Improving the Consumption of Nutritious Foods: What Can Business and Government Do Together? Lawrence Haddad Global Alliance for Improved Nutrition (GAIN) SDC, September 20, 2018
The Problem 1 in in 3 3 people le 2 world rldwid ide are billion Deficient in maln lnouris ished Deficient in vitamins or vitamins or minerals minerals Overweight Chronic or Obese Hunger 151m 51m stunted 38m wasted under 5’s over weight 1.9 821 billion million SOFI 2018
Inadequate food consumption is the common denominator in all forms of malnutrition Poor Diets Diabetes Type 2
Poor diet contributes to six of the top 10 Poor diet contributes to 2016 Risk Factors 1, 3, burden of disease factors in India 4, 5, 8 & 9 India Source: IHME, http://www.healthdata.org/results/country-profiles www.gainhealth.org 4
..and five of the top ten in Switzerland Switzerland www.gainhealth.org
But food consumption does not automatically improve with income growth 131 % change in consumption,1990-2010 96 g/day 40 39 37 20 19 18 16 13 12 8 8 6 5 5 4 2 1 -6 -3 -7 -14 -16 -17 -8 -8 Vegetables & Pluses Seafood Sugar sweetened beverages Source: Global Dietary Database estimates for GAIN
So what is going on? Have we all become worse at making choices? Brighton Beach, UK 1976 Guardian August 15, 2018
Food Availability Has Diversified Very Weakly quality East Asia South Asia Africa quantity From data in Fig 6.3 Global Panel report
Healthy foods like fresh fruits & vegetables are unaffordable for large parts of the world Share of per capita Bangladesh 52% household income India to buy 5 fruits and Pakistan vegetables Zimbabwe /day/person Availability, affordability, and consumption of fruits and vegetables in 18 countries across income levels: findings from the Prospective Urban Rural Epidemiology (PURE) study. Miller, Victoria et al. The Lancet Global Health , Volume 4 , Issue 10 , e695 - e703
And the prices of nutrient rich foods are increasing …. Ethiopia: % Change in real prices 2007-2016 -35.2 Oils and fats -23.6 Sugar and honey -2.3 Grains, roots & tubers Other Vitamin A rich veg & fruits 18.8 Other fruit & veg 22 Legumes and nuts 26.2 Dairy products 26.9 Flesh foods and small animal protein 33.4 Eggs 34.1 Dark green leafy vegetables 61.9 Source: from Kalle Hirvonen, IFPRI
But desirability is also key. The public sector is always going to be outspent on making nutritious food desirable … ..so what it does spend has to be engaging $ 1 billion $50m Advertising spend of Hershey and Aid spending on General Mills in Diet Related NCDs 2016 in 2014 (2016 GNR) https://www.nature.com/articles/d41586-018-03918-7
But nutritious foods are losing the desirability war Public Service Announcements for nutritious foods are overwhelmed by commercial ads — persuasively and financially
The Solutions 1. Engage better with Business 2. Build Demand for nutritious foods 3. Improve Access to nutritious foods 4. Create a more Enabling Environment for business to support improved consumption of nutritious foods
1. Why Do We Need to Engage Business? X X
Businesses: a big part of the problem Results from Access to Nutrition Index 2018 (22 largest food and beverage companies) Percent of 23,000 product lines that are "healthy" 32% Percent of products that meet WHO EURO standards for 14% marketing to children Number of companies that cover all media in their responsible 6 marketing commitments to children Number of companies that extend responsible marketing to 1 children in the 13-18 year group Top score on Marketing of Breast Milk Substitutes (Danone) 60% https://www.accesstonutrition.org/sites/gl18.atnindex.org/files/resources/atni_report_global_index_2018.pdf
But they have to be part of the solution, because … … food supply chains are Farms, ranches, fisheries, almost 100% Agricultural input companies ( seeds etc. ) private … Transporters, aggregators, warehouses, distributors Basic processing, industrial processing, packaging Wholesalers and markets, retailers (formal & informal), restaurants Source : HLPE 2017
The food environment is also partly shaped by the private sector Refrigeration, preservatives, Testing equipment Media (traditional & social); Marketing companies Private employers; Traders and speculators Business finance institutions; Infrastructure companies Source : HLPE 2017
2. Governments need to shift demand for nutritious foods
