Micronutrient dietary needs require consideration, especially for women of reproductive age, pregnant and lactating women, and children and adolescents. The odds of death in childbirth double with anaemia (Daru et al. 2018), a condition often caused by nutrient deficiency and affecting almost 470 million women of reproductive age and more than 1.6 billion people globally (WHO 2008). Iron deficiency is estimated to cause 591,000 perinatal deaths and 115,000 maternal deaths per year (Stoltzfus et al. 2004), whereas undernutrition is an underlying cause of 45% of all deaths of children under the age of 5.

Animal-sourced foods can provide high-quality amino acid profile and micronu-
trient bioavailability. A recent study showed improved linear growth in children
receiving animal-sourced foods vs cereal-based diets or no intervention (Eaton et al.
2019). Daily egg provision to young children has also shown increased linear growth
compared to control (Iannotti et al. 2017). These changes in growth can be equated to
larger economic gains across nations, continents, and globally. A review of the
association between stunting and adult economic potential found that a 1 cm increase
in stature is associated with a 4% increase in wages for men and a 6% increase in
wages for women (McGovern et al. 2017). The Cost of Hunger in Africa series has
quantified the social and economic impact of hunger and malnutrition in 21 African
countries and concluded that (a) 8–44% of all child mortality is associated with
undernutrition, (b) between 1% and 18% of all school repetitions are associated with
stunting, (c) stunted children achieve 0.2–3.6 years less in school education, (d) child
mortality associated with undernutrition has reduced national workforces by
1–13.7%, and (e) 40–67% of the working age population suffered from stunting as
children (The Cost of Hunger in Africa series | World Food Programme 2021).
Furthermore, hunger and undernutrition have cost countries between 2% and 17% of
their GDP (The Cost of Hunger in Africa series | World Food Programme 2021).

Fish and fish products can be a key component of a healthy diet, given their
nutrient-dense profile, including protein, omega-3 fatty acid and other micronutrients.
In addition to the underconsumption of fruits, whole grains, nuts and seeds, as noted
earlier, seafood is also generally eaten below recommended intake levels. With the
exception of high-income Asia Pacific, seafood omega-3 fatty acid consumption is
lower than the optimal levels in all 21 global burden-of-disease regions. The recently-
released 2020–2025 Dietary Guidelines for Americans also notes that only 10% of
Americans eat the recommended amount of seafood – two servings – each week.

3 Building the Evidence on Healthy Diets from Sustainable Food Systems

Foremost, we need evidence on actual food consumption to consider shifts to dietary patterns that promote all dimensions of individuals’ health and well-being; *have low levels of environmental pressure and impact*; are accessible, safe and equitable; and
are culturally acceptable (FAO and WHO 2019). Considering current environmental challenges, transitioning to food systems that can enhance natural ecosystems, rather than simply sustaining them, may be desirable.

The conceptual transition from healthy diets to healthy diets from sustainable food systems has been mediated by recent studies linking food availability patterns, and projections, to non-communicable disease health consequences, and the environmental impacts of food production (Tilman and Clark 2014; Springmann et al. 2018a; Willett et al. 2019). A broad range of food availability patterns have been tested as alternatives to current patterns, including Mediterranean, vegetarian, vegan, pescatarian, low animal products and many other variants (Aleksandrowicz et al. 2016; IPCC 2019). The most recent set of studies is embodied in the work of the *EAT-Lancet Commission on healthy diets from sustainable food systems* (Willett et al. 2019). Healthy diets, based on food groups, were designed from a large body of evidence from nutrition observational studies. This helped to establish ranges of inclusion of different types of foods. It is important to note that these dietary recommendations diverge from most food-based dietary guidelines, and often have lower ranges of inclusion of animal-sourced foods, which have been the topic of significant debate, and therefore not widely accepted. The authors then used six environmental dimensions of importance to planetary health and earth system processes (greenhouse gas emissions, cropland use, water use, nitrogen and phosphorus use and biodiversity), using the planetary boundaries concept (Rockström et al. 2009), as boundary conditions for achieving a healthy diet from a sustainable food system. The environmental limits of food described by the EAT-Lancet Commission define a safe environmental space for food to help guide sustainable food consumption patterns.

