intakes exceed their needs. Today, more than one billion people worldwide are overweight (with a bodily mass index - BMI >25) and at least 300 million are obese (BMI >30).

Overweight and obesity cause, worldwide, 2.8 million deaths, so that today 65% of the world's population live in a country (all high-income countries and most middle-income countries) where overweight and obesity kills more people than underweight. In a country such as the United States of America, this means that today's children could have shorter life expectancies than their parents.

But obesity and non-communicable diseases (NCDs) linked, in particular, to unhealthy diets are no longer limited to rich countries. It is estimated that by 2030, 5.1 million people will die annually before the age of 60 from such diseases in poor countries, up from 3.8 million today.

Obesity and overweight affect 50% or more of the population in 19 of the 34 OECD countries, but they have become public health challenges in all regions. Death and disease from NCDs now outstrip communicable diseases in every region except Africa, and it is expected that NCD deaths will increase globally by 15% between 2010 and 2020 - and by over 20% in Africa, South-East Asia and the Eastern Mediterranean.

Moreover, NCDs are more rapidly fatal in poorer countries. In both South-East Asia and Africa, 41% of deaths caused by high BMI occur under age 60, compared with 18% in high-income countries.

An important time lag exists between the onset of obesity and the increase in health-care costs, but it has been estimated for instance that the costs linked to overweight and obesity in the United Kingdom of Great Britain and Northern Ireland in 2015 could increase by as much as 70% relative to 2007 and could be 2.4 times higher in 2025. In countries such as India or China, the impact of obesity and diabetes is predicted to surge in the next few years. On average, a 10% increase in NCDs results in a loss of 0.5% of gross domestic product (GDP).

The Special Rapporteur finds that the fight against NCDs is underfunded, in part, because it was not included in the Millennium Development Goals adopted in 2000. Less than 3% of development assistance for health goes to combating NCDs, even though they cause more than one-third of all premature deaths. The poorest segments of the population are affected disproportionately. Annually, 100 million people are pushed into poverty because they cannot afford the necessary health services. In India, for example, treatment for diabetes costs an affected person on average 15-25% of household earnings, and cardiovascular disease leads to catastrophic expenditure for 25% of Indian families and drives 10% of families into poverty.

'The agrifood systems must be reshaped to address these challenges of malnutrition - under-nutrition, micro-nutrient deficiency, and over-nutrition - not in isolation, but concurrently,' the report recommends.

'Ensuring adequate availability of and accessibility to fruits and vegetables and diets that are sufficiently diverse and balanced across food groups requires the rebuilding of agrifood systems. This means prioritising access to adequate diets that are socially and environmentally sustainable over the mere provision of cheap calories. Any intervention seeking to address the diverse forms of malnutrition described above should be assessed against the requirement that it favour, and does not create obstacles to, such a re-prioritisation.'

On a positive note, the report notes that a number of recent efforts have sought to address micro-nutrient deficiency, moving beyond the classic focus on low calorie intake.

For instance, the World Food Programme and the United Nations Children's Fund (UNICEF) launched in 2006 the Ending Child Hunger and Under-nutrition Initiative. In 2008, the UN Food and Agriculture Organisation (FAO), World Health Organisation (WHO) and UNICEF launched the Renewed Efforts against Child Hunger and Under-nutrition (REACH) initiative, which aims to scale up interventions addressing child under-nutrition through the coordinated action of UN agencies, civil society, donors and the private sector, under country-led plans.

The Scaling Up Nutrition (SUN) multi-stakeholder initiative, which was launched in 2009 and has gained momentum since the presentation of the SUN Framework in April 2010, seeks to promote targeted action and investment to improve nutrition for mothers and children in the 1,000-day period from pregnancy to age 2, when better nutrition can have a life-changing impact on a child's future.

