The Food System Triggering Debate - White Paper a prism of present and future challenges for health promotion and sustainable development - Ilona ...
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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 Acknowledgements 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 Switzerland –– 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 Social (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). Sustainable 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 la 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 e 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 Unemployment 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 ks 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- rs In 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 (www.who.int/hia/evidence/doh/en). –– 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 Sustainable Society 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) development 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 Restaurants 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) Production –– 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 processing Social/Cultural Systems Economic Systems Re c y clin g People n s u m p ti o n Co 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 (www.gainhealth.org/about-gain). 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 (www.nhsggc.org.uk/ 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: www.who.int/globalchange/environment/en) 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 Decline “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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