POLICY BRIEFING: Sustainable and Healthy Eating Patterns?

The food problem makes the headlines, and generates soundbites on daily basis – and for good reason. Food is a convergence issue. It is both cause and consequence of some of the most pressing challenges we face today. About 30% of climate changing greenhouse gas (GHG) emissions can be attributed to the production and distribution of food; agriculture is also the main cause of deforestation and biodiversity loss, a major user and polluter of scarce water resources and responsible for the disruption of global nitrogen and phosphorus cycles. Overfishing has caused the collapse of important fish stocks and threatens the stability of marine ecosystems.

Nor have the economic benefits of this rapaciousness been evenly distributed: ten food companies collectively generate daily revenues of more than $1.1bn while over a billion people who rely upon agriculture for their livelihoods live below the poverty line of US$1.25 a day. Some 800 million people worldwide still go hungry and two billion suffer from debilitating micronutrient deficiencies even as a further two billion – now increasingly citizens of less affluent countries – are overweight or obese. This in turn creates a whole new set of problems; diet-linked non communicable diseases (NCDs) such as heart conditions, strokes, diabetes and some cancers are becoming the burdens of the poor rather than the side effects of wealth, in affluent countries but increasingly also in the developing world. Indeed it is in the low and middle-income countries that the paradoxes of insufficiency and excess are at their most extreme: hunger coexistent with overconsumption, impoverished soils and also excessive use of inputs, inconceivable wealth, and unspeakable poverty.

All the signs are that these problems are set to grow, not just because our population is growing, meaning more mouths to feed, but also because our food demands are changing. As people become richer, they start to demand, and be able to afford not just more food, but more of the foods that they like – notably meat and dairy products.

If food is a convergence issue, meat and dairy foods sit at its very core. The rearing of livestock for meat, eggs and milk generates some 14.5% of total global GHG emissions, occupies 70% of agricultural land (including a third of arable land, needed also for crop production), is the main agricultural cause of deforestation, biodiversity loss and land degradation, and a major polluter of waterways. Meat-heavy diets are implicated in rapid growth in diet related diseases around the world. Indeed – most of the world’s obese and overweight are to be found not in OECD countries but in low and middle income economies.

Of course the problems are well recognised. Something clearly needs to be done. And some things are being done; but most of the policy and research attention has so far focused on doing more better – on producing and distributing more food in ways that use less land or emit fewer greenhouse gas emissions per unit of food produced – all founded on the assumption that demand trajectories are what they are and need to be met.

But a growing body of research concludes that this ‘more food with less impact’ approach is by itself insufficient, for two reasons. First it will not produce the deep cuts in emissions needed if the food system is to help deliver on the Paris climate reduction commitments – and if food is let off the hook as a ‘special case’ then the onus on other sectors becomes almost unbearable. Secondly, more food per se does not address the systemic inequities that are important determinants of food security – greater supply does not automatically lead to better access or improved food quality – or the growing problems of obesity and NCDs. Nor does the ‘more food’ agenda do much to tackle social and economic causes of the 30% of food that is wasted at huge social and environmental cost, nor the deep absences and inadequacies of food system governance sitting at the heart of our problems, from deforestation through to aggressive junk foods marketing by large corporations.

Many other approaches are also needed. One that is attracting increasing interest by civil society and researchers alike, is to focus on the driver of production – our eating patterns. What we eat dictates what we produce. Might dietary change help us solve multiple problems at the same time? If so, what do such eating patterns look like? And once we have worked out what they look like, how do we achieve change?

