The State of Food Security and Nutrition in the World 2022

For repurposing scenarios such as those discussed in the preceding section to materialize, thus effectively contributing to making a healthy diet less costly and more affordable, other agrifood systems policies, and policies and incentives outside agrifood systems, will be needed (see Figure 1 in Chapter 1). If aligned and put in place, these complementing policies can offer support in two ways (Figure 24). First, they can provide incentives (or disincentives) that can support shifts in food supply chains, food environments and consumer behaviour towards healthy eating patterns. Second, they can ease or mitigate the unintended consequences or trade-offs from repurposing support, particularly if these include a reduction in the access to nutritious foods and healthy diets for vulnerable and disadvantaged population groups.

FIGURE 24Complementing policies, both inside and outside agrifood systems, are critical to support repurposing support efforts

SOURCE: FAO.

Attention must also be given to the private sector, not just farmers but agribusiness and also enterprises in other sectors that constitute the food industry, as their actions can enable or go against the intended objectives of repurposing support in practice. Ignoring the interlinkages between agrifood systems and other systems can produce unintended and uncompensated costs and consequences.

Other agrifood systems policies complementing repurposing support efforts

The 2020 and 2021 editions of this report have highlighted and examined in-depth several agrifood systems policies that, while not designed directly to increase the availability and reduce the cost of nutritious foods, will support repurposing efforts by promoting shifts in food supply chains and enabling healthy food environments and consumer behaviours that promote dietary changes to healthy diets.^3,15 Shaping an enabling food environment to enhance the demand for healthy diets can affect consumer prices and the incentives needed to reduce the relative price of nutritious foods. In addition, some of the policies incentivize changes in the nutritional quality of the food supply. A non-exhaustive analysis of policies oriented to these objectives is presented below.

Implementing mandatory limits or voluntary targets for reformulating food and beverage products

Food standards and food reformulation programmes, with mandatory limits or closely monitored voluntary targets, aim to improve the nutritional quality of processed food and drink products, which is in turn a mechanism to increase the availability of nutritious foods. Such measures also incentivize changes in the production of ingredients from agriculture for food processing, such as fats, oils and sugars. Although reformulation programmes promote products with a healthier nutrition profile so they can be well aligned with repurposing policy support, reformulated foods should not replace the consumption of fresh and home-prepared nutritious foods.

A comprehensive policy approach to promote reformulation includes regulatory action to eliminate transfatty acids (TFA); government-led reformulation programmes to progressively reduce saturated fats, free sugars, salt/sodium and energy covering all major categories of highly processed food and beverages; and, adoption of evidence-based nutrient profile models to inform policies that encourage reformulation.²³⁷ Food product reformulation programmes are now in place in 82 countries.²³⁸ National or local policies to eliminate TFA have succeeded in reducing TFA intakes and have been followed by favourable changes in health outcomes.^{239,240,241,242,243} Countries that have been able to shift their production towards crops producing oils with higher levels of mono- or polyunsaturated fatty acids achieved more easily the transition to “healthier” oils than those that rely heavily on imports and have been driven to replace the supply of oils rich in TFA with products with a high content of saturated fat.^244,245 By 2021, mandatory TFA policies were in effect for 3.2 billion people in 57 countries.²⁴⁶

Similarly, well-designed reformulation targets can lead to reductions in sodium levels in food and population sodium intakes. Both voluntary or mandatory sodium reduction policies have shown to be effective in reducing salt levels in processed foods, depending on the products and the population.²⁴⁷ The cooperation of the food industry is vital to the success of such interventions.^247,248 In order to help realize the full potential of salt reduction, the WHO global sodium benchmarks provide guidance to countries and industries to reduce the sodium content in a wide range of processed food categories.²⁴⁹

Improving nutritional value through fortification and biofortification

Food fortification refers to the post-harvest addition of micronutrients to food, through a form of processing to increase the content of one or more essential micronutrients to improve the nutritional quality of the food supply and provide a public health benefit with minimal risk to health. Biofortification, on the other hand, adds those micronutrients through techniques of crop cross-breeding with varieties of higher concentration of desired micronutrient(s) or genetic modification.²⁵⁰ These are among the most cost-effective measures to help prevent micronutrient deficiencies,²⁵¹ as these can supply essential micronutrients to large segments of the population without requiring radical changes in food consumption patterns nor individual decision for compliance.^252,253,254

