An Inside View: The Sight and Life team’s top ten favorite blog posts 

 

What is the Sight and Life Team reading? 

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Over the years, Sight and Life has tackled a range of topics including deep dives into social marketing and nutrition concepts. During this ‘Zoom era’ of fast-paced and constant inundation of information, we take a step back to reflect on those pieces that really resonate with us. We are excited to share the top ten Sight and Life blog posts that made a lasting impression on our team members.  

Read to the end of our top ten favorites, listed in no particular order, and find out which blog received the overwhelming majority of votes from our team. See if your favorite made the list!  


1. The Convergence of COVID-19, Climate Change and Malnutrition
(April 25, 2020)

This piece, written by Sight and Life’s Managing Director, Klaus Kraemer, was identified by our staff as a favorite for its timeliness, published as the world was beginning to grapple with the first effects of the Coronavirus. While many were facing concerns for their immediate health and safety, this blog provided a reassuring and long-term perspective. Breda Gavin-Smith described this as her top pick as it “really highlights the essence of Sight and Life. Already in April of 2020, we saw the difficulties Covid-19 would present nutritionally and we were challenging others on solutions to the nutrition crisis that would inevitably follow.” She further commended the post for simultaneously linking issues of climate change, malnutrition and Covid-19, and identifying this as an opportunity to bring together diverse stakeholders. 

2) Nutrition & Immunity Series: 

Part I of II – The Role of Nutrition in the Immune System: Should we pay more attention? (April 17, 2020)  

Part II of II – The Role of Nutrition in the Immune System: Should we pay more attention? (April 29, 2020) 

minerals, immunity, nutrition, immune system, immune response

This two-part series, by our Global Public Health Nutrition Manager, Breda Gavin-Smith, addresses the necessity of nutritious foods in supplying the body with resources to support immune response and best defend itself from various attacks. For optimum performance of the immune system, access to sufficient antioxidants, which serve to decelerate cell damage from free radicals, are essential. Even marginal deficiencies of specific nutrients have been demonstrated to impair the immune responseOur team favored this series for illustrating a new and important facet of the pandemic, highlighting the pertinence of nutrition in addressing Covid-19.  Read Part I and Part II here.

3) Spotlight: Gratitude to frontline workers at the time of coronavirus (April 14, 2020)  

COVID-19 Essentials Delivery

Jointly written by Srujith LingalaKalpana Beesabathuni, and Priyanka Kumari, this piece celebrates India’s dedication and efforts in preventing hunger and providing basic health care activities. Our team agrees that the striking element of this work is its clear reminder of thvital role played by frontline workers to ensure the health and nutrition of families confronted with unprecedented food scarcity. Learn more in the full blog post here

4) Crisis Leads to Purpose – Have you found yours today?  (April 11, 2020) 

A decisive plan of action by the Sight and Life team is laid out in this post for relief efforts targeting pregnant women, lactating women, and mothers of children under five years of age across India. In addition, it solicits the nutrition community for donations to provide nutritious mealand medical kits. This piece outlines a plan to assist in alleviating the dire situations faced by many in India as a result of Covid-19. Our team identifies this blog post as a favorite for creating a road map, giving others a practical way to contribute to relief efforts.    

5) Five-Step Plan to Prevent an Impending Nutrition Famine During COVID-19 in India (May 15, 2020) 

In the midst of the Covid-19 pandemic, Executive Assistant, Pavithra Balasubramanian, found encouragement in this blog postWritten by Srujith Lingala, Manager of Technology and Entrepreneurship, this piece not only provides an actionable plan to address the pandemic crisis, it also serves as a reminder that we are all connected in this global challenge. Read the full post here

6) Changing the Standard: Why multiple micronutrient supplements in pregnancy are an ethical issue (May 26, 2019) 

This highly rated blog post, authored by Klaus Kraemer, emphasizes the need for immediate action in addressing disparities in antenatal care, particularly in Low-and middle-income countries (LMICs). Klaus Kraemer identifies the ethical obligation for world health leaders to update global and national guidelines in response to the advances in scientific research comparing iron and folic acid (IFA) and multiple micronutrient supplements (MMS) on birth outcomes. Learn more about MMS in the full blog post here.

7) Alternative Proteins: What’s the deal? (October 4, 2020) 

Source: Good Food Institute

Team members selected this post as a favorite for offering a holistic perspective to the conversation on alternative proteinsThe article provides a snapshot of the landscape and offers resources to understand key elements of the alternative proteins discussion, including nutritional value, investments being made in plant-based food companies, and the role of inclusive business models in increasing affordabilityDive into the details by clicking here.

8) Food Systems Innovation Hub: Small and medium enterprises – Key to good nutrition (January 20, 2021) 

 

Of course, we would be remiss not to mention the fantastic series on the Food Systems Innovation Hub. This piece, written by Srujith Lingala, provides an in-depth perspective on the importance of bolstering Small and Medium Enterprises (SMEs).  SMEs comprise about 90% of all businesses and have the potential to improve the nutrition and overall health of a country’s population. Be sure to read the full blog post here and check out the entire series on food systems here.

9) Essential Reading on Behavior Change Communication (BCC) (May 7, 2018) 

Behavior change communications, BCC, SBCC

Another look into the Sight and Life team and work, this piece comes recommended for its wealth of resources pertaining to behavior change communication (BCC). In addition to our four-part webinar series, this blog outlines key BCC learnings along with a diverse array of readings, a toolkit, books, and more to supply readers with valuable, actionable resources. Learn more about behavior change communications by reading the full post here.

10) It Makes Me Smile (July 30, 2020)

Rowena Merritt, Head of Research at the National Social Marketing Centre, and mother to a8-year-old boy with a strong affection for ‘fizzy’ drinks, addresses the essential task of understanding your target audienceBoth informative and humorous, this piece also highlights the importance of discovering and offering an acceptable exchange to the target audience in order to change their behavior. This top runner of Sight and Life blog posts was selected for its humanizing elementTeam members could relate to this piece as fellow mothers, while otherselected it for the accessible manner in which it conveyed social marketing themes. Yet others appreciate this blog post for emphasizing the critical element of listening to the target audience.  

 

Stay tuned for more great posts from the team! 

Inspire! Invest! Innovate!

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“If your only tool is a hammer then every problem looks like a nail.” – Abraham Maslow

If you have been following our blog series on Food Systems Innovation Hubs, you will have learned all about the pressing nutrition problems facing low- and middle-income countries (LMICs) (read the blog here), read up on how bolstering a country’s small and medium enterprises (SMEs) (read the blog here) can foster good livelihoods, realized how important media campaigns are to enabling healthy food choices (read the blog here), and considered how policy can help or hinder positive change in our food systems (read the blog here). You may also have discovered how food fortification can make our bodies and our planet healthier (read the blog here) and joined us in celebrating entrepreneurs who are true nutrition heroes (read the blog here). After all of that, you may now be asking yourself how we can address these challenges in a holistic way, bringing the multiple approaches and solutions highlighted in these texts together into one cohesive strategy. Not only are food systems complex, but each is also unique to the geography and culture it is supposed to nourish. Therefore, a one-size-fits-all solution clearly does not exist, and the approaches used by high-income countries (HICs) cannot be expected to work in the same way for LMICs.

Our aspiration is that the transformation of failing food systems lies in Innovation Hubs. Operating in a variety of different locations, they will be able to mold themselves to the needs of their specific nations and communities by engaging directly with its people, its culture, its entrepreneurial talent, and its unique climate. This will be achieved by focusing on three key actions: Inspire! Invest! and Innovate!

Inspire!

We will encourage existing exceptional food and technology companies with market prowess to expand into the Global South, with the goal of growing market interest, aligning with a range of investors, and developing and testing new products. For example, when nutritious crops such as teff in Ethiopia are aggregated in one place from hundreds or thousands of smallholder farmers, then milled on a large scale, it opens the possibility of making it affordable to the poor. It also allows for the addition of vitamins and minerals during the processing and for producing a safer product by eliminating the carcinogenic aflatoxin.

Invest!

We will facilitate investment in local companies that have the potential to scale, as well as in technology transfer, in nutrition, food safety, and consumer studies to prove market viability and show latent existing demand for nutritious foods. As an illustration, farmers in Kenya currently indicate a willingness to use climate-smart approaches such as insects for animal feed. Impact evaluations may convince other entrepreneurs to enter the market or help broker a partnership between a global insect feed company and a local feed company.

Innovate!

We will stimulate innovation throughout the value chain tailored to Global South markets and draw additional investment into scaling up and innovating new technologies, which will be especially impactful to the SMEs and start-ups that dominate food production there today. These SMEs also face unique binding constraints compared to their developed-nation peers. A fully automated temperature sensing insect-control greenhouse, for example, may save on costs in the Netherlands, where energy and skilled labor are relatively cheap but are unprofitable in West Africa, where backup electric generators and replacement parts are far more costly.

Food Systems Innovation Hubs are a bold, new initiative that will accelerate innovation, streamline processes, and support nature-positive, biodiverse agriculture to better nourish the nations and communities they serve.  Join us in this coordinated effort to improve the world’s food systems. We welcome you to bring your unique skills and resources to bear in helping solve these unique challenges.

Watch this engaging webinar discussing the importance of a Food Systems Innovation Hub HERE.

 

Helping Entrepreneurs Helps Us All

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“Once in a blue moon, exceptional ideas turn into great companies that change the world” – Dr. Eleni Gabre-Madhin

In a recent Global Entrepreneurship Report, Africa was shown to be the region that reports the most positive attitude towards entrepreneurship, with three-quarters of working-age adults considering entrepreneurship a good career choice. This is heartening since youth unemployment and underemployment are concentrated in low- and middle-income countries (LMIC), which are home to 87 percent of the world’s unemployed youth — 62 million young people, according to the International Labor Organization.

Distribution of capital invested in new ventures – capital availability for entrepreneurs in the Global South is abysmally low. Source: https://startupsusa.org/global-startup-cities/

Today’s youth are more entrepreneurial than ever, starting twice as many businesses as the baby boomer generation. However, capital availability in the global south is abysmally low, hampering these talented self-starters’ capacity to get their innovations off the ground. Since 2016, Sight and Life has been running our Elevator Pitch Contest, which helps refine, support, and launch the inventions of talented young people who are working to develop new agricultural and nutrition technologies. 

Sight and Life catalyzes theme based innovations through the Elevator Pitch Contest

Take, for example, Nicholas Myers, a chemist and pitch contest winner. His Paper Analytical Device – a lab-on-paper that measures iodine levels in salt and urine samples – helps monitor iodized salt programs at a low cost in real-time. But just because a better solution to a problem exists, like Myers’ invention, does not necessarily mean that it will be adopted. With a shift from the nutrition field to public health, Myers found additional uses for his innovation, adapting the iodine test card to also measure levels of penicillin-class antibiotics present in pharmaceuticals with greater than 95% accuracy to detect breaches in medicine compliance.  Such discoveries of multiple uses accelerate the adoption of an invention.

EPC, Sight and Life, Elevator Pitch Contest“At the time of the contest, my invention was making its way through the “Valley of Death,” which is a relatively low funding period between R&D and commercialization. The contest provided a platform on which I, a chemist, reached hundreds of experts in the micronutrient sector, and these multi-disciplinary connections are critical to pushing an invention through the “Valley of Death” and to commercialization.” – Nicholas Myers (Read the full interview here)

 

Several other barriers exist to scaling up nutrition interventions in LMICs, like access to high-quality products in a particular area, inflated costs of public health goods and services, erratic cash flow, and public health facilities that are difficult to reach, underfunded, understaffed, and understocked. To overcome these barriers, Sight and Life has studied sustainable social enterprises that integrate nutrition interventions at scale to benefit large numbers of underserved communities.

Why consider social business models and entrepreneurship when it comes to public health? Over four billion people carry the burden of a “poverty penalty” and are forced to pay more for lower quality basic public health goods and services due to market inefficiencies. Of these people, only a tiny fraction can benefit from government or humanitarian services, and even then, these resources are often plagued with piecemeal or inadequate funding. This large percentage of the world’s population is often referred to as the Base of the Pyramid or BoP. Grant-funded humanitarian projects may have limited reach and finite intervention periods, but the BoP represents a five trillion-dollar market value. Models that tap this market could simultaneously improve the quality of life for the poor and outlast the sporadic, albeit well-meaning injections of charitable sources. Enterprises with sound business models can make quality public health goods available and affordable.

My team and I have witnessed such success in improving food systems by supporting entrepreneurship and promoting effective business models in the Global South. We are doubling down, initiating Food Systems Innovation Hubs in emerging markets. The hubs will nurture entrepreneurs in these rapidly growing economies by establishing sound business models and forming partnerships with investors, donors, government, and companies in the localities where they operate.

There is a massive well of untapped entrepreneurial talent in the developing world, and Sight and Life is committed to helping them help us all in our quest to alleviate malnutrition. To learn more about Food Systems Innovation Hubs, watch the recent webinar and learn how to be part of the coordinated effort to improve the world’s food systems. Read further on the topic by clicking HERE

Fortifying Our Food to Fight Climate Change

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Fortification Definition: The practice of deliberately increasing the content of an essential micronutrient, i.e. vitamins and minerals (including trace elements) in a food, so as to improve the nutritional quality of the food supply and provide a public health benefit with minimal risk to health.

