The nexus between international trade, food systems, malnutrition and climate change

How are intra-household dynamics, gender roles and time availability related to food access and children's diet quality during the Covid-19 lockdown?

The association between food access and children's diet quality has been documented mainly from its external dimension (e.g., availability, prices, food properties, and marketing). However, existing research has underscored that the external food environment cannot fully account for variations in children's diet quality, even amid the COVID-19 lockdown. It is increasingly evident that elements within the domestic food environment also play a crucial role in shaping this relationship. Specifically, gender roles influence how food is procured and consumed, along with challenges related to time constraints. This study explores the influence of the domestic time-gender axis and household dynamics in food access and children's dietary quality in 14 female-headed households in Santiago, Chile, during the COVID-19 lockdown. Employing a photo-elicitation exercise, we engaged with families residing in the same urban neighborhood but exhibiting varying levels of dietary quality among their children. Our analysis utilized a framework incorporating both socio-ecological food environment and gender theories. Our findings show that within these households, only one unit of "person-time" was available to address all food and caregiving tasks. Due to an unequal gender system, this limited time allocation was disproportionately absorbed by women, who were already burdened with multiple responsibilities. The lack of time favors the consumption of ultra-processed foods and hinders the intake of fresh foods. Other associated intrahousehold dynamics, such as children's fussiness and special diets, accentuates these time scarcity consequences. These difficulties were further exacerbated by strategies adopted in response to the COVID-19 lockdown, however, in families where food-related responsibilities were shared more equitably the lockdown was less disrupting. These results indicate that on top of external food environment policies, comprehensive gender-transformative policies that include food socialization processes are needed to promote healthier diets among all.

Bridging the gap between science and food policy: nutrition as a driver of policy drawing on Scotland as a case study

Access to adequate food is one of the Human Rights set out in international law and hence its delivery (through policy) is the role of government. 'Food policy' cannot be the role of a single government department, however, since regulations must take care of public goods (e.g. public health and protecting the natural environment) while also creating an economic environment attractive to private sector participation. From the mid-20th century, much of food policy was driven by a need to encourage the production base, but more recently the importance of considering food policy through the lens of nutritional requirements is increasingly recognised, alongside the importance of minimising environmental damage. This review paper draws on experience of working with policymakers (in particular the Scottish Government) and of active participation in an EC-commissioned project. It highlights the need for the research community to invest time and resources in understanding what evidence policymakers are asking for and to consider that alongside evidence from those who will be impacted by the policy (stakeholders). Examples of effective ways of engaging stakeholders and policy communities simultaneously are outlined and the paper provides some thoughts on the boundaries between the science and policy communities and how to bridge them. The Case Study also highlights the importance of evidence to inform prioritisation and consultation at a local level when aiming to meet multiple policy goals nationally.

Trade liberalization and nutrition transition: Evidence from China

We examine the impact of trade liberalization on the nutrition transition between 1997 and 2011. Our findings demonstrate that the reduction in tariff rates has had a significant effect on the dietary patterns of both rural and urban residents in the country. With the decrease in tariffs, there has been a noticeable increase in the consumption of animal products (such as meat and aquatic products), vegetables, beans and nuts, as well as packaged and processed foods. Simultaneously, there has been a decrease in the demand for staple foods, fruits, and dairy products. Consequently, there has been an increase in the proportion of overall calories derived from fat and protein, while the proportion from staple foods has declined. As a result, trade liberalization has led to increased food expenditure, while reducing the cost of maintaining a healthy diet. Furthermore, trade liberalization has also contributed to a growing risk of obesity. Additionally, our study identifies rising incomes, specialization in agricultural production, changing food prices, and shifting food preferences as the primary mechanisms of the trade-diet relationship.

Does obesity Kuznets curve exist in developing economies? Evidence from 38 African countries based on heterogeneous panel data analysis on income-level classification

Introduction

The global pandemic disease known as the obesity epidemic has spread throughout the planet. Particularly, Africa is facing a growing problem of obesity, and the trend is rising. This is a result of a ticking time bomb. Given the claim that multiple socio-economic factors significantly affect the diversity in obesity rates between nations, economic development can be seen as a key contributor to this variation.

Methods

Relying on the aforementioned avowal, this extant research examines the relationship between obesity and economic growth using urbanization, trade openness, and unemployment as intermittent variables within the Obesity Kuznets Curve (OKC) framework. Using panel data from 1990 to 2020, a panel of 38 African countries subdivided into income levels (Low income, Lower-middle income, and Upper-middle income) were analyzed. With the presence of residual cross-sectional reliance and slope heterogeneity, the Augmented Mean Group (AMG) econometric approach is employed.

Results

Key outcomes from the mentioned estimation method unveiled that economic growth positively impacts obesity among all the study panels. Variably, unemployment was evidenced to have a palpable positive impact on obesity concerning Low-income economies whereas on the side of the Lower-middle income panel together with Upper-middle income economies and the aggregated panel, a significant negative relationship is observed with obesity. Further, urbanization enhanced obesity in the Low-income panel and the aggregated panel of African nations, whereas an adverse effect is identified in both the Lower-middle and Upper-middle economies in Africa. Moreover, except for Low-income African economies, all the other panels of African nations in terms of income levels were noted to have a significant negative effect on obesity from trade openness.

Discussion

Finally, the long-run coefficients indicated that the OKC is valid among all panels of African countries. The study thus preferably suggests in African economies that addressing the inverted U-shape relationship between obesity and economic growth requires a multifaceted approach that considers the evolving dynamics of both factors. Policy makers should, therefore, aim to balance promoting economic growth and safeguarding public health through targeted interventions and long-term strategies.

