ZERO DRAFT Claudio Schuftan’s suggestions ( cschuftan@phmovement.org
)
[I am afraid the technocratic prevails over the participatory and the consultative in this zero draft. I fear its fate is guarded at best].
Introduction: The call for monitoring and policy impact assessment .......................................................... 2
What Outcomes? .......................................................................................................................................... 5
Food Environment .................................................................................................................................... 6
Available Indicators ............................................................................................................................... 7
Research needed ................................................................................................................................... 9
Diet Quality ............................................................................................................................................. 10
Available Indicators ............................................................................................................................. 11
Research needed ................................................................................................................................. 12
Environmental Sustainability .................................................................................................................. 12
What Policies? ............................................................................................................................................. 12
Agricultural Production ........................................................................................................................... 14
Market and Trade Systems ..................................................................................................................... 14
Food Transformation and Consumer Demand ....................................................................................... 15
Consumer Purchasing Power .................................................................................................................. 15
What Process? ............................................................................................................................................ 16
Two ways to assess potential nutrition impact of policies ..................................................................... 16
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Avoiding nutritional harm based on specific policies ......................................................................... 17
Policy portfolio review ........................................................................................................................ 17
Stakeholders involved in implementing a Policy Impact Assessment .................................................... 18
Conclusions ................................................................................................................................................. 19
Annex 1: Glossary of key terms........................................................... Ошибка! Закладка не определена.
Annex 2 ............................................................................................... Ошибка! Закладка не определена.
Annex 3 ............................................................................................... Ошибка! Закладка не определена.
Annex 4 ............................................................................................... Ошибка! Закладка не определена.
Annex 5 ............................................................................................... Ошибка! Закладка не определена.
References .......................................................................................... Ошибка! Закладка не определена.
Acknowledgements ............................................................................. Ошибка! Закладка не определена.
The Second International Conference on Nutrition (ICN2), jointly organized by The Food and Agriculture of the United Nations (FAO) and the World Health Organization (WHO), was convened at FAO
Headquarters in Rome, from 19-21 November 2014, under the theme “Better Nutrition, Better Lives”.
Member states endorsed the Rome Declaration on Nutrition and the Framework for Action . The Rome
Declaration on Nutrition enshrines the right of everyone to have access to safe, sufficient and nutritious food, and commits governments to preventing malnutrition in all its forms, including hunger, micronutrient deficiencies and obesity. The Framework for Action recognizes that governments have the primary role and responsibility for addressing nutrition issues and challenges, in dialogue with a wide range of stakeholders.
ICN2 highlighted the role of food systems – the way food is produced, processed, distributed, marketed and prepared for human consumption – is crucial in the fight against malnutrition in all its forms including overweight and obesity. To this end, the ICN2 Rome Declaration of Nutrition includes:

Commitment 15c) Member States committed to enhance sustainable food systems by developing coherent public policies from production to consumption and across relevant sectors to provide year-round access to food that meets people’s nutrition needs and promote safe and diversified healthy diets.”

Commitment 15d: “Member States committed to raise the profile of nutrition within relevant national strategies, policies, actions plans and programmes, and align national resources accordingly”.
The ICN2 Framework for Action includes an adopted set of recommendations on actions toward food systems that promote diverse and healthy diets. Among those is:
2


Recommendation 8: “encourages countries to review national policies and investments and integrate nutrition objectives into food and agriculture policy, programme design and implementation, to enhance nutrition sensitive agriculture, ensure food security and enable healthy diets”.
The Sustainable Development Goals (SDGs) also highlight commitments toward sustainable food systems that support good nutrition, congruent with those enumerated in the ICN2 outcome documents. SDG2: End hunger and ensuring access by all people, in particular the poor and people in
vulnerable situations, including infants, to safe, nutritious, and sufficient food all year round by the year
2030.
The UN Zero Hunger Challenge includes an aspiration to achieve “100% access to adequate food.”
The CAADP Nutrition Capacity Development Initiative has recommended that National Food Security
Investment Plans include the objective to “increase availability, affordability and consumption of fresh,
healthy and nutritious food.” (see Dufour et al. 2013, p65)
These commitments harken ??
back to 20 years ago, where at the 1996 World Food Summit, UN member nations pledged to ensure that “All people at all times have access to sufficient, safe, nutritious
food to meet dietary needs and food preferences for a healthy and active life.”
In recognition of its importance to nutrition, more funds have been committed to nutrition-sensitive agriculture than any other single area of nutrition. For example, $19.2 billion were committed by many donors and governments in 2013 at the G8 meetings (Government of UK 2013) (Nutrition for Growth
Summit). 1 already allocated? Just promises?
Despite high-level goals and financial commitments to nutrition-sensitive agriculture, targets and benchmarks in the agriculture sector for improved nutrition are largely absent. Effects of these investments need to be monitored on food—the agriculture and food sector’s main, unique ultimate contribution to nutrition. Decision makers need the tools to consider how the nutrition sensitivity of national policies might be improved addressing the multiple burdens of malnutrition including overweight and obesity. A way of tracking what is being done, and estimating what kind of impact it may have on nutrition, is needed. Nutrition-sensitive is a neologism to avoid talking about the social determinants of agriculture/food security/nutrition.
Measurement is important for accountability to the goals and ideals laid out in international and
national declarations. It is also important to track progress on nutrition-sensitive agriculture. Are we doing what we say? Are we doing the right things? Monitoring processes leading to appropriate outcomes strategically can help identify good practices to improve policies for positive impact on nutrition. Information shapes and drives policy; as the saying goes, “What gets measured gets managed.” …provided the info is used… a big if.. Rhetoric is less likely to be translated into action if there are no indicators or systems to measure progress in processes leading toward stated goals.
1 The Scaling Up Nutrition movement, which now includes 55 countries, includes two kinds of action to improve nutrition: nutrition-specific activities to target the immediate causes of malnutrition (such as micronutrient supplementation and deworming), and nutrition-sensitive development to target the underlying causes of malnutrition, including lack of access to food, health care, and care practices.
3