Willett et al. (2019) found that flexitarian diets that allow for diversity in consumption options, including moderate meat consumption, would significantly reduce environmental impacts compared to baseline scenarios reflecting current consumption patterns. Flexitarian diets include the following characteristics:

(a) high in diverse plant-based foods.

(b) high in the consumption of whole grains, legumes, nuts, vegetables and fruits.

(c) low in the consumption of animal-sourced foods (but requiring increases in fish consumption).

(d) low in fats, sugars and discretionary/ultra-processed foods.

These diets can avert 10.8–11.6 million deaths per year from non-communicable diseases, a reduction of 19–24% from the baseline (consistent with the Global Burden of Disease studies). From an environmental perspective, transitions towards flexitarian patterns could primarily contribute to reducing greenhouse gas emissions, as a reduction in animal-sourced foods also reduces land use and the numbers of animals utilised, along with their associated emissions. However, increases in fruits, nuts and vegetables require more land, water and fertilisers, and therefore increases in productivity of cereals and legumes to bridge yield gaps by close to 75%, and reductions in waste of 50% would be needed to achieve these diets within all sustainability constraints. These dynamics are consistent across many studies
exploring dietary variants (Aleksandrowicz et al. 2016; Jarmul et al. 2020). How-
ever, the environmental footprint of foods is strongly dependent on where and how
foods are produced, leaving significant room for innovation and improvement.
Moreover, the adoption of any of the four alternative healthy diet patterns
(flexitarian, pescatarian, vegetarian and vegan) could potentially contribute to sig-
nificant reductions of the social cost of greenhouse gas emissions, ranging from USD
0.8 to 1.3 trillion (50–74%) (FAO et al. 2020).

However, a limitation of plant-based diets is that they may not fulfil micronutrient needs, especially of those most vulnerable, such as women of reproductive age, pregnant and lactating women, and children and adolescents. In contexts in which diverse options for fortified cereals, grains, and foods are abundant, these outcomes demonstrate great potential for improving health and environmental indices, because risk of undernutrition can be mitigated by the diversity of options in the food environment. In particular, biofortification of staple foods can lead to the higher accessibility of micronutrients, particularly for the poor and vulnerable. However, in contexts in which such diversity of high-quality, fortified products is not abundant, the health risk of anaemia and iron deficiency due to a lack of vitamins and minerals is significant (as outlined above). The recommendations to move to more plant-based diets are complicated by the high quality of animal-sourced foods in terms of their amino acid profile and micronutrient bioavailability and the evidence that the addition of such foods to plant-based diets of many populations could have large individual and societal benefits. Thus, when economic and socio-cultural sustainability are considered, as well as the complex landscape of diverse nutrition situations globally, healthy diets that take sustainability into consideration will look different in diverse contexts around the world.

Transitions towards healthy diets, let alone sustainable consumption, are critical
contributors to achieving climate stability and halting the rampant loss of biodiver-
sity. Combined actions on securing habitat for biodiversity, improving production
practices, and encouraging better consumption would allow for halting biodiversity
loss and bending the curve towards restoration by 2030 (Leclere et al. 2020).

There is also a financial case for shifting to healthy diets from sustainable food
systems. There are hidden costs in our dietary patterns and the food systems
supporting them, two of the most important of which are the health- and climate-
related costs that the world incurs (FAO et al. 2020). If current food consumption
trends continue, diet-related health costs linked to non-communicable diseases and
their rates of mortality are projected to exceed USD 1.3 trillion per year by 2030. On
the other hand, shifting to healthy diets that include sustainability considerations
would lead to an estimated reduction of up to 97% in direct and indirect health costs.
The diet-related social cost of greenhouse gas emissions associated with current
dietary patterns is projected to exceed USD 1.7 trillion per year by 2030. The
adoption of healthy diets that include sustainability considerations would reduce
the social cost of greenhouse gas emissions by an estimated 41–74% in 2030 (FAO
et al. 2020).