In recent decades, two very modern elements have radically transformed the world’s food systems: rapid technological advancement and global warming. Giant leaps in technology have been possible as innovations rapidly build on each other. In most cases, they have been tremendously efficient and beneficial. For instance, the cost of DNA sequencing per genome was US$100 million in 2001. Today it costs just US$1,000. Smart agricultural technologies such as low-cost sensors for soil, irrigation, and cloud computing have empowered farmers to make data-driven decisions, access best practices in real-time, and minimize the use of inputs, putting them in a position to conserve resources while improving productivity. Advances in genome sequencing, aerial and satellite coverage, and mobile platforms for precision farming also benefit smallholder farmers.

Despite these positive developments, climate change has proven to be a formidable challenge. Rising levels of carbon dioxide in the atmosphere not only heat up the globe, creating drought and other weather shocks that significantly impact crops, but they also reduce the concentrations of essential micronutrients and protein in major food staples such as rice, wheat, maize, pulses, and potatoes. This could potentially compromise the nutritional intake and consequent health of future generations.

How can we wield humanity’s considerable capacity for innovation to combat climate change’s devastating effects on the world’s crops?

We have already seen some new technologies developed which allow growing cycles to be reduced, enabling food to be grown by anyone, anywhere – even in tiny urban spaces. Another surprising solution may be food fortification. In the wake of the 2019 EAT-Lancet Report on Food, Planet and Health, Greg Garret and colleagues raised an intriguing concept: Can Food Fortification Help Tackle Climate Change? Data to support this notion is still limited. Still, given the massive contribution of food production to greenhouse gas emissions, along with the fact that food and micronutrient production will need to increase to meet the needs of 10 billion people by 2050, this question certainly deserves further exploration.

While global warming is most certainly a global problem, its effects are keenly felt in low- and middle-income countries (LMICs). These regions also have seen less widespread fortification of their local food staples than high-income countries (HICs). Therefore, fortification could be an effective “one-two-punch” against both dietary micronutrient deficiency and the climate change shocks experienced by food systems.

Sight and Life believes that targeted investment and technology transfer from HICs to LMICs will be crucial in sharing and adapting existing techniques, like food fortification, to new markets. To that end, we are initiating Food Systems Innovation Hubs in Africa and Asia to accelerate this process. These hubs will share both capital goods and knowledge resources with partners in developing countries, allowing LMICs to access productivity and sustainability enhancing innovations, which will be key to fortifying local diets and strengthening their fragile food systems.

To learn more about Food Systems Innovation Hubs, watch the recent webinar and learn how to be part of the coordinated effort to improve the world’s food systems. Read further on the topic by clicking HERE

 

Progress through Policy

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“Red tape will often get in your way. It’s one of the reasons I often carry scissors.” – Richard Branson

The lack of harmonized regulations and standards prevents the most vulnerable populations from accessing high-quality and affordable nutritional products like MMS. Photo Credit: Vitamin Angels

Several low- and middle-income countries that see significant levels of maternal anemia and low birth weight newborns are considering the introduction and scale-up of Multiple Micronutrient Supplements, or MMS, to provide mothers the nutrients they need for healthy pregnancies. This is an admirable goal, albeit one that is frustratingly impeded by significant regulatory challenges. For example, there is little consensus on how a nutritional product is classified in different countries or by international agencies; it can be considered either a dietary supplement and regulated as a food or a therapeutic product regulated as a drug. In addition, regulatory agencies worldwide set different manufacturing requirements and quality standards for nutritional products, which are not always harmonized. This then presents challenges when a nutritional supplement is imported into or manufactured in countries with different regulation levels, ultimately preventing the most vulnerable populations from accessing high-quality and affordable products with the potential to improve health outcomes significantly.

A country’s food system is an equally complex machine, with the interplay between farmers, consumers, regulators, testers, manufacturers, and distributors. Inefficiencies or problems anywhere in this ecosystem can cause a domino effect felt along the value chain. Sadly, authorities in many countries in the Global South currently lack the capacity to create and enforce regulatory frameworks conducive to providing safe, nutritious, and accessible foods. Many producers also struggle to comply with the regulatory frameworks in place due to a lack of testing capacity and compliance support, leading to products that do not meet national or international standards or align with label claims.

There are systemic hurdles to delivering proper nutrition to those who need it. What can be done?

One of the most important steps in inducing a transformational change in food systems is integrating nutrition in sectors beyond public health, bringing private sector players into the nutrition fold. How can governments achieve this? Let us take the example of large-scale staple food fortification in India, such as rice or edible oil. Given that fortified variants are usually slightly more expensive to produce than unfortified products, voluntary fortification does not present a strong business case for the private sector, and compliance can quickly evaporate when there is a change of corporate management or leadership in the governing body—making fortification mandatory would increase compliance. The government is also poised to assist companies by educating their citizens on the health benefits of choosing a fortified food. This assistance, or “carrot”, creates a market incentive to balance the “stick” of mandatory regulation.

 

The Indian government roped in the most popular cricketer in the country, Virat Kohli, for a brand-agnostic campaign to create a consumer pull for fortified foods and incentivize the private sector to sustainably introduce fortified variants in the market. Source: Food Fortification Resource Centre

As demonstrated by this example, government regulators and the private sector can find ways to support the health of their population and consumers in a coordinated manner.

The challenges highlighted earlier can seem intractable, but Sight and Life believes that a new initiative can lead to real progress – Food Systems Innovation Hubs. These hubs, which will operate in rapidly emerging economies in need of regulatory assistance, can share expertise and resources to foster capacity-development and address existing gaps in regulations and standards. They will also provide testing monitoring support to allow producers and processors to improve the quality of their output. The Food System Innovation Hubs will focus on accelerating technology transfer, and investment from the Global North to the Global South, enabling the kind of knowledge sharing that can contribute to increased standardization across borders.

Everyone benefits when food systems prioritize good health.
 

Food Systems Innovation Hubs are a bold, new initiative that will accelerate innovation, streamline processes, and support nature-positive, biodiverse agriculture to better nourish the nations and communities they serve.  Join us in this coordinated effort to improve the world’s food systems. We welcome you to bring your unique skills and resources to bear in helping solve these unique challenges.

Watch this engaging webinar discussing the importance of a Food Systems Innovation Hub and be part of the coordinated effort to improve the world’s food systems. Read further on the topic by clicking HERE

Small and Medium Enterprises – Key to Good Nutrition

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According to our estimates, 600 million jobs will be needed by 2030 to absorb the growing global workforce, which makes SME development a high priority for many governments around the world[i].
(The World Bank)

Small and Medium Enterprises, commonly referred to as SMEs, constitute approximately 90% of all businesses worldwide, accounting for nearly 50% of total employment[i]. They are also the most significant actors in many developing countries’ food systems, and yet SMEs often struggle to attract interest and investment. Most high productivity technologies rest with conglomerates in the global north who benefit from large consumer markets and, more importantly, pools of venture capital to develop disruptive innovations. These innovations are vital to boosting nature-positive production of agricultural goods while preserving and advancing equitable livelihoods. The disparity of investment between conglomerates and the SMEs of low and-middle-income countries (LMICs) limits the latter’s ability to stay ahead of the innovation curve[ii]. This in turn caps a community’s economic development and stifles its citizenry’s upward mobility, making access to affordable and good nutrition more challenging.
 
If we want to help improve the nutrition levels and health of a population, we should therefore look to bolster its SMEs.

Room for improvement

Sight and Life has long been interested in finding ways to boost the productivity and income of SMEs in LMICs and has researched different business models which can be most effective. Recently, we investigated constraints in egg production in four countries – Kenya, Ethiopia, Malawi, and India – and identified five business models that are viable and sustainable (read more on why we love eggs here). Of those five, the Egg Hub model has proven to be the most successful. An ‘Egg Hub’ is a centralized unit providing high quality affordable inputs, extension services, training, and market access to small and medium farm enterprises (out-growers) involved in layer farming.  This approach showed rapid increase in egg yields, achieved self‐sufficiency, reduced the price of eggs, and provided a high income for the farmers, a majority of whom are women. We found that this model was successful in improving hen productivity from an average of 40 eggs per bird to 270-300 eggs – an outstanding result.

It should be noted that private companies were the ones to develop the Egg Hub model, and although the commercial players did not see any immediate profit, they will have long‐term sustainable gains through increased market share, justifying their initial capital investment.[iii]

20% lower egg prices “We now eat eggs frequently as they are easily accessible, unlike in the past.” – Young mother
3X more income “We are very happy as we are able to support our family through the business.” – Smallholder farmer
2x more eggs “We have raised the bar in our standard of living. Even our children will be able to find jobs through the same business of raising chicken.”  – Farmer

This study demonstrates how impactful the right kind of efforts can be on SMEs, the livelihoods they support, and food systems. To enable more of this sort of targeted investment all along the value chain, Sight and Life is initiating Food Systems Innovation Hubs in rapidly emerging markets such as Nigeria, Bangladesh, and Rwanda. These hubs will work to alleviate malnutrition through corporate partnerships, impact investors, and government collaboration in the context of a robust entrepreneurial culture in these geographies.

Food Systems Innovation Hubs can help unlock the full potential of SMEs by using proven strategies and increasing capital flow to LMICs. We encourage you to join us in this effort by joining the upcoming webinar on February 2 to learn more about this initiative and how you can contribute.


 
 Read further about our ideas for the Food Systems Innovation Hub HERE

References

[i] The World Bank
[ii] https://www.worldbank.org/en/topic/smefinance. Accessed online on January 17, 2021
[iii] Beesabathuni K, Lingala S, Kraemer K. Increasing egg availability through smallholder business models in East Africa and India. Matern Child Nutr. 2018;14(S3):e12667. https://doi.org/10.1111/mcn.12667

Valuing Nutrition

 

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“It would be easy to give the public information and hope they change behavior, but we know that doesn’t work very satisfactorily. [If it did] none of us would be obese, none of us would smoke and none of us would drive like lunatics.”
– Ian Potter, Director New Zealand Health Sponsorship Council

Why do we choose the foods that most commonly make it to our tables? Are they the cheapest options? The tastiest? The easiest to grow? Are they perhaps infused with nostalgia or promoted by an irresistible advertising campaign? Not surprisingly, a multitude of factors are at play, although their hierarchy is naturally affected by a person’s buying power and economic status.

Consider, for example, the habits of consumers considered to be Bottom of Pyramid (BoP). Fully two-thirds of the world’s population fall into this category, many living in the Global South’s rapidly emerging economies. Some of these booming communities continue to struggle with malnutrition and micronutrient deficiencies, even as their buying power increases. It turns out that increased availability of nutritious foods by itself will not generate change on the scale necessary to meet national and global commitments related to hunger and malnutrition. Interestingly, it has been demonstrated that BoP consumers are ready to pay more for nutritious products if they deem them to be valuable. For example, mothers will want to give their children the best food they can afford, selecting something they perceive as higher quality, not necessarily the cheapest product on the shelf. [i]

Understanding the consumer

Encouraging a shift towards nutritious, safe, and tasty and affordable foods in the developing world will require social marketing campaigns to generate demand for these diets by shaping the consumer’s understanding of what is valuable. How can we best support efforts to empower consumers to make healthy choices?

Sight and Life has studied the ways alternative protein brands have chosen to engage with their consumers in High-Income Countries. Two American companies, for example, appealed to certain narrative “archetypes” – The Hero and The Innocent – providing the brands a more human feel and allowing their consumers to identify either as a climate change fighting Hero, or as a person free from any societal guilt, ie. an Innocent. (You can read more on this study here). But would these archetypes speak to BoP consumers in the Global South? Can we alter the manifestations of such archetypes such that they resonate with low-and-middle-income consumers? Can the sense of purpose be made more personal and placed within the Global South consumer’s needs?

An innovative solution

Such an avenue of exploration can be undertaken by Sight and Life’s new initiative, Food Systems Innovation Hubs. The factors that drive demand for nutritious foods in the Global South are convenience, affordability, and aspirational value. The Innovation Hubs – located in places such as Bangladesh, Nigeria, and Rwanda – will address all three factors by engaging in downstream activities such as running market surveys and consumer campaigns, lowering distribution costs through common logistics, shaping industrial policy towards nutrition, and creating an enabling environment through regulatory and marketing support. Most importantly, these hubs will focus on discerning and amplifying the values and priorities of the communities it serves, ultimately helping them choose healthy, nutritious diets.

To learn more about the Food Systems Innovation Hubs by joining us on February 2 for a webinar or reading the blog series HERE.

