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The triple burden of malnutrition is growing in low- and middle-income countries (LMICs). Increasing access to affordable ultra-processed foods in the food environment is contributing to this problem. While existing explanations for this triple burden of malnutrition have examined demand-side factors of food choices, the supply-side policies relating to the food environment drivers, ideas and actors’ interests have been neglected. Using a case study of Ghana, this analysis combines the Advocacy Coalition Framework with the narrative policy analysis to unpack the supply-side food environment policies and actors driving the triple burden of malnutrition. Applying a mixed methods analysis of the transcripts, the narratives reveal public, private and civil society organization (CSO) coalitions with different ideas and interests in the food environment. In the private sector coalition, food companies engage in aggressive advertising and are driven by profit motives – leading to the supply of more ultra-processed foods. The public sector is failing to regulate the market because of inadequate policies, limited institutional capacities and coordination, enforcement challenges, inadequate resources, and self-interest. Social activism by CSOs, for example, pressuring food companies to deliver healthy foods and holding the government accountable, is also lacking. The result is a triple sector (public, private and CSO) failure in the urban food environment with consequences on the availability of ultra-processed foods. This has long-lasting implications for the reduction of the triple burden of malnutrition and the achievement of zero hunger. To accelerate nutrition-sensitive food environments that deliver healthier food options, we argue that it is critical to entertain the ideas and interests of stakeholders and implement food environment policies that cover private and public sector initiatives, as well as increase consumer awareness.
The food system is responsible for some of society’s most pressing sustainability challenges. Diets are currently unsustainable in many countries as evidenced by the growing burden of malnutrition, degradation of natural resources, contributions to climate change, and unaffordability of healthy diets. There is an urgent need to address the gaps in understanding of what a sustainable food system means across varying populations and geographies and how we can better measure these systems, while identifying how dietary choices impact on human health and the environment. However, decision makers and experts are questioning whether it is possible to meet environmental, social, and economic goals simultaneously, or whether trade-offs are necessary. Thus, the development of better measurements and indicators to clearly understand the benefits and considerations for healthy and sustainable food systems is needed.
The food systems approach can contribute to food security and reduced malnutrition levels by identifying key investments and policies throughout the food system, including production, processing, marketing, and consumption of food. However, in countries facing fragility and conflict, it has proven difficult to implement such an approach and achieve the desired results. This has been the case in Afghanistan, where high levels of malnutrition stem in part from an undersupply of nutritious food. Multi-sectoral approaches to promote nutrition sensitivity and achieve diet-based solutions have also had only limited impact. This paper reports on an analysis of the nutrition sensitivity of food systems in Afghanistan using multi-sector consultations and gap analyses to examine two key food and nutrition policies, the National Comprehensive Agriculture Development Priority Program and the Afghanistan Food Security and Nutrition Agenda. It highlights gaps in the policies and identifies investment priorities to make food systems more nutrition sensitive. The results show that instilling nutrition sensitivity into the operation of Afghanistan’s food systems can only be accomplished if certain key measures are incorporated into the food system. These include addressing the absence of knowledge in the population regarding healthy diets, the lack of sufficient food for vulnerable populations, weak irrigation systems, capacity constraints at individual and institutional levels, data challenges, and weak natural resource management. In addition, the above weaknesses are compounded by the continued violence and conflict-induced insecurity, weak government, and inadequate investments. Given the role of different sectors in contributing to improved nutrition, appropriate and effective multi-stakeholder coordination and collaboration is paramount to such efforts.
This publication presents an in-depth analysis of the food system in Ghana with the dual purpose of providing an overview of the current situation, and identifying opportunities for leveraging the role of small and medium-sized enterprises for nutrition-sensitive food systems. The data collected and the results of the analysis enhance the understanding of some of the challenges that, in the Ghanaian context, contribute to determining diet-related issues; more importantly, the analysis identifies opportunities and entry points for improving diets by overcoming some of the challenges faced by small and medium-sized enterprises. The information provided could be of support not only for further analyses, but also for planning interventions and designing policies to improve nutrition in Ghana and in other contexts.
Chronic non-communicable diseases (NCDs) such as hypertension, stroke, diabetes and cancers, are major causes of disability and death in Ghana. NCDs are not only public health problems. They are also developmental problems, because the rising prevalence of long-term chronic conditions has major social and financial implications for affected individuals, families, healthcare providers and the government. This University of Ghana Readers volume from the Regional Institute for Population Studies presents social and medical science research on Ghanas NCD burden. The body of multidisciplinary research spans the last fifty years and offers important insights on NCD prevalence and experience as well as cultural, health systems and policy responses. This volume will be an essential resource for researchers and students in the health sciences, healthcare providers, health policymakers, and lay individuals with an interest in Ghanas contemporary public health challenges.