The purpose of this paper is to lay the groundwork for a process by which food systems policies could be assessed for their impact on diets and food environments what exactly are these?
. Jargon These would be analogous to processes for social, environmental, and health impact assessments of policies that inform debate around a new policy.
2 Three ingredients would need to be defined at the outset of such a system: (1) a set of food security and nutrition processes and outcomes that could be monitored; (2) priorities for which food systems policies should be assessed; and (3) a process by which the potential nutrition impact of such policies could be deliberated delivered?
. This paper discusses each of these three areas, with the goal of clarifying what needs to be in place to be able to analyze if policies have an influence on nutrition. It is not a monitoring & evaluation (M&E) tool that can attribute changes in nutritional status to a particular policy. Rather, the purpose is to expose the gaps in each of these areas
(outcomes, policies, process reverse the order ), and what is needed to close the gaps, with the intent of informing future monitoring and impact assessment of food systems policies on diets and food environments.
2
E.g. An environmental impact assessment aims at identifying, predicting, evaluating and mitigating the environmental effects of development proposals prior to major decisions being taken (Abaza et al. 2004).
4

Fig 1.
The purpose of this section is to identify processes leading to outcomes that are relevant to monitor in relation to the ICN2 and SDG commitments, including data needs and data sources (at national and local levels). For assessments of the existing food environment ?
as well as tracking how it changes in the presence of new food systems policies and investments, we need a suite of indicators that reflect a healthy and sustainable food system.
The Millennium Development Goals have shown the importance of well-chosen indicators. “The MDGs have had enormous communicative power. Once the goals were defined and the targets set, they began to shape the way that development was understood” (Fukuda-Parr et al. 2013, p. 19). The only foodrelated indicator in the MDGs was FAO’s “undernourishment” indicator (proportion of the population with access to adequate calories). This focus on calories to alleviate hunger has not been significantly updated since the 1960s-70s, when the focus of agriculture was to combat hunger and famine via increased staple crop production in the Green Revolution (World Bank 2014). In terms of food availability, the commodities tracked for food security purposes are typically only the major staple crops
(maize, wheat, and rice, and sometimes oilseeds). This focus on statistics on calories, and staple production and prices, leads to policies that prioritize staple food production.
In the post-2015 development agenda, the global community now has an opportunity to align indicators better with ideals for nutritious food access—especially since it is increasingly clear that poor diets are a major cause of all forms of malnutrition, and food access is a major contributor to poor diets. Now, with the persistence of undernutrition and micronutrient malnutrition, and rapidly increasing incidence of obesity and diet-related non-communicable diseases, it has become clear that goals and metrics of caloric supply and staple grains are insufficient. New metrics are needed that point attention to the
quality of diets that are available and affordable, and consumed. See new Brazilian Guidelines
5

A consensus view is that:

“Food and agriculture policies can have a better impact on nutrition if they monitor [ dietary consumption and ] access to safe, diverse, and nutritious foods.” This principle was developed through a consultative process involving dozens of development partners, and appears in the
FAO Key Recommendations for Improving Nutrition through Agriculture and Food Systems (FAO
2015, Herforth and Dufour 2013). The same principle appears in The Framework for Joint Action
on Agriculture and Nutrition, presented at the ICN2 by the EC, FAO, World Bank Group, and
Technical Centre for Agricultural and Rural Cooperation (2014).