 

References

[i] “Marketing Nutrition for the Base of the Pyramid”, Report by Hystra – Hybrid Strategies Consulting, April 2014

A Double Burden on our Emerging Economies

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Malnutrition, in all its forms, including undernutrition (wasting, stunting, underweight), micronutrient deficiencies, overweight, obesity, and resulting diet-related noncommunicable diseases, is the leading cause of poor health globally[i]. The double burden of malnutrition is characterized by the coexistence of undernutrition along with overweight and obesity, or diet-related noncommunicable diseases within individuals, households, and populations and across the life course.

Cause for concern

The obesity epidemic has received much attention in recent decades, particularly in high-income countries, and with good reason. According to the World Health Organization, 39% of the world’s adult population is overweight, with 650 million of these adults being obese. An estimated 38.2 million children under the age of 5 were overweight or obese in 2019[ii]. Obesity brings with it a myriad of health challenges such as the increased risk for type 2 diabetes, coronary heart disease, stroke, and certain types of cancer,[iii] and increased risk of severe illness from the virus that causes COVID-19[iv]. This puts tremendous pressure on individuals and health systems.

A parallel epidemic plaguing large swaths of the globe has been undernutrition. While we have seen some positive changes with a relative reduction in undernutrition of 19% from 1991 to 2017 and the prevalence of hunger fallen from 14.8 percent in 2000 to 10.8 percent in 2018, progress remains slow. Eight hundred and twenty million people are undernourished, and 9% of the world’s population are food insecure[v].

Unfairly, these two epidemics have collided in low- and middle-income countries, giving rise to a problem known as the Double Burden of Malnutrition. These two forms of malnutrition – over and under – can coexist within countries and communities (for example, where there is a prevalence of both undernutrition and overweight in the same community), within households (when a mother may be overweight or anemic and a child or grandparent is underweight), and even within the same person over their lifetime (obesity with deficiency of one or various vitamins and minerals, or an overweight adult who was stunted during childhood). Sadly, this has become the new norm in many parts of the world that have had to continue tackling undernutrition while finding themselves increasingly challenged to fight growing rates of obesity.

These countries cannot afford to ignore the potential of unhealthy diets. A food system that is efficient in delivering healthy food to all at an affordable price, in all situations, is required. High-income countries have seen the cost and consequences of not recognizing this sooner. Current estimates suggest that malnutrition costs the global economy US$3.5 trillion a year – 11% of the world’s GDP.[vi]

Although the double burden remains a largely untapped area for integrated policy action, there are opportunities to act. It presents a unique opportunity for mutual learning and collaboration between the Global North and Global South, as every country in the world is affected by one or more forms of malnutrition.

A way forward

This sparked an idea within the Sight and Life team – The Food Systems Innovation Hub, a place poised to deliver just such a point of collaboration. Designed to accelerate technology transfer and targeted investment in emerging economies such as Nigeria, Rwanda, and Bangladesh, they will provide a mechanism for sharing techniques and knowledge to tackle this double burden. This may take the form of social marketing campaigns to generate demand for more nutritious foods or of even more ambitious measures like aggregating the output of a local crop (teff in Ethiopia, for example) to make it more affordable and nutritious by fortifying it with vitamins and minerals.

We have a long way to go to achieve the Sustainable Development Goals outlined by the UN, but I am confident that these Innovation Hubs will be a step in the right direction. Sight and Life invites you to join us in this new, bold initiative and learn how you can become involved. 

Read more on the Food Systems Innovation Hubs HERE and watch the Foods Systems Innovation Hub webinar to find out more. Learn more about the Double Burden of Malnutrition in the 2018 issue of Sight and Life Magazine.

References

[i] https://www.who.int/news-room/fact-sheets/detail/malnutrition (accessed 7 January 2021).
[ii]https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight#:~:text=Some%20recent%20WHO%20global%20estimates,%25%20of%20women)%20were%20overweight (accessed 7 January 2021).
[iii]https://www.ncbi.nlm.nih.gov/books/NBK44656/#:~:text=The%20prevalence%20of%20obesity%20changed,children%20during%20the%20same%20period. (accessed 7 January 2021).
[iv] https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html (accessed 7 January 2021).
[v] https://ourworldindata.org/hunger-and-undernourishment (accessed 7 January 2021).
[vi] www.nutraingredients.com/Article/2014/11/14/Malnutrition-costs-11-of-world-sGDPGlobal-Nutrition-Report (accessed 29 October 2018).

Innovation for Transformation

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The Covid-19 pandemic has served as a collective reminder that our well-being is delicately intertwined with that of our neighbor. During this crisis, we have also seen that the transfer of data, information, know-how, and resources across borders has been crucial in accelerating our capacity for mitigation. By sharing new treatment strategies, developing safe and effective vaccines, and distributing PPE to those who need it most we have come together in a global, coordinated effort. This has been remarkable and heartening to witness.

“It is unacceptable that hunger is on the rise at a time when the world wastes more than 1 billion tonnes of food every year. It is time to change how we produce and consume, including to reduce greenhouse emissions. Transforming food systems is crucial for delivering all the Sustainable Development Goals. As a human family, a world free of hunger is our imperative.” UN Secretary-General António Guterres 
Here at Sight and Life, we care deeply about the health and wellbeing of our fellow world citizens and have been working to improve access to quality nutrition globally since our inception during the famine in the Horn of Africa in the mid-1980s. Through our work at the foundation, we have seen firsthand the immense impact scientific evidence, technology transfer, and targeted investment can have on food systems.

Innovate for nutrition

Take the egg, for example. Eggs are nutrient-dense animal source foods and have been shown to reduce stunting in young children. But eggs are expensive and scarce in most low and middle-income countries (LMIC). In Malawi, smallholder farmer groups have increased their income and produce more and more affordable eggs with the support of an Egg Hub, a centralized unit that provides inputs, technical assistance, credit, and market access (learn more by visiting egghub.org).
 
Unfortunately, an immense gulf still exists that we cannot continue to ignore. In LMIC the effects of malnutrition and climate change become progressively dire. Most high productivity technologies that can help mitigate these shocks rest with organizations in high-income countries (HIC) that benefit from large consumer markets and large pools of venture capital to test and try innovations to make food systems nutritious and sustainable. These innovations are vital to boosting the nature-positive production of agricultural goods while preserving and advancing equitable livelihoods.

At the same time, in rapidly emerging consumer markets in the global south, such as India and Nigeria, the effects of malnutrition and climate change remain devastating. Malnutrition in young children is a life-sentence not only for that child but also for the community and country in which they live and grow. A stunted child may never catch up to his or her peers and will therefore fail to thrive and lead a dignified life, as every child should have the right to do.

Collaboration is key

Sight and Life is determined to change all of this. That is why we are launching a new initiative – Food Systems Innovation Hubs.

We will work to establish hubs in rapidly emerging consumer markets, such as India, Bangladesh, Nigeria, Rwanda, and Kenya to stimulate investment in resilient and responsive food systems, as well as facilitate relevant technology transfer and know-how from HIC to LMIC. Through partnerships, government collaboration, impact investors, and philanthropies in the context of local entrepreneurs, these hubs will catalyze a transformative change for society-wide dietary shifts towards more efficient, healthier, and more environmentally friendly food systems.

Get involved

I invite you to join us in this coordinated effort to improve the world’s food systems and to reach out to learn how you can become involved. I know that we can work together to solve this global problem of peoples’ and planetary health. To learn more,  about Food Systems Innovation Hubs watch the recent Food Systems Innovation Hub webinar discussing the importance of innovation and nutrition for global health. To connect with us, please email info@sightandlife.org.

“The Power of Us”

Micronutrient Forum Connected 2020

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Connecting the nutrition community

An important milestone in the evolution of the Micronutrient Forum, and in the growth of the global nutrition community as a whole, took place in November 2020. Four years after its previous very successful conference, which took place in Cancun, Mexico, the Micronutrient Forum (MNF) held its fifth global conference, MNF CONNECTED.

For five days, people from all over the world came together online to explore the conference theme of ‘Building New Evidence and Alliances for Improving Nutrition.’ This was a bold experiment – a strong act of recovery from the disappointment of having to cancel the 5th MNF global conference in its originally planned form in Bangkok during March of this year as a result of the COVID-19 pandemic.

A huge effort went into planning the original conference; an ever greater effort went into planning and delivering this innovative virtual alternative. In its own words, “The Micronutrient Forum serves as a global catalyst and convener for sharing expertise, insights and experience relevant to micronutrients in all aspects of health promotion and disease prevention, with special emphasis on the integration with relevant sectors.” This mission was very effectively fulfilled during MNF CONNECTED.

Structure and content

The online conference was structured in five tracks:
Track 1: Micronutrient Biology and Status Assessment
Track 2: Efficacy and Safety of Micronutrient Interventions
Track 3: Program Effectiveness
Track 4: Designing an Enabling Environment for Micronutrients
Track 5: Food Systems

Conferences always provide a wealth of information and a host of opportunities to exchange research findings and opinions. MNF CONNECTED 2020 was no exception. Making a virtue of necessity, the conference organizers created a dedicated website that was strongly branded and easy to navigate, giving visitors the sense of entering a special space full of information and action.

Launched in advance of the conference, this website functioned as a place of meeting, information and sharing for all participants, providing the opportunity to conveniently review and select elements from the extensive conference program. The content included sessions that were livestreamed each day along with a large amount of pre-recorded contributions that could be viewed on demand.

A significant advantage of this format was that conference delegates had the opportunity to watch sessions that might otherwise have been running simultaneously, and to follow contributions from all of the tracks – an important consideration in the context of an event whose aim is to be a “global catalyst and convener for sharing expertise, insights and experience.” This facilitating role is also being expanded beyond what would have been possible in the context on a traditional conference, for the entire conference content will remain online and be accessible to delegates for the coming year.

The enforced choice of online delivery had the additional benefit of reducing attendance costs considerably and eliminating travel costs completely, making this event accessible as never before. Delegate numbers exceeded 3,500, with an unprecedentedly high level of participation on the part of colleagues from low- and middle-income countries. Certain of these, however, reported that the broadband coverage in their location was insufficient to cope with the requirements of streaming – an issue that will certainly be addressed if a similar conference is held again.

High expectations

First established in 2006 as the successor to the International Vitamin A Consultative Group (IVACG) and the International Nutritional Anemia Consultative Group (INACG), the Micronutrient Forum convened international conferences in Istanbul in 2007, Beijing in 2009, Addis Ababa, Ethiopia in 2014, and Cancun, Mexico in 2016. It was chaired by Alfred Sommer  (professor and former dean of Johns Hopkins Bloomberg School of Public Health, and the former Chair of IVACG) from its inception until 2010, when it lapsed due to USAID’s decision to discontinue support. A group of interested organizations, including Sight and Life, brought it back to life after brief hiatus and in 2014 convened the Addis conference. From 2010 to 2017 Lynnette Neufeld (Director, Knowledge Leadership at GAIN) was Chair of the Steering Committee of the Micronutrient Forum.

Saskia Osendarp

Since staging its 2016 conference, the Micronutrient Forum has become a legal entity and non-profit organization under the leadership of Executive Director Saskia Osendarp and MNF Board Chair Howdy Bouis, entering a new level of organizational maturity.

Expectations of the 5th global conference were therefore high – and additionally so because of the impact of the COVID-19 pandemic on many of the world’s poorest and most vulnerable populations. As Princess Bajrakitiyabha Narendira Debyavati, the Princess Rajasarinisiribajra of Thailand, observed when formally opening the conference on 9 November, the global nutrition community can still connect and collaborate in the face of COVID-19, working harmoniously to combat micronutrient deficiencies around the world.

Joel C. Spicer

Joel Spicer, President and CEO of Nutrition International, and responsible for hosting the Micronutrient Forum for six years, put it more bluntly during the second day of the conference: “It’s time to ring the alarm bell for nutrition,” he said: “if nutrition doesn’t get attention now, it will slip through the cracks.” (Watch the full session: How to keep micronutrients as a priority with shifting global, national and donor priorities?)

Sense of urgency

Lawrence Haddad

This sense of urgency was likewise conveyed by Lawrence Haddad, Executive Director of GAIN, who gave the keynote speech during the opening of the conference. Looking forward to next year’s United Nations Food Systems Summit, with its stated aim to “launch bold new actions to deliver progress on all 17 SDGs”, as well as to the Nutrition for Growth (N4G) Summit to be held in December 2021, Lawrence stated that “our global food system is on the wrong track, and we have to find the levers to get it onto the right track,” emphasizing that “2021 is the best opportunity for positive change we will have in the next ten years.” (Watch the full session: How to meet global micronutrient needs within sustainable food systems)

This, then, was the setting for the work of the five conference tracks – not just to present the findings of self-contained research studies and implementation programs but to seek the connections between these lines of endeavor. Time and again, the interrelated themes of connection and collaboration were revisited by conference speakers and also delegates, who had the opportunity to correspond with presenters via a live chat facility and also to connect with them online before or after their live sessions.

Micronutrient biology, the subject of conference Track 1, is something that can be influenced by designing and delivering appropriate interventions on the basis of scientific evidence. The enabling environment, the subject of Track 4, can likewise be shaped by targeted policy interventions. Delivering effective programs (Track 3) based on efficacious and safe micronutrient interventions (Track 2) can help address micronutrient deficiencies. 