Like other countries in the sub-region particularly West African economies, Ghana is grappling with multiple burdens of malnutrition which is accompanied by climate change that influence food production and consumption trends, and thereby leading to undernutrition and affecting overall development. In addition, growing incomes, accelerated urbanization, and expanding middle classes are also causing significant changes in consumer behavior and nutritional choices, necessitating both public and private expenditures for better food market integration. While food insecurity, and undernutrition (e.g. stunting, micronutrient deficiencies) persist, obesity and diet-related non-communicable diseases are rising rapidly. General nutrition situation and identification of the highest priority nutrition problems. Various estimates of nutritional status of Ghanaian children under aged 5 years show that 19% were stunted, 5% were wasted, and 11% were underweight. In 2018, the Multiple Indicator Cluster Survey (MICS) showed nearly similar rates of stunting (18%), wasting (7%) and underweight (13%), suggesting that stunting prevalence improved only marginally during the last 5-6 years, whereas child wasting and underweight worsened during the period. Other significant problems of undernutrition in Ghana include a high prevalence anemia in children 6-59 months (55%), adolescent girls (48%) and women of reproductive age (42%). From the foregoing, the high priority nutrition challenges in Ghana, include “stunting and wasting in children under 5 years of age; anemia in children 6-59 months of age, adolescent girls, and women of reproductive age; but also, overweight and obesity in school-age children and younger adolescents; and overweight and obesity in women of reproductive age (15-49 y of age). Report of the Demographic and Health Surveys show a significant rising trend in adult obesity – from 10% in 1993 to 40% in 2015 (GSS et al., 2015). Also, the Ghanaian food environments (particularly in the urban areas) is currently characterized by cheap highly-processed foods, with nutrient-dense foods such fruits and vegetables lacking in meals because it is unaffordable (Laar, 2021).
Global estimates show over half a billion people go hungry (FAO, 2020) and close to 2 billion people are either obese or overweight with another 2 billion of the world’s population suffering from micronutrient deficiencies (Micha et al., 2020, Fresco et al., 2017). Inarguably, the world faces significant malnutrition problem (including micro- and macro-nutrient deficiencies, obesity, and diet related non-communicable diseases). This is evident in a recent analysis pointing out that effort in achieving the Global Nutrition Targets is likely to be missed. The observed malnutrition threat is accompanied by climate change, which is influencing food production and consumption trends, and thereby leading to undernutrition and affecting overall development. In addition, there are growing incomes, accelerated urbanization, and expanding middle classes which are also causing significant changes in consumer behaviour and nutritional choices, necessitating both public and private expenditures for better food market integration. As a result, there is a pressing need to examine our food systems to guarantee food and nutrition security and to advance sustainable development. It is likely that the COVID-19 impact may further exacerbates the worsening food insecurity and nutritional status of the most vulnerable groups including women, children and adolescents, refugees and displaced people, smallholders in rural areas, and the urban poor.
Developing country food systems have changed dramatically since the Green Revolution period. At the same time, malnutrition still represents a challenge and is now understood to encompass the three simultaneous dimensions of undernourishment, micronutrient deficiencies, and over-nutrition manifest in overweight and obesity. These changes in food systems and in the understanding of the global malnutrition challenge necessitate fresh thinking about food systems-based strategies to reduce malnutrition. This paper introduces a special section that offers such new perspectives. We discuss trends with respect to indicators of the triple burden of malnutrition to understand the extent of global malnutrition challenges and then relate those to food systems transformation in developing countries.
A growing number of governments, donor agencies, and development organizations are committed to supporting nutrition-sensitive agriculture (NSA) to achieve their development goals. Although consensus exists on pathways through which agriculture may influence nutrition-related outcomes, empirical evidence on agriculture’s contribution to nutrition and how it can be enhanced is still weak. This paper reviews recent empirical evidence (since 2014), including findings from impact evaluations of a variety of NSA programs using experimental designs as well as observational studies that document linkages between agriculture, women’s empowerment, and nutrition. It summarizes existing knowledge regarding not only impacts but also pathways, mechanisms, and contextual factors that affect where and how agriculture may improve nutrition outcomes. The paper concludes with reflections on implications for agricultural programs, policies, and investments, and highlights future research priorities.