Chadwick, for example, subscribed to the miasma theory of contagion: that disease was spread by foul air. Chadwick had his contradictions.
Reshaping agriculture for nutrition and health : an IFPRI book
On the one hand he believed in market discipline, but on the other hand he was convinced that the public interest had to take priority when making policy decisions about the shape of society and its public health infrastructure. His real legacy was to champion the notion that the public good cannot be delivered without effort and firm commitment. When considering the sober tasks ahead, a long view of the nexus of food, supply, health, environment, and culture is required. Over the last 10 years, key transformations in supply have reshaped health and culture: how we eat and food's meaning see Table 1.
From this perspective, the changes of the 20th century are only the most recent in a series of revolutions. But as Table 1 indicates, the scale and pace of change has accelerated more recently and the increase in output has been unprecedented. Since World War II, more food per capita has been produced globally. More mouths have been fed. Supply chains and trade routes have grown.
Nowhere has this picture of advance been clearer than in the United States. Total supplies, measured in calories, rose over the 20th century. The US food system has been characterized by oversupply rather than undersupply. When measured against its already generous starting point, the 20th century yielded even more. By an extra calories per person per day were being produced in the United States than in , and this for a larger population.
Throughout the last century, US farms revolutionized what they did and how they grew what they grew. The range of crops dropped. Markets concentrated. Farm size grew. The rural population fell. In , for instance, US farms had 12 million horses and mules and just over 2 million tractors.
Just 15 years later, the animals were down to 2 million and tractor numbers had doubled. More importantly for the wider US economy, this combination of technical and economic changes, both on and off the farm, facilitated the fall in the proportion of disposable income that US consumers spent on food, even while the actual expenditure rose.
In , an average of By , this was down to 9. This pattern shift in food production and costs is almost always interpreted as progress, particularly for people on low incomes. Its appeal to consumers was modernity, enabling them to trade up, to eat foods previously the preserve of the affluent, and buy other things.
Meat and dairy products, for example, could become everyday foods rather than just special treats. This illustrates the mismatch of US production, consumption, and health which has translated so heavily into burdens on US healthcare. The revolution on farms and in supply chains enabled but also responded to dramatic changes in consumer food culture, encapsulated by the term nutrition transition.
As populations get wealthier and are subject to powerful marketing and changed availability of foods, their pattern of diet changes from traditional staples to processed foods, which are fattier, saltier, and sweeter. Feast day foods become everyday foods. Meat and dairy consumption rises.
Sugary drinks replace water. Diets that are now known to be inappropriate for health become normalized. Huge marketing expenditure influences this process. Just how can tiny health budgets possibly compete let alone compensate for such vast sums? To add to the inequality of weight between health and the sheer avalanche of food products, today new viral, virtual, text, and other marketing methods have now joined traditional forms of 20th-century reach such as TV, radio, and print media, as well as sponsorship, educational materials, and funding. The net effect is that food culture has been reengineered, which is why it is folly for public health proponents to restrict their actions to narrow conceptions of education.
By food culture is meant the sum of how humans relate to food, where and how we shop, our tastes, the experience, how we get to and from the food point of contact, our conceptions of quality and normality, and our aspirations. Table 2 gives an overview of this broader conception of food culture and how patterns of food purchasing, type, format, and meaning have changed in developed societies across two centuries of industrialization.
In the developing world today, these transitions are often concertinaed. The challenges that these processes raise for policy-makers are both daunting and exciting. One challenge has been to reengage public policy-makers with their responsibilities for the public good. With the ascendance of neoliberalism in economics in the s and its triumph as the dominant force in national and international politics in the s—the transition that generated the so-called Washington Consensus 29 —the role of government came under attack and was weakened.
Food governance was articulated as a relationship between consumer, corporation, and markets. This happened differently in different countries but generally a narrow conception of market logic dominated, triumphing at the General Agreement on Tariffs and Trade, which achieved a global agreement to reduce tariffs, open up trade, and allow big companies to define food markets. Today, with the banking liquidity bailout still close, we are reminded of the limits of what markets mean and, to restate the core challenge, in food and health policy, we now have to engage with more than just insufficiency of nutrients, the 20th century's challenge.