The challenge of inadequate food systems

However, the 2020 edition of the State of Food Security and Nutrition in the World, jointly prepared by FAO, IFAD, UNICEF, WFP and WHO and published by FAO in July, estimates that almost 690 million people went hungry in 2019 – up by 10 million from 2018, and by nearly 60 million in five years. One reason for this is the world’s inadequate food systems, which fail to deliver many of the elements essential for a healthy, balanced diet, and which also do not meet the nutritional requirements of the world’s most vulnerable populations. The very concept of ‘food systems’ is a relatively new one, however – there was no conference track dedicated to it when the Micronutrient Forum last convened, in 2016 – and although inadequate food systems might be easy to diagnose and describe, they are much less easy to fix.

David Nabarro

This conundrum was eloquently and memorably expressed by David Nabarro, the founding coordinator of the UN Scaling Up Nutrition (SUN) Movement, who is currently advising the Director General of WHO on its response to the COVID-19 pandemic. In his concluding observations on 13 November, he observed that, “A malnourished child does not have an alarm light on its head to flash ‘nutrition emergency’. The emergency is invisible – and it leads to lifelong disadvantages that are mental, emotional, and physical, as well as economic. This magnificent MNF CONNECTED has realized that malnutrition is a sign that things are not right. Acting to change this is complex, however.” Quoting Saskia Osendarp, and thanking her for her leadership in delivering this conference, David continued, “We need to step out of our own shadow and work together as never before.” (Watch the full session: Look up, don’t look down: how to redesign the future for nutrition post-COVID19)

“The power of us”

This was the key take-away from a remarkable event that was a milestone in every sense of the word. Saskia Osendarp re-emphasized David Nabarro’s point in her concluding remarks: “We all want to meet up again physically, but this conference has shown how connected we can all be. There are no magic bullets, and we must work much more closely across sectors to address micronutrient deficiencies – using the power of us.”

Klaus Kraemer
Klaus Kraemer

Klaus Kraemer, Chair of the Micronutrient Forum Conference Committee, and Managing Director of Sight and Life Foundation, observed in this context that, “As a global nutrition community, we need to speak in a clear and coordinated voice.” For, as he continued, “If we want to change policy, we need to speak the language of policy.” This will be a major challenge for the nutrition community – to speak clearly in a concerted voice that external decision-makers can understand.

Too important to be left to nutritionists?

Eileen Kennedy, professor and former dean of the Friedman School of Nutrition Science and Policy at Tufts University, perhaps had this in mind when she quoted a nutritionist of days gone by as saying that nutrition was too important to be left to the nutritionists. (Watch the panel discussion: How to keep micronutrients as a priority with shifting global, national and donor priorities?) The remark had been made not in this century but in the previous one, by Howard A. Schneider, Director of the Institute of Nutrition at the University of North Carolina, at the Nutrition-related Oversight Review, Hearings Before the Subcommittee on Domestic and International Scientific Planning, Analysis, and Cooperation of the Committee on Science and Technology, U.S. House of Representatives, Ninety-fifth Congress, First Session, in 1977.

“The nourishment of human beings is a complex affair that taps a multitude of the components and agencies of both our public and private lives,” said Schneider. “Like Clemenceau’s aphorism that war is too important to be left to the generals, I sometimes am persuaded that human nutrition is too important to be left to nutritionists.”

From “The power of us” to “Speech to power”

Francesco Branca

The achievements of MNF CONNECTED were great. For them to be translated into action, intensified cross-sectoral collaboration is necessary. But so is speech to power. As Francesco Branca, Director of the Department of Nutrition for Health and Development at WHO put it: “We can’t have a world with three billion left out.” (Watch the full session: How to meet global micronutrient needs within sustainable food systems)
 
MNF CONNECTED will be the subject of a Sight and Life Special Report that is scheduled for publication on 1 February 2021. Watch this website for further information. 

The Dietary Diversity Score Dilemma

Why do fortified foods go uncounted?

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Today, Sight and Life is joining hands with FAO to celebrate World Food Day. This year, in fact, marks the 75th Anniversary of the founding of FAO, and World Food Day 2020 aptly has the theme “Grow, nourish, sustain. Together. Our actions are our future.”

Here at Sight and Life, we have been working for many years on food fortification programs designed to enhance the diet quality of vulnerable populations. In this blog, we take a closer look at how micronutrient deficiencies are measured, and we challenge researchers and policy-makers to re-think current dietary metrics in the face of the Covid-19 pandemic.

Food Fortification

Improving the quality of diets worldwide

The latest SOFI report reminds us that access to nutritious food is one of the most pressing issues of our time (2). Globally, the majority of consumed calories are derived from grains (45%), followed by sugars and fats (20%), then fruit and vegetables (11%) (1). These numbers illustrate a recurring situation: people in low-income countries rely on the consumption of staples due to the high cost of fresh and nutritious foods such as fruit, vegetables, and animal-source foods. This is not surprising when we reflect that healthy and diverse diets are five times more expensive than staple-based diets (2).

The current pandemic has intensified an already unacceptable situation by compromising access to school feeding programs, disrupting nutritious food value chains, and further reducing the purchasing power of consumers. Food fortification is a recognized and cost-effective approach to improve the nutritional status of populations in both high-income and low-income countries. It benefits especially those who rely on a staple-based diet that is generally poor in essential micronutrients.

When access to nutritious foods is limited, the fortification of staple foods can help ensure an adequate intake of essential micronutrients. Moreover, fortified foods help support the body’s immune defenses against infections (3) (read more: the role of nutrition in the immune system). In short, food fortification enhances dietary diversity, a key element of diet quality, and has important health benefits too.

Dietary diversity: What is it and how do we measure it?

Dietary diversity was found to serve as a proxy indicator to assess and predict the intake of micronutrients (4,5,6). To easily assess the dietary diversity of a population, a practical tool was developed: the Dietary Diversity Score (DDS) (7). The score reflects the number of different (and pre-defined) food groups that have been consumed by a sample of the population during the previous 24 hours, as described by Krebs et al in 1987. The score is calculated by summing up the number of food groups consumed.

Dietary Diversity Score

Today, the DDS has been differentiated according to the intended target groups and counts up to 12 food groups, depending on the target group of the score (Figure 1). In both the DDS for women and the DDS for children, we find a differentiation for some specific fruits and vegetables to adequately reflect their specific micronutrient composition. Globally, less than one in three children aged 6–23 months (29%) were found to consume five out of eight pre-defined food groups and thus meet the minimum dietary diversity (MDD) (2).  The percentage of children meeting the MDD varies greatly across the globe. In Burkina Faso and Guinea respectively, for example, only 5.2% and 5.9% of children received the MDD, whereas in Turkmenistan and Peru respectively, 82.5% and 82.9% of children met the MDD score (8). The MDD-W (W = women) was included as a core indicator in the Demographic and Health Survey (DHS) in 2019. To date, three countries have published data (2). The available data indicate poor dietary diversity and consequent micronutrient inadequacy.

Overall, the advantage of DDS indicators is the ease with which the data can be collected, analyzed and interpreted. DDS is a practical tool for use in resource-poor settings, and its results can easily be communicated. The most remarkable limitation of DDS, however, is the fact that it does not reflect the intake of fortified food.

Even more astonishing is the fact that the DDS guideline strongly recommends documenting the consumption of these foods (9). The extent to which we can accurately predict micronutrient adequacy in populations with a diet based on cereals and/or other staples, which are often fortified, is still entirely unknown.

Figure 1: Food group classification for different dietary diversity scores

Figure reference: Muthini D, Nzuma JM, Qaim M. (2018). Subsistence production, markets, and dietary diversity in the Kenyan small farm sector (No. 127). Global Food Discussion Papers.

What about fortified foods?

In scientific literature, the lack of differentiation between fortified and non-fortified foods appears to be recognized by two studies only, both from the Philippines. One study by Tsz-Ning Mak et al, suggested to improve the sensitivity of DDS by differentiating between nutrient-rich or fortified foods and energy-dense foods that are low in micronutrients (10). Likewise, Daniel et al experienced difficulties when attempting to classify certain nutrient-dense foods, such as organ meat, in the DDS scoring system. This proved to be difficult, as great differences in micronutrient composition exist between the same foods within the same food group (11).

Interestingly, the World Food Programme (WFP) recently introduced a new scoring methodology to monitor the impact of the consumption of their Super Cereal, which is distributed among vulnerable groups of women. Based on its nutrient composition, the fortified Super Cereal is now considered to be part of the food group ‘meat’, whereas traditionally, it would have been part of the food group ‘grains’ (12).

The lack of attention from the global nutrition community to the assessment of fortified food consumption seems misaligned with the extensive efforts and resources expended on food fortification. Foods fortified with crucial micronutrients such as iron, folic acid, vitamin A and iodine are recognized as increasing diet quality. However, without differentiating between fortified and unfortified food in the DDS, it will be impossible to accurately measure and monitor the results of our efforts on food fortification.  Why do we acknowledge the varying micronutrient compositions of different groups of fruits and vegetables, but not those of fortified and non-fortified foods?

Conclusion

At Sight and Life, we urge researchers and policy-makers to re-think the need for a cost-efficient, practical, and rapid diet quality indicator that has the capacity to promote and acknowledge the contribution of fortified foods to diet quality worldwide. The necessity to re-think our dietary metrics was stressed in Miller et al’s recent review (13). Likewise, Walls et al’s recent paper highlights the inadequacy of existing dietary indicators for measuring the ongoing nutrition transition (14).

By adapting the DDS-W food classification to reflect the intake of the Super Cereal fortified food, WFP took a step in the right direction. However, we should not stop here. We therefore invite global stakeholders to tackle this issue. The inclusion of fortified foods in dietary metrics such as the DDS will enhance the visibility of their impact on the nutritional status of vulnerable populations. This, in turn, could encourage policy-makers (and other actors of the enabling environment) to strengthen food fortification standards, laws and regulatory monitoring.   

All graphics created by Sight and Life’s Architect and Design Specialist Anne Milan.
 
References

1 Future Food Systems: For people, our planet, and prosperity 2020. The Global Panel on Agriculture and Food Systems for Nutrition.

2 UNICEF. The State of Food Security and Nutrition in the World 2020. Transforming food systems for affordable healthy diets. Rome FAO 2020

3 FOOD FORTIFICATION: A WEAPON AGAINST COVID-19 Food Fortification Initiative http://www.ffinetwork.org/FFI_COVID-19andFortification.pdf

4 Hatloy A, Torheim LE, Oshaug A: Food variety-a good indicator of nutritional adequacy of the diet? A case study from an urban in Mali, West Africa. Eur J Clin Nutr 1998, 52:891–898.

5 Ogle MM, Hung PH, Tuyet HT: The significance of wild vegetables in micronutrient intakes of women in Vietnam: an analysis of food variety. APJCN 2001, 10:21–30.

6 Torheim LE, Barikmo I, Parr CL, et al: Validation of food variety as an indicator of diet quality assessed with a food frequency questionnaire for western Mali. Eur J Clin Nutr 2003, 57:1283–1291.

7 Krebs-Smith SM, Smiciklas-Wright H, Guthrie HA, Krebs-Smith J. (1987). The effects of variety in food choices on dietary quality. Journal of the American Dietetic Association, 87(7), 897-903.

8 UNICEF. Expanded Global Database Complementary Feeding. 2019. Online. Access October 15, 2020. https://data.unicef.org/topic/nutrition/infant-and-young-child-feeding/

9 Kennedy G, Ballard T, Dop M. (2013). FAO Guidelines for Measuring Household and Individual Dietary Diversity. Rome, Italy: Food and Agriculture Organization of the United Nations.

10 Mak TN, Angeles-Agdeppa I, Lenighan YM, Capanzana MV, Montoliu I. Diet Diversity and Micronutrient Adequacy among Filipino School-Age Children.

11 Daniels MC, Adair LS, Popkin BM, Truong, YK (2009). Dietary diversity scores can be improved through the use of portion requirements: an analysis in young Filipino children. European Journal of Clinical Nutrition, 63(2), 199-208.

12 WFP. Minimum Dietary Diversity for Women (MDD-W), WFP Guidance. January 2019

13 Miller V, Webb P, Micha R, Mozaffarian D, Database GD. (2020). Defining diet quality: a synthesis of dietary quality metrics and their validity for the double burden of malnutrition. The Lancet Planetary Health, 4(8), e352-e370.

14 Walls HL, Johnston D, Mazalale J, Chirwa EW. (2018). Why we are still failing to measure the nutrition transition. BMJ global health, 3(1), e000657.

Alternative Proteins: The nutritionists perspective

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The world’s population is growing, and for many, the question of how we ensure an adequate food supply for all while sustaining our planet and natural resources is a crucial one. Fundamental to addressing the current global nutrition crisis is to deliver food that can guarantee delivery of adequate nutrients to people affected by all forms of malnutrition and the population as a whole. According to the Food and Agriculture Organization of the United Nations (FAO), sustainable diets have a low environmental impact while contributing to food and nutrition security for our present and future generations. In other words, sustainable diets should respect and protect ecosystems and biodiversity next to being culturally acceptable, affordable, accessible, safe and healthy [1].

