Authors: Mohamed Nimal, Gabriel Makiriro, Ana Larrañaga, Elin Bergstrøm, Stephanie Whiteman
Part 1: An introduction to food environmentsPart 2: We need healthy food to be accessible and available to allPart 3: The need for front-of-package labellingPart 4: Unhealthy marketing aimed at children: Why is it important to regulate it?Part 5: The need for a healthy school food environment
By: Elin Bergstrøm
2021 was considered the super year for food. Conferences like the UN Food Systems Summit, the UN Biodiversity Conference, and the Nutrition for Growth Summit all brought attention to the extensive structural transformation that is needed to provide a growing population with healthy food from a sustainable food system. The concept of food environments is often at the heart of discussions about food system change, and food environment interventions are considered key to both fundamentally reshape our food system and reduce the growing burden of non-communicable diseases (NCDs). But what exactly are food environments? And why are they so important to ensure healthy and sustainable diets for all? This blog series will take a closer look at the concept of food environments and highlight different aspects every day. First, what exactly are food environments.
The term ‘food environment’ has been conceptualisedin various ways and first emerged in ecology to explain the different features of species’ food chains (1). In the 21st century, the concept developed and was used to examine the built environment in human societies, particularly focusing on the linkages between the built environment, diets, and chronic diseases (1). Over the years, the term food environment has been a way to conceptualise the multiple and complex factors that influence our food choices and is today commonly defined as “the physical, economic, political and socio-cultural context in which consumers engage with the food system to make their decisions about acquiring, preparing and consuming food” (2, p. 28)
To put it more simply, food environments are where people meet the food system (3) and constitute the multiple factors that determine what you eat. If you think about why you ate a specific meal for dinner yesterday, you will come across various factors of your food environment that influenced you to choose exactly that meal. For example, you might have seen a recipe on Instagram or Tik Tok that you wanted to try out or there was an offer for frozen pizza at your local supermarket. Digital platforms and the availability, accessibility and price of different foods in your neighbourhood are important factors in your food environment that help determine what you eat.
Food environments are constantly evolving and there are perhaps two features that have received particular attention the past years. There has been a sharp increase in the time people spend on digital platforms and without really thinking about it, many of us are part of a new and influential type of food environment – the digital food environment. According to the World Health Organisation (WHO), this can be defined as “the online settings through which flows of services and information that influence people’s food and nutrition choices and behaviour are directed” (4, p.1). Digital food environments come with both opportunities and obstacles when it comes to influencing people’s food choices. Digital technologies can help people make more informed food choices for example through apps that provide nutritional information. However, the influence of digitalization on our dietary behaviour is complex and poorly understood (4). New forms of unregulated digital food marketing, a sharp increase in meal-delivery apps, and influencers who bombard us with conflicting messages about what to eat and not, are all concerning developments within the digital food environment (4).
The UN Food Systems Summit aimed to shed light on another important aspect of food environments, namely sustainability (5). Food production contributes to almost one third of all greenhouse gas emissions and leads to deforestation, biodiversity loss, and depletion of freshwater resources (6). Food environments are therefore critical in supporting sustainable diets and recent research have even expanded definitions of the food environment to include sustainability and ecosystems, which ultimately set the boundaries for our society. Food environments can therefore be defined as:
the consumer interface with the food system that encompasses the availability, affordability, convenience, promotion and quality, and sustainability of foods and beverages in wild, cultivated, and built spaces that are influenced by the socio-cultural and political environment and ecosystems within which they are embedded (1, p.5).
Many have tried to define what a sustainable and healthy diet looks like, and although research is showing that a more plant-based diet is the solution (6), this is a complex and highly debated issue. The sustainability properties of different foods also vary depending on location and context and they are often not clear to the consumer, making it difficult to make sustainable choices in the local food environment.
The concept of food environments shows that there are various and complex factors that influence our food choices. What you eat is a result of processes that are highly dynamic and span multiple sectors and systems. Adopting a healthy and sustainable diet is therefore not only up to the individual, but requires a system approach where “all sectors work as one, towards common goals” (5), as the UN Secretary General put it in his closing remarks of the UN Food Systems Summit. Let’s hope talk turns into action this time.
By: Mohamed Nimal
“Healthy food!” – what comes to your mind when someone says these words? We tend to forget the former (“healthy”) and only see the latter (“food”) part. If affordable and accessible, it is consumed. Do we ask ourselves whether the food provides the nutritional value that is required by our body? We often tend to forget that the calories consumed in excess will reflect on our health. Foods low in nutritional value may lead to unwanted outcomes in the long term, with the risk of obesity and related non-communicable diseases (NCDs).
