Deficiencies in one or more micronutrients such as iron, zinc, and vitamin A are widespread in low- and middle-income countries and compromise the physical and cognitive capacity of millions of people. Food fortification is a cost-effective strategy with demonstrated health, economic and social benefits. Despite ongoing debates globally and in some countries regarding the performance and safety of food fortification, the practice offers significant benefits across each of the main vehicles for food fortification (large-scale food fortification, biofortification and point-of-use or home fortification) ranging from reducing the prevalence of nutritional deficiencies and economic benefits to societies and economies. Using Sight and Life’s global and national experiences in implementing food fortification efforts, we demonstrate how different programs in LMICs have successfully addressed challenges with food fortification and in doing so, find that these efforts are most successful when partnerships are formed that include the public and private sector as well as other parties that can provide support in key areas such as advocacy, management, capacity building, implementation and regulatory monitoring.

Nutrient profiling (NP) models aim to assess the nutritional quality of individual foods, according to their energy content and nutrient composition. NP models, initially created to prevent obesity in high-income countries, have tended to penalize dietary energy by giving lower ratings to foods containing excessive calories, fat, sugar, and salt. Energy-driven NP models may need to be reconceptualized for use in low- and middle-income countries (LMIC) where hunger, undernutrition, and micronutrient deficiencies continue to be issues of public health concern. Consistent with the position of the WHO that the purpose of NP methods is to address an identified public health problem, NP models intended for use in LMIC ought to address inadequate intakes of vitamin A, B vitamins, folate, calcium, iron, iodine, and zinc and the frequent lack of high-quality protein. Those models of nutrient density that feature beneficial nutrients (high-quality protein, vitamins, minerals, and trace elements) may be better suited to LMIC needs than are some current NP models that are wholly based around nutrients to limit. NP models intended for LMIC and global use will also need to take food fortification into account. The challenge for LMIC public health agencies is how to balance the future risk of excess “empty” calories against the continuing danger of inadequate nutrients and micronutrient deficiencies that persist at the population level.

No abstract

Climate change, rapid urbanization, war, and economic recession are key drivers of the current food systems’ disruption, which has been exacerbated by the COVID pandemic. Local, regional, and global food systems are unable to provide consumers with nutritious and affordable diets. Suboptimal diets exacerbate the triple burden of malnutrition, with micronutrient deficiencies affecting more than two billion people, two billion people suffering from overweight, and more than 140 million children who are stunted. The unaffordability of nutritious diets represents an obstacle for many, especially in low- and middle-income countries where healthy diets are five times more expensive than starchy staple diets. Food system transformations are urgently required to provide consumers with more affordable and nutritious diets that are capable of meeting social and environmental challenges. In this review, we underline the critical role of innovation within the food system transformation discourse. We aim to define principles for implementing evidence-based and long-term food system innovations that are economically, socially, and environmentally sustainable and, above all, aimed at improving diets and public health. We begin by defining and describing the role of innovation in the transformation of food systems and uncover the major barriers to implementing these innovations. Lastly, we explore case studies that demonstrate successful innovations for healthier diets.

The need for a profound food system transformation has never been greater. The growing burden of malnutrition has become the new normal, with two billion people who are overweight, over 140 million children under five who are stunted and over two billion people affected by hidden hunger. Food fortification has been recognized as a cost-effective strategy to address micronutrient deficiencies. Small and medium enterprises (SMEs) play a strategic role in the food supply chain in low- and middle-income countries, accounting for over 80% of food sales. It is therefore critical to create an enabling environment to facilitate SMEs’ involvement in food fortification practices as a potential solution to tackle all forms of malnutrition. This review highlights SMEs’ relevance as agents of change in the food system through food fortification practices and their indirect yet key role in producing nutritious, tasty and affordable foods. It discusses their challenges (e.g., access to long-term finance, sustainable technical assistance, limited capacity), presents solutions and discusses how different actors can help SMEs to overcome these challenges. Furthermore, it presents a relevant public–private partnership case study to demonstrate how SMEs can address the growing burden of malnutrition through food fortification practices, nutrient profiling schemes and demand generation.