The nutrition community has advocated that the indicators to track SDG2 include a measure of nutritional quality of food (SCN 2015, 1000 Days et al. 2015, BMGF 2014). Currently the only such indicator available is at individual diet level, but there is a need monitoring toward the goal to “Increase year-round household access to adequate, affordable micro-nutrient-rich food groups such as legumes, fruits and vegetables, and animal-source foods” (BMGF 2014).

The Global Panel on Agriculture and Food Systems for Nutrition calls for improved metrics and data, specifically of food environments and diet quality, for effective food system policies in the post-2015 era (Global Panel 2015).
Overall, if used, indicators on access to adequate nutritious food and dietary quality would enable better informed policy options to improve food security and nutrition. If collected over time and used , these indicators would also allow for an improved evidence base of how agriculture and food policies can affect nutrition. Monitoring data do not guarantee policy solutions; the data could lead to a variety of responses in various sectors, and may not necessarily lead to immediate action. In the absence of such indicators and data, however, it will be difficult to deliberate policy options, and to capture how
“nutrition-sensitive” investments are contributing to improved nutrition. A good start would be disparity reduction measures to curb the scandalous inequalities.
Looking forward, if governments and other actors in the international community are to be able to assess gaps and improvements in food systems for nutrition, two key are areas at a minimum need to be tracked: the food environment still undefined here , and diet quality. Furthermore, these measures need to account for gender and social equality . And, the ICN2 and SDG goals regarding food systems rest on sustainable production, so indicators of environmental sustainability are also needed.
One of the primary ways agriculture and food systems can affect nutrition is through improving the food environment: including increasing year-round availability and affordability of diverse, nutritious foods and diets. Is this a definition? The food environment constrains and signals consumers what to purchase; it can be defined aha… as the availability, affordability, convenience, and desirability of various foods (Herforth and Ahmed 2015). The food environment strongly affects diets. This is recognized in social ecological and political frameworks for nutrition and physical activity, which place individual factors determining food and beverage intake in the midst of environmental settings,
6

influenced by sectors including agriculture, aggressive marketing, and industry (USDA Dietary Guidelines for Americans 2010).
A challenge is that available indicators reflect only small parts of the food environment, or are proxies for what truly needs to be measured. Meaningful information on food availability and affordability has not been tracked, either through national/global monitoring systems or as indicators of desired impacts from nutrition-sensitive agricultural interventions and investments. However, there is an emerging area of research on improving methods and metrics. More research…?
Available Indicators
Below is a compilation of indicators that are available given existing data and that have been tracked.
Sources that have included them as monitoring indicators are listed. The newest of these indicators to be compiled across countries is the % of calorie supply from non-staples, and fruit and vegetable availability (both included in the 2015 Global Nutrition Report).
Available indicator
Availability (all nutrient based!)
What it measures
% Undernourishment Proportion of the population unable to access adequate calories
Availability of calories Dietary Energy Supply
(kilocalories/ capita/day)
% calorie supply from nonstaples 3
Proxy for diversity/micronutrient density of food supply
% of protein supply derived from animal origin (grams/capita/day) 4
Fruit and vegetable availability
(grams/ capita/day) food based
5 this one
Affordability To me, much more important
Unclear implication; related to diversity of food available
Fruit and vegetable availability
Data source
FAO
FAO
FAO food balance sheets
FAO food balance sheets
FAO food balance sheets
Source
FAO
FAO
FAO 2013, GNR 2015
FAO 2013, GNR 2015
GNR 2015
3 As the share of energy supply from starchy staples goes down, the proportion of stunting also goes down (FAO et al. 2013; Remans et al. 2014); but it could indicate the likelihood of consuming diets excessive in animal-source food, sugar, and fat, because these are all also highly correlated with a lower proportion of energy supply in starchy staples and gross national income (Herforth 2015). The indicator of energy supply derived from non-staples is not significantly correlated with obesity rates (Remans et al. 2014).
4 There is no defined optimal value, and it is not clear whether increases are positive or negative. An increase in animal protein consumption might be consumed disproportionately by the wealthier, for whom increases may be negative for health, instead of by the poor, for whom increases may be positive for health.
5 400-600 g per capita daily of fruits and vegetables are recommended as a minimum intake for healthy diets (WHO and FAO 2003; Lock et al. 2004). Recent analyses show that fruit and vegetable availability falls below dietary need in most countries in the world (Siegel et al. 2014; Keats and Wiggins 2014).
7