While this is the case for those who have access to food, it breaks my heart for those who do not have the option to choose what they get to eat or whether they get to eat at all. It becomes a human right issue, because access to healthy food is critical for our development and survival. Which brings us to why we need to talk about access and availability? Because without access to healthier food we simply cannot eat a healthy diet. When healthy options are not available, we tend to settle for foods that are high in calories and lower in nutritional value. Without access to food and availability of healthy food options it could lead to hunger and undernourishment. Another important aspect of food that is currently discussed across the globe is whether our planet can produce enough healthy food for all in a sustainable way to feed the coming generations.
In this discussion we will look at food through a holistic lens to gain a brief understanding of access and availability of healthy & sustainable food.
While I looked for a definition for healthy food, it took me in multiple directions as there is no clear distinction between “food” and “diet”, however, both words are used interchangeably and are always linked to the behaviours of individuals. Hence the definition by the scientific group for 2021 United Nations Food Systems summit is quoted, “Nutritious food is one that provides beneficial nutrients (e.g. protein, vitamins, minerals, essential amino acids, essential fatty acids, and dietary fibre) and minimizes potentially harmful elements (e.g. anti-nutrients, quantities of sodium, saturated fats, and sugars).” The group further went on to conclude that a healthy diet is health-promoting and disease-preventing.
The EAT-Lancet Commission outlines a planetary health diet that focuses on the food we eat, the ways we produce it, and how the amounts wasted or lost have major impacts on human health and environmental sustainability. If we look at the plate carefully (figure 1), you will notice that half of the plate is filled with plant-based food, and a very small fraction with animal sourced protein. Our dietary habits will become healthy when we move away from foods that have excess added sugars and salt, are high in saturated fats, and are ultra-processed.
Access to healthy food can be achieved by actions at global, national and local level, for example commitments to advance the implementation of guidelines for food service/retail environments (such as worksites, hospitals, colleges, food banks and pantries, parks, and recreation centres), improving the supply (access) of healthy foods, and driving consumer demands for healthy foods through behavioural modification (strategies that influence choice or action). Every government has a critical responsibility to ensure that their citizens have access to healthy food and that it is affordable.
Healthy food should be consumed taking into account its benefits and we should always avoid and limit food that causes us harm and that may lead to disease. Access and availability also become barriers when it comes to healthy eating. It is important to note that dietary habits of individuals are significantly influenced by the level of awareness, be it the consumer or for those around the consumer. Particularly children and young adolescents dietary behaviour are influenced from home environment, school environment and by the options available in the neighbourhood. Hence it is crucial that those who make food for children are well informed about the dietary needs of the children to tackle this huge barrier to healthy eating. Children can make a difference if they learn from a young age about healthy options and we are able to create a generation who is more aware about healthy food who could tackle the access and availability of healthy food for all.
The current 2030 agenda has multiple goals to ensure that we do not leave anyone behind on any aspect of life. If we look closely at the SDG 2, “Zero Hunger; End hunger, achieve food security and improve nutrition and promote sustainable agriculture”, it emphasises the actions member countries have to take to achieve the already off-track targets. The COVID-19 pandemic has pushed us further back in terms of access to and availability of food, but we need to fight this battle together and build back better to address this.
Ahead of the first ever UN Food Systems Summit, which was held in September 2021, Dr. Agnes Kalibata, UN Secretary-General’s Special Envoy to the 2021 Food Systems Summit said this statement, which stuck with me: “It is a once in a generation opportunity to make a difference for millions of people, to define a new deal for people, planet, and prosperity – don’t hold back!”
We should choose healthy diets and sustainably produced food for us and for the future. Learn and encourage others on how to make healthy choices from available information, we have to consider it all (link to Stephanie’s Blog). Let me start at home for myself or you can do this at your home, because it only takes one of us to initiate change and we do not need to hold back when it comes to our health and the planet!
(1) Access to Healthy Foods [Internet]. Centers for Disease Control and Prevention. Available from: https://www.cdc.gov/nutrition/healthy-food-environments/improving-access-to-healthier-food.html
(2) Environmental Influences on Dietary Behavior among Children: Availability and Accessibility of Fruits and Vegetables Enable Consumption [Internet]. Taylor & Francis. Available from: https://www.tandfonline.com/doi/abs/10.1080/10556699.1998.10603294
(3) Gebremariam M, Vaqué-Crusellas C, Andersen L, Stok F, Stelmach-Mardas M, Brug J et al. Measurement of availability and accessibility of food among youth: a systematic review of methodological studies. International Journal of Behavioral Nutrition and Physical Activity. 2017;14(1).
(4) Shearer C, Rainham D, Blanchard C, Dummer T, Lyons R, Kirk S. Measuring food availability and accessibility among adolescents: Moving beyond the neighbourhood boundary. Social Science & Medicine. 2015;133:322-330.
