Thank you for sharing this excellent draft. Several very relevant comments and suggestions were already submitted. However, I should like to underline a few challenges that could deserve more emphasis.
1. As suggested by one discussant, malnutrition has to be clearly defined right from the onset to include both undernutrition (which includes micronutrient malnutrition) and nutrition-related chronic diseases. The rural and the urban poor are more exposed to both forms of malnutrition and the resulting ‘double burden of malnutrition’ than their more affluent peers. We showed that the poor and women were particularly affected by the double burden, in urban Burkina Faso and Benin. This double burden of malnutrition is quite a challenge and it deserves more emphasis.
2. A more complete and clear definition of food security should be reminded, and whether or not it includes access to a diversified diet (qualitative dimension of food security). Access to food and nutrition information was part of the initial FAO definition but it seems to have been dropped or at least neglected. Both the quantitative and the qualitative dimensions of food security are to be addressed. I totally agree that food security indicators should be modulated for urban and rural areas.
3. A distinction is needed between ‘minimally-processed’ foods and ‘ultra-processed’ foods. The former are essential while the latter are not. The challenge is how to increase and improve local food processing in order to displace imported foods and drinks. The issue of increasing consumption of ultra-processed foods, mostly produced and marketed by the Big Food, is directly linked with increasing obesity and other nutrition-related chronic diseases. It cannot be overlooked anywhere. Local food systems have to be protected and made more efficient, even if they cannot feed the whole population.
4. We would suggest that more emphasis be given to the ‘pull’ effect that urban food demand should have on local production. This was highlighted in our discussion paper for FAO which Dr Florence Egal referred to. This would imply that local foods are valued, reversing the current trend. Social marketing efforts are needed to counteract the effective and powerful commercial marketing of imported foods, fast food and carbonated beverages.
5. It has been convincingly argued elsewhere that food value chains may be acted upon with a nutrition lens in order to improve the nutritional profile of foods, and not only to increase efficiency and reduce waste. The integration of nutrition in food value chains may be considered.
6. In several industrial countries, several strategies are implemented to bring food producers and consumers closer together. One of these is the ‘Family Farmers’ approach whereby urban families sign contracts with local producers and pay in advance to get their basket of vegetables (and some local fruits) on a regular basis. Organic farms are primarily involved. Can such an approach not be applied in low and middle income country cities as a means of consuming local fresh products and supporting local food production while reducing the environmental damage?
7. As mentioned by Bert Cramer, community and traditional food practices contribute to food security and need to be better recognized. Several traditional plant or animal foods should also be valued and their consumption promoted.
8. Finally, I should like to give an example of an initiative linking nutrition and agriculture for improved health in Cotonou (Benin, West Africa). The project was implemented a few years ago with external and local funding. It links self-help groups formed several years earlier for the surveillance and prevention of nutrition-related chronic diseases, with a cooperative of urban food producers. The dual purpose is to increase vegetable consumption and to support local producers while improving the safety and quality of the produce (contact person: Dr Victoire Agueh, Director of the Regional Public Health Institute firstname.lastname@example.org).
Hélène Delisle, Ph.D., Professor Emeritus, Department of Nutrition Faculty of Medicine, University of Montreal, Canada