Food Bytes: July 1 - July 7

Food Bytes is a weekly blog post of “nibbles” of information on all things food and nutrition science, policy and culture.

Ever wonder why the nutrition community doesn’t play nice with each other? I do. Phil Baker at Deakin University just published an interesting, but heady, paper trying to understand nutrition action networks and what it would take to make them more effective in garnering political commitment towards ending malnutrition. Just take a look at the figure below looking at the context in which nutrition sits. Talk about complex! They argue for four things to improve political commitment to nutrition:

Complex contexts for the nutrition world

  1. Coordinating bodies that are better at advocating resources can of course, get more money and strengthen the networks in which they work.

  2. Coordinating and governance bodies need to be more inclusive and transparent in their decision making.

  3. Civil society should work to influence decision makers. Helps when transparency is in place.

  4. Finances matter and create powerful incentives for us to play in the sandbox together.

I may have gotten all this wrong, but like I said, the paper is intense, but super important to better understand why nutrition hasn’t seen massive progress like other sectors. I really do think that the grand nutrition architecture has some serious issues around coordination, cooperation, and reality checks it needs to come to grips with. Not Phil’s words, but mine…For another blog post!

Of course, the nutrition community doesn’t just struggle with political commitment. It also struggles with delivering key interventions to those populations most in need. A recent study by Stuart Gillespie and colleagues looked at 24 different nutrition interventions to see if their coverage is measured and tracked in major health surveys done at the national level. These interventions are things like vitamin A and iron supplementation, growth monitoring, and infant feeding counseling. Basically the answer is no. The coverage of these interventions are not collected and not in any standard way across countries. The paper presented a few case studies including India. The figure on the right shows the scatter of data collection of key nutrition actions (counseling, growth monitoring and food supplements) typically not included in the core national health surveys. The bars show the national coverage of data and the dots are the states of India. Another paper published in PLoS medicine looked not only at whether or not a health intervention coverage was captured in surveys, but looked at need, use, and quality of those interventions. It would be great to see these authors do a follow up looking at those three measures to assess effective coverage of nutrition indicators.

And while we are ripping on the functionality of nutritionists and their work, let’s discuss the indecisiveness of the science they dabble in. The Atlantic published a piece on why nutritional sciences is so confusing for consumers. There have been a lot of articles on this recently, and I think it started with Michael Pollan’s book In Defense of Food a decade ago. The Atlantic argue that doing the science is very hard - figuring out what people eat and the consequences of those eating patterns - is not so straight forward and as the article highlighted “inexact.” But the evidence over decades has accumulated and most nutritionists agree largely on what is considered a healthy diet and the healthful habits that people should take on. But that is sort of boring isn’t it. The article also highlights the emerging role of the microbiome. But more on that later.

There have been a few recent papers looking at the impact of interventions to improve food environments. One was a systematic review and meta-analysis on sugar‐sweetened beverage - SSB - taxes and their impact on beverage purchases and dietary intake. A suite of different taxes were examined mainly in Europe and US cities. What the researchers found was that a 10% SSB tax was associated with an average decline in beverage purchases and dietary intake of 10% in 6 jurisdictions. This tax was associated with a 2% increase in total untaxed beverage consumption (e.g. water) but this was not significant. Another study looked at the anticipated impacts of implementing a 2016 Chilean Law of Food Labeling and Advertising mandating front‐of‐package (FOP) warning label for products high in sodium, total sugars, saturated fats, and/or total energy. Researchers photographed packaged food and beverage products from six different supermarkets in Santiago, Chile before the law went into effect. They found that basically very little reformulation by industry occurred before the law went into action and <2% of products would have avoided at least one warning label with reformulation. A similar study looked at the food supply ahead of the law implementation and found similar issues.

While we are on the topic of FOPs, a really interesting study looked at how realistic would it be to mandate these types of labels in the U.S. The study found that: “Certain interpretive FOP labels which provide factual information with colors or designs to assist consumers interpret the information could similarly withstand First Amendment scrutiny, but questions remain regarding whether certain colors or shapes would qualify as controversial and not constitutional. Labels that provide no nutrient information and only an image or icon to characterize the entire product would not likely withstand First Amendment scrutiny.” Wow. Interesting. Gotta love the ol’ US of A’s constitution.

