The Role of Demand Creation in Addressing the Double Burden

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With most food consumed across the world being obtained from the marketplace, from large, multinational companies to small street vendors, businesses have a significant influence on the food people eat. However, we know that businesses are interested in promoting their own products, thus there is a need for wide ranging market development for more affordable, accessible, and nutritious food.

There is increasing recognition on the role of demand creation for improving consumption of nutritious foods. Food purchase drivers, and subsequent purchase decisions, need to be addressed to adopt healthy eating behavior and improve diets. Yet, for that – fundamental questions have yet to be addressed:

What motivates consumers to buy and consume more nutritious foods?

How can we make nutritious diets and foods more desirable to consumers?

On March 2019, during the 4th Hidden Hunger Congress in Stuttgart, Germany, Breda Gavin-Smith, Sight and Life’s Global Public Health Nutrition Manager, co-chaired a session with Alessandro Demaio, CEO of EAT on “The role of demand creation in addressing the double burden of malnutrition”. The session brought together four visionaries in order to further understand the significant role of demand creation in improving the consumption of healthy nutritious foods.

The role of demand creation across the food system in addressing the double burden of malnutrition – setting the scene

Rowena Merritt, Head of Research at the National Social Marketing Centre, examined the principles underpinning demand creation and provided an overview on how it can address the double burden of malnutrition. Knowledge is not enough to change the behavior of beneficiaries and target consumers because rational decisions are overrated when it comes to food. When creating demand for nutritious foods, it is therefore imperative to link desired behavior change with something the consumer cares about. What is it that they value? What moves them? What motivates them? There is much the public sector can learn from the private sector when it comes to communicating promises and benefits (as opposed to facts, figures or product features as is often does) and there are successful examples showcasing this. The key and challenge is to offer consumers/beneficiaries immediate benefits that outweigh the barriers of changing their behavior. When this is done, we can start seeing a change in behavior.

hidden Hunger. double burden, demand generation, food, healthy
Rowena Merritt presents at the 4th Hidden Hunger Conference in Stuttgart, Germany.

“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

Identifying opportunities to increase supply and demand for nutritious foods – the Fill the Nutrient Gap

Natalie West, Nutrition Consultant at Fill the Nutrient Gap (FNG), looked at how the FNG assessment identifies opportunities to increase the demand for nutritious foods. The FNG situation analysis for decision making identifies context-specific barriers and entry points for food, health and social protection systems to improve nutrition through increasing availability, access, affordability and choice of healthy, safe, nutritious foods. It does so through the review and analysis of secondary sources of information on access to and availability of nutritious foods, and Cost of the Diet analyses and modeling that assess affordability of a nutritious diet, and possible improvements thereof. Stakeholders from multiple sectors (food system, health, agriculture, food processing, marketing, retail, and social and behavior change communication) are engaged throughout the process. Based on the FNG results, they formulate recommendations around improving nutrient intake, and supply and demand stimulation for nutritious foods. Demand creation is not only about consumer demand, but also about awareness and push by policy makers, to ‘enable’ or ‘allow’ consumers to have demand (i.e. making nutritious choices available and affordable).

An example of a double duty in action – incorporating demand creation as a key component in improving micronutrient intake in Ghana – the case of OBAASIMA

Daniel Amanquah, Food Fortification Specialist for Sight and Life, reviewed OBAASIMA which is a demand driven approach to address micronutrient deficiencies in Ghana. Consumer demand for nutrient-dense foods has a greater chance of success if foods fit the underlying consumer values that inform and guide consumption decisions and purchasing choices. Factors that drive demand for nutritious foods are convenience, affordability, and the aspirational value of nutritious foods. OBAASIMA recognizes the importance of consumer values and conducts insight research to help understand the target population. The OBAASIMA demand creation strategy draws on deep consumer insights and deploys above and below-the-line marketing to ensure continued consumer awareness and affinity for the OBAASIMA seal. The seal trademark is awarded to products that adhere to the minimum fortification content, as well as nutrition criteria on maximum allowable levels of sugar, salt, fat, and trans-fat. This helps inspire healthy food choices by making products easily identifiable and recognizable.

Obaasima, demand generation, Ghana, women, nutrition

Chef’s Manifesto – leveraging chefs to create demand for healthier foods

Paul Newnham, Director at the SDG2 Advocacy Hub, spoke on the importance of engaging diverse actors in creating demand for healthier foods. New voices must be brought into nutrition conversations that are struggling to reach their target audience. As food influencers and the bridge between farm and fork, chefs have an important role to play in helping us to rethink food– what we eat and how its produced – with conversations that prioritize taste and language that inspires action. Present in our schools, neighborhood gardens, community projects and businesses, chefs can speak to farmers, consumers, politicians and communities alike with a message of sustainable, nutritious food for all to deliver the Sustainable Development Goals by 2030. Adding greater food diversity to our plates is a first step in making Agenda 2030 a reality, as biodiversity not only adds nutritional value to our diets but also strengthens food systems and builds climate resilience. The Chefs’ Manifestois an initiative that works to bring new voices into the food system debate, raise awareness about key challenges and solutions, and bridges the gap between high-level UN debates and the general public.