Consumer Price Index for food
Domestic food price volatility index
Prices of staple grains
Affordability of food
(typically-consumed basket)
Overall stability of affordability of food
Affordability of basic staples
National data
FAO GNR 2015, FAO
FAO, WFP
VAM and other national-level sources
Other possible indicators, which are not currently collected and/or compiled across countries, include those in the following table.
Novel indicator
Availability
Sugar availability (grams/ capita/day) capita)
6
Availability of legumes/nuts/seeds
(grams/capita/day)
Packaged food retail (volume per
Fresh food retail volume
(kilograms per capita)
What it would measure
Proxy for excess added sugars in the food environment
Proxy for access to lowestcost protein source, relevant for access to diets associated with lower
NCDs
Availability of packaged food in markets
Availability of fresh food in markets
Potential data source Source
FAO food balance sheets
Herforth
2015
FAO food balance sheets
Euromonitor 2014
Euromonitor 2014
GNR 2015
GNR 2015,
IOM and
NRC 2015,
FAO 2013
Lee et al.
2013
(INFORMAS)
Availability of healthy and unhealthy foods and beverages how defined? in communities and retail outlets
Functional diversity of production at community level
Affordability
Minimum cost of a nutritious diet based on local markets compared to the income range of low-income communities
Availability of diverse components of healthy diets
In some locales, a proxy for access to diverse food
Healthy food items available and accessible at all markets
None yet available at national scale; Can be determined at local level using Save the
Children CoD tool
Remans et al. 2011
SCN 2014,
Herforth
2015
6 National-level sugar availability appears to be significantly associated with diabetes prevalence (Basu et al. 2013)
8

Relative prices of different food groups
% share of food budget spent on fruits and vegetables
Affordability of diverse components of healthy diets
Proxy for affordability of fruits and vegetables (but also reflects consumption behavior)
Affordability of fruits and vegetables
Euromonitor 2014
Herforth
2015, Lee et al. 2013
GNR 2015
% share of food budget spent on fruits and vegetables per 100g consumed
Convenience
Distance to market
Desirability
Measures of children's exposure to food promotions on all major media
Proxy for convenience of access to diverse foods
Food marketing
Combine Euromonitor or HCES and dietary intake data
Author
Author
Swinburn et al. 2013,
Kelly et al.
2013
(INFORMAS)
SCN 2014
Safety of food supply
Extent of biological and chemical contaminants in food e.g. salmonella, heavy metals, pesticides
% population with access to improved water
Food safety
Food (water) safety FAO GNR 2015
Research needed
In the absence of well-developed and valid indicators to measure key pieces of the food environment, there is not a clear consensus or way forward for monitoring healthy food systems, or evaluating the impact of food system policies. While proposing several existing and novel indicators for a dashboard of food system outcomes, the Global Nutrition Report acknowledges, “Even though we selected the dashboard indicators (Table 7.3) based in part on the availability of internationally comparable data, there are many data gaps.”
There are major data gaps in the area of understanding national and local food environments. Existing data capture only availability and prices of calories, staple foods, and overall food baskets (composed of commonly consumed items sometimes without specific attention to how well these food baskets would meet dietary needs). Research gaps include those highlighted in the New York Academy of Sciences
“Global Research Agenda for Nutrition Science” (2014):

What indicators can capture adequacy of food access, including not only adequate dietary energy, but also affordability and convenience of healthy food (i.e., food environments)?
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
What is needed to enable data collection of better food indicators (such as capacity development of national bureaus of statistics or ministries of agriculture, international alignment on indicators to be collected, and open data)?
Key research and data needs include:

There is a need to develop indicators of availability and affordability of diverse nutritious foods. o Current data may be adequate for national availability, but not local availability. As suggested in the novel indicator table above, FAO food balance sheets could be used to estimate per capita supply and estimated prevalence of inadequate consumption of diverse food groups (Herforth 2015). Can we not forget food groups? They have haunted us for decades… o Current reported data are inadequate for prices of diverse foods, but data collection systems may be adequate. The techniques used to regularly compile and report local level market price data for staple grains (such as through WFP VAM) could be expanded to more diverse foods (Herforth 2015). o The Consumer Price Index for food is a useful measure of food affordability in countries, but is not based on a nutritious diet. A CPI for Nutritious food could be created.
However, i

There is also a need to develop indicators of convenience of procurement and preparation of diverse foods, as well as measures of their promotion and marketing.