The U.S. is not always the asshole in the room. Well, maybe we are. Let’s talk USAID. For those of you who are not familiar with them, they are the United States Agency for International Development and self describe as “the world's premier international development agency and a catalytic actor driving development results.” Okay…they are also the agency driving around in white trucks all over Africa and Asia with the cringe-worthy signage “From the American People.” Awkward. USAID has done some not so good things in international development but it has done some good things too, dammit. They have been committed to nutrition. The Official Development Assistance (ODA) numbers that are reported in the Global Nutrition Report each year demonstrate their financial commitment. They have supported many programs at a significant scale in low- and middle-income countries. Some impactful, some, not so much. I am really screwing myself over here to ensure I never get USAID money aren’t I. Anyways, they just published the history of USAID in nutrition. It is a nice story. Check it out.

Speaking of food environments and obesity, with the Chicago Council on Global Affairs, I did a one-minute video on why is obesity such an issue globally and the importance of food systems in solving, not just contributing to the issue. If your attention span lasts the whole one minute, you can find out my favorite food. It involves a food rich in zinc!

It’s not just food systems that need to improve if we want to make a dent in the obesity pandemic, it is what is inside our bodies as well. The microbiome is the next frontier for science and its role and relationship with obesity is a complex Game of Thrones TV series - it is going to take some time to dig into the history, to understand the future and who really rules us. Some researchers argue that our microbiota is associated with the propensity of being overweight. Others argue that diet is a big driver of the biome composition and species richness, maybe more so than the biological state of nutritional status - i.e. overweight and underweight. But unraveling this game requires us to be brave, yonder north of the wall, and live in peace with the Wildlings. And John Snow. Rrrrrrr.

And as always, I throw in something just to scare the hell out of any of you who are still living in la la land thinking the world is just bliss. Check out this paper. The title reads: "Global warming has increased global economic inequality.” Boom. Do I need to say more? Now you can go back to your mind-numbing regular programming.

Just so you don’t think I am a vindictive person, I leave you with Google’s Stories of Yoga. For any of you yogi gurus out there, this is everything you want and need to know about yoga, its history, its practice and its inspiration. See? I can be nice. NAMASTE!

Food Bytes: May 26 - June 2

Food Bytes is a weekly blog post of “nibbles” of information on all things food and nutrition science, policy and culture.

Loved this NYT article about Africa’s millennials who are making their way back to farming. “We are making farming sexy.” Hallelujah. Welcome you “agripreneurs.” Make Africa the world’s breadbasket.

Speaking of leading newspapers, if you live in L.A., the city of angels, you will like the new Food section of the LA Times. It is more about where to eat and cook and less about politics and there is a paywall. While LA is having a renaissance on all things food creation, Gotham city is shutting many of its old school diner doors. “A luxury rental tower called the Frontier stands on the site of the old Frontier Diner in Murray Hill.” The New York we all loved died long ago…

Addicted to the joe? Here is everything you ever wanted to know about coffee and its expansion from Africa to the Americas.

Policy does matter. Did you doubt that? Bloomberg Philanthropy highlights the new Task Force on Fiscal Policy for Health – co-chaired by Mike Bloomberg and economist Larry Summers – to address the growing health and economic burden of noncommunicable diseases with fiscal policy tools that are currently underutilized by governments and their leaders. Lots o’ case studies including good stuff on sugar tax.

We know America is struggling. The Brookings Institution has published an interactive exploration of how she is doing. The Hamilton Project’s Vitality Index is a measure of a place’s economic and social wellbeing. It combines a county’s median household income, poverty rate, unemployment rate, prime-age employment rate, life expectancy, and housing vacancy rate. What does this have to do with food? Well, everything. Check it out.

Vitality Index of America. The bluer, the better.

