Disruption of transnational food supply chains and the disruption, if not devastation of many vulnerable livelihoods by COVID-19 pandemic policy responses have revived interest in earlier understandings of food self-sufficiency. But, simply winding back past policy will not address more recently recognised food challenges such as malnutrition and safety.
All too many food policymakers and researchers have been effectively compromised, for instance, with generous research and travel funding by food and beverage businesses aimed at discouraging criticisms of their lucrative business practices.
It is nevertheless important for authorities to make sure that food is produced safely for consumers. The authorities should not be concerned only when food exports are blocked by foreign importers for failing to meet phyto-sanitary standards.
Is food safe for consumption? Are toxic agro-chemicals putting consumers at risk?
Are antibiotics being used for breeding animals for food, putting animal and human health at risk of antimicrobial resistance? Are food processing practices compromising consumer nutrition?
Singapore
According to an in-depth study commissioned by Food Bank Singapore in 2019, one in 10 Singaporeans struggles to get sufficient, safe and nutritious food at least once in the last 12 months. Of this, 10.4% or two out of five households struggle to get such food at least once a month. Photo: Sosharp / Dreamstime
MALNUTRITION THREAT LOOMING LARGER
The world has to deal with three major types of malnutrition: dietary energy undernourishment, or hunger; ‘hidden hunger’, due to micronutrient deficiencies of vitamins, minerals and trace elements; and diet-related non-communicable diseases (NCDs).
Many of the poor lack the means to improve their condition, with the poorest often lethargic, due to not getting enough to eat, or not being able to gain sufficient nourishment from food due to gastrointestinal diseases, typically as a result of poor sanitation and hygiene.
Although hunger and starvation have reportedly been declining in recent decades, dietary energy undernourishment has been falling less quickly than poverty, although the poverty line is supposedly principally defined by an income level that precludes hunger.
The nutrition situation in the world remains worrying as other manifestations of malnutrition – including stunting, obesity, diabetes and anaemia – have been growing, or declining slowly at best, according to available official evidence.
MICRONUTRIENT DEFICIENCIES
Micronutrient deficiencies threaten human health and well-being, but rarely get much public policy attention. ‘Hidden hunger’ is due to diets lacking essential micronutrients – vitamins, minerals, trace elements – vital for the body to develop and function well.
Insufficient vitamin A, iron, calcium and zinc seem to be the major micronutrient deficiencies of public health importance. All too many people are anaemic, with especially serious consequences for women of reproductive age. In many countries, iodine deficiencies have been successfully tackled by iodizing salt, while vitamin A is typically tackled with costly supplements for children under five. Such hidden hunger is usually better addressed by dietary diversity and the consumption of food with needed micronutrients. Previous measures to control the three leading micronutrient deficiencies of global concern, which are vitamin A, iron and iodine, mostly involved nutrient supplementation. However, while this can be implemented quickly in acute and high-risk situations, supplementation is not sustainable.
Food-based approaches offer long-term benefits at relatively low cost though they are unlikely to deliver dramatic measurable results immediately.
They enable and encourage the diversity of food systems, supplies and dietary diversity, but only over the long run. Biofortification can help, but for this to work well, close collaboration is needed between nutritionists and dieticians on the one hand, and scientists working to improve food crops and animal-source foods on the other.
San Pablo City, Philippines
Macro- and micronutrient deficiencies are the leading nutritional problems in the Philippines, with anaemia being one of the most alarming issues affecting many infants and pregnant women. Photo: Renato Borlaza / iStock
CHILD UNDERNUTRITION
Most parents are not aware that the first 1,000 days, from conception until the child is two are most critical for child development. Infant malnutrition starts with pregnant mothers suffering micronutrient deficiencies or diet-related NCDs. We can and must do much more to enable and promote ‘exclusive breastfeeding’ for the first six months of every child’s life. Various work and maternity leave arrangements as well as childcare facilities should be made available to enable its widespread adoption.
