“Food systems” has become a very popular term in the fields of agriculture, nutrition, and health, but what does it mean to have a food systems perspective? How do food systems address the triple burden of malnutrition, and what can countries learn from one another to strengthen their own food systems?
Dr. Ruerd Ruben, of Wageningen University in The Netherlands, and Dr. Namukolo Covic, of the International Food Policy Research Institute, are both involved with the CGIAR Research Program on Agriculture for Nutrition and Health’s Flagship Research Program on Food Systems for Healthier Diets. In this two-part podcast, hear a recent conversation they had on what it means to take a global perspective on food systems, and how this approach is changing the way we look at hunger and malnutrition.
An excerpted script of the first installment appears below.
Q: Thank you for your time today, Dr. Covic and Dr. Ruben. Could you explain what we mean when we talk about the triple burden of malnutrition?
Namukolo Covic: The triple burden refers to the different ways in which malnutrition is currently manifesting. The first is undernutrition, usually characterized by children under five years old being shorter than they are supposed to be for their age as well as being underweight. The second way is through a lot of micronutrients that we need, such as iron, zinc, and iodine, being deficient. Children as well as adults tend to show these micronutrient deficiencies. The third burden being overweight or obese, and then succumbing to other health problems related to that, such as diabetes, high blood pressure, and sometimes even some forms of cancer related to nutrition. So because of these three ways of malnutrition manifesting, we talk about a triple burden.
Ruerd Ruben: I’m not a specialist in nutrition, but I’m always struck by two phenomena of how those three manifestations of malnutrition are linked. Young people that might have suffered from underweight, stunting, or wasting, once they are able to survive, might be very vulnerable to getting overweight or even obese. Those two aspects are not independent from each other – over the life cycle of a person, they are linked to each other. The second thing that was always very impressive to me is that large parts of undernutrition become an irreversible part of the human life. If there are failures in the way in which young people shape their bodies and their intestinal systems and even their brains, there is no way of getting that corrected later, unlike many other aspects of economic life, where you can compensate. That is not possible in those two phenomena of malnutrition, which make it more than just a burden – it is a lifetime part of your human evolution.
NC: I totally agree, Ruerd, and I think even more worrying is the fact that often when we are talking stunting and children being short for their age, we tend to worry about the height. I think the height, as you have indicated, is actually the least of our problems. It’s all the other underlying things, like limited brain development, that have much longer-term consequences and are likely to even carry through to the next generation because of the limitations in educational outcomes they bring about.
RR: Yes, and that is also the reason I think we started to not think about nutrition or malnutrition particularly, but about food systems as a procedure, an approach to address those triple burden aspects. We tend to look at phenomena, but usually we are too late with our intervention. I’m fully convinced that the major interventions in terms of policy should take place very early in life, really, in the first thousand days. It is just too late if you start at the very end of a food value chain to improve diet. You also have to look not only at quantities, but particularly at qualities of food and how to maintain the nutritional value for the consumer, and be extremely creative -- an intervention in food systems means you start with changing consumer opportunities and consumer behavior. You organize the system, including the way food is produced, transported, and processed -- towards areas where people live, and so it keeps the healthy component of the food readily available for consumers most vulnerable in the life cycle.
NC: Ruerd, you’ve touched on something I think is very important. The idea of having a food systems approach is really critical because a lot of the efforts in development have just focused on increasing productivity of very limited crops that are not always very nutrient dense to start with. Getting to a more quality diet then becomes even more difficult. Also, a lot of food processing activities have tended to focus on reducing waste and spoilage without necessarily taking into account the quality of the final product. There’s really a need for some serious creativity to ensure we start producing products that actually address the nutrient needs of people.
RR: In terms of organization, food systems analysis and policies mean that you do not always intervene at the moment, the point where the problem becomes apparent, but that you try to start earlier. Food waste is a good example, I think. Most of the problems in food waste are apparent in quality losses at the end of the supply chain, close to the consumer, at the market, perhaps, but the right intervention starts very early in the supply chain – at the producers’ level, for instance – in improved packaging or transport. While you incur the cost in the beginning of the value chain, the benefits are reaped at the very end, so you need collaboration between people engaged in food systems both up and downstream to get such changes implemented. I think that is limiting much of our agriculture and food policy making – we tend to focus at the places where the problems are, but we have to resolve them much earlier and much more precisely with interventions involving multiple stakeholders.
Q: If you each could make a recommendation on where to start with the food systems approach, to create healthier diets and avoid parts of the triple burden of malnutrition, what would those initial recommendations be? What are the first steps?
