Chapter 1 Introduction

Ensuring sustainable, healthy diets should be a worldwide priority. Yet we are further from achieving that goal than ever before. Instead, multiple crises are unfolding. It is a stark reality that roughly 690 million people are chronically undernourished (a number that may rise considerably during 2020 due to the wide-reaching effects of the coronavirus pandemic), and more than 2 billion people are overweight or obese. Millions of people die every year due to poor-quality diets, which are now responsible for around 20% of premature mortality worldwide. Pressures on healthcare systems are growing inexorably in the wake of an epidemic of non-communicable diseases (NCDs) including stroke, cardiovascular disease, and diabetes. At the same time, the food systems upon which diets rely contribute significantly to climate change and the degradation of environmental resources, upon which they themselves depend. The impacts of the coronavirus pandemic have also highlighted the fragility of food systems to shocks.

This report argues that food systems are profoundly dysfunctional at many levels. The long-term goal is a fundamental transformation of the food system. This must be urgently pursued to improve diet quality for all, ensure sustainability, and build resilience. This cannot be achieved overnight, therefore the initial transition steps should not be delayed. This report focuses on pragmatic first actions to get us moving in the right direction. There are signs of growing openness by governments to approach these policy challenges through connected systems thinking, rather than relying on traditional siloed approaches. The opportunities for multi-win actions are real, and courage is already being shown by some low- and middle-income country (LMIC) governments that are willing to engage in national dialogues around possibilities for a different future. The Global Panel urges governments, the private sector, development partners, civil society, and citizens to engage in a food system transition as an absolute priority – by focusing on the first steps needed to make lasting change possible.

This report focuses primarily on LMICs but also includes important messages for governments and donor agencies in high-income settings. It builds on a first Foresight report published in 2016, which made the case for much wider and systematic use of a food systems lens in shaping policies across sectors, and sounded the alarm that poor-quality diets were leading to a deterioration globally in human health and nutrition. 1

This second report also distils the latest science, as well as the perspectives of many experts and policymakers from around the globe, to bring an even stronger light to bear on how deficiencies in our food systems profoundly affect both human and planetary health, and how these impacts will only become worse without concerted whole-of-society commitment to changing how food systems function (Part I).

The picture painted by the Global Panel’s findings is bleak. Without action, policymakers must expect the situation to worsen considerably. But the Panel has also found that the situation is capable of being addressed, given political will, and decisive action. The goal that frames this entire report is to make healthy diets accessible, affordable, and desirable to everyone, and at the same time, ensure that food systems deliver those diets sustainably (see Boxes 1.1 and 1.2).

The greater part of this report is about action. Part II (Chapters 4-7) distils the complexity down into clear actions which are essential steps in the transition needed to transform food systems, while recognising the need to tailor these to local circumstances.

Part III discusses the political and economic realities, as well as the difficult trade-offs which policymakers in LMICs will face when deciding upon the bold reforms which are needed. It also identifies systemic factors which could block change, impede progress, or drive food systems in the wrong direction. These must also be addressed and include,for example, biases in subsidies, research funding and price incentives. Encouragingly, there is evidence that even relatively modest rebalancing of these factors could yield substantial benefits, at little or no cost.

This report also sets out who needs to act. While the focus   of the Global Panel is primarily on LMICs, this report’s findings constitute a stark warning for every nation. The advice and recommendations offered are particularly important for LMICs where the burden of malnutrition in all its forms is greatest, and where food systems are repeatedly damaged by a multitude of shocks. But many of the recommendations are also relevant for high-income countries (HICs) where food systems are also increasingly fragile and inequitable. Individuals and families suffering from inadequate diets are not restricted to LMICs.

There is a clear role for policymakers to act within their respective countries. But it is also essential for governments and relevant international organisations to  work  together as part of an integrated and coherent framework for global, national, and local action.