Commercial determinants of health: future directions

This paper is about the future role of the commercial sector in global health and health equity. The discussion is not about the overthrow of capitalism nor a full-throated embrace of corporate partnerships. No single solution can eradicate the harms from the commercial determinants of health-the business models, practices, and products of market actors that damage health equity and human and planetary health and wellbeing. But evidence shows that progressive economic models, international frameworks, government regulation, compliance mechanisms for commercial entities, regenerative business types and models that incorporate health, social, and environmental goals, and strategic civil society mobilisation together offer possibilities of systemic, transformative change, reduce those harms arising from commercial forces, and foster human and planetary wellbeing. In our view, the most basic public health question is not whether the world has the resources or will to take such actions, but whether humanity can survive if society fails to make this effort.

Food availability and food habits among Ghanaians: Tracking the dietary transition in Ghana

Background: Although extreme hunger has reduced significantly, people are eating nutrient-poor cheap foods that are unhealthy and environmentally unsustainable. Even though dietary practices are changing in Ghana, there is minimal national-level analysis of the changes and their implication for population health. Aim: This study describes shifts in food availability and consumption in Ghana from 1983-2013. Methods: Data from the Food and Agriculture Organisation (FAO) food balance sheets and a scoping review were used. Descriptive analysis was conducted in excel for the FAO data, and Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews recommendation was followed for the scoping review. Results: The availability of total calories increased from 1527 kcal in 1983 to 3016 kcal in 2013, representing 608 kcal above the daily recommended allowance for women. Sugar and sweeteners was the food group with the highest increase of 1075%. Vegetables contributed the least to food availability, with less than 40 kcal a day. Rice contributed the most to food availability among cereals (56 kcal in 1983 to 304 kcal in 2013), replacing maise as the primary cereal. Conclusion: After the 1983 famine, there were significant increases in food availability in Ghana. The provision of rice, sugars and tubers meant to end hunger, changed dietary patterns and has resulted in low dietary diversity, high energy intake and overweight/obesity. Therefore, there is a need to intervene and increase the availability of other food groups.

Interlinkages between Climate Change and Food Systems: The Impact on Child Malnutrition-Narrative Review

The pandemics of obesity, undernutrition, and climate change represent severe threats to child health. They co-occur; interact with each other to produce sequelae at biological, psychological, or social levels; and share common underlying drivers. In this paper, we review the key issues concerning child diet and nutritional status, focusing on the interactions with climate and food systems. Inadequate infant and young child feeding practices, food insecurity, poverty, and limited access to health services are the leading causes of malnutrition across generations. Food system industrialization and globalization lead to a double burden of malnutrition, whereby undernutrition (i.e., stunting, wasting, and deficiencies in micronutrients) coexists with overweight and obesity, as well as to harmful effects on climate. Climate change and the COVID-19 pandemic are worsening child malnutrition, impacting the main underlying causes (i.e., household food security, dietary diversity, nutrient quality, and access to maternal and child health), as well as the social, economic, and political factors determining food security and nutrition (livelihoods, income, infrastructure resources, and political context). Existing interventions have the potential to be further scaled-up to concurrently address undernutrition, overnutrition, and climate change by cross-cutting education, agriculture, food systems, and social safety nets. Several stakeholders must work co-operatively to improve global sustainable nutrition.

Managing water-land-food nexus towards resource efficiency improvement: A superedge-based analysis of China

Challenges at the intersection of water conservation, land protection, food security, and economic growth cross industrial boundaries, and also involve synergies with multiple policy domains. Despite this, little is known about how system heterogeneity affects water, land, and food (WLF) consumption performance at a sectoral level. This study integrates superedge analysis with a flow interaction network, elasticity theory, and utility analysis to detect the WLF nexus with regard to resource efficiency gains. Three indicators (intra-sector recycling efficiency, trans-sector allocation efficiency, and symbiosis of system structure) are proposed as mechanisms by which to quantitatively explore intra-sector and trans-sector nexus, and formulate improvement strategies for sectoral WLF savings. The results show synergies between recycling efficiency and water/food productivity. Manufacturing servitization and agricultural industrialization can drive more efficient WLF allocation by minimizing resource misallocation, whilst positive industrial ecology enhances WLF circulation and facilitates reducing resource undue competition. In addition, the ability of industries to save resources under the nexus is examined. Approximately 93% of sectors suffer from resource waste, misallocation, and undue competition. Therefore, strategic paths enhance resource synergy and, through so doing, enable WLF efficiency gains.

China's Trade of Agricultural Products Drives Substantial Greenhouse Gas Emissions

China's trade of agricultural products has expanded rapidly over the past two decades, resulting in considerable shifts in greenhouse gas (GHG) emissions worldwide. This study aims to explore the evolution of GHG emissions embodied in China's trade of agricultural products from 1995 to 2015. The GHG emissions embodied in China's exports of agricultural products experienced three stages of fluctuation, showing a significant upward trend (1995-2003), a fluctuating trend (2004-2007), and a fall back to the previous level (2008-2015). The embodied GHG emissions in China's imports were witnessed at times of sustained growth, rising from 10.5 Mt CO₂-eq in 1995 to 107.7 Mt CO₂-eq in 2015. The net import of embodied GHG emissions has grown at an average annual rate of 25.1% since 2008. In terms of regional contribution, the distribution of China's trading partners tended to be diversified. The increasing net imports of oil crops to China resulted in a significant GHG emissions shift from China to the US and Brazil. Asian countries contributed to 76.9% of the total GHG emissions embodied in China's agricultural exports. The prominent impacts of China's trade of agricultural products on global GHG emissions provide important implications for climate-related policy choices.

A new dietary guideline balancing sustainability and nutrition for China's rural and urban residents

Diets have important but often complex implications for both environmental quality and nutrition. We establish a production-oriented life cycle model to quantify and compare the farm-to-gate environmental impacts and food nutritional qualities underlying rural and urban diets in China from 1980 to 2019, a period of rapid urbanization and socioeconomic changes. The environmental impacts of rural diets were generally higher than those of urban diets, but this gap reduced after 2000. Environmental and nutritional values varied considerably across the 31 Chinese provinces due to their different food intakes and dietary structures. Dietary changes coinciding with urbanization increased greenhouse gas emissions, eutrophication potential, and nutritional quality, but decreased energy consumption and acidification potential. Based on our results, we propose a new dietary guideline to mitigate environmental impacts and improve nutritional quality.

