Food Systems: Pathways for Improved Diets and Nutrition

Reshaping Food Policy and Governance to Incentivize and Empower Disadvantaged Groups for Improving Nutrition

The coronavirus disease 2019 (COVID-19) pandemic has exacerbated global malnutrition challenges, disrupted food supply chains, and left poor and vulnerable people unable to produce and access safe and affordable food, especially in developing countries. Food policy and governance are currently malfunctioning, despite their recognized roles in improving food security and public nutrition in many local and national contexts. This article reviews existing food policies and governance with implications for disadvantaged groups in the food systems, particularly smallholder farmers, women, and small- and medium-sized enterprises (SMEs), highlighting the importance of reshaping food policies and governance. To end malnutrition in the post-COVID era, multiple sectors, including health, agriculture, social protection, education, and infrastructure, must make greater collaborative efforts to develop and implement food and nutrition policies. Several recommendations for reshaping food policy interventions and governance are summarized.

Household Decision-Making: Implications for Production, Consumption, and Sale of Nutrient-Rich Foods

Household decision-making influences choices related to the production, sale, purchase, and consumption of nutrient-rich foods. The present study assessed the effect of household decision-making in two regions of Ethiopia within two groups of households, most vulnerable households and model farmer households. The study focused on identifying barriers and facilitators relating to decisions about nutrient-rich foods-in this case fruits, vegetables, and animal source foods. The results provide insights into how future agricultural programs can affect key aspects of decision-making to maximize the positive impacts on diet and food security.

Food Systems as Drivers of Optimal Nutrition and Health: Complexities and Opportunities for Research and Implementation

The Sustainable Development Goals (SDGs) are intricately linked to food systems. Addressing challenges in food systems is key to meeting the SDGs in Africa and South Asia, where undernutrition and micronutrient deficiencies persist, alongside increased nutrition transition, overweight and obesity, and related chronic diseases. Suboptimal diets are a key risk factor for mortality and 3 billion people cannot afford a healthy diet; in addition, food systems are not prioritizing environmental sustainability. Optimizing food systems and increasing agricultural productivity beyond calories, to nutrient-rich vegetables and fruits, legumes, and livestock, and sustainable fishing, are required. Strengthening of research around food systems-on pathways, value chains, and development and validation of metrics of diet quality-is required. The development of new technology in crop management and pest control and addressing natural resource degradation is key. Engaging with the public and private sectors, outreach to donors and policymakers, and strengthening cross-disciplinary collaborations are imperative to improving food systems.

Transforming Food Systems: The Missing Pieces Needed to Make Them Work

Food systems lie squarely at the intersection of several overarching goals of the UN and member states, as embodied in the Sustainable Development Goals, including eliminating poverty, hunger, and malnutrition in all its forms, achieving good health and well-being, while promoting environmental sustainability. The need for radical transformation of current food systems is inescapable if the world is to achieve one, let alone all, of these goals. Meeting this challenge will inevitably be disruptive to current food systems, carry costs, and be politically onerous. But the projected benefits far outweigh these difficulties. This commentary spells out the complexity of issues that need to be tackled to design and implement food systems that improve diets, nutrition, and health in an equitable fashion, while simultaneously respecting planetary boundaries. Six critical domains are identified that must be addressed for the successful transformation of food systems: 1) reinvent agriculture, 2) transform food environments for healthy diets, 3) mitigate climate change, 4) productively engage the private sector, 5) influence public policy priorities, and 6) establish true cost accounting of food. Because science is crucial for each of these domains, a research-driven strategy, emphasizing a collaborative process, is outlined. Bold, new, but technically and politically feasible actions are needed to effectively transform current food systems.

Food Crop Diversity, Women's Income-Earning Activities, and Distance to Markets in Relation to Maternal Dietary Quality in Tanzania

BACKGROUND

Women's dietary diversity and quality are limited in low- and middle-income countries (LMICs). Nutrition-sensitive interventions that promote food crop diversity and women's access to income could improve diets and address the double burden of malnutrition in LMICs.

OBJECTIVES

We examined the associations among food crop diversity and women's income-earning activities with women's diet quality, as well as effect modification by access to markets, in the context of small-holder food production in rural Tanzania.

METHODS

Data from a cross-sectional study of 880 women from Rufiji, Tanzania, were analyzed. Women's dietary intake was assessed using a food frequency questionnaire. The prime diet quality score (PDQS; 21 food groups; range, 0-42), a unique diet-quality metric for women that captures the healthy and unhealthy aspects of diet, was computed. Generalized estimating equation linear models were used to evaluate the associations of food crop diversity and women's income-earning activities with PDQS, while controlling for socio-economic factors.

RESULTS

Maternal overweight (24.3%) and obesity (13.1%) were high. The median PDQS was 19 (IQR, 17-21). Households produced 2.0 food crops (SD ± 1.0) yearly. Food crop diversity was positively associated with PDQS (P < 0.001), but the association was strengthened by proximity to markets (P for interaction = 0.02). For women living close (<1.1 km) to markets, producing 1 additional food crop was associated with a 0.67 (95% CI, 0.22-1.12) increase in PDQS, versus a 0.40 (95% CI, 0.24-0.57) increase for women living farther away. The PDQS increased with women's salaried employment (estimate, 0.96; 95% CI, 0.26-1.67).

CONCLUSIONS

Household food production may interact with access to markets for sales and purchases, while nonfarm income also improves women's diet quality in rural Tanzania. Programs to improve women's diet quality should consider improving market access and women's access to income (source of empowerment), in addition to diversifying production.