These are not aimed at replacing a balanced and diverse diet, but at preventing the long-term consequences and public health impacts of micronutrient deficiencies, while efforts to bring healthy diets within reach continue to move forward, as might be the case of policy support reform processes. Decisions on which micronutrients to add, to which foods and in what amounts should be based on evidence of micronutrient intake gaps, consumption patterns, feasibility of the selected food vehicle to be fortified, and, if available, biochemical indicators of micronutrient status of the population.^{252,253,254,255} To achieve policy coherence, these decisions also need to consider the foods promoted by the repurposing policy support, as well as the resulting potential changes in consumption patterns. In addition to the micronutrient deficiencies, fortification and biofortification policies need to consider an alignment with policies for the reduction of diet-related NCDs, e.g. salt iodization.^256,257

Enacting legislation on marketing of food and beverages, and the implementation of nutrition labelling policies

Repurposing support efforts can also be supported by enacting legislation (or regulations, standards and/or other legal instruments) restricting marketing of food and beverages and implementing nutrition labelling policies, including interpretive front-of-pack nutrition labelling.^258,259,260 Policies to protect people from the harmful impacts of marketing of food and beverages,²⁶¹ particularly children from birth to 18 years of age, are designed to influence consumer behaviour and help to shift demand towards nutritious foods.^262,263,264 Implementation of policy action in this area is growing, with 52 countries having implemented restrictions on the marketing of food and non-alcoholic beverages to children²³⁸ and 144 countries having adopted legal measures on marketing of breastmilk substitutes.²⁶⁵

Nutrition labelling can also help increase demand for nutritious foods. For example, research shows that the use of nutrition labels is associated with choosing healthy diets,^{266,267,268,269,270} although many people still do not read nutrient declarations on the back of food packages – where such declarations exist – and understanding of such labels remains a challenge.^{266,267,271,272,273} Simplified nutrition information in a prominent place on the front of food packages (front-of-pack labelling) can guide consumers towards healthier food choices and can encourage food manufacturers and retailers to reformulate their products, being an important complement to the repurposing support efforts. For instance, a recent systematic review found that food labelling not only led to changes in consumers choices, but also to significant reductions of TFA and sodium content in processed foods.²⁶⁹ Forty-two countries are now implementing front-of-pack labelling initiatives.²³⁸

Taxation of energy-dense foods high in fats, sugars and/or salt

Taxation of energy-dense foods and foods high in fats, sugars and/or salt can complement repurposing support efforts towards subsidizing and stimulating the supply and consumption of nutritious foods. This type of taxation helps to curb the demand for such foods and, by influencing the relative affordability of healthier food options, helps shift demand towards nutritious foods.²⁷⁴ Twenty-six countries have now implemented taxes on foods typically high in fats, sugars and/or salt.²³⁸ There is clear evidence from countries that this type of taxation reduces purchases of these taxed foods.²⁷⁵ Individuals that prefer to continue paying high prices for such taxed foods become a source of revenues for the government that can be effectively reinvested in agrifood systems, or in health initiatives to help tackle the impact of unhealthy diets (which can also build public support for taxation measures).²⁷⁶

On the other hand, value-added tax (VAT) reductions for nutritious foods may lead to a reduction in their prices, but the transmission of this change will depend on factors such as market structure and the seasonality of fresh foods, etc. For example, in Latvia, a reduction of the VAT for several fruits and vegetables from the standard rate of 21 percent to 5 percent led to a considerable decrease of retail prices of these foods. However, the retail price reduction only corresponded to 88 percent of the reduction of the VAT, which means that not the entire tax reduction was passed on to consumers.²⁷⁷

Combining land-use policies with other complementing policies to address food deserts and swamps

Physical access to affordable nutritious foods, which any repurposing support strategy should aim to increase, can be undermined because of the absence or low density of food shops, markets or outlets – particularly fresh foods of short self-life or requiring refrigeration – within a practical travelling distance (referred to as food deserts)¹⁸⁴ or in the case of shops and outlets offering an overabundance of energy-dense foods high in fats, sugars and/or salt and few nutritious foods (food swamps).¹⁸⁴ Food deserts and food swamps are often found in LICs, underserved areas in HICs and are an increasing problem in LICs and MICs.¹⁸⁴

