The Food System Triggering Debate - White Paper a prism of present and future challenges for health promotion and sustainable development - Ilona ...

Triggering Debate – White Paper
The Food System

a prism of present and future
challenges for health promotion
and sustainable development

With the kind support of Health Promotion Switzerland
This white paper has been authored by Ilona Kickbusch on behalf of Health Promotion Switzerland.

                                                          Lead author
                                                          Professor Kickbusch Ilona, Kickbusch Health Consult; Director Global Health Programme,
                                                          Graduate Institute of International and Development Studies, Geneva, Switzerland


                                                          This work was undertaken in close coordination and with the leadership and support of Health
                                                          Promotion Switzerland as initiator of the healthy3 initiative. A special thank you goes to the members
                                                          of the healthy3 core group.
                                                          Lead by Dr. Thomas Mattig and his healthy3 team (i.e. Mr. Ruedi Zurkinden, Dr. Ursel Broesskamp-Stone,
                                                          Dr. Thomas Streiff, Mr. Florian Kuendig, and the lead author), the core group members did accompany the
                                                          writing process and provided detailed advice, guidance and very valuable inputs:

                                                          Healthy3 team Health Promotion Switzerland
                                                          –– Dr. Thomas Mattig, Director Health Promotion Switzerland
                                                          –– Dr. Ursel Broesskamp-Stone, Head International Affairs – Senior Advisor Policy, Health Promotion
                                                          –– Mr. Florian Kuendig, healthy 3 Coordinator, Health Promotion Switzerland
                                                          –– Mr. Rudolf Zurkinden, Head Partner Relations, Health Promotion Switzerland

                                                          External experts
                                                          –– Prof. Paul Burger, Head Sustainability Research Programme, University of Basel, Switzerland
                                                          –– Dr. Natacha Litzistorf, Director Equiterre, Geneva, Switzerland
                                                          –– Prof. Dr. Jean Simos, Environmental Health, University of Geneva, Switzerland; also on behalf
                                                             of Dr. Litzistorf Natacha, Director Equiterre, Switzerland
                                                          –– Prof. Dr. Sylvie Stachenko, University of Alberta, Global Vice-President for Institutional Affairs &
                                                             Partnerships of the International Union for Health Promotion and Education (IUHPE), Canada
                                                          –– Dr. Thomas Streiff, Partner, Brugger and Partners, Zurich, Switzerland
“The most political act we do on a daily basis            –– Prof. Dr. Daniel Wachter, Head Sustainable Development, Federal Office for Spatial Development,
is choosing what to eat.”                                    Bern, Switzerland; Coordinator of the Swiss Federal Sustainable Development Strategy
     Professor Jules Pretty, University of Essex, UK
                                                          The lead author and Health Promotion Switzerland greatly acknowledge the active and very valuable
                                                          contributions of the members of the International Think Tank (ITT) into this White Paper “The Food System:
“The silent hunger crisis – affecting one sixth           a prism of present and future challenges for health promotion and sustainable development”.
of all of humanity – poses a serious risk for world       They met in November 2009 in Zurich, Switzerland:
peace and security. We urgently need to forge             –– Moderator: Mr. Mathis Brauchbar, Advocacy, Zurich, Switzerland
a broad consensus on the total and rapid eradication of   –– Dr. Fiona Adshead, Director Health Promotion, WHO (until January 2010) – current position:
hunger in the world.”                                        Director General, Department of Health, UK
                 FAO Director-General Jacques Diouf      –– Dr. Carolyn Bennett, Member of the Canadian Parliament, Former Minister of State for public health,
                                                             Ottawa, Canada
To promote health along with equity and sustainable       –– Dr. Supakorn Buasai, CEO ThaiHealth, Bangkok, Thailand
development as top priorities in local, national and      –– Dr. Tourane Corbière, Research Fellow, Industrial Ecology Group, University of Lausanne, Switzerland
international policymaking                                –– Prof. Dr. Alan Cribb, Bioethics and Education, King’s College, London, UK
                          People’s Health Movement       –– Prof. Dr. Marina Fischer-Kowalski, Professor Social Ecology, University of Vienna, Austria
The Food System: a prism of present and future challenges for health promotion and sustainable development   5

–– Dr. Uzma Hamid, Head Corporate Citizenship, and Diversity, KPMG, London, UK                                   List of contents
–– Dr. Corinna Hawkes, Research Fellow, Centre for Food Policy, Center for Epidemiological Studies
   in Health and Nutrition, University of São Paulo, Brazil
–– Dr. Eva Jane-Llopis, Head of Chronic Diseases and Wellness, World Economic Forum, Geneva,
   Switzerland                                                                                                   List of Abbreviations                                                                                             6
–– Prof. Dr. Peter Kopelman, Principal, St George’s, University of London, UK
–– Dr. Wilfred Kreisel, former Director of the WHO Centre for Health Development (WKC), Kobe, Japan              1    Introduction                                                                                                 7
   (retired in January 2006); free lancing consultant as of 2006
–– Dr. Venkatesh Mannar, President Micronutrient Initiative, Member of The Aga Khan Foundation, Canada           2 The conceptual base of the health promotion and the sustainable development agenda                              8
–– Ms. Christine Mueller, Head Food, Health and Nutrition, Swiss Federal Office for Agriculture, Bern,             2.1 Conceptual considerations                                                                                   8
   Switzerland                                                                                                   		    2.1.1 Sustainable development                                                                               8
–– Dr. François Pythoud, Head International Sustainable Agriculture, Swiss Federal Office for Agriculture,       		    2.1.2 Health promotion                                                                                      9
   Bern, Switzerland                                                                                             		    2.1.3 Linking health promotion and sustainability                                                          10
–– Prof. Dr. Daniel Tarschys, Political Science and Public Administration, University of Stockholm, Sweden         2.2 Integrating Public Health and Sustainable Development Concepts                                             11
–– Dr. Simon Zadek, Managing Partner, AccountAbility, Zurich, Switzerland
                                                                                                                 3 How food links health promotion and sustainable development                                                    14
Further special thanks go to Carmel Bouclaous, PhD student at the Graduate Institute of International and          3.1 The food system                                                                                            14
Development Studies, Geneva for her support of the lead author Prof. Kickbusch.                                    3.2 The links between food, health and sustainable development                                                 14
                                                                                                                   3.3 The challenges: equity, health, sustainability                                                             18
We would also like to thank the students of the 2010 Advanced Master of Public Health course of the Faculty of   		    3.3.1 A more equitable food system                                                                         18
Medicine of the University of Geneva who discussed and commented on an advanced draft of the White Paper         		    3.3.2 The challenge: a healthier food system                                                               20
with Thomas Mattig, Director Health Promotion Switzerland, and the healthy3 team, Switzerland: Monique           		    3.3.3 The challenge: a more sustainable food system                                                        22
Archambault, George Bediang, Laurence Bittar, Isabelle Bolon, Sophie Bucher, Anne Chatton, Maria Divorne,
Murielle Duckstein, Thierry Dutoit, Myriam Fantazi, Laurence Fehlmann-Rielle, Jackie Ferreira, Christina         4 The governance of food and health                                                                              25
Fiorini Bernasconi, Céline François, Liz Ho, Ana Lourenço, Amir Moayedoddin, Babak Moayedoddin, Angela             4.1 The governance challenges in relation to the food system                                                   25
Mota dos Santos, Nadia Nouar, Ahmed Osman, Maria-Pia Politis-Mercier, Francisco Puig, Ludovic Queuille,            4.2 The governance responses at the global level by the UN system                                              27
Simon Regard, Liliana Roldan, Merryl Schoepf, Sophie Sierro, Rama Sivapragassen, Chiara Testera Borrelli,        		    4.2.1 Food justice: combining the right to food and health                                                 28
Catherine Torriani, Raphaël Tremeaud, Joanne Wiesner, Barbara Wildi, Karin Zurcher as well as the staff:         		    4.2.2 Food security: ensuring the access to food as a key dimension of health
Prof. Philippe Chastonay, Benoît Bastard, Eric Brenner, Olivier Duperrex, Emilien Jeannot, Max Klohn, Beat       			         and human security                                                                                   29
Stoll, Astrid Stuckelberger and Florence Walker.                                                                 		    4.2.3 Food sovereignty: addressing powerlessness and democratic deficit                                    31
                                                                                                                   4.3 Governance at the national level: the emergence of comprehensive national food policies                    31
                                                                                                                   4.4 Governance at the local level: the emergence of local food policies                                        33