The last food bytes posting highlighted the research on processed foods, and impacts on weight gain. This thoughtful NPR piece talks about how hard it is to move away from processed foods, even when Americans are cooking more. Sarah Bowen and colleagues discuss the barriers: cost, time, and culinary resources. It just ain’t that easy to cook wholesome, from scratch meals day after day. You just can’t beat convenience sometimes. As the authors say: “… inequality is baked into our food system.” And ain’t that the truth.

Our favorite Tamar Haspel over at the WashPo is keeping it real. Now she is delving deep on the plant based burgers which seem to be all the rave. There are two - The Beyond Burger (peas) and Impossible Burger (soy). She takes both to task on environmental impacts, nutrition impacts and cost. And then there is steak. Will we ever replace it or our craving for it?

CSIS’s Take As Directed has a great podcast with Chris Murray at IHME on global diets and risk of disease. He discussed this paper that was highlighted previously on Food Bytes. “Diets account for more deaths [cardiovascular and cancers] than any other risk factor.” He argues the medical community is surprised and skeptical of this message. Interesting!

The Economist breaks down taxes on sugary drinks. Mexico was the trendsetter and now, 40 countries and seven American cities have started to tax sugary drinks. They argue that those that are not in favor of the tax argue that taxes are a “fun-killer, souring people’s pleasure” and can be regressive, because poorer people spend a bigger share of their incomes on soft drinks. But if demand is sensitive to increased prices, then a tax will change behavior, in a positive direction. Let’s see how it all plays out. The bigger question is, will taxes make a dent in the obesity pandemic. Hard to tell.

For any of you who collect and analyze child growth data (also known as anthropometry) in the field, the WHO has finally released a technical report that defines basic criteria and standards for sampling, training and standardization of anthropometrists, data collection, supervision, for data management including quality assessment and analysis, interpretation and reporting of anthropometric data. FINALLY. This is LONG overdue. Well done WHO. 

And last but not least, GAIN has started a new site called Nutrition Connect. Its purpose is to mobilize knowledge, share experiences, and stimulate dialogue on public private engagements (PPE - not be confused with PPP!) for nutrition. Links can also be found in the Food Archive’s Resources page.

Food Bytes: May 6 - May 25

Food Bytes is a weekly blog post of “nibbles” of information on all things food and nutrition science, policy and culture.

The Annual Reviews have just released a special issue on the Future of Food. Presents 20 articles on "Research & efforts to ensure a safe, nutritious, & affordable global food supply, while preserving biodiversity & minimizing environmental damage." Keen to read these by some stellar scientists!

Processed food is having its moment. New research shows that those who eat ultra-processed foods gain more weight than those who ate whole or minimally processed foods. Researchers at the National Institutes of Health, tested this using the randomized, controlled trial approach. Study participants on the ultra-processed diet ate an average of 508 calories more per day and ended up gaining an average of 2 pounds over a two-week period. People on the unprocessed diet ended up losing about 2 pounds on average over a two-week period. Fantastic food writer Bee Wilson has a new book entitled: The Way We Eat Now: How the Food Revolution Has Transformed Our Lives, Our Bodies, and Our World. She writes about how these processed foods, ala junk food, has taken over traditional diets everywhere in the world, and is having impacts on health, at a very alarming pace.

Another study highlighted the impacts of poor diets on health. An estimated 80,110 new cancer cases among adults 20 and older in the United States in 2015 were attributable to eating a poor diet. Other research supports this claim. The study found that decreasing dietary fat and eating more fruits and vegetables may lower a woman’s risk of dying of breast cancer. They tracked 48,835 women ages 50 to 79 without breast cancer since the 1990s.

The way we eat is changing. There is a fantastic piece by the Guardian looking at how more and more people are eating alone, and it has quite dramatic changes on the way we eat, what we eat and why we eat. Netflix is involved in this equation…

Let’s discuss individual foods. Are you obsessed with vanilla? Check this out. Like citrus? You may be disappointed after reading this. With 70% of America consuming bananas, they can’t be that bad right? Think again. Do you dig on swine? This may scare you.