The last few years have seen a huge amount of research into the ‘what’ question. There are still major uncertainties, but the emerging indications are that synergies between good nutrition and lower environmental impacts are possible although – since it is possible to eat healthily at great environmental cost and vice versa – not inevitable (Figure 1). Broadly speaking ‘win-win’ diets are diverse and rich in wholegrains, tubers, lentils and pulses and field grown ‘robust’ horticultural produce (rather than those grown in heated greenhouses or requiring rapid transport by air). If consumed animal products can be a useful source of micronutrient but should be eaten in modest quantities and all parts of the animal eaten. Processed foods high in fat and sugar are limited. Of course a fuller definition of sustainability needs to incorporate other important concerns around labour standards, animal welfare or the cultural place of food. But what we know so far is a start.

Figure 1: characteristics of healthier, lower environmental impact eating patterns

Adapted from: Garnett T (2014) and from Gonzalez-Fischer C and Garnett T (forthcoming). Planets, pyramids and the Planet: Developments in national healthy and sustainable dietary guidelines: a state of play assessment. Food Climate Research Network (FCRN), Food and Agriculture Organisation (FAO).

Answers to the ‘how’ questions are far thinner on the ground. Of course a vast body of work on behaviours, consumption patterns and practices and on how these might be changed already exists. Some is academic, concerned with theory or simply with understanding why people do what they do. There is also a very extensive literature driven by public interest organisations and priorities, focusing on behaviours that have implications for health (smoking, drug addiction, obesity, alcohol), society (voting practices, organ donation) or the environment (transport, food, energy use) the aim being to understand in order to change. And then there is industry-led work: here insights into people’s behaviours, motivations, habits and practices are central to the development of effective marketing strategies.

Valiant attempts have been made to cluster and categorise this vast and inchoate literature.(1) What emerges quite strikingly is how far stakeholders’ particular disciplinary lens colours their perception of the issues. This has clear implications for the types of interventions that are advocated. So, if one were to simplify somewhat, an economics based, rational choice perspective will see the individual as balancing the monetary, health, taste, convenience and other costs of a particular food against the benefits as they are perceived to be. Where consumption leads to undesirable consequences, such as GHG emissions or poor health, then several policy approaches are possible, all of which are based on the notion that people will act to improve their wellbeing. One approach is to inform people, through labelling for example, about the consequences of their purchasing decisions. These informed people can then choose to buy healthier or greener products, if they think there are benefits in so doing, benefits that may be personal (improved health) or societal (environmental sustainability). If the societal gain comes at some apparent economic or other cost to the individual, the decision to do the ‘right thing’ can still be rationalised as one of personal gain too – the ‘benefit’ here may be a sense that one’s children will inherit a better world, the assuaging of personal guilt or simply the glow of self-approbation. Another rational approach is to tax the food in question or subsidise more desirable alternatives. This is an over simplistic explanation which has been criticised by economists themselves. But the assumptions underlying this approach still underpin a great many public health and environmental information and labelling campaigns as well as campaigns by NGOs and others for health or environment taxes on foods.

An alternative approach rejects this rational consumer model. Here, the individual is ‘locked in’ to particular diets and practices around food because of the way the city is planned, the timings and structure of the day, the foods that are available, the relationship between genders and generations, and the unevenness with which our educational system and the workings of the economy distribute knowledge, agency, income and ability. From a health or sustainability perspective, the problem lies not with the individual but with how society at different levels is organised. Individuals are products of their circumstances and individual choice nigh on illusory, particularly for the poor and less educated. The inference is of course that, if the system changes, so too will our practices. All this may suggest a stronger role for regulation, planning, and for changing the organisation of institutions and in what they deliver – this might include anything from the core syllabus taught in schools and universities, to the food on offer in hospital or school canteens.

A third framing focuses on desire, impulses, instincts, inertia and contexts, based on the idea that, far from being rational, most of our decisions are based on impulses, on how a situation is framed or a product positioned. We eat more on bigger plates than on smaller plates, we eat more when presented with more choice – or even the illusion of more choice – and we respond to advertisements that explicitly link the product in question (chocolates, alcohol, coffee, ice-cream) with power, say, or seductiveness. From this perspective, interventions are about nudging people into more sustainable practices by changing the default, or by playing around with the ‘choice architecture’ – actions might include anything from asking people to ‘opt into’ eating meat when specifying dietary preferences, to changing supermarket store layouts. Social marketing approaches provide a bridge between rational consumer choice and nudge type perspectives. Habit and automaticity have strong roles to play in both the second and third theories of consumption.