This century now has to address a more complex picture of under-, over-, and malconsumption simultaneously on a massive scale. Even a rich country like the United States has well-documented populations suffering food insecurity. Food policy needs to change rapidly; hunger politics needs to be fused with the new politics of how food is grown; how the supply chain works; how as well as whether it gets to the consumer; how and whether consumers burn off the calories; how sustainable the food supply chain from farm to consumer is; and so on.
In this new analysis, our conception of public health has to be carefully rethought. Delicate issues of politics run throughout the policy terrain of food and health, from issues of accountability to questions of collective versus individual responsibility. We can have confidence, however, that the case for redesigning food policy on ecological public health grounds is based on sound science.
One might have expected a quick uptake.
Reshaping agriculture for nutrition and health
Some governments ignored or refused to consider it, whereas others notionally accepted but then marginalized it, a sober reality check for those who believe the language of evidence-based policy, a reminder that science is about values and policy levers not just evidence. The stakes for sound relations between policy and science are high in an era of climate change, energy, and water stress, and when knowledge about physiology is being transformed by genomics. What difference does this emerging big picture make? Certainly it makes food and health policy harder and the process of policy-making more politically delicate.
The terrain requires a judicious mix of detail and panorama. Setting priorities can only be resolved by debate and good governance but contenders may be identified. The following section considers 7 of them. Getting the conceptual framework right for food policy has never been more important. It is the lens through which everything is viewed and delivered.
Ecological thinking within public health is not per se new—the word ecology was invented by Haeckel in the midth century 35 —but is essential for the 21st century. The word ecological conveys two linked but distinct ideas. One promotes the idea that food is the result of relationships, actions in a web, and sees public health as a sequence of actions to protect and enhance health through food.
The other highlights how food connects people and planet; here ecological stresses our reliance on the thin membrane of biomass that surrounds the surface of Planet Earth. Trying to capture this notion of ecological public health, Geof Rayner and I have proposed that policies ought to aim always to address 4 dimensions or levels of existence. The second is the physiological world, by which is meant the importance of biology and the bodily processes that transform food—not just calories but micronutrients too—into bodily manifestation; food's biological impact is shaped by inherited genetic potential.
The third is the social world, by which is meant the human relationships and all the societal institutions and interactions that frame how humans live, our domestic and working and everyday lives. The fourth is the cognitive world of interpretive structures within the human mind that are necessarily personally experienced and yet have meanings that others may share. This refers to how consciousness of existence shapes our actions. To see food and health as shaped by the interplay of these 4 dimensions requires us to think in a cross-disciplinary way. By doing so, we can make sense of what and when public health works.
To improve hygiene and contain infections, for instance, requires not just an understanding of microbiology but of social and cultural relationships, too, because the latter facilitate transmission. That is why changing human behavior is always part of public health campaigns. Tackling tuberculosis, for instance, involved changing cultural mores about spitting in public, washing hands, and so on. Similarly, stopping food-borne infections requires food handlers to behave differently, imposing barriers in what might be otherwise convivial relations with colleagues.
Yet so much policy effort to tackle food-related noncommunicable diseases has been limited to health promotion via soft policy levers such as education. Is it any wonder that education programs have struggled when competing with the might of food industry marketing? If we are serious about altering diet-related ill health, action needs to be coherent across all levels of existence.
An example of current incoherence concerns the consumption of fish. Nutritionists encourage consumers to eat fish for their essential fatty acids, yet environmental analysis of the seas point to fish stocks being at danger levels. Both sources of evidence are true but their implications for policy are not joined up. The advice needs to be changed: eat only sustainably sourced fish; or get your essential fatty acids from seeds and seaweed, whatever is appropriate culturally and nutritionally.
The point is that nutrition needs to be based on environmental principles. In the s, the public health champions of the new food policy approach won the day by showing how health could be injected into the business model and that some business could benefit. Just as environmentalists have been trying to reformulate what is meant by efficiency for an era molded by climate change and energy pressures, 39 so ecological public health needs to be injected into the food business model.
Carbon footprint audits are beginning to feature in company reports and accounts, measurement being a first step toward reducing greenhouse gases GHGs. Some voices in business dismiss the ecological public health perspective as too complex and challenging or as containable by offering niche products.