Dynamic Impacts of External Uncertainties on the Stability of the Food Supply Chain: Evidence from China

The food supply chain operates in a complex and dynamic external environment, and the external uncertainties from natural and socio-economic environment pose great challenges to the development of the food industry. In particular, the COVID-19 pandemic and Russia–Ukraine conflict have further exacerbated the vulnerability of the global food supply chain. Analyzing the dynamic impacts of external uncertainties on the stability of food supply chain is central to guaranteeing the sustainable security of food supply. Based on the division of food supply chain and the classification of external uncertainties, the TVP-FAVAR-SV model was constructed to explore the dynamic impacts of external uncertainties on food supply chain. It was found that the impacts of external uncertainty elements were significantly different, the combination of different external uncertainty elements aggravated or reduced the risks of food supply chain. And some uncertainty elements had both positive and negative impacts in the whole sample period, as the magnitude and direction of the impacts of various uncertainties in different periods had time-varying characteristics.

Virtual water transfers in Africa: Assessing topical condition of water scarcity, water savings, and policy implications

Africa is facing an increasing challenge with respect to water scarcity (WS), which is driven by climate change, population growth, and socioeconomic growth combined with inadequate water resources management. In particular, there is significant concern of virtual water (VW) trade, which plays the key role in water resource management and food security sustainability. Using bilateral trade data, this study consistently evaluated the change and balanced trade of major grains, the VW flows, WS status, water dependency (WD), water self-sufficiency (WSS), and water savings/losses within5 African sub-regions and their partners from 2000 to 2020. The ratio of water use to water availability was used to estimate the WS. The WD was quantified by the ratio of the net VW import to the regional water appropriation and the regional water savings/losses were also quantified by multiplying the inter-regional trade by the virtual water content of the imported/exported grains. The overall average trade deficit of African regions was found to increase to -1364.22 × 10⁶ tons and Africa imported 41,359.07 Bm³ of VW from grain products. Green water contributed 79.33% of the total VWI. The WS values for East African countries were >100, indicating overexploitation. Besides, the overall WD in Africa was 465.5% for the studied period. The trade of main grains between Africa and the rest of the planet corresponded to a global water loss of 2820.7 Bm³·yr^-1. However, the inter-continental cereal VW trade pattern and high trend will continue in the future. In view of the rising tension of WS, some African countries need to revise international crop trade and water resources conservation policies to promote a more balanced ecosystem. This study exemplifies that decision makers would consider VW flows and water savings/losses for enhancing water use efficiency and fair trading, thus increasing food production in Africa.

Connected and extracted: Understanding how centrality in the global wheat supply chain affects global hunger using a network approach

While global food trade has allowed countries to buffer against domestic food production shortfalls and gain access to larger markets, engaging in trade has also opened economies up to shocks and increased extraction of food resources. With this research, we analyze how the global grain network influences country-level nourishment, while controlling for per capita land and food production. First, we model the trade network structure of the global wheat supply chain to measure the centrality or positionality of countries. We use spatial regression analysis to assess the impact of trade networks, volume, purchasing power, production capacity and geography on undernourishment. We find that the six countries most central to the global grain trade by betweenness and eigenvector centralities account for more than half of all wheat exports globally by volume. The centrality of these countries as opposed to volume of wheat produced or traded, determines their influence in the wheat supply chain network. The parametric component of our analysis confirms that trade, and centrality have significant implications for national levels of nourishment. Our findings suggest that for countries with low purchasing power, increasing centrality allows improvements in nourishment levels but for countries with very high purchasing power, increasing centrality can increase hunger outcomes. To counteract perturbations and shortfalls such as those being experienced currently in the globalized food system, local and regional governments may consider refocusing on regional and local based food systems.

'A contradiction between our state and the tobacco company': conflicts of interest and institutional constraints as barriers to implementing Article 5.3 in Bangladesh

INTRODUCTION

Bangladesh has not yet adopted measures to implement Article 5.3 of the WHO Framework Convention on Tobacco Control. The National Tobacco Control Cell (NTCC) has drafted a guideline for implementation, but progress has stalled amid high levels of tobacco industry interference in public policy. This paper examines the barriers to minimising industry interference in a context of close relationships between government officials and tobacco companies.

METHODS

In-depth interviews were conducted with government officials, representatives from civil society, think tank and media organisations, and academic researchers. The data were analysed using a '3 Is' framework developed within the political sciences, emphasising the interactive role of ideas, interests and institutions in policy change.

RESULTS

The findings indicate that policy ideas about protecting public health policy making from tobacco industry interests are largely restricted to the Ministry of Health and Family Welfare, and the NTCC specifically. Both individual and institutional conflicts of interest emerge as key barriers to progress to minimising industry interference and for tobacco control governance more broadly. The data also suggest that development of an Article 5.3 guideline has been shaped by the perceived interests of political actors and institutions, and the institutional position of the NTCC, constrained by limits on its resources, authority and isolation from other ministries.

CONCLUSION

NTCC's initiatives towards implementing Article 5.3 constitute an important opportunity to address conflicts of interest that restrict tobacco control in Bangladesh. Progress in minimising industry interference is essential to realising the commitment to being smoke free by 2040.

Trade and foreign fishing mediate global marine nutrient supply

SignificanceThe world produces enough food to nourish the global population, but inequitable distribution of food means many people remain at risk for undernutrition. Attainment of Sustainable Development Goal 2 relies on greater attention to distribution processes that match food qualities with dietary deficiencies. We explore this in the context of fisheries. Foreign fishing and international trade divert nutrients caught in marine fisheries from nutrient-insecure toward nutrient-secure nations. Where nutrient-insecure countries do benefit from foreign fishing and trade, there tends to be high vulnerability to future changes in nutrient flows arising from changes to foreign fishing and trade. This research highlights the need for greater transparency around distribution of fish and for nutrition security to be considered more centrally in development of trade agreements.

