1. Do you have any general comments on the draft political declaration and its vision (paragraphs 1-3 of the zero draft)?
I believe the vision is very much on target overall and the focus on different forms of malnutrition is exactly correct. If anything, I would focus more on social disparities and on poverty. For example the last bullet from paragraph 2 could be brought further up and given more prominence. Many of the observed health outcomes - from under-nutrition to obesity – are linked directly to social and economic disparities, in both developed and developing countries.
Small comment on para 3 line 8. Is the intent to say “processed foods containing sugars and fats, particularly saturated and trans-fats… etc”
Or is the intent to say “processed foods as well as sugars and fats, particularly saturated and trans-fats… etc.”
I am assuming it is the former, but the punctuation (comma) makes it ambiguous.
2. Do you have any comments on the background and analysis provided in the political declaration (paragraphs 4-20 of the zero draft)?
Paragraph 7. “Halt the increase in the prevalence of overweight in children under 5”.
According to recently published data, obesity rates in the 2-5y age group in the US have gone down between 2004 and 2012. Data from Europe seem to show “no obvious trend towards increasing prevalence” among infants and pre-school children (Cattaneo et al. 2010). This could be very different in middle-income and low-income countries – one more reason to focus on their needs.
Paragraph 10. Providing year-round access to safe, nutritious foods and balanced diets while avoiding food processing in general seems a bit contradictory. After all, cheese is one way to have milk year-round. That is how food processing developed in the first place and it does have a role in providing safe, affordable foods – year round.
Year-round access to fresh foods and fresh produce is not sustainable in many parts of the world, since it involves greenhouses, imports, air miles, refrigeration, cold storage, and of course waste. So there is a need for food processing – the good kind. I would not dismiss it.
Paragraph 11. One important concept is that agricultural production has sometimes been measured in terms of daily calories. Nutrients need to be included as well. That point is mentioned and reinforced in the following paragraph
Paragraph 14. “Empowering the consumer to make healthy food choices” is a phrase that I associate with middle class supermarket shoppers in the US. There are whole segments of society – globally - that have virtually no choice when it comes to foods, healthy or not – how can this paragraph be refocused to better capture their needs? What if there is no choice?
Paragraph 14. Not all commercial messages promoting energy-dense but nutrient-poor foods are automatically “misleading”. Often, such messages say that the empty calories are good tasting (true), cheap (true), and convenient (all true). On the other hand, health and nutrition claims can be misleading. For example, saying “this kale salad will give you sufficient energy for the whole day” – that is misleading.
I am not sure that the blanket statement that energy-dense nutrient-poor foods “induce addictions” is even correct. Overconsumption by the poor can be readily explained in economic terms (low cost), with no need to invoke physiology.
Paragraph 17. Hmm – isn’t this a sweeping condemnation of just about everybody? Perhaps a bit strong. I would argue for more health diplomacy.
Paragraph 20. I like this. I also think that there should be a mention that food and nutrition surveillance, indicators and metrics, are lacking when it comes to middle income and low income countries. Perhaps there should be a mechanism for sharing resources, expertise, and data? And should such a mechanism involve public-private partnerships?
3. Do you have any comments on the commitments proposed in the political declaration? In this connection, do you have any suggestions to contribute to a more technical elaboration to guide action and implementation on these commitments (paragraphs 21-23 of the zero draft)?
Please provide your comments in the appropriate fields relating to these commitments:
21. Commitment I: aligning our food systems (systems for food production, storage and distribution) to people’s health needs;
The agriculture and health industries often go their own ways, partly because people’s health needs and consumer preferences are not necessarily the same – in high income countries, health is a low ranking factor in food choice – well after taste, cost, convenience, and variety. In lower income countries, hunger might take priority over health concerns. So the real question is – how to achieve the agriculture – health convergence where people want to buy healthy foods? Once that happens, food systems will follow.
Commitment II: making our food systems equitable, enabling all to access nutritious foods.
This could be a good place to mention gender equity, poverty reduction and human right.
Commitment III: making our food systems provide safe and nutritious food in a sustainable and resilient way;
Cannot argue with that. On the other hand, studies from the US and France show that the most nutrient-dense foods were not the most environmentally friendly, whereas foods associated with lowest greenhouse gas emissions were nutrient poor. So nutrient density and environmental impact of foods may well be on collision course – what are we going to do about that?
Commitment IV: ensuring that nutritious food is accessible, affordable and acceptable through the coherent implementation of public policies throughout food value chains.
There is nothing wrong with wanting nutritious foods to be available, accessible, affordable, and acceptable. However, some of the inherent contradictions need to be resolved – or at least fully addressed in an objective manner. The problem that we face is this: grains, fats and sweets are good tasting, filling, available, accessible and inexpensive. Many nutrient rich foods (not all, clearly) taste bad and cost more. What are food value chains going to do about that?
Commitment V: establishing governments’ leadership for shaping food systems.
Just a caution here – in general, food systems are shaped by the private sector in response to consumer demand. When governments take the lead in shaping food systems (e.g. through collectivization or central planning) it can turn out badly. Besides, weren’t governments just slammed in Para 14 above?
Commitment VI: encouraging contributions from all actors in society;
Yes – and here I would specifically mention the private sector that is involved in every phase of every food system mentioned above. What is their role exactly in the Rome Accord??
Commitment VII: implementing a framework through which our progress with achieving the targets and implementing these commitments can be monitored, and through which we will be held accountable.
Yes, a monitoring system will be good to have.
22. Commit to launch a Decade of Action on Nutrition guided by a Framework for Action and to report biennially on its implementation to FAO, WHO and ECOSOC.
Yes, that is good also.
Prof. Dr. Adam Drewnowski