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Poor countries tend to be unhealthy and unhealthy countries tend to be poor.

(Bleakley, H., 2010)

The Role and Reach of Government Policy in Nutrition Security

June 2012

Note: availability and access to safe and nutritious food are not automatic to the poor, socially excluded and marginalised groups health care costs generally, and especially to treat lifestyle diseases, are high and rising; government can directly and indirectly influence the kinds of consumption choices or food utilization decisions towards good health.

Understanding the Concepts

Nutrition: - the process of providing or obtaining the food necessary for health and growth; - the provision to cells and organisms, of the materials necessary (in the form of food) to support life. Government policy: - a principle or rule to guide decisions and achieve rational outcomes; - a term used to describe any course of action which intends to change a certain situation. Also known as public policy Nutritional guidelines: - a set of recommendations on the proportional intake of each food group necessary for proper nutrition and health.

Nutrition is not necessarily just food; and food is not the only source of nutrition. An imbalanced diet in relation to daily caloric requirements can lead to under nutrition or over nutrition, both of which have adverse health and socioeconomic consequences. There is a growing consensus on the need to focus on nutrition as opposed to just food calorie-protein intake for good health.

Contents:

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Understanding the Concepts. Why should Government intervene in nutrition security? How Can Governments Influence Nutrition Security? Policy Intervention Critical Control Points. Bottom line! Recommended reading Healthy organic vegetables grown in Suriname with support from NGO, The Caribbean Institutes project working with small farmers to revitalise horticulture production. (Photo: Maureen Silos) Jamaican produce on sale in the Barbados market through a US mass marketing chain! As food prices rise, intraregional trade will become critical to food security (Photo: Brent Theophille).

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Nutrition security is enabled and assured within an environment that encourages and motivates society to make food choices consistent with short- and long-term good health. Nutrition policies and regulations must have an effect on the cost of producing healthy commodities; on how those costs relate to final retail prices; on how responsive consumers are to price changes and on how the policy directly influences the consumers preference for the healthy product (Ralston, 1999).

Why Should Governments Intervene in Nutrition Security? Shift to diets high in fats, salt and refined carbohydrates, and low in fruits, vegetables, legumes, provisions and nuts have been linked to drastic increases in incidences of chronic non-communicable diseases (CNCDs).
The simple answer: prevention is better than the cure. It is also the more cost-effective option in the long-run. There is enough evidence that health care costs are astronomical, rising and out of reach of the majority of a countrys citizens. Who bears the fall out? The government and ultimately, the tax payers as more and more of a countrys tax revenues are diverted into health care. It is therefore in Governments interest to nurture a healthy population. Although consumption choices are the ultimate responsibility of an individual/household, there are a number of situations and circumstances that may limit, disrupt or even prevent them from exercising their right to make a healthy choice. Because economic activities and growth depend, in part, on a productive labour force, government are required to intervene to ensure that the citizens have access to food, and especially foods that are essential to good health. A business as usual approach would significantly compromise human capital formation in both the short and long run and for resource-scare SIDs, including those of the Caribbean, and severely undermine development.

The CARICOM Regional Food and Nutrition Security Policy (RFNSP, 2010) recognises the
regions vulnerabilities to policy shifts and economic and financial shocks in leading world economies. The 2008 to 2010 financial crisis had immediate and deep impacts on food prices in the Caribbean, threatening several vulnerable groups with food insecurity. Building resilience for food and nutrition security (FNS) requires urgent and concerted attention to food system policy and critically, nutrition policy. This challenges governments to unambiguously determine where, how and to what extent they can make meaningful interventions. Recognising the need for interventions primarily in consumer behavioural change, communication and in sharing best practices across sectors linked to FNS, the CARICOM Council on Human and Social Development (COHSOD) is an important partner in implementing the RFNSP. COHSOD is supporting the design of food service operations in schools and has agreed to focal points/teams from within the education sectors to support RFNSP implementation.