Many of the drivers influencing food systems are global in nature, and their impacts cut across geographic boundaries. They include climate change, geopolitical factors, international trade, and the extensive deterioration of many environmental resources, including land, biodiversity, soil, and fresh water. Countries seeking to transform their food systems are likely to achieve much less if they act alone. Worse, in the absence of concerted actions, individual countries engaged in reform may be vulnerable in terms of trade, food safety standards, limitations to available data, as well as a range of humanitarian pressures which can beset LMICs – such as conflict, fragile neighbouring states, and forced migration. The policy change and investment agendas critical to a viable future for global and local food systems need to enjoin all nations.

1.1 The many problems affecting today’s food systems

1.1.1  COVID-19 and the resilience of food systems: a wakeup call

The coronavirus crisis has underscored the inter-connectedness of the world’s food system, and its fragility to shocks which can rapidly affect many regions and countries. The economic effects of the pandemic have been far-reaching. Millions of people have been pushed into poverty due to job losses (for example,  a survey of 700 businesses in Nepal found that three in five employees lost their salaried job during lockdown). 2 Billions of consumers are worried about how to access food, farms face uncertainty about access to labour, and restaurants face bankruptcy.

The crisis has also highlighted health inequalities, as pre-existing health conditions linked to inadequate diets have substantially increased the risk of severe symptoms and death. While some elements of the food system have adapted to the new normal of coronavirus lockdowns (such as pop-up local farmers’ markets, farmer-to-customer food corridors in China and Costa Rica, and food supply chains supporting online purchases and delivery), the coronavirus represents just one new challenge to the effective functioning of global food systems. Yet, it has shaken complacency. Current food systems are neither robust to shocks nor delivering the healthy diets that underpin good nutrition for all.

1.1.2  Our diet choices and food systems are harming human health – a nutrition crisis

Today, unhealthy diets are responsible for more deaths globally than tobacco, high blood pressure, or any other health risk combined. 3 According to the Global Burden of Disease initiative, one in five deaths is associated with a poor-quality diet. People in every region of the world would benefit from rebalancing their diets by eating more nutrient-rich foods within a diverse diet, and eating less calorie-dense foods and processed products based on ingredients known to compromise health (see Box 1.1).

Box 1.1: What is a healthy diet?

While there is no single dietary pattern that delivers ‘good health’ in every society, there is broad agreement on what elements should be included in healthy or high-quality diets They include a diversity of foods which are safe, and provide levels of energy and key nutrients of all kinds appropriate to age, sex, disease status and physical activity (i.e. nutrient-rich). The World Health Organization (WHO) emphasises the importance of starting healthy-eating habits in early life (notably through exclusive breastfeeding).

It advises people to eat plenty of fruit, vegetables, wholegrains, pulses, fibre, nuts and seeds, fish, and some dairy and lean high-quality meats in moderation. 4 The WHO recommends limiting intake of free sugars, sugary snacks and beverages, processed meats, trans-fats and salt. In this report, the Global Panel is not promoting or endorsing a single or universal diet for all. It seeks instead to promote policy actions across the entire food system to secure a high-quality diet for everyone.

The ‘triple burden’ of malnutrition (impaired child growth manifested as stunting, deficiencies in minerals and vitamins, and the growing epidemic of diet-related NCDs linked to overweight and obesity) hinders progress in other development domains, especially in LMICs such as Indonesia, Bangladesh and South Africa which are successfully reducing undernutrition but at the same time experiencing burgeoning epidemics of diabetes and cardiovascular disease. 5 NCDs are placing an ever-increasing burden on government budgets for healthcare, especially in countries with rapidly growing populations, falling poverty, and shifting dietary patterns. Poor diets and nutrition are also a key factor in pushing people into lifetimes of inequality by impairing children’s health, learning and development, and limiting the productivity and prosperity of millions of individuals, particularly in sub-Saharan Africa and South Asia.

