MAPPING EVIDENCE OF FOOD SYSTEM TRANSFORMATION FOR HEALTHIER DIETS: WHAT WORKS?

This blog post also appears as part of IFPRI's special series of analyses on the UN Food Systems Summit.

Effective food systems innovations—defined as policies, technologies, and/or institutional innovations that trigger changes in food systems dynamics and outcomes—can help produce healthier, more sustainable outcomes, and are essential to confront our current global challenges, which are formidable.

Food insecurity persists around the world, along with high rates of micronutrient malnutrition and increasing numbers of people who are overweight or obese, a precursor for many non-communicable diseases such as diabetes. If food systems transformation continues along the current trajectory, this already dire situation will grow worse, creating a growing nutrition crisis that threatens the stability of national health systems.

The many dialogues, research outputs, and potential solutions being discussed in advance of the upcoming UN Food Systems Summit are exploring the far-reaching impacts and complex interactions of our global food systems. In particular, food systems should help provide consumers with healthier, more sustainably produced and distributed foods, and also encourage them to consume better and healthier foods. But how we make these transformations happen is not so clear. A key question is, which food system innovations have proven effective and are worth investing in?

To answer this question, we conducted a systematic search and review of evidence for the impact of food system innovations on dietary and nutrition related outcomes. We limited the review to study the food environment, or the component of the food system where consumers interface with foods, and consumer behavior, which encompasses the choices consumers make about what foods to buy and then what foods to actually consume. Though our search was global in nature, we primarily included evidence for the four focus countries of the CGIAR Research Program on Agriculture for Nutrition and Health (A4NH): Bangladesh, Ethiopia, Nigeria, and Viet Nam. These countries are examples of low- and middle-income countries at different stages of food systems transformation, but all to varying degrees are simultaneously experiencing undernutrition, micronutrient malnutrition, and growing overweight and obesity rates.

The search found 150 studies. Of note, it was difficult to find evidence on private sector innovations, as such evidence is often not published to hide profitable strategies from the competition. After conducting the search, we rated each study for the quality and strength of its evidence, how far it went toward demonstrating dietary change or change in nutritional status, what it found, and the extent to which gender was addressed in the study. These findings can be tracked in the evidence map linked below.

An important component of the review was to understand the extent to which food system innovations have the potential to reduce gender discrepancies related to access to healthier diets. We categorized each innovation as being either gender blind, gender accommodating, or gender transformative. By gender accommodating, we mean they acknowledge gender inequalities and seek to ensure women benefit, but do not challenge drivers of inequalities; gender transformative interventions attempt to transform gender relations to promote gender equality. We also considered whether the analyses of the food system innovations’ effects were gender blind, gender disaggregated, or limited to effects among women or girls.

This exercise led us to the following general conclusions:

1. High-quality evidence on food systems innovations is lacking. The paucity of high-quality evidence makes it difficult to make conclusions about what works and what does not. Most research is based on observational data or qualitative observations, rather than randomized trials or quasi-experimental evidence. In general, more evidence and stronger evidence is needed to understand which innovations help improve diets and under what conditions.
2. Apart from interventions working to improve infants’ and young children’s nutrition, there is limited evidence on most types of food system innovations. There is also limited evidence of effects along different stages of the pathway of change, of dynamic effects and system-wide changes by food system innovations, of the cost-effectiveness and sustainability of effects.
3. There is limited evidence on gender-accommodating and gender-transformative food system innovations, and there is no systematic analysis of gender-specific impact of innovations. This gap clearly needs addressing by the next generation of studies on food systems innovations.

We did find three types of innovations that have shown potential (though, for the last two, we only found evidence from other low- and middle-income countries):

1. A nutrition-relevant, multi-sectoral national policy backed with the necessary financial, logistic, and human resources for effective implementation appears to be a promising strategy to improve nutrition in some of the focus countries.
2. Compulsory and simple nutrition labeling seems a promising, relatively low-cost, food system innovation in contexts with high or increasing consumption of unhealthy foods.
3. Well-designed taxes on foods like sweetened beverages have potential for at least reducing demand.

Further replication of the type of nutrition labeling that has become more common in Latin America and more examples of successful sweetened beverage taxes would help add to this evidence base. Putting images of traffic lights on packaging to convey broad health messages, an approach first used in Chile, has spread through Latin America and led to reformulation of products to avoid “red light” ratings; well-designed sweetened beverage taxes have reduced demand, though impacts on actual health outcomes have not been identified.

Despite these promising findings, there is a clear need for more research that generates evidence on food environment innovations and factors influencing purchasing behavior. Even as many actors are debating which “game changers” on which to pin hopes of food system transformation, our review suggests that more and stronger evidence is necessary to understand which “game changers” offer the best hopes of carrying out food systems transformation. Without improved evidence (and investment in that evidence), we may be placing false hope in some solutions that may prove ineffective and wasting a chance to transform food systems for more sustainable, healthier diets.

Els Lecoutere is the Science Officer of the CGIAR GENDER Platform, Kenya, and was previously a Postdoctoral Researcher in the Development Economics Group of Wageningen University & Research (WUR), the Netherlands; Marrit van den Berg is an Associate Professor in the WUR Development Economics Group; Alan de Brauw is a Senior Research Fellow with the International Food Policy Research Institute's Markets, Trade and Institutions Division. The authors are part of A4NH's Food Systems for Healthier Diets research flagship.