To overcome the challenges of food deserts or swamps, land-use policies – including zoning, regulations and taxation – become very important. National and local governments have, for example, applied zoning laws and planning regulations: i) to restrict food retail and food service outlets which mainly offer energy-dense foods high in fats, sugars or salt in certain areas; and ii) to introduce support and incentives for the sale of nutritious foods.^184,278 Similarly, regulatory authorities can use licensing processes to influence what types of food premises are permitted or what types of food that outlets are allowed to sell. Several authorities use these powers to avoid food swamps around schools by limiting, for example, hot food takeaway outlets close to school premises.^{278,279,280,281} Moreover, tax credits and exemptions can be used to incentivize retailers to sell more fresh produce and healthier drink options. The use of a combination of zoning laws and financial incentives has successfully increased the availability of affordable, fresh produce in some low-income neighbourhoods and boosted the purchase of fruits and vegetables.²⁸²

Implementing healthy public food procurement and service policies

One area of policy that has an untapped potential to support repurposing of food and agricultural policy support is the implementation of public food procurement and service policies.^ai By setting nutrition and sustainability criteria for meals or snacks and drinks sold or served in public settings, or bought with public funds, these policies can put nutritious foods on people’s plates in the places where they study, work, or live, while helping to shape eating habits and shift demand towards healthier diets that include sustainability considerations. They can also stimulate increased production of perishable, nutritious foods such as fruits, vegetables and dairy products, and help mitigate any unintended consequences of repurposing, particularly targeting those most vulnerable to these changes during the transition.

The scale of institutional demand and the structured nature of public sector purchasing processes can create large-scale, predictable demand for nutritious foods (both perishable foods and foods that are low in unhealthy fats, sugars and salt), thereby increasing the economic viability of producing such foods, reducing the risks and creating an accessible, guaranteed market. The financial scale of government buying – representing between 12 and 20 percent of countries’ GDP with a significant proportion of those funds being spent on food – shows the potential of this policy measure to influence wider agrifood systems.

The European cities of Copenhagen and Vienna, for example, found that implementation of procurement policies requiring a given percentage of food to be organic stimulated increased supply of organic fruits, vegetables and other products.^283,284,285 In a similar way, the introduction of nutrition or sustainability criteria that increase the plant-based portion of meals served in public settings could stimulate production of fruits, vegetables, legumes and nuts and other nutritious foods. Experience in other countries or cities has shown that public food procurement policies can prompt diversification by both farmers and food manufacturers.²⁸⁶

Healthy public procurement and service policies are most commonly implemented in schools (reported in 91 countries).²³⁸ There remains a great deal of scope to expand implementation into other sectors including nurseries, universities, hospitals, residential care facilities, prisons, military, government offices and food aid programmes. Only 16 countries have policies covering other settings, of which only four countries have policies covering all food procured by the government.²³⁸

In one example of procurement policies with a wider scope, in the Philippines, in 2021, the Quezon City Healthy Public Food Procurement Policy introduced mandatory nutrition standards for all food supplies in city-run hospitals, offices, departments and institutions. A programme to source nutritious foods and healthy ingredients from micro-, small- and medium-sized enterprises, supports the policy.²⁸⁷

Social protection system policies to mitigate possible trade-offs

As analysed in the previous section, the repurposing of food and agriculture policy support can lead, in some scenarios, to trade-offs that may negatively affect some population groups: it includes reduction of farm incomes and slower patterns in poverty reduction and economic recovery. In this regard, social protection policies can play a key role in facilitating the transition of population segments or stakeholders that may be negatively affected by the repurposing of policy support.

Counting on programmes formulated with a shock-responsive social protection^aj approach, taking advantage of their orientation towards identifying risks to livelihoods and scaling them up to effectively respond to risks,²⁸⁸ can be an effective way to mitigate potential negative effects of the repurposing of food and agriculture polices in countries where the extension of social insurance schemes have still not reached wide segments of the population. During the current COVID-19 pandemic, for example, several countries around the world have increased the value and duration of benefits of existing programmes (i.e. vertical expansion), as well as included new beneficiaries into their social protection schemes (i.e. horizontal expansion).^289,290 In Sierra Leone, for example, the unconditional cash transfer known as the Et Fet Po programme implemented a top-up benefit for households with people with disabilities and was expanded to add 65 000 new recipients/households, mostly coming from vulnerable rural areas^291,292 (see Box 16 for more examples).