                                                                                                                 5    Recommendations                                                                                             36
                                                                                                                      5.1 General recommendations                                                                                 36
                                                                                                                      5.2 Global sustainable and healthy food policies                                                            37
                                                                                                                      5.3 National sustainable and healthy food policies                                                          38
                                                                                                                      5.4 Encouraging local action for sustainable and healthy food policies                                      38

                                                                                                                 6    Outlook and way forward                                                                                     40

                                                                                                                 7    References                                                                                                  42
6     The Food System: a prism of present and future challenges for health promotion and sustainable development         The Food System: a prism of present and future challenges for health promotion and sustainable development    7

List of Abbreviations                                                                                              1 Introduction

ADA           American Dietetic Association                  OCHA    Office for the Coordination of                In the 21st century, the purpose of governance should        1. H
                                                                                                                                                                                    ow can joint policy goals be developed so that
ADB           Asian Development Bank                                 Humanitarian Affairs                          be healthy and sustainable development. There is                health promotion can contribute to addressing
APHA          American Public Health Association             OHCHR   Office of the High Commissioner               a growing recognition of the significance of building           major challenges facing humankind such as
ARNS          African Regional Nutrition Strategy                    for Human Rights                              a bridge between the health promotion agenda and                food, water, fuel, changing consumption patterns,
CFS           Committee on World Food Security               OHRLLS  UN Office of the High Representative          the sustainability agenda: in many cases, the best              climate change and the environment?
CGIAR         Consultative Group on International                    for the Least Developed Countries;            choices for health are also the best choices for the plan-   2. T
                                                                                                                                                                                    hrough which strategies can a high level of com-
              Agricultural Research                                  Landlocked Developing Countries and           et; and the most ethical and environmental choices are          plementarity and integration be achieved between
CSIS          Center for Strategic and International                 Small Island Developing States                also good for health. But too frequently, the two agen-         health and the environmental, economic and
              Studies                                        SF      San Francisco                                 das are dealt with in separate debates and policy               social impacts?
DALY          Disability-Adjusted Life Year                  SCN     Standing Committee on Nutrition               arenas. There has not yet been a deep enough effort          3. W
                                                                                                                                                                                    hat conceptual framing and common language
DESA          Department of Economic and Social              UN      United Nations                                to link the two agendas and to ensure that they sup-            can help move a shared agenda forward?
              Affairs                                        UNCTAD  United Nations Conference on Trade            port each others’ normative and strategic goals in
DPA           Department of Political Affairs                        and Development                               a more systematic manner.                                    The series of white papers, initiated on occasion
DPKO          Department of Peacekeeping Opera-              UNDP    United Nations Development Programme          There is also growing awareness of how interconnect-         of the 2010 IUHPE Conference, will look at a set of
              tions                                          UNEP    United Nations Environmental                  ed many of the major challenges that we face at the          21st century challenges and explore the interfaces
EIS           Environmental Impact Statement                         Programme                                     beginning of the 21st century are – and policy makers        between policy agendas so as to explore commonal-
FAO           Food and Agriculture Organization              UNHCR   Office for the United Nations High            know that working in silos or only at the national level     ity of purpose and shared policy solutions.
              of the United Nations                                  Commissioner for Refugees                     does not provide solutions. Yet it remains difficult to
FDA           Food and Drug Administration                   UNICEF  United Nations Children’s Fund                engage other sectors in joint policy action at all levels
FFFI          Fresh Food Financing Initiative                USA     United States of America                      of governance, in particular around “wicked problems”           This first paper deals with the food system
GAIN          Global Alliance for Improved Nutrition         USDA    United States Department of Agriculture       for which there is no easy or quick solution. This ap-          as a prism of present and future challenges
GECFS         Global Environmental Change and Food           WB      World Bank                                    plies in particular to the greatest challenge in today’s        for health promotion and sustainable devel-
              Systems                                        WFP     World Food Programme                          world, the increasing inequity between and within               opment, and sets the attainment of a sustain-
GM            Genetically Modified                           WHO     World Health Organization                     countries – with the burdens of unsustainable devel-            able food system – “a system that can supply
HO            Health Organizations                           WTO     World Trade Organization                      opment falling disproportionably on the poorest. It is          safe, healthy food with positive social benefits
IDB           the Inter-American Development Bank            WTO-AoA World Trade Organization Agreement            therefore one of the key goals of the healthy3 initia-          and low environmental impacts” (Ambler-
IFAD          International Fund for Agricultural                    on Agriculture                                tive to move from a “silo” to “systems” approach.               Edwards et al., 2009) – as the joint policy goal.
              Development                                                                                          Health promotion has always been dedicated to work-             It is aimed both at the health promotion
IFPRI         International Food Policy Research                                                                   ing with others: health is everybody’s business. Ensur-         and the sustainable development community.
              Institute                                                                                            ing a commitment to health across government and by
IHR           International Health Regulations                                                                     many different societal actors is critical for addressing
ILO           International Labour Organization                                                                    the major social determinants of health. For many hu-
IMF           International Monetary Fund                                                                          man beings, it is good governance that makes the dif-
IUHPE         International Union for Health Promo-                                                                ference between life and death – it provides access to
              tion and Education                                                                                   education, health care, social protection, the rule of
MDGs          Millennium Development Goals                                                                         law and participation in the economy. It is from this un-
NCDs          Non-Communicable Diseases                                                                            derstanding that policy concepts such as health in all
NFA           National Food Administration                                                                         policies and investment for health, approaches such as
NGO           Non-governmental organization                                                                        health in the settings of everyday life, and instruments
NHANES        National Health and Nutrition                                                                        such as health impact statements have been developed.
              Examination Survey                                                                                   Based on these experiences, the healthy3 initiative
NYC           New York City                                                                                        wants to take health promotion concepts and strate-
                                                                                                                   gies one step further by exploring three questions:
8    The Food System: a prism of present and future challenges for health promotion and sustainable development                            The Food System: a prism of present and future challenges for health promotion and sustainable development              9