(5) Pechey R, Marteau T. Availability of healthier vs. less healthy food and food choice: an online experiment. BMC Public Health. 2018;18(1).
(6) Access to Healthy Food and Why it matters: A Review of the Research [Internet]. The Food Trust. Available from: http://thefoodtrust.org/uploads/media_items/access-to-healthy-food.original.pdf
(7) Healthy diet: A definition for the United Nations Food Systems Summit 2021 [Internet]. United Nations. Available from: https://www.un.org/sites/un2.un.org/files/healthy_diet_scientific_group_march-2021.pdf
(8) EAT-Lancet Commission Summary Report [Internet]. EAT Forum. Available from: https://eatforum.org/content/uploads/2019/07/EAT-Lancet_Commission_Summary_Report.pdf
By: Stephanie Whiteman
“We are what we eat’‘- this is a saying that I’m sure many of us have heard before, but what does it mean? Food is one of the basic necessities of life. It gives our body the nutrients we need to not only survive, but to also thrive. All of the food we eat, whether it be a fruit salad with Greek yoghurt or a triple stack double bacon burger with an upsized portion of fries, eventually impacts us. The food we treat and nourish our bodies with will impact our overall health and well-being. Given that we only have one body, how do we ensure that we are feeding it the best way we can? We will touch on one possible solution – front-of-package labelling (FOPL).
Nutrition labelling has been a part of the food and beverage industry for a long time. Most of us may be familiar with the typical nutrition facts panel that is at the back of most pre-packaged foods. Most of them look like this:
Ideally, we should all be reading the nutrition facts label and the decision on what foods we buy should largely be based on that information, along with other things such as price and taste. However, this is not an ideal world. How many of us can honestly say that we turn to the back of the food item we want, read the nutrition facts, and then compare options based on, for example, the calories or amount of added sugars? Even if we do read it, it can sometimes be difficult to determine if the number of grams given is considered too high or low. This is where FOPL comes in.
Front-of-package labels put all necessary nutritional information at the forefront, and allow customers to quickly and correctly identify products that contain excess amounts of calories, sugars, fats, and sodium. There are many different types of labelling systems that have been adopted in different regions across the world. Here are some examples(1):
Several research studies have been conducted on these labels and there is general consensus that front-of-package nutrition warning labels systems perform better than any other systems (2,3). Most people spend only a few seconds examining food labels, which means the simple warning labels work best. Imagine how easy it would be for adults and children to make healthier choices when there are warning labels on the products. For example, deciding between two similarly priced granola bars for a mid-morning snack, one with the clear warning label “HIGH IN SUGAR” – you would be surprised how many granola bars are high in sugar – and one without. The healthier choice would be to choose the granola bar that is lower in sugar.
The beauty of front-of-package warning labels is that it allows for all persons regardless of socio-economic status, age, language or education to easily identify and differentiate healthy foods versus unhealthy foods. Not only would adults be able to make better choices, but now children will also be able to make informed decisions. This is especially important to empower youth to make healthy choices.
We all need to eat food to survive, but to ensure that we thrive and live healthy lives, we also need to make healthy food choices. People have the fundamental right to have accurate, accessible and easy to understand information about the foods they consume. Front of package labels, most notably the warning labels, take us one step closer to making these healthier choices. For the countries that have this in place, we thank you for your commitment. For countries that have yet to implement FOPLs, we urge you to take the necessary steps to have this important policy implemented, as it is one of the many roads we need to take to create a healthy food environment.
By: Ana Larrañaga
Marketing of unhealthy ultra-processed foods is highly effective and targets children and young people like us, making an entire generation more vulnerable to developing non-communicable diseases.
To protect our future health, it is essential to regulate different forms of unhealthy marketing!
Childhood is a crucial stage for the formation of healthy habits. Studies have confirmed that the habituation to sweet tastes during the first years of life affects the flavours and food preferences in the later stages of life. One more reason to boost efforts to promote a nutritious and balanced diet from early childhood!
Unfortunately, profit-driven food systems have created unhealthy food environments, and the promotion of fruits, vegetables, grains, and cereals falls short in the face of the enormous promotion of unhealthy products. Millions of advertisements are directed at children and young people like us each year, and a significant portion of these correspond to products that would make us more likely to develop non-communicable diseases (NCDs). This includes mainly sugary drinks and ultra-processed products that are high in fats, sugars, and artificial sweeteners and flavours.
It is important to reflect on the impact of marketing aimed at children. They are particularly vulnerable in the face of market mechanisms for ultra-processed products, infant formulas, and sugary drinks. From a rights-based approach, children’s best interests are above the commercial interests of the industries; however, few governments around the world have acted firmly in this matter.
