Recommendations
The following recommendations are proposed to bring hidden hunger to the agenda and to ensure healthy diets.
Recommendation Number 1. Practical steps should be taken at all points across the food systems to retain/increase the micronutrient density; policymakers should look for actions across food systems and align them towards a common objective. A focus should be placed not just on the production or supply-side aspects of the food system, but also on demand-side interventions that support consumers to have both the agency and the impetus to make better food choices for themselves and their families.
Recommendation Number 2. Governments and the private sector need to work together on aligning individual food systems, attaining healthy diets, and tackling micronutrient deficiencies. Extensive inter- and multi-stakeholder dialogue is required for these two parties to do this.
Recommendation Number 3. Accountability should be improved at all levels and governments committed to tackling micronutrient deficiencies and other forms of malnutrition need to set targets.
Recommendation Number 4. Health information systems need to address key micronutrient deficiencies, relevant to the specific country context. There is a need for more data so that response efforts can be better informed and tailored accordingly.
Public-private partnerships have enormous potential to end hidden hunger. Working together across the food system, governments, private actors, and other stakeholders can ensure that interventions to address food and nutrition security are connected and considered as a system. A multidimensional, multi-stakeholder approach tailored to country-specific contexts is necessary. Engagement with the private sector is essential in order to address long-term economic and livelihood-based success that can lead to the development and implementation of sustainable opportunities and interventions to end hidden hunger.
References
1Development Initiatives: 2018 Global Nutrition Report: shining a light to spur action on nutrition. Bristol, Development Initiatives, 2018.
2Our World in Data: Micronutrient deficiency (accessed July 19, 2019). https://ourworldindata.org/micronutrient-deficiency
3Black RE, Allen LH, Bhutta ZA, Caulfield LE, de Onis M, Ezzati M, Mathers C, Rivera J: Maternal and child undernutrition: global and regional exposures and health consequences. Lancet 2008;371:243–260.
4GAIN, UNICEF, Brighter Futures: Protecting early brain development through salt iodization – the UNICEF-GAIN partnership project. New York, UNICEF, 2018.
5Young MF: Maternal anaemia and risk of mortality: a call for action. Lancet Glob Health 2018;6:e479–e480.
Briony Stevens
United Nations World Food Programme
Via Cesare Giulio Viola 68
Parco dei Medici, IT–00148 Rome (Italy)
Published online:
Biesalski HK (ed): Hidden Hunger and the Transformation of Food Systems. How to Combat the Double Burden of Malnutrition? World Rev Nutr Diet. Basel, Karger, 2020, vol 121, pp 21–30 (DOI:10.1159/000507499)
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Bianca Carduccia, bChristina OhaZulfiqar A. Bhuttaa–d
aCentre for Global Child Health, Hospital for Sick Children, Peter Gilgan Centre for Research and Learning (PGCRL), Toronto, ON, Canada; bDepartment of Nutritional Sciences, University of Toronto, Toronto, ON, Canada; cCentre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan; dDalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Abstract
Over the past decade, public health advocates and policymakers have grappled with the increasing issue of the double burden of malnutrition. Building on the Sustainable Development Goals and the United Nations Decade of Action on Nutrition, strengthening food systems is paramount to addressing hidden hunger, otherwise known as micronutrient deficiencies, and the provision of healthy, sufficient quality and quantity, affordable, safe, and culturally acceptable food. Using the UNICEF Innocenti Framework on Food Systems for Children and Adolescents as guidance, this review identifies four evidence-based food system strategies to drive improvements in micronutrient deficiencies in low- and middle-income countries in the context of school-aged children and adolescents: agriculture, food supply chains, food environments, and social behavioral change communication. With multiple players and drivers in the picture, strong and reliable oversight from national and local governments is required, through accountability, regulation, and sustained commitment to creating policies and proper infrastructure to support healthy food consumption and limit access to unhealthy food items. Moreover, given the complexity of hidden hunger, a holistic systems approach with a “right to food” lens is required to begin addressing and improving the diets and nutrition of children and adolescents. This involves synergistic and collaborative actions from all actors within the food system, as well as interactions with systems that have the ability to deliver nutrition interventions at scale. These systems include health, water and sanitation, education, and social protection. Only through partnerships and collaboration between all drivers, determinants, and key components of the food system, including its interactions with other global systems, will we be able to appropriately address hidden hunger in school-aged children and adolescents.
© 2020 S. Karger AG, Basel
More than ever before, an estimated 821 million people worldwide are suffering from insufficient diets, indicating an unfortunate regression from previous efforts and gains [1, 2]. According to the 2019 Global Burden of Disease Study on the health effects of dietary risks (1990–2017), most regions are not meeting the optimal level of intake of fruits, vegetables, whole grains, nuts and seeds, milk, calcium, fiber, omega-3 fatty acids, and polyunsaturated fatty acids, while consumption of sugar-sweetened beverages, sodium, trans-fats, and processed meats are exceeding optimum levels [3]. These patterns not only threaten the survival of the world’s current children and adolescent populations, nations and their economies, but also their ability to thrive, and that of future generations. With substantial scientific evidence, various disciplines and sectors are now calling for the transformation of the global food system to address the future health and wellbeing of our population [4, 5].
The food system is defined as “a system that embraces all the elements