The economic costs are vast. The impact on the global economy of all forms of malnutrition has been estimated at US$3.5 trillion per year. When the impacts of certain agricultural practices that are harmful to the environment are included, this figure rises to more than US$6 trillion per year in terms of the value of lost productive life alone. 6

1.1.3 Ensuring sustainable, healthy diets for all is contingent on a food system that can deliver required nutrient-rich foods (see Box 1.2)

Sustainable delivery depends not only on what foods are produced, but on how they are produced, how much is wasted, how they are processed, and how incentives for enhanced production efficiency are influenced by consumer demand.

Each of these factors is influenced by food system policies. For example, since food prices and marketing strategies do not generally reflect the real costs of food production (where negative externalities are accounted for), the contribution of food systems to greenhouse gas emissions and environmental

A child born today will experience a world that is more than four degrees warmer than the pre-industrial average, with climate change impacting human health from infancy and adolescence to adulthood and old age.

Watts et al. (2019) 7

Nothing short of a systemic transformation of food systems is required if we are to feed the world’s current and future population sustainably under climate change.

Steiner et al. (2020) 8

Box 1.2: Defining sustainable food systems

For the purposes of this report, the term ‘sustainable food system’ is broadly used if the contribution of a place’s food system (which delivers locally produced but also imported and marketed foods) can be continued without undermining the ability of the natural environment to function in the long term: that is, the system does not drive biodiversity loss, pollution, soil degradation, or climate change. (For a more detailed and nuanced discussion of ‘sustainability’ in the context of food systems, and how the term is used in this report, see Chapter 3).

degradation has low visibility. 9 It is therefore challenging for  governments to give a high priority to policy changes which  would drive food system changes which promote planetary  as well as human health.

In pursuing the goal of healthy diets, the sustainability of food  systems is a critical concern, as their capacity to function effectively  is inextricably bound to the continuing depletion or degradation  of natural resources as well as to the growing climate crisis. The escalating impacts of weather-related shocks across LMICs  is driven by changing climatic patterns, with some of the most  severe anomalies affecting producers and consumers in Africa, South Asia, and small-island states. While changes are needed to  make local food systems more resilient to climatic shocks, reversing  the emissions and natural resource degradation associated with  most food production, marketing and processing is both a national  and a global responsibility. Individual nations can do a lot, but a transformation of food systems with planetary implications  requires all nations working towards common goals. It is not a  luxury to seek to enhance food systems in ways that are sustainable,  able to protect planetary resources and nurture human health  simultaneously. It is a paramount policy priority of the 21st century.

The unsustainability of food systems is very costly. Agriculture  and agriculture land use already accounted for an estimated 21%  of total anthropogenic greenhouse gas emissions between 2007  and 2016 10 and for roughly 70% of global fresh water use. The  pressures applied to natural resources by food production have  also left 25% of the world’s cultivated land area degraded. 11 These  hidden costs of today’s failing food and land systems – through  their impact on health, nutrition and the natural environment – have been estimated at US$12 trillion a year, rising to more than US$16 trillion by 2050 if current trends continue. 12

1.1.4 Major flaws in today’s food system

Our food systems have achieved a great deal over many years. They  have enabled substantial increases in agricultural productivity over  the past 50 years, with a threefold expansion in crop production. 13  These gains have been primarily in grain output (rice, maize and  wheat), which has increased by almost a billion metric tons since  the mid-1960s. 14 This increase in production played a critical role in reducing hunger: the share of people in resource-poor countries living with average daily food intakes of less than 2200 kcal fell from  57% in the early 1960s to just 10% by the end of the century. 15

Food systems do not provide only food but also jobs, income, infrastructure, skills (socio-economic outcomes) and ecological services (environmental outcomes). This means that food systems can make a significant contribution not only to food and nutrition security, but also to inclusive development
and a viable environment for fighting climate change.

