What is needed for assessing the impact of food systems policies on nutrition: Outcomes and Processes for Accountability
UN Standing Committee on Nutrition, 2015
Drafted by Anna Herforth
ZERO DRAFT ClaudioSchuftan’s suggestions ()
[I am afraid the technocratic prevails over the participatory and the consultative in this zero draft. I fear its fate is guarded at best].
Contents
Introduction: The call for monitoring and policy impact assessment
What Outcomes?
Food Environment
Available Indicators
Research needed
Diet Quality
Available Indicators
Research needed
Environmental Sustainability
What Policies?
Agricultural Production
Market and Trade Systems
Food Transformation and Consumer Demand
Consumer Purchasing Power
What Process?
Two ways to assess potential nutrition impact of policies
Avoiding nutritional harm based on specific policies
Policy portfolio review
Stakeholders involved in implementing a Policy Impact Assessment
Conclusions
Annex 1: Glossary of key terms
Annex 2
Annex 3
Annex 4
Annex 5
References
Acknowledgements
Introduction: The call for monitoring and policy impact assessment
The Second International Conference on Nutrition (ICN2), jointly organized by The Food and Agriculture of the United Nations (FAO) and the World Health Organization (WHO), was convened at FAO Headquarters in Rome, from 19-21 November 2014, under the theme “Better Nutrition, Better Lives”. Member states endorsed the Rome Declaration on Nutrition and the Framework for Action. The Rome Declaration on Nutrition enshrines the right of everyone to have access to safe, sufficient and nutritious food, and commits governments to preventing malnutrition in all its forms, including hunger, micronutrient deficiencies and obesity. The Framework for Action recognizes that governments have the primary role and responsibility for addressing nutrition issues and challenges, in dialogue with a wide range of stakeholders.
ICN2 highlighted the role of food systems – the way food is produced, processed, distributed, marketed and prepared for human consumption – is crucial in the fight against malnutrition in all its forms including overweight and obesity. To this end, the ICN2 Rome Declaration of Nutritionincludes:
- Commitment 15c) Member States committed to enhance sustainable food systems by developing coherent public policies from production to consumption and across relevant sectors to provide year-round access to food that meets people’s nutrition needs and promote safe and diversified healthy diets.”
- Commitment 15d: “Member States committed to raise the profile of nutrition within relevant national strategies, policies, actions plans and programmes, and align national resources accordingly”.
The ICN2 Framework for Action includes an adopted set of recommendations on actions toward food systems that promote diverse and healthy diets. Among those is:
- Recommendation 8: “encourages countries to review national policies and investments and integrate nutrition objectives into food and agriculture policy, programme design and implementation, to enhance nutrition sensitive agriculture, ensure food security and enable healthy diets”.
The Sustainable Development Goals (SDGs) also highlight commitments toward sustainable food systems that support good nutrition, congruent with those enumerated in the ICN2 outcome documents.SDG2:End hunger and ensuring access by all people, in particular the poor and people in vulnerable situations, including infants, to safe, nutritious, and sufficient food all year round by the year 2030.
The UN Zero Hunger Challenge includes an aspiration to achieve “100% access to adequate food.”
The CAADP Nutrition Capacity Development Initiative has recommended that National Food Security Investment Plans include the objective to “increase availability, affordability and consumption of fresh, healthy and nutritious food.” (see Dufour et al. 2013, p65)
These commitments harken?? back to 20 years ago, where at the 1996 World Food Summit, UN member nations pledged to ensure that“All people at all times have access to sufficient, safe, nutritious food to meet dietary needs and food preferences for a healthy and active life.”
In recognition of its importance to nutrition, more funds have been committed to nutrition-sensitive agriculture than any other single area of nutrition. For example, $19.2 billion were committed by many donors and governments in 2013 at the G8 meetings (Government of UK 2013) (Nutrition for Growth Summit). [1]already allocated? Just promises?