The Special Rapporteur said that it is troubling that the 1981 International Code of Marketing of Breast-milk Substitutes and subsequent World Health Assembly (WHA) resolutions remain under-enforced, despite the wide recognition that exclusive breastfeeding for the first six months and continued breastfeeding, combined with safe and adequate complementary foods, up to 2 years old or beyond is the optimal way of feeding infants, and reduces the risk of obesity and NCDs later in life.

'Countries committed to scaling up nutrition should begin by regulating the marketing of commercial infant formula and other breast-milk substitutes, in accordance with WHA resolution 63.23, and by implementing the full set of WHO recommendations on the marketing of breast-milk substitutes and of foods and non-alcoholic beverages to children, in accordance with WHA resolution 63.14.'

The Special Rapporteur stresses that nutrition initiatives can be strengthened by adopting a human-rights-based approach (accountability, participation and non-discrimination) and by being integrated into broader national strategies for the realisation of the right to food. Such an approach will increase effectiveness and the ability to contribute to sustainable, long-term solutions.

Agricultural imbalance

The report also draws attention to the fact that agricultural production has risen dramatically over the past 40 years, the combined result of crop breeding, intensive fertiliser use, the mechanisation of production on large plantations in new cultivated areas and, in countries that could afford it, subsidies supporting farmers and intense research and development efforts.

'But there was an imbalance in this development. Some basic cereals and soybean were promoted, and the subsidies they benefited from were partly responsible for overproduction and over-consumption. In comparison, too little was done to improve the availability and affordability of pulses such as lentils or pigeon peas, or of fruits and vegetables, for instance by reducing post-harvest losses and improving marketing through better transport infrastructure connecting farmers to consumers.'

Between 1961 and 2009, while fruit and vegetable production increased 332%, world oilseed production increased by 610% and meat production increased 372%. This was associated with shifting diets.

Over roughly the same period (1963-2003), developing countries increased the amount of calories they consumed from meat (119%), sugar (127%) and vegetable oils (199%), and industrialised countries also increased vegetable oil consumption (105%). Globally, diets became increasingly energy-dense and rich in sugar, salt and saturated fats, as many higher-fibre foods were replaced by heavily processed foods.

According to the report, agricultural policies led to these shifts in diets through two channels. First, maize and soybean have become a conveniently cheap input for the food-processing and livestock industries. Most of the world's soybean is processed into meal to feed animals and into vegetable oil. Increasingly larger quantities of cereals (primarily maize) are used to produce sweeteners derived from starch (high-fructose corn syrup), largely explaining the global increase in caloric sweetener consumed. In 2000, says the report, 306 kcal were consumed per person per day, about a third more than in 1962, and caloric sweeteners by then also accounted for a larger share of both total energy and total carbohydrates consumed.

'Because the prices of basic crops went through such a significant decline, the agrifood industry responded by "adding value" by heavily processing foods, leading to diets richer in saturated and trans-fatty acids, salt and sugars. This, combined with urbanisation and higher employment rates for women, precipitated the rapid expansion for processed foods, both domestically and through exports dumped on foreign markets.'

Another impact on diets was through the price channel, by changing the relative prices of foods in the consumer's basket. In high-income countries, healthy diets including a wide range of fruits and vegetables are more expensive than diets rich in oils, sugars and fats. While this may not be the reason why overweight and obesity have been increasing over the years, it is certainly one factor among others responsible for this situation, the report underlines.

The report finds that the globalisation of food supply chains affects nutrition in two ways. First, the general pattern has been for developing countries to export high-quality foods, tropical fruits and vegetables in particular, to rich countries, while importing refined grains.

This means that while increased trade may have lowered the price of macro-nutrients in low-income countries (although with a greater vulnerability to price shocks), the reverse has been true for micro-nutrient-rich products, leading poor families in developing countries to shift to monotonous, micro-nutrient-poor diets, relying mainly on starchy staples, as more diverse diets may become unaffordable or less affordable than diets comprised of staples.