However, a fourth and possibly less deterministic model of consumption sees people consuming not just for reasons of self-interest, or because they are at the mercy of ‘the system’, or of their hormones, or because of inertia, but because, through consumption they are actively trying to construct identity for themselves, form relationships with others, and create meaning in their lives. Eating at MacDonald’s or drinking at the pub is actually about the process of forging and maintaining friendships; baking bread or – alternatively – eating junk food can be expressions of agency or resistance to the status quo, whether this be the food industry or one’s lentil loving eco-parents. Consumption is variously an embodiment of creativity, love, and commonality – or of rebellion and opposition. Since this consuming creativity, or creative consumption, is a fundamental part of human nature, we should seek to promote conditions in which people can flourish – that is, fulfil their basic urges – without causing damage to the environment.   This perspective touches upon all the others above. As such, a range of interventions may be needed; these may include measures to change the socio-economic context which shapes the ways we express identity, societal-level challenges to prevailing norms, aspirations and expectations – as well as more fine grained approaches to address attitudes and values at the individual level.

In addition to disciplinary bias and the problems of cross-transferability, discussions about behaviour and what to do about changing it are also strongly influenced by values and ideologies. Where is the locus of responsibility seen to lie – with the individual or with the socio-economic system as a whole? And of course others still might ask ‘is practice x really a problem, who says it is, and why do they say so?’ Take for example the much-lamented loss of the family meal and our increasing reliance on convenience food. What, exactly, is the nature of the problem – are the concerns to do with moral decline and the breakdown of family values, or are they about disempowerment, corporate take-over and capitalist enslavement? Or – actually – is this not really a problem at all but simply a morally neutral consequence of the fact that people have more exciting things to do than eat and women better things to do than cook?

These different values and ideologies feed into ideas about what sorts of interventions are possible, effective and legitimate. For some, taxing certain foods is an obvious way to modify consumption. For others, it is either unacceptable (nanny state interventionism) or misguided (people do not respond in predictable ways to price changes). For some people product reformulation (less salt, fewer calories, more vegetables) represents an effective and painless way of achieving improved health outcomes while for others this approach simply perpetuates unequal and disempowering systems of production and consumption that are ultimately controlled by a powerful food industry. Many argue that we should market sustainable food as the new aspirational lifestyle must-have – while for others, this me-myself-I approach is emblematic of the selfish consumerism that lies at the root of our environmental problems. It is an obvious, but nevertheless important point, that whoever dominates the policy discourse sets the boundaries of the discussion – and this is a source of immense frustration for those who come from a different perspective.

How far are these theories of change borne out by actual evidence? What do we know about the effectiveness of interventions aimed at shifting diets in more sustainable directions? In 2015, a study by the Food Climate Research Network and Chatham House sought to address just this question.(2) However, since the whole sustainable diets agenda is so new it was obvious that the evidence base would not be there; instead we looked at interventions aimed broadly at encouraging ‘healthier’ eating, or pro-environmental activities such as recycling.

We reviewed a range of interventions that broadly reflect the influences of different disciplinary approaches – psychology, sociology, economics – and clustered them into five broad categories: interventions focused on changes in price (taxes, subsidies and so forth); changes in food system governance (trade agreements, national planning and procurement policies); industry agreements; ‘settings’ based interventions – for example changes in the layout or provision of foods in stores, canteens, and schools – and finally, at efforts to educate, inform or empower individuals through awareness raising campaigns, cookery projects and so forth (Table 1).

Table 1: A typology of interventions

Adapted from: Garnett T, Mathewson S, Angelides P and Borthwick F (2015). 

