© 2020 S. Karger AG, Basel
In order to spark the transformation required for sustainability, it is essential to appreciate the connection between food systems and the creation of just societies and healthy populations. There is great potential for food systems to contribute to healthier, nutritious diets, and the health of the planet. For now though, the way we produce, distribute, market, prepare, eat, and dispose of food has a significant and growing cost to public health and nutrition. The “State of Food Security and Nutrition in the World 2019” lays bare some of the impacts of our current food system [1]. Biodiversity is being eroded at an alarming rate by the destruction of ecosystems, and climate change is accelerating, with food systems contributing centrally to both trends. We also know that our food systems have been bad for children who are suffering from the triple burden of malnutrition-undernutrition, hidden hunger, and overweight and obesity. Food systems are failing to deliver nutritious, safe, affordable, and sustainable diets for all children.
In 2017, IPES-Food, in collaboration with the Global Alliance for the Future of Food, undertook a review of existing scientific literature in order to contribute to understanding of the impacts of food systems on human health [2]. The review focused on addressing the practices, political economy, and power relations that currently prevail, and identified what can be done in order to build healthier food systems. The information has been updated where new data have become available.
Health Impacts of Food Systems and Their Estimated Costs
We clustered the health impacts of food systems into five key impact channels, aiming to focus on the different ways in which people get sick (i.e., the negative health impacts of food systems). These five interconnected channels are discussed below: (i) occupational hazards; (ii) environmental contamination; (iii) contaminated, unsafe, and altered foods; (iv) unhealthy dietary patterns, and (v) food insecurity.
1. Occupational Hazards
People get sick because they work under unhealthy conditions. Farmers, agricultural laborers, and other food chain workers get sick as a result of exposure to health risks in the field, factory or workplace, including acute and chronic pesticide exposure risks, production line injuries, and livelihood stresses. Pesticides alone are responsible for an estimated 200,000 acute poisoning deaths each year, with 99% of these in developing countries [3]. Children are among those exposed to pesticides via ingestion, inhalation, or dermal contact, and are uniquely vulnerable to adverse effects due to developmental, dietary, and physiological factors [4]. The costs of pesticides extend far beyond farmers’ health bills, and also include lost productivity and income. Estimations of economic costs are difficult to come by. In the USA, where direct and indirect costs from occupational morbidity and mortality amount to USD 250 billion, the highest mortality rates have been found to be in the agricultural, food manufacturing, and food preparation industries [5]. In the UK, it is estimated that the health-related benefits of withdrawing approval for seven active substances used in pesticides could reach GBP 354–709 million in avoided healthcare costs for the maximum exposed farmworker population aged over 30 years. Extrapolating these figures, such benefits could reach EUR 3,568–7,160 billion over 30 years for the entire EU population [6].
2. Environmental Contamination
People get sick because of contaminants in the water, soil, or air. The health impacts arise via the exposure of whole populations to contaminated environments “downstream” of food production, via pollution of soil, air, and water resources, or exposure to livestock-based pathogens (e.g., contamination of drinking water with nitrates, agriculture-based air pollution, antimicrobial resistance).
Endocrine disrupting chemicals (EDCs) – chemicals that interfere with hormonal systems – are ubiquitous in food systems and are generally seen to pose one of the greatest challenges for public health. EDCs cause annual health costs of USD 217 billion in the EU (1.28% of GDP) and USD 340 billion in the USA (2.33% of GDP) [7].
3. Contaminated, Unsafe, and Altered Foods
People get sick because specific foods they eat are unsafe for consumption. Illnesses arise from the ingestion of foods containing various pathogens (i.e., foodborne disease) and risks arising from compositionally altered and novel foods (e.g., nanoparticles). An estimated 600 million people – almost 1 in 10 people in the world – fall ill and 420,000 die every year after eating contaminated food. Children under the age of 5 years carry 40% of the foodborne disease burden, with 125,000 deaths per year [8]
4. Unhealthy Dietary Patterns
There has been a marked increase in unhealthy dietary patterns, a trend that has been accompanied by increasing rates of overweight, obesity, and non-communicable diseases (NCDs) worldwide. Unhealthy diets are now the leading risk factor for deaths and loss of disability-adjusted life-years, surpassing for example tobacco smoking and high blood pressure [9]. It is diets in their entirety and overall balance that are increasingly being associated with health impacts. The diet-related health impacts manifest themselves in raised risks of obesity and/or NCDs.
Poor diets are often characterized by overconsumption of specific foods or groups of foods with problematic health profiles (e.g., resulting in obesity and NCDs, including diabetes, heart disease, cancers), and tend to be shaped by unhealthy “food environments.” Food environments have been defined as the physical, economic, political, and sociocultural context in which consumers engage with the food system to make decisions about acquiring, preparing, and consuming food [9, 10]. There is ongoing articulation to focus on the interaction between people’s daily lives and activities that shape their diets [11]. Increased consumption of sugar-sweetened beverages has been singled out as a significant contributor to the obesity epidemic in recent years [12]. Overconsumption of animal products has been connected with heart disease, diabetes, and various cancers [13]. High sodium intakes are associated with higher blood pressure and hypertension [14]. Globally, 1.7 million annual deaths from cardiovascular causes have been attributed to excess sodium intake [15]. A number of recent studies suggest that high consumption of saturated fats is associated with increased risk of coronary heart disease and diabetes [16]. The negative health impacts of trans fatty acids – a type of unsaturated vegetable fat typically found in manufactured cooking oils – are now the subject of broad consensus, with legal limits and bans in Denmark, Austria, Switzerland, Iceland, Hungary, Norway, and Latvia [17]. In the USA, a nationwide ban on partially hydrogenated oils – the primary dietary source of artificial trans fats – came into effect in 2018 [18]. Overall,