Foro Global sobre Seguridad Alimentaria y Nutrición (Foro FSN)

General comments

The structure of the V0 report is fully adequate due to the four chapters and subentries. So is the Conceptual framework and the five Definitions and extended concepts. The Introduction (page 9) quite precisely outlines the present frame of the report.

Specific comments

1     APPROACH AND CONCEPTUAL FRAMEWORK

 1.1:   Definitions 1, 2 (sustainable) and 3 (F. environments) are sequentially necessary, but reading one after the other one perhaps gets the impression of redundancy.

1.2:  FS Typologies are very important because of the different food environments. To whom will this be addressed?

2 THE BURDEN

Due to my medical background and nutritional path I’ll concentrate on the triple burden of the adequate approach given to the malnutrition term.

2.1    When considering Undernutrition I would only like to make two comments. The first is related to the evaluation of anthropometric measurements, maybe it would be worth suggesting a proved general standard, such as the one by Cole or CDC, WHO because of its design would be the third option. The second is that when considering stunting (and obese stunted children), the easy calculated target height should be attempted in order to evaluate more precisely the causes of height reduction.

2.2   Overweight & Obesity. It is ok for adults. Because of the firm tracking from childhood to adulthood and the poor therapeutic results in all ages, the pediatric approach should be particularly stressed, as the World Heart Federation has signaled since 2004. This, furthermore due to the presence already in children of obesity comorbidities (1)

2.3   Micronutrient Malnutrition, causes and consequences. Perhaps it would be worth adding a 2.3.4 entry for zinc

2.3.4. Other important micronutrients. For further versions I would consider the importance of essential amino acids (EAA), because in LMIC the amount of protein intake is less worrisome nowadays, but the quality does matter. The deficiency in lysine and tryptophan (2, 3) have clinical consequences that should be avoided. Deficiency of all EAA is also associated with stunting (4).

4    GARNERING QUALITY DIETS FROM SUSTAINABLE FOOD SYSTEMS

4.1.2. Food value chains and Food environments affect nutrition and diets. Figure 27 (page 68) depicts precisely the value chain for nutrients. In this context one option for dry LMIC will be to get complete proteins from plants. Mixing flours (5, 6) of chickpeas and sorghum (~20/80%) could be an issue until transformed seeds could be available.

REFERENCES

• Moya M. Lysine genetically enriched cereals for improving nutrition in children under 5 years in low- and middle-income countries. J Nutr Health Food Eng 5(2): 00164. DOI: 10.15406/jnhfe.2016.05.00164.
• Moya M.  Fatty Liver Disease among Other Comorbidities Requiring Early Diagnosis in Pediatric Obesity. Obes Control Ther 2013; 1(1), 02.  http://symbiosisonlinepublishing.com/obesity-control-therapies02.pdf.
• Moya M. Low tryptophan chronic intake present consequences. BAOJ Pediatrics 2016 (In press)
• Semba RD. Trehan I, Gonzalez-Freire M, Kraemer K, Moaddel R, Ordiz M. Perspective: The potential role of essential amino acids and the mechanistic target  of rapamycin complex (mTORC1) pathway in the pathogenesis of child stunting. Adv Nutr 2016; 7(5) 853-65.
• El-Adawy TA. Nutritional composition and antinutritional factors of chickpeas (Cicer Arietinum L) undergoing different cooking methods and germination. Plant Foods Hum Nutr 2002; 57(1): 83-97
• Suri DJ. Tano-Debrah K, Ghosh SA. Optimization of the nutrient content and protein quality of cereal-legume blends for use as complementary foods in Ghana. Food Nutr Bull 2014; 35(3): 372-81

We wish to thank for the opportunity to comment on the Nutrition and food systems V0-draft. The draft is well planned and covers the food system as well as diet and health as well as diet and NCD. As a response to the specific important questions 1-12 we would like to give the following input:

1. The purpose of this report is to analyse the ways in which food systems influence dietary patterns and hence nutritional outcomes. The objective is to focus on consumers and consider sustainability issues. The report aims to be solution oriented and to highlight efficient policies and programs. Are those major objective(s) clearly reflected in the V0 draft?