Changes in Climate Vulnerability and Projected Water Stress of The Gambia's Food Supply Between 1988 and 2018: Trading With Trade-Offs

Background

The coexistence of under- and overnutrition is of increasing public health concern in The Gambia. Fruits, vegetables and pulses are essential to healthy and sustainable diets, preventing micronutrient deficiencies and non-communicable diseases, while cereals significantly contribute to energy intake. However, environmental changes are predicted to intensify, reducing future yields of these crops if agricultural productivity and resilience are not improved. The Gambia is highly climate-vulnerable and import-dependent, but the extent of its reliance on other climate-vulnerable countries for its supply of nutritionally important crops is currently unknown.

Methods

We used United Nations Food and Agriculture Organization data, with novel origin-tracing algorithms applied, to analyse The Gambia's supply of cereals, fruits, vegetables and pulses between 1988 and 2018. The climate vulnerability of countries was assessed using Notre Dame Global Adaptation Initiative (ND-GAIN) index scores, and projected water stress (2040) assessed using World Resources Institute (WRI) scores. Multilevel generalized linear mixed-effects models were used to identify changes in the overall climate vulnerability and projected water stress of supply.

Results

Between 1988 and 2018, The Gambia's supply of cereals, fruits, vegetables and pulses diversified, with the proportion domestically produced falling (Cereals: 61.4%-27.7%; Fruits: 93.0%-55.7%; Vegetables: 24.6%-16.3%; Pulses: 100.0%-76.0%). The weighted-average ND-GAIN scores improved (indicating less climate vulnerability) for supply of all crops except cereals, but the weighted-average WRI score for supply deteriorated (indicating increased projected water stress) for all crops except vegetables. When just considering imports, weighted-average ND-GAIN scores deteriorated for fruits and cereals while showing no significant change for other food groups, and the WRI score deteriorated for cereals only.

Conclusions

Despite some notable improvements in the environmental vulnerability of The Gambia's supply of nutritionally important crops (particularly vegetables), considerable, and in some cases increasing, proportions of their supply are produced in countries that are vulnerable to climate change and future water stress. This may have implications for the availability, affordability, and hence consumption of these crops in The Gambia, ultimately exacerbating existing nutritional challenges. Exploring the options to strengthen supply resilience-such as altering trade patterns, agricultural techniques and diets-should be prioritized.

Healthy and sustainable diets from today to 2050—The role of international trade

The connection between international trade and food systems (un)sustainability is both contentious and critical for policy work supporting progress towards achieving the twin goals of hunger alleviation and dietary health while improving the overall sustainability of development. We characterize the food system using a set of metrics based upon the EAT-Lancet commission dietary guidelines for both over- and under-consumption of different foods to assess country-level dietary health and sustainability in tandem. Using a partial equilibrium model of agricultural production and trade, we then project the functioning of the global agricultural system to 2050 and calculate the metrics for that year. For most regions we find increased overconsumption above the expert-defined healthy and sustainable diet thresholds, with more limited progress towards closing dietary health and sustainability gaps where they currently exist. Trade influences this dynamic into the future under certain socioeconomic conditions, and we find that under a “business as usual” trade environment, future agricultural import profiles continue to be misaligned with dietary health and sustainability outcomes, suggesting the potential for early intervention in trade policy as a means to positively influence food system outcomes.

Moving from silos to synergies: strengthening governance of food marketing policy in Thailand

Background

Governance processes play an important role in shaping the formulation and implementation of policy measures such as restrictions on marketing of ultra-processed foods. However, there is limited analysis of the factors that affect governance for nutrition, especially in low- and middle-income countries such as Thailand and the Southeast Asia region. This study aimed to examine governance factors that create opportunities and challenges for the introduction of policy to restrict food marketing in Thailand, in line with the WHO recommendations to restrict food marketing to children.

Methods

A qualitative study design was used. Interviews were conducted with 20 actors with experience and in depth knowledge of food marketing in Thailand, including government, civil society, industry and international organisations. Open questions were asked about experiences and perceptions of the governance processes related to policies for restricting food marketing in Thailand. Themes were derived from the 3-i Framework which relates to interests, ideas and institutions influencing the introduction of food marketing policy were identified and analysed using abductive methods.

Results

Actors viewed institutional challenges as a significant barrier to advancing effective regulation of food marketing. Three major clusters emerged from the data: interests (priorities, relationships), institutions (formal structures, informal structures, broader institutional strategies), and ideas (norms). The study has three major findings in relation to these factors, highlighting the influence of formal structures, institutional interests in food marketing issues, and ideas in promoting multisectoralism. The siloed nature of policymaking was reflected in the government failing to stimulate engagement among key actors, posing challenges for implementation of effective policy change. Contested interests led to disagreements between actors over food marketing agenda and thus competing policy priorities. Consistent with these findings, the lack of effective mechanisms to promote multisectoral coordination across diverse actors reinforced barriers to policy change.

Conclusion

The findings highlight ongoing challenges to the government’s aim to strengthen policy to restrict food marketing which, without greater coordination in governance mechanisms, will hinder effective regulation and the achievement of public health goals. This analysis suggests that the Government should prioritise the development of a holistic, multisectoral approach to improve governance for better nutrition outcomes by overcoming policy silos.

An Analysis of Agricultural Systems Modelling Approaches and Examples to Support Future Policy Development under Disruptive Changes in New Zealand

Agricultural systems have entered a period of significant disruption due to impacts from change drivers, increasingly stringent environmental regulations and the need to reduce unwanted discharges, and emerging technologies and biotechnologies. Governments and industries are developing strategies to respond to the risks and opportunities associated with these disruptors. Modelling is a useful tool for system conceptualisation, understanding, and scenario testing. Today, New Zealand and other nations need integrated modelling tools at the national scale to help industries and stakeholders plan for future disruptive changes. In this paper, following a scoping review process, we analyse modelling approaches and available agricultural systems’ model examples per thematic applications at the regional to national scale to define the best options for the national policy development. Each modelling approach has specificities, such as stakeholder engagement capacity, complex systems reproduction, predictive or prospective scenario testing, and users should consider coupling approaches for greater added value. The efficiency of spatial decision support tools working with a system dynamics approach can help holistically in stakeholders’ participation and understanding, and for improving land planning and policy. This model combination appears to be the most appropriate for the New Zealand national context.