2 The conceptual base of the health promotion                                                                                         Fig. 1: Visual Representation of Sustainable Development – Interlocking Circles
                                                                                                                                      (Source: IUCN, 2006)
  and the sustainable development agenda
“Human beings are at the centre of concerns for                  their rights and obligations and mediate their differences
sustainable development. They are entitled to a healthy          (UNDP Glossary).
and productive life in harmony with nature.”                     Health governance: The actions and means, adopted by
                (Rio Declaration, 1992, first principle)        a society, to organize itself in the promotion and protection of
                                                                 the health of its population (Dodgson, Lee & Drager, 2002).
                                                                 Environmental governance is best understood as the establish-
2.1 Conceptual considerations                                    ment, reaffirmation or change of institutions to resolve conflicts
                                                                 over environmental resources. It also explains why the
                                                                                                                                                                      Bearable                                 Equitable
In order to enable a dialogue, it is important to de-            choice of these institutions is a matter of social justice rather
velop an understanding of the conceptualizations                 than of efficiency (Paavola, 2007).
of both health promotion and sustainable develop-
ment.                                                            2.1.1 Sustainable development
Both concepts have evolved in the last decades and               The concept of sustainable development is more than
there is a rich debate and literature which cannot               “sustainability”. While sustainability is frequently
                                                                                                                                                     Environment                           Viable                                Economic
be reflected fully in this paper. Yet some important             understood as durability in terms of programme
common features can be highlighted. Both health                  implementation, sustainable development implies
promotion and sustainable development are norma-                 a paradigm shift from a model of development based
tive concepts which aim to bring about a significant             on inequity and exploitation of resources to one that
paradigm shift in how societal development is under-             requires new forms of responsibility, solidarity and
stood: they aim at nothing less than to redefine the             accountability not only at the national but also at the
interface of society with biological and ecological              global level.
systems. Both conceptualizations want to achieve
transformative change in society and propose new                 Glossary: “Sustainable development is development that meets
governance mechanisms in different sectors and                   the needs of the present without compromising the ability of         The governance challenge of sustainable develop-          Glossary: Health promotion is the process of enabling people
spheres of activity. It has been said that sustainable           future generations to meet their own needs. It contains within it    ment involves:                                            to increase control over, and to improve, their health. To reach
development is perhaps “the most challenging politi-             two key concepts: the concept of ‚needs‘, in particular the es-      –– a commitment to equity within and between              a state of complete physical, mental and social well-being, an
cal concept that has been developed to guide govern-             sential needs of the world’s poor, to which overriding priority         societies and between generations,                     individual or group must be able to identify and to realize aspira-
ment action” (Spangenberg, 2003). Within the health              should be given; and the idea of limitations imposed by the state    –– the responsible use of resources and                   tions, to satisfy needs, and to change or cope with the environ-
arena, a similar statement can be made for health                of technology and social organization on the environment’s abil-     –– policy approaches that recognize the inter­            ment. Health is, therefore, seen as a resource for everyday life,
promotion.                                                       ity to meet present and future needs” (Our Common Future –              dependence between sectors.                            not the objective of living. Health is a positive concept empha­
This paper will therefore attempt to focus in particu-           Brundtland Report, 1987).                                                                                                      sizing social and personal resources, as well as physical capaci-
lar on governance challenges that arise in relation                                                                                   2.1.2 Health promotion                                    ties. Therefore, health promotion is not just the responsibility
to food, health promotion and sustainable develop-               This approach has frequently been represented as the                 Health, according to the Ottawa Charter (1986), is        of the health sector, but goes beyond healthy life-styles
ment.                                                            interaction between three pillars or three circles: econ-            created in the context of everyday life – that means it   to well-being (Ottawa Charter, 1986).
                                                                 omy, society and the environment – as in the following               is part of the social dynamics of social organization,
Governance: Is the conscious creating, shaping, steering,        illustration:                                                        lifestyles and patterns of consumption, but also (and     Health promotion implies a paradigm shift from
strengthening and using of international and transnational                                                                            this is frequently neglected) part of the interaction     a deficit model of health focused on disease (the bio-
institutions and regimes of principles, norms, rules and                                                                              with the bio-physical environment. Figure 2 (Dahl-        medical model) to a socio-ecological model aimed at
decision-making procedures that influence how autonomous                                                                              gren & Whitehead, 1991) illustrates the original con-     strengthening resilience and assets for health – in
actors behave (Krasner, 1983).                                                                                                        ceptual model on which health promotion is based.         particular by addressing the social determinants of
Governance is a neutral concept comprising the complex mech-                                                                          People are in the center of a complex web of individ-     health and the capabilities for health.
anisms, processes, relationships and institutions through                                                                             ual, social, economic, cultural and environmental
which citizens and groups articulate their interests, exercise                                                                        factors which impact on their health and well-being.
10   The Food System: a prism of present and future challenges for health promotion and sustainable development                                                                        The Food System: a prism of present and future challenges for health promotion and sustainable development          11