While international measures suggest that wasting, stunting and underweight among children are declining, this is still occurring all too slowly. Child undernutrition remains high, with national shares still rising in many, including middle-income, countries. Child stunting not only adversely affects children’s physical development, but also their cognitive development. How can societies and economies progress if future generations continue to be handicapped from the outset?
A system of morality penetrates throughout in such a way that it encourages a sense of public duty, or ‘civicness’, but allows that to be shaped by widespread participation.
NON-COMMUNICABLE DISEASES
The crises of obesity, diabetes and other diet related NCDs in middle-income countries remain alarming, with NCDs among the leading causes of premature death and disability. The prevalence of overweight, obesity, diabetes and related morbidities has increased in most countries.
Overweight and obesity are risk factors for NCDs, such as diabetes, cardiovascular diseases and cancers, which reduce the quality of life and labour productivity, and unnecessarily raise healthcare costs, both private and public. Over-eating – often wrongly termed ‘over-nutrition’ or ‘overnourishment’ – often also leads to diet-related NCDs and their consequences. Various NCDs are due to what we have eaten or drunk in excess, especially processed sugars.
Excessive consumption of starchy foods or carbohydrates raises blood sugar levels, which cause diabetes and other problems including excessive weight gain. Thus, sugar addiction directly contributes to various malnutrition problems. Often, people are not aware of the consequences of eating many more carbohydrates, calories or dietary energy than they normally use or need.
Meanwhile, excessive salt consumption contributes to hypertension or high blood pressure which, in turn, causes various other health problems.
Meanwhile, deep fried food has become the most popular type of fast food, concealing possible staleness or even spoilage, as more meals are increasingly purchased, not prepared at home.
Kolkata, India
Civic volunteers of a social welfare association distributing grocery items to those in need during the COVID-19 lockdown period. The pandemic has reportedly intensified food insecurity in India, with the hunger crisis gripping vast swaths of rural hinterland and some urban areas. Photo: Suprabhat Dutta / iStock
The affordability of healthy and unhealthy foods will shape nutrition outcomes, thus effective national pricing policies can be used to improve diets in low- and middle-income developing countries.
BALANCED, HEALTHY DIETS
The consequences of not eating properly need to be widely understood. Healthy diets should be adequately diverse, to ensure consumption of various foods. Consuming a variety of nutritious foods can supply most nutrients people need. We all need macronutrients (carbohydrates, protein, fats) – without over-eating staples like rice or read, or fatty, sugary and salty food – and micronutrients, especially vitamins and minerals.
Governments, employers, family and peer pressure as well as popular culture, including social media, can help encourage better eating. Food regulations, supervised institutional meal arrangements and dietician-supervised public messaging can thus improve eating practices, behaviours and habits.
When people better understand the effects of their food behaviours, and have relevant, easily comprehensible and actionable knowledge and information as well as readily accessible and affordable options, many will try to improve their food behaviours. However, misleading ‘information’ from food and beverage companies and advertising firms is widespread, influential in popular culture and actively promoted by increasingly subtle means. The problem is made worse by popular, even iconic, figures who dispense misleading ideas, even half-truths, as part of their own discourses and narratives, often without meaning to do harm, but as part of their own efforts to gain or retain popularity, legitimacy and authority.
Various media and popular culture – at the workplace, place of worship and at home – as well as peers, family and friends greatly influence food behaviours. Women, typically the main family caregivers, are particularly important, often influencing foods purchased, preparation mode and consumption circumstances, such as food availability and drinks served.
The affordability of healthy and unhealthy foods will shape nutrition outcomes, thus effective national pricing policies can be used to improve diets in low- and middle-income developing countries. Some nutritious foods such as dairy products, eggs and white meat can be very expensive in many such countries. Local production and cheaper imported foods, such as soya, can provide alternatives to dairy products. In many countries in Asia and Sub-Saharan Africa, for example, fruits and vegetables are relatively expensive, while oils, fats and sugar tend to be universally cheap.