Bodi, ochro and pumpkin on sale at a vendors stall on Charlotte Street, Port-of-Spain, Trinidad
Source: Central Bank: Floods may have affected rising food prices, Published: January 8, 2012 Shaliza Hassanali, http://guardian.co.tt

How Can Governments Influence Nutrition Security? According to Ralston (1999), whether or not they are directed specifically at the food sector, regulations can affect the: (1) varieties and qualities of foods available for purchase, (2) prices consumers face, (3) information consumers receive about a product, and (4) consumer confidence in the food supply.
Practitioners and policy makers have become more convinced of the need to focus on nutrition as opposed to just food calorie/protein intake in addressing the ongoing challenge of food and nutrition security (FNS). Policies and regulations can directly or indirectly affect both the supply and demand side of the food system. The primary objective of government policy should be to encourage positive changes in diets and lifestyles. This can be done through regulating and modifying the food system, making healthy foods more acceptable (i.e. whether through affordability or any other set of critical societal factors), and educating individuals and communities to make healthy lifestyle choices. Effective interventions must have focus as to exactly who will be impacted and how. The recommendation is to focus on strategies that address the specific aspects of the susceptibilities (e.g. access to foodproduction (i.e. resources, and purchasing nursing power, nutrition deficiency and in the commonly utilized foods, etc.) of the most vulnerable nutrition groups pregnant mothers, young children elderly/infirmed).

Policy Intervention Critical Control Points (PICCP): building blocks.

Using the 4 main areas suggested by Ralston (see pg.3) one can construct a framework for policy interventions to influence dietary choices in favour of nutrition. The Supply side:
Influencing the cost of producing healthy commodities

Food Production: Government will need to:- provide incentives for production of preferred healthier commodities to help moderate production costs, promote GAP and mitigate risks; - articulate a clear policy on GMOs, food additives and other elements that influence the nutritional and safety status of foods and hence human health; - encourage and support food and beverage manufacturers who produce healthy; processed food options;

The assumption that this relates to local/regional food production, is implicit. One could ask: what and who determines which commodities are healthy? Based on the nutrients required for healthy life, nutritionists are able to identify and recommend a range of food options (plant and animal based) to suit particular health profiles, i.e., nutritional guidelines! If good agricultural practices (GAP) are in place, then food crops and livestock are farmed this way. i.e., in a manner than maintains their inherent nutrient values. Healthy foods start with good practices. However, in contemporary agriculture, use of genetically modified organisms (GMOs) is standard for the major food crops (e.g., corn, wheat, white potato, soy bean) and livestock (e.g., dairy, poultry). This has raised concerns over possible adverse consequences on human health from consumption of GM foods. In fact there has been an ongoing debate in the US on biotechnology food policy, and the state of California is getting ready to vote on the issue of labelling of GM foods, which if approved by voters would become the first of its kind in the nation. Of course, the giant food companies are fighting vigorously against its success. Relying on the market is neither sufficient nor a desirable option. Government must intervene to ensure that food produced in the farm maintains its inherent nutritional value and is safe and that the associated production costs are not prohibitive or exclusive to a small portion of the population. There is a direct link between continuous consumption of highly refined and processed foods and beverages and chronic lifestyle diseases, such as obesity. The nutritional labels generally indicate that the majority of these consumables are empty calories, laden with artificial ingredients and additives that have zero or questionably nutritional value. Extra-regional imports dominate the content of processed foods, whether as ingredients or final product. This is explained as a lack of competitiveness of local raw materials, in terms of consistent supplies of low priced and standardised quality farm produce for processing. Since Caribbean consumers have exhibited a preference for processed foods, Government must also intervene to ensure that the health factor in the transformation chain from fresh to chilled-packs to processed is maintained. Such interventions should aim at facilitating and enabling production of healthy options of processed foods at comparable prices.

Associated Policy Issues:

- Farming Systems Research such as raising productivity levels for nutrient dense commodities and production input research; - Food processing and product development technologies to optimise use of local nutrient-dense food varieties. - Bio-safety and Food safety regulations that enhance the health factor and reduce production costs; Governments should make more effective use of Green Box measures for efficient and sustainable production of healthier foods.

Influencing the costs of final retail prices of healthy commodities It is understood that this must consider both local/regionally produced and imported food commodities.