Fig. 2: Factors that influence our health                                                                                                                                       tinue to develop largely in parallel – also because                  2.2 Integrating Public Health and Sustainable
(Source: Dahlgren & Whitehead, 1991)                                                                                                                                            they have frequently been too narrowly conceived as                       Development Concepts
                                                                                                                                                                                dealing with “health” and “environment” respectively
                                                                                                                                                                                rather than as normative concepts with major simi-                   For health promotion, the first principle of The
                                                                        om    i c , c u lt u r a n d e n v i r o             nme                                                larities in their implications for governance.                       Rio Declaration (1992) is of eminent importance:
                                                            -e   co n                                                                  nt a
                                                                                                                                              l co                              Clearly, sustainability is a “larger” agenda than                    “Human beings are at the centre of concerns for sus-
                                                   o   c io                                                                                          nd
                                               s                                                                                                          itio                  health promotion as it constitutes a general princi-                 tainable development. They are entitled to a healthy and
                                        r   al                                                                                                                   ns
                             G   en                                               Living and                                                                                    ple on how we organize our societies overall. Health                 productive life in harmony with nature.”
                                                                               working conditions                                                                               promotion continually challenges health policy with a                This sentence resonates with the Declaration of
                                                                                                                                                                                socio-ecological perspective on how we organize                      Alma Ata (1978) which frames health as contributing
                                    Work                                                                                                                                        health in our societies in a more sustainable manner.                to a socially and economically productive life. Health
                                 environment                                                                                                                                    Its commitment to a social concept of health creates a               is both an outcome of key determinants and a contri-
                                                                                 an   d co m m u n i t y n e t w                                                                special affinity to the concept of social sustainability.            bution to societal development and well-being. The
                                                                        c   ia l                                             or
                                                                                                                                                          Water and
                                                                   So                                                                                                           Yet, health promotion needs to engage more system-                   determinants-based approach makes it easy for
                      Education                                                                                                                           sanitation
                                                                                                                                                                                atically in approaches which create a complementa-                   health promotion to relate to the concept of sustain-
                                                                                            l lif e s t y l e f a
                                                                                 vi   dua                           ct                                                          rity between health and the environmental, economic                  ability, and to the three pillars of sustainable devel-
                                                                              di                                         o                                        Health care
                                                                                                                                                                                and social dimensions of sustainable development.                    opment as they have been summarized by many au-

                Agriculture                                                                                                                                        Services
                                                                                                                                                                                                                                                     thors – economic, social and environmental. To date,
                 and food
                                                                                                                                                                                Background: While some principles of what later came to be           most attempts to link health promotion and sustain-
                production                                                                                                                                            Housing
                                                                                                                                                                                understood as a sustainability agenda were already expressed         ability reflect thinking similar to the approach illus-
                                                                                                                                                                                in the Health for All principles of the World Health Organization    trated in Figure 3 from the Public Health Agency of
                                                                                       Age, sex and                                                                             in the late 1970ties, the Ottawa Charter for Health Promotion        Canada (originally developed by Hancock, 1993).
                                                                                      constitutional                                                                            in 1986 was one of the first health documents to make explicit
                                                                                         factors                                                                                reference to the responsible use of resources. It states: “The
                                                                                                                                                                                overall guiding principle for the world, nations, regions and
                                                                                                                                                                                communities alike, is the need to encourage reciprocal mainte-
                                                                                                                                                                                nance – to take care of each other, our communities and our
                                                                                                                                                                                natural environment. The conservation of natural resources
                                                                                                                                                                                throughout the world should be emphasized as a global respon-
Glossary: Determinants of health refer to the many factors                                           –– a commitment to health equity within and between                        sibility.” The third World Health Conference on Health Promotion
which combine together to affect the health of individuals and                                          societies through action on the social determinants                     – organized jointly by the WHO and the UNEP in 1991 in Sunds-
communities. Whether people are healthy or not, is determined                                           of health,                                                              vall Sweden – was dedicated to this principle which, in the health
by their circumstances and environment. The determinants                                             –– investment for health as a valuable resource for                        promotion debate, has been referred to as the socio-eco­logical
of health include: the social and economic environment, the                                             individuals, communities and societies – indeed                         model of health. The Sundsvall Declaration on Supportive
physical environment and the person’s individual characteristics                                        for the global community as a whole,                                    Environments for Health was adopted and taken to the Rio Earth
and behaviours (                                                    –– horizontal policy approaches – health in all poli-                      Summit in 1992. It was one of the documents that contributed
Capabilities, referred to as functional, are construed in terms                                         cies – that recognize the value of health in all                        to the inclusion of health in the Agenda 21 document, with Chap-
of the substantive freedoms people have reason to value, instead                                        sectors and are accountable for health impact.                          ter 6 focusing on Protecting and Promoting Human Health.
of utility. They include happiness, desire-fulfillment, choice                                                                                                                  Since then, public health agencies and health promotion organi-
or access to resources. The emphasis is not only on how human                                        2.1.3 Linking health promotion and sustainability                          zations around the world have responded to the global sustain-
beings actually function but on their having the practical choice,                                   Sustainability and health promotion share impor-                           able development agenda as well as to the sustainability policies
to function in important ways if they so wish (Sen, 1979).                                           tant similarities with regard to their normative and                       of their respective national governments and local authorities.
                                                                                                     conceptual base as well as their integrative ap-                           References to population health are frequently found under the
Health Promotion considers health a human right                                                      proaches to governance.                                                    heading of social sustainability.
and is deeply committed to equity, social justice and                                                There has been a gradual convergence and over­
empowerment. The governance challenge of health                                                      lapping of agendas (Dooris, 1999) and an evolution of
promotion involves:                                                                                  thinking in both arenas. Yet the two frameworks con-
12   The Food System: a prism of present and future challenges for health promotion and sustainable development                     The Food System: a prism of present and future challenges for health promotion and sustainable development   13

Fig. 3: Relationship – Public Health and Sustainable Development                                                              Fig. 4: Representation of Sustainable Development –
(Source: Public Health Agency of Canada)                                                                                      Concentric Circles
                                                                                                                              (Source: Ott, 2003)

                                                                                    Vibrant and Just Society
                                                                                    Supportive social networks and
         Flourishing Environment                                                    cultural values
         Healthy ecosystems                                  Quality of Life        Sound education and high                                         Economy
         Supportive built environments                                              literacy rates

                                                             Healthy and
                                       Healthy               Communities       Strong Public
                                       Environments                            Health Capacity                                                     Environment

