List of proposed policies for governments
Using a participatory and transdisciplinary approach involving international experts to identify the effects, effectiveness, and potential dynamics that lead to synergies and trade-offs across outcome areas, we propose a list of 44 policies for governments to create healthy diets from SFS: 27 for food supply chains and 17 for food environments. The complete list is available in Table 3. In this list, there is no hierarchy to how the proposed policies are presented, as they are classified according to the prior defined domains and subdomains (Table 1).
TABLE 3 NEAR HERE
The wording, (dis)aggregation level, classification, and number of policies changed across the process, based on the inputs and outputs of each step of the process (Figure 1).
The subdomain with more policies was ‘food production’, with 16 proposed policies. The subdomains of ‘food storage, processing, packaging and distribution’, ‘food trade and investment agreements’ and ‘food labelling’ included 4 proposed policies each, followed by ‘food loss and waste’, ‘food promotion’, ‘food provision’ and ‘food prices’ with 3 policies each. Two subdomains (‘food composition’ and ‘food retail’) included 2 policies each.
Perceived double- and triple-duty potential, synergies and trade-offs
The results from the initial survey showed that 61% of the proposed policies (n=28) were considered by respondents to have double- or triple-duty potential. However, after applying the modifications suggested by the experts during the survey analyses and the regional workshops, the final list included 91% of proposed policies (n=40) with perceived double- or triple-duty potential (Table 3). A total of 24 policies were perceived to have double-duty potential (one for ‘undernutrition’ and ‘obesity/NCDs’, four for ‘undernutrition’ and ‘environmental sustainability’, and 19 for ‘obesity/NCDs’ and ‘environmental sustainability’). A total of 16 policies were perceived to have triple-duty potential.
One synergy and four trade-offs were identified during the scoping review (Burgaz et al., 2023). Nevertheless, a wider range of synergies and trade-offs was identified during the regional workshops, overall resulting in four potential synergies and thirty-two trade-offs identified. According to the experts, five trade-offs (out of the 32) could be minimised or avoided in some contexts by adding specific requirements in the proposed policies. The five changes proposed by experts are underlined in Table 3. The outcome area with more trade-offs identified was ‘undernutrition’ (n=14), mostly related to lower yields or the potential increase in prices of final products as a consequence of the policy. Eleven trade-offs were identified for ‘environmental sustainability’, mainly regarding the increase of greenhouse gas emissions (GHGEs) from transport, packaging, or food waste. A total of 9 trade-offs were identified for ‘obesity and NCDs’, mainly regarding the fact that some of the policies (e.g. on waste, reformulation or labelling) would only be implemented in foods with packaging, nutrition facts or expiration dates, which tend to be unhealthier/processed and not for fresh, natural products. Some of the detected trade-offs applied to more than one outcome area. All the identified (scientific and perceived) double- or triple-duty potential, synergies and trade-offs are also available in Table 3.
In addition, three proposed policies were removed as experts considered they were only beneficial for one outcome, with low effectiveness levels and potentially negative for other proposed outcomes. These policies were: (1) reduction of plastics in food packaging (perceived to have a low impact on environmental sustainability but potential negative effects for undernutrition), (2) regulations from governments to reduce water use in farming (perceived to have an impact on environmental sustainability but potential negative effects for undernutrition) and (3) awareness campaigns for food waste reduction (perceived to have a low impact on environmental sustainability and no effects in the other outcome areas). The full results on the perceived effects and effectiveness of the 46 initially proposed policies can be found in Annex 3.
Implementation considerations
During the workshops, experts stressed that the relevance of some proposed policies may be context-specific, such as in the case of: (1) the need to include water or implement water fountains as part of school food and nutrition programmes; (2) the need to reduce meat consumption (which was considered to be less applicable in contexts where current consumption is very low, with high rates of undernutrition, food insecurity and micronutrient deficiencies); (3) the use of labels (among countries that have implemented warning labels, countries with healthy score labels, and countries without any label and voluntary ingredient list agreements); (4) strategies related to food loss (experts in Europe did not consider policies in this area a priority as the rates in food losses during harvest and transport are often very low); (5) strategies related to food waste at retail and consumer level (some experts argued that in certain LMIC in regions the generation of food waste is very low and the majority of the groceries are bought in local markets that prioritise fresh, unprocessed foods). Hence, experts reasoned that some policies would apply best to contexts where the specific challenges associated are high.