Solution oriented approach is very welcome. It is important to state clearly the different stakeholders in the food system and the interests. Consumer focus is important, as food price is a big driver of consumption. It is equally important is to clearly state how profit drives trade. Political decision makers have an obligation and responsibility to act. Very important message on p.10 paragraph starting on line 14: Acting to change systems is never easy. Vested interests, technical difficulties and human and financial resource constraints all have to be overcome. Effort and focus need to be sustained. But key decision- makers in the public and private sectors have an obligation and a responsibility to act, and they should  feel empowered to do so. Right now the political momentum is with those who aim to shape their food  system towards improved nutrition. The SDGs – the world’s main accountability tool for sustainable  development over the next 15 years – have a lot to say about food security, nutrition, climate and sustainable consumption.

1. Do you think that the overall structure of the draft is comprehensive enough, and adequately considered and articulated? Does the draft strike the right balance of coverage across the various chapters? Are there important aspects that are missing? Does the report correctly focus on the links between nutrition and food systems without straying beyond that?

The draft is well balanced. However, the role of trade and agricultural subsidies could be more clearly stated. We have evidence on their role in shaping the consumption (increase sugar consumption, replace healthier plant oils with palm oil). This should be stated clearly as policy instruments and the decision makers using them are directly steering consumption, sometimes towards unhealthy diets contributing to NCDs, expenses and deaths. 

1. Does the conceptual framework need to be edited? Simplified? Should “the food environment” as defined in the draft be central to the framework?

The draft states clearly there are many stakeholders and players in the food system, all contributing to the food environment.

1. Are production systems and their role in shaping diets and nutritional outcomes adequately addressed?

The role of economic drivers in the food system can be clearly (and briefly) stated. There is profit in the food system, unfortunately not always for the primary producer, nor equally distributed. Food system is complex as food is a necessity as well as a commodity - it is up to the food system stakeholders to act responsibly. As stated at the end of the draft (p. 105) “Nutrition is not a sector but cross-cutting development problem that needs to be integrated into the activities and policies of…. such as ministries of finance…”. It is clear not all the stakeholders act responsibly.

1. Does this draft cover adequately the main controversies in the field of Nutrition and food systems? Are there any remaining gaps?
2. The project team is working on a categorization of food systems. Are you aware of specific approaches of use in that perspective, and particularly of quantitative indicators that could be used?
3. Does this draft adequately show the multiplicity and complexity of diets and nutrition issues across different food systems and specific contexts with a good regional balance?
4. What areas of the document are in need of strengthening or shortening?
5. Chapter 4, Section 4.1 contains case studies/examples of effective policies and actions in different contexts/countries across the food system for diets and nutrition. Could you offer other practical, well-documented and significant examples to enrich the report and provide better balance to the variety of cases and the lessons learned, including the trade-offs or win-win outcomes in terms of addressing the different dimensions of diets for FSN?
6. Section 4.2.2 on “Institutional Changes and Governance Across the Food System Movements for Nutrition” requires more work, and more inclusion of evidence and of the various players. Any inputs on this section are most welcome.

Section 4.2.4 on future research and data needs. It would be valuable to mention here the need for nutrient content data, as it is the basis of all calculations. The nutrient content differs due to climate, soil, fertilizers, storage, cooking, etc.

1. Is the report too technical or too simplistic? Are all the concepts clearly defined?
2. Are there any major omissions or gaps in the report? Are topics under-or over-represented in relation to their importance? 