Despite high-level goals and financial commitments to nutrition-sensitive agriculture, targets and benchmarks in the agriculture sector for improved nutrition are largely absent. Effects of these investments need to be monitored on food—the agriculture and food sector’s main, unique ultimate contribution to nutrition. Decision makers need the tools to consider how the nutrition sensitivity of national policies might be improved addressing the multiple burdens of malnutrition including overweight and obesity.A way of tracking what is being done, and estimating what kind of impact it may have on nutrition, is needed.Nutrition-sensitive is a neologism to avoid talking about the social determinants of agriculture/food security/nutrition.
Measurement is important for accountability to the goals and ideals laid out in international and national declarations. It is also important to track progress on nutrition-sensitive agriculture. Are we doing what we say? Are we doing the right things? Monitoring processes leading to appropriate outcomes strategically can help identify good practices to improve policies for positive impact on nutrition. Information shapes and drives policy; as the saying goes, “What gets measured gets managed.” …provided the info is used… a big if..Rhetoric is less likely to be translated into action if there are no indicators or systems to measure progressin processes leading toward stated goals.
The purpose of this paper is to lay the groundwork for a process by which food systems policies could be assessed for their impact on diets and food environmentswhat exactly are these?.Jargon These would be analogous to processes for social, environmental, and health impact assessments of policies that inform debate around a new policy.[2]Three ingredients would need to be defined at the outset of such a system: (1) a set of food security and nutrition processes and outcomes that could be monitored; (2) priorities for which food systems policies should be assessed; and (3) a process by which the potential nutrition impact of such policies could be deliberateddelivered?.This paper discusses each of these three areas, with the goal of clarifying what needs to be in place to be able to analyze if policies have an influence on nutrition. It is not a monitoring & evaluation (M&E) tool that can attribute changes in nutritional status to a particular policy. Rather, the purpose is to expose the gaps in each of these areas (outcomes, policies, processreverse the order), and what is needed to close the gaps, with the intent of informing future monitoring and impact assessment of food systems policies on diets and food environments.
Fig 1.
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What Outcomes?
The purpose of this section is to identify processes leading to outcomes that are relevant to monitor in relation to the ICN2 and SDG commitments, including data needs and data sources (at national and local levels). For assessments of the existing food environment? as well as tracking how it changes in the presence of new food systems policies and investments, we need a suite of indicators that reflect a healthy and sustainable food system.
The Millennium Development Goals have shown the importance of well-chosen indicators. “The MDGs have had enormous communicative power. Once the goals were defined and the targets set, they began to shape the way that development was understood” (Fukuda-Parr et al. 2013, p. 19). The only food-related indicator in the MDGs was FAO’s “undernourishment” indicator (proportion of the population with access to adequate calories). This focus on calories to alleviate hunger has not been significantly updated since the 1960s-70s, when the focus of agriculture was to combat hunger and famine via increased staple crop production in the Green Revolution (World Bank 2014).In terms of food availability, the commodities tracked for food security purposes are typically only the major staple crops (maize, wheat, and rice, and sometimes oilseeds). This focus on statistics on calories, and staple production and prices, leads to policies that prioritize staple food production.
In the post-2015 development agenda, the global community now has an opportunity to align indicators better with ideals for nutritious food access—especially since it is increasingly clear that poor diets are a major cause of all forms of malnutrition, and food access is a major contributor to poor diets. Now, with the persistence of undernutrition and micronutrient malnutrition, and rapidly increasing incidence of obesity and diet-related non-communicable diseases, it has become clear that goals and metrics of caloric supply and staple grains are insufficient. New metrics are needed that point attention to the quality of diets that are available and affordable, and consumed. See new Brazilian Guidelines
A consensus view is that:
- “Food and agriculture policies can have a better impact on nutrition if they monitor [dietary consumption and] access to safe, diverse, and nutritious foods.” This principle was developed through a consultative process involving dozens of development partners, and appears in the FAO Key Recommendations for Improving Nutrition through Agriculture and Food Systems (FAO 2015, Herforth and Dufour 2013). The same principle appears in The Framework for Joint Action on Agriculture and Nutrition, presented at the ICN2 by the EC, FAO, World Bank Group, and Technical Centre for Agricultural and Rural Cooperation (2014).
- The nutrition community has advocated that the indicators to track SDG2 include a measure of nutritional quality of food (SCN 2015, 1000 Days et al. 2015, BMGF 2014).Currently the only such indicator available is at individual diet level, but there is a need monitoring toward the goal to “Increase year-round household access to adequate, affordable micro-nutrient-rich food groups such as legumes, fruits and vegetables, and animal-source foods” (BMGF 2014).