Many studies (Springmann et al. 2018a; Swinburn et al. 2019; Willett et al. 2019; Global Panel on Agriculture and Food Systems for Nutrition 2020; HLPE 2020) that
discuss redirecting consumption recognise the need for different consumer
behavioural shifts in different locations and contexts. For example, in low-income
countries, achieving a healthy diet from sustainable food systems would require
increasing the consumption of most nutrient-rich food groups, including animal-
sourced foods, vegetables, pulses and fruits, while reducing some starches, oils and
discretionary foods (Willett et al. 2019). In contrast, in many high-income countries,
achieving the same balance would require reducing the consumption of animal-
sourced foods, sugars and discretionary/processed foods, while still increasing the
consumption of healthy plant-based ingredients. For many countries, the transition
will be complex and the changes difficult to implement. The Global Nutrition Report
2020 demonstrated that, of the 143 countries with comparable data, 124 have double
or triple the burden, meaning that micronutrient deficiency is still prevalent in many
developed countries demonstrating high levels of overweight/obesity (Development
Initiatives 2020). It would be required that these actions play out simultaneously in
different population cohorts within these countries to achieve the desired benefits
(Willett et al. 2019; Development Initiatives 2020; HLPE 2020), while a smaller
number of countries (e.g., Japan) would have smaller adjustments to make.

A global shift towards healthy diets from sustainable food systems will require
significant transformations in food systems, and there is no one-size-fits-all solution
for countries. Assessing context-specific barriers, managing short-term and long-
term trade-offs and exploiting synergies will be critical. In countries where the food
system also drives the rural economy, care must be taken to mitigate the potential
negative impacts on incomes and livelihoods as food systems transform to deliver
affordable healthy diets (FAO et al. 2020). Artificial intelligence may be able to
assist in the transition to healthy diets from sustainable food systems. Examples of its
application are in the management and automation of crop and livestock production
systems and the development of demand-driven supply chains. However, trade-offs
and ethical considerations that arise from the use of artificial intelligence need to be
carefully managed (Camaréna 2020).

Fish and fish products have one of the most eco-efficient production profiles of all animal proteins. Ocean animals are more efficient than terrestrial systems in producing protein; their impact on climate change and land use is, in general, much lower than that of terrestrial animal proteins. One vital way to improve consumption of nutrient-rich and sustainable seafood is through aquaculture, the world's fastest growing food sector. According to the Global Panel on Agriculture and Food Systems for Nutrition (2021), "Aquaculture has real potential to accelerate economic growth, provide employment opportunities, improve food security, and deliver an environmentally sustainable source of good nutrition for millions of people, especially in low- and middle-income countries". The Ocean Panel also documented that the volume of food production from the ocean could be considerably increased. Under optimistic projections, the ocean could produce up to six times more food than it does today, and it could do so with a low environmental footprint.
# 4 Transitioning to Healthy Diets from Sustainable Food Systems

The evidence is abundantly clear that, without shifts in consumption patterns towards health and sustainability, we will fail to achieve multiple Sustainable Development Goals (SDGs), the Paris Climate Agreement, or the post-2020 biodiversity goals, and we will lose the opportunity to reposition food in such a way to improve health and regenerate the environment. Achieving these transitions and managing the trade-offs and synergies will require additional attention to many facets of food systems, including:

**Food Environments** The consumption of healthy diets from sustainable food sources is dependent on sustainably produced healthy dietary items being available, affordable and accessible in different outlets. Whether they are in open markets in low- and middle-income countries, in supermarkets or in corner shops across the globe, or available through bartering and sharing, the provisioning of nutritious food at affordable prices is a critical element for achieving transitions towards sustainable consumption (Downs et al. 2009; Swinburn et al. 2019; FAO et al. 2020). These physical environments need to be developed so as to suit culture and tradition in different locations. Additionally, regulated advertisement and product placement will be essential for addressing positive behavioural changes (Swinburn et al. 2019). To increase consumption of healthy diets, the cost of nutritious foods must be affordable for all, although farmers must also be compensated for the real cost of growing food. The cost drivers of these diets can be found throughout the food supply chain, within the food environment, and in the political economy that shapes trade, public expenditure and investment policies (Swinburn et al. 2019; FAO et al. 2020).

Tackling these cost drivers will require large transformations in food systems at the producer, consumer, political economy, and food environment levels. Trade policies, mainly protectionary trade measures and input subsidy programmes, tend to protect and incentivise the domestic production of staple foods, such as rice and maize, often to the detriment of nutritious foods, like fruits and vegetables. International trade could certainly improve food system resilience by spreading the risk of disruption in supply where it is not fully reliant on domestic production and/or trading with neighbouring countries. However, substantial imports from climate-vulnerable countries by climate-resilient trade partners could lead to a number of interlinked problems, including a 'nutrient drain' of healthy dietary items away from production countries to countries with a much more diverse supply of foods, disrupting supply to importing countries when yields in production countries are affected by environmental influences (Scheelbeek et al. 2020). Non-tariff trade measures can help improve food safety, quality standards and the nutritional value of food, but they can also drive up the costs of trade, and hence food prices, negatively affecting the affordability of healthy diets (FAO et al. 2020). Nutrition-
sensitive social protection policies, such as cash transfers, may assist the purchasing power and affordability of healthy diets of the most vulnerable populations.