Yet new ways of farming were seen as too difficult in the s, only for the dustbowl, recession, and world wars to bring them to the fore. Winning business to health-focused change in the s required opportunism, hard work, and perseverance by policy thinkers and researchers. Efficiency and markets need to be redefined. Productivity increases are needed but not at all costs. Twenty-first-century food production will have to be low carbon and water efficient. It will have to use land sustainably, protect soil structure, and rebuild, not just freeze biodiversity at current collapsing rates.
Long supply routes, profligate energy use, and distorted price structures for nutrients—which have successfully delivered cheap calories while failing adequately to internalize the cost of environmental and health burdens—will have to be reworked. Moving food policy to an ecological public health perspective will require cool political judgment. Food is subject to extremely powerful lobbies. Commercial interests dominate food messaging space. Junk food can too easily triumph.
Although the language of consumerism accords primacy to the consumer, in fact power and markets are highly concentrated in most countries, and a global super elite has emerged. This inequality of power in the food system needs to be rebalanced. Competition policy is lagging far behind commercial reality; it ought to be a friend of public health.
Controls on marketing are also sorely needed.
How else can the informational imbalance between companies and health departments be righted? The annual marketing budgets of two giant food corporations dwarf the biannual budget of the WHO. Part of the rebalancing of power over the food system requires public health bodies to be more assertive. For decades, the prevailing ethos has been to rely on soft health policy measures such as labeling, health education, advice, and therapeutics that can be individualized rather than on population-wide or hard measures such as fiscal or championing regulatory interventions.
Both soft and hard measures are required but whichever is used, emphasis is needed on tackling upstream causal drivers not just on downstream consumer behaviors. Power relations in the food system are not static, however; they have shifted in the 20th century from farmers to manufacturers and now to retailers and traders, with the wholesalers also seeing an erosion of their position in many product supply chains.
The consciousness industries marketing and advertising too have a huge presence, a feature of the shift from producer-driven to buyer-driven supply chains. Western values are often said to center on constitutional as well as historical commitments to freedom and choice. Yet the imbalance of power in the food system, and the complexity of inequalities within and between societies in their access and availability of food, suggests that we need to debate what choice means in reality.
Some argue that public health proponents can learn from the food industry—appealing to consumers to choose health— whereas others believe that we must do things differently. Advocates of social marketing argue that public health can harness the experience and techniques of the advertising industry. In truth, democracy is messy and takes time; control is neater but harsher and riskier.
Ideologically, food and health policies have tended to be locked in to consumerism and choice. Yet choice can mean different things; even in prisons, where food selection is seriously restricted, there are choices. Choice is not an absolute driver of food and health. Indeed, choice is a dimension not a state of existence see Figure 1.
In Figure 1 , the consumerist ideal of unrestricted choice is at the left end of the dimension, whereas poorer consumers remain closer to the limitations of choice experienced in total institutions such as prison. Rethinking choice for the era of ecological public health.
Source: Lang et al. As their wealth rises, consumers can move leftwards along the dimension of choice. Though developing countries need to give their consumers more choice, ecological public health for rich societies like the United States and UK probably means less of certain kinds of choices. All the yearround strawberries come at a cost as supply chain managers of Western supermarkets range the world for sources. There are not enough planets to feed the world with the volume or range enjoyed by Americans or Europeans. Does this mean producing fewer cheap calories and consumers eating differently?
The advantages of simplicity and consuming less might be greater if the benefits were clearer. This is the term for the process used by retailers whereby they decide what to offer consumers and how to present it. Category buyers in retail chains filter what gets presented on shelves; their contracts and product specifications have more immediate impact on choice than consumers. Public health priorities need to be part of that choice-editing process. Food policy architecture straddles a 5-level food governance system: global, regional, federal, state, and community.
This multilevel governance structure offers potential for better public health learning while adding further difficulties to already complex terrain. Public interest nongovernmental organizations NGOs have tended to pursue their interests through the UN, while business tends to see its allies in the Bretton Woods institutions. One implication of multilevel food governance is the need to be clear about the appropriate level for ecological public health intervention.
The right allies need to be in place; lines of communication should not be restricted to existing power brokers but across the food system. In the longer term, we need to debate whether the institutional imbalances and divisions of responsibility are fit for purpose. Attempts to integrate nutrition across the UN, via the Standing Committee on Nutrition, for example, have been honorable but tortuous. They have not achieved requisite policy leverage. But what institutions would be needed to deliver coherent ecological public health?