There is a need to develop systems that can measure these indicators at local levels, which is the most important geographic level for influencing diets, because it is where prices, convenience, and marketing have the most influence on diets.
Diet quality is also critical to measure, to understand what dietary gaps exist, in what geographies and seasons, and in what populations. Data on actual dietary consumption reveals dietary trends over time, as well as opportunities for improvement through the food environment, consumer knowledge, and social protection (among other tools).
A challenge is that there is very little individual food /meals consumption data collected, and limited capacities to do so. However, there are opportunities in terms of new indicators that have been validated, an increasing number of investments that are using these, and a growing body of research on improved methods and metrics. A feasible approach to improve data systems for dietary intake /meals
10

consumend may rest on the compilation of existing publicly available dietary data, which FAO is undertaking (GIFT). Reference to the Brazilian Guidelines necessary.
Available Indicators
Some indicators of dietary quality have been developed and validated, such as dietary diversity scores.
These are tracked in most countries for infants/young children, but not women/adults.
Available indicator
% of women reaching minimum dietary diversity (MDD-W)
What it measures
Micronutrient adequacy of diets of women of reproductive age
Data source
None; not yet measured internationally. DHS and MICS would be a potential data source.
DHS and MICS
Source
SCN 2015,
1000 Days et al. 2015,
BMGF 2014,
SCN 2014
WHO et al.
2008
% of young children reaching minimum dietary diversity
Food Insecurity Experience Scale
(FIES)
Micronutrient adequacy of diets of children age 6-24 months; caring practices
Self-reported lack of food; could be an informative complement to more specific dietary data
Gallup World Poll Ballard et al.
2013
% of households consuming iodized salt
Proxy for iodine adequacy UNICEF
Other indicators are needed to reflect total dietary quality, beyond micronutrient adequacy (reflected in individual dietary diversity scores), including those that measure moderation of unhealthy dietary components. ?? totally unclear. Moderation in the consumption? How measured?
Novel indicator
Total diet quality score based on dietary guidelines (e.g. Healthy
Eating Index)
% ultra-processed food of total food intake
% of population consuming <2g salt/day or >2g?
% of population consuming <5% dietary energy intake from sugar or >5%?
Botanical dietary variety
Micronutrient intakes
???
What it would measure
How well individuals’ diets match dietary guidelines
Potential data source
National dietary surveys
Source
Proxy for diet pattern related to chronic disease risk
Meeting WHO recommended limits for salt intake (WHO 2012)
Meeting WHO recommended limits for sugar intake (WHO 2014)
Proxy for healthfulness of diet related to chronic disease risk
Micronutrient adequacy of diets in selected populations
National dietary surveys Monteiro
National dietary surveys
2013, SCN
2014
National dietary surveys
National dietary surveys Herforth
2015
National dietary surveys
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We have to get away from nutrients and into meals like Brazil proposes
Research needed
Both indicators and data collection methods need to be developed to monitor diets /meal consumption globally (Vandevijvere et al. 2013). Research is needed to develop proxies that can be used to measure dietary quality, encompassing aspects of both adequacy (getting enough of certain foods/nutrients) and moderation (not getting too much how much is not toomuch?
of certain foods/nutrients) (Herforth et al.
2014). These need to be developed keeping in mind feasibility of both collection systems (are dietary surveys needed? How in depth?), and users (what indicators reflecting diet quality are meaningful to policy makers?). Existing data sources to monitor population diet quality include food intake surveys and household budget and expenditure surveys, and these have various strengths and weaknesses in terms of data quality, precision, and feasibility (Vandevijvere et al. 2013). Research on the social determination of nutrition?
While food environments and dietary /meals quality are the top priority outcomes for which indicators and data collection systems need to be developed for food system impact on nutrition, the sustainable development agenda emphasizes healthy and sustainable food systems. Often, healthy diets tend to be more sustainable diets (see Annex 4), but other metrics of environmental sustainability of food production, processing, and retail, are critical to track. Some of the metrics that have been recently proposed are found in Annex 2 .
The purpose of this section is to define the scope of which policies should be assessed for their impact on food and diet outcomes described above.
Ideally, what actions should be monitored, or assessed for their impact on food and dietary outcomes?
Policies and legal frameworks that shape the food environment, and public investments that support the implementation of policies. In addition, private sector investments can have large impacts on the food system and thus they should also be subject to a priori impact assessment.
The FAO Key Recommendations for Improving Nutrition through Agriculture and Food Systems states that “Food and agriculture policies can have a better impact on nutrition if they:

Increase incentives (and decrease disincentives) for availability, access, and consumption of diverse, nutritious and safe foods through environmentally sustainable, agroecological production, trade, and distribution. The focus needs to be on horticulture, legumes, and smallscale livestock and fish – foods which are relatively unavailable and expensive, but nutrient-rich
– and vastly underutilized as sources of both food and income.”
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
Include measures that protect and empower [the] poor people and women. Safety nets that allow people to access nutritious food during shocks or seasonal times when income is low; land tenure rights; equitable access to productive resources; market access for vulnerable producers
(including information and infrastructure). Recognizing that a majority of the poor are women, ensure equitable access to all of the above for women.”
To unpack what it might mean, in terms of policy options, (1) to increase incentives and decrease disincentives for diverse, nutritious, safe foods/ meals , and (2) to protect and empower [the] poor people and women, we use existing frameworks. Who is we?
In 2014, the Global Panel on Agriculture and Food Systems for Nutrition conducted a mapping of major areas that influence the food environment which determine diet quality. The Global Panel brief classifies policies into four areas, with detailed examples of policies in each area that can positively, or negatively, influence nutrition:
(1) Agricultural production
(2) Market and trade systems
(3) Food transformation and consumer demand
(4) Consumer purchasing power
13