Tensions and coalitions: A new trade agreement affects the policy space for nutrition in Vietnam

Global trade has shaped food systems over centuries, but modern trade agreements are hastening these changes and making them more complex, with implications for public health and nutrition transition. This study aimed to understand the impact of the 2018 Comprehensive and Progressive Agreement for Trans-Pacific Partnership (CPTPP) on the policy space for public health nutrition in Vietnam. We conducted comparative document review and key informant interviews, and our analysis drew on a framework of policy space and the theory of advocacy coalitions. We identified 10 CPTPP sections with potential public health nutrition implications; and 50 Vietnamese policies relevant to nutrition having one or more tensions with one or more CPTPP sections. A majority of policy tensions were in sections of the CPTPP relating to technical barriers to trade and government procurement; most tensions related to protecting policy-making from vested interests. Different groups of policy actors hold different beliefs and interests on these issues, and therefore promote different framings and policy approaches. We identified two advocacy coalitions working very separately on issues affecting nutrition policy space: a trade coalition holding the policy position that free trade improves nutrition by default; and a nutrition coalition holding the policy position that nutrition should be explicitly considered in trade policy. The policy space for nutrition in Vietnam has important potential constraints through written policy, and the trade and nutrition coalitions will need to interact more regularly and constructively in order to foresee where these tensions will arise in practice, and create plans for their mitigation. This study adds to global evidence of free trade agreement impacts on nutrition policy space, and we extend previous work by explaining these actor groupings in the policy space through the theory of advocacy coalitions.

Climate Change and Infections on the Move in North America

Climate change is increasingly recognized for its impacts on human health, including how biotic and abiotic factors are driving shifts in infectious disease. Changes in ecological conditions and processes due to temperature and precipitation fluctuations and intensified disturbance regimes are affecting infectious pathogen transmission, habitat, hosts, and the characteristics of pathogens themselves. Understanding the relationships between climate change and infectious diseases can help clinicians broaden the scope of differential diagnoses when interviewing, diagnosing, and treating patients presenting with infections lacking obvious agents or transmission pathways. Here, we highlight key examples of how the mechanisms of climate change affect infectious diseases associated with water, fire, land, insects, and human transmission pathways in the hope of expanding the analytical framework for infectious disease diagnoses. Increased awareness of these relationships can help prepare both clinical physicians and epidemiologists for continued impacts of climate change on infectious disease in the future.

First Nations Peoples' Participation in the Development of Population-Wide Food and Nutrition Policy in Australia: A Political Economy and Cultural Safety Analysis

BACKGROUND

Healthy and sustainable food systems underpin the well-being of Indigenous peoples. Increasingly governments are taking action to improve diets via population-wide policies. The United Nations Declaration on the Rights of Indigenous People states that Indigenous peoples have the right to participate in all decisions that affect them. We analysed Australian national food and nutrition policy processes to determine: (i) the participation of Aboriginal organisations, (ii) the issues raised in Aboriginal organisations' policy submissions, and (iii) the extent to which Aboriginal organisations' recommendations were addressed in final policy documents.

METHODS

Political economy and cultural safety lenses informed the study design. We analysed publicly-available documents for Australian population-wide food and nutrition policy consultations occurring 2008-2018. Data sources were policy documents, committee reports, terms of reference and consultation submissions. The submissions made by Aboriginal organisations were thematically analysed and key policy recommendations extracted. We examined the extent to which key recommendations made by Aboriginal organisations were included in the subsequent policy documents.

RESULTS

Five food and nutrition policy processes received submissions from Aboriginal organisations. Key themes centred on self-determination, culturally-appropriate approaches to health, and the need to address food insecurity and social determinants of health. These messages were underrepresented in final policy documents, and Aboriginal people were not included in any committees overseeing policy development processes.

CONCLUSION

This analysis suggests that very few Aboriginal organisations have participated in Australian population-wide food and nutrition policy processes and that these policy development processes are culturally unsafe. In order to operationalise First Nations peoples' right to self-determination, alternative mechanisms are required to redress the power imbalances preventing the full participation of Aboriginal and Torres Strait Islander peoples in population-wide food and nutrition policy decisions. This means reflecting on deeply embedded institutional structures and the normative assumptions upon which they rest.

International investment liberalization, transnational corporations and NCD prevention policy non-decisions: a realist review on the political economy of tobacco, alcohol and ultra-processed food

BACKGROUND

Public health concerns relating to international investment liberalization have centred on the potential for investor-state dispute settlement (ISDS)-related regulatory chill. However, the broader political and economic dimensions that shape the relationship between the international investment regime and non-communicable disease (NCD) policy development have been less well explored. This review aimed to synthesise the available evidence using a political economy approach, to understand why, how and under what conditions transnational corporations may use the international investment regime to promote NCD prevention policy non-decisions.

MAIN BODY

Methods: Mechanisms explaining why/how the international investment regime may be used by transnational health-harmful commodity corporations (THCCs) to encourage NCD prevention policy non-decisions, including regulatory chill, were iteratively developed. Six databases and relevant grey literature was searched, and evidence was extracted, synthesized and mapped against the various proposed explanatory mechanisms.