Policies that more generally foster behavioural change towards healthy diets will also be needed. A critical challenge is the tremendous perishability of fruits and vegetables, particularly in tropical climates (Mason-D'Croz et al. 2019), where refrigeration, food processing and sustainable packaging may be critical contributions in creating environmental and public health value. In both urban and rural areas, the lack of physical access to food markets, especially to fresh fruit and vegetable markets, represents a formidable barrier to accessing a healthy diet, especially for the poor. Finally, empowering all people, and especially the poor and vulnerable, with sufficient physical and human capital resources, assets and incomes is the necessary precondition to improving access to healthy diets. This will enable the making of choices, regarding what to produce and consume, leaving no one hungry or malnourished, while allowing them to consume healthy and nutritious food and preserving ecosystems, biodiversity and natural resources. However, making progress and achieving this objective entails dealing with all trade-offs, negative externalities and benefits emerging from policies and combinations of policies presented previously.

***Addressing Food Safety Issues Across Value Chains*** Food safety is positioned at the intersection of agri-food systems and health, thus there are very strong interconnections of bi-directional links among food safety, livelihoods, gender equity and nutrition disciplines (Grace et al. 2018).

Food safety across the value chains must be ensured along all stages until consumption. Responsibilities lie with all actors, from producers to processors, retailers and consumers. Consumer behaviour in households regarding the storing (temperature) and handling of foods (cross-contamination) impacts strongly on the onset of food-borne intoxications. In the European Union, surveillance data indicate that most of the strong-evidence outbreaks in 2018 took place in a domestic setting (EFSA and ECDC 2019). The safety of food is a matter of growing concern, especially after the global estimation of the burden of food-borne disease comparable to that of HIV/AIDS, malaria and tuberculosis together, with low- and middle-income countries bearing 98% of the global burden (WHO 2015). Most of the known health burden comes from biological hazards (virus, bacteria, protozoa and worms), which cause acute intoxication that is easier to detect and control. Chronic effects due to chemicals (natural or processed contaminants, pesticide residues, etc.) are more difficult to be traced and quantified as to their actual impact on the disease burden. The *Global Burden of Foodborne Diseases report* (WHO 2015) quantified the burden of disease from aflatoxin, cassava cyanide and dioxins, and other studies have estimated the burden for four food-borne metals (arsenic, cadmium, lead and methylmercury), which is substantial (Gibb et al. 2019). Since temperature and humidity are important parameters for the growth of fungi, climate change is anticipated to have an impact on the presence of mycotoxins in foods.

The riskiest foods for biological hazards are livestock products, followed by fish, fresh vegetables and fruit (Grace et al. 2018). In addition to the disease burden,
food-borne diseases in low- and middle-income countries also have a great impact on economic costs and market access (Unnevehr and Ronchi 2014). In recent years, the possible impact of microplastics and nanoplastics on health via food has gained a lot of attention, with multiple studies identifying the occurrence of micro and nanoplastic particles found in food commodities such as water, filtering molluscs and fish (Lusher et al. 2017; Toussaint et al. 2019; van Raamsdonk et al. 2020). Currently, there is considerable effort to standardise the methods of analysis and identify the health impact from dietary exposure.

Food scares happen from time to time, with the subsequent food incidents (real or perceived) causing a sudden disruption to the food supply chain and food consumption patterns with a high societal impact. In these situations, providing real-time information to consumers is very important so as to maintain confidence in the food supply. Contaminant-based food scares relating to the use of antibiotics, hormones and pesticides have occurred in a number of food and drink sectors and appear to be of more concern to consumers compared to hygiene standards and food poisoning (Miles et al. 2004). Explicit investigations into the aforementioned food scares and their cumulative impact on food purchase behaviour could help to further our understanding of consumer responses to food scares (Knowles et al. 2007).