- The Global Panel on Agriculture and Food Systems for Nutrition calls for improved metrics and data, specifically of food environments and diet quality, for effective food system policies in the post-2015 era (Global Panel 2015).
Overall, if used, indicators on access to adequate nutritious food and dietary quality would enable better informed policy options to improve food security and nutrition. If collected over timeand used, these indicators would also allow for an improved evidence base of how agriculture and food policies can affect nutrition. Monitoring data do not guarantee policy solutions; the data could lead to a variety of responses in various sectors, and may not necessarily lead to immediate action. In the absence of such indicators and data, however, it will be difficult to deliberate policy options, and to capture how “nutrition-sensitive” investments are contributing to improved nutrition.A good start would be disparity reduction measures to curb the scandalous inequalities.
Looking forward, if governments and other actors in the international community are to be able to assess gaps and improvements in food systems for nutrition, two key are areas at a minimum need to be tracked: the food environment still undefined here, and diet quality. Furthermore, these measures need to account for gender and socialequality. And, the ICN2 and SDG goals regarding food systems rest on sustainable production, so indicators of environmental sustainability are also needed.
Food Environment
One of the primary ways agriculture and food systems can affect nutrition is through improving the food environment: including increasing year-round availability and affordability of diverse, nutritious foods and diets. Is this a definition? The food environment constrains and signals consumers what to purchase; it can be defined aha…as the availability, affordability, convenience, and desirability of various foods (Herforth and Ahmed 2015). The food environment strongly affects diets. This is recognized in social ecological and political frameworks for nutrition and physical activity, which place individual factors determining food and beverage intake in the midst of environmental settings, influenced by sectors including agriculture, aggressive marketing, and industry (USDA Dietary Guidelines for Americans 2010).
A challenge is that available indicators reflect only small parts of the food environment, or are proxies for what truly needs to be measured. Meaningful information on food availability and affordability has not been tracked, either through national/global monitoring systems or as indicators of desired impacts from nutrition-sensitive agricultural interventions and investments. However, there is an emerging area of research on improving methods and metrics.More research…?
Available Indicators
Below is a compilation of indicators that are available given existing data and that have been tracked. Sourcesthat have included them as monitoring indicators are listed. The newest of these indicators to be compiled across countries is the % of calorie supply from non-staples, and fruit and vegetable availability (both included in the 2015 Global Nutrition Report).
Available indicator / What it measures / Data source / SourceAvailability(all nutrient based!)
% Undernourishment / Proportion of the population unable to access adequate calories / FAO / FAO
Dietary Energy Supply (kilocalories/ capita/day) / Availability of calories / FAO / FAO
% calorie supply from non-staples[3] / Proxy for diversity/micronutrient density of food supply / FAO food balance sheets / FAO 2013, GNR 2015
% of protein supply derived from animal origin (grams/capita/day)[4] / Unclear implication; related to diversity of food available / FAO food balance sheets / FAO 2013, GNR 2015
Fruit and vegetable availability (grams/ capita/day)[5]this one food based / Fruit and vegetable availability / FAO food balance sheets / GNR 2015
AffordabilityTo me, much more important
Consumer Price Index for food / Affordability of food (typically-consumed basket) / National data
Domestic food price volatility index / Overall stability of affordability of food / FAO / GNR 2015, FAO
Prices of staple grains / Affordability of basic staples / FAO, WFP VAM and other national-level sources
Otherpossible indicators, which are not currently collected and/or compiled across countries, include those in the following table.
Novel indicator / What it would measure / Potential data source / SourceAvailability
Sugar availability (grams/ capita/day)[6] / Proxy for excess added sugars in the food environment / FAO food balance sheets / Herforth 2015
Availability of legumes/nuts/seeds (grams/capita/day) / Proxy for access to lowest-cost protein source, relevant for access to diets associated with lower NCDs / FAO food balance sheets
Packaged food retail (volume per capita) / Availability of packaged food in markets / Euromonitor 2014 / GNR 2015
Fresh food retail volume (kilograms per capita) / Availability of fresh food in markets / Euromonitor 2014 / GNR 2015,
IOM and NRC 2015,
FAO 2013
Availability of healthy and unhealthy foods and beverages how defined? in communities and retail outlets / Availability of diverse components of healthy diets / Lee et al. 2013 (INFORMAS)
Functional diversity of production at community level / In some locales, a proxy for access to diverse food / Remans et al. 2011
Affordability
Minimum cost of a nutritious diet based on local markets compared to the income range of low-income communities / Healthy food items available and accessible at all markets / None yet available at national scale; Can be determined at local level using Save the Children CoD tool / SCN 2014, Herforth 2015
Relative prices of different food groups / Affordability of diverse components of healthy diets / Herforth 2015, Lee et al. 2013
% share of food budget spent on fruits and vegetables / Proxy for affordability of fruits and vegetables (but also reflects consumption behavior) / Euromonitor 2014 / GNR 2015
% share of food budget spent on fruits and vegetables per 100g consumed / Affordability of fruits and vegetables / Combine Euromonitor or HCES and dietary intake data / Author
Convenience
Distance to market / Proxy for convenience of access to diverse foods / Author
Desirability
Measures of children's exposure to food promotions on all major media / Food marketing / Swinburn et al. 2013, Kelly et al. 2013 (INFORMAS)
Safety of food supply
Extent of biological and chemical contaminants in food e.g. salmonella, heavy metals, pesticides / Food safety / SCN 2014
% population with access to improved water / Food (water) safety / FAO / GNR 2015
Research needed
In the absence of well-developed and valid indicators to measure key pieces of the food environment, there is not a clear consensus or way forward for monitoring healthy food systems, or evaluating the impact of food system policies. While proposing several existing and novel indicators for a dashboard of food system outcomes, the Global Nutrition Report acknowledges, “Even though we selected the dashboard indicators (Table 7.3) based in part on the availability of internationally comparable data, there are many data gaps.”
There are major data gaps in the area of understanding national and local food environments. Existing data capture only availability and prices of calories, staple foods, and overall food baskets (composed of commonly consumed items sometimes without specific attention to how well these food baskets would meet dietary needs). Research gaps include those highlighted in the New York Academy of Sciences “Global Research Agenda for Nutrition Science” (2014):
- What indicators can capture adequacy of food access, including not only adequate dietary energy, butalso affordability and convenience of healthy food (i.e., food environments)?
- What is needed to enable data collection of better food indicators (such as capacity developmentof national bureaus of statistics or ministries of agriculture, international alignment on indicators to be collected, and open data)?
Key research and data needs include:
- There is a need to develop indicators of availability andaffordability of diverse nutritious foods.
- Current data may be adequate for national availability, but not local availability. As suggested in the novel indicator table above, FAO food balance sheets could be used to estimate per capita supply and estimated prevalence of inadequate consumption of diverse food groups (Herforth 2015).Can we not forget food groups? They have haunted us for decades…
- Current reported data are inadequate for prices of diverse foods, but data collection systems may be adequate. The techniques used to regularly compile and report local level market price data for staple grains (such as through WFP VAM) could be expanded to more diverse foods (Herforth 2015).
- The Consumer Price Index for food is a useful measure of food affordability in countries, but is not based on a nutritious diet. A CPI for Nutritious food could be created. However, in order to know which foods are out of reach, data on the cost of a nutritious food basket should be able to be as they sometimes are disaggregated into different food groups of public health significance (e.g., grains and tubers, fruits and vegetables, legumes and nuts, milk, other animal-source foods, and ultra-processed foods).
- There is also a need to develop indicators of convenience of procurement and preparation of diverse foods, as well as measures of their promotion and marketing.
- There is a need to develop systems that can measure these indicators at local levels, which is the most important geographic level for influencing diets, because it is where prices, convenience, and marketing have the most influence on diets.
Diet Quality
Diet quality is also critical to measure, to understand what dietary gaps exist, in what geographies and seasons, and in what populations. Data on actual dietary consumption reveals dietary trends over time, as well as opportunities for improvement through the food environment, consumer knowledge, and social protection (among other tools).