Hard to swallow

30th May 2019

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Paul Tucker

The global food system is damaging the planet and our health, the Wellcome Trust's Modi Mwatsama tells Huw Morris. Only a wide-ranging food revolution – encompassing production, policy, marketing and diet – will change that

There are times when Modi Mwatsama ponders the intricate links between food systems, public health and climate change and wonders where to start.

Every country is wrestling with the monumental health and environmental consequences of people's diets. Around 820 million people across the globe do not have enough food. Many more eat badly, and consequently suffer from conditions such as diabetes, heart disease and obesity. On the other side of the coin, global food production puts enormous pressure on the planet's resources, swallowing up 40% of the world's land and 70% of its freshwater.

The way we eat is hurting the planet and ourselves. Mwatsama grapples with this challenge in her role as senior science lead in food systems, nutrition and health at the Wellcome Trust's 'Our Planet, Our Health' programme. The programme focuses on a panoply of issues affecting planetary health: how to make the earth a healthy home for humanity; what we eat; how we produce it; how we design cities to promote healthy lifestyles; how we shift societies to more sustainable energy sources.

Policymakers do not have the resources to gather evidence and analyse it. Our Planet, Our Health aims to plug that gap. Like many in her field, Mwatsama has learned to take a deep breath.

The scale of the problem

“We are seeing salt reduction, traffic light labelling and sugar taxes starting to work“

“If you stop and look at the big picture you can think: 'where do you start?'“ Mwatsama says. “But it's the nature of complex systems, and all governments have these challenges. This is just one of many they have to solve.

“The easiest way is to start off with the one bit of the picture where the evidence really shows a measurable impact. We are seeing salt reduction, traffic light labelling and sugar taxes starting to work. When you break it down into chunks you can start to make a difference.“

The three big threats to public health, according to Mwatsama, are mental health, drug-resistant infections and climate change. The health risks of poor diet sit in the background of this unholy trinity, outweighing the combined damage from alcohol, smoking, unsafe sex and drug abuse. Meanwhile, food systems contribute around 30% of global greenhouse gas emissions. Two thirds of these emissions are due to the production of animal-based foods and animal feed. With the global population set to reach 10bn by 2050, we need to start eating healthily and sustainably.

Mwatsama points to landmark figures revealed by the Institute of Health Metrics' Global Burden of Disease, published in The Lancet. Around 70% of the burden of global disease is down to non-communicable diseases such as heart disease, diabetes, obesity and cancer, all of which are related to diet. Globally, one billion people are under-nourished, another two billion suffer from a micronutrient deficiencies, and two billion are overweight or obese.

“Until the Global Burden of Disease project, nobody really attempted to add up the combinations of different risk factors or find out what proportion are diet-related,“ she says. “We have started to appreciate the scale of the problem, although that's not to say other risks are not important. But huge numbers of the world's population are affected by poor diet.“

The big food fight

The global food system stacks the odds against health and the environment

  • The Eatwell Guide recommends that people should reduce their meat intake from 62g a day to 15g a day
  • 70% of the burden of global disease is down to non-communicable diseases such as heart disease, diabetes, obesity and cancer
  • 1.2% - Just 1.2% of food marketing spending goes on fruit and vegetables
  • 30% - Food systems contribute around 30% of global greenhouse gas emissions; two-thirds of these emissions are due to the production of animal-based food and animal feed
  • 820m people across the globe do not have enough food

Plant-based for the planet

So what is the answer? One place to start is meat. In the UK, under the Eatwell Guide, the recommendation is that the typical person should reduce their meat intake from around 62g a day to around 15g a day. “That's a significant reduction of around 75% just to meet health recommendations,“ says Mwatsama.

Eating more plant-based food – fruit, vegetables, pulses, nuts – is as good for the environment as it is for health. “They have a lower impact on the environment and they're good for health as they increase fibre intake,“ Mwatsama says. “At least 70% of the UK population is not meeting their target for eating fruit and vegetables. Pulses are much better for the environment than meat and they are a very good source of protein and iron, so they make a good substitute.“

Our Planet, Our Health is also funding research into how much people need to cut their meat intake to reduce impact on water and land. “That's a win-win benefit that people weren't talking about a few years ago and are only starting to recognise. Now we need to think about how to make it happen.“

Agricultural subsidies are a big obstacle. The Common Agriculture Policy accounts for 40% of the European Budget, with the vast majority of its subsidies supporting animal feed or production – and this is a trend repeated around the world. “The impacts of the food system on the environment are phenomenal,“ says Mwatsama. “You need to look at what the drivers within the food system are; there are challenges all the way. Very few subsidies go to plant-based food, pulses, fruit, vegetables or nuts.“

Mwatsama points to guidelines set by the EAT-Lancet Commission on healthy diets from sustainable food systems. “What we need now is for governments to translate global scientific targets into national targets for each country based on what they eat and currently produce, then use those as a guide to inform policy. Most subsidies have not been set with health or environmental considerations in mind.“

Set up to fail

“It's hard to do the right thing when the whole system is structured for you to do the exact opposite“

However, there are other factors driving food systems. Unhealthy food is cheaper for the consumer, but makes huge profits. Mwatsama points out that, per kilo, crisps are about 12 times more profitable than raw potatoes. Huge amounts of food are also wasted; estimates put this loss at between 30-50% from production through to consumption. Around a third of food in the UK is wasted, with 60% of that lost at farms. Procurement standards set by supermarkets are another obstacle, and many consumers do not understand use-by dates on food labels.

“Multi-buy offers on fresh food are not a good idea,“ she adds. “It's good to have discounts to make it more affordable, but promotions make people buy more when they are not going to eat that extra bag of salad before it goes off.“

Other drivers are subliminal. The food industry's marketing culture “not only causes people to eat the wrong things, but makes them eat more – and the more people are exposed to marketing, the more they are likely to eat the food they see,“ Mwatsama says, adding that just 1.2% of food marketing spending goes on fruit and vegetables.

“There is an element of choice driving people's individual behaviour, but at the same time it's very hard to do the right thing when the whole system is structured for you to do the exact opposite.“

This helps to explain why the public is largely unaware of the issues. Until recently, many professionals did not join the dots, either.

“Experts in climate change and sustainable food systems are aware of this, but I don't think there is a general awareness among the wider public or policymakers and governments. Perhaps some private sector actors think about the risk to their businesses. But the figures are not well known and we need to address that.

“Some of these problems have been tackled in silos. Those who work on environmental issues will probably be up to speed on the challenges to freshwater and greenhouse gas emissions, but until recently they have not reached out to those working in the food and nutrition space to say: 'have you considered environmental impacts?'

“My career in public health nutrition has focused on tackling the biggest diseases related to unhealthy diet, but it's not until the past four to five years that I started to think about the environmental impact. As climate change has risen in prominence, we are realising that, if you look at health consequences in isolation, you are going to end up with a new set of problems with the environment.“

Changing tastes

Modi Mwatsama was director of policy and global health at the UK Health Forum between 2009 and 2018, and joined the Wellcome Trust last year. She was previously a senior researcher at the Global Research Network on Urban Health Equity at University College London, and a manager at Heart of Mersey, England's largest cardiovascular disease prevention programme. Before that, she was a policy officer at the National Heart Forum.

Mwatsama has served on several national advisory committees, including Public Health England groups on dietary guidelines, sugar and global health.

She has a degree in human nutrition from London South Bank University and a masters in public health nutrition from the London School of Hygiene and Tropical Medicine. She also gained a doctorate in public health from the latter institution, and is an honorary assistant professor there.

Huw Morris is a freelance journalist.

Image credit: Akin Falope


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