Improving Diets Through Food Systems In Low And Middle Income Countries

Taking a food systems approach is a promising strategy for improving diets. Implementing such an approach would require the use of a comprehensive set of metrics to characterize food systems, set meaningful goals, track food systems performance, and evaluate the impacts of food systems interventions. Food systems metrics are also useful to structure debates and communicate to policy makers and the general public. This paper provides an updated analytical framework of food systems and uses this to systematically identify relevant metrics and indicators based on data availability in low- and middle-income countries (LMICs). The list of indicators partly overlaps with the Sustainable Development Goals (SDG) indicators, but these do not cover all aspects of the food system. We conclude that public data are relatively available on food systems drivers and outcomes, and on some, but not all, of the activities. With only minor additional investments, existing surveys could be extended to cove

Taking a food systems approach is a promising strategy for improving diets. Implementing such an approach would require the use of a comprehensive set of metrics to characterize food systems, set meaningful goals, track food systems performance, and evaluate the impacts of food systems interventions. Food systems metrics are also useful to structure debates and communicate to policy makers and the general public. This paper provides an updated analytical framework of food systems and uses this to systematically identify relevant metrics and indicators based on data availability in low- and middle-income countries (LMICs). The list of indicators partly overlaps with the Sustainable Development Goals (SDG) indicators, but these do not cover all aspects of the food system. We conclude that public data are relatively available on food systems drivers and outcomes, and on some, but not all, of the activities. With only minor additional investments, existing surveys could be extended to cover a large part of the required additional data. For some indicators, targeted data collection efforts are needed. Because of the overlap with the SDG indicators, part of the collected data could serve not only to describe and monitor food systems, but to track progress towards attaining the SDGs.

Malnutrition in all its forms is a major challenge everywhere in the world, and particularly in low and middle income countries. To reduce malnutrition, innovations in food systems are needed to both provide sufficient options for consumers to obtain diets with adequate nutritional value, and to help consumers make conscious and unconscious choices to choose healthier diets. A potential solution to this challenge is food systems innovations designed to lead to healthier diets. In this paper, we lay out a multidisciplinary framework for both identifying and analyzing innovations in food systems that can lead to improvements in the choices available to consumers and their diets from a health perspective. The framework identifies entry points for the design of potential food systems innovations, highlighting potential synergies, feedback, and tradeoffs within the food system. The paper concludes by providing examples of potential innovations and describes future research that can be developed to support the role of food systems in providing healthier diets.

This report strengthens the economic case for increased public investment and more robust policy attention to food safety in low and middle income countries and provides guidance on ways to achieve significant, broad-based impact from such actions.

Food systems and diets are transforming rapidly in many parts of the world, particularly in low- and middle-income countries (LMIC). Changes in income, employment, taste, and location have direct implications for food choices and shopping patterns, which in turn have impacts on consumers’ nutrition and health, as well as environmental sustainability and resilience of the food system.

The national food system of Bangladesh has made substantial progress since experiencing famine in 1974, soon after independence. After the famine, the government placed a strong emphasis on policies required to attain grain self-sufficiency; since attaining self-sufficiency, the production system, policies related to it, and resulting diets have begun to diversify. Nonetheless, undernutrition remains a problem, and fruit and vegetable consumption are inadequate for most people relative to international recommendations. Moreover, as the food system has begun to transition towards a modern one, challenges related to food safety and perceived food adulteration have begun to rise. Further, increased processed food intakes are potentially associated with existing rising overweight and obesity status. Both government interventions and innovations are needed to help shift the national food system to improve nutrient-dense food availability, particularly among the poor, and to limit the increase in processed food consumption.

Investments in social assistance programs (SAPs) in low- and middle-income countries (LMICs) are increasing. As investments increase, the objectives of these programs are expanding from focusing on reducing poverty to addressing other social issues such as improving diets and nutrition. At the same time, there is increasing interest in addressing all forms of malnutrition within the framework of food systems. Given the intersections between SAPs and food systems, we reviewed the effectiveness of SAPs (agriculture asset transfers, cash transfers, in-kind transfers, vouchers, public works and school meals programs) for reducing all forms of malnutrition across the lifecycle within a food systems framework. As several programs included multiple treatment arms, each representing a unique program design, we used study arm as the unit of analysis and assessed the proportion of study arms with positive or negative program impacts on diet and nutrition outcomes among men, women and children. The majority of the studies included in this review were from evaluations of agriculture asset, cash and in-kind transfer programs. There was clear evidence of positive impacts on women’s and children’s diet-related outcomes. Very few studies assessed program impact on women’s nutritional status outcomes. However, there was some evidence of impacts on increasing body mass index and hemoglobin concentration (Hb) with in-kind transfer programs. Among children, several study arms across the agriculture asset, cash and in-kind transfer programs found positive impacts on increasing height-for-age Z-score (33%-45% of study arms) and weight-for-height Z-score (33%-50% of study arms) and decreasing the prevalence of wasting (43%-60% of study arms). Cash and in-kind transfer programs also found positive effects on reducing stunting prevalence in 33% and 45% of study arms, respectively. Lastly, a few study arms assessed program impact on increasing Hb with some evidence of positive impacts in in-kind and school feeding programs. There was a paucity of relevant evidence of the effectiveness of voucher and public works programs on diet and nutrition outcomes, for men’s outcomes and on micronutrient status. Several challenges remain in understanding the potential for SAPs to improve diet and nutrition outcomes within food systems including the heterogeneity of program and evaluation designs, populations targeted by the programs and included in evaluations and indicators used to assess impact. Addressing these challenges in future evaluations is important for informing program and policy actions to improve the effectiveness of SAPs within food systems for improving diet and nutrition outcomes across the lifecycle.