Global Forum on Food Security and Nutrition (FSN Forum)

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    • Dear Drafting Team,

      The European Federation of the Associations of Dietitians (EFAD)1 specialist Public Health group recognizes the huge amount of work of the  HLPE FSN team for the draft Report on Reducing inequalities for Food Security and Nutrition (FSN) and welcome the opportunity to participate in this consultation. 

      We offer the following comments and suggestions, which we hope will contribute to an even stronger version of the report.

      • We find that the proposed framework is an effective conceptual device to guide the conversation and action surrounding inequalities and food insecurity, especially when combined with the food systems framework (p.26). The framework and the report adequately discuss the implication of adopting the six-dimension definition of FSN. We agree with the view that addressing inequalities in FSN requires a drastic transformation of the food systems and the whole status quo upon which they exist. While global tendencies, especially market-driven (as the report highlights when discussing the commercial determinants of health and food - p. 66), exist, we celebrate that the report recognizes context-specific realities of and solutions to FSN. 
      • In this regard, and while realising the ‘universal development’ approach (Longhurst, 2017) that guides this report, we would like to suggest to also include data about high-income regions, like Europe, in some of the featured tables and figures. Just like the report recognises, inequalities and FSN are also present in those countries, but, when it comes to FSN data, their relevance may end up being blurred by the magnitude of the data in other regions. For instance, epidemiological surveys performed in European countries show that poor iron status affects 10±30% of menstruating women and iron deficiency anaemia, which in the case of adolescents, might increase up to 48%. Likewise, research on healthy diet affordability found that, in 2019, for 16 out of 24 countries at least 10% of the population in (sub)urban areas would be confronted with income-related food insecurity. After the COVID-19 pandemic and the inflation crisis these figures are likely to have grown. Displaying such data along the text and in key elements of the report such as table 2.1. can contribute to appreciating the existence and scope of FSN in high-income countries and regions like Europe. Rising awareness is the first step toward taking action towards the issue in the region.
      • We would like to identify three aspects that we find underrepresented in the report. The first one is food literacy. Various definitions of food literacy exist. Vidgen and Gallegos (2014) define it as 'the scaffolding that empowers individuals, households, communities or nations to protect diet quality through change and strengthen dietary resilience over time. It is composed of a collection of inter-related knowledge, skills and behaviours required to plan, manage, select, prepare and eat food to meet needs and determine intake'. Cullen et al (2015) conceptualize food literacy as the interconnection of two spheres: community food security and individual food skills, which lead to a comprehensive understanding of the food system within a society and culture which culminate in food choices that impact health and wellbeing. Several works describe the relation between food literacy and food insecurity. In this regard, while we recognize the structural factors as major drivers of FSN, and while running from individualistic approaches, we do believe that empowering individuals, families and communities about their relation to food can leverage some of the inequities that lead to FSN. Moreover, increased food literacy is directly related to enhancing the autonomy dimension of FSN.
      • The second point is the recognition of how the way in which FSN is tackled can create further health inequalities. Food aid is the main mechanism to face FSN in high-income countries, but without proper political involvement and regulation it often ends up acting as a bandaid for hunger instead of an ensurement of the possibility to have adequate nutrition. Dealing with inequalities in FSN cannot be separated from the promotion of diet quality.
      • Thirdly, we are delighted that the authors identified the aggressive marketing of infant formulae as an issue, and wondered if there could be an extension of the 'life-course' approach and some mention of the fact that the elderly are also a group at risk. 
      • Last, may we draw your attention to the following work on measuring food and nutrition insecurity, which complements the existing reference by Barrett (2010) and can allow to identify further ways of operationalizing and monitoring the elements of the conceptual framework
      1. Castetbon K. Measuring food insecurity. In: Biesalski H., Drewnowski A., Dwyer J., Strain J., Weber P., Eggersdorfer M., editors. Sustainable Nutrition in a Changing World. Springer; Cham, Switzerland: 2017. 
      2. Anderson S., editor. Core indicators of nutritional state for difficult-to-sample populations. J. Nutr. 1990;120:1559–1600. doi: 10.1093/jn/120.suppl_11.1555. 
      3. Carrillo-Álvarez E, Salinas-Roca B, Costa-Tutusaus L, Milà-Villarroel R, Shankar Krishnan N. The measurement of food insecurity in high-income countries: A scoping review. Int J Environ Res Public Health. 2021;18(18):9829. 
      4. Beacom E., Furey S., Hollywood L., Humphreys P. Investigating food insecurity measurement globally to inform practice locally: A rapid evidence review. Crit. Rev. Food Sci. Nutr. 2020 doi: 10.1080/10408398.2020.1798347.

      The European Federation of the Associations of Dietitians (EFAD) specialist Public Health group reasserts the recognition to the drafting team and wants to express its willingness and availability to be further involved in this activity.

      1 Elena Carrillo (Spain), Amanda Avery, (United Kingdom), Teresa Rodrigues (Portugal), Zeynep Begüm Kalyoncu (Turkey) Zoi Toumpakari (United Kingdom), Bernadette Kiss-Toth (Hungary) and Manuel Moñino (Spain). http://www.efad.org/en-us/specialists-networks/public-health/

      References

      1. Hercberg S, Preziosi P, Galan P. Iron deficiency in Europe. Public Health Nutr. 2001;4(2B):537–45. 
      2. Penne T, Goedemé T. Can low-income households afford a healthy diet? Insufficient income as a driver of food insecurity in Europe. Food Policy [Internet]. 2020;99(101978):101978. Available from: https://www.sciencedirect.com/science/article/pii/S0306919220301822
      3. Vidgen HA, Gallegos D. Defining food literacy and its components. Appetite.2014:9;76:50–9. 
      4. Cullen T, Hatch J, Martin W, Higgins JW, Sheppard R. Food literacy: Definition and framework for action. Can J Diet Pract Res [Internet]. 2015;76(3):140–5. 
      5. Michou M, Panagiotakos DB, Lionis C, Costarelli V. Socioeconomic inequalities in relation to health and nutrition literacy in Greece. Int J Food Sci Nutr [Internet]. 2019;70(8):1007–13. 
      6. Begley A, Paynter E, Butcher LM, Dhaliwal SS. Examining the association between food literacy and food insecurity. Nutrients [Internet]. 2019 [cited 2023 Jan 3];11(2):445. 
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