NC: I think the first step would be to map what our food systems actually look like, because there’s likely differences in different areas. While the foods might be the same, the drivers of the changes that are taking place might need to be looked at from a contextual standpoint. For us to know where we might really be able to do things differently, we need to know what the issues are in the various contexts. So that’s a starting place. The other is to look at the policy environment to make sure the policy instruments now being put in place start using a food systems lens so you don’t end up with a situation where the policies now being developed come with the same limitations of the ones that exist. That would be another entry point, and then after that, start looking at what types of innovations might actually be useful to move us in a more positive direction.
RR: Although I would agree it is important to understand the structure of the food system and the value chain, I am inclined to say many of the real changes start with experiments. The proof of the pudding is in the eating, and that saying is really appropriate if we talk about changes to food systems. Small changes, small ways in which food systems might become more accessible – by changing packaging size or the way food is promoted, by providing information, perhaps by preparing foods for home delivery – those changes, in a practical sense and perhaps at a very local level, provide examples for the business sector, to see what is affordable for them to do, and whether they are able to mobilize large groups of consumers from it. I am very much in favor of this sort of experimental approach, where we introduce small, and sometimes large, modifications in food systems and supply chains, hoping that will provide, let’s say, the kind of multiplier opportunity for other businesses to step in. That is the only way, I think, in which real changes will take place.
NC: You know, Ruerd, South Africa is an interesting case study: it has large food companies, but also large contingencies of poverty. One of the things you observe in the South African food markets is that the food industry has actually adapted, and provide very small packaging for some of the poorer socio-economic settings. Because South Africa tends to concentrate people by socio-economic status, it’s easy to organize their distribution processes that way. The drawback I see there is that although they have adapted to providing smaller packages that poorer people can afford, the quality of those products still [have] the same problems they had before. If they were laden with salt, they’re still laden with salt. If they were laden with sugar, they’re still laden with sugar, but in more affordable packaging sizes. That doesn’t really help. While that is a positive change in making packages more affordable, there is this element of the quality that has not necessarily come along with it. Those are issues, I think, where some attention would still be required.
RR: I fully agree that you need simultaneous changes in quantities and qualities and delivery modes, etcetera. The typical example is the soup packets in many countries in sub-Saharan Africa and Asia: the salt content is sometimes far too high, but it is, technically speaking, possible to reduce the salt content by offering an alternative that maintains the flavor but is less damaging for health. I think we should provide, in terms of real-time experiments, the opportunity to show there is a business case also in making those adjustments. Perhaps we should accompany those changes in the supply chain product compositions, because just saying they have to do it is not sufficient. You should be a partner in the innovation process, and innovation in food quality just goes too slow because everybody considers it too risky. In a food systems research program, I think you can reduce a little of those risky components of innovations by better linking the producer to the consumers and to outlets. That might provide the incentive for making those adjustments. This is also the European experience – we have seen some agreements industry-wide so there is not a competition on food quality in itself, and the whole sector tries to improve the quality and the healthiness of its products. You cannot do it just by one industry.
NC: I think tied to that, for me, is an almost disturbing tendency to exclude the private sector from conversations around the quality of food. If they are not around, but they’re the ones providing us the foods, how do we expect them to respond? There’s been an almost unhealthy tendency to castigate the private sector. We have these brushes we paint everybody with, which leads to an unhealthy disengagement, which does not necessarily help the kinds of developments that should take place for a better-quality diet.
RR: Yes. That is indeed the reason why public sector and research agencies can provide the kind of minimum basis that enables the private sector to make their investment – not only to improve their individual profit-making capacity, but also to guarantee that in addition to their private goals, they are also satisfying public goals. The public goal in this case is a contribution to a better nutritional status for large parts of the population, which will translate itself later into substantially reduced health costs for the society. There is a good reason to get involved in private-sector decisions about quality and distribution of food, particularly the more nutrient-dense foods, and to see whether you can provide through public investment and information minimum guarantees that enable them to make steps forward. Just saying they should do it is not sufficient, I think.
NC: I’m particularly fascinated by the way Wageningen Univeristy seems to have found some kind of balance between working with the private sector as well as the public sector in some of the research done there. I think there are really some lessons to be learned, at least for us on the African continent, where you find, sometimes, researchers really battling with, how can I engage with these guys, am I going to be red-listed as now my research is not as useful as it could have been. I hope, somehow, with the program we are involved in now, some of those lessons can be brought to bear.
Thank you to Ruerd Ruben and Namukolo Covic for sharing their thoughts on food systems. Please listen to the second installment of this podcast or visit A4NH's Flagship Research Program on Food Systems for Healthier Diets to learn more about this topic.