There are many promising approaches to managing food safety in low- and middle-income countries, but few have demonstrated an impact at scale. Food safety management systems are designed to prevent, reduce or eliminate hazards along the food chain, which includes primary production (farms), processors, retail distribution centres, supermarkets, and retail food outlets (Ricci et al. 2017). Food safety control at primary production is achieved using good general hygiene practices. Food business operators should implement and maintain permanent procedures based on the Hazard Analysis and Critical Control Points principles (WHO and FAO 2006), which are effective in controlling most of the hazards during food production. Small-scale retail producers might have difficulties in Hazard Analysis and Critical Control Points due to the complexity of some systems and a lack of both resources to implement and access to information and appropriate education. Transitions to circular food systems, local food systems, or short circuit systems are often slowed or hampered by current food safety regulations. Ensuring food safety, while enabling small-holder farmers or craft food companies to operate in local contexts, will be critical to facilitating the transition to more sustainable food systems and greater availability of healthy diets while supporting local economies.

To avoid confusion caused by multiple different national standards, the Food and Agriculture Organization of the United Nations and the World Health Organization established the Codex Alimentarius Commission to address safety and the nutritional quality of foods and develop international standards to promote trade among countries (Codex Alimentarius Commission 2007). The Codex Alimentarius establishes standards for maximum levels of food additives, maximum limits for contaminants and toxins, maximum residue limits for pesticides and veterinary drugs and gives indications for limits of microbiological hazards in a given food commodity. At the national level, government food safety systems monitor compliance with official standards through food inspections. While metrics are considered key to
monitoring and improving performance, they can also have unintended consequences, including focusing efforts on the thing to be measured rather than the ultimate goal of improving the thing being measured, stifling innovation through standardisation, costs that increase in disproportion to benefits attained, incentivising perverse behaviour to game metrics and reduced attention to things that are not measured (Bardach and Cabana 2009), the balance and potential of large multinationals vs. small and medium-sized enterprises, short vs. long value chains, and low- and middle-income countries.

Even in higher income countries, small and medium-sized firms find it difficult to
comply with complex and technocratic rules, measures and metrics that are charac-
teristic of best practice food safety management systems and risk-based approaches:
these methods are hardly applicable in low- and middle-income countries. The same
applies for traceability, which only appears to be attainable in niche, high-value
markets in low- and middle-income countries (Grace et al. 2018).

**Local Producers and Value Chains, Income and Land Inequality** For many consumers, especially in low- and middle-income countries, local production is the main supplier of nutritious food (fruits, vegetables, pulses) and the primary provider of economic activity. Small and medium-sized farms produce critical nutrient diversity in rural areas (Herrero et al. 2017), and hence the transition to sustainable consumption requires support and value chain creation for linking food system actors (HLPE 2020).

As with any change, some people will be disadvantaged by the transition to healthy diets from sustainable food systems. It is important to provide support and transition options for potential losers impacted by the required changes to food systems (Herrero et al. 2020).

Many cities are playing more active roles in the development of city region food systems, notably recognising that environmental damage in areas within close proximity to cities impacts a large number of people, and that greater collaborations between cities and peri-urban spaces offers important opportunities for tackling environmental challenges while increasing the availability of healthy diets, and supporting stronger rural economies (e.g., the Paris Food System Strategy (Mairie de Paris 2015)). Vertical farming could provide opportunities for increasing food production in urban areas (Al-Kodmany 2018).

**The Role of Trade in Open and Closed Economies** Trade is an essential instrument in the food system, but it is not always geared towards sustainable consumption. While trade can act as an insurance policy to local disruptions, it can also increase exposure to disruptions in external markets. This is evident in many low- and middle-income countries where trade in cheaper, ultra-processed food with long shelf lives competes with healthy dietary items. In many regions around the world (i.e., the Pacific, South America), this is likely a contributing factor to the high prevalence of obesity and increases in non-communicable diseases (Swinburn et al. 2019). However, trade also eases the leveraging of comparative advantages, which can allow production to be located where it is more efficient (Frank et al. 2018; IPCC 2019). This has been a key feature of scenarios for achieving greenhouse gas
mitigation targets (IPCC 2019). However, when facing varied levels of regulation and power dynamics, trade can facilitate the outsourcing of environmental impacts of the food system to more vulnerable countries and individuals. Export-oriented value chains often are dominated by larger producers, who can concentrate market and political power as dominant producers and suppliers of food, as well as sources of employment and revenue to governments (Swinburn et al. 2019). These aspects are intertwined with the political economy of food and need to be accounted for.