FINDINGS

Eighty-nine sources were included. THCCs may be incentivised to use the ISDS mechanism since the costs may be outweighed by the benefits of even just delaying regulatory adoption, particularly since the chilling effect tends to ripple out across jurisdictions. Drivers of regulatory chill may include ambiguity in treaty terms, inconsistency in arbitral rulings, potential arbitrator bias and the high cost of arbitration. Evidence indicates ISDS can delay policy adoption both within the country directly involved but also in other jurisdictions. Additionally, governments are adopting standard assessments of public health regulatory proposals for trade and ISDS risk. Various economic, political and industry-related factors likely interact to increase (or decrease) the ultimate risk of regulatory chill. Some evidence indicates that THCCs take advantage of governments' prioritization of foreign investment over NCD prevention objectives to influence the NCD prevention regulatory environment.

CONCLUSIONS

While ISDS-related regulatory chill is a real risk under certain conditions, international investment-related NCD prevention policy non-decisions driven by broader political economy dynamics may well be more widespread and impactful on NCD regulatory environments. There is therefore a clear need to expand the research agenda on investment liberalization and NCD policy beyond regulatory chill and engage with theories and approaches from international relations and political science, including political economy and power analyses.

Impact of Epidemic-Affected Labor Shortage on Food Safety: A Chinese Scenario Analysis Using the CGE Model

Human food safety should be given priority during a major public health crisis. As the primary element of agricultural production, labor tends to suffer the most during a period of public health concern. Studying the impact of epidemic-affected labor shortages on agricultural production, trade, and prices has important implications for food security. This study used a calculable general equilibrium model to study the changes in agricultural production, trade, and prices under different labor damage scenarios. The results showed that agricultural production was less affected under a scenario where the epidemic was controlled locally. The output of agricultural products decreased by about 2.19%, and the prices of agricultural products increased slightly. However, the nationwide output of agricultural products decreased by only 0.1%, and the prices remained largely stable. In the case of the spread of the epidemic, the output of agricultural products in the epidemic area decreased by 2.11%, and the prices of certain agricultural products increased significantly. For example, the price of vegetables increased by 0.78%, the price of pork increased by about 0.7%, and those of agricultural products in other parts of the country also increased slightly. Compared with the national spread scenario, the local outbreak scenario had a smaller impact on Chinese food security, indicating Chinese effective policy against the epidemic. Although the impact of labor shortage under the influence of the epidemic on China was relatively limited, and considering its stable food security, we should pay attention to the increase in the process of agricultural products and changes in agricultural trade in the epidemic area. The residents in the epidemic areas could not effectively obtain nutritious food, which affected their health. Thus, the government should also completely mobilize agricultural resources to ensure the nutrition safety of residents during major public health incidents.

Global relationships between crop diversity and nutritional stability

Nutritional stability – a food system’s capacity to provide sufficient nutrients despite disturbance – is an important, yet challenging to measure outcome of diversified agriculture. Using 55 years of data across 184 countries, we assemble 22,000 bipartite crop-nutrient networks to quantify nutritional stability by simulating crop and nutrient loss in a country, and assess its relationship to crop diversity across regions, over time and between imports versus in country production. We find a positive, saturating relationship between crop diversity and nutritional stability across countries, but also show that over time nutritional stability remained stagnant or decreased in all regions except Asia. These results are attributable to diminishing returns on crop diversity, with recent gains in crop diversity among crops with fewer nutrients, or with nutrients already in a country’s food system. Finally, imports are positively associated with crop diversity and nutritional stability, indicating that many countries’ nutritional stability is market exposed.

Crop diversification could be important for food security. Here, using methods from network science, the authors find that a positive relationship between crop diversity and nutritional stability globally does not necessarily equate to improving nutritional stability in a given country.

From consumers' science to food functionality-Challenges and opportunities for vibrational spectroscopy

Current available methods used to measure or estimate the composition, functionality, and sensory properties of foods and food ingredients are destructive and time consuming. Therefore, new approaches are required by both the food industry and R&D organizations. Recent years have witnessed a steady growth on the applications and utilization of vibrational spectroscopy techniques [near (NIR), mid infrared (MIR), Raman] to analyse or estimate several properties in a wide range of foods and food ingredients. This chapter will provide with an overview of vibrational spectroscopy techniques, the combination of these techniques with multivariate data analysis, and examples on the use of these techniques to measure composition, and functional properties in a wide range of foods.

Trade–Climate Nexus: A Systematic Review of the Literature

In the climate–trade debate, moderate attention is dedicated to the role of trade agreements on climate. In turn, trade agreements could help countries meet climate goals by removing tariffs, harmonizing standards on environmental goods, and eliminating distorting subsidies on fossil fuels. This paper aims to provide an overview of the role of trade agreements on climate-change mitigation. This systematic literature review is based on the international economic literature published between 2010 and 2020. This literature review underlines that the effectiveness of the trade agreements and WTO negotiations on emission reduction is weak. This is due to different national interests and protectionism. The elimination of trade barriers stimulates trade, but this may also raise greenhouse gas emissions and cause other environmental problems (e.g., deforestation). Furthermore, this article points out that emission leakage is also a crucial issue hindering the success of global climate agreements on greenhouse gas reduction. The greatest beneficiaries of the trade agreements are usually the largest GHG emitters, such as China, the US, and the EU. By contrast, developing countries are in a weaker position regarding climate–trade negotiation. The literature review offers policy solutions which can contribute to emission reduction and tools for stimulating a trade-related climate-change abatement policy.

A Sustainability Compass for policy navigation to sustainable food systems

Growing acknowledgement that food systems require transformation, demands comprehensive sustainability assessments that can support decision-making and sustainability governance. To do so, assessment frameworks must be able to make trade-offs and synergies visible and allow for inclusive negotiation on food system outcomes relevant to diverse food system actors. This paper reviews literature and frameworks and builds on stakeholder input to present a Sustainability Compass made up of a comprehensive set of metrics for food system assessments. The Compass defines sustainability scores for four societal goals, underpinned by areas of concern. We demonstrate proof of concept of the operationalization of the approach and its metrics. The Sustainability Compass is able to generate comprehensive food system insights that enables reflexive evaluation and multi-actor negotiation for policy making.

Australia in 2030: what is our path to health for all?

