Sustainable food systems for cardiovascular health

In a perfect world evidence-based food and nutrition goals would swiftly be translated by governments into clear dietary guidelines. People would then change their food choices to reflect the latest advice. This would lead to growing demand for healthier products while demand for less healthy products would decline.

However, current food systems are complex with long food chains that involve several different actors. Many factors on the supply side of the market (what is produced, how it is sold and at what price) have an impact on the food environment which, coupled with individual food preferences, influences consumer decisions about what to eat. The complexity of food systems presents challenges as well as opportunities for policymakers. Many global and external drivers are well beyond the unilateral control of national or regional authorities – let alone individuals. Yet, there are many different entry points along the food chain where policymakers can take action to enable and encourage healthy sustainable diets. (Figure 1)
Below we look at some of these, namely: agriculture & food supply, trade & investment agreements, food promotion and food-environment links.

Agriculture & supply side issues: how can food production affect cardiovascular health?

The European Union’s Common Agricultural Policy (CAP) can, broadly speaking, define which products are produced and promoted and can, therefore, play a strong role in creating an environment conducive to positive dietary changes, which, in turn, promotes cardiovascular health. There is a need to thoroughly assess the nutrition and health benefits of substantially reforming or abolishing CAP. A radical rethink of CAP could contribute greatly, for example, to the promotion of foods such as fruit and vegetables, known to protect against cardiovascular disease (CVD) and other non-communicable diseases (NCDs). The question is now if the recent proposal from the European Commission with one of its objectives aiming to “improve the response of EU agriculture to societal demands on food and health, including safe, nutritious and sustainable food…” will deliver.

Impact of trade & investment agreements on food and nutrition

Trade and investment agreements affect the food and nutrition environment relevant to cardiovascular disease by:

  • Directly influencing the relative price and availability of unhealthy foods; and
  • Restricting governments’ abilities to implement strong public health nutrition policies (constraining the policy space) and increasing the extent to which other stakeholders, such as industry, can influence policy.

    Targeted assessments of the impact on health of trade policy, ideally as part of trade negotiations, are needed, along with policy analyses to look at how nutrition can be taken into account in trade/investment policymaking1.

Food promotion: one of the major drivers of consumption patterns

The commercial promotion of food and beverages high in fat, sugar or salt contributes heavily to a food environment which tends to cause obesity in Europe; moreover these products are a significant risk factor for the development of diet-related NCDs.

Food marketers particularly target children – due to their independent spending power and considerable influence over family spending – and try to influence their diets and taste preferences, while also developing their brand loyalty, as this will often last into adulthood2. Promotion now takes place in both traditional broadcast and, increasingly, through highly-targeted digital media.

WHO has established a Set of recommendations on the marketing of foods and non-alcoholic beverages to children3 and a framework for the implementation of these recommendations and some European countries have introduced restrictions on unhealthy food promotion to children. However, most are voluntary or based on a self-regulatory approach and many have been criticized for being too narrow in scope or ineffective against the full spectrum of promotion to which today’s children are exposed.

Current approaches are not, therefore, doing enough to limit children’s exposure to marketing for unhealthy foods. While more research is needed regarding digital food promotion (social networks, website, etc.), there is already sufficient evidence of the combined impact of various forms of food marketing to justify the need of decisive policy measures to protect consumers, particularly children, from the ubiquitous marketing of unhealthy foods.

Food-environment links – identification of a healthy and sustainable dietary patterns

Global environmental change is affected by food system activities – particularly agriculture. Globally, trends are towards a higher consumption of meat and animal products4. Yet, these foods have higher food-based greenhouse gas emissions and higher water footprints than plant-based foods5.
Environmental change may have a negative impact on diet-related health overall with studies showing that poorer people would have a reduced calorie intake while wealthier people would have a reduced F&V intake6. Findings show that there is considerable overlap between consuming cardiovascular health-promoting diets and achieving higher levels of environmental sustainability. Dietary guidelines and broader policy approaches, which go beyond influencing individual choice, are needed to promote health-environment win-wins.

Based on: Transforming European food and drink policies for cardiovascular health – Chapter 3: Sustainable food systems for cardiovascular health. EHN paper 2017

  1. Hirono, al. BMJ Open 6, (2016).
  2. Lobstein, al. Lancet (2015).
  3. WHO. Set of recommendations on the marketing of foods and non-alcoholic beverages to children. (2010).
  4. Tilman, D.& Clark, M.Nature 515, 518–522 (2014).
  5. Hess, T., Andersson, U., Mena, C.& Williams, A. Food Policy 50, 1–10 (2015).
  6. Springmann, al. Lancet 387, 1937–1946 (2016).
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