Policy options for these four areas are summarized in the tables below. Paper 2 in this series (by R
Nugent) presents the investment/policy needs prioritized by food system type (on a continuum from rural subsistence? – industrialized); see that brief for more detail. These policy options generally focus on what can be done to improve food environments and diets, and may be a first target for nutrition impact assessment. A potential impact assessment however, should also be applied to those policies that may negatively affect the healthfulness of food environments and diets. Such “negative” policy options would fall under the same policy areas in the left column of the tables below.
(Can include further examples)
Policy Area
Agriculture Research
Policies
Input Subsidies
Policy Options
Extension Investments
Land and Water Access
Targeted subsidies
Move toward crop-neutral policy support for agriculture
(Pingali 2015 – biased policies toward staple grains); decoupled agricultural subsidies (Pilchman 2015)
Supply chain incentives for production; agricultural policies that are crop-neutral, to enable entry into markets for fruits, vegetables, and other underproduced crops
Source
Global Panel 2014
Global Panel 2014
Global Panel 2014
Global Panel 2014
NOURISHING
Brief 2 in this series (Hawkes) describes market and trade systems.
Policy Area
Trade Policy
Infrastructure
Investment in?
Agribusiness Policy
Public procurement
Policy Options
“Trade and investment agreements protect food sovereignty, favour healthy food environments, are linked with domestic health and agricultural policies, and do not promote unhealthy food environments.”
(Swinburn et al. 2013b)
Source
Global Panel
2014, INFORMAS
Farm to market roads; Irrigation; Improve water quality. Global Panel
2014, Nugent
(this series)
La Via Campesina options here
Offer healthy foods and set standards in public institutions, e.g. school, work, and health facilities;
Government encourages and supports private
Global Panel 2014
Global Panel 2014
NOURISHING,
INFORMAS,
Nugent (this
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companies to implement similar policies
Healthy retail incentives Incentives for shops to locate in underserved areas; planning restrictions on food outlets; reduce in-store product density of unhealthy foods series)
NOURISHING,
INFORMAS
The NOURISHING Framework and INFORMAS drill down ?
further into the area of food transformation and consumer demand.
Policy Area
Labelling Regulation
Advertising Regulation Restrict advertising to children that promotes unhealthy diets in all forms of media; sponsorship restrictions
Fortification Policy
Purchase incentives/pricing policy
Food transformation policies
Nutrition promotion
Policy Options
Nutrient lists on food packages; clearly visible labels; menu labels; rules on nutrient and health claims street lamp logo (red, yellow,green)
See Ted Greiner in World Nutrition Nov/Dec 2015
Price promotions at point of sale; health related food taxes
Elimination of trans fats; reduce energy density of processed foods; portion size limits
Education about food-based dietary guidelines, mass media, social marketing; community and public information campaigns; Nutrition, cooking/food production skills on education curricula; workplace health schemes; health literacy programmes
Source
Global Panel
2014,
NOURISHING,
INFORMAS 7
Global Panel
2014,
NOURISHING,
INFORMAS
Global Panel 2014
NOURISHING,
INFORMAS,
Nugent (this series)
NOURISHING
NOURISHING,
Nugent (this series)
Safety nets during shock situations can increase consumer purchasing power and therefore are related to the kinds of foods people buy and consume.
Policy Area
Work Guarantee
Schemes
Cash transfers
School feeding
Policy Options Source
Global Panel 2014
Global Panel 2014
Global Panel 2014
7 Swinburn et al. 2013b
15

Consumer subsidies Target to [the] poor people and women Global Panel 2014
Information to describe the food environment and food/ meals consumption can reveal problems in the nutrition situation; policy options described in the previous section can be designed to help solve those problems and improve nutrition. The aim of an impact assessment of policies would be to move toward integrated policies that work coherently across multiple sectors to support food environments that allow consumption of diverse and healthy diets /meals and avoidance of ultraprocessed foods . But what would the process look like to deliberate between policy options, and also to assess potential impact of other policies on food and diets? The claim holders have to be involved for this. We cannot again do it top-down from our ivory towers.
A framework and process by which the potential nutrition impact of such policies could be deliberated is important to moving appropriate policies forward. Tracking progress on actions, or assessing potential impact on food systems and nutrition a priori, however, is fraught with challenges:
 limited capacity and political priority for nutrition within governments
 limited capacities for monitoring; information systems are not necessarily in place for high quality data