Malnutrition has for too long been a neglected issue. Yet it is a problem that affects one in three people worldwide. Today, 159 million children are stunted, 50 million are wasted and more than 2 billion people are overweight or obese. But in 2015 for the first time in history, through the Global Goals, the world has committed to ending malnutrition in all its forms. As the 2016 Global Nutrition Report makes clear, tackling malnutrition is one of the largest challenges facing all countries. Malnutrition comes in many guises: stunting, wasting, deficiencies of essential vitamins and minerals, and obesity. Reaching the ambitious target of ending malnutrition is only achievable if world leaders can ensure agriculture and food systems policies strengthen nutrition outcomes. There is a moral imperative to eliminate malnutrition. Undernutrition contributes to 45% of the 16,000 children under the age of five who die every day. The impacts extend well beyond health: stunted children who survive are permanently disadvantaged, perform worse at school and are robbed of future earnings that could support them and their families. But eliminating malnutrition is also an economic imperative. The costs of undernutrition in terms of lost national productivity are significant, with between 3% and 16% of GDP lost annually in Africa and Asia. The good news is that we know that the economic returns from investing in nutrition are high – GBP 16 generated for every pound invested. Boosting nutrition can boost growth.

The section on Climate Change is very commendable and clearly articulates the nexus among agriculture, food and nutritional security and the threat of climate change. Although some of your casestudies are focused on sustainable agriculture. The report can be strengthened with simplifying the language generally; and using language and more case studies that promotes this nexus in intervention.

Also, the graphs can be more explicit for anyone to relate with and use with anyone.

Dear committee:

Fully agree with Mr. Sommers, from California, for more than 40 years still the same questions and guidelines, more discussion. Here are my points.

Introduction page 9: lines 17-22 the paragraph is like a question-answer dilemma to justify the lack of an adequate answer.

Introduction page 9: lines 31-34, the simple statement that industrial scale production is a threat for environment, and with the exact amount of money on environmental damage of US$ 3 trillion, is ridiculous, if you simply do the math’s with the WB actual population of 7.5 billion (2016 e), means that the cost of living, we owe US$ 400/year/human, to Mr. Environment,  and this bring me to a simple question: Does it worth to feed the hunger at any cost? Or you prefer to let the most needed die? Because the FAO´s expert panel argued that the environment in the long term will suffer. This full paragraph looks like a environmentalist or a vegetarian type individual was in charge of it.

The Title is a Wikipedia like study case, and it avoids crucial facts, like the promotion at governmental levels of proven tools like the use of GMO´s to close the gap. This year example is Brazilian the severe drought, living the government to use fast track 10 million TN “permit” of GMO maize from USA, or the Mexican case, where authorities deny breeding GMO maize for poor farmers do to “cultural” reasons argued by NGO´s and they have to buy Transgenic maize flour imported from USA.

The argument that obesity comes solely for industrial foodstuffs can be a misleading opinion, the fact is: “the energy balance”, you can be eating the same, for instance in low income rural areas, but reduction of energy output do to a change in labor habits can be a trigger in obesity, and my point is clear, rural farmers energy in labor works reduction (agricultural, water supply, firewood collection, etc.) due to a beneficial factors such as electricity, water pumps, etc. and this Framework do not address it, is not knowing the “whole Picture” of the matter.

The Chapter 4.2.4 should make the point of promoting alternative energy output, mainly some type of organized exercise to balance the energy income, that´s the most important point in rural as in urban areas, rather than blame the use of industrialized food.

It has no sense, to be writing the same over and over and not making any important point that can leave to any government to make a clever choice.

 Dear HLPE Project Team,

I have read through your Report with interest and commend you for the great effort and amount of work carried out. I will focus my comments on the conceptual framework which I think may need to be simplified a little, and make a small comment on section 4.2.3.

I believe the conceptual framework you have developed may be a bit “heavy”- it seems to put together 3 different sets of concepts and the final outcome is a bit confusing. To specifically respond to your question # 3, I do believe that making the concept of food environment  (FE) the centre piece of the framework would help make the latter simpler and clearer and would “tighten” the text a little. This is also justified on the grounds of what you write in Chapters 2 and 3. In the these you tell us: 1) that unhealthy diets account for “at least 40% of all NCD mortality” (p.33), 2) that globally speaking the world is moving towards unhealthy diets as incomes increase. This raises the question of what kind of food is becoming more available and accessible (and partially as a consequence, more desireable) worldwide. This is where I think the Food Environment framework stands at the intersection between what the food system supplies and what people actually eat.    

