Ms. Gertruida Johanna Gericke (Gerda) on behalf of NNIA
Dietitians and nutritionists have an important role and responsibility in the facilitation of environmentally sustainable diets for a number of reasons. They ought to be leading discussions on how our food behaviours can affect both health and the environment. Health and sustainability can go hand in hand and nutrition professionals are in the best position to combine healthy eating messages and sustainable diet advice, and support governments and consumers to take action.1
Environmental sustainability of food systems is complex and dependent on a range of policy areas, including climate change, water, ecosystems, land use, soil, food production and distribution, as well as local and global economics. Advocacy represents an intervention into the mentioned complex, dynamic and highly contextual socio-political systems in which strategies must be adjusted on a continual basis due to rapidly changing conditions.1,2
The purpose of this paper is to highlight the role and responsibilities of nutritional professionals to engage as advocates for environmentally sustainable diets. The paper consists of three parts: (i) Art and science of advocacy, (ii) Reflection of environmentally sustainable diets, and (iii) Role and responsibility of nutrition professionals as advocates.
Part 1: Art and science of advocacy
Advocacy has been described as an activity conducted on the basis of experience and tacit knowledge, as opposed to a more evidence based and prescriptive approach within the larger domain of strategic communication. Three broad and overlapping forms of strategic communication are advocacy, social mobilization and behaviour change communication.3
Advocacy is a continuous and adaptive process of gathering, organizing and formulating information into argument to be communicated to decision-makers through various interpersonal and media channels; aiming at creating awareness and influencing decision towards raising resources or political and social leadership acceptance and commitment for a specific programme, thus preparing society for its acceptance.3
Effective advocacy is essential for addressing and solving nutritional problems. Well-planned and well-implemented advocacy can establish significant achievements over varying periods of time. Strong investments in strategic and operational capacities for advocacy are of fundamental importance, including human, organizational and financial resources.2
Successful advocacy is underpinned, strengthened and supported by2:
- Strong leadership is of critical importance. Negotiation, persuasion and mobilization skills are key leadership attributes.
- Situation analysis and research are needed to identify the local advocacy needs and gaps, and to inform the advocacy strategies and tactics. Opinion leader research and stakeholder analysis should guide strategies.
- Broad, effective and relevant partnerships will ensure that all issues are addressed; will also ensure that comparative advantages are leveraged with partnerships to produce results.
- Research is needed for the initiation and throughout the implementation, thus developing a sound evidence base.
- Development of clear goals, time-bound objectives are essential; including the development of clear processes and actions plans. These may need fine tuning over time.
- Development of advocacy messages, channels and methods targeted to different audiences, sectors and contexts. Compelling messages and strategic communication tools are essential for better results.
- Involve media and champions meaningfully in advocacy; also involve informal meetings, and participate in consultations and desk-side briefings
- Monitor and evaluate progress, and continuously assess to inform further planning and implementation, and make adjustments as needed to ensure further improvement and success.
- Allocate sufficient resources to develop and support research, materials and events.
Part 2: Reflection of environmentally sustainable diets
Already in 1934, an Argentine physician and nutrition expert, Pedro Escudero, recommended that a healthy diet was one that was qualitatively complete, quantitatively sufficient, harmonious in its composition, and adequate for its purpose and the individual. More recent understanding and insight in food systems made scientists realize that requirements related to food production and processing should be incorporated in such a recommendation. Sustainable diets or sustainable nutrition are not new terms. However, no standardized definition exists for them. In 1986 Gussow and Clancy defined a sustainable diet as a diet that made up of foods that are not only healthy, but also contribute to the sustainability of the entire food system. This led to the well-recognized definition of the FAO (2010). “Sustainable diets are those diets that have low environmental impacts which contribute to food and nutrition security and to healthy life for present and future generations. Sustainable diets are protective and respectful of biodiversity and ecosystems, culturally acceptable, accessible, economically fair and affordable, nutritionally adequate, safe and healthy, while optimizing natural and human resources.” 4
Meat and diary products are major contributors to greenhouse gas emissions and other environmental impacts. Hence emphasis is placed on the reduction of meat (red and processed meat and meat products in particular), and replaced with appropriate plant-based proteins such as beans, lentils and other pulses as well as plant based dairy alternatives. Increased intakes of fruits and vegetables, whole grain carbohydrates are recommended, as well as reduced intake of saturated fats, sugar (and sugary foods) and salt intakes.1,5
Sustainable diets promote all dimensions of people’s health and well-being, have low environmental impact and are accessible, affordable and equitable, as well as culturally acceptable.
Sustainable diets have as their aim to4:
- achieve optimal growth and development of all individuals, and support functioning and physical, mental and social well-being at all stages of life for present and future generations;
- help prevent all forms of malnutrition (under- and over-nutrition);
- reduce the risk of diet-related non-communicable diseases; and
- support the preservation of biodiversity and planetary health.