The following key topics were raised several times during the discussions in the workshops: (1) the need to change the wording from ‘healthy and sustainable [crops/foods/diets]’ to ‘healthier, more sustainable [crops/foods/diets]’ to ensure a flexible, context-specific meaning; (2) the difficulty (due to the lack of scientific and empirical evidence) to understand the effects of some proposed policies that have never been implemented, particularly with regards to different contexts, settings and populations; (3) the urgency to address the gap in literature regarding women’s empowerment, and to understand which are the effective policies and the barriers to policy development; (4) the crucial role that proper design, implementation, monitoring and evaluation play in ensuring that the effect and effectiveness of the proposed policies is attained; (5) the need to differentiate according to national, regional or local jurisdictions when assessing the effects, effectiveness and potential synergies or trade-offs; and (6) the difficulty of determining which synergies or trade-offs may arise from each of the proposed policies, without being able to apply them in a specific context (as they may vary due to social, economic and environmental factors).
Some experts also suggested keeping the gender perspective as a cross-cutting topic across policies, as to ensure women’s social protection and recognition in all aspects related to the food system. In this vein, another suggestion was to adapt the proposed policies to make them gender-neutral (for instance, by including terms such as “farmers” or “fishers” instead of adding a disclaimer at the end of the policy such as “including women and vulnerable groups”), as a mechanism to avoid the misconception of having to include women as if they were a minority group. Additional concerns raised referred to ensuring that consumers could prioritise healthy, environmentally sustainable and fresh products, as some interventions in the subdomains of food composition, labelling or waste are only applicable to processed foods. From these discussions, we identified additional potential trade-offs that to the best of our knowledge have not yet been reported by the literature. For instance, with regard to food reformulation, experts were concerned about the impact that such policies would have on prices and their subsequent effect on vulnerable groups.
As the initial purpose was to have only policies with double- or triple-duty potential, a common suggestion made by experts was to keep some proposed policies that only impact one outcome area, but that were very effective and valuable for the sustainability of food systems. Such four “important single-duty actions”, all part of the ‘food production’ subdomain, were kept in the final list: (1) sustainable carbon sequestration practices; (2) sustainable fisheries; (3) optimisation of water resources management; and (4) climate change impact preparedness. Also within the subdomain of food production, there were some common concerns regarding agriculture/food production. First off, experts expressed the need to differentiate between support or subsidies provided to farmers/businesses producing healthy and sustainable foods for human consumption, versus those producing healthy and sustainable foods for animal feed (i.e. corn, soya, oats). Secondly, experts from low- and middle-income countries (LMICs) highlighted the importance of including livestock production with agroecological principles for countries where mixed farming, small-scale production, and rural/family farms are largely dominant, as there the sector remains critical to food and nutrition security. A third topic raised by experts was that the majority of support from the government in neo-liberalist economies tends to go to big companies, while there should be a switch towards supporting smallholder farmers, start-ups, and small and medium-sized enterprises (SMEs).
The complete feedback received from the workshops, the reasons for exclusion/inclusion, and the information analysed which led to final list of proposed policies is available in Annex 4.
Prioritisation of proposed policies
Table 4 provides an overview of the results from the ranking, including the codes and titles from the 27 proposed policies for food supply chains, and the 17 for food environments.
A total of 21 Food-SAT and INFORMAS2.0 experts participated in the final meeting to discuss the final list of proposed policies. Ten experts completed the survey, resulting in 13 complete rankings: one for undernutrition, four for obesity/NCDs, six for environmental sustainability, and two for health inequalities. No rankings were completed for women’s empowerment. Therefore, the extent to which experts agreed on the level of priority of the proposed policies could only be calculated for the outcome areas of ‘obesity/NCDs’ and ‘environmental sustainability’. Using the Gwet AC2 coefficient, the agreement among experts for ‘obesity/NCDs’ was moderate for the food supply chains policies (0.56), and fair for food environments policies (0.38). The agreement among experts for ‘environmental sustainability’ was moderate for food supply chains (0.58) and for food environments (0.58). The complete analyses for the ranking and the experts’ agreements are available in Annex 5.
TABLE 4 NEAR HERE
From the top-five ranked food supply chains policies, two were perceived to have triple-duty potential: (a) incentives for crop, fish and livestock diversification, and (b) support for start-ups and small- and medium-sized enterprises producing healthier and more sustainable foods. The other three top-ranked policies had perceived double-duty potential (two for obesity/NCDs and environmental sustainability, and one for undernutrition and environmental sustainability). For food environments, three of the top-five had perceived triple-duty potential: (a) affordability of healthier and more sustainable diets, (b) subsidies for healthier and more sustainable foods, and (c) marketing restrictions of less healthy and less sustainable foods to children across all media. The other two top-ranked policies had perceived double-duty potential (both of them for obesity/NCDs and environmental sustainability).