In my view, it is important to recognize the mediating role of food environments on what people eat, and in turn the effect that various aspects of the food system have on the food environment rather than connecting the different elements of the food system directly to diets (see Figure 6.1 in the latest Glopan Report for an illustration of this). The central message should be that food systems need to make healthier food more available, accessible and acceptable – the three pillars of food environments. The question is then how do food systems, in their various aspects which you identify as “drivers” and value chains activities contribute to making healthy food more/less available, affordable and acceptable. This is what you have started to do in Section 4.1.2, which I think should be given more relevance. What I think would be needed is to transfer information that you have under 3.2 under each of the paras on page 70. For example, section 3.2.3 could feed into para 2 on page 70 thus contributing to explaining what helps/hinders healthy food becoming more affordable. And so on… I would also categorize the policies and programmes that you have under section 4.1.3 in the same way (i.e. which contributed to making healthy foods more available, etc). That would help identify whether countries are working more on one aspect (eg: availability) and not another (eg. affordability) and whether there are any trade-offs.

The NOURISHING website has some interesting examples of policies:

http://www.wcrf.org/int/policy/nourishing-framework/about-nourishing

I think the above approach I am suggesting would also help countries focus better on what needs to improve in order to help their citizens achieve a better diet and to monitor their work. In this respect, the benchmarking work of the INFORMAS team is very useful:

https://www.fmhs.auckland.ac.nz/en/soph/global-health/projects/informas.html

On the topic of Nutrition Governance, I was happy to see that you have a section on social movements. Historically social movements related to food (especially in HICs) have focused their efforts on environmental sustainability aspects- so: locavore movements, KM 0, Farmers’ markets, box delivery schemes, etc. Increasingly however the healthiness of (such) foods is entering their narrative and becoming an important topic. What this suggests is the role played by social movements in raising people’s awareness and in partially determining a shift in consumer demand (food acceptability?). In other words, “policies” “from below” need as much attention and support as those from above.

An interesting article in this respect would be:

Huang T. et al, (2015) “Mobilisation of public support for policy actions to prevent obesity”, The Lancet, vol.385

One last small thought on the structure of the report: I think that at the moment the Report is indeed a bit too long and not focused enough. I think that taking the FE concept as a categorizing tool should help avoid some repetitions and take out links between food systems and diets that are maybe a bit too indirect. As Florence has pointed out, I would also start the Report by outlining “the problem” (i.e. increases in NCDs worldwide, triple burden of malnutrition), followed by the strong role played by diets, the evidence that diets worldwide are becoming unhealthier (Section 3.1.2), the role of FE, and the contribution of the various elements of the food system in leading to this.

Thank you for the opportunity and I hope these comments are useful.

Kind regards,

Dalia

Consultant

Nutrition and Food Security Division

FAO

Ps. I have not had time to read through all the comments that have come in- just the first ones. I may thus be repeating comments already made… apologies for that!

1. La finalidad de este informe es analizar cómo los sistemas alimentarios influyen en los hábitos alimentarios y, por tanto, en los resultados nutricionales. El objetivo es centrarse en los consumidores y considerar las cuestiones relacionadas con la sostenibilidad. El informe pretende estar orientado a la búsqueda de soluciones y destacar las políticas y programas eficaces. ¿Refleja claramente el borrador cero este/estos objetivo(s) principal(es)?

Así es, aunque aún se siguen escribiendo algunas conclusiones del informe.