                                       Prosperous Economy
                                       Reduced impact of disease and injury
                                                                                                                              Both health promotion and sustainable development
                                       Increased emergency preparedness and response
                                                                                                                              contribute to shifting the discourse on 21st century
                                       Reduced pressure on the health care system
                                                                                                                              risks and challenges, often with the same aim but with
                                                                                                                              different starting points.
                                                                                                                              Many of the same driving forces and political factors
                                                                                                                              need to be addressed in order to affect the trans-
                                                                                                                              formative change explicitly sought in both concepts.
                                                                                                                              In particular, the healthy cities movement and the
Such a model takes the three pillars of sustainable                  Some of the proponents of the concept of sustain­        sustainable cities movement have shown that many
development – economy, society and environment –                     ability would consider the understanding and appli-      policy and action proposals for greater well-being
and considers their interdependence and interaction                  cation of sustainable development – through the          and quality of life at the local level reach similar con-
as the key determinants for the creation of “healthy                 three overlapping circles – as expressed in Figure 1     clusions irrespective of whether a health (promotion)
and sustainable communities”, reflecting more or less                and Figure 3 as not far reaching enough. Figure 4        lens or a sustainability lens is applied. In the sustain-
the first principle of the Rio Declaration. One of the               (Ott, 2003) illustrates a more integrated view which     ability debate, this has been expressed as follows:
most important contributions by health promotion to                  brings social and environmental dimensions into a        “Achieving progress toward sustainability thus implies
integrating frameworks and building a joint agenda                   closer interdependence, positioning economic activ-      maintaining and preferably improving, both human and
between health promotion and sustainability was the                  ity within society and recognizing that all social ac-   ecosystem well-being, not one at the expense of the
Healthy Cities Project, launched in 1987, which con-                 tion takes place within a bio-physical environment.      other. The idea expresses the interdependence between
tributed significantly to the dissemination of health                This viewpoint is remarkably close to the health pro-    people and their surrounding world” (Hodge & Hardi,
promotion concepts and approaches worldwide.                         motion model described above. Human health, both         1997). Indeed, the term “well-being” – as used both
                                                                     as an outcome and a critical resource, could then be     in this understanding of sustainability and in the WHO
Glossary: A healthy city is defined as a city that is continually    positioned in the innermost circle.                      Constitution and the Ottawa Charter (1986) – offers
creating and improving physical and social environments and                                                                   itself as the better metaphor of joint discourse
expanding community resources which enable people to mutually                                                                 (Labonté, 1991). Well-being describes the common
support each other in performing all the functions of life and                                                                goal for joint action.
in developing to their maximum potential (Health Promotion
Glossary, 1998).
14   The Food System: a prism of present and future challenges for health promotion and sustainable development                            The Food System: a prism of present and future challenges for health promotion and sustainable development   15

3 How food links health promotion and sustainable                                                                                     Fig. 5: The Food System – linear model
                                                                                                                                      (Source: Northeast Network for Food, Farm and Health Policy Education)
                                                                                                                                                                                Bio-Physical Environment
3.1 The food system                                              are, in turn, influenced by it (Northeast Network for
                                                                 Food, Farm and Health Policy Education). Figures 6
                                                                                                                                         Air                         Land                       Energy                      Water
The food system can be considered a prism of the                 and 7 show more circular models of the complex
                                                                                                                                         –– Quality                  –– Erosion                 –– Renewable                –– Quality
interface between the sustainability agenda and                  interactions.
                                                                                                                                         –– Ozone Depletion          –– Compaction              –– Non-renewable            –– Quantity
major public health challenges that health promo-
                                                                                                                                         –– Global Warming           –– Depletion
tion aims to address.
A food system governs what we eat; and there has                 3.2 The links between food, health and
been increasing concern at all levels of governance                   sustainable development
and in different policy sectors, civil society, academia
and business that the food system today is not sus-              The promotion of a more sustainable, healthier, and                     Agri/Aqua      Food            Food            Transpor­       Wholesale       Retail            Household
tainable and endangers both health and the future of             more equitable food system is a primary public                          Culture        Production      Processing      tation and      Brokers         Markets           Consump-
the planet.                                                      health goal. From a public health and health pro-                                                                      Distribution                                      tion
                                                                 motion perspective, the long standing concern with                      Inputs         Field Crops
Glossary: “Food systems encompass (i) activities related to      food, nutrition and diet must be widened to an ap-                      –– Seeds
the production, processing, distribution, preparation and        proach that is concerned with the food system in its                    –– Feed        Horticul-       Manu­           Rail
consumption of food; and (ii) the outcomes of these activities   many dimensions.                                                        –– Chemi-      tural Crops     facturing       Air
contributing to food security, food availability, food access    The link between food, health and sustainable devel-                       cals                        and             Water
and food utilization. Food systems also contribute to a range    opment has been well formulated by the American                         –– Equip-      Animals         Packaging       Roads                           Institutional
of other socioeconomic (e.g. wealth) and environmental           Public Health Association in a major policy state-                         ment                                                                        Food
(e.g. greenhouse gas emissions) issues” (Global Environmental    ment (APHA, 2007). Similarly, the American Dietetic                                    Seafood                                                         Service
Change and Food Systems Online).                                 Association, in its position statement, encouraged
                                                                 environmentally responsible practices geared to-                     Resources                                                                                                  Wastes
The sum of all the processes in a food system is some-           wards the conservation of natural resources, the re-
times referred to as a food chain. The linear presenta-          duction and management of waste, and the support
tion of a food chain (from farm to fork) can be mislead-         of the ecological sustainability of the food system                     Political-Economic Environment                             Social-Cultural Environment
ing because it neglects simultaneously interacting               (ADA, 2007). Such a sustainable food policy needs to                    Capital, Government Regulation, Taxation,                  Labor Force, Educational and Research
processes, complex cause and effect relationships                take a systems approach and address both the un-                        Markets                                                    Institutions, Cultural Values, Lifestyles,
and feedback loops. For consumers, the sequential                sustainable production as well as the unsustainable                                                                                Information Systems, Technology, Health
concept of the food chain can sometimes be more                  consumption of food, as both contribute to the sig-                                                                                Care Systems
easily understood but it can also obscure the real dy-           nificant negative health and environmental impact.
namics that drive the food system. A household’s food
system comprises all the food chains it participates in          Glossary: A “sustainable food system” is “one that provides
to meet its consumption requirements and dietary                 healthy food to meet current food needs while maintaining
preferences, and all the interactions and feedback               healthy ecosystems that can also provide food for generations
loops that connect the different parts of these chains.          to come with minimal negative impact to the environment.
There are many possible visualizations of a food sys-            A sustainable food system also encourages local production and
tem, which can mainly be differentiated by their level           distribution infrastructures and makes nutritious food available,
of complexity. Figure 5, a model developed for the               accessible, and affordable to all. Further, it is humane and just,
Northeast Network for Food, Farm and Health Policy               protecting farmers and other workers, consumers, and commu-
Education, shows this complexity: it combines the                nities” (APHA, 2007).
linear model from resources to wastes within the
biophysical, socio-cultural, and economic-political              The priority goal of health promotion with regard to
spheres, which greatly influence the food system and             healthy food must be to contribute to the establish-
16    The Food System: a prism of present and future challenges for health promotion and sustainable development        The Food System: a prism of present and future challenges for health promotion and sustainable development      17

Fig. 6: The Food System – circular model                                                                           Fig. 7: The Food System – circular model
(Source: City of Vancouver, 2009)                                                                                  (Source: San Francisco Food Alliance, 2005)

                                                  –– Backyard gardening                                                                                                Natural Resource/
                                                  –– Community, rooftop                                                                                              Environmental Systems
                                                     and school gardens
                                                  –– Local farmers
                                                                                                                                                    o d u c ti o n                                   t r i b u ti o
                                                                                                                                               Pr                                             D is                    n

     Waste Management                                                                      Processing
     –– Composting                                                                         –– Canning and
     –– Wormbins                                                                              processing
     –– Food recovery                                                                      –– Cooking
                                                                                           –– Small-scale food