 limited accountability for tracking private investments monitoring impact of policies on outcomes is difficult because of long and complex impact pathways and external influences
 tracking actual implementation of policies; sometimes policies are in place but not effectively implemented. Do you realize all these are top-down?
In the current context of nutrition-sensitive commitments, there are increased opportunities to build capacity for participatory monitoring relevant food and diet outcomes, and to prioritize policy options that can address nutrition problems with explicit participation of claim holders . Caveats notwithstanding, the SUN movement in particular offers opportunities to participatorily track nutritionsensitive policies based on claim holders demanding basic political commitments toward improved nutrition. What would such tracking look like?
There are two ways that a nutrition impact assessment could be thought of. One is based on identifying specific diet-related harms that could come from the policy under review, and where relevant, creating safeguards against those potential harms. Another is based on a holistic review of the entire foodrelated policy portfolio, compared to known gaps in food access and diets in the population and
16

population sub-groups, to estimate what the cumulative impact is of existing policies, and how a new policy could change that.
8
Avoiding nutritional harm based on specific policies
Health, social, and environmental impact assessments are based on assessment, identification, and mitigation of risk related to a specific policy. When risks are identified by whom?
, safeguards are then put in place to mitigate the risk; or, if risks are significant enough, the investment/policy is not carried out. But the process is not always rational! Vested interests interfere… naïf?
Unlike a health risk or an environmental risk, it is difficult to identify a clear nutrition risk of a specific policy other than a few stand-out cases (foods with trans-fats, sugar-sweetened beverages, sodium, ultraprocessing ). In other cases, nutrition risk is much more nuanced, and hard to pin down policies that affect specific food types as “bad” for nutrition. For example, increased availability/decreased cost of meat and grains can be positive or negative for nutrition, depending on the population segment and the rest of the diet in that population. Production of those same foods can be positive or negative for the producers’ nutrition, depending on the rest of the food environment.
A nutrition impact assessment could be done with some similarities to a participatory social impact assessment: which populations would likely be positively affected? Negatively affected? Neutral? Are different priority weights to be assigned to different sub-populations, such as children and women of reproductive age? Food fortification assessment may provide a model, as proposed fortification schemes incur analysis of population likely to benefit vs. harm.
Policy portfolio review
Another potential tool for estimating the effect of a potential new policy could be a policy portfolio review. This would entail assessment of the cumulative impact of the existing policy portfolio or nonpolicy fait accompli , and how an additional policy would affect nutrition outcomes in light of the whole portfolio.
A policy portfolio imbalanced in favor of some foods over others can have impacts on food environments (including what is produced, its price, and how it is marketed), and on diets /meals . In the
US, subsidized commodities make up 57% of energy intake, and the percentage increases for certain demographics (younger, poorer, less educated) (Siegel et al. 2015). Other research has shown that what
8 Note: The USAID IYCN project developed a Nutrition Impact Assessment Tool focused on avoiding harm to nutrition from programs (2011). That tool dealt with harms to infant and young child feeding, among other equity concerns. Identifying nutrition risks depends on understanding potential harms to nutrition, and the pathways through which a policy could cause harm to nutrition. Because this paper focuses on food, only the food pathways are discussed. Other pathways would include those in the social domain – exclusion of vulnerable groups, reduced women’s empowerment; and those in the health domain – policies that would increase health risks from farming, policies that reduce parents’ ability to provide optimal food and care for infants and young children.
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is consumed mirrors what is produced more than dietary recommendations (HEI paper). Are you leaving out aggressive advertising?
A holistic look at policies has been recommended previously (Pinstrup-Andersen 2013, World Bank
2014). The results of an analysis of a policy portfolio review might look something like the “perverse pyramid” developed by the Physicians for Responsible Medicine (2007); Annex 3 . The group tallied agricultural subsidies in the United States by food group, and compared them to food groups recommended in the U.S. Dietary Guidelines for Americans.
A policy portfolio review could show the extent to which policies favor foods that are under-consumed or over-consumed compared to dietary recommendations, as well as foods that have greater or lesser environmental footprint. Another “double pyramid” shows the relative environmental impact of foods in the way they are typically produced (Barilla 201x), Annex 4 . This double pyramid implies that typically, recommended diets tend to have lower environmental impact than diets that contribute to obesity and
NCDs.
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A key question is, who will be the custodian of the process to estimate the likely impact of policies on food environments and diets?
There are different [stakeholder] groups for three areas of policy impact assessment:
1.
Improved monitoring and information systems for food and diets
As discussed in the “outcomes” section, not only are indicators of key food systems outcomes for nutrition currently under development, relevant potential monitoring systems need to be strengthened.