Some places, as we know still are food insecure in the world. The UN FAO reports 815 million people go to bed hungry. Venezuela, sadly is not immune, and is really in a free fall. NYT is reporting that “Butchers have stopped selling meat cuts in favor of offal, fat shavings and cow hooves, the only animal protein many of their customers can afford.” Terrible times for the country. Let’s hope things turn around soon.

On the polar opposite, but strangely, very much on the same side of the coin, it always thought that urbanization is driving the obesity pandemic. A very impactful Nature study has shown that 55% of the global rise in mean body mass index since the mid-1980s—and more than 80% in low- and middle-income regions—was due to increases in body mass index in rural areas. The team of scientists argue that: “There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.”

The difference between rural and urban mean body mass index in women. Figure A is 1985. Figure B is 2017.

Nature is on a role. They also just published a really important paper nothing related to food, but on HIV. The researchers used a high spatial resolution across the continent to look at HIV prevalence sub-nationally. They already published a similar study examining undernutrition. They show that the epidemic is very unevenly spread. Of the 25 million HIV-positive people in sub-Saharan Africa, one third live in very small, highly concentrated pockets. The remaining two-thirds are spread out more broadly. This work will help hone in on the hotspots and where attention should be drawn to continue progress on halting the spread of HIV.

As for furthering education and building capacity, the London School of Hygiene and Tropical Medicine is starting a new Center on Climate Change & Planetary Health and the University of Washington has a new degree program on Food Systems, Nutrition and Health. Google them if you are interested in these new academic programs!

The Sustainable Development Solutions Network is hosting a 3-day webinar on Nutrition-sensitive agriculture. Sign up! We have three stellar speakers who will be talking about:

  • Smallholder production and Dietary Diversity

  • Market Challenges and Solutions to Nutritious Food Access

  • Women’s Empowerment for Better Nutrition

And on a personal note, I was sad to hear about the passing of Kenyan writer Binyavanga Wainaina. He has some famous stories, including How to Write About Africa. But his most defining moment has been his coming out as a gay man, in a letter to his mum, raising awareness and rights of LGBTQIA throughout the continent.

Why Hunger Amidst Plenty?

I had the pleasure of doing a keynote talk at the “Ending Global Hunger Conference” at the Center for Global Food Security of Purdue University . My talk was entitled “Why Hunger Amidst Plenty?” My slides are here.

The punchline of the talk was this: We are living in a complex world made up of multiple burdens of malnutrition. While the obstacles to address the burden are daunting for citizens, there are tools to solve it. We just need political will, global cooperation, and immediate action.

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The malnutrition burden is massive. But the story is mixed - there is the good, the bad, and the ugly. Let’s start with the good. Stunting is coming down - in some places quite fast - like Ethiopia, Bangladesh and Nepal. Also, the risk of dying from a famine has become much, much smaller than at any time in history. Then there is the bad. For the third year in a row, there has been a rise in world hunger. The absolute number of undernourished people has increased to nearly 821 million in 2017, from around 804 million in 2016. These are levels from almost a decade ago. Further, “hidden” hunger remains significant but is shrouded in mystery. We don’t know the state of micronutrient deficiencies, particularly among the nutritionally vulnerable populations, such as children under five years of age, women and adolescent girls. And now the ugly. Overweight and obesity is rising everywhere and among every stage of life. No country has stopped the trends we are witnessing.

The question remains why?

  • Why do we still have hunger & undernutrition?

  • Why are we not seeing improvements? And in some cases reversals of progress?

  • How did we get to this place of paradox: hunger & obesity?

  • What can we do about it?

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I argue that hunger is still rampant because of poverty, conflict change, conflict, poor infrastructure, unstable markets, food loss and waste, and periods of seasonal hunger in rural places.

But how did we get to this place of paradox? That is complex but in a nutshell, our lives and lifestyles are transforming as are our diets and food systems. Many in the world are now consuming sub-optimal diets, exercising less and hence are more sedentary, and these contribute to the risk of disease and death. At the same time, healthy diets are not accessible to all.