                                                                                                                   Social/Cultural Systems                                                                                Economic Systems

                                                                                                                                                Re c y clin g               People                n s u m p ti o n

     Consumption                                                                              Access
     –– Community kitchens                                                                    –– Emergency food
     –– Cultural                                                                                 programmes
        Celebrations                                                                          –– Buying Clubs
     –– Dining out                                                                            –– Neighbourhood
                                                                                                 grocery stores
                                                                                                 and markets
                                                 Distribution                                                                                                          Political Systems
                                                 –– Farmers Markets
                                                 –– Community Sup-
                                                    ported Agriculture
                                                 –– Good Food Boxes
                                                 –– Grocery home
                                                    delivery services
18   The Food System: a prism of present and future challenges for health promotion and sustainable development                         The Food System: a prism of present and future challenges for health promotion and sustainable development                19

ment of a more sustainable, healthier, and more             and Bomford, 2009) also shows the interface be-                        food-borne illnesses and from pathogens and pesti-        mandatory premarket risk assessment of GM crop;
equitable food system in which choices for health are       tween the energy crisis and the food crisis: the de-                   cide residues in food.                                    and at the international level, the Codex Alimentarius
also the best choices for the planet and to support ethi-   pendency on fossil fuels of our present food system                    Climate change is a significant and emerging threat       Commission (CAC, 2001; 2003) and the Cartagena
cal and environmental choices that are also good for        – both in production and distribution will present a                   to all countries but hits the poorest countries hard-     Protocol on Biosafety (CPB, 2000) cover food and en-
health. Health promotion must be concerned with             major risk to food security.                                           est. Many important diseases are highly sensitive to      vironmental safety of biotechnology.
how food is governed, produced, distributed and con-        Food is critical for survival – healthy food would be                  changing temperatures and precipitation, and this         Undernutrition is responsible for more than a third
sumed. Healthy food as a priority for healthy public        regarded by many as the single most important deter-                   contribution is expected to grow in the future. Threats   of all deaths of children under the age of five world-
policy must be positioned not only in relation to con-      minant of health. The Millennium Development Goals                     include common vector-borne diseases such as              wide. The number of children in developing countries
sumers and their choices but with reference to wider        have as their first goal to ERADICATE EXTREME POV-                     malaria and dengue; as well as other major killers        who were underweight still exceeded 140 million in
drivers of the food economy.                                ERTY & HUNGER (UN, 2005). Worldwide, the hungry                        like malnutrition and diarrhoea. The inter-linkage        2006 (UN, 2008). This is often referred to as a hidden
                                                            amount to more than 1.02 billion people (FAO, 2009).                   between animal health and pandemic threats is also        epidemic. A significant dimension of this epidemic is
                                                            They lack the most critical determinant of health.                     increasing. There is an increasing danger of food-        “hidden hunger” – the lack of micronutrients which
3.3 The challenges: equity, health, sustainability         The present food economy does not deliver enough                       borne and animal-borne outbreaks which are linked         can lead to blindness, low birth weight and stunted
                                                            food to major parts of the growing world popu­                         to the present system of food production and distri-      growth. Southern Asia alone accounts for more than
3.3.1 A more equitable food system                         lation, despite enormous growth rates. About 70 %                      bution. For instance, current high-density animal         half the world’s undernourished children; least
       Food as a determinant of health, well-being          of the world’s poor depend on agriculture for their                    production operations have been associated with in-       progress in reducing child malnutrition is in sub-
       and productivity                                     livelihood but the global food economy has contrib-                    creased livestock disease outbreaks; with such inci-      Saharan Africa.
The number of people lacking access to food has             uted to destroying local farming systems and liveli-                   dences as the influenza A virus in Hong Kong chicken
risen. There are also major concerns that in view of        hoods. Food insecurity in both the developing and the                  facilities in 1997 that killed 6 humans and led to the    Glossary: Many factors can cause malnutrition, most of which
demographic change – by 2040 the planet will host           developed world has worsened and this highlights                       destruction of 1.2 million birds and the mad cow dis-     relate to poor diet or severe and repeated infections, particularly
9 billion people – these already dramatic figures will      major inequities as well as paradoxes and tensions                     ease in 1996 that led to the slaughter of 11 million      in underprivileged populations. Inadequate diet and disease,
increase exponentially. A recent report (Heinberg           between scarcity and affluence.                                        animals and the destruction of 1.2 million animals at     in turn, are closely linked to the general standard of living, the
                                                                                                                                   the onset of the foot and mouth outbreaks in 2001         environmental conditions, and whether a population is able
                                                            With recent increases in food prices, it is estimated that 1 billion   (Tilman et al., 2002). Climate change is also pre­        to meet its basic needs such as food, housing and health care.
                                                            people will go hungry, while another 2 billion will be under­          dicted to cause major crop losses in the world’s          Malnutrition is thus a health outcome as well as a risk factor
Fig. 8: Undernourishment in 2009, by region                 nourished. According to the World Bank, the rise in the prices         poorest regions (Nelson et al., 2009).                    for disease and exacerbated malnutrition, and it can increase
(Source: FAO, 2009)                                         of various staples has recently pushed thirty-three countries          The biotechnology revolution is, by far, the most         the risk both of morbidity and mortality (WHO, 2005).
                                                            into food crises. FAO estimates an increase of 75 million in the       controversial chapter in agricultural science. The        The Global Alliance for Improved Nutrition (GAIN), with its pop-
                                                            number of undernourished people, bringing the number from              enhanced agronomic traits of Genetically Modified         ulation-based and targeted programmes, aims to reduce
Latin America and the Caribbean (53)
                                                            854 to 923 million (FAO, 2008). That is about one seventh              (GM) crop may potentially increase agricultural yield;    malnutrition through food fortification and other sustainable
                Near East and North Africa (42)
                                                            of the world population.                                               thus playing a major role in the reduction of hunger      strategies. Its innovative partnership projects in 26 countries
                          Developed countries (15)
                                                                                                                                   and the increase in food security in the developing       deliver fortified foods to over 200 million people at risk and
                                                            For many people in the developing world, food and                      world (WHO, 2005; Runge et al., 2003). However, the       plans to reach one billion. More than half of these individuals
                                                            water are not safe. Over 200 disease agents can be                     current debate on GM crop revolves around its po-         are women and children (
                                                            transmitted through food and water and while they                      tential risk as compared to crops modified through
                                                            are an integral part of many public health and devel-                  conventional breeding (Applegate, 2001; NRC, 2000;        There is an increase in child poverty in the developed
                                                            opment strategies, they do not get the same atten-                     IFT, 2000; Hollingworth, 2003; NAS, 2000); including      nations (UNICEF, 2008). Here too, there is evidence
                                                            tion as some of the highly prioritized infectious                      the potentially negative effects on plant biodiversity    that children go hungry and that poor nutrition due
       Sub-Saharan                                          diseases such as HIVAIDS, tuberculosis or malaria.                     and herbicide resistance (Watkinson et al., 2000;         to income inequalities results in health disparities
       Africa (265)                                         For example, globally there are 1.8 million deaths                     Dale et al., 2002; Madsen and Streibig, 2003); intel-     throughout the lifespan. In Russia and Ukraine, for
                               Asia and the
                                                            a year from diarrhoea through contaminated food                        lectual property rights and problems in assuring          example, one child in seven was malnourished, while
                               Pacific (642)
                                                            and water, deaths that occur mainly in very poor and                   equal access to genetic resources particularly to de-     in Albania, Uzbekistan and Tajikistan, the figure rose
                                                            disadvantaged communities (WHO, 2005). The food-                       veloping countries (WHO, 2005); and the link between      to one in three (UNICEF, 2001). In the USA, figures
                                                            borne illnesses through lack of food safety (due                       GM seed industry, energy-intensive technologies and       indicate that 8 % of children under the age of 12 expe-
                                                            to patterns of unsustainable food production and                       fossil-fuel based food system (Heinberg and Bon-          rienced hunger (Wehler, 1995).
                                                            consumption) need to receive more attention. It is the                 ford, 2009). As precautionary measures, some coun-        The combined economic impacts of such individual
Millions of people                                          poor who suffer disproportionally from infectious                      tries have instituted guidelines or legislation for       underdevelopment through poor nutrition are sig-
20    The Food System: a prism of present and future challenges for health promotion and sustainable development             The Food System: a prism of present and future challenges for health promotion and sustainable development       21

