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• Recommendation 4: Increase responsible and sustainable investment in nutrition, especially at country level with domestic finance; generate additional resources through innovative financing tools; engage development partners to increase Official Development Assistance in nutrition and foster private investments as appropriate.
• Recommendation 5: Improve the availability, quality, quantity, coverage and management of multisectoral information systems related to food and nutrition for improved policy development and accountability.
• Recommendation 6: Promote inter-country collaboration, such as North– South, South–South and triangular cooperation, and information exchange on nutrition, food, technology, research, policies and programmes.
• Recommendation 7: Strengthen nutrition governance and coordinate policies, strategies and programmes of United Nations system agencies, programmes and funds within their respective mandates.
3. POLICY AND PROGRAMME OPTIONS TO IMPROVE
NUTRITION IN ALL SECTORS
3.1 Sustainable Food Systems Promoting Healthy Diets⁶ The types of foods produced and how they are processed, traded, retailed and marketed through the supply chain impact the collective surroundings, opportunities and conditions that influence people’s food and beverage choices and dietary practices and consequently, their nutritional status.
Information and education concerning dietary practices are vital, but consumers must also be empowered through enabling food environments.⁷ Food environments that provide safe, diverse and healthy diets are particularly important for vulnerable groups, who are more constrained by lack of resources.
A food system approach – from production to processing, storage, transportation, marketing, retailing and consumption – is thus key to promote healthy diet and improve nutrition as isolated interventions have limited impact.
Since food systems have become increasingly complex and strongly influence people’s ability to consume healthy diets, coherent action and innovative food system solutions are needed tability to consume healthy diets, coherent action and innovative food system solutions are needed to ensure access to sustainable, balanced and healthy diets for all. These solutions should include production, availability, accessibility and affordability of a variety of cereals, legumes, vegetables, fruits and animal source foods, ⁴ The term “interventions” refers to those actions (policies and programmes) designed to address immediate and/or underlying determinants of nutrition among individuals and households.
⁵ As defined in the ICN2 Declaration, the term agriculture comprises crops, livestock, forestry and fisheries.
⁶ A healthy diet refers to a balanced, diverse and appropriate selection of foods eaten over a period of time. A healthy diet ensures that the needs for essential macronutrients (proteins, fats and carbohydrates including dietary fibres) and micronutrients (vitamins, minerals and trace elements) are met specific to the person’s gender, age, physical activity level and physiological state. WHO indicates that for diets to be healthy (a) daily needs of energy, vitamins and minerals should be met, but energy intake should not exceed needs; (b) consumption of fruit and vegetables is over 400 g per day; (c) intake of saturated fats is less than 10% of total energy intake; (d) intake of trans-fats is less than 1% of total energy intake;
(e) intake of free sugars is less than 10% of total energy intake or, preferably, less than 5%;
(f) intake of salt is less than 5 g per day. For more information, see the WHO Fact Sheet on Healthy Diet (Fact sheet No 394, September 2014, http://www.who.int/mediacentre/ factsheets/fs394/en/).
⁷ Food environments are the collective surroundings, opportunities and conditions that influence people’s food and beverage choices and nutritional status.
138 Ending Malnutrition including fish, meat, eggs and dairy products; diets containing adequate macronutrients (carbohydrates, fats and protein), fibre and essential micronutrients (vitamins and minerals) in line with WHO recommendations on healthy diet, and produced and consumed sustainably. On the other hand, these solutions should include measures to restrict the production, availability, accessibility and promotion of food products leading to excessive intake of energy, fats, sugars and salt/sodium.
Globally, the food system contains a diverse mix of traditional and modern supply chains. Both offer risks and opportunities for nutrition.
Low-income consumers in low and middle income countries have a greater tendency to buy food via traditional supply chains, where losses are high, and safety and quality control are limited. Modern processing and retailing offer more fruits, vegetables and animal-source foods through cold chain storage, and contribute to improved food quality and safety, but highly processed foods of low nutritional value contribute to rising obesity and diet-related NCDs.
Investing in rural populations is vital for equitable human development.
Subsistence and family farmers, most of whom are women, and often lack access to and control of critical inputs and markets, can be more effectively engaged to meet local nutrition needs, while commercial producers are critical to stabilizing global supply and prices, and to applying sustainable practices at scale.
Raising women’s incomes brings great health and nutrition benefits as often women manage household resources and greatly influence household food consumption, in particular of infants and young children. Improving agriculture and food technology gives women more time, improves their incomes and nutrition, and generally enhances their well-being as well as their infants and young children. It is also important to increase women’s control over resources such as income, land, agricultural inputs and technology.
Natural and manmade disasters, emergencies, conflicts and shocks have increased in recent years, in both frequency and intensity. Resilience is necessary to prevent further deterioration of the nutritional status of crisis-affected populations, while nutrition is critical to strengthening both community and individual resilience. Resilience requires that preventive and curative interventions to address the underlying causes of malnutrition are implemented before, during and after crises.
Climate change affects production and productivity, and this directly affects diets and nutrition, smallholder farmer⁸ incomes, as well as food price volatility. Food systems themselves have a major impact on the ⁸ Smallholder farmers here also refer to agriculture and food workers, artisanal fisherfolk, pastoralists, indigenous peoples and the landless. See Committee on World Food Security, Global Strategic Framework for Food Security and Nutrition, 2013.