It is also important to consider the impacts of the rising number of barriers to international trade on the affordability of nutritious foods (including non-tariff measures put in place to ensure food safety), as restrictive trade policies tend to raise the cost of food, which can be particularly harmful to net food-importing countries (FAO et al. 2020). Protectionary trade measures such as import tariffs and subsidy programmes make it more profitable for farmers to produce rice or corn than fruits and vegetables. According to data from Tufts University, removing trade protection across Central America would reduce the cost of nutritious diets by as much as 9% on average (FAO et al. 2020). The efficiency of internal trade and marketing mechanisms is also important, as these are key to reducing the cost of food for consumers and avoiding disincentives to the local production of nutritious foods.

**The Political Economy of Food** Swinburn et al. (2019) demonstrated that the current food system has large power imbalances and conflicts of interest when large commercial interests in food manufacturing and trade exist. While some large food companies are interested in opportunities to increase their environmental sustainability, financial interests often prevail over sustainability concerns. Swinburn et al. (2019) articulates that changes in the regulatory environment and new incentives, combined with global efforts on sustainable trade, will be required to create the necessary accountability and shifts towards healthy diets.

**Modifying Behavioural Changes** Most studies exploring the transitions towards healthy diets from sustainable food systems have focused on the technical feasibility of the diets and their production elements. Transition pathways and the levers for eliciting the required behavioural changes in consumption have received less attention (Garnett 2016; HLPE 2020).

Educating consumers to make healthy choices can modify behaviour in some cases. Educational campaigns in high-income countries have increased awareness and have also achieved some modest gains in fruit and vegetable consumption. However, most have not realised the target levels for consumption over the longer term (Brambila-Macias et al. 2011; Thomson and Ravia 2011; Rekhy and McConchie 2014). Certain people are more receptive to education on healthy diets than others. Providing nutritional information was found to change the behaviour of consumers already interested in nutrition, but was unable to influence consumers with low interest in nutrition (Lone et al. 2009). Conversely, marketing incentives for healthy diets have been found to be more effective for people who have less healthy eating habits (Chan et al. 2017). Educational activities are more effective when used in conjunction with environmental modifications, such as increasing the availability and accessibility of healthy dietary items (Van Cauwenberghe et al. 2010).
Altering food availability options can enhance healthy diets. A review of studies found that the strategic placement of fruit and vegetables could moderately increase fruit and/or vegetable choice, sales or servings (Broers et al. 2017). However, individual studies show mixed results. Furthermore, the provision of financial incentives to make healthy diets more affordable has been shown to increase consumption of fruits and vegetables (Olsho et al. 2016).

Taxes and front-of-pack information labels have been used with success to moderate the purchase of unhealthy dietary items, as well as influence reformulation of unhealthy products (Colchero et al. 2017; Roache and Gostin 2017; Taillie et al. 2020). Although the magnitude of effect ranges, there is evidence that fiscal measures such as taxes on unhealthy dietary items improve diets (Andreyeva et al. 2010; Brambila-Macias et al. 2011; Eyles et al. 2012; Niebylski et al. 2015). A sugar-sweetened beverage tax has reduced consumption of such drinks in the study cohorts in Berkeley, USA (Lee et al. 2019) and Mexico (Sánchez-Romero et al. 2020). A review on the effect of subsidies for healthy dietary items and taxation on unhealthy dietary items found evidence that taxation and subsidy intervention influenced dietary behaviours to a moderate degree. The study suggests that food taxes and subsidies should be a minimum of 10 to 15% and should both be implemented to improve success and effect (Niebylski et al. 2015).