CHAPTER 1: HOW AUSTRALIA IMPROVED HEALTH EQUITY THROUGH ACTION ON THE SOCIAL DETERMINANTS OF HEALTH: Do not think that the social determinants of health equity are old hat. In reality, Australia is very far away from addressing the societal level drivers of health inequity. There is little progressive policy that touches on the conditions of daily life that matter for health, and action to redress inequities in power, money and resources is almost non-existent. In this chapter we ask you to pause this reality and come on a fantastic journey where we envisage how COVID-19 was a great disruptor and accelerator of positive progressive action. We offer glimmers of what life could be like if there was committed and real policy action on the social determinants of health equity. It is vital that the health sector assists in convening the multisectoral stakeholders necessary to turn this fantasy into reality. CHAPTER 2: ABORIGINAL AND TORRES STRAIT ISLANDER CONNECTION TO CULTURE: BUILDING STRONGER INDIVIDUAL AND COLLECTIVE WELLBEING: Aboriginal and Torres Strait Islander peoples have long maintained that culture (ie, practising, maintaining and reclaiming it) is vital to good health and wellbeing. However, this knowledge and understanding has been dismissed or described as anecdotal or intangible by Western research methods and science. As a result, Aboriginal and Torres Strait Islander culture is a poorly acknowledged determinant of health and wellbeing, despite its significant role in shaping individuals, communities and societies. By extension, the cultural determinants of health have been poorly defined until recently. However, an increasing amount of scientific evidence supports what Aboriginal and Torres Strait Islander people have always said - that strong culture plays a significant and positive role in improved health and wellbeing. Owing to known gaps in knowledge, we aim to define the cultural determinants of health and describe their relationship with the social determinants of health, to provide a full understanding of Aboriginal and Torres Strait Islander wellbeing. We provide examples of evidence on cultural determinants of health and links to improved Aboriginal and Torres Strait Islander health and wellbeing. We also discuss future research directions that will enable a deeper understanding of the cultural determinants of health for Aboriginal and Torres Strait Islander people. CHAPTER 3: PHYSICAL DETERMINANTS OF HEALTH: HEALTHY, LIVEABLE AND SUSTAINABLE COMMUNITIES: Good city planning is essential for protecting and improving human and planetary health. Until recently, however, collaboration between city planners and the public health sector has languished. We review the evidence on the health benefits of good city planning and propose an agenda for public health advocacy relating to health-promoting city planning for all by 2030. Over the next 10 years, there is an urgent need for public health leaders to collaborate with city planners - to advocate for evidence-informed policy, and to evaluate the health effects of city planning efforts. Importantly, we need integrated planning across and between all levels of government and sectors, to create healthy, liveable and sustainable cities for all. CHAPTER 4: HEALTH PROMOTION IN THE ANTHROPOCENE: THE ECOLOGICAL DETERMINANTS OF HEALTH: Human health is inextricably linked to the health of the natural environment. In this chapter, we focus on ecological determinants of health, including the urgent and critical threats to the natural environment, and opportunities for health promotion arising from the human health co-benefits of actions to protect the health of the planet. We characterise ecological determinants in the Anthropocene and provide a sobering snapshot of planetary health science, particularly the momentous climate change health impacts in Australia. We highlight Australia's position as a major fossil fuel producer and exporter, and a country lacking cohesive and timely emissions reduction policy. We offer a roadmap for action, with four priority directions, and point to a scaffold of guiding approaches - planetary health, Indigenous people's knowledge systems, ecological economics, health co-benefits and climate-resilient development. Our situation requires a paradigm shift, and this demands a recalibration of health promotion education, research and practice in Australia over the coming decade. CHAPTER 5: DISRUPTING THE COMMERCIAL DETERMINANTS OF HEALTH: Our vision for 2030 is an Australian economy that promotes optimal human and planetary health for current and future generations. To achieve this, current patterns of corporate practice and consumption of harmful commodities and services need to change. In this chapter, we suggest ways forward for Australia, focusing on pragmatic actions that can be taken now to redress the power imbalances between corporations and Australian governments and citizens. We begin by exploring how the terms of health policy making must change to protect it from conflicted commercial interests. We also examine how marketing unhealthy products and services can be more effectively regulated, and how healthier business practices can be incentivised. Finally, we make recommendations on how various public health stakeholders can hold corporations to account, to ensure that people come before profits in a healthy and prosperous future Australia. CHAPTER 6: DIGITAL DETERMINANTS OF HEALTH: THE DIGITAL TRANSFORMATION: We live in an age of rapid and exponential technological change. Extraordinary digital advancements and the fusion of technologies, such as artificial intelligence, robotics, the Internet of Things and quantum computing constitute what is often referred to as the digital revolution or the Fourth Industrial Revolution (Industry 4.0). Reflections on the future of public health and health promotion require thorough consideration of the role of digital technologies and the systems they influence. Just how the digital revolution will unfold is unknown, but it is clear that advancements and integrations of technologies will fundamentally influence our health and wellbeing in the future. The public health response must be proactive, involving many stakeholders, and thoughtfully considered to ensure equitable and ethical applications and use. CHAPTER 7: GOVERNANCE FOR HEALTH AND EQUITY: A VISION FOR OUR FUTURE: Coronavirus disease 2019 has caused many people and communities to take stock on Australia's direction in relation to health, community, jobs, environmental sustainability, income and wealth. A desire for change is in the air. This chapter imagines how changes in the way we govern our lives and what we value as a society could solve many of the issues Australia is facing - most pressingly, the climate crisis and growing economic and health inequities. We present an imagined future for 2030 where governance structures are designed to ensure transparent and fair behaviour from those in power and to increase the involvement of citizens in these decisions, including a constitutional voice for Indigenous peoples. We imagine that these changes were made by measuring social progress in new ways, ensuring taxation for public good, enshrining human rights (including to health) in legislation, and protecting and encouraging an independent media. Measures to overcome the climate crisis were adopted and democratic processes introduced in the provision of housing, education and community development.