To Shift Norms : use hybrids of public and private approaches Private sector Public sector • Uses powerful • relies on emotional and logical, linear, aspirational health messaging messaging
Example in Kenya from GAIN work
Like a Healthy Gossip Campaign in Indonesia
Price incentives What does the evidence say? “To maximize success and effect, this review suggests that food taxes and subsidies should be a minimum of 10 to 15% and preferably used in tandem ”. Nutrition 31 (2015) 787 – 795
The UK sugar levy had an impact on reformulation even before it went into effect in April 2018 SWA = sales weighted average https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/709008/Sugar_re duction_progress_report.pdf
3. Improve Access to Affordable Nutritious Foods
Fortification is a basic way of making foods more nutritious mandate the fortification mandate at least one Percent of of edible oils, margarine kind of cereal grain countries that … and ghee fortification 21% 45% http://www.fortificationdata.org Source: Global Fortification Data Exchange
And there is a big unfinished fortification agenda Fortification of edible oil: FACT surveys 100 99 98 99 98 98 98 96 95 93 90 89 89 54 54 36 34 24 23 8 7 Côte India, Nigeria, Nigeria, Senegal Tanzania Uganda d'Ivoire, Rajasthan Kano Lagos Abidjan Household uses vehicle* Vehicle is fortifiable** Vehicle is fortified*** Source: Global Repository for FF
But businesses need to realize that being purpose driven is the smart thing to do “During the 2008 – 2009 financial crisis, US firms with high social capital, as measured by corporate social responsibility intensity, had stock returns that were 4 – 7 % higher than firms with low social capital .” Social Capital, Trust, and Firm Performance: The Value of Corporate Social Responsibility during the Financial Crisis. Lins et al. 19 March 2017
There are many pathways to pressuring companies to be more purpose driven % demanding US company is more purpose driven New Hires 77 Current employees 76 Customers 68 Other stakeholders 61 Regulators and policymakers 53 Investors and shareholders 52 Suppliers and vendors 44 i3 (ignite, imagine, innovate) Index, a national survey of C-Suite Executives commissioned by Covestro in USA https://www.agilitypr.com/pr-news/public-relations/profit-driven-vs-purpose-driven-business-ceos-stand/
But for older infants and younger children commercial solutions remain elusive There is no proven business model for fortified complementary foods Appropriate complementary feeding remains one of the most important life-saving nutrition interventions, and must be aggressively promoted across the world. 29
Reducing food loss is a clear business opportunity FAO infographic http://www.fao.org/europe/news/detail-news/en/c/447069/
Tomato Supply Chain Opportunities in Nigeria Lack of cold Lack of proper Lack of cooling facility crating/Packaging transportation in the market from farm to retail Cold Chain Packaging & Crating GAIN in NIGERIA: SOME PROBLEM-SOLVING INTERVENTION ACTIVITIES 31
4. Create an Enabling Environment Businesses to Act Positively for Nutrition
Promote Accountability of Business to Identify Responsible Businesses
Hidden barriers “It is proposed to provide for exemption from sales tax on premixes to fight growth stunting .” p. 14. Government of Pakistan 2017 Budget.
Address the “Missing Middle” of Finance Access to finance as a barrier: Dark red=most important barrier Finance – get slide on access to finance for SMEs Un-investible business propositions in nutritious foods or a lack of finance? World Bank Enterprise Surveys http://www.enterprisesurveys.org/data/exploretopics/firm-characteristics
Workplace Programs are Missing Opportunities to Focus on Diet & Nutrition Improive nutrition environment at work
Labels and Symbols Can Make a Big Difference to Inform Choice
Enable Consumer Movements
Activist Investors can also create an environment for change “Companies in nearly all sectors will see increasing demands from investors to address environmental and social issues .” https://www.activistinsight.com/research/TheActivistInvesting.AnnualReview.2018.pdf?x45687
And we have to do all this sustainably Global average water footprint (litres/kg) 4400 Not all F&V are equal when it comes 3000 to natural resource tradeoffs 1600 1200 860 700 460 200 180 130 http://waterfootprint.org/media/downloads/Hoekstra-2008-WaterfootprintFood.pdf
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