Un mercado en Kenia en abril de 2020. Fotografía: © Sambrian Mbaabu/Banco Mundial
“Let food be thy medicine and medicine be thy food.” The notion that nutritious and safe diets support good health has been around at least since antiquity, as this quote, often misattributed to Hippocrates, attests. What to eat – and not to eat – regularly grabs news headlines, as consumers try to balance scientific advice and marketing trends with their own culinary traditions, pocketbooks, and local food options.
Now, with so many people falling ill from the coronavirus (COVID-19), unhealthy diets are contributing to pre-existing conditions that put them more at risk. And in much of the world, illness also means loss of income. Hence the pandemic has raised the stakes for consumers, producers and policy makers worldwide. What would it take to get healthy food right? Answers to this question are as pressing and relevant as ever.
With so many people falling ill from the coronavirus (COVID-19), unhealthy diets are contributing to pre-existing conditions that put them more at risk.
There are uncertainties around what constitutes healthy food and appropriate policy interventions. But a growing body of evidence and analysis points towards actions that may save lives – and at the very least improve the well-being of billions.
The quality of diets is essential to health
Diets are crucial to the health status of people around the world. Food is not a peripheral concern: according to the 2017 Global Burden of Disease report, metabolic risks accounted for most of the top five risks of disability and death. More than 2 billion people are overweight or obese, with over 70% of them in low- and middle-income countries. Unsafe food caused an estimated 600 million illnesses and 420,000 premature deaths in 2010, according to the World Health Organization, undermining people’s health and nutritional security. And emerging evidence suggests that people with pre-existing, diet-related conditions such as severe obesity, heart disease, and diabetes, are suffering more serious consequences from COVID-19, including more severe illness and a greater need for intensive health care, such as respirators.
Malnutrition also severely weakens people’s immune systems, increasing people’s chances of getting ill, staying ill, and dying because of illness. Iron, iodine, folate, vitamin A, and zinc deficiencies are the most widespread, with over 2 billion people affected worldwide. This “hidden hunger” not only increases the risk of morbidity and mortality, but also contributes to poor growth, intellectual impairment, and perinatal complications. This lowers countries’ human capital and development prospects.
Expect food and nutrition insecurity to rise
Global inequity on food and nutrition is about to get much worse. The World Food Program has warned of a potential doubling of acute food insecurity in low- and middle-income countries this year due to income and remittance losses. Experience from 2008 also points to an impending nutrition crisis. Studies in Bangladesh, Cambodia, and Mauritania assessed the impact of the 2008 global food price crisis, suggesting it increased acute malnutrition by 50% among poor children. Other studies found evidence of a significant rise in stunting among both urban and rural children.
COVID-19 puts diets at risk through disrupted health and nutrition services, job and income losses, disruptions in local food supply chains, and as a direct result of infections among poor and vulnerable people. At the same time, there is evidence that the sale of snacks and non-perishable foods is growing rapidly in the crisis, at the expense of fresh foods, such as vegetables and fruits, and high protein foods, such as legumes, fish and meat. Junk food manufacturers reportedly see the crisis as an opportunity to expand their market share.
COVID-19 puts diets at risk through disrupted health and nutrition services, job and income losses, disruptions in local food supply chains, and as a direct result of infections among poor and vulnerable people.
How can we improve access to healthy food when people need it most? And what can we do to limit the harm caused by unhealthy diets? We propose three areas for immediate and medium-term action.
1. Secure food at affordable prices for poor communities
The first area of action is to adopt policies that secure food at affordable prices for the most vulnerable. Remembering lessons from the past, international organizations including the FAO, IFAD, World Bank and World Food Programme have joined with agriculture ministers from countries of the G20, ASEAN, African Union, and Latin America and the Caribbean and are calling on exporting countries to avoid trade disruptions and keep food and agricultural inputs flowing across borders.
Attention to international trade must be complemented by steps to keep domestic food production, processing, and marketing functional and safe, despite social distancing and movement restrictions. And social safety net programs are essential to provide resources for families who have lost the ability to buy food.
2. Ensure better nutrition
The second area is no less important: countries must go beyond high-calorie staples and ensure better nutrition to boost people’s resilience and lower their risks from pre-existing, diet-related conditions and foodborne illnesses. On the agricultural side, this may take many forms, from promoting kitchen gardens, growing bio-fortified crops, and diversifying food produced for domestic consumption, to improving cold chains for more perishable nutritious food, upgrading fresh food markets, and investing in food safety.
Stepping up nutrition advice, promoting breast-feeding, and fighting misinformation around COVID-19 transmission will help preserve the role of nutritious food as an ally against illness.
On the health side, stepping up nutrition advice (delivered, for example, by mobile phone twinned with cash transfers, or through community workers), promoting breast-feeding, and fighting misinformation around COVID-19 transmission will help preserve the role of nutritious food as an ally against illness, even in hard times. In designing interventions, there is much we can learn from the findings of the South Asia Food and Nutrition Security Initiative (SAFANSI). Another key resource is the Optima Nutrition tool, developed in partnership with the Bill & Melinda Gates Foundation to help improve the efficiency of nutrition spending and better reach vulnerable groups such as women and children.
3. Realign public spending for better health and nutrition
The third area that’s ripe for action is realigning public spending to match health and nutrition objectives. Growing food and eating meals may be largely private activities, but they are shaped in countless ways by public policies and by incentives that reach a half trillion dollars a year in 53 countries reviewed by the OECD. Data is hard to come by, but most price support schemes are thought to go to a limited number of crops that form the basic ingredients of carbohydrate-rich, nutrition-poor packaged foods.
Fruit and vegetables, on the other hand, remain prohibitively expensive in many countries. Public support for cereals and sugar, combined with private marketing and clever packaging, is encouraging a transition to unhealthy diets in low and middle-income countries. For example, in Nepal, data shows that unhealthy snack food and beverage products comprise nearly 25% of calorie-intake among 1- to 2-year-old children.
Food safety is imperative – foodborne disease in low- and middle-income countries is estimated to cost $110 billion in lost productivity and medical expenses each year. It’s also urgent to tackle obesity. A new World Bank study on the health and economic consequences of the obesity epidemic encourages governments to increase taxation on unhealthy foods and regulate their marketing and advertising. Learning from successful examples such as Chile and Mexico, it also urges governments to subsidize healthier foods and mandate adequate labelling on processed foods. Over 47 countries are already experimenting with these approaches.
Being smarter about public resources, including by deploying taxes on items like sweetened beverages, would help generate resources at a time when budgets are constrained and governments are ramping up social safety net programs. This would create more fiscal space for health and nutrition interventions that help fight infectious diseases like COVID-19, while building resilience for future generations.
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