ICN2: Information Note on the Framework for Action 139 environment.⁹ Some food production systems have the potential to reduce emissions intensity significantly. Food loss and waste should be reduced to ICN2: Framework for Action The Framework for Action lists the following nine recommended actions for
sustainable food systems promoting healthy diets (Recommendations 8–16):
• Recommendation 8: Review national policies and investments and integrate nutrition objectives into food and agriculture policy, programme design and implementation, to enhance nutrition sensitive agriculture, ensure food security and enable healthy diets.
• Recommendation 9: Strengthen local food production and processing, especially by smallholder and family farmers, giving special attention to women’s empowerment, while recognizing that efficient and effective trade is key to achieving nutrition objectives.
• Recommendation 10: Promote the diversification of crops including underutilized traditional crops, more production of fruits and vegetables, and appropriate production of animal-source products as needed, applying sustainable food production and natural resource management practices.
• Recommendation 11: Improve storage, preservation, transport and distribution technologies and infrastructure to reduce seasonal food insecurity, food and nutrient loss and waste.
• Recommendation 12: Establish and strengthen institutions, policies, programmes and services to enhance the resilience of the food supply in crisis-prone areas, including areas affected by climate change.
• Recommendation 13: Develop, adopt and adapt, where appropriate, international guidelines on healthy diets.
• Recommendation 14: Encourage gradual reduction of saturated fat, sugars and salt/sodium and trans-fat from foods and beverages to prevent excessive intake by consumers and improve nutrient content of foods, as needed.
• Recommendation 15: Explore regulatory and voluntary instruments – such as marketing, publicity and labelling policies, economic incentives or disincentives in accordance with Codex Alimentarius and World Trade Organization rules – to promote healthy diets.
• Recommendation 16: Establish food or nutrient-based standards to make healthy diets and safe drinking water accessible in public facilities such as hospitals, childcare facilities, workplaces, universities, schools, food and catering services, government offices and prisons, and encourage the establishment of facilities for breastfeeding.
⁹ The two major contributions of agriculture to the atmospheric composition and climate are due to deforestation and animal husbandry – of which food production and consumption constitute a significant share. The potential for biological carbon sequestration is compromised by tillage. See FAOSTAT, Greenhouse Gas Emissions from Agriculture, April 2014.
140 Ending Malnutrition improve food system efficacy and sustainability. There is an urgent need, therefore, to develop more sustainable food systems by encouraging sustainable food production and consumption practices. Agreement on shared principles of sustainability in promoting healthy diets is needed, and this will require policy coherence among the environment, agriculture and food sectors.
3.2 International Trade and Investment Trade and investment have become increasingly important to food systems.
Trade and investment agreements affect how the food system functions at global, regional, national and local levels, influencing food prices, availability, access and consumption as well as nutrition outcomes, food safety and dietary options.
Coherence between trade and nutrition policy is vital. Trade policy should support and provide adequate flexibility to implement effective nutrition policies and programmes. While trade has substantially increased the availability of and sometimes access to food for people, trade policies and agreements should not negatively impact the human right to food.
Implementation of the World Trade Organization Agreement on TradeRelated Aspects of Intellectual Property Rights should be supportive of food security and nutrition, and the obligation of Member States to promote, realize and protect the human right to food. The recommendations of Codex Alimentarius are also key for ensuring that international trade respects and promotes health and nutrition.
ICN2: Framework for Action
The FFA sets out the following two recommended actions for international
trade and investment (Recommendations 17–18):
• Recommendation 17: Encourage governments, United Nations agencies, programmes and funds, the World Trade Organization and other international organizations to identify opportunities to achieve global food and nutrition targets, through trade and investment policies.
• Recommendation 18: Improve the availability and access of the food supply through appropriate trade agreements and policies and endeavour to ensure that such agreements and policies do not have a negative impact on the right to adequate food in other countries.¹⁰ ¹⁰ United Nations General Assembly resolution A/RES/68/177, paragraph 25.
ICN2: Information Note on the Framework for Action 141
3.3 Nutrition Education¹¹ and Information Knowledge and education empower people to make informed healthy dietary and lifestyle choices, to improve infant and young child feeding practices and care, and to improve hygiene and health promoting behaviour.
Lifestyle and behaviour change is an important objective of nutrition education. It can also help reduce food losses and waste and boost sustainable resource use.
Governments, nongovernmental organizations (NGOs), the private sector and nutrition advocates should lead by example and can help promote desired healthy lifestyle changes, including through active and accessible quality health and agricultural inputs and services, food and nutrition knowledge and skills included in primary and secondary school curricula (including teaching hygiene, food preparation and culinary practices in schools), public nutrition information, social marketing campaigns, and regulations on nutrient and health claims.
Health services should be more active in nutrition education; dietary counselling should be part of primary health care, and nutrition counselling part of health workers’ training. Pre-natal and post-natal dietary counselling can significantly improve maternal and child nutrition. Adolescent girls and women in particular will benefit from better nutrition education to promote exclusive breastfeeding in the first six months of life and appropriate infant and young child feeding. Educational outreach should extend to husbands, fathers and other caregivers.
People should be informed of the nutritional content of food and meals at the time of purchase through easy-to-understand nutrition labels.
Regulations on nutrient and health claims are also needed to safeguard consumers.