FA0 (2019), Food Systems at Risk 16

The challenge of food systems today is not that they are ‘broken’  but that they are no longer aligned with changing global priorities.  In particular, food systems today have three major inter-linked  weaknesses which are driving today’s nutrition crisis, and which  constrain them in delivering sustainable, healthy diets for all. Showing why and how these weaknesses must be tackled is key  to enabling the food system transition. Key arguments of this  second Foresight report are as follows:

First, the world’s food systems are outmoded. They were  shaped half a century ago to feed as many people as possible  at the lowest cost. Today, food systems need to do more than  merely feed people. They need to nourish people in ways that  support human health, while ensuring sustainability. Current  systems are unable to meet these essential requirements. They  produce insufficient nutrient-rich foods to meet today’s needs,  let alone future demand (see Chapter 4). What is produced  contributes in negative ways to both human and planetary  health, and they are also vulnerable to a wide variety of global  and local shocks. Food systems that deliver healthy diets  sustainably are essential to delivering many of the Sustainable  Development Goals. However, most governments accord little  priority to the fundamental policy changes which are urgently  required, leading to policy stasis which is allowing an alarming  escalation of global and local challenges.

Second, healthy diets today are unaffordable for too  many people. It is estimated that around three billion people  today simply cannot afford the least-cost form of healthy diet recommended by national governments. 17 18 Hence the emphasis  in this report, particularly in Chapter 6, on making affordability  of sustainable, healthy diets a top policy priority globally.

If sustainable, healthy diets are to be affordable to all, a wide  range of policy instruments must design through the lens of an integrated food system and implemented in joined-up  rather than piecemeal ways.

Third, despite growing calls for food system  transformation, 19  20 21  22 23 the essential steps in any transition  have not been well defined. Also, the long-term agenda is largely  posited without a clear understanding of the trade-offs that will inevitably be involved, and the scale and diversity of benefits  that transition steps will deliver. Policymakers must make the  challenges and trade-offs transparent, and assess them through  political, societal, and economic lenses, facing them head-on.

1.2 A new vision for food systems

This report shows that healthy diets for all can only be delivered  if they are sustainable, and if their accessibility and affordability  are an integral part of how food systems function. Food systems  and the planet’s natural resources are closely linked. Ensuring  that both are nurtured in ways that support sustainable, healthy  diets is a key principle. Food systems – from supply to demand –  must support both human and planetary health, and actions to  protect natural resources and mitigate climate change must also  support the goal of sustainable food systems.

In the wake of the coronavirus pandemic, policymakers around  the world are facing a new reality. While conventional policies,  incentive structures and patterns of demand have influenced  recent trends in food supply and demand, a fundamentally  different approach will be needed if food systems are to be less  fragile to future economic shocks, disease outbreaks or climate-  related natural disasters.

1.2.1 What change is needed in our food systems?

While several conceptual models of food systems are available,  they tend to present the food system as a relatively controllable  or even static entity which has different components or  domains. The reality is very different. A food system, whether  global or local, is a dynamic complex system which is constantly  changing in response to myriad exogenous and endogenous  drivers: demographic shifts, economic growth, changing patterns  of consumer lifestyles and demand, shifts in trade patterns and investment, new technology, changes in the natural  environment, and more. The many parts of a food system are thus in constant flux, and for the policymaker this presents  substantial challenges in terms of the steps needed to achieve  desired changes. The scale and complexity are immense, but  at the same time the goals are critical.

In this report, food system transformation is characterised as a long-term goal. The desired aim is a system having a number  of key characteristics tied to achievable, positive health and  planetary goals which are stable while the system itself is  constantly shifting and evolving. To get there, a transition period  is essential to enable global and national leadership. Given how  today’s food systems are largely based on a 20th century vision of feeding the global population, a new vision needs to be clearly articulated so that different pathways can be harnessed  to nourish people in ways that are sensitive to, and reflect,  a society’s culture, traditions and aspirations.

1.3 Framing policy approaches for a food system transition

In 2016, the Global Panel produced a first Foresight report which  argued for fundamental shifts in policy in LMICs to enable food  systems to deliver healthy diets for all. 24 That publication shone a spotlight on the approach that policymakers must take to  ensure complementarity and additionality from food-related  policies and programmes implemented across multiple sectors.  Adopting a food system lens was advocated then, and it remains  important. For example, this perspective urges governments to  better trace how a production-focused policy can affect wages  or transportation costs, or how a consumer-focused tax may  impact food processing and retail companies.