The food industry has shown the capability to rapidly adapt and innovate to meet the growing demand for more sustainable diets. This initiative is particularly reflected in the growing market for alternative proteins, which are increasingly becoming available to consumers, albeit in the Global North rather than Global South. This innovation responds to the globally growing demand for protein and could potentially alleviate some of the pressures on the food system. However, do these products meet the need for higher quality (i.e., more nutritious) food and help us move towards global food security?

Key messages
– The increasing demand for protein has resulted in rapid innovations led by the food industry in categories such as alternative proteins, of which the nutritional content can still improve.
– Currently, many alternative protein products are less than ideal substitutes considering they are high in salt, low in some key nutrients and often ultra-processed.
– Transparency regarding the nutritional content of alternative proteins is needed to inform consumers, enabling them to make informed choices.
– Policymakers, the food industry, consumers and nutritionists are called to dialogue to deliver nutritious and sustainable alternative protein products.

Plant based meats

Alternative proteins – what are they?

Alternative protein sources encompass everything from algae to re-engineered plant-based legumes and a variety of meat substitutes. Think of lab-grown meat, plant-based meat, single-cell proteins from yeast or algae, and edible insects. The market share of alternative proteins has significantly increased in the past decade (read more in our blog post Alternative Protein: What’s the deal?), and a large variety of products are found in supermarkets throughout the Global North.

According to scientific literature, three factors have led to the increase of alternative protein consumption: animal welfare, environmental friendliness, and taste preferences [2]. Generally, the consumption of alternative proteins are found to be higher among women and the well-educated [2]. Women also tend to have a more positive attitude towards meat alternatives or alternative proteins than men due to perceptions of health and weight regulation. Overall, meat alternatives are perceived as healthier when compared to regular meat products. But besides the environmental and social marketing strategies (read more in our blog post Alternative Proteins: Speaking to consumers), what do we really know about alternative protein products’ nutritional value? How do alternative proteins fit in the transition towards healthy and sustainable diets for everyone, everywhere?

Beyond the headlines

Alternative proteins have the potential to disrupt the global food system in significant ways. Conscious of this movement, stakeholders’ interests are rapidly increasing.  A complete understanding of the entire alternative protein landscape and its impact on public health and nutrition is required for both public and private actors to fully comprehend alternative proteins’ role within the global scenario. At Sight and Life, we value the importance of going beyond the persuasive environmental (Save the plant, Earth Day every day) and health (cholesterol-free, plant-based) claims that are currently associated with such products, and strive to understand the science and nutritional benefits of this emerging trend.

In this blog, we dive into the nutritional content of five popular alternative protein products consumed in the Global North and compare them to their ‘natural’ counterparts (Table 1).

Table 1: Protein products compared to their ‘natural’ counterparts

Nutrient content 

Most consumers quickly glance at the nutrient label and generally focus on the calories or energy content of the product. The energy content of the alternative protein products we reviewed was found to be roughly equal to that of their ‘natural’ counterpart. However, because the energy content of a product has very little to do with its nutritional content, a deeper nutritional investigation is warranted.

Sodium

We took a look at the sodium (or salt) content – expressed in Daily Value % (DV) according to the U.S Food and Drugs Administration [3] – of alternative protein products compared with their natural counterparts. As illustrated in Figure 1, the same portion size of alternative protein and its natural counterpart contain varying DV% of sodium. In fact, the alternative protein products exceed the DV% of their natural equivalent. Remarkable is the sodium level found in the Chicken Chunks from The Vegetarian Butcher. One portion size of the vegetarian chicken chunks provides almost a quarter of your daily recommended salt intake whereas chicken is typically 4% DV. In other words, the consumption of one portion of the vegetarian Chicken Chunks leads to the intake of 1,36 grams of salt out of the 5 gram daily recommended by World Health Organization [4]. Scientific evidence shows that a high salt intake represents one of the major dietary risk factors for death worldwide [5] and is associated with an increased risk of high blood pressure, stroke, and cardiovascular diseases. Unfortunately, the findings from these five products are no exception. A study involving over 150 different plant-based products found only 4% of them to be low in salt [6].
 

Figure 1: Daily Value % Sodium per portion size

Essential nutrients: Iron, zinc, and vitamin B12

Key nutrients such as iron, zinc, and vitamin B12 are absent in most of the alternative products except for the Impossible Burger, which has been fortified. In the vegetarian diet, these are known nutrients of concern [7;8]. This subject matter has also been observed in Curtain and Grafenauer’s study. The authors found that less than a quarter of plant-based products (24%) were fortified with vitamin B12, 20% with iron and only 18% with zinc [6]. While fortification of alternative proteins may be a potential solution, there is an urgent need to examine fortification in the context of bioavailability of nutrients in plant-based products – this continues to be an important yet unexplored area to date.

Labeling

Getting a clear overview of the actual nutritional content of some of the alternative protein products has proven to be rather difficult as the information provided online or on the nutritional label of the product was found to be limited. Data on energy (calories), macronutrients, and fiber are provided for all five alternative protein products reviewed. However, the nutrition labels of The Vegetarian Butcher Chicken Chunks and Quorn Mince lack nutritional information regarding key minerals (calcium, zinc) and vitamins (vitamin A, D, and B complex) (Figure 2). Not only did most products not contain iron and vitamin B12, but the lack of nutrient information on the label was concerning considering alternative protein products are often chosen as alternatives to meat products, which are a natural source of iron and B12.
Lack of key nutritional information on the label of alternative protein products does not guarantee a complete overview of their nutrient profile. How does this affect the nutrient intake of the consumer?

Figure 2: Nutrient content list displayed on the nutritional labels of alternative protein products

Processing and ingredient list

According to the latest FAO recommendations on ultra-processed food [9], it was found that four out of five analyzed alternative protein products were classified as such (Table 2). To assess whether alternative protein products can be defined as ultra-processed foods, the products’ ingredient lists were investigated. In particular, the presence of at least one specific class of ingredients or food substances in the food list was sufficient to define such product as an ultra-processed food. In most alternative protein products ingredient lists, we found thickeners, colors, flavors, additives, and emulsifiers, which are part of food classes characteristic of the ultra-processed food group identified by the FAO [9;10]. The cricket flour was the only alternative protein not classifiable as ultra-processed food. Furthermore, from the labeling investigation, we noticed that alternative protein products consisted of up to 21 different ingredients – except for the cricket flour, which is exclusively composed of dry crickets.      

Table 2: Classification of alternative protein  products according to the food processing state proposed by the FAO

Conclusion

The growing demand for alternative proteins has resulted in rapid and impressive innovations from the food industry. It’s not yet perfect, but perhaps directing our efforts towards improved nutrition labeling, reformulation on nutrient content, and improved consumer awareness for these types of products will help us move towards a healthy and sustainable protein supply for all.

Consumer guidance and food industry regulations developed by policymakers could ease the transition to a plant-based diet in a healthy and sustainable manner. The EAT-Lancet report has also contributed to this debate by pushing for more sustainable (plant-focused) diets [11]. However, as a nutrition community, we should be cautious of the possible trade-offs and the potential impacts on health. The consumer and their access to safe, nutritious, affordable, and aspirational food should remain at the core of our endeavors.

When considering the potential of alternative protein sources, we should reflect upon their contribution to dietary diversity. As availability and access to nutritious food is highly related to dietary diversity, this should not be an exception for alternative protein sources. The promotion of dietary diversity is vital to guarantee sustainable and nutritious diets as it is an indicator of diet quality. Issues related to dietary diversity accessibility are present in both the Global North (food desert, food swamps) and the Global South[12].

When discussing alternative protein products, we need to acknowledge the wide and varying needs for animal-sourced protein intake worldwide. In the Global North, it is recommended to moderate the intake of these foods as it has been found to be a risk factor for several diet-related diseases. In contrast, an increased intake of animal-sourced foods is generally advised in the Global South. In fact, animal-sourced products remain a great source of essential vitamins and minerals, and the consumption of these foods has been found to be significantly associated with reducing stunting[13]. Therefore, it emerged that the replacement of meat with alternative protein products is not always suitable for all global circumstances.

Furthermore, consumers should have access to nutritious food and be informed and guided by clear, realistic, and up-to-date food-based dietary guidelines. Consumers should be conscious of how to identify a healthy choice out of the countless possibilities and, in the context of alternative protein sources, should be aware of the fact that ‘vegan’, ‘vegetarian’, or ‘plant-based’ does not necessarily equal a ‘healthy’ option. Finally, the discussion around the nutritional impact of alternative proteins should be embedded within the broader debate on dietary diversity. There is no ‘one size fits all’ solution, and this discussion should be adapted to the local context and nutritional needs of different populations.

All graphics created by Sight and Life’s Architect and Design Specialist Anne Milan.

References

1 FAO Burlingame B, Dernini S. Sustainable diets and biodiversity. 2010.

Michel F, Hartmann C, Siegrist M. Consumers’ associations, perceptions and acceptance of meat and plant-based meat alternatives. Food Quality and Preference. 2020 Aug 20:104063. 

U.S Food & Drugs Administration, Daily Value on the New Nutrition and Supplement Facts Labels. Accessed October 1, 2020. Online https://www.fda.gov/food/new-nutrition-facts-label/daily-value-new-nutrition-and-   supplement-facts-labels

4   WHO, Salt reduction fact sheet 2020. Accessed October 1, 2020. Online https://www.who.int/news-room/fact-sheets/detail/salt-reduction

 Afshin A, Sur PJ, Fay KA, Cornaby L, Ferrara G, Salama JS, Mullany EC, Abate KH, Abbafati C, Abebe Z, Afarideh M. Health effects of dietary risks in 195 countries, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet. 2019 May 11;393(10184):1958-72.

6 Curtain F, Grafenauer S. Plant-based meat substitutes in the flexitarian age: An audit of products on supermarket shelves. Nutrients. 2019 Nov;11(11):2603.

 Ekmekcioglu C, Wallner P, Kundi M, Weisz U, Haas W, Hutter HP. Red meat, diseases, and healthy alternatives: A critical review. Critical reviews in food science and nutrition. 2018 Jan 22;58(2):247-61.

Craig WJ. Nutrition concerns and health effects of vegetarian diets. Nutrition in Clinical Practice. 2010 Dec;25(6):613-20.

Monteiro CA, Cannon G, Lawrence M, Costa Louzada MD, Pereira Machado P. Ultra-processed foods, diet quality, and health using the NOVA classification system. Rome, FAO. 2019.

10 Codex Alimentarius, FAO/WHO 2019 GSFA. Accessed October 1, 2020. Online http://www.fao.org/gsfaonline/additives/index.html

11 Willett W, Rockström J, Loken B, Springmann M, Lang T, Vermeulen S, Garnett T, Tilman D, DeClerck F, Wood A, Jonell M. Food in the Anthropocene: the EAT-Lancet Commission on healthy diets from sustainable food systems. The Lancet. 2019 Feb 2;393(10170):447-92

12 HLPE, Accessed October 1, 2020. Online http://www.fao.org/3/a-i7846e.pdf

13 FAO, IFAD, UNICEF, WFP and WHO. 2020. The State of Food Security and Nutrition in the World 2020. Transforming food systems for affordable healthy diets. Rome, FAO.

Alternative Proteins: Speaking to consumers

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The global food system is recalibrating in the wake of many factors, one of which is the increasing demand for traditional proteins, driven in large part by low-or-middle-income emerging markets in the Global South (see Alternative Proteins: What’s the deal?). What this has led to is the rise of a new category ‘Alternative Proteins’ encompassing everything from re-engineered plant-based legumes to lab-grown meats. The mushrooming of new brands in this category have been centered in the Global North, with some markets even reaching close to saturation point (read this to find out what all the hype is about). The market share is expected to change as the case for alternative proteins in the Global South gains traction.

At Sight and Life, we thought it would be interesting to study how some alternative protein brands have chosen to open conversations with their consumers in such a fresh, new category. It becomes easier to understand the way brands speak if one were to look at them through the archetype lens, providing the brand a more human feel. Similar to how fictional characters are written according to paradigms in order to help understand their actions, a brand archetype is a way of presenting a brand and define its symbology, values, behaviors, messages – as a persona, thus making it more recognizable and relatable to target audiences. We looked at the main sources of brand communications available to decode the semiotics – the official brand website, the major social media accounts, official digital/ television advertisements, if any, and digital banners.

Key messages:

– The novelty of the alternative proteins’ category allows for bold claims, bold brand names, bold imagery
– The current marketing is for a consumer higher up in Maslow’s Hierarchy of Needs – looking for a greater sense of purpose to participate in, a future-forward perspective
– Improving the world is an often-cited end goal and functions as the gratification – the product sensory experience is not usually the show runner
– Most brands in this space tend to speak to the public the same way they would to an investor – however, Impossible Foods and Beyond Meat have evolved and struck up new conversations with the consumer

Innocent vs. Hero Archetype 

First, we looked at Impossible Foods and Beyond Meat, both based out of the United States. Both these brands stand out as more evolved in their marketing to consumers in that they attempt to engage the consumer in a less technical and more emotional conversation. This strategy could be because both brands are available in retail and need to do more than highlighting the scientific angle to their products.