But why? There is a general lack of recognition of the impacts of marketing as a means to encourage the consumption of products among children. Despite this, studies have confirmed that children are more likely to prefer products with flashy packaging containing pictures, prizes, toys, or famous characters. Furthermore, thanks to digital media, marketing has managed to expand its field of influence and reach younger audiences through tablets, computers and cell phones (in addition to traditional media such as cinema, radio, printed ads, and television). As stated by the WHO–UNICEF–Lancet Commission, “young people around the world are enormously exposed to advertising from business, whose marketing techniques exploit their developmental vulnerability and whose products can harm their health and wellbeing”.
Another reason that explains the lack of action by governments is self-regulation schemes. Cleverly, many industries promoting unhealthy products choose to implement self-regulatory schemes to prevent governments from developing mandatory laws or regulations. In this way, industries that advertise to children have managed to position themselves as socially responsible actors that avoid these problematic practices. Unfortunately, independent studies have proven that these schemes are usually too weak and leave children and youth unprotected against different predatory forms of unhealthy marketing.
Childhood and youth should be seen as an opportunity to protect wellbeing and development, thus building healthier futures. We believe decision-makers in all countries should take positive steps to implement strict regulatory frameworks that effectively protect our health.
By: Gabriel Makiriro
The growth and development of individuals occur at an early age(1). Many of our critical moments in social, psychological, physical, and intellectual development happen in schools, and healthy food plays an important role in these processes(2). Because of this, it is important to recognize and focus on healthy nutrition in schools. According to the Centre for Disease Control and Prevention, students spend a long time in schools, and half of their calories are consumed there(3). In this blog post, we are going to explore healthy food in the school environment.
The Food and Agriculture Organization of the United Nations (FAO) defines the school food environment as all the spaces, infrastructure, and conditions inside and around the school premises where food is available, obtained, purchased, and/or consumed (for example tuck shops, kiosks, canteens, food vendors, vending machines); also taking into account the nutritional content of these foods(4). All actors that are part of the school environment should be involved in promoting a healthy diet among students, for example through nutrition education or school meal programs. Globally, the FAO acts as an advocate for healthy food in schools(1). The organization promotes the integration of nutrition in national curricula in schools, encourages the use of nutritious locally produced food, and oversees legal aspects to protect children’s rights to healthy food, education, and health are put in place(1).
A healthy food school environment develops students that make informed and healthy choices and establishes a positive example for the health and longevity of the community and the environment(5). Optimal nutrition for students contributes to physical and neural development and leads to improved academic performance and attendance(6). Healthy diets prevent all forms of malnutrition and chronic non-communicable diseases such as diabetes, heart diseases, stroke, and cancer(7).
A healthy diet includes fruits, vegetables, legumes (e.g. lentils and beans), nuts, whole grains (e.g. unprocessed maize, wheat, and brown rice), meat, fish, eggs, low-fat milk, and dairy products, and less salt and fat(7). A healthy school nutrition environment provides students with nutritious and appealing foods and beverages, consistent and accurate messages about good nutrition, and ways to learn about and practice healthy eating before and after school(8).
Ideally, schools should serve a nutritious breakfast and lunch daily, offering a variety of fresh fruits and vegetable choices in the school meal program(8). Additionally, the health promotion messages in the school must reinforce healthy food and nutrition education, all food and beverages offered at school must be healthy food choices, food service staff should be trained in quality menu planning options, food safety, and nutrition science and there should be a school garden(9). Sales and marketing of ultra-processed foods high in sugars, salts/sodium, and fats should not happen in schools.
Parents also play a role in nutrition education by reinforcing instructions given to children at schools, supporting school breakfast and lunch programs by purchasing meals, and packing lunches that are consistent with a healthy diet(5). The community surrounding the school should be involved in local agriculture partners in farm to school programs, offering fresh food to schools, promoting healthy eating, and knowledge in food production among students(5).
In different countries and governments, there are school policies and programs that encourage children to adopt and maintain a healthy diet. In the United States of America, the healthy school lunch initiative is implemented to modify the food environment during school lunch periods, displaying, marketing, increasing the convenience of healthy foods, and, providing many healthy options for students(6). This initiative increases healthy food consumption and improves students’ eating behaviors. In the Netherlands, a healthy school canteen program helps schools to make cafeteria offerings healthier(10). Students can make more healthy food choices and develop healthy eating habits(10). Other governments and different agencies should plan and contribute to healthy food initiatives in schools.
Centre for Global Child HealthThe Hospital for Sick Children (SickKids)525 University AvenueSuite 702Toronto, Ontario, CanadaM5G 2L3