[Stakeholders] Actors involved in this step toward policy impact assessment include: National bureaus of statistics, ministries of agriculture (for food price information), ministries of health (for diet quality information), and international organizations that collect or analyze food and diet data (such as WFP and FAO, and DHS/ MICS). What about public interest CSOs?
2.
Identification of specific risks from policies
A participatory regulatory body could be responsible for this type of assessment (similar to the U.S. FDA for unsafe food additives or contaminants such as trans-fats and aflatoxins, or the U.S. EPA in environmental review and safeguarding). Or, private/independently contracted companies could be responsible for a policy review to be presented to the relevant regulatory body. Bad idea… Such a regulatory body would need to be appointed and have credible oversight of relevant government bodies and private companies.
3.
Food system policy portfolio review
9 The U.S. IOM Committee this year recommended lower meat intake based on environmental concerns, although these recommendations were not accepted as part of the official U.S. Dietary Guidelines policy.
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The actors would correspond to the key types of policies described above. The main actors involved would include representatives from the agriculture, trade, and communication sectors, as these have to do with policies related to production, marketing, and consumer information. In addition, health and social protection actors such as public interest CSOs would be relevant. Who would be responsible for a portfolio review, and what would be done with the conclusions? In some countries, SUN focal points may be the necessary but not sufficient starting point; in other countries that elevate nutrition to a vice presidential level, such as Uganda, a multi-sectoral policy review could take place.
A strong governing body could have the authority to undertake all three of these areas. We have been there before in the 1970s/80s in the era of nutrition planning and then with National Nutrition Action
Plans in the 90s. To what avail? A major challenge for any kind of nutrition impact assessment, however, is that in many countries, nutrition governance is weak (Gillespie et al. 2015). Furthermore, the home of nutrition varies within governments. The FAO Key Recommendations for Improving
Nutrition through Agriculture and Food Systems states that “Food and agriculture policies can have a better impact on nutrition if they Develop capacity in human resources and institutions to improve nutrition through the food and agriculture sector, supported with adequate financing; and support multi-sectoral strategies to improve nutrition within national, regional, and local government structures.” Very FAO-centered…
Actions to create an enabling political environment for nutrition are as essential to potential nutrition impact assessment of policies, as they are to any other area of action on nutrition. And participatory processes are here a must. Examples of actions to create an enabling political environment for promoting nutrition are show in Annex 5 (from the Global Nutrition Report 2015). They include the categories of (1) governance and political economy, and (2) capacity and resources, in addition to (3) framing and metrics, which has to do with improving the type and quality of data collected to enable any nutrition impact assessment of food systems policies. See my letter in WN Nov/Dec 2015 re The
GNR.
Note that no country has a system in place that enables analysis of either the current situation regarding healthy and sustainable food system, nor the impact of policies on it. Nutrition information systems and nutrition leadership is missing in many countries. The needs for improved metrics, and for a feasible political process for reviewing policies with a nutrition lens, are not restricted to high income or low income countries; they are universal.
Policies influencing the food environment have effects on people’s food choices and dietary practices and nutritional outcomes in many ways; and there are opportunities to make these influences more nutrition-sensitive , i.e., address the social determinants of nutrition
To enable policymakers to choose policies that benefit nutrition, and to estimate the impact of new food systems policies on food environment and dietary outcomes, [three] four ingredients need to be
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available: (1) feasible, valid metrics that reflect desired outcomes of healthy food environments and diets; (2) a clear set of types of policies that would be reviewed, (3) sufficient nutrition governance to enable a process for assessing nutrition impact of policies and (4) participatory approaches . This working paper has sought to lay out the needs around each.
Outcomes
Need to use some existing indicators more across countries
Need to develop ones that are missing, where the missing information precludes understanding food environment and dietary outcomes
Need to develop information systems to enable collection and reporting of these outcomes.
Policies
The main relevant policies are in the domains of agricultural production, market and trade, food transformation and consumer demand, and consumer purchasing power.
Need to ensure that specific policies will not create nutritional harm.
Governments, and claim holders [and donors why donors?] need to review entire portfolios, and compare the cumulative supports to in these to dietary recommendations. Where there is a significant disconnect, it can be expected that food environment will not support healthy dietary consumption. This can be verified with consulting with the population about the monitoring of food environment and dietary outcomes.
Process
A participatory process is needed for reviewing policy portfolios, individual policies in light of potential nutritional harms, and strengthening/assuring quality of relevant data systems.
Strengthen and democratize nutrition governance to allow policy review across sectors (e.g. agriculture, social protection, trade)
I am afraid the technocratic prevails over the participatory and the consultative in this zero draft. I fear its fate is guarded at best.
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