As a result, many people are now affected by both food insecurity and obesity at the same time.  Food-insecure populations, really no matter where they live, are subject to the same, but unique influences in trying to consume a healthful diet:

  • Limited resources and lack of access to healthy, affordable foods

  • Cycles of food deprivation and overeating

  • High levels of stress, anxiety and depression

  • Limited access to health care

  • Fewer opportunities for physical activity

  • Greater exposure to marketing of obesity-promoting products

The question remains, what to do? There is no one simple measure that can successfully shift the burden at the national or global scale. Rather, a constellation of different approaches and strategies, operating across scales and supply chains, and targeted at different people and organizations will be required. I argue for 10 actions:

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  1. Care. We need governments, industry and citizens to care about their diets and their nutrition, climate change and food systems.

  2. Push for countries to develop a food systems policy. No country has implemented a full range of updated, comprehensive, and evidence informed strategies to encourage a healthier and more equitable food system.

  3. Consider the situation a “Syndemic” and take on triple duty actions.

  4. Consider options for keeping the food system within environmental limits. Dietary, technological change on farms, and reductions in food loss and waste are critical to reduce environmental impacts of our food system on the planet.

  5. Don’t forget about who will continue to feed the world. As Ruth DeFries eloquently wrote: “Now we are transforming from farmers to urbanites. Our newest experiment-to feed massive numbers of people from the work of a few-is just beginning. The outcome is yet to be seen.” Who will feed us when the average age of the world’s farmer is 60?

  6. Invest in small and medium holder farmers. Smallholder farmers have more diversified landscapes, making important contributions to the overall dietary diversity for the world’s population. 53-81% of micronutrients in the food supply are produced by small and medium farms. These farms make up 84% of all farms and 33% of the land areas globally and are more predominant in Asia and sub-Saharan Africa.

  7. Maximize net increases of nutrition along value chains. Identify points in the chain that can be “leveraged for change.” Leverage points can cause nutrients to be lost or exit the value chain as well as enhance the nutritional value of select nutrient-rich foods.

  8. Engage and empower women in on- and off-farm opportunities. Women need social capital including information and access to new technologies and farming practices and tapping into social networks that may assist in times of hardship. Women need access to credit with greater ability to invest in infrastructure and to smooth consumption or production shocks. And last, we need to improve their human human capital and agency - give them opportunities for education, and increase their ability to get health and nutrition services.

  9. Help consumers navigate this complex web. Give them the information and knowledge the make healthy choices. Make them affordable, accessible and culturally appropriate. But consumers are super, duper confused

  10. Dig deeper. We must address the underlying social determinants that impact malnutrition. Every country is impacted by poverty but its determinants may be different, or the same…

Food Bytes: Weekly Nibbles from Mar 4 - 24

Food Bytes is a weekly blog post of “nibbles” of information on all things food and nutrition science, policy and culture.

The Chicago Council on Global Affairs released their annual report. This year focuses on water: From Scarcity to Security: Managing Water for a Nutritious Food Future. There are lots of nuggets on the links of water to food and nutrition. Definitely worth a read.

IFPRI has also launched a new book: Agriculture for improved nutrition: Seizing the momentum. I contributed a chapter on biodiversity and its importance for food and nutrition security.

I always like what Bee Wilson writes. She recently wrote a great piece in the Guardian on how modern food is killing us. The grape story is an interesting analogy of how our food system has changed.

I just can’t help myself, but the EAT Lancet continues to get press. This article hones in on how it spurred a global debate. Great. It did its job. Keep debating! The Guardian is going a bit nuts on the diet side. They also published a recent piece on “peak beef.” And the Hopkins HUB, published an article on proteins of the future where they warn us to “get ready for a menu of lab-grown steaks, "bleeding" plant burgers, and cricket smoothies!”

Speaking of animal source foods, eggs seem to be bad for us once again. The nutrition science field is just one big teeter totter. This JAMA study shows that eggs increase cholesterol and cardiovascular mortality.