Take Impossible Foods, for instance. The brand talks about respecting the magical moments we celebrate (all in the company of good food), without harming the planet. Impossible Foods has set out on a mission to create ‘Paradise’, a world where everything and everyone lives in harmony. When it talks about its mission (#MissionEarth and #MissionImpossible), much of the brand imagery alludes to elements of an ideal world – happy adults, happy youth, happy children, happy creatures, happy trees, and a blue sky. If you pay attention to the brand’s vocabulary, you can see it is current, outspoken, and determined, and seems to speak to a younger audience – the millennials and Gen Z – fitting into the Innocent archetype. The Innocent is someone that dreams of the ideal, is an eternal optimist, and celebrates wholesomeness.

A screenshot of the Mission page on the brand’s website. Source: https://impossiblefoods.com/mission/

Impossible Foods is not just for vegetarians; it is for meat lovers and the environmentally conscious and the flexitarians who may be a bit of all three. It also spotlights its science story, the champion being ‘heme’ – this is what makes the meat ‘bleed’ and gives it the right texture and flavor. Impossible Foods celebrates great taste, as much as the lack of environmental repercussions – which is significant since it shows that it understands the consumer is ultimately tempted by indulgence and not delayed gratification, no matter how noble the cause. It works hard to lend a sense of purpose to the Impossible Foods consumer in a vibrant, cool way – pops of color, flat icons, catchy hashtags et al. On social media, you can see Impossible Foods stand up for causes that are outside of environmental concerns. The leadership team even writes on Medium.com, a popular online publishing platform. In short, the brand continues to leverage every opportunity and every channel to reach its target consumer.

Now, let’s look at Beyond Meat. This brand brings to mind the Hero archetype, looking to inspire others to do better, achieve more, truly test the limits, go beyond and not settle for the standard. The Hero is an archetype that strives for mastery, showing courage that improves the world and this is exemplified in Beyond Meat’s communication. For starters, the brand logo is a buffalo that’s wearing a cape. The Hero is all about action, and Beyond Meat is no exception.

Beyond Meat’s homepage featuring Kevin Hart as the Beyond Ambassador. Source: https://www.beyondmeat.com/

Most of the brand’s imagery is dark and grave – a great deal of black is used to convey the brand’s bold personality, and the green bits pop up in places for greater emphasis. Much of the copy in the brand’s videos and banners is serious or inspirational. Beyond Meat breaks down four main reasons to make meat from plants: improve human health, positively impact climate change, address global resource constraints, and improve animal welfare. It features well-known sports and television personalities who act as Beyond Ambassadors.

The Go Beyond page, which features inspiring stories from individuals and communities. Source: https://www.beyondmeat.com/go-beyond/

Here we see two brands communicating a sense of purpose to the consumer – Join #MissionImpossible or #GoBeyond. Impossible Foods does shine a spotlight on its all-star element, heme, assuring the consumer of an equally – if not more – fulfilling gastronomic experience. Still, the real hero is the consumer, who chooses to further this larger cause. Beyond Meat also places the responsibility on its consumer to challenge the status quo and find a better solution.

Talking Logic vs Talking Emotions

Let us now move to the last two brands we considered, which have not yet started speaking to consumers, but are looking to craft their identity. In Hong Kong, HK Avant Meats is a brand that has innovated the production of high quality, sustainable, and tasty fish products. The brand uses cell technology to harvest premium delicacies from our seas and oceans, without harming the water bodies. How well does the brand convey this to an outsider, a potential consumer? Based on the website, the brand’s vocabulary is currently more scientific and functional than emotional, with terms such as ‘cell technology’, ‘GMO-free’, ‘innovate’, ‘sustainable’ etc. There are two products under the Avant Meats banner – Avie and Zellulin. The imagery for both is opposite to the clinical environment the brand sets up on its homepage: Avie feels like a lifestyle brand for younger millennials while Zellulin cues a luxury category such as cosmetics or perfumes.

HK Avant Meats advertising samples for Avie and Zellulin.

Lastly, there is Clear Meat, a start-up from India. The brand is resting on scientific credentials at the moment and does not yet elaborate on product experience. If we were to delve into the semiotics here, we see the process is celebrated more than the end product. This message is also apparent as the brand speaks of gratification and the emphasis on the process continues to overshadow the product.

From even a glance as cursory as this, we can see that given the novelty of the conversation, brands run the risk of speaking to consumers the same way they would talk to a potential investor. The consumer that these brands are targeting (potentially targeting – in the case of the last two) is ahead of the curve, someone who is aligned to the brand’s journey and mission and advocates the cause and not the product alone. Such a consumer could appreciate the larger objective and may even be willing to compromise on indulgence. This leads us to question how alternative protein brands should be speaking to consumers in the Global South? Could we alter the manifestations of such archetypes such that they resonate with low-and-middle-income consumers? In the seesawing between purpose and indulgence, how much weight should each carry? Can the sense of purpose be made more personal and placed within the Global South consumer’s direct needs? And lastly, will the product be the hero, or should the consumer be the hero?

You might also ask, what is the nutritional value of these products? Read more about this subject matter in the next post in this series Alternative Proteins: The nutritionists perspective.

All graphics created by Sight and Life’s Architect and Design Specialist Anne Milan.

Alternative Proteins: What’s the deal?

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What are alternative proteins, and why are we talking about them?

Global Population 10 Billion

The global food system will need to feed 10 billion people by 2050 – including a nearly 75% increase in meat demand, driven mostly by low-and-middle-income emerging markets in the Global South[1]. Currently, the meat sector is a trillion-dollar market projected to increase by nearly 4% annually[2]. This tremendous growth in meat consumption poses significant resource challenges, and meeting this demand must occur in a holistically sustainable way. A promising alternative protein industry has recently emerged to address this challenge with products ranging from reconfigurations of the typical plant-based legumes into meat substitutes, like Impossible Burger, to using edible insects and introducing novel products such as lab-grown meat or single-cell proteins from algae, yeasts, or fungi. Compared to meat counterparts, alternative proteins’ projected positive impacts on climate and animal welfare and potential health benefits have piqued interest in this sector[3]

Investments in Plant-Based Food Companies (2010–2019)

Source: Good Food Institute

The alternative protein industry can be segmented by protein source and level of processing: fortified or otherwise modified plant-base (including fungi and algae), insect-based, and lab-grown meat or by application: direct consumption, animal feed, and supplements. With a current market capitalization of $2.2 billion and concentrated in the Global North, most alternative protein startups and associated funding focused initially on segments with existing demand and potential growth opportunities like plant-based products. However, there is a rising favorable environment for alternative protein in the Global South due to increasing disposable incomes, consumer affinity towards sustainable consumption, less competition, and growing venture capital funding for startups. Furthermore, as European and American markets are becoming saturated with alternative protein products and more competitive, we anticipate these companies expanding their business model to the Global South. This plant-based movement has also spurred new developments such as the European Alliance for Plant-based Foods (EAPF), bringing together like-minded organizations in the plant-based value chain around a unique mission: To put plant-based foods at the heart of the transition towards more sustainable and healthy food systems. 

At Sight and Life, we are working to advance innovations that need cross-sectoral expertise in nutrition, marketing, and business models in the Global South. We seek to pre-empt the movement of alternative protein into the Global South and identify priority focus areas as the industry shifts geographical focus. Two alternative protein segments relevant to these markets over the next five years are plant-based processed products and insect-based animal feed.

Why plant-based?

Plant based meats

The plant-based category is the largest source of alternative proteins today. In 2019, plant-based companies in the U.S. raised nearly US$ 750 million, or 90% of the total funding for alternative proteins[4]. These companies are sustainable and significantly less resource-intensive than animal husbandry and their products, due to the dominant use of ingredients of soy and pea. Paired with environmental benefits, the ability to closely mimic a range of meat variants at a competitive price, plant-based meats are well-positioned to cater to the Global South. Moreover, multi-national food companies and protein producers, which have a presence in low-and middle-income countries, are investing in plant-based products. 

Why insect-based animal feed?

Insect based animal feed

The demand for animal source foods in the Global South is witnessing a sharp rise, with demand projected to increase by 73% by 2050. The market has seen a spike in input costs as traditional feed ingredients such as soy and fishmeal commodity prices rise. More and more farms are therefore demanding cheaper feed sources such as insects, as meat consumption increases. Though large-scale production of insect feed occurs in the Global North, there is an opportunity to scale existing small and medium enterprises in the Global South by adopting and innovating new technologies.

To meet the unique nutrition needs, the share of wallet and palate of the consumers, three areas that need attention are accessibility, awareness, and local taste preferences. Along these lines, Sight and Life will share insights in a three-part blog series on approaches that would make alternative proteins relevant for consumers in the Global South.

Making alternative proteins aspirational

Marketing a new product becomes critical in a new category, especially when consumers do not have any previous food product perceptions. In the next blog post, we investigate how alternative protein brands have established themselves and communicate with their consumers. Puja Peyden Tshering, Sight and Life’s consumer insights specialist, analyses four brands through an archetype lens, understanding the brand through a more human feel. Read the thought-provoking questions she raises as companies start speaking to consumers in the Global South in this blog post.

Alternative proteins through a nutritionist lens

With alternative proteins set to radically change our diets over the next few years, do we know if their nutritional value is as good as their substitutes, and whether they are appropriate for the Global South where the prevalence of malnutrition is high? Sight and Life’s nutritionists, Breda Gavin Smith, Kesso Gabrielle van Zutphen, and our interns Chiara Ferraboschi and Kris Woltering move beyond the headlines and provide a complete understanding of the entire alternative protein landscape and its impact on public health and nutrition in this interesting post.

Inclusive business models for alternative proteins

Alternative proteins currently cater to the premium segments, millennials, and Gen Z in the Global North, who enjoy a high spending power. But for alternative proteins to successfully cater to low-and-middle-income countries, affordability is a crucial lever. Sight and Life’s business model specialists, Kalpana Beesabathuni and Srujith Lingala, together with interns Hannah Wang and Emily Voorhies, identified market opportunities and viable business solutions that are sustainable and capable of producing protein alternatives to wrap up the series. 

Stay tuned!

All graphics created by Sight and Life’s Architect and Design Specialist Anne Milan.

References 

[1] Food Agriculture Organization (2011). World Livestock 2011: Livestock in Food Security. Rome: Food and Agriculture Organization. Accessed September 29, 2020. Available online via http://www.fao.org/docrep/014/i2373e/i2373e.pdf 

[2] ReportLinker (2017). Opportunities in the Global Meat Sector: Analysis of Opportunities Offered by High Growth Economies. Accessed September 29, 2020. Available online via https://www.reportlinker.com/p04826928/?utm_source=PRN

[3] World Economic Forum.(2019). Meat: the Future series Alternative Proteins. Accessed September 29, 2020. Available online via http://www3.weforum.org/docs/WEF_White_Paper_Alternative_Proteins.pdf

[4] The Good Food Institute. (2019). U.S. State of the Industry Report Plant-based Meat, Eggs, and Dairy. Accessed September 29, 2020. Available online via https://www.gfi.org/files/soti/INN-PBMED-SOTIR-2020-0507.pdf

Take-Home Rations

A route to nutrition security

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On August 28, 2020, Times of India published “Take-Home Rations: A route to nutrition security” by Dr. Rajan Sankar of TINI Tata Trusts (read the more about Dr Rajan Sankar here) and Kalpana Beesabathuni, Sight and Life’s Global Lead for Technology and Entrepreneurship. The full article can be read  here.

Abstract

The disruption of food systems by Covid-19 and its impact on the availability of nutritious food in large parts of the country has brought to light the importance of the Take-Home Rations (THR) programme and its potential to deliver fortified food to the last mile in the country. The THR programme is unique in its reach and scale; it is also well resourced with a budget of Rs. 13,500 crore and hundreds of millions of beneficiaries. The current crisis presents a window of opportunity for THR to fully realise its promise and transform India’s nutrition security scenario.

India is home to one-third of the world’s stunted children (4.7 crore) and half of the world’s wasted children (2.6 crore). Nearly 41% of children less than five years old are anaemic. To combat malnutrition, the Government of India launched the Integrated Child Development Services (ICDS) programme in 1975; it offers a variety of nutrition and health services for the first 1,000 days of life. This time span is vital for preventing long-term consequences associated with malnutrition, particularly during pregnancy and also when infants transition out of breastfeeding.

Read the full article on the Times on India website here. We also invite you to take a look at the Take-Home Rations Compendium, a recent analysis of the THR program here.  

Vestine Nyirahabimana 

Method and Evaluation Specialist for Sight and Life

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I grew up in a rural area where agriculture was the primary source of food and income. There were varieties of fresh food in our village, but many people, including me, had no idea how a healthy diet looks. It took me time to know that local fresh food provides more nutrients and flavor than a refined one.