Food Pricing: Government will need to: - build capacity in the food system for efficient handling, storage and distribution of food that retains quality and safety and moderates transactions costs; - institute a special FNS incentives regime for a basket of preferred healthy commodities that facilitates their efficient postharvest preparations, distribution and retailing (especially with regards to the imported elements) at affordable prices; - enhance efficiency of food safety regulations (inspections, approval of food additives, etc) so as not to unduly increase the prices of healthier foods; - arrive at a consensus-based industry marketing-advertising codes that do not unduly promote unhealthy foods over the healthier commodities; - integrate access to healthy food commodities as a special aspect of safety net programmes for the vulnerable. Since there is a limit to how far Government can intervene in pricing, the need for Government to work with private retailers is key to influencing retail prices. Its primary strategy should be to partner with private sector with the goal of enhancing availability and affordability of a specified FNS basket of healthier commodities.

Who and what determines the final retail prices of food? That depends on the number, operational efficiencies and influence of the players along the chain from its production to retailing. Government, though policy, is a major player. From observation, generally, price should not always be the standard yardstick for measuring the health attributes of a food commodity. However, with the growth of the organic movement, organic foods, marketed as healthier, usually come with a higher retail price tag, and out of the pocket of the average consumer. To make meaningful interventions through food pricing, government will need to be guided by nutritional guidelines which provide indications of the relative weighting among foods. Once a basket of preferred healthy commodity options is identified, then the extent of influence and hence mechanisms that governments can use will differ, depending on whether such commodities: are produced locally or imported; are offered in their fresh form or processed; appeal to and attract the aspirational buyers, i.e., branded foods. Generally, the most effective means of interventions are through taxes, which have an instant and direct price impact. Another indirect means is through incentives along the farm to market chain, which impact on production and transactions costs, and could lead to lower retail prices. However, there are some elements of pricing that may not be as easily influenced by government policy, such as, branding and advertising, which strongly influence consumer perceptions and purchasing decisions beyond just affordability issues. For fresh commodities, taxation may not be the most effective option since in most CARICOM states, fresh farm produce, especially locally grown and regional imports are generally exempt from consumption and other taxes. However, if the preferred basket of healthy commodities contains fresh fruit, vegetables and other produce from extra-regional sources, then there is scope to use tax policy and other concessions to influence retail prices. For the healthier processed foods, a similar consideration will need to be made in terms of government actions that impact both production and transactions cost and/or institute some measure of price controls that are not in violation of international trade rules. Another direct option that does not depend on influencing price, but enhances purchasing power, is through an appropriate mix of food procurement and safety net measures that enhance access for vulnerable groups and influence demand.

The Demand side: Influencing how responsive consumers are to price changes; Influencing consumers preference for the healthy product; Can Government influence the food choices of an individual or household? The answer is not a straightforward yes or no. There are actions that can be taken by Government to promote greater utilisation of a number of commodities that are deemed important to a healthy diet. But in the final analysis, the purchasing decisions and methods of utilising and consuming food, rest with the customer. A number of factors influence consumer preferences, including: level of health consciousness and health status religious beliefs incomes and purchasing capacity relative prices capacity to substitute perceptions of safety and quality convenience marketing and advertising proximity and placement on supermarket shelves and a host of other factors that are not as obvious or not easily be measured. This makes Governments ability to influence purchasing decisions and consumption habits very complex, especially when working in an environment where retailers are not generally interested in, or supportive of a national policy for healthy eating. Government will need to act on the basis of an understanding that a 'onetype-plate does not fit-all-palates(1). This requires that interventions aimed at influencing demand, need to be target-specific, such as, pregnant or breastfeeding mothers, to the diabetic and others inflicted with CNCDs, to the sporting community, etc. Such interventions need to be informed by analysis of the different population segments based on well defined criteria (to include age/stage of growth, religious beliefs, health profile, extent of physical activity, etc.,) and the food options that are best suited for nutrition and good health. Government will also need to exercise its power of influence through its food procurement programmes, mandating that the food it purchases, provides or makes available is in keeping with the nutritional guidelines standards established by its authorities. Through programmes already in existence (e.g. meal programmes in schools and hospitals), Governments have an avenue to directly influence the purchase and use of healthy and nutritious foods. Similar programmes aimed at other state institutions and then transferred to the private sector could further amplify the benefit to society.