If Africa doesn’t have it tough enough these days, my heart goes out to Mozambique with the cyclone devastation, the armyworm seems to be eating its way across the continent destroying staple crops like maize. Let’s hope R & D can be ramped up quickly with solutions.

I am a closet Chipotle lover and Tamar Haspel outlines the woes the chain has been dealing with.

Two other interesting papers came out last week. One is unpacking stunting - faltering of linear growth in children. The other is a paper in the journal I edit, Global Food Security, on the use and interpretation of dietary diversity indicators in nutrition-sensitive agriculture literature.

In the world of food ethics, with colleagues at Hopkins and Columbia University, we published two papers. The first is in the Oxford Handbook of Public Health Ethics. The chapter focuses on three key ethical challenges in the nutrition public health sphere: the prioritization of key actions to address the multiple burdens of malnutrition, intergenerational justice issues of nutrition-impacted epigenetics, and the consequences of people’s diet choices, not only for humanity but also for the planet. In the second paper, we unpack the meaning of nutrition and demonstrate that a standalone right to adequate nutrition does indeed exist in international human rights law as a sum of other rights. This right to nutrition is, essentially, the sum of the human rights to food, health, education, water and sanitation, a healthy environment, information, political participation, and social security, along with rights ensuring adequate protection of and nondiscrimination against specific groups, such as women, children, and indigenous peoples.


Nutrition and Agriculture Research: Some Thoughts

I recently was asked to provide some commentary at the International Food Policy Research Institute (IFPRI) at the ARENA-II (Advancing Research on Nutrition and Agriculture) project policy seminar. I thought I would post my speaking notes on what I think is a really fascinating set of research findings stemming from the project. The seminar presented new research on food markets and nutrition including cross-country studies of the costs of nutritious foods and nutritious diets as a whole, and case studies of fish, dairy, and poultry products. The event can be watched here.

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ARENA is trying to understand markets in low-income contexts. Markets play a key role in delivering food and nutrition, even for poor and remote rural households. But nutrient-rich foods, especially animal-sourced foods, are very expensive in poor countries, suggesting that markets for perishable but nutritious foods are not functioning well. Both scientific research and real-world programs have largely focused on farm-level interventions to diversify household production and consumption, not recognizing the important role of market purchases.

The major findings coming out of ARENA:

1. Nutritious foods are typically very expensive sources of calories in low income countries, although there are exceptions.

2. Consumption patterns are strongly associated with prices - price variations explains a LOT of the gap between low and high consumers.

3. Indirect evidence that non-price factors (also implicit price factors) matter a lot: e.g. refrigeration and water quality.

4. No single solution for improving affordability or increasing consumption:

  • Eggs: domestic productivity is key, often improving feed sectors (maize, soybean, fishmeal).

  • Dairy: production in some countries, but trade in others. Markets work incredibly badly in rural areas.

  • Fish: cheap and nutritious but under-appreciated by consumers.

  • Domestic and international value chains very important, but also important to think about industrial policy: e.g. How do we create a viable modern dairy industry that delivers affordable safe milk to both rural and urban consumers?

My talking points:

Diets are significant risk factors of morbidity, disability and mortality

The Global Burden of Disease based out of the University of Washington in Seattle has recently assessed the burden of malnutrition in all its forms for the Syndemic commission report in the Lancet. Globally and in the lower income countries, malnutrition in all its forms (shown as the contributions of undernutrition, high. body-mass index, and dietary risks) contributes as much disease burden as high blood pressure, tobacco, high fasting blood glucose and water, sanitation and hygiene combined. For countries with a low Socio-demographic Index, undernutrition incurs a much higher burden both in absolute terms and relative to the other leading contributors. The recognition that undernutrition and obesity are both due to poor diet quality and a low variety of healthy foods is a more helpful perspective to resolve nutrition problems collectively.

