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How to attain healthy diets for all?

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Dr Shweta Khandelwal, Head Nutrition Research and Additional Professor, PHFI, explains how concerted efforts from governments, farmers, businesses and public will help achieve a world of healthy diets and nutritious food

Forty years ago, in 1979, the FAO member countries set up a World Food Day to raise awareness on factors related to poverty and hunger. Perhaps these visionaries knew early on that at some point in the future (which is our present now) poor diets will take centre stage as the number one killer across the globe. In 2017, 11 million deaths were attributable to poor diets. The just released India’s first Comprehensive National Nutritional Survey (CNNS 2016-18) reported that only 6.4 per cent of Indian children aged less than two years get a ‘minimum acceptable diet’ (a composite measure of feeding frequency and diet diversity). While sub-optimal nutrition impacts the overall health and quality of life of people, it also adversely impacts the productivity of the country. It is estimated that that India lost nearly 4 per cent of the GDP or at least $10 billion annually in terms of lost productivity, illness, and death due to co-existence of multiple forms of malnutrition – underweight, wasting, stunting, overweight-obesity and micronutrient deficiencies.

For aiming to correct anything, it is important to recognise and accept what’s not being done right. Do we know what a healthy diet is? Experts around the world have formed consensus largely on composition of diets while leaving individual sources / food items to region specific customisation. Evidence supports consumption of fresh fruits vegetables, whole grains, high quality protein (increasingly more emphasis on plant proteins and limiting meat) and some amount of dairy but limiting trans fats, sugar and salt in our diets. Next question is how do we get these sustainably and perennially?

While India produces enough food to feed its population, 39 per cent of its population or 194 million are under-nourished. The 2018 Global Hunger Index ranks India 103 out of 119 countries. Another 30 million are obese in India. As if this was not enough, climate change is exacerbating India’s nutrition woes. Not only are yields decreasing, nutrient contents getting diluted but several food security challenges (due to floods, famines) have struck the most vulnerable sections. In addition, high levels of air pollution especially in the northern parts like Rajasthan, Uttar Pradesh and Haryana cost about 1.7 years to India’s average life expectancy. It is recognised increasingly that nutrition is not a mere food availability problem. The world has set a challenge to achieve Zero Hunger by 2030. This doesn’t only mean producing enough food. It has to be healthy and diverse food. There are several sectors which feed in and out of the nutrition cycle for individuals and for formulation of robust public health nutrition policy at the government level. A world of healthy diets and nutritious food needs a concerted effort from governments, farmers, businesses and the general public to participate and make informed choices.

The recently released (Sep 2019) global report from the Food and Land Use Coalition (FOLU) proposes a reform agenda of real actionable solutions to attain sustainable nutrition security. They outline 10 critical transitions: Promoting Healthy Diets; Scaling Productive and Regenerative Agriculture; Protecting and Restoring Nature; Securing a Healthy and Productive Ocean; Investing in Diversified Sources of Protein; Reducing Food Loss and Waste; Building Local Loops and Linkages; Harnessing the Digital Revolution; Delivering Stronger Rural Livelihoods; Improving Gender Equality and Accelerating the Demographic Transition. These cross-cutting recommendations highlight ways to limit the promotion of unhealthy food while establishing positive practices to promote healthy alternatives and greater nutritional balance.
In line with World Food Day’s theme around promoting and prioritising healthy diets across various sectors, we propose a F-O-O-D F-I-X for to accelerate India’s attainment of Swastha Suposhit Bharat vision.
Fix food systems and accountability issues for making healthy diets accessible to all – oppose conflict of interest and uphold public health and nutrition. Access to healthy food and human basic needs- opportunity to maximally tap the human potential, uncompromised growth and development coming from food and nutrition security, clean drinking water, education, safe pollution free environment etc. climate smart sustainable. Financial levers by politicians- encourage favourable price packaging promotion placement.

Opportunity for win win engagement education, empowerment of customers at all levels – This will not only motivate masses to make informed choices but to help understand the implications. Parents are usually running out of time. Quick fixes from markets and food systems thriving on cheap calories ultra-processed foods are predisposing us towards malnutrition especially childhood obesity. To have an effective Jan Andolan, start early and start nutrition education everywhere possible – public places, schools, workplaces, even prisons or hospitals etc. Use of multimedia should be to spread positive nutrition messages around how to choose healthy and not merely to advertise high fat, sugar and salty ultra-processed foods. Education modules or media stories should be impactful and pegged to provide guidance for all actors.

Orchestrate multi-sectoral policies on food and nutrition security and promotion of health- food is increasingly understood as an interconnected system involving multiple sectors, but policies targeting different parts of the food system are typically made in isolation. Poshan Abhiyaan has made an effort to bring together 17 or more ministries and departments to develop strong cohesive policies. However inter-ministerial coordination and smooth functioning still remain challenging. Efforts to improve processes around priority-setting, meeting timelines, fund allocation, disbursement, documentation and robust monitoring must be continued.

Develop, design, document local solutions for local nutrition problems while imbibing wisdom or direction from published work or interventions. Align life course perspective for healthy living by use of robust technology, sound feedback loop for queries, suggestions, strong independent, monitoring. One problem’s solution should not fuel some other issue and this can be checked by taking everyone together and making each voice heard. Push for transparency, open access of nationally collected data to researchers and academia.

Focus and forward work on benefits of healthy diets on all forms of malnutrition- Several economic benefits have been discussed ($1 investment yields $16-18 returns). Vulnerable need more attention and urgent action.

Invest in and incentivise capacity to do research and pilot interventions around healthy diets – In addition to philanthropies and private donors, it is important for the government to accord priority to train and/or upgrade the skill set of their programme personnel. In addition, partnerships with academia and research bodies should be established and used symbiotically. Financial help must be earmarked for testing innovative ideas and/or scaling up as necessary. Without trained staff and upgraded technology, we will not have far reaching, sustainable and replicable impact on public health and nutrition.

Exchange case studies, document success and failure lessons to build a robust evidence pool –Trained teams must collate good quality evidence and feed into the government system. High quality reviews should be commissioned or periodically conducted and used in planning new ideas or improving the course of ongoing action.

We may survive longer using machines, technology and other advanced inventions etc. but for thriving in a nourished productive way, healthy diets appear to be the most favourable bet. Let us all pledge on this 40th World Food Day to not only imbibe healthy eating as a part of our lives but also support others around us in achieving this goal.

The views expressed are personal.

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