In the face of global food and nutrition crises, incremental adjustment in existing technology is not enough; the future of food systems hinges on innovative solutions that can help achieve the Sustainable Development Goals (SDGs). Innovative approaches and opportunities for the transformation of food systems exist. ‘Innovations’ includes new products, business models, policy practices, technologies, behavioral insights, or ways of delivering products and services that benefit the poor in low- and middle-income countries (LMICs). These include the innovative use of technology, the reallocation of government expenditure, and the promotion of more nutritious diets. However, scaling these innovations requires capital and platforms to connect stakeholders and facilitate the transfer of technology and know-how. It is here that food system innovation hubs have a key role to play. This chapter draws attention to the role that food system innovation hubs can play in creating healthy, resilient and inclusive communities in LMICs. Eight different archetypes of food innovation hubs are described, and the opportunities for these hubs to deliver planet-friendly nutritious and safe foods are explored. These archetypes include science and technology parks, research centers, incubators, accelerators, advanced development spaces, innovation districts, virtual hubs and nodes. Food system innovation hubs can provide transformative solutions to food systems by bringing the right innovations to market faster in a cost-effective manner.

The world is facing a malnutrition crisis in the midst of rising rates of urbanization; more than half of the world’s population lives in urban areas, a number that is expected to reach two-thirds by 2050, consuming 80% of the world’s food. Instead of the development of existing cities into ‘mega-cities,’ urbanization is creating a patchwork of smaller urban areas. In 2018, close to half of the world’s urban residents lived in settlements or towns with less than 500,000 inhabitants. These settlements are classified as secondary cities and are, in terms of population, the fastest growing urban areas. Poor diets among city inhabitants are the consequence of a combination of forces. These include changes in types of occupation, particularly for women; food-environment factors; shifts in norms and attitudes regarding food; globalization of food supply chains; lack of infrastructure; post-harvest food loss and waste, etc. Secondary cities offer entry points for food system transformation. Secondary cities are characterized by strong urban-rural linkages and the opportunity for localized food production and consumption. These cities could also play a key role in enhancing resilience to food security shocks. This chapter discusses the challenge of the growing triple burden of malnutrition in urban contexts and argues for the important role of secondary cities in transforming urban food systems. Through three case studies of secondary cities in LMICs, these cities are shown as emerging players in nutrition-centered food system interventions.

BackgroundSecondary cities tend to be better linked with local food systems than primate cities, acting as important platforms to trade agricultural produce with rural surrounding. COVID-19, conflicts and climate change continue to expose inefficiencies in food systems and have further exacerbated malnutrition, calling for substantial food systems transformations. However, tackling current food systems' challenges requires new approaches to ensure food and nutrition security. Nutritious and agroecologically produced food offer the potential to transform food systems by improving diets and alleviating pressure on the environment, as well as by creating jobs and reducing poverty. This paper describes the design of a project by a Swiss public-private consortium to improve food and nutrition security and to reduce poverty in city ecosystems in six secondary cities in Bangladesh, Kenya and Rwanda through governance/policy and supply and demand side interventions.MethodsThe Nutrition in City Ecosystems (NICE) project promotes well-balanced nutrition for city populations through interdisciplinary agricultural, food, and health sector collaborations along city-specific value chains. Adopting a transdiciplinary systems approach, the main interventions of NICE are (i) advocacy and policy dialogue, (ii) building of decentralized institutional capacity in multi-sectoral collaborations, (iii) support of data-driven planning, coordination and resource mobilization, (iv) anchoring of innovations and new approaches in city-level partnerships, (v) capacity building in the agricultural, retail, health and education sectors, as well as (vi) evidence generation from putting policies into practice at the local level. NICE is coordinated by in-country partners and local offices of the Swiss public-private consortium partners.DiscussionThe NICE project seeks to contribute to urban food system resilience and enhanced sustainable nutrition for city populations by (A) strengthening urban governance structures involving key stakeholders including women and youth, (B) generating income for producers along the supply chain, (C) triggering change in producers' and consumers' behavior such that nutritious and agroecologically produced foods are both in demand as well as available and affordable in urban markets, and (D) allowing a scale up of successful approaches to other national and international cities and city networks.