Since 2016, the need for actions to transform food systems  has become increasingly recognised within the wider policy  community, with many other reports now addressing food  systems issues. Yet few have attempted to articulate the socio-political realities which have to be involved in transforming  food systems from where they are today to where they need to be. There are undeniable challenges to face. So rather than  elaborating even more on the vision of a different future  (however important that may be), this report of the Global  Panel focuses instead on articulating pragmatic strategies to  manage an effective transition.

There is now an opportunity for LMICs to grasp the  opportunities present today; to link climate, pandemic,

The current food system “must be transformed to one that is safe, sustainable, healthy and fair to all.

Commission for the Human Future (2020) 25

There is no future for business as usual – we are reaching irreversible tipping points for nature and climate, and over half of the global GDP, US$44 trillion, is potentially threatened by nature loss.

World Economic Forum (2020) 26
13

economic and health concerns, and mould them into a coherent  policy narrative that will support actionable steps in the right  direction. Such a strategy will point to a visionary future, but it will be defined by what is currently technically possible,  politically feasible, and socially and economically acceptable.  High-income country (HIC) governments and their donor  agencies have an equal responsibility to act by reforming their  own food systems, but also need join with LMICs in making the  necessary global changes possible by supporting them through  the transition.

Despite the urgency of past calls for action, the world is failing  to make the significant changes needed at the scale and pace required to address the inter-linked challenges of unhealthy diets,  environmental resource degradation and dysfunctional food  systems. While these are systemic threats, it would be a mistake  for policymakers to seek merely to mitigate their impacts while  shying away from fundamentally transforming food systems. However, the cost of transforming food systems in LMICs, and  indeed in all countries, will not be inconsequential.

The cost of ensuring that every individual is able to eat a healthy  diet every day will be significant, especially if the world moves  towards pricing food in ways that better reflect the ‘true’ cost of production, processing and marketing. 27 Yet the cost of not acting will be immeasurably higher. Just as there are compounding risks  to inaction, there are co-benefits to decisive action in terms of  millions of new jobs, a reduced economic burden of ill health  and reduced costs to health systems, and substantial gains from  avoiding global damage from climate change. Estimates suggest  that positive outcomes will contribute trillions of dollars to the  world’s economy. One recent analysis puts the economic gains  from a fundamental food system transformation at US$10.5  trillion per year by 2050.  28 However, many political leaders remain  reluctant to invest for the medium to long term. Therefore, in  moving forward, it will be important to ensure transparency on  the costs of inaction as well as costs of action, and the benefits  to be realised.