Despite food availability and affordability, a good number of children would suffer from malnutrition. In today’s world, “more than 95% of all chronic disease is caused by food choice, toxic food ingredients, nutritional deficiencies, and lack of physical exercise,” explains author, investigative journalist, educator Mike Adams.

Vestine, Sight and Life

“I believe that a healthy eating education is needed to promote sustained adoption of healthy eating behaviors. My motivation in nutrition is that if we teach people to fix their diet, they can then correct their health issues!” 

 

Working for Sight and Life is an opportunity for me to contribute towards achieving this goal and give back to the community by using my technical skills. I will develop an effective monitoring and evaluation system that provides information, brings learnings, and influences decision making while measuring Sight and Life’s contribution to the anticipated change. Through this role, I also look to gain knowledge and expertise on how nutrition plays a vital role in improving people’s lives.

Exchange in Behavior Change

Making consumers feel, instead of do

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One of the most often expressed grievances related to the COVID-19 pandemic has been around wearing face masks. Everyone is made aware of its importance when stepping out. We can thank the hundreds of videos, posters (digital and offline), social media content, and articles on the subject. Not wearing a face mask outside today could mean instant scrutiny, even mockery or humiliation. Sometimes I wonder how many wear face masks to protect their health and that of others, and how many wear face masks because ‘everybody else is doing it’ or it is ‘cool’ or ‘popular’ or ‘this one is branded and oh so pretty’. Of course, this is not to say there is only one motivation at play here, or that one is better than the other. It just is an excellent example of how simple awareness-raising of the health benefits is not enough – motivation comes from a combination of individual and social factors as well as knowledge.  

Social marketing’s impact

In the context of social marketing, we briefly discussed the idea of ‘exchange’ in our blog post by social marketing expert Rowena Merritt, “It Makes Me Smile,” posted a fortnight back. We explained how, if the goal is to change a behavior, offer something in return. While most of us might think of cash incentives or gift vouchers as rewards, the exchange is often non-monetary, such as making someone feel unique, or creating a sense of control or ownership. At Sight and Life, we think about whom we are serving and what could be a compelling exchange for our target audience. 

Research is important

Let us look at the Eat More, Eat Better campaign* launched in Rajasthan – a state in Northern India – in 2018. The project aimed to improve food access and food choices for pregnant and lactating women (PLW), whose calorie intake was 40% below doctors’ recommendations. However, we quickly realized that we needed to do more than raise awareness; we needed to offer an exchange that our audience valued. To help us do this, we used social marketing techniques and tools and conducted in-depth formative research. 

The findings helped identify critical insights to develop a behavior change strategy, the most notable being:
  A. The kitchen was generally the mother-in-law’s domain, and she associated eating more with being indulgent, greedy or lazy. This perception was not relaxed even for her pregnant or lactating daughter-in-law!
  B. The husband tried to balance patriarchal norms with being more emotionally available to his wife. For instance, he would occasionally smuggle in goodies or fruits for his wife to eat.
  C. Snacking, rather than the three meals, carried greater permission for the PLW as it did not lead to territorial clashes in the kitchen and was also something that was not frowned upon by the mother-in-law.

Based on these findings, the social marketing project focused on introducing a new behavior – nutritive snacking for PLW. The habit of snacking was accepted and already practiced, making it a more natural behavior to change. PLW were provided a specially designed snack box that she could use when away from the kitchen and a small treat pouch that she could use to carry snacks in her sari.  The baby was dubbed a ‘Champion’ that would fill both the mother and father with pride and parents were encouraged to do what is best for their ‘Champion’. Fathers were also asked to sign a pledge to support the nutritional needs of their wives and babies actively. And the exchange? The PLW felt special and cared for by her husband and empowered when it came to looking after herself and her baby. 

This is a graphic for the Eat More, Eat Better campaign paying a tribute to the region’s unique Rajput painting style. It shows a husband urging his wife to eat more and calling her the mother of the ‘Champion’.

Another good example is our work in the 2017 Karnataka WASH (Water, Sanitation and Hygiene) behavior change project. As part of the larger objective to improve nutritional status among school-going children, Sight and Life worked with PATH and Karuna Trust on a strategy to prevent loss of nutrients among children by aiming to influence motivations regarding several behaviors:
  A. Washing hands with soap at key times, including before meals, after using the toilet, after play, and after handling garbage
  B. Drinking water from safe sources only
  C. Rejecting open defecation or urination
  D. Flushing the toilet with water after use
  E. Keeping their school tidy and free of garbage
  F. Eating vegetables and healthy snacks

The formative research delved into the physical, social-normative, and biological factors that drove eating and hygiene practices in school. The team conducted a combination of ethnographic interviews and focus group discussions exploring codes related to hygiene, sanitation, and social influence. Based on this information, the team designed a phased strategy where they tried to make the behavior changes as fun, easy, and as popular (the social norm) as they could by deploying the following:
  A. Physical cues – for example, rhymes and short messages, relevant signboards, installing a tippy tap, soap for handwashing and buckets and jugs made available in toilets (making it easy)
  B. Games – specially crafted games and someone entrusted with the responsibility of owning these games (making it fun)
  C. Role modeling – each class elected a role model, who would then encourage his/her classmates to adopt health behaviors (making it popular) 
  D. Helper crews – specifically created to ensure all tasks were fulfilled (making it fun, easy and popular!) 

In 2017 Sight and Life’s intern, Shannon King, worked in India to research the implementation of these school-based nutrition and WASH intervention strategies to develop healthy eating habits while improving hygiene and sanitation behaviors.

It is interesting to see how the ‘fun’ element was given great importance, and rightly so since the target audience was young children. The rhymes and games helped children identify ideal WASH behaviors; watching role models encourage the same outside of playtime helped build good habits. Rhymes and games acted as an essential feel-good factor and led to a higher recall for a topic that runs the risk of being regarded as boring and irrelevant by many children. 

Knowledge is key

Figuring out the exchange is an engaging journey, one which requires exploring the individual and society, the motivations at play, and the broader environment they are all delicately balanced within. This summer, Sight and Life is holding a three-day online course with the SSPH Lugano Summer School, “Generating Demand for better public health goods and services: A systems and consumer-centered approach”. The course will look at how to create demand for healthy products and healthy behaviors (and we will also talk about exchange). Further details regarding enrollment can be found here. We look forward to (virtually) meeting you there!

* The formative research for the Eat More, Eat Better campaign was completed by Eva Monterrosa, former Sight and Life Senior Research Manager.

It Makes Me Smile 

How can behavioral insights for unhealthy foods help create demand for healthy food?

Back to Overview

I had convinced my son that “fizzy” drinks were disgusting. I told him they were bad for him, that they are full of teeth rotting sugar and that they did not taste nice. He believed me and never wanted to try one. However, eventually, children reach an age where their friends become authorities on seemingly everything, and they start to listen more to their mates than their mum.

On the school run yesterday, my 8-year old son: “Oliver says, mixing red and blue makes green.”
Me: “No, I am sure that makes purple.”
My son: “No, Oliver knows Mummy.”*

Then later

Me: “Why are you digging a massive hole in our lawn?”
My son: “Freddy said we could find diamonds in our gardens.” 
Me: “Err no, darling, we don’t have diamond mining in the UK.” 
My son: “Yes, we do. Freddy told me so (as he carries on digging).”

When Oliver and Freddy told my son that he should try a “fizzy” drink as they were “fun”, he no longer listened to me and my warnings. He used his pocket money to buy a can of Cola-Cola. The result – he loved it! Why do you love it? I asked him.

“It makes me smile Mummy,” he replied simply.

For me, this uncomplicated response summed up everything – unless healthy and nutritious drinks such as milk and water make my eight-year-old “smile”, he will keep wanting Coca-Cola. And although I can use a metaphorical “stick” and ban him from drinking such drinks now, without the “carrot”, I will not win the battle in the long run. As soon as he is old enough to walk to school and go out by himself, he will just choose to buy unhealthy drinks with his pocket money.

Apart from my son’s questionable trust in his friend’s advice (and their questionable art and geological knowledge), what can we learn from his Coke experience? And how can we use such insights to create demand for nutritious food and drinks?

For me, the key is this

LISTEN. Listen to your target audience – the people whose behavior you want to change. Whatever people do, even if it seems foolish to you, they will have their reasons. These reasons might not be rational (as my son’s experience demonstrates), but then we are driven by emotion, and our decisions and actions are rarely logical.

Many of you might have focused on educational interventions in the past, believing that people simply need to know what is good for them and what is not. However, do not be fooled; education does not always work.

If we always made rational decisions, none of us would overeat, smoke, salute three times to magpie birds (which I do due to a silly old English superstition), or drive like lunatics. But rest assured, when you ask and listen, your target audience will have their reasons.

When I worked at the Department of Health England, they ran the 5-a-day campaign, trying to encourage people to eat more fruit and vegetables. However, during the campaign run, consumption went down. Why? They made the incorrect assumption that knowledge and changes in attitudes are sufficient, and ignored beliefs or benefits gained from eating unhealthy foods (do carrots and broccoli make my 8-year-old smile? You can guess the answer).

The whole social marketing discipline is based on the idea of exchange, and if you want people to change their behavior, you have to offer them something in return. Often this is non-monetary – a feeling of belonging, sophistication, or security. Or, an alternative product that gives them the same or greater benefits as the product they are currently using. These benefits must be immediate, as we value these more than longer-term ones.

You only can work out what the exchange should be by listening to your target audience and understanding the benefits they derive from the negative behavior, such as consuming high-sugar soft drinks. Coke gave my son immediate happiness; how can we create that same feeling with a healthy drink? 

For deeper insight on formative research, take a look at our Action in Brief on “Eat More, Eat Better”, a behavior change strategy to support improved food access and food choices for women in the northern Indian state of Rajasthan. 

Further Learnings

This summer Sight and Life are running a three-day course as part of the Swiss Lugano Summer School. The session “Generating demand for better public health goods and services: A systems and consumer-centered approach” and will explore how social marketing, behavioral insights, and innovations in behavioral science can be used to create demand for healthy products and behaviors. The course will also explore how public-private partnerships can make healthy products more attractive to consumers and develop sustainable business models. Further details and where you can enroll click here

I hope to “see” some of you there.

*In case you are wondering, mixing yellow and blue make green.

 

Nutrition in the Workplace is a Winning Solution During and Post-COVID-19

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The Food and Agriculture Organization of the United Nations (FAO) highlights the importance of good nutrition before, during and after an infection. While no foods or dietary supplements can prevent a COVID-19 infection, maintaining a nutritious diet is important to supporting a healthy immune system to fight infections. In addition, the World Health Organization (WHO) states that a well-balanced diet is critical to receive the essential vitamins, minerals, fiber, protein and anti-oxidants the body needs to be in good health and build a strong immune system to lower the risk of chronic illnesses and infectious diseases. Therefore, a nutritious diet is important for all age groups throughout the COVID-19 pandemic.

Diet and nutrition of the workforce during and post-COVID-19

The COVID‑19 crisis has had a dramatic impact on the world’s workforce; partial or total workplace closures have restricted business operations and have affected an estimated 80% of the global workforce. The worst-hit workers are those working in small and medium-sized enterprises, and low-wage workers in informal employment, with limited access to safety nets. For others, adjustments in the work process and arrangements to work from home have enabled them to retain their jobs during COVID‑19.

Currently, employers are facilitating a gradual return to the workplace. Workplace canteens are opening to workers if social distancing rules can be maintained or providing packaged meals to avoid fully opening staff canteens. Most workers eat at least one main meal during their working day. Workers who encounter time challenges to prepare home-cooked meals to rely on catered meals facilitated by their employer. Others bring their lunch or go to food outlets, markets, or takeaways. For many of them, it remains a daily task to obtain a diet containing all the recommended nutrients. In some labor-intensive sectors, nutrient requirements are so high that they are difficult to be obtained through the diet alone. Also pregnant or nursing women have elevated nutrient requirements that will need careful meal planning.

A survey among employees highlighted the main challenges workers face to eat healthily:
1) easiest food choices aren’t always the healthiest
2) “I don’t always have time to buy and prepare healthy food”
3) “it’s too expensive”
4) “the people I’m around don’t eat healthily.”

Cantina, workplace nutrition
Source: Pixabay

Nutrition and health at work

Nutrients, including vitamins and minerals, are critical in many functions of physical and mental health. The role of nutrition in immunity is not only to support preventing but also resolving infections that have been well established. Among other reported benefits of nutrition are increased energy and reduced fatigue, as well as enhanced alertness, cognitive and mental performance. Nutrition also plays a role in many other functions such as bone density and muscle strength and slowing progression of non-communicable diseases.

A pre-COVID-19 survey in the UK revealed that infections, musculoskeletal problems, mental health conditions, and diabetes were among the main health reasons for sick absence. However, nutrition as a direct modifiable factor for many of these health conditions is often overlooked by employers. Higher absence rates among workers can be expected post-COVID-19 due to “suspected infections” but also as a result of increased mental problems; approximately half of the young people reported anxiety or depression since the start of the pandemic. Therefore, during and post-COVID-19 pandemic, healthy eating, and nutrition programs in the workplace are important in fostering employee immunity, physical and mental health. Centrally distributed workplace nutrition provides the opportunity to reach many workers and contribute to employees’ essential nutrient requirements.