nificant. Experts agree that the effects of poor nu-         3.3.2 The challenge: a healthier food system              Changes in the way food is produced and consumed          countries. The distribution of obesity is significantly
trition are life-long, intergenerational and irrevers-              The nutrition transition and the rise of chronic    – combined with low levels of physical activity –         related to social inequalities and the predominance
ible; they include reduced life expectancy, impaired                disease                                             have led to a global epidemic of chronic disease – in     of certain obesity industries and obesogenic envi-
cognitive development, impaired immunity, and in-            Large shifts have occurred in dietary and physical         particular in the developed world but increasingly        ronments which in turn reinforce new patterns of
creased maternal and child mortality. The global             activity and inactivity patterns – these are referred to   also in the emerging economies. Many low- and mid-        food consumption.
cost burden is estimated at $180 billion annually.           as the nutrition transition. These changes are re-         dle-income countries are facing a nutrition transition
The 10-year productivity loss from iron deficiency           flected in nutritional outcomes, such as changes in        as they too are subject to “the most radical change to    Glossary: Obesogenic environments: A set of circumstances
alone is estimated at $25 billion in 5 asian countries       average stature and body composition. Modern soci-         the way humans eat since the discovery of agriculture     that encourages people to eat and drink more calories
(ADB, 2004). This puts into question health gains            eties seem to be converging to a pattern of diet high      (Pollan, 2008).” WHO projects that by 2015, approxi-      than they expend and to become obese (
for the next generation. It is estimated that better         in saturated fat, sugar, and refined foods and low in      mately 2.3 billion adults will be overweight and more     content/default.asp).
nutrition could save China and India $5 billion and          fiber, often termed the “Western diet”. Many see this      than 700 million will be obese (WHO, 2006a). Over-
$2.5 billion respectively, in terms of savings in            dietary pattern to be associated with high levels of       weight and obesity are major risk factors for a           Healthier diets could save millions of lives every
health care costs, with indirect gains for productiv-        chronic and degenerative diseases and with reduced         number of chronic diseases, including diabetes, car-      year and support the environment. A central con-
ity (Shekar and Lee, 2006).                                  disability-free time.                                      diovascular diseases and cancer. It is estimated that     cern is the increasing demand for animal protein
                                                                                                                        today almost 80 % of the 246 million people with dia-     worldwide with consequences for livestock manage-
                                                                                                                        betes live in the developing countries (UN, 2006).        ment and water use. If the American level of meat
                                                                                                                        Malnutrition and obesity often exist side-by-side         consumption (217 pounds per year) were to be repli-
                                                                                                                        within the same country, the same community and           cated worldwide, the global grain harvest could just
                                                                                                                        even within the same household in resource poor           support 40 % of the present world population (Rob-
Fig. 9: Stages of the Nutrition Transition                                                                              settings. The health systems of developing countries      erts, 2009). Conversely, if such a meat-based diet
(Source: Popkin, 2002)                                                                                                  are frequently ill prepared and do not have the re-       were to be replaced globally by a well-balanced
                                                                                                                        sources to deal with this “double burden of disease”      plant-based diet, a growing global population could
                                                                                                                        which paradoxically is one of the outcomes of the         be fed without additional strain on the environment
     Urbanization, economic growth, technological changes for work, leisure and food processing,
                                                                                                                        rapid economic growth in many of the countries            and without increased cost of food (Duchin, 2005).
     mass media growth
                                                                                                                        concerned. A projection of disease burden for low-        The World Health Organization in its Global Strategy
                                                                                                                        income countries predicts that, in 2030, NCDs will        on Diet, Physical Activity and Health (endorsed by the
     Pattern 3                              Pattern 4                               Pattern 5                           contribute to half of the total burden of disease         May 2004 World Health Assembly) recommends
     Receding Famine                        Degenerative Disease                    Behavioral Change                   (Mathers and Loncar, 2006).                               diet low in meat, rich in fruits and vegetables, low in
                                                                                                                        Food systems that promote increased food intake,          added sugar and limited salt, and low in saturated
                                                                                                                        non healthful foods, and together with physical           fatty acids. The Mediterranean diet and the Japa-
                                                                                                                        inactivity lead to “obesogenic societies”. The United     nese diet are both low in meat and saturated fats
     –– starchy, low variety,               –– increased fat, sugar,                –– reduced fat, increased
                                                                                                                        States is such a society: since the mid-seventies, the    and high in legumes and other vegetables; they are
        low fat, high fiber                    processed foods                         fruit, veg. CHO, fiber
                                                                                                                        prevalence of overweight and obesity has increased        associated with both a low incidence of disease and
     –– labor-intensive work/               –– shift in technology                  –– replace sedentarianism
                                                                                                                        sharply for both adults and children. Data from two       low environmental impact. The UK Cabinet Office
        leisure                                of work and leisure                     with purposeful
                                                                                                                        NHANES surveys (CDC) show that among adults               has published a broad-ranging analysis of food
                                                                                       changes in recreation,
                                                                                                                        aged 20–74 years, the prevalence of obesity in the        trends and issues. Diets with less animal and dairy
                                                                                       other activity
                                                                                                                        USA increased from 15.0 % (in the 1976–1980 survey)       products, fish from sustainable sources and sea-
                                                                                                                        to 32.9 % (in the 2003–2004 survey).                      sonal field-grown and locally produced fruits and
                                                                                                                        The obesity epidemic puts into question the health        vegetables were recommended for reducing envi-
                                                                                                                        gains for the next generation. According to the           ronmental impact (SDC, 2009). Similar findings
     MCH deficiencies, weaning              obesity emerges,                        reduced body fatness,
                                                                                                                        World Health Organization, childhood obesity is one       were reached by others through life-cycle analysis
     disease, stunting                      bone density problems                   improved bone health
                                                                                                                        of the most serious public health challenges of the       of food products (Carlsson-Kanayma, 1998; Kramer
                                                                                                                        21st century. Its prevalence has increased at an          et al., 1999; Brower and Leon, 1999; Jungbluth et
                                                                                                                        alarming rate. In 2007, an estimated 22 million chil-     al., 2000). In order to identify measures to reduce
     slow mortality decline                 accelerated life expectancy,            extended health aging,              dren under the age of 5 years were overweight             the environmental impact of the production proc-
                                            shift to increased DR-NCD,              reduced DR-NCD                      throughout the world. More than 75 % of overweight        ess, the Department for Environment, Food and
                                            increased disability period                                                 and obese children live in low- and middle-income         Rural Affairs, in the United Kingdom, has also
22   The Food System: a prism of present and future challenges for health promotion and sustainable development          The Food System: a prism of present and future challenges for health promotion and sustainable development                 23