**Reducing Food Loss and Waste and Embracing Circularity** As discussed in Action Tracks 1 and 3, a critical component of rebalancing food systems is reducing food loss and waste. Food loss and waste currently accounts for significant losses of food availability around the world, and current estimates are, for food loss, 14% (FAO 2019) and, for food waste, 17% (United Nations Environment Programme 2021) of total production, depending on the type of commodity. In low- and middle-income countries, these losses occur mostly at the pre-consumer stage due to harvest and storage losses, while in OECD countries, they are more significant at the consumption stage (for example, sell-by dates). Circular food systems have been suggested as a mechanism for reutilising these biomass streams (Jurgilevich et al. 2016). For example, it has been estimated that circular livestock could produce 7–23 g of protein per capita/day while decoupling livestock from land use systems (Van Zanten et al. 2018). Microbial protein production in fermentation processes or through alternative foods (i.e., insects, algae) are considered part of these solutions (Parodi et al. 2018; Pikaar et al. 2018).

## 5 The Key Trade-Offs and Synergies

Food systems in low-, middle- and high-income countries are changing rapidly. Increasingly characterised by a high degree of vertical integration and high concentration, transitions in food systems are being driven by new technologies that are changing production processes, distribution systems, marketing strategies, and the food products that people eat (Stordalen and Fan 2018; Herrero et al. 2020).
In terms of synergies, the arguments for aligned action on healthy diets from sustainable food systems are attractive from multiple standpoints. The possibility of engaging in triple-win actions linking health, consumption and the environment presents a real opportunity to achieve numerous global commitments simultaneously, which could be desirable from a policy perspective. These include planned emissions reductions (United Nations 2015; IPCC 2019; Leclere et al. 2020), reductions in non-communicable diseases and malnutrition in all its forms, and achievement of SDG goals and targets (SDGs 1, 2, 3, 6, 8, 12–16). These multi-sectoral opportunities will require increased concerted action and alignment at the global and national levels. While these synergies could potentially lead to human and planetary well-being, their achievement could also yield significant trade-offs that will require resolution (Herrero et al. 2021). Some of these are related to the following dimensions:

**Multiple Environmental Trade-Offs** Changing consumption patterns can have impacts on the environmental footprints of the food system. Over a decade ago, Stehfest et al. (2009) demonstrated that reductions in the demand for animal-sourced foods could lead to reduced greenhouse gas emissions. These effects were mediated through reductions in methane production and carbon dioxide due to the use of less land and fewer animals for achieving consumption targets. More recently, studies integrating many environmental indicators (Springmann et al. 2018b; Van Zanten et al. 2018; Willett et al. 2019) confirmed those findings, but due to the compositions of the healthy diets with higher amounts of coarse grains, fruits, vegetables and nuts, the environmental impact of these diets remains high. The impacts on different locations are markedly different due to different limiting constraints (i.e., water scarcity). It is only when consumption is modified, waste is reduced, and productivity increased that improvements across all environmental metrics are obtained.

**Trade-Offs with Affordability and Availability** A key trade-off of pursuing healthy diets from sustainable food systems is the increase in the costs of the diets in many countries, as a result of increasing the demand for nutrient-rich foods. A significant portion of the people living in extreme poverty are the two billion who struggle to access sufficient foods and suffer acute caloric and nutrient deficiencies. Even the cheapest healthy diet costs 60% more than diets that only meet the requirements for essential nutrients. Examples like the EAT-Lancet diet are not affordable for an estimated 1.5 billion people (Hirvonen et al. 2020, Table 1) and almost double the cost of the nutrient adequate diet; it is five times as much as diets that meet only the dietary energy needs through a starchy staple (FAO et al. 2020). This is of concern, as the high cost and unaffordability of healthy diets is associated with increasing food insecurity and different forms of malnutrition, including child stunting and adult obesity. The unaffordability of healthy diets is due to their high cost relative to people's incomes. Healthy diets are unaffordable for more than 3 billion poor people in low-, middle- and high-income countries, and more than 1.5 billion people cannot even afford a diet that only meets required levels of essential nutrients (FAO et al. 2020; Global Panel on Agriculture and Food Systems for Nutrition 2020). The cost of a healthy diet is much higher than the international poverty line, established at
<table><caption>**Table 1** Number and share of people with daily income below the cost of the EAT-Lancet reference diet, by country income levels and major regions (Hirvonen et al. 2020)</caption><thead><tr><th></th><th>Number of countries</th><th>Population (in millions)</th><th>Share (%)</th></tr></thead><tbody><tr><td>Global</td><td>141</td><td>1579.02</td><td>23.8%</td></tr><tr><td>By country income level</td><td></td><td></td><td></td></tr><tr><td>High income</td><td>38</td><td>9.00</td><td>0.8%</td></tr><tr><td>Upper-middle income</td><td>37</td><td>254.07</td><td>10.8%</td></tr><tr><td>Lower-middle income</td><td>40</td><td>1005.89</td><td>37.1%</td></tr><tr><td>Low income</td><td>26</td><td>310.06</td><td>62.2%</td></tr><tr><td>By geographical region</td><td></td><td></td><td></td></tr><tr><td>East Asia and Pacific</td><td>13</td><td>319.88</td><td>15.0%</td></tr><tr><td>Europe and central Asia</td><td>45</td><td>14.86</td><td>1.7%</td></tr><tr><td>Latin America and Caribbean</td><td>19</td><td>62.84</td><td>11.6%</td></tr><tr><td>Middle East and North Africa</td><td>11</td><td>48.40</td><td>19.4%</td></tr><tr><td>North America</td><td>2</td><td>3.95</td><td>1.2%</td></tr><tr><td>South Asia</td><td>7</td><td>627.31</td><td>38.4%</td></tr><tr><td>Sub-Saharan Africa</td><td>44</td><td>501.77</td><td>57.2%</td></tr></tbody><tfoot><tr><td colspan="4">We used the World Bank's PovcalNet system to calculate the share of people in each country whose daily consumption or income was less than the estimated cost of the EAT-Lancet reference diet.</td></tr></tfoot></table>