Evidence for nutrition programs at work

Workplace nutrition programs can include “education” or “coaching” programs to encourage workers to consume more nutritious foods. Access to nutrition consultation and personalized nutrition advice has a significant potential health improvement rate. Nutrition programs can also include (subsidized) nutritious food offers at work, such as healthy lunch choices or fruits, fortified lunches, or micronutrient supplements. The evidence for the health benefits of nutrition in the workplace is growing. Micronutrients provided to workers through fortified foods or supplements significantly improved workers’ nutrition status in various workplace settings. Anemia, common colds, urinary tract infections, and work absence were reduced in Bangladeshi women garment factory workers receiving multi-micronutrient-fortified rice along with iron and folic acid supplement and nutrition counseling for 10 months. Infection-related work absence was reduced by almost two-thirds in healthcare workers consuming multi-micronutrient supplements for one year. Other reported benefits of providing micronutrients in the workplace are manifold; reduced heart rate, improved body mass index scores, bone density, perceptual and cognitive functioning, improved mood, and reduced depression.

What are the benefits for the worker and employer?

Employers bear many of the costs related to absenteeism and presenteeism. On average, employees cost businesses the equivalent of three months per year in lost productivityUnhealthy eating (too much salt, sugar, saturated fat), as well as inadequate essential nutrient intake, raises the risk of low productivity. By optimizing workplace nutrition, workers receive the nutrition needed to stay alert and focused while employers benefit from reduced absenteeism and less presenteeism or unproductive use of time. Better nutrition also equates to improved resilience to infections and stress – other potential pathways to better work performance.

Workplace Nutrition Graphic

Employers’ social responsibility for the nutrition of own employees

Employers have an essential role to play during the COVID-19 crisis to provide good nutrition, especially for the most vulnerable in society. It is important that work environments facilitate good nutrition to support the physical and mental health of their workers. Investing in workplace nutrition is a high return on investment for the employer and can increase workers’ health, work attendance, morale, efficiency, and productivity. A recent report by GAIN-SUN-Eat Well demonstrated that “workforce nutrition” is a win-win for employers looking to improve both employee health and business outcomes. Moreover, it can contribute to the nutrition targets of the United Nations Sustainable Development Goals (SDGs), specifically SDG 2 (zero hunger), SDG 3 (good health and wellbeing), and SDG 8 (decent work and economic growth).

IMPact4Nutrition, Workplace nutrition, India
Nutrition awareness session for female garment workers at Arvind Ltd, an IMPAct4Nutrition private sector partner.

There is a growing awareness among the public and private sectors that workplace nutrition can benefit both employees and businesses. IMPAct4Nutrition (read more in our Action in Brief on IMPact4Nutrition) is an example of a public-private engagement that aims to bring together the diverse private sector interested in contributing to the Indian Government’s social movement named POSHAN Abhiyaan or National Nutrition Mission. Diverse partners are engaged including UNICEF, Sight and Life, CSRBox, Tata Trusts, and the Confederation of Indian Industries. The priority by IMPAct4Nutrition is promoting nutrition in the workplace by targeting key nutrition behaviors in the workplace in three areas; assets and core business for nutrition, cash/corporate social responsibility for nutrition, and employee engagement for nutrition. During COVID-19, IMPAct4Nutrition has developed digital training modules to support companies in promoting good nutrition across their business ecosystem with practical, easy to follow tips on how employees can maintain an appropriate nutritional status. Through these modules, the platform is reaching 10 million employees, their families, and communities in 51 companies across India.

In June 2020, IMPact4Nutrition was honored with a UNICEF global INSPIRE Award in the category ‘Best Multistakeholder Engagement’. Nearly 100 campaigns from 50 countries were nominated and voted on by UNICEF staff worldwide. 

The reward is high

A successful workplace nutrition program can be part of a broader organization’s framework tailored toward health and wellness. A successful program requires buy-in from leadership as well as a dedicated coordinator and resources for implementation. Quantitative data such as surveys, nutrition, and health data will help to evaluate if the program was a success. Besides the employer, trade unions, foodservice operators, and incentives by insurance companies can further contribute to a positive nutrition environment at work.

Nutrition programs in the workplace offer a direct opportunity to workers and employers; they have the potential to improve workers’ physical and mental health, and loyalty and thereby improve work attendance, productivity, and employer reputation. The potential return on investment of investing in workplace nutrition is high. Therefore, proper nutrition in the workplace is a win-win proposition for employers and employees. Investing in workers’ nutrition should be a goal if organizations are to thrive.

Reference Links:
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Priyanka Kumari

Program Coordinator for Sight and Life

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Growing up in an agriculture family from east India, I would stroll past lush green fields of paddy, wheat, and corn during vacations. Behind this prosperity, there were scenes of hundreds of women farmers with their infants in cloth pouches at their back, working in the fields under the scorching heat. Although they satisfied the hunger of thousands, they themselves could not afford a meal due to income disparity and uneven margin distribution across the value chain. This pushed them and their children towards malnutrition.

These experiences began my endeavor to bring change at grassroots and uplift these households has strengthened with each of my experiences with farmers over the years. I wish to grasp every opportunity I get to change and improve the lives of millions of women farmers in India.

“I believe that agriculture and nutrition work in accordance, steering the health of millions. Sight and Life offers an opportunity to analyze food system holistically and share multi-sectoral findings creating innovations to prevent malnutrition.”

 

Innovations in supply chain and developing technical skills are crucial to improve production efficiency, streamline last-mile distribution, and boost technology adoption, ultimately increasing farmer’s share in the food system as an investor and consumer. This became my passion as an agribusiness professional and motivated me to take the next step. At Sight and Life, I get opportunities to enhance livelihoods and improve nutrition among low-income households. 

 

 

Elvis Gakuba

Rwanda Country Manager for Sight and Life

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Growing up as a refuge, in a region where conflict dominated the headlines, I saw people suffering firsthand and often due to the political situation and discriminative policies which unfairly affected women, children, and the elderly more. These experiences have deeply influenced my life and my choice of education eventually leading me to a career in nutrition. Now I can make a difference through my work to ensure there are not vulnerable people suffering from policies related to food or health. 

 

“I truly believe that we have enough quality food to feed us all, and no one should suffer from hunger or malnutrition, with the right policies, and political will, hunger, and malnutrition will be defeated.”

For the past 15 years, I have been involved in shaping policies and implementing them to address gender equality, food security, and fight all forms of malnutrition in Rwanda, Burundi, and East Africa. 

Feeding Families in Need During COVID-19 Pandemic

 

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There are many hungry bellies to feed around the world and we are merely scratching the surface to nourish the vulnerable populations of the world. Due to the current COVID-19 pandemic triggering lockdowns around the world, issues in nutrition such as food systems and malnutrition have been heightened and are now more of a global urgency than ever before. Here at Sight and Life, we are working on initiatives in Rwanda, South Africa and India to help improve the lives of those in need during this crisis.

“The only silver lining during this grave crisis has been how quickly and effectively we’ve been able to work together as a team and with our partner organizations to identify food insecurity hotspots and mobilize resources for emergency hunger relief. The guiding principle behind our efforts has been to look beyond just filling bellies but make sure adequate and critical nutritional needs are met,” expresses Sight and Life team members.

In India, we have partnered with grassroots NGOs across India, such as Aahawaan Foundation, based in Bangalore, and Kutumb, working in Uttar Pradesh, to donate grocery kits and nutritious food to the affected communities.

Kutumb is an organization attending to abandoned and slum children by giving them a sense of family. They are also dedicated to strengthening all units of marginalized and underprivileged families, realizing that children can be nurtured best in a family setting. Together with Kutumb, we provided nutritious food to over 1500 children with moderate acute malnutrition in 75 villages located in Uttar Pradesh. 

In Bangalore, we teamed up with the Aahawaan Foundation who is committed to providing basic requirements and facilitate the development of the overall potential of people and their communities. Together, we delivered 15-day grocery kits with staples and fortified kernels as top-up was delivered to migrant workers and their families ensuring that the nutritional needs are met, beyond just filling stomachs.

 “I was unsure of how I would provide for my own children and was hence, worried about feeding my neighbor’s children as well. This ration will help me cope with this crisis for some more time,” explains Sita Ben, one of the many women workers our partner reached with an essential food kit. She spoke about her difficulties during this pandemic as she is responsible for her children and neighbor’s children as they are unable to return due to the lockdown in India. Now she can sleep a little bit knowing she has the ability to feed her and her neighbor’s children.

Meanwhile, in Delhi, monthly ration kits made it to 200 daily-wage households. The kits contain additional essential supplies such as oil for cooking, grains, lentils, and an egg for a family of four in order to help ease the pain of many in unfortunate situations.

 “A great number of my fellow countrymen are forced to walk a thousand miles, often hungry, just to reach the safety and comfort of their families. We are grateful for the opportunity to raise funds on their behalf and support them with nutritious meals,” explains the Sight and Life team. 

We are committed to doing more however, we need support. Please donate to via our Milaap or GoFundMe crowdfunding page to further our efforts. We are also interested in partnering with organizations that have similar initiatives and are located in Rwanda, South Africa, or India.

Five-step plan to prevent an impending nutrition famine during COVID-19 in India

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India’s isolation measures in response to COVID-19 are having a far-reaching impact and is among one of the largest initiatives globally to impose strict limitations on its 1.3 billion citizens. People with pre-existing vulnerabilities, marginalized communities, pregnant and lactating women (PLW), daily wage earners, migrant workers, and the elderly have been the hardest hit as the protective measures disrupt the economy.

To ease the effects of the pandemic, the national and state governments have announced extensive stimulus packages and policy measures. The national government on 12th May announced a $265 billion relief package aimed at injecting liquidity into the economy. The first tranche of $ 22.6 billion included several social protection measures such as payment of ex gratia amount to marginalized populations, increased wages for workers under the National Rural Employment Guarantee Act, doubling rations for three months, collateral-free loans to women’s Self Help Groups (SHGs), the inclusion of support to COVID-19 under Corporate Social Responsibility (CSR), and financial assistance to villagers through farmer cooperatives. These aid benefits are aimed to help more than 810 million Indians and are a step in the right direction.

In addition, integrating nutrition in the current policies will be fundamental to improving nutritional status and building immunity of the population, especially high need groups like PLW and children under 5 years of age. The WHO guidance on diet during the COVID-19 pandemic states that “good nutrition is crucial for health, particularly in times when the immune system might need to fight back”. India is already battling a high prevalence of malnutrition (Table 1). As India, in unison with the rest of the world, battles an evolving pandemic of unprecedented proportions, policymakers must be vigilant, agile, and innovative to halt our population from sliding into hunger and acute malnutrition due to the COVID-19 outbreak.

Table 1:

Source: Comprehensive National Nutrition Survey 2016-2018, Ministry of Health and Family Welfare Govt. of India.

We propose a five-point plan to put nutrition-sensitive policy measures in place to combat the adverse effects of COVID-19:

1. Increase budget and coverage for essentials

Many state and national governments have gone beyond the entitlement provisions under the National Food Security Act – 2013 to announce a stimulus package, the key elements of which are grain and pulses, and cash transfers to lower-income households. While this is a necessary and commendable step, a much stronger nutrition-sensitive hunger mitigation and food programming scheme is crucial. A basic, nutritious diet, recommended by the EAT-Lancet Commission, would cost at least INR 33.69 per day. Accounting for a family of 4, cash transfer of INR 500 per month would only satisfy a family’s requirement for approximately four days a month! Most states’ announcement of transferring an additional INR 1,000 only satisfies their requirement for an additional eight days. India has surplus food grains to weather the current crisis. Universal access and 3x more rations, irrespective of possession of ration cards, will be effective in addressing hunger including the 70 million poor households who lack an identification document.

2. Address malnutrition through dietary diversity, supplementation, and fortification:

Current food supplies through the Targeted Public Distribution Systems (TPDS) are predominantly comprised of grain and pulses. In the current situation where farm supply chains are expected to take at least four months to be restored, essentials such as vegetables, milk, and eggs, could be sourced directly from the farmers and made available in the open markets, supplied through public distribution systems and provided as weekly take home supplies to children and PLW. A few state governments such as the Telangana government have directed Anganwadi workers to provide eggs to mothers and children. Scaling such initiatives to a national level will help improve nutrition outcomes during the pandemic.
 
The honorable Prime Minister of India, in his address to the nation, ‘Mann ki baat’ on 25th August 2019, announced fortification of rice that is distributed to India’s poor through the public distribution systems, Integrated Child Development Services (ICDS) and mid-day meals. This would be the right time to implement the policy and improve access to fortified products including salt, edible oil, flour, rice, and milk. The aforesaid initiative is critical in the current scenario when nutrient consumption is bound to be erratic due to cash and food shortage