Supplementary Food Programme
The Malaysian government has increased its budget allocation for the Supplementary Food Programme (Rancangan Makanan Tambahan) substantially in the National Budget 2021, to ensure that students from low-income families will be adequately provided for. Image source: hemsementa.blogspot.com
COVID-19 AND ITS IMPACT
The COVID-19 crisis has had several unexpected effects, including renewed attention to food security concerns. Earlier understandings of food security in terms of production self-sufficiency have given way to the practice of importing supplies since the late 20th century promotion of trade liberalisation. The pandemic’s secondary impacts have exacerbated COVID-19-induced food insecurity due to job and income uncertainties, worsening the prevalence of malnutrition.
Yogyakarta, Indonesia
The Indonesian government has developed food barns to secure rice stocks amid food security challenges due to the COVID-19 outbreak, which has disrupted logistics and led to price increases earlier this year. Photo: raditya / iStock
The entire ‘nutrition value chain’ – ‘from farm to mouth’, from production to consumption – needs to be considered to ensure that the food system better feeds the population.
In particular, the pandemic has had a major impact on health and nutrition of school children, particularly due to the closure of most schools around the world from mid-2020. Even though some schools have reopened, many remain closed.
In many primary schools around the world, school meals provide a major source of children’s daily food and nutrient requirements, typically a third of daily dietary requirements. The closure of schools not only disrupts schooling, but also the nutrition and growth of children, particularly for children who are not well fed at home.
Protracted disruptions in school feeding have already led to lockdown-induced hunger and malnutrition for these children. For example, in Malaysia, the supplementary school feeding programme was disrupted for many months due to school closure since mid-March 2020. By contrast, other countries have continued to provide school meals through home delivery, takeaway, food rations and cash transfers to the children’s families.
TRANSFORMING FOOD SYSTEMS
Food systems need to be repurposed to better produce and supply safe and nutritious food. Ensuring that food systems improve nutrition is not just a matter of increasing production. The entire ‘nutrition value chain’ – ‘from farm to mouth’, from production to consumption – needs to be considered to ensure that the food system better feeds the population.
Food systems have to improve production practices, post-harvest processing and consumption behaviour. Resource use and abuse as well as environmental damage due to food production and consumption need to be addressed to ensure sustainable food systems.
Food systems at the global level used to provide jobs to more than a billion people. However, the pandemic caused an estimated loss of about 451 million jobs, or 35% of formal employment, with those in food processing, services, and distribution most at risk, and disproportionately affecting women workers.
It is crucial for local farmers, as well as small and medium food producers to be kept viable, as they are critical to maintaining food supplies for poorer consumers. Developing countries will need to quickly revise their agricultural policies and practices to promote food agriculture for local consumption.
Governments must realise that improving nutrition is crucial for economic and social progress. No country can achieve and sustain development with a malnourished population. Without healthy people, future productivity and progress will be severely compromised.
Good nutrition and food safety are necessary for healthy societies and future progress. Governments should use the COVID-19-induced reconsideration of food security and supply chains to better address malnutrition and food safety issues.
Food security initiatives prompted by pandemic considerations should promote food system changes that will encourage more sustainable and healthy diets. This opportunity to strengthen food systems must also prioritise nutrition, food safety and dietary diversity.
PROF WAN MANAN MUDA
Prof Wan Manan Muda is Visiting Professor at Alma Ata University in Jogjakarta, Indonesia. He was Professor of Nutrition and Public Health at Universiti Sains Malaysia (USM), where he spent 34 years lecturing in the field of nutrition and public health until December 2016. In 2017, he served as a Senior Visiting Research Scholar at the Center for Southeast Asian Studies (CSEAS) at Kyoto University, Japan.
DR JOMO KWAME SUNDARAM
Dr Jomo Kwame Sundaram is a Senior Advisor at Khazanah Research Institute in Malaysia. He served as United Nations Assistant Secretary-General from 2005 to 2015, and was Professor at the University of Malaya from 1986-2004. Dr Jomo received the 2007 Wassily Leontief Prize for Advancing the Frontiers of Economic Thought.
DECEMBER 2020 | ISSUE 7
Future-Proofing Our Recovery