USD 1.90 purchasing power parity per day. At a global level, on average, a healthy diet is not affordable, with the cost representing 119% of mean food expenditures per capita per day. Where hunger and food insecurity are greater, the cost of a healthy diet even exceeds average national food expenditures. The cost of a healthy diet exceeds average food expenditures in most countries in the Global South. 57% or more of the population throughout sub-Saharan Africa and Southern Asia cannot afford a healthy diet (FAO et al. 2020).

Part of the reason why many of the components of healthy diets are expensive follow the basic economics of supply and demand. In many cases, production of key dietary components does not meet the required demand, even at the global level, and therefore their prices are high. Mason-D'Croz et al. (2019) recently demonstrated this for fruits and vegetables, a key component of healthy diets. The study concluded that even under optimistic socioeconomic scenarios, future supply will be insufficient to achieve recommended levels in many countries. Even where supply exists (i.e., India), internal barriers like poorly developed markets mean that increased incomes do not necessarily result in increased consumption of healthy diets (Fraval et al. 2019).

Low market access can be a large barrier to achieving a healthy diet. A 'food desert' refers to areas with poor access to a retail outlet with fresh produce, where cheap, ultra-processed, and unhealthy dietary items can predominate. While food deserts are often associated with economically disadvantaged communities in high-
income countries (Walker et al. 2010; Ghosh-Dastidar et al. 2014), they also affect
poor urban communities in low- and middle-income countries, particularly newly
urban communities (Battersby and Crush 2014). Food deserts can also occur in areas
that lack refrigeration, or have harsh environmental conditions or poor storage
conditions, far from towns, where highly processed foods can be stored easily
(i.e., the Pacific). Vertical farming may provide opportunities for food production
in urban areas, where available land for farming is limited and expensive. Currently,
economic feasibility, codes, regulations, and a lack of expertise are major obstacles
to implementing vertical farming (Al-Kodmany 2018).

**Trade-Offs with Pandemics and Zoonosis** In contexts in which animal-sourced food consumption is higher than recommended, shifting towards greater plant consumption would also have the added benefit of preserving ecological systems and wildlife and avoiding the spillover of zoonotic agents (mainly viruses) from wildlife to humans. In contexts in which animal-sourced food consumption is critical for maintaining appropriate intake of essential nutrients, it is vitally important to scale up a ONE HEALTH approach that enables environmental, animal, and human health (Wood et al. 2012; Gale and Breed 2013) while avoiding causing a public health threat. In recent years, there have been several examples of such spillovers (Ebola, SARS, MERS and COVID-19) with dramatic economic and public health consequences and the potential to cause global pandemics (see Box 1). A consequence of the COVID-19 pandemic is the disruption of global, or concentrated, value chain production in terms of affordability and food availability; inversely, many local value chains have seen increases in production and market shares.

The global burden of disease from food consumption is very different across the
globe (WHO 2015), and it is, in large part, produced by zoonotic infections. Today,
the largest food source attributions in food-borne