Second, the globalisation of food chains leads to a shift from diets high in complex carbohydrates and fibre to diets with a higher proportion of fats and sugars. As a result of this 'nutrition transition', disease patterns shift away from infectious and nutrient-deficiency diseases toward higher rates of coronary heart disease, non-insulin-dependent diabetes, some types of cancer and obesity. This trend is particularly noticeable in emerging economies.

While the globalisation of food chains has meant that a diversity of foods are available year-round to certain consumers, it has had negative impacts on local food systems and increased the ecological footprint of food systems. It has also led many consumers to shift towards an increased consumption of staple grains, meat and dairy products, vegetable oil, salt and sugar, and a lower intake of dietary fibre.

'Increased foreign direct investment in the processing industry and supermarket expansions have made processed foods, including in particular soft drinks, accessible to a larger range of consumers (albeit not to the poorest among them).'

The report notes for instance that following the entry into force of the North American Free Trade Agreement, US companies massively increased investments in the Mexican food-processing industry (from $210 million in 1987 to $5.3 billion in 1999) and sales of processed foods in Mexico soared at an annual rate of 5 to 10% in the period from 1995 to 2003. The resulting rise in soft drink and snack consumption by Mexican children is at the source of the very high rates of child obesity in the country.

'Significant concerns are expressed today about the marketing practices of the agrifood industry, particularly as regards marketing to children. The range of practices is wide: they include television advertising, product placement, promotional partnerships, sales promotions, and direct marketing in schools, among others. Most advertisements promote unhealthy foods, high in total energy, sugars and fats, and low in nutrients.'

According to the report, a recent study covering television advertising in Australia, Asia, Western Europe, and North and South America, found that in all sampled countries, children were exposed to high volumes of television advertising for unhealthy foods, featuring child-oriented persuasive techniques, leading the authors to call for regulation of food advertising during children's peak viewing times.

Recommendations

The report goes on to make several suggestions with respect to protecting and promoting adequate diets. For instance, it recommends using taxation to encourage healthy diets, saying that the introduction of food taxes and subsidies to promote a healthy diet constitutes a cost-effective and low-cost population-wide intervention that can have a significant impact. Research shows that a 10% tax on soft drinks, which have considerable negative health impacts, could lead to an 8 to 10% reduction in purchases of these beverages.

'The standard concern raised when such taxes are discussed is that they could penalise the poorest segment of the population, who spend proportionally more of their incomes on food and often are pushed into adopting unhealthy diets. But that concern can be met by using the public revenue from the tax to make healthy foods more affordable, for it is relative prices that must change.'

The report also calls for the revision of the existing system of subsidies, saying that where subsidies are an agricultural policy instrument, they are often biased in favour of large grain and soybean producers, or of the livestock industry. The potential negative externalities on public health and the environment were never considered in shaping those subsidies. The existing subsidies must now be re-examined in order to align agricultural policies with the requirement of adequate diets.

Furthermore, the report advocates the regulation of marketing practices. States should implement fully in legislation the International Code of Marketing of Breast-milk Substitutes and subsequent WHA resolutions.

But the marketing practices of the food industry have impacts such that bolder action is required. Self-regulation by the agrifood industry has proven ineffective, the Special Rapporteur notes, adding that he sees no reason why the promotion of foods that are known to have detrimental health impacts should be allowed to continue unimpeded.

'Premature deaths resulting from non-communicable diseases linked to bad diets are deaths that can be avoided, and States have a duty to protect in this regard. By implementing the Global Strategy for Infant and Young Child Feeding and the Global Strategy on Diet, Physical Activity and Health, as well as the Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases, States are not only making political commitments but also discharging their duty under international human rights law to guarantee the right to adequate food.'

As such, the report underscores, States should set binding targets in pursuing a double-track approach: (a) protecting the right to adequate diets; and (b) ensuring a transition towards more sustainable diets.               

Kanaga Raja is Editor of the South-North Development Monitor (SUNS), which is published by the Third World Network. This article is reproduced from SUNS (No. 7308, 14 February 2012).

*Third World Resurgence No. 257/258, January/February 2012, pp 5-8