Food Forever and the Chefs’ Manifesto are joining forces to launch the 2020FOR2020 campaign whose aim is to inspire 2,020+ chefs from across the world to champion biodiversity by 2020. Chef actions will be showcased online and at global food events throughout the year to demonstrate how chefs can inspire better ways of cooking, eating and advocating for biodiversity conservation. 

nutrition, biodiversity, chefs, 2020FOR2020

Find out more about demand generation and this Sight and Life session by checking out the presentations of each speaker:

Rowena Merritt | The role of demand creation across the food system in addressing the double burden of malnutrition – setting the scene

Natalie West | Identifying opportunities to increase supply and demand for nutritious foods – the Fill the Nutrient Gap

Daniel Amanquah | An example of a double duty in action – incorporating demand creation as a key component in improving micronutrient intake in Ghana – the case of OBAASIMA

Paul Newnham | Chef’s Manifesto – leveraging chefs to create demand for healthier foods

The Double Burden of Malnutrition

Impacts of obesity and undernutrition

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Increasingly those in the global nutrition arena are discussing challenges presented by the double burden of malnutrition (DBM), a concept first discussed in 1992 at the International Conference on Nutrition (ICN) held by the Food and Agriculture Organization (FAO) and the World Health Organization (WHO). The concept refers to the coexistence of undernutrition and overnutrition in the same population across the life course.

There are over two billion people worldwide who are overweight or obese while at the same time undernutrition persists, sometimes within the same country, city or household.” 
– Shauna Downs, Institute of Human Nutrition & Earth Institute, Columbia University

Many governments are now challenged with having populations that are subject to both nutrient “excesses” and “deficiencies”. Undernutrition is not only a phenomenon of low- and middle-income countries (LMICS), and overnutrition is not just a rich country’s problem (Kolčić, 2012).

Currently, two billion people are overweight or obese, one-third of the population still suffers from iodine deficiency, 40 percent of women of reproductive age have anemia, and 17 percent of preschool children are underweight (UNSCN 2010). Increasingly these conditions occur at the same time in the same population, in the same household, and even in the same individual (FAO 2006). The below graphic was featured in the article, “The Multiple Burdens of Malnutrition“, from the Sight and Life magazine focused on Food Systems and highlights these coexisting dynamics.

There is gathering evidence that when economic conditions improve, obesity and diet related non-communicable diseases may escalate in countries with high levels of undernutrition. There is also evidence to indicate that undernutrition in utero and early childhood may predispose individuals to greater susceptibility to some chronic diseases (Shrimpton and Rokx, 2012).

The scale of the global problem continues to increase, with few examples of the trend reversing or even reducing. This will be further challenged in coming years by an increasingly urban population. In just two decades, two-thirds of the global population will reside in the urban areas of the current LMICs. People in urban environments are becoming increasingly exposed to relatively cheap energy dense processed foods, access to healthier foods, especially fruits and vegetables, is increasingly difficult and there is reduced energy expenditures due to sedentary occupations and lifestyles, with less opportunity and areas to get adequate exercise (Shrimpton and Rokx, 2012).

The Solution?

The double burden of malnutrition certainly has shared drivers and solutions giving a unique opportunity for combined nutrition responses. The WHO recently launched a policy brief drawing attention to the issue with the aim of encouraging action for cost-effective interventions and policies within the United Nations Decade of Action on Nutrition – and, through this, to contribute to achieving the Sustainable Development Goals of ending all forms of malnutrition (SDG2) and ensuring healthy lives and well-being for all at all ages (SDG3) (WHO, 2017)

Referred to as double-duty actions, these may be interventions, programmes and/or policies, that have the possibility to reduce the risk or burden of both undernutrition (including wasting, stunting and micronutrient deficiency or insufficiency) and overweight, obesity or diet-related NCDs (WHO, 2017)

Double duty can be achieved at three levels: through doing no harm with regard to existing actions on malnutrition; by retrofitting existing nutrition actions to address or improve new or other forms of malnutrition; and through the development of de-novo, integrated actions aimed at the double burden of malnutrition (WHO, 2017)

The challenge for many countries is the absence of positive experiences, evidence and success stories in dealing with the double burden of malnutrition. Convincing governments of the win-win scenario that can be gained by viewing malnutrition more broadly rather than the previous silo approach is a real test for the global nutrition community as realities, constraints and limitations of the country context unfold.

References

FAO (2006) The double burden of malnutrition, Case studies from six developing countries (Accessed on 17th June 2017)

Kolčić, I (2012) Double burden of malnutrition: A silent driver of double burden of disease in low– and middle–income countries. J Glob Health. Vol 2(2). Online. (Accessed on 17th June 2017)

Shrimpton, R and Rokx, C (2012) The double burden of malnutrition – A Review of Global Evidence (Accessed on 17th June 2017)

WHO (2017) The double burden of malnutrition -Policy brief (Accessed on 17th June 2017)

UNSCN (2010) This Sixth report on the world nutrition situation (Accessed on 17th June 2017)

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