Checklist for sustainable healthy diets:
- Early initiation of breast feeding, exclusive breast feeding until six months of age, and continued breast feeding until two years and beyond combined with appropriate complementary feeding for age;
- Adequate (i.e. reaching but not exceeding the needs) in energy and nutrients to meet individual needs for an active and healthy life across the life cycle;
- Aligned with the WHO guidelines to reduce the risk for non-communicable diseases, and ensure health and well-being for the general population;
- Inclusion of balance and variety within and across food groups, and with preference for foods with limited levels of fats, sugars, and sodium/salt (home and /or industrially prepared);
- Inclusion of whole grains, legumes, nuts and a variety of fruits and vegetables;
- Inclusion of moderate amounts of eggs, diary, poultry and fish; small amounts of meat;
- Inclusion of safe and clean drinking water as the fluid of choice;
- Contain minimum levels (or none if possible) of pathogens, toxins, and/or other agents that can cause foodborne diseases at higher exposure;
- Minimization of greenhouse gas emissions, water and land use, nitrogen and phosphorous application and chemical pollution;
- Preservation of biodiversity, including that of crops, livestock, forest-derived foods and aquatic genetic resources, and avoidance of overfishing and overhunting;
- Minimization of the use of antibiotics in food production;
- Respect for local culture, skills, knowledge and consumption patterns and values on how food is sourced, produced and consumed;
- Affordability and desirability of food;
- Generation of little food loss and waste;
- Avoidance of adverse gender-related impacts, especially with regard to time allocation (e.g. for buying and preparing food, fetching water and firewood, etc.)
The guidelines provide directions for policy recommendations for sustainable food systems that are healthy, environmentally friendly and culturally and economically sustainable.4,5
Part 3: Role and responsibility of nutritional professionals as advocates
Nutrition creates a special context for advocacy regarding sustainable diets. A new strategy ought to be launched to develop the concept of sustainable diets in the various contexts of industrialized and developing countries to ensure food security and quality. The new approach, including various systems, should be based on low-input agro-ecological staple food production including limited animal husbandry, short-distance production-consumption nets, minimal food processing and refining, relevant culinary skills, nutrition education, and recognition of positive ancestral local cultures, as well as use of recent technological tools. Biodiversity improvement appears to be a key for sustainable food production and food consumption.5
Though environmental sustainability of food systems is complex and dependent on a range of policy areas (climate change, water, ecosystems, land use soil, food production and distribution and local and global economics), that fall outside the sphere of the profession of nutrition professionals, the nutrition profession should be leading the discussion on sustainability as it relates to consumer food and nutrition choices, and interpreting the evidence as it applies to their practices. They should implement those practices in their homes, work places, and communities to reduce the environmental impact of food, whilst promoting optimum nutrition.1
- Nutrition professionals should be proactive advocates for healthy sustainable diets, seeking to influence a range of policy areas, including education, pricing, and accessibility at local and national level.1
- Nutrition professionals are appropriately trained to combine healthy eating messages and sustainable diet advice, and support consumers to take action.1,5
- Nutrition professionals need to build stronger relationships across the food system to strengthen the understanding of how different sectors interact, and how food behaviours impact on health and the environment. Better understanding will retain nutrition professionals’ position as experts in the interpretation of nutritional science. Nutrition professionals ought to provide advice and support for the consumer in a changing food environment, considering the structural and socio-cultural barriers to those changes.1,5
- Nutrition professionals should be skilled in showing how a more sustainable diet can be cost effective compared to a more “traditional” diet, e.g. by replacing meat with more plant based protein. This may be accompanied with training in appropriate cooking skills to prepare such a diet.1,5
- In the past, food based dietary guidelines only provided advice on foods, food groups and dietary patterns to provide good nutrition to the general public to promote overall health and prevent chronic disease of lifestyle, thus only addressing the “health” part of diet. The “sustainable” part of healthy sustainable diets should be added.4,6
- Probable increases in food prices due to costs associated with investment in sustainability on various levels. Increased knowledge and skills could facilitate understanding and affordable choices among consumers.
- Healthy food choices should be available to all, be it in cost and/or physical accessibility.
- A move towards more sustainable diets might be hampered by cultural norms. Certain dietary patterns are well and deeply established from generation to generation.
Environmental sustainability of food systems is complex and dependent on a range of policy areas. Advocacy represents an intervention into the mentioned complex, dynamic and highly contextual socio-political systems in which strategies must be adjusted on a continual basis due to rapidly changing conditions. Nutrition professionals have diverse roles in many areas, including public health, education, research, and academia and should utilize this broad base of expertise to be agents of behaviour change and influence policies at both local and international levels.
- BDA Policy statement: sustainable diets.bda.uk.com.2020.
- Pelletier D et al. The principles and practices of nutrition advocacy: evidence, experience and the way forward for stunting reduction. Mather and Child Nutrition. 2013:9(Suppl.2):83-100.
- UNICEF. Strategic communication for behaviour and social change in South Asia. UNICEF Regional office for South Asia: Kathmandu. 2005.
- Sustainable health diets -Guiding principles (http:/www.fao.org/documents/cards/en/c/ca6640en).
- Martinelli SS & Cavalli SB. Healthy and sustainable diet: a narrative review of the challenges and perspectives.http://www.scielo.br/scielo.php?script=sci-arttext&pid=S14513-81232019001104251&Ing=en&nrm=iso=ting=en. https://doi.org/10.1590/1413812320182411.30572017.
- Food-based dietary guidelines in Europe (https://ec.europe.eu/jrc/en/health-knowledge-gateway/promotion-prevention/nutrition/food-based-dietary-guidelines).