Our knowledge of diets is still a black box

Understanding what people are eating is important to shape food system and nutrition policies, including dietary guidelines. However, determining what people are eating, remains somewhat of a black box. We don’t know key questions such as, what are people actually eating? Where do they get their food from and how much do they pay, or are willing to pay for food? What influences their dietary choices? Does health or even the environment factor into their decision making? Data on diets and their sourcing and costs are developing with better use of metrics and surveys that feed into larger databases. We are learning more and more with each passing year. We still have significant gaps in low-income settings on many of these questions.

Diets are inequitable

We are really living in a time of haves and have nots. Globally, there is a significant debate going on about the impacts of animal source foods (mainly large ruminants) on climate change, the environment and on human health. Clearly, this debate sits with high-income countries and those countries which produce and consume vast quantities of meat that do not align with the sustainable development goals. However, we know that the production and consumption practices of some, will impact the many living in low-income countries who do not have the resources to adapt and change rapidly and are limited in their options. The inequities are staggering - the rural, the poor, the geographically isolated struggle to get enough animal source foods that are important, particularly for young children who are growing and developing and need nutrient-rich foods high in iron, zinc, protein, D, B12 etc. The ARENA study advances are understanding of the challenges that rural populations face in getting access to these critical foods – eggs, dairy and fish, rich in important nutrients and other health promoting properties – through both informal and formal markets. While the evidence is growing on the impacts of on-farm production to dietary diversity of households, we know rural peoples, smallholder farming families and day labor workers are net buyers of food and they need market that work.

 My questions

I know the ARENA is meant to of course shed and shine a light but it is also meant to set out a research and policy agenda. Here are some of my questions that I was left wondering about for future research:

  • Infrastructure is so important. Not just roads but technology and innovation along supply chains. What would be the role of the private sector or PPPs to accelerate action and get over the barriers to access?

  • We cannot think about commodities as stand alone. They interact (the ARENA shows how important feed sectors (maize, soybean, fishmeal) are critical for the growth of animal source foods). How do we grapple this with land use changes?

  • The enabling environment is key. What should policies focus on? Subsidies? Trade?

  • Changing food environments or markets. How shall we measure changes and rapid shifts that we are seeing in many rural places, with the encroachment and influence of urban hubs? I would be keen to see how processed, packaged foods are changing the diets and market landscape in rural places.

  • Many consumers all over the world are driven by the same issues - price, convenience, taste. Other factors matter too like reliability and safety. How do we get consumers to care more about nutrition or is that completely unrealistic? What are the trade-offs?

  • Eggs: Can these rural areas shift from scavenging systems to intensive systems? How realistic is that? How much does that cost? Is there infrastructure and investment to do this? There is new evidence showing eggs increase cholesterol and heart disease risk - once again, eggs are deemed to not be god for us. Should we be worried about future burdens if we are promoting these foods to children to improve nutrition?

  • Dairy: Lactose intolerance. The expression of lactase which digests lactose from milk in humans is generally lost after weaning, but selected mutations influencing the promoter of the lactase gene have spread into the human populations. This is considered a classical example of gene-culture co-evolution, and several studies suggested that the lactase gene has been under strong directional evolutionary selective pressure in the past 5000 to 10,000 years. These data indicate that a combination of socio-economic, ethnic and evolutionary factors converged to shape the genetic structure of lactase persistence in East African populations. A Lancet systematic review study in 2017 showed that lactose malabsorption is widespread in most of the world, with wide variation between different regions and an overall frequency of around two-thirds of the world's population. 63% (54–72) in sub-Saharan Africa. Lactose malabsorption was also widespread in Africa. including northern Africa (53–84%) and sub-Saharan Africa (77–100%), with the exception of Niger (13%), Kenya (39%), Sudan (55%), and Tanzania (45%) - pastoralist populations. I am keen to learn more about this?

  • Fish: What would be the strategies to improve the status of fish among consumers as they get wealthier? What role does aquaculture play in these areas and ensuring feed is affordable and more sustainable? What about alternative feeds?

  • Are there gender links to any of these commodities as they become commercialized and how does that change household intake of these foods?

  • How do we ensure these rural places thrive? Someone needs to feed this growing urban population. Who will it be and how if rural places struggle to feed themselves?