¿Considera que la estructura general del borrador es suficientemente exhaustiva, y está adecuadamente considerada y articulada? ¿Cree que el informe logra encontrar el equilibrio apropiado en lo que respecta a la cobertura de los diferentes capítulos? ¿Hay aspectos importantes que no aparezcan reflejados? ¿Considera que el informe se centra adecuadamente en los vínculos entre la nutrición y los sistemas alimentarios sin desviarse a otras consideraciones?

Creemos importante el enfocarse más en la producción agroalimentaria sostenible, con el objetivo de crear mercados e incentivos que fomenten modelos de consumo y producción sostenibles, promoviendo la mejora de la productividad y métodos de producción con un uso eficiente de recursos a través de enfoques basados en el mercado.

¿Es necesario modificar el marco conceptual? ¿Simplificarlo? ¿Debe ser el “entorno alimentario”, tal y como se define en el borrador, un elemento esencial del marco?

Creemos que el marco conceptual no debe modificarse.

¿Aborda de forma apropiada este borrador los sistemas productivos y su papel en la elaboración de las dietas y los resultados nutricionales?

Sería recomendable el elaborar algún cuadro en donde se explicara como son los “Sistemas Ingeniosos del Patrimonio Agrícola Mundial” (http://www.fao.org/docrep/014/i2232s/i2232s.pdf).

1. ¿Cubre adecuadamente este borrador las principales controversias en materia de nutrición y sistemas alimentarios? ¿Detecta alguna carencia?

               Las cubre

1. El equipo del proyecto está trabajando en una categorización de los sistemas alimentarios. ¿Conoce algún enfoque específico empleado para este fin en este marco, y concretamente, algún indicador cuantitativo que pudiera ser utilizado?

¿Cree que este borrador describe adecuadamente la multiplicidad y complejidad de las dietas y las cuestiones nutricionales en los diferentes sistemas alimentarios y contextos específicos con un apropiado equilibrio regional?

Sería más claro el poner qué tipo de cultivos son mayormente consumidos contra el costo de las mismas.

¿Qué secciones del documento deben ampliarse o acortarse?

Se toca muy brevemente el tema de pérdidas y desperdicio de alimentos, sería muy interesante abordar el tema de investigaciones sobre especies que presentan por ejemplo mayor tolerancia a la sequía. Debería abordarse el tema sobre consideraciones del conocimiento tradicional en los sistemas productivos.

La sección 4.1 del capítulo 4 incluye estudios de casos/ejemplos de políticas y actuaciones efectivas en diferentes contextos/países en todo el sistema alimentario para mejorar las dietas y la nutrición. ¿Podría compartir otros ejemplos prácticos, bien documentados y significativos para enriquecer el informe y proporcionar una visión más objetiva de los diferentes casos y lecciones aprendidas, incluyendo las contrapartidas o los resultados mutuamente beneficiosos a la hora de abordar las diferentes dimensiones de las dietas para la SAN?

Recomendamos tomar en cuenta otros documentos de las Naciones Unidas y de la FAO e iniciativas como el reporte de “Sustainable Diets and Biodiversity” (http://www.fao.org/docrep/016/i3004e/i3004e00.htm), el programa 10YFP (http://www.unep.org/10yfp/), reporte del talle “Biodiversity in sustainable diets” (http://www.fao.org/ag/humannutrition/24994-064a7cf9328fbe211363424ba7796919a.pdf).

La sección 4.2.2 sobre "Cambios institucionales y de gobernanza en los movimientos del sistema alimentario para la nutrición" requiere más trabajo y más evidencias de los diferentes agentes. Cualquier contribución a esta sección es bienvenida.

Para la sección de manejo de recursos naturales sostenibles recomendamos el reporte “Sustainable Diets and Biodiversity” (http://www.fao.org/docrep/016/i3004e/i3004e00.htm).

¿El informe es demasiado técnico o demasiado simplista? ¿Están todos los conceptos claramente definidos?

Es un documento equilibrado.

¿Tiene el informe alguna carencia u omisión significativa? ¿Hay temas poco o demasiado representados en relación a su importancia?