  1. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet. Global Panel on Agriculture and Food Systems for Nutrition. Food systems and diets: facing the challenges of the 21st century.London, UK; 2016.
  2. UNDP. Rapid Assessment of Socio Economic Impact of COVID-19 in Nepal. 2020.
  3. Afshin A, Sur PJ, Fay KA, Cornaby L, Ferrara G, Salama JS, et al. Health effects of dietary risks in 195 countries, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2019. 393(10184):1958–72. Available from: http://dx.doi.org/10.1016/
  4. WHO.Healthy diet [Internet]. 2020 [cited 2020 Apr 29]; Available from: https://www.who.int/news-room/fact-sheets/detail/healthy-diet
  5. Development Initiatives. 2020 Global Nutrition Report: Action on equity to end malnutrition. Bristol, UK; 2020.
  6. Food and Land Use Coalition. Growing Better : Ten Critical Transitions to Transform Food and Land Use. Global Consultation Report of the Food and Land Use Coalition 2019.
  7. Watts N, Amann M, Arnell N, Ayeb- Karlsson S, Belesova K, Boykoff M, et al. The 2019 report of The Lancet Countdown on health and climate change: ensuring that the health of a child born today is not defined by a changing climate. Lancet. 2019.394(10211):1836–78.
  8. A S, Aguilar G, Bomba K, Bonilla J, Campbell A, Echeverria R, et al. Actions to Transform Food Systems Under Climate Change. Wageningen, The Netherlands; CGIAR Research Program on Climate Change, Agriculture and Food Security (CCAFS). 2020
  9. Editorial. The true cost of food. Nat Food. 2020.1(4):185–185.
  10. IPPC. Climate Change and Land: an IPCC special report on climate change, References desertification, land degradation, sustainable land management, food security, and greenhouse gas fluxes in terrestrial ecosystems [P.R. Shukla, J. Skea, E. Calvo Buendia, V. Masson - Delmot. 2019.
  11. IPPC. Climate Change and Land: an IPCC special report on climate change, References desertification, land degradation, sustainable land management, food security, and greenhouse gas fluxes in terrestrial ecosystems [P.R. Shukla, J. Skea, E. Calvo Buendia, V. Masson - Delmot. 2019.
  12. Food and Land Use Coalition. Growing Better : Ten Critical Transitions to Transform Food and Land Use. Global Consultation Report of the Food and Land Use Coalition 2019.
  13. FAO. The future of food and agriculture–Trends and challenges. 2017.
  14. FAO. World agriculture: towards= 2015/2030. Rome, Italy; 2003.
  15. Pingali P, Stamoulis K, Stringer R. Eradicating extreme poverty and hunger: towards a coherent policy agenda. ESA Working Paper No. 06- 01(FAO). 2006
  16. Dury S, Bendjebbar P, Hainzelin É, Giordano T, Bricas N. Food Systems at risk: new trends and challenges. Rome, Montpellier, Brussels,; 2019.
  17. Herforth A, Bai Y, Venkat A, Mahrt K, Ebel A, Masters WA. Cost and affordability of healthy diets across countries. Technical Background Paper for SOFI 2020: The State of Food Security and Nutrition in the World, 2020. 2020
  18. FAO, IFAD, UNICEF, WFP and WHO. The State of Food Security and Nutrition in the World: Transforming Food Systems for Affordable Healthy Diets. Rome, Italy; 2020
  19. Food and Land Use Coalition. Growing Better : Ten Critical Transitions to Transform Food and Land Use. Global Consultation Report of the Food and Land Use Coalition 2019.
  20. FAO & WHO. Strengthening Nutrition Action. Rome, Italy; 2018. 1–112 p.
  21. UNICEF and GAIN. Food Systems for Children and Adolescents: Working together to secure nutritions diets. In Florence, Italy; 2018. Available from: https://www.unicef.org/nutrition/food-systems.html
  22. Willett W, Rockström J, Loken B, Springmann M, Lang T, Vermeulen S, et al. Food in the Anthropocene: the EAT–Lancet Commission on healthy diets from sustainable food systems.
  23. Searchinger T, Waite R, Hanson C, Ranganathan J. Creating a Sustainable Food Future: A Menu of Solutions to Feed Nearly 10 Billion People by 2050. Vol. 1, World Resources Report. 2019. Available from: www.SustainableFoodFuture.org.
  24. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet. Global Panel on Agriculture and Food Systems for Nutrition. Food systems and diets: facing the challenges of the 21st century. London, UK; 2016.
  25. Commission for the human future. Round Table on Global Food Security. Food is at the heart of our future [Internet]. 2020 [cited 2020 Jul 6]. Available from: https://humanfuture.net/sites/default/files/Final Report on Food Security.pdf
  26. World Economic Forum in collaboration with AlphaBeta. The Future Of Nature And Business. Geneva, Switzerland; 2020.
  27. Editorial. The true cost of food. Nat Food. 2020.1(4):185–185.
  28. Food and Land Use Coalition. Growing Better : Ten Critical Transitions to Transform Food and Land Use. Global Consultation Report of the Food and Land Use Coalition 2019.