Influencing Demand: Government will need to:

- provide and make accessible credible nutrition information and food needs guidelines that match various health and preference profiles in order to help to inform consumers choices by using:
Food Information Regulation

that provides guidelines for labelling requirements, advertising restrictions, and standards of identity and product grades, etc. upgrading the scope of Government market development agencies to support the marketing of targeted healthier commodities ; enforce adherence to nutrition guidelines in government-led meal-nutrition programmes in schools, hospitals and other public institutions as a strategic advantage to reach and influence citizens on nutrition and health issues related to food choices;

Government needs to partner with retailers, housewives associations and consumer groups to create an environment for nutrition. The endgame should be to encourage and enable positive changes in diets and lifestyles through regulating the food supply system, enhancing acceptability of healthy foods, and providing information to allow individuals, families and communities to make healthy choices.

phrase coined by CaRAPN to emphasise the need to offer a range of options for nutritional guidelines and daily diets that meet the health, religious and other requirements of different segments of a population.
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Notes:

The Role and Reach of Government Policy in Nutrition Security

Bottom line
The responsibility for safe and nutritious food is shared by all players in the food system. This requires cooperation and coordination of producer activities guided by government directives and adoption encouraged by appropriate incentives. An efficient food system should ensure that foods meet science-based safety characteristics, while ensuring the appropriate balance of other qualities, taking into consideration other relevant factors such as technical feasibility, costs considerations, as well as social, ethical and environmental concerns through the integrated activities of all stakeholders - both private and public. In all interventions, whether public or private sector led, there should be no compromise on at least three core elements: 1. providing assurance of food safety and quality, 2. enhancing consumers ability to access and afford the recommended healthier food choices, 3. adopting a multi-sectoral approach to create the synergies necessary for efficient actions.
Recommended Readings:
Ralston, K. How Government Policies and Regulations Can Affect Dietary Choices. www.ers.usda.gov/publications/aib750/aib750q.pdf> Sinha, D.P. 1995. Changing patterns of food, nutrition and health in the Caribbean. Nut. Research, 15(6): 899 - 938. WHO. 2011. From Burden to Best Buys: Reducing the Economic Impact of NonCommunicable Diseases in Low- and Middle-Income Countries. www.who.int/nmh/publications/best_buys_summary.pdf> World Health Organization, Food and Nutrition Policy and Plans of Action, Report for the WHO-FAO Inter-Country Workshop Hyderabad, India, 17-21 December 2007. Accessed February 12th, 2012 , www.searo.who.int/LinkFiles/Publications_SEA-NUT-175.pdf Martorell R, Kettel Khan L, Hughes ML. 2000. Grummer-Strawn LM. Overweight and Obesity in preschool children from developing countries Int J Obesity 24:959-967. FAO. 2002. Safe Food and Nutritious Diet for the Consumer. www.fao.org/worldfoodsummit/sideevents/papers/y6656e.htm> CDC. 2011. Improving the Food Environment Through Nutrition Standards: A Guide for Government Procurement. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division for Heart Disease and Stroke Prevention. www.cdc.gov/salt/pdfs/DHDSP_Procurement_Guide.pdf> Janice Meerman, Making Nutrition a National Priority: Review of policy processes in developing countries and a case-study of Malawi, (2008). Accessed February 12th, 2012 http://www.foodsec.org/fileadmin/user_upload/eufaofsi4dm/docs/malawi_case_study.pdf
Research/ Content: Editor: Brent Theophille Jeanelle Clarke Diana Francis

The views and opinions expressed herein, errors and omissions are those of the author and not necessarily those of Inter-American Institute for Cooperation on Agriculture (IICA), the Technical Centre for Agriculture and Rural Cooperation (CTA) or the Caribbean Regional Agricultural Policy Network (CaRAPN) an IICA-CTA initiative in the Caribbean.

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