started working with the industry on the develop-           transportation on climate change would be reduced;      Fig. 10: Global environmental change
ment of roadmaps for various food items (DSCF as            and farms would become energy self-sufficient with      (Source:
cited in SDC, 2009).                                        production of on-site renewable energy (Heinberg
                                                            and Bomford, 2009).
3.3.3 The challenge: a more sustainable food               The environmental effects of different dietary                                                           Climate change
       system                                               patterns are significant. They depend on many fac-
       The combined negative health and environ-            tors, including the proportion of animal and plant
       mental impacts                                       foods consumed and the method of food production.
The present food system delivers low cost food at           Industrial animal production consumes especially                                                        Diverse pathways
a high cost to the environment and to human and             large amounts of energy, requiring 35 calories of
animal health. The APHA policy paper on sustain­            fossil fuel to produce 1 calorie of food energy – not         Stratospheric ozone                                                             Desertification and
able food systems for example summarizes the neg-           counting the energy required for processing, pack-            depletion                                                                       land degradation
ative health and environmental impacts that accrue          aging, cold storage, and transportation of meat. In-                                                                 Agroecosystem
in the USA in the production and distribution of food.      terestingly, a comparison of the amounts of energy                                          UV exposure                 productivity
Of particular relevance are the intensive methods           required to produce a calorie of food shows great                                                                                                Population
applied in industrial agriculture which requires large      variability depending on the type of animal protein;                                                                                          displacement
quantities of non-renewable fossil fuel, fuel-based         this is mainly due to differences in feed conversion                                                     Human health                                                        Altered
“inputs”, such as fertilizers and pesticides, as well as    efficiencies between species (Smil, 2000; ADA,                                                                                                                               precipitation
                                                                                                                                                in several eco-                              Water quantity
antibiotic overuse in industrial food animal produc-        2007; Carlsson-Kanyama et al., 2003; Carlsson-
                                                                                                                                               system services                               and safety
tion. All of these can have negative environmental          Kanyama & Gonzalez, 2009). Despite this impact on
and health impacts (Correll, 1998; Tilman et al., 2001;     climate change risk, the contributions of the food
Tilman et al., 2002; Butler et al., 2007; Fox et al.,       system and meat consumption are generally left out
2007; Foley et al., 2005): for example, the Institute of    of the discussion on global climate change. Some              Biodiversity loss and
                                                                                                                                                                                                             Freshwater decline
medicine estimated in 1998 that antibiotic resistance       debates at the Climate Summit 2009 in Copenhagen              ecosystem function
cost the US public health system US$ 4–5 billion a          were an exception. Lord Stern, the author of the in-
year (Harrison & Lederberg, 1998). Worldwide, agri-         fluential 2006 Stern Review (Stern, 2006) on the cost
culture and land-use change are estimated to cause          of tackling global warming, said at the Climate
about one third of global warming due to greenhouse         Change Conference in Copenhagen in December,
gas emissions. A range of other factors can be identi-      that a successful deal would lead to soaring costs
fied in relation to the production, distribution, con-      for meat and other foods that generate large quan-
sumption and recycling of food.                             tities of greenhouse gases. “Meat is a wasteful use
Today, the entire food system is highly vulnerable          of water and creates a lot of greenhouse gases. It      Meat production is a powerful contributor to nega-         The expanding aquaculture operations pose issues
to global fossil fuel depletion resulting from the in-      puts enormous pressure on the world’s resources.        tive environmental impacts, particularly in relation       similar to industrial meat production facilities, in-
dustrialization of agriculture. In industrial nations,      A vegetarian diet is better.”                           to the use of energy and water. The Food and Agri-         cluding high stocking densities, use of antibiotics
an average investment of 7.3 calories of energy input                                                               culture Organization of the United Nations (UN FAO)        and parasiticides, and waste discharge into the sur-
is required to produce and bring to the table a calorie                                                             estimates that approximately 18 % of all greenhouse        rounding environment.
of food energy. The surge in oil price, in 2008, showed                                                             gas emissions worldwide come from livestock pro-
alarming implications on costs in the entire food sys-                                                              duction. Industrialized agricultural methods are fos-      The “environmental DALYs” per capita provide an overall meas-
tem with a simultaneous doubling of food commodity                                                                  sil fuel intensive; the US food system accounts for an     ure of the environmental disease burden rate by country.
prices. Knowing that crude oil production is expected                                                               estimated 10.5 % of the nation’s energy use and 19 %       They vary widely across countries, similar to the total burden
to begin its terminal decline in a few years, a food                                                                of its fossil fuel consumption. Transportation is a fur-   of disease. Globally, 24 % of the total disease burden, or 13 mil-
system transition is required to make the food sys-                                                                 ther user, with studies estimating that the average        lion premature deaths, could potentially be prevented through
tem a net producer of energy rather than a net user.                                                                vegetable travels approximately 1500 miles from            environmental improvements (or shifted to other causes
For resilience against fossil-fuel price volatility, de-                                                            farm to supermarket.                                       of premature death or disability) (Prüss-Üstun et al., 2008).
centralization and relocalization of the food system                                                                Industrial agriculture requires extensive irrigation.
become priorities. Then, consumers would enjoy                                                                      Industrial meat production, especially beef, requires
fresher, more local and seasonal food; the impact of                                                                the most water – much of it to irrigate feed crops.
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