Opinion: Key policy levers for healthy and sustainable diets: revisiting agricultural and health economic signals, September

Robyn Alders, AO
Senior Scientific Advisor for the global livestock and aquaculture policy project of the Centre for Global Health Security, Chatham House; Member of the Crawford Fund’s NSW Committee and the recipient of a Crawford Fund Medal for her contribution to the world’s food security and to childhood nutrition.

Humanity is at a crossroads as we seek to deliver optimal and sustainable diets for the 9 billion people and over 27 billion dependent companion and food animals predicted by 2050. The Sustainable Development Goals (SDGs), launched in 2015, encourage us to rethink the linkages between health, nutrition security and sustainable agriculture and to review associated policy frameworks. Nevertheless, to thoroughly rethink our current food and nutrition challenges, revisiting the historical and policy drivers that contributed to our current circumstances assists with identifying feasible and efficient options required to deliver healthy and sustainable human diets.

From early history, wildlife played a critical role in the emergence of earth’s most successful mammalian species: Homo sapiens. Utilisation of wild animal-source foods through hunting and gathering was the main evolutionary driver of an upright posture and gait and was critical to nutritional health, development and early expansion of our species. Archaeological finds place the beginning of agriculture before 7000 B.C. and animal domestication (mostly dogs used as hunting aids) thousands of years prior to that time. Since the introduction of sedentary agriculture, a growing human population has been sustained through the domestication of plant and animal species for food and industrialisation of agricultural systems without fully taking human nutritional requirements and natural capital into account. Food underpins population growth, and, therefore, the sustainability of the world’s food systems is also dependent on a slowing of the global growth rate of both people and their domesticated animals.

At the end of the 2nd World War, the Food and Agriculture Organization of the United Nations was formed with a mandate to achieve global freedom from hunger. During the ensuing period we have witnessed an incredible increase in the production of food. The decision was made to focus initially on increasing the production of staple foods, maize (Zea mays L.), rice (Oryza sativa L.) and wheat (Triticum aestivum L.). Plant breeders and farmers responded with the Green Revolution leading to a huge increase in yields. In most cases, agricultural yields have focused on weight or volume of an agricultural product. Consequently, an emphasis was placed on increasing the size of cereal grains and vegetables, initially without recognising that this was accompanied by increased energy content and a dilution of micronutrient density. In parallel, intensification of livestock production systems steadily increased since the mid-1880s and now dominates our global livestock food systems. As with intensification of crop production, intensively raised livestock and aquaculture systems has been accompanied by declining nutritional quality of the end product. Intensification has led to increased food production but it has also contributed to the emergence, spread and maintenance of new disease agents, antimicrobial and pesticide resistance, changing nutritional profiles of food and increased interaction and movement of people, plants, animals and microbes. Intensification has been accompanied by increasing globalisation of the food system, longer value chains and decreased farmer and producer negotiating power. Increasing yields, i.e. quantity of food, has been essential to support financial security for farmers who sell into value chains where economic value continues to be assigned based on weight or volume rather than a natural nutrient density score.

The intensification of agricultural production, globalisation of food value chains, increase in energy-dense food and dilution of micronutrient content has occurred simultaneously with increasing urbanisation, increasingly sedentary work places and increasing production and consumption of ultra-processed food. This convergence of events has resulted in growing problems with non-communicable diseases such as obesity, cardiovascular disease and diabetes across all countries over the past 50 years, sometimes coexisting with undernutrition in low- and middle-income countries. Additional consequences of the emergence of sedentary agriculture thousands of years ago that have received less attention include: (i) the emergence of gender-based division of labour¹; (ii) declining power of women; (iii) decreased height of women relative to men (i.e. enhanced sexual dimorphism)²³; and (iv) increasing prevalence of anaemia in women⁴. In addition to tackling stunting in undernourished children, should a greater focus also be placed on stunting and anaemia in women?