In addition to expanding existing programmes, new social protection initiatives can be created to support households’ livelihoods in case of shocks, including from policy shifts. The PROCAMPO (and later Proagro) programme in Mexico, for example, was implemented after the liberalization of trade due the implementation of the North American Free Trade Agreement (NAFTA) in 1994, as a compensatory income transfer targeted to producers in front of the anticipated decrease in domestic prices of basic crop formerly protected by border prices.²⁹³ After 25 years of operation (it was replaced by a new initiative in 2019), the programme showed mixed results: it had positive effects in reducing poverty and inequality, but it also benefitted more the richest and largest producers rather than the poorest and smallest, as the transfer was mostly linked to the production area owned by beneficiaries.²⁹⁴

While countries are strengthening their national social protection systems (consisting in social insurance, social assistance and labour market interventions), the design of new programmes or the expansion of existing programmes with a shock-responsive approach might be an important part of the complementary interventions to address the possible trade-offs of the repurposing of food and agricultural policy support. Effective targeting and adequate benefits of these complementing interventions will be key for reducing the impact of possible negative income effects due to policy reform.²⁹⁵

Environmental and climate-related policies and incentives

Promoting affordable healthy diets and pursuing environmental and climate goals can offer important synergies with the repurposing of food and agricultural support. For example, supporting adaptation and mitigation can help enhance the production of a variety of nutritious foods that constitute healthy diets while also improving the livelihoods of farmers and employees operating along the value chains (Box 17). Additionally, the production of fruits and vegetables can contribute to increasing biodiversity and supporting environmental sustainability.³⁰⁰ Investments promoting and marketing neglected and underutilized species could ensure meeting dietary requirements of the population, particularly in LICs, while diversifying production and supporting biodiversity.³⁰¹

Similarly, seeking to limit reliance on chemical fertilizers by promoting intercropping or rotations with legumes not only contributes to soil health but also promotes production of safe nutritious foods by limiting chemical contamination and increasing availability of pulses. Preliminary evidence suggests that forms of regenerative agriculture, which improve environmental sustainability, might increase the nutritional content of produce.³⁰²

Because of these synergies, environmental and climate policies can provide incentives for the production of nutritious foods that contribute to healthy diets. Yet, trade-offs are pervasive and can contribute to significantly undermining the affordability of healthy diets. A clear example is provided by policies that aim to address the environmental externalities of unhealthy diets (for instance, transportation, packaging, and emissions of volatile organic compounds required to produce and market highly processed food items) – as those externalities are staggering.³ Internalizing those costs through pricing (e.g. carbon taxes, or cap and trade systems) could contribute to significantly altering the relative prices of nutritious foods and foods of high energy density and minimal nutritional value, but this is not easy to implement in practice and might require global agreements.

Health system policies to complement repurposing

Food and health systems are intrinsically interconnected in multiple ways.³¹⁰ Effective health systems are vital to provide needed care including essential nutrition actions for the treatment and prevention of different forms of malnutrition and diet-related NCDs.³¹¹ This will continue to be the case until agrifood systems are able to sustainably deliver affordable healthy diets. Furthermore, accessible health services are essential to face the potential trade-offs with regard to income loss or reduction that can reduce utilization of basic social services, including health services, by the poor. Therefore, any strategy to repurpose support to food and agriculture to deliver affordable healthy diets will have to look at the health system as well.

Health services that protect poor and vulnerable groups whose diets do not provide all the nutrients they need are particularly relevant in the context of repurposing support efforts. Examples include mother and child nutritional services and the provision of vitamin or mineral supplements in settings where micronutrient deficiencies are prevalent.³¹¹ Moreover, health promotion and education activities of health professionals, who are particularly trusted sources of advice for promoting dietary behaviour change, potentially increase demand for affordable healthy diets.

The health system has a critical role in protecting and promoting the health of the food and agricultural workforce. Agriculture employs 27 percent of the world’s labour force³¹² and workers along the entire food chain can be exposed to different hazards in their workplace. For example, an estimated 385 million agricultural workers are affected every year by unintentional acute pesticide poisoning.³¹³ Hazards can affect the physical and mental health of workers, and adequate health and safety standards are, therefore, essential.³¹⁰

Important threats that cross the health and agrifood system nexus include zoonoses, antimicrobial resistance (AMR) and food-borne hazards. Healthier diets – such as those any repurposing support strategy should promote – often constitute fresh, more perishable foods,³⁰ which are more susceptible to contamination and spoilage during production, transportation and storage. Policies and systems must ensure that these foods are safe to eat according to their intended use. Food-borne diseases have significant economic consequences for those affected and for the health care system. Efforts by just one sector cannot, therefore, fully address these issues, and complementary actions within the health sector are required.