What emerged most starkly from our research was a landscape of huge craters interspersed with the occasional mountain, mountains of evidence around public awareness raising, labelling and other voluntary initiatives – but very little on other approaches.

We do of course have ‘natural experiments’ to draw upon – for example we can track the impacts of real life trade agreements; we find, in fact, that these international food trade agreements have been ‘highly successful’ in shifting consumption patterns. They work. The downside is that they work the wrong way – they have been effective in getting us to eat more, rather than fewer high fat, high sugar unsustainable and unhealthy foods.

Notwithstanding the massive knowledge gaps we were able to make a few observations.

First there is almost an inverse relationship between the plethora of awareness raising and labelling-type interventions and their effectiveness. They don’t work, or they don’t work enough, or they don’t work enough on their own. Note that the superabundance of evidence here reflects not so much researchers’ ignorance but their impotence. It is within the power of an academic to design an awareness-raising intervention – but changing an international food trade agreement, or getting governments to implement a 20% tax, say, on unhealthy foods is evidently much harder (although the tax literature is actually growing, thanks to interventions by countries such as Mexico – and the promised sugar tax in the UK may yield some interesting insights). Of course the enthusiasm for labelling and handy leaflets also reflects policy makers’ reluctance to adopt more robust approaches. This needs to change.

Secondly, while there are some examples of successful food industry actions, either taken individually or in collaboration with others, it is unwise to assume that goodwill or enlightened self-interest will do the job. Companies can play an important part in helping provide, price or promote more sustainable options but they still have their profit margins to consider. Government should provide a framework within which they operate – and keep the threat of regulatory action hovering in the background.

Thirdly and linked to this, governments need to govern. There is a need for policy makers to set a strong regulatory and fiscal framework.

Fourthly, composite approaches are needed:  no one approach will achieve the changes we need in the time we have. A mix of regulatory, fiscal, voluntary and other approaches is required. Time, commitment and money also need to be invested in developing clear and consistent metrics and reporting processes, so that impacts can be monitored to add future improvements in intervention design.

Fifthly, we found that some settings can be particularly promising sites for intervention. School based interventions in particular show promising and positive results on the health side; they now need to start incorporating environmental objectives.

Sixthly, a whole supply chain approach is needed to understand the environmental and health relationships, including trade- offs. While there are many overlaps between health and environmental goals there can be trade-offs too, particularly when a whole supply chain approach is considered. Thus production and consumption side measures, and the relationship between them, need to be understood and considered together and interventions designed with these in mind.

Finally – and this is critical: lack of evidence is not an excuse for inaction. Action engenders evidence: policy inaction leads to a paucity of empirical evidence. Trials and experimentation particularly based on some of the more politically challenging fiscal and regulatory approaches are essential.

The challenge of moving towards a more sustainable food system – and more sustainable eating patterns as part of that – has for too long been seen in terms of producing better ‘things’ – breeds, seeds, energy efficient kit. But we have these things, or at least enough of them for now. What we need to do now is to pay more attention (and money) to the ‘glue’ that binds these things together – to the relationships among people, institutions and societies.

Notes:

(1) Jackson, T. (2004) Models of Mammon: A Cross-Disciplinary Survey in Pursuit of The “Sustainable Consumer‟, Working Paper Series, Nr 2004/1, Centre for Environmental Strategy, University of Surrey, Guildford, United Kingdom and Jackson T (2005). Motivating Sustainable Consumption: a review of evidence on consumer behaviour and behavioural change. A report to the Sustainable Development Research Network, Centre for Environmental Strategy, University of Surrey, Guildford, United Kingdom.

(2) Garnett T, Mathewson S, Angelides P and Borthwick F (2015). Policies and actions to shift eating patterns: What works? A review of the evidence of the effectiveness of interventions aimed at shifting diets in more sustainable and healthy directions. Food Climate Research Network and Chatham House, University of Oxford.