And how could agreement be achieved across ministries, at the national level, to integrate health, culture, and food supply? In private, many believe it will take crises—such as threatened in — with runaway food commodity prices—to bring fissiparous agencies together. But in such circumstances, already powerful voices can dominate input to decisions.
The main challenge for institutional reform is to inject ecological public health across existing departments and bodies. Climate change is already proving to be one such common rallying point, but the ecological public health perspective is more than climate change, important though that is. Seeing the breadth of what needs to be addressed sends signals to policymakers about the need to ensure that institutions are appropriate. A UK — Cabinet Office review of food policy which saw the nutrition— environment link led to the creation of a new cross-government food policy committee with parallel ministerial and civil service structures.
The case for having a top-level integration point had become overwhelming.
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Time will tell as to its effectiveness but without such a structure, there is no chance. The smaller Nordic countries have also been experimenting with such structures. A theme for future food and health policy will be how to link the strong evidence on public health nutrition with equally strong evidence on the environmental attributes of eating. It is inconceivable that all humanity could eat a diet such as that consumed by many Americans or Western Europeans, high in calories and intensive in energy use.
Rich, developed countries will have to lower their food system's ecological footprint. This is a matter of inter- as well and intranational justice. Within climate change negotiations, for example, the justice issue has come to the fore. It deserves to for food policy, too. There is more than a whiff of neocolonialism when Western advocates of sustainability target China or India for aping Western lifestyles.
It is Western countries that developed food systems into oil dependency for mechanization, agrichemicals, and fertilizers. Humans inhabit an ecological niche on a crowded, delicately balanced planet where our actions threaten serious dislocation and perhaps even catastrophe. Defining what a sustainable food system is has become an urgent matter. The UK government took tentative steps in the right direction with its Food Matters report, which set priorities on nutrition and greenhouse gas reduction. Slowly, the competing demands long faced by consumers trying to eat sustainably are being acknowledged by policy-makers.
What is a sustainable diet? How can it be delivered? Some argue that for developed countries, it is dietary simplicity: eating less, consuming fewer preprocessed foods, cooking more from raw, seasonal ingredients. Others counter that only highly centralized food production units i. Undoubtedly food policy for the ecological public health era will need cross-disciplinary research.
As was noted above, the pursuit of evidence-based policy is more complicated than the term implies. Policy-makers do not receive consistent or coherent evidence. Often, the evidence that academics believe needs policy responses appears irrelevant to policy-makers. As well as evidence-based policy, we need to conduct research that is policy relevant, providing data on troublesome issues.
An example of the latter is the cost of food. More sustainable food tends to imply rising costs, reversing the long decline in food process and the proportion of domestic expenditure on food. This has big implications for social equality; does making food more costly help or hinder the poor? This is fundamentally a political question. For decades, progress has been defined as cheaper food, yet now we know that prices also need to internalize the full cost of environmental and health externalities. There is already a vibrant debate about the potential of taxing fat, but consider how much more complex this policy debate needs to be if the food system is to reduce carbon, or if carbon and calories are not neatly aligned.
In the EU, a carbon trading system began in , giving carbon a price to incentivize CO 2 emission reduction, rather as the US created the Acid Rain Program to price sulfur and nitrous oxide to reduce acid rain. Such schemes are favored by economists and bankers, not least since they create new lines of business in themselves.
It remains to be seen if they can actually cap, reduce, and contain bad practice more effectively than direct market interventions. Moreover, it is uncertain if they can or will reshape consumer culture which other analyses suggest might be a key factor.
No single research project can be expected to tick all such boxes, but research programs must collectively do that. An immediate area for research is how to define a sustainable diet in locally appropriate ways. It is not likely that a sustainable diet would be the same in uplands of the United States as in Africa or China but the principles might be. GFAR is an open forum and a movement for change. KFA4: Demonstrating impact and improving investments. Foresight for Better Futures. Transformative Investments. Accountability for Action.
All aboard the Chachafruto Express. Food Biodiversity: The bottomless well of innovation. Diversified Agri-food Systems: Bastions of biodiversity, nutrition GCARD3 ends with commitment to go forward together. City : Canberra. Country : Australia. Social Share Share to.
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