Podría ahondarse más el tema de promover, mejorar y facilitar el cambio hacia sistemas alimentarios más sostenibles, se debe seguir investigando cultivos que pudieran aportar nutrientes a poblaciones vulnerables o con problemas nutrimentales, es decir el tomar en cuenta la conservación y protección de los ecosistemas y sus recursos naturales, en este sentido integrarse las metas de Aichi con los Objetivos de Desarrollo Sustentable, por ejemplo la meta 14 dice “Para 2020, se habrán restaurado y salvaguardado los ecosistemas que proporcionan servicios esenciales, incluidos servicios relacionados con el agua, y que contribuyen a la salud, los medios de vida y el bienestar, tomando en cuenta las necesidades de las mujeres, las comunidades indígenas y locales y los pobres y vulnerables”, y no solo tomar en cuenta el tema de fortificación agronómica o modificaciones genéticas.

De acuerdo a la decisión 21 de la COP 12 del CBD, se reconoció el valor del enfoque “Salud compartida” para abordar la cuestión intersectorial de la diversidad biológica y la salud humana como enfoque integrado coherente con el enfoque por ecosistemas que integra las complejas relaciones entre los seres humanos, los microorganismos, los animales, las plantas, la agricultura, la vida silvestre y el medio ambiente.

Otro tema que se toca poco es sobre la desertificación y la pérdida de la biodiversidad  las cuales están estrechamente relacionadas con la producción de alimentos, así como podría darse algún ejemplo sobre buenas prácticas de manejo del pastoreo para evitar la degradación de los suelos (http://www.fao.org/3/a-x5320s/x5320s0b.htm).

También deberían tomarse en cuenta publicaciones sobre la huella hídrica en la agricultura, para promover tecnologías como agricultura por goteo (http://wfn.project-platforms.com/Reports/Report47-WaterFootprintCrops-Vol1.pdf).

GENERAL COMMENTS ON THE HLPE REPORT ON NUTRITION AND FOOD SYSTEMS

This report is very welcome. The extensive references are very useful, there are some eye-opening data, and there is a good range of cases.  My comments are mainly on the consumer’s actual and potential role in the food system, which I feel deserves more attention, and a number of imbalances in the coverage. Specific comments are made in the notes on the attached pdf.

1.    The “education” dimension needs more prominence, coherence and specificity.  “Education” in food and nutrition now means anything (including independent insights, perceptions and actions) which results in informed food practices (the currently accepted definition of “nutrition education” is given in the comments on the text). The various schools of thought and practice (STPs) (e.g. “food and nutrition education”, “communication”, “behaviour change”, “behavioural economics”, “social marketing”) which outline, practise and test essential processes, structures and theoretical frameworks in nutrition interventions, need to be defined early in the report and the terms handled correctly and consistently. 

(a)  Specifically, the current philosophy of "nutrition education" is misrepresented as meaning information dissemination. 

(b) Generally, many of the interventions mentioned in the report (e.g. community development, service training, counseling, health promotion, social marketing, consumer education, awareness-raising, political advocacy, labeling, ENAs, conditional social protection schemes) involve consumer outlooks, understanding, attitudes, perceptions and practices, and hence some form of education. The report has a tendency to comment in passing on the effectiveness or ineffectiveness of such approaches rather than recognizing commonalities and linking them to the principles promoted by the STPs. 

(c) All STPs have inbuilt limitations and strengths, which should be acknowledged when proposing strategies (e.g. “nudges” work only in specific conditions).  A consistent stance should be taken, for example, on the effectiveness of information dissemination, community dialogue, different forms of mass media etc.

(d) A great deal is known by STP practitioners about what works and what does not. It would be desirable for a team of at least three experts from different STPs  to be invited to review the report at this stage, agree on the use of the terms and suggest clarifying detail.

