Today is World Health Day. The theme is food safety – an issue very relevant to health given that, according to the World Health Organization, over 200 diseases are caused by unsafe food containing harmful bacteria, parasites, viruses and chemical substances. Food safety is a good example of how the primary determinants of health often – indeed typically – lie outside the health sector.

We have known for a long time that people’s health is determined largely by influences outside the health sector: the water supply, for example, or the built environment. Agriculture is another critical influence. Agricultural practices have implications for all kinds of health problems: malnutrition, obesity and non-communicable (chronic) diseases, foodborne illnesses, malaria, HIV/AIDS, livestock-related diseases and occupational ill-health, to name a few.

At the same time, agriculture is essential for good health: it produces the world’s fibre and materials for shelter; in many countries it is a critical source of livelihoods among the poor. Not least, agriculture produces food. In so doing, it is an important weapon against micronutrient malnutrition, obesity and diet-related non-communicable diseases, and foodborne disease, conditions that affect billions of adults and children throughout the world.

Feeding the world

Yet we know that the production of the nutritious, healthy and safe foods needed to tackle these problems is easier said than done. The primary goal of agricultural policy over past decades has been to produce enough food – enough calories to feed the world – while supporting livelihoods and creating profits for the various interests in the food supply chain. A laudable agenda: people need enough food; farmers need livelihoods; companies need profits to generate economic growth and wealth. But the focus on producing more of a few commodities means that nutrition has not fared as well.

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We now know that “dietary diversity” – diets incorporating foods from a wide range of food groups, such as cereals, nutrient-rich roots and tubers, dark green leafy vegetables, fruits rich in vitamin A, meat, eggs, fish and seafood, legumes, nuts and seeds – is essential to combat under-nutrition and provide healthy diets. Yet as pointed out by an article in the Proceedings of the National Academy of Sciences, during the “Green Revolution” in the late 1960s to mid 1980s – when there were huge productivity gains for wheat, rice and corn in developing countries – “although overall calorie consumption increased, dietary diversity decreased for many poor people, and micronutrient malnutrition persisted.”

Today, the vast majority of investment in agricultural research still goes into corn, soybeans, rice and the like. This helps neither micronutrient deficiencies nor unhealthy diets. We know from the scores of food-based dietary guidelines around the world that a healthy diet is a lot more colourful than refined carbohydrates, sweeteners, fats and soybean- and corn-fed meat, even if it does provide us with enough – and for many people in the world, excessive – calories.

Healthy food is also safe food. Yet microbiological (e.g. E.Coli, norovirus, trematodes) and chemical (e.g. mycotoxins, persistent organic pollutants) hazards in food, as well as unconventional agents (e.g. bovine spongiform encephalopathy) affect billions of people a year; diarrhoeal diseases – the leading cause of sickness and death among children under the age of 5 in developing countries and a lead cause of undernutrition – are often transmitted by unsafe food.

Part of the answer to these problems is a new approach to agricultural policy, one that considers health as an agricultural objective. It also requires new thinking from health: what can we do that can support agriculture? All too often the health sector demands help from other sectors without offering up much itself.

Looking beyond the farm

But for real policy coherence we have to look further than agriculture on one side and health on the other: we need look at what goes on in-between. One of the important lessons from food safety is that the problems are not just on the farm – contamination can occur all along the food value chain from farm to mouth. Between farm and mouth is also the space where healthy food often becomes unhealthy.

For example, there have been huge increases in poultry production in past decades – seemingly good news since it’s a cheap source of protein and micronutrients and has a healthier nutrient profile than red meat. Yet after the farm, much of this “healthy” meat is mixed up with refined carbohydrates and fats and offered as high calorie ready-to-eat and fast food. Not so healthy. And all too often, households that need better access to nutritious foods to address micronutrient deficiencies are let down by post-harvest waste and nutrient losses after the food leaves the farm.

So, yes, we have to address on-farm problems, such as aflatoxins, antimicrobial residues and inadequate production. But for real coherence, we need policies that will shift the entire food system towards health and well-being: transparency and accountability for food safety; new types of markets to get healthy foods to everyone; technologies to help small-scale producers overcome constraints.

Creating healthy, sustainable food systems is a daunting task, not least because it challenges existing, often entrenched, economic interests. What we need is food system policies – not just agricultural policy – to provide space for the type of innovation and diversification that will produce a flourishing food economy and deliver nutritious, healthy and safe foods to meet people’s needs. And for that, we need a much more effective system of food governance at all levels. Let’s not shy away from creating one.

Author: Corinna Hawkes is a member of the International Panel of Experts on Sustainable Food Systems (IPES-Food) and affiliated with the Centre for Food Policy, City University, London, and the Leverhulme Centre for Integrative Research on Agriculture and Health 

Image: An employee of the Ocean Spray company holds cranberries as he stands in a pool of some 2000 pounds (907 kg) of floating cranberries at a promotional cranberry bog display set up at New York’s Rockefeller Center, October 17, 2014. REUTERS/Mike Segar