A One Health approach helps multiple sectors (including agrifood, environment and health systems) communicate and work together to achieve better outcomes for human, ecosystem and animal health.³¹⁴ The COVID-19 pandemic underlined the links between health and agrifood systems, and the relevance of the One Health approach. The Africa One Health University Network (AFROHUN), for example, provided a platform for learning and exchange among stakeholders in diverse fields including public health, veterinary medicine, pathobiology and environmental health in eight African countries (Cameroon, Democratic Republic of the Congo, Ethiopia, Kenya, Rwanda, Senegal, Uganda and the United Republic of Tanzania).³¹⁵

To address food safety concerns, FAO and WHO established the Codex Alimentarius,³¹⁶ an international food safety code that includes guidelines, standards and regulations established to protect the health of the consumers and to ensure fair practices in the food trade for potential food safety hazards. For example, for aquatic food the Codex sets specific regulations on food hygiene, sampling and analysis, inspection, certification and labelling; however, for example for aquatic food, the Codex tends to be applied, for the most part, for international trade and rarely used in domestic marketing, creating different standards for food safety at local and international levels.⁷⁵ To fully support the repurposing agenda, governments will need to harmonize national legislations with these same standards for all levels, including at local levels.^ak

Finally, robust health, food and nutrition monitoring and surveillance systems are needed to be able to track the impact, both positive and negative, of repurposed food and agricultural policies.

Other system policies and incentives: transportation and energy

In the 2020 edition of this report, inefficiencies along the food value chain were identified as drivers of the cost of nutritious foods.³ The efficiency of food transportation is an important area that governments should consider during the repurposing of food and agricultural support. Targeted policies and incentives to the transportation sector^al will be important for reducing the costs of nutritious foods. Even if food and agricultural policies are repurposed, if the inefficiencies and problems in transportation^am are not adequately addressed, repurposing support efforts could be undermined and may not be effective in reducing the cost of healthy diets.

Many governments that implemented lockdowns all over the world in the face of the COVID-19 pandemic considered the food and agriculture sector as “essential” so as to be exempt from those kinds of restrictions. This allowed food value chains to continue working and supplying food even in the hardest periods of lockdowns. However, the lack of transportation was one of the most serious threats to maintaining the food supply active in several countries.³¹⁷ For example, in Nigeria, harbours continued their operations, while internal transportation by traders and truckers faced limitations that affected the regular supply of food or agricultural inputs. To facilitate food transportation, governments should not only invest in infrastructure but also support the development of transportation and logistics services for domestic traders, which are in most cases SMEs, and are crucial for the functioning of the food supply chain, though they are not often recognized as part of it.³¹⁸

It is also important to consider the linkages with energy systems. Agrifood systems are becoming more energy intensive, and this has implications for food prices, as well as for the environment. On the one hand, several studies have highlighted the relationship between energy and food prices,³¹⁹ and the recent hikes in food prices have been pushed also by increases in energy prices.³²⁰ On the other hand, it has been estimated that almost a third of the emissions of the global agrifood system comes from energy-related activities.³²¹ Moreover, about one-third of the world population relied on traditional fuels such as wood, charcoal and agricultural residues for household cooking in 2019, with a demand that in some areas exceeded the sustainable capacity of forests and trees.³²² The environmental outcomes of more sustainably boosting economic activity in agrifood systems through better use of policy support can be enhanced with policies that support more efficient use of energy in agrifood systems.

To this end, investments in renewable energy sources at the farm level or the introduction of freight truck fuel economy standards at the transportation stage can be very coherent.³²³ In addition, the lack of cold chains is a key determinant of food losses of perishable foods, such as fruits and vegetables, and its availability in LICs and LMICs is much lower than in HICs,³²⁴ making more challenging the improvement of the cold chains situation with environmental considerations in LICs and LMICs. As cold chains are energy intensive, reducing their carbon footprint is a main topic of research, and improvements in technology as well as in operation and management of cold chains can play a key role in increasing the availability of cold chains logistics in LICs and LMICs while also taking into account the environment.³²⁵ Taking advantage of the potential efficiencies in sustainable energy use of local agrifood systems, considering the restoration of degraded forests and the establishment of fast-growing tree plantations, improving the use of residues from wood harvesting and processing, and the recovery of post-consumer wood through its cascading use within a more circular economic framework³²⁶ should also be considered as part of a policy portfolio complementing the food and agriculture policy reform.