Implications of international trade and investment agreements on policy space for restricting marketing of unhealthy food and beverages to children: lessons from inter-disciplinary expert interviews

OBJECTIVE

To determine the implications of international trade and investment agreements (TIA) for national governments' policy space to restrict the marketing of unhealthy food and beverages to children.

DESIGN

In-depth interviews based on a series of policy scenario 'vignettes,' guided by an adapted scenario analysis methodology.

SETTING

Global.

PARTICIPANTS

Nine key informants from relevant sectors, with expertise regarding the intersection of public health nutrition policy, international trade law and international investment law.

RESULTS

Participants consistently identified the relevance of several principles, common to many TIA: non-discrimination, necessity and justification, market access requirements and quantitative restrictions, intellectual property rights and trademark protections and fair and equitable treatment of investors. Two main policy design factors that interact heavily with TIA-related policy space were the framing of objectives and regulatory distinctions drawn. Contextual factors may shape the analysis of TIA-related policy space on a case-by-case basis, while the relative power of the actors and institutions involved in both domestic and international policy spheres may influence whether and how such legal constraints to policy space are activated.

CONCLUSIONS

Regulatory marketing restrictions run the risk of incurring challenges under World Trade Organization agreements and other free TIA. However, concerned policymakers should be aware of the difference between theoretical risk, threat of a challenge and realistic initiation and/or loss of a formal dispute. Our findings indicate that there is policy space to adopt significant marketing restrictions, though an understanding of these legal risks and strategic policy design are important.

Challenges and opportunities of the fourth revolution: a brief insight into the future of food

By 2050, the global population is projected to be in excess of nine billion people. This will result in an increased burden and stress on the food production systems, particularly in adjustments to several stages of the value chain that will require improvements and/or modifications in their effectiveness such as reducing waste, adapting to climate change, food security, and health. Disruptions such as digital agriculture, digital food, food agility, big data, have been utilized to characterize the changes in the way agro-food systems evolve and function, as well as in the approach they have been analyzed, measured, and monitored. It has been long recognized that the food industry is considered as a data driven enterprise. These characteristics are very important as the food industry becomes global and sustainable. The food industry is currently undergoing significant changes, and with this, challenges are occurring. These challenges are brought about from the food chains, climate changes, and the ability to be resilient in the production of food. Furthermore, health and cultural changes to food are occurring, where the diseases of obesity, diabetes, and aging in the population will continue to change the consumer's patterns and choices; whereby the consumer will be persuaded to choose and eat healthy and more nutritious foods. Indeed, the cultural awareness and social innovation to prevent food waste and therefore improve food security and sustainability will also prove to further complexities. This short review will briefly discuss some of the forefront issues in food value chains with a focus on using technology.

Towards food supply chain resilience to environmental shocks

Environmental variability and shock events can be propagated or attenuated along food supply chains by various economic, political and infrastructural factors. Understanding these processes is central to reducing risks associated with periodic food shortages, price spikes and reductions in food quality. Here we perform a scoping review of the literature to examine entry points for environmental variability along the food supply chain, the evidence of propagation or attenuation of this variability, and the food items and types of shock that have been studied. We find that research on food supply shocks has primarily focused on maize, rice and wheat, on agricultural production and on extreme rainfall and temperatures-indicating the need to expand research into the full food basket, diverse sources of environmental variability and the links connecting food production to consumption and nutrition. Insights from this new knowledge can inform key responses-at the level of an individual (for example, substituting foods), a company (for example, switching sources) or a government (for example, strategic reserves)-for coping with disruptions.

Stakeholder Perceptions of Policy Tools in Support of Sustainable Food Consumption in Europe: Policy Implications

Transitioning agri-food systems towards increased sustainability and resilience requires that attention be paid to sustainable food consumption policies. Policy-making processes often require the engagement and acceptance of key stakeholders. This study analyses stakeholders’ solutions for creating sustainable agri-food systems, through interviews with a broad range of stakeholders including food value chain actors, non-governmental organizations, governmental institutions, research institutions and academic experts. The study draws on 38 in-depth, semi-structured interviews conducted in four European countries: France, Iceland, Italy and the UK, as well as three interviews with high-level EU experts. The interviewees’ solutions were analysed according to a five-category typology of policy tools, encompassing direct activity regulations, and market-based, knowledge-based, governance and strategic policy tools. Most of the identified solutions were located in the strategic tools category, reflecting shared recognition of the need to integrate food policy to achieve long-term goals. Emerging solutions—those which were most commonly identified among the different national contexts—were then used to derive empirically-grounded and more universally applicable recommendations for the advancement of sustainable food consumption policies.

Sustainability of Mussel (Mytilus Galloprovincialis) Farming in the Po River Delta, Northern Italy, Based on a Life Cycle Assessment Approach

Molluscan shellfish aquaculture is considered a “green” industry because of the limited presence of chemicals and risk of pathogens during farming in licensed areas, which provide a safe, nutritive and healthy food source. Moreover, the environmental impact of their production is lower than all other fish animal per unit of protein. In particular, mussels’ production was the first organized mollusk aquaculture in Europe and is now one of the most extended. Italy is the second main European producer of mussels. Taking into account the relevance of the sector, Italian Mediterranean mussel (Mytilus galloprovincialis) aquaculture has been considered for a life cycle assessment (LCA), from a cradle-to-gate perspective. The mussel farms were located in the northern Adriatic Sea, close to the Po River Delta, a region traditionally vocated to bivalve aquaculture. Results have shown that the growing and harvesting phases are the most critical life cycle stages (“hotspots”) due to the production and use of boats, and the great quantity of non-recyclable high-density polyethylene (HDPE) socks used during the yearly productive cycle. Several improvement potentials have been identified and estimated by means of a sensitivity analysis. Furthermore, regarding the principal exporting countries to Italy (Spain and Chile), the transport factors in an overall sustainability assessment have been considered, in order to compare the local and global mussels supply chain.