“Unsafe diets are killing people” – GAIN on malnutrition

For almost 20 years, the Global Alliance for Improved Nutrition (GAIN) has been working with governments, the private sector, and civil society to combat malnutrition. Speaking with Ben Cooper, GAIN executive director Lawrence Haddad discusses how food companies can make a positive contribution to global efforts to end hunger and increase access to nutritious foods.

Ben Cooper: Why does GAIN place such an emphasis on mobilising businesses in pursuit of its aim to improve access to nutritious food for all? 

Lawrence Haddad: Businesses are vital because most people, even in very poor rural areas, buy their food. Our mission at GAIN is to improve the consumption of nutritious and safe foods, and if that is your mission, you have to bring governments, businesses, and civil society together. 

Governments set the rules of the game. Sometimes they’re not very good at setting the rules and sometimes they’re terrible at enforcing the rules. Businesses have to be incentivised and supported to do the right thing.

The consensus within the NGO community appears to be that food companies are often failing to do the right thing. What is your view?

Some companies are much more progressive than others. At a sector level, we are fortunate to have something called the Access to Nutrition Index (ATNI), a non-profit group that evaluates 25 big food and beverage multinationals, scoring them based on their governance, their products, their practices basically. It finds that some companies do relatively well compared to others. None of them does very well in an absolute sense.

What kinds of regulations are particularly important in relation to malnutrition?

So, I'm firmly in favour of things like mandatory fortification. Governments need to tell companies "you need to fortify edible oil with vitamin A and vitamin D". Voluntary fortification is helpful but ultimately not terribly effective. You need to add micronutrients to key staples that are low-cost and people can afford. You need to get trans fats out of food. 

I’m in favour of sugar taxes. I think fiscal policy, in general, has been under-utilised. You can think of gradations of VAT on different types of food for example. There are all sorts of things governments could be doing both on the regulatory side and on the incentive side. 

Governments don’t do enough to incentivise big food companies to do good things. Companies that do well on the ATNI scores, for example, you could even link corporate tax rates to that. 

Governments are massive purchasers of food. They buy food for their schools, for their health systems, for their safety-net programmes, for their criminal systems. They do not buy food from a strong healthy diets perspective. They look to the minimum they can get away with on nutrition and then try to minimise costs. 

If they decided to purchase healthier foods for their schools, hospitals, and safety-net programmes, that would be a massive demand platform for healthy food.

Governments have an important role to play in promoting healthy diets but research often suggests public health messaging about nutrition is ineffective. Why do you think this is?

Most of the public health campaigns around healthy eating are really boring. Very – what I would call – left brain, very logical, scientific. "Eat five fruits and vegetables a day. This is good for you so why aren’t you doing it? You should be doing it!" That doesn't work.

They have to be science-based obviously but they have to appeal to what people care about. Find out what people care about and then link the healthy messages to that. So, that’s about emotion, aspiration, and humour and those kinds of things. 

So do companies have something to contribute here in terms of consumer marketing nous? 

The private sector is absolutely brilliant at triggering all of that. At GAIN, we’ve just launched the Demand Generation Alliance, and it’s about triggering these societal and cultural triggers to get healthy eating to be seen as a valued, interesting, sexy thing to do. 

We're actually working with agencies that are really good at crafting powerful messages. Sometimes they craft those messages for the wrong reasons but we’re trying to get them to begin thinking “how would you sell healthy food?”.

Is the responsibility passed to food companies from governments evolving, from simply ensuring people have enough food to keep them nourished, and has the pandemic accelerated that trend?

Definitely. Covid-19 has just intensified those pressure points and it’s also shown the food system is pretty fragile. Just-in-time production can be disrupted quite easily by even minor temporary lockdowns. 

Everyone woke up to the fact that food doesn't magically appear in supermarkets. People who had never thought about food before had suddenly become more concerned about it. And I think it’s also shown how important food system workers are.  

You are chairing Action Track 1 on hunger and nutrition ahead of the UN Food Systems Summit in September. That is set to include the “Zero hunger, Nourish the Future” initiative, through which it is hoped companies and investment funds will pledge to align $5bn of their collective investments with commitments being made by governments, donors and development banks to “end hunger and nourish the future by 2030”.

What is the rationale behind this and what has the response been so far?

We’re trying to get big food companies to sign up to an ‘end hunger’ pledge and this is a pretty hard thing to do. Why are we doing it? Because hunger numbers are rising because of Covid-19. Why is it hard? Because companies don’t see themselves as part of the ending hunger solution. 

But I have been really surprised by how many companies have wanted to engage with us and align what they do better with the things we know will end hunger, investing in farmers, investing in the food supply, empowering young farmers, that kind of thing.

Alignment is an interesting word. Companies have sought to boost their reputations by claiming their strategies are aligned with UN Sustainable Development Goals (SDGs) but have been accused of using the SDGs as greenwash.

What should food companies be doing to validate claims of alignment with SDG 2, which pertains to hunger and nutrition?

That’s a pretty complicated question to answer because it's very technical. Climate’s easy, because you can add everything up. At that level, greenhouse gas emissions lead to a certain level of warming so that’s easier in a way. But there is no one metric like that for health and nutrition, unfortunately. There are mechanisms. 

The Access to Nutrition Index is very in-depth. There are 250 indicators but only for 25 companies. The World Benchmarking Alliance is routinely tracking what companies publicly state they do and will look across all the SDGs and make an assessment of whether that meets some kind of minimum level of fidelity to the SDGs. 

The mechanism that we’re going to use for the hunger pledge is this World Benchmarking Alliance, and we are going to work with them to set up standards for fidelity to the ten investment areas.

Ultimately, for the food system to be sustainable do you believe these types of investments have to become the norm?

Yes, I do. And I think the unifying thing, the vision by 2030, would be that we would be utilising prices that better reflect the negative externalities. We’d like to see prices reflecting environmental externalities, health externalities. I think that’s the way to knit it all together.

But bringing about that sort of change will require substantial government intervention and legislation – and making food more expensive, even if those prices reflect the true cost and true value of the food, would be unpopular with most consumers, would it not?

Governments will be reluctant to do that until popular sentiment gives them cover to do that. Very few governments make legislation that's against the grain of popular sentiment, unless there’s an immediate threat to public health of course. Many people would argue there is an immediate threat to public health but it’s so chronic. That’s the problem. 

Governments leap into action when there’s an acute food safety issue because people are dying. Well, people are dying from chronic disease due to diet. 

We talk about unsafe food and we think about unsafe food as food that is contaminated or has some toxin or some bacterium in it, but we know that diet is related to six of the top ten risk factors for the global burden of disease. That’s mortality and morbidity in one metric. Unsafe diets are killing people.