The agricultural sector is not alone in paying inadequate attention to human nutrition. In terms of human health systems, medical doctors receive relatively little training in nutrition as this is covered by the separate professions of dietetics and public health nutritionists. In many cases, dietetics received significant inputs from animal nutritionists the early days of the profession. As no female of our domesticated animals, including those used in biomedical research, menstruate, is this part of the reason why special attention is not given to woman’s nutritional requirements? In terms of economic signals, medical research and development funding is heavily weighted towards palliative care with public health and dietetics receiving significantly less support. Numerous studies have indicated the physical and mental health benefits of eating healthy, nutritious food. Should farmers and producers of healthy, nutritious food be seen as key components of public health nutrition? Ensuring equity of access to health care is also vital to reducing the prevalence of ‘eating down’ where pregnant women are reluctant to consume nutritious food due to a fear of obstructive labour caused by a large birthweight child. Clearly, agricultural and medical professionals must work together seamlessly to achieve optimal health outcomes. We must also work with, amongst others, engineers and food scientists to achieve nutrient recycling and innovative processing of food with healthy nutritional profiles to ensure stable supply across the seasons and years.

The challenge of achieving nutrition-sensitive agriculture and value chains in the face of climate change, weather variability, diminishing agricultural lands, declining soil health and increasing human and domesticated animal populations, presents an unparalleled opportunity to rethink how we produce food, maintain healthy ecosystems and keep people well and happy⁵. Realigning economic and policy drivers will be a complex but worthy endeavour which requires active collaboration with social scientists including economists and political scientists. With commitment by and collaboration between public and private sectors and civil society, we must deliver policy environments that facilitate: (i) the production of food using the principles of regenerative, climate-smart agriculture; (ii) valuing food according to its natural nutrient density in addition to weight and/or volume; (iii) actively tailoring nutrition by gender, age, reproductive and health status; (iv) valuing nutrients in waste products and enabling their recycling; and (v) restructuring healthcare services to place a higher value on preventive medicine.

Robyn Alders, AO

Robyn is a member of the Crawford Fund’s NSW Committee and the recipient of the 2014 Crawford Fund Medal for her contribution to the world’s food security and to childhood nutrition. She was born and raised on a grazing property on the Southern Tablelands of NSW. Robyn has recently left the Sydney Environment Institute at the University of Sydney to take on the role as Senior Scientific Advisor for the global livestock and aquaculture policy project being implemented by the Centre for Global Health Security within Chatham House.

For over 20 years, she has worked closely with smallholder farmers in Africa and Asia as a veterinarian, researcher and colleague.

In January 2011, Robyn was made an Officer of the Order of Australia for distinguished service to veterinary science as a researcher and educator, to the maintenance of food security in developing countries through livestock management and disease control programs.

References

¹ Kohn, L. 2017. Pristine Affluence: Daoist Roots in the Stone Age. Three Pines Press, St Petersburg, FL, USA.

² Gray, J.P. and Wolfe, L.D. 1980. Height and sexual dimorphism of stature among human societies. American Journal of Physical Anthropology 53(3):441-456. https://doi.org/10.1002/ajpa.1330530314

³ Dyble, M., Salali, G.D., Chaudhary, N., Page, A., Smith, D., Thompson, J., Vinicius, L., Mace, R. and Migliano, A.B. 2015. Sex equality can explain the unique social structure of hunter-gatherer bands. Science 348(6236):796-798.

⁴ Metz, J., Hart, D. and Harpending, C. 1971. Iron, folate, and vitamin B12 nutrition in a hunter-gatherer people: a study of the !Kung Bushmen. The American Journal of Clinical Nutrition 24(2):229–242. https://doi.org/10.1093/ajcn/24.2.229

⁵ Alders, R.G., Ratanawongprasat, N., Schönfeldt, H. and Stellmach, D. 2018. A planetary health approach to secure, safe, sustainable food systems: workshop report.  Food Security, 10(2), 489-493, DOI 10.1007/s12571-018-0780-9, https://doi.org/10.1007/s12571-018-0780-9