2.    Socio-cultural drivers (p.57) This is the field of action of the STPs mentioned above. There is considerable evidence for a  more elaborate picture than the one presented here (see e.g. Contento,2007[1]). Socio-cultural drivers should include (among other elements) (a) the inertial power of acquired habits and skills and the time it takes to change them, (b)  household food expectations as a drag on change (change is easier for individuals), (c) time and convenience for HH cooks (major factors in the nutrition transition), (d) the social values given to specific foods (e.g. F&V not seen as a “real” food, pulses as “food of desperation”, soda drinks as young and glamorous, meat as an aspirational luxury),(e) “health beliefs”, especially the perception that what one eats makes a real difference to one’s health, (f) the practice/ understanding of prevention rather than cure in all health matters, including diet, (g) the habit of making changes, maintaining them and passing them on to the next generation, and the confidence to do it (“self-efficacy”), (h) the practice of getting information, knowing where to get it, and acting on it.   All of these are more widespread and influential than specific food taboos, which seldom have a critical effect on overall diet quality. 

3.    Access, availability and utilization: Theory of change.  The report often makes the assumption that access and availability will change dietary behaviour. For example, “Lack of affordable nutritious food can create a marked barrier to consumption” (p.70)– but so can perceptions of nutritious food and belief in its value, even in situations of scarcity. (The experience of the International Year of Pulses has highlighted some of these barriers.)The limitations of this mainly economic change model should be spelt out, exemplified and taken into consideration throughout the report.

4.    Balance and discrepancies in emphasis  Several parts of the report focus on one aspect of the issue at the expense of others – e.g. developed vs developing countries, smallholders vs industrial agriculture, high tech and low-tech solutions, obesity vs undernutrition.  In particular:

-       Environment and behaviour  A main assumption is that environments condition consumer behaviour (e.g. p.99). This is of course correct, but the influence is reciprocal, as implied in Fig. 1 (food system): environment and consumer are both conditioned and conditioning: e.g. having only fast-food restaurants in an area limits the eating-out possibilities, but if there is consumer demand for fast-food, the market is likely to supply. The trick is to work out the balance of influences in any given context.

-       Community development, consumer capacity, consumer demand are treated well, but do not get the attention that they deserve in relation to other parts of the food system.  There is evidence that supplyside actions frequently need to be reinforced by social acceptance and readiness to change.  In Fig. 27, for example, surely one of the main entry points for nutrition must be consumer demand for healthier food (as shown in the Conceptual Framework, Fig.1).

-       Agriculture’s impact on nutrition A great deal of attention is given to improvements in agriculture, PH losses, marketing etc. but the claim is also made (p.109) that there is “little empirical evidence on the role of agriculture and other nutrition-sensitive sectors on nutrition”.  Such discrepancies need to be aired.

-       Information and advice  Although the report states that information and advice alone have weak effects on changing dietary practice, much of the document assumes that information is the only “educational” strategy required - e.g. labeling and dietary guidelines figure in the model of the food system in Fig 1 as “educational” aspects of the food environment (both are likely to be ineffectual without some more diverse implementation strategy). The report proposes (near the end) to explore whether information makes a difference – however it needs only cite the existing evidence.

-       Emphasis on specific micronutrients  The report states (p.35) that "the best estimation of the relationship between diet and health consists of evaluating global dietary patterns and not in the analysis of specific foods and nutrients".  However the text goes on to look in depth at three specific micronutrient deficiencies. Should there be more on overall dietary imbalances?

-       Supplements and food-based solutions The issue of micronutrient supplements vs food-based solutions is rightly raised - needs more discussion?

-       School meals  The report claims that feeding programs - particularly school feeding - have “a direct impact on nutrition and diets”. The impact of school feeding needs a more nuanced discussion, especially in view of the relatively great length of some of the other sections in the report (e.g. on trade), the enormous sums which are spent on school meals, and the absence of evidence of nutritional impact (according to the Global School Feeding Sourcebook). Further questions about school meals are whether they have any concurrent impact on home diets, or longitudinally on children’s food choices when they become adults –i.e. whether there is any real effect on attitudes, understanding or food practices. I do not know of any studies in these areas. 

-       Policy p.69  What about examples of policies and programs aimed at improving consumer awareness and demand? 

5.    Strategy choices  How are policy-makers to choose between, balance or combine the different options for tackling national nutrition issues? Ideally governments should be able to map what is already in place, assess its cost and review models of other countries’ overall policies and plans. Cost-effectiveness and long-term, sustained impact on food practices are key criteria. The ICN2 Framework listed desirable actions, but did not supply the means for governments to arrive at workable and affordable strategy choices based on their own situations.  What guidance can this report give?

6.    Some gaps in coverage are urban agriculture, consumers’ associations, and professional training in FNE/BCC in national services.

Jane Sherman, Food and Nutrition Education consultant

Rome 26.11.2016

1 Global Panel on Agriculture and Food Systems for Nutrition. 2016. Food systems and diets: Facing the challenges of the 21st century. London, UK.

In order to strengthen this draft, the HLPE would welcome submission of material, evidence-based  suggestions, references, and examples, in particular addressing the following important questions:

1. The purpose of this report is to analyze the ways in which food systems influence dietary patterns and hence nutritional outcomes. The objective is to focus on consumers and consider sustainability issues. The report aims to be solution oriented and to highlight efficient policies and programs. Are those major objective(s) clearly reflected in the V0 draft? I think they are

2. Do you think that the overall structure of the draft is comprehensive enough, and adequately considered and articulated? Does the draft strike the right balance of coverage across the various  chapters? Are there important aspects that are missing? Does the report correctly focus on the links between nutrition and food systems without straying beyond that?  The draft is comprehensive and articulated, the balance between chapters is right

3. Does the conceptual framework need to be edited? Simplified? Should “the food environment” as defined in the draft be central to the framework?  Perhaps simplified, and the food environment occupying a central place

4. Are production systems and their role in shaping diets and nutritional outcomes adequately addressed?  Yes they are. More emphasis on ecological matters are perhaps necessary

5. Does this draft cover adequately the main controversies in the field of Nutrition and food systems? Are there any remaining gaps? Sorry. I am not familiar with the controversies

6. The project team is working on a categorization of food systems. Are you aware of specific approaches of use in that perspective, and particularly of quantitative indicators that could be used?  No

7. Does this draft adequately show the multiplicity and complexity of diets and nutrition issues across different food systems and specific contexts with a good regional balance? I think the multiplicity and complexity are adequately shown

8. What areas of the document are in need of strengthening or shortening?

9. Chapter 4, Section 4.1 contains case studies/examples of effective policies and actions in different contexts/countries across the food system for diets and nutrition. Could you offer other practical, well-documented and significant examples to enrich the report and provide better balance to the variety of cases and the lessons learned, including the trade-offs or win-win 8outcomes in terms of addressing the different dimensions of diets for FSN? Sorry. It is not my field of expertise

10. Section 4.2.2 on “Institutional Changes and Governance Across the Food System Movements for Nutrition” requires more work, and more inclusion of evidence and of the various players. Any 11 inputs on this section are most welcome. Sorry. It is not my field of expertise

11. Is the report too technical or too simplistic? No Are all the concepts clearly defined?  Yes

12. Are there any major omissions or gaps in the report? Are topics under-or over-represented in relation to their importance?   No

Under the heading  Gender

Unemployment accelerates   Male out-migration f4rom the rural areas. Education also plays a major role in migration. Illetearacy amoung women is yet another issue This transfers the responsibility of farm management  on the shoulder’s of Women farmers. Their physical burden increases tremendously as they have to solely handle  most of the farm operations along with household chores. Disasters events like droughts, heat waves  fuel up their physical and psychological  distress situations .There should be a methodologies for calculating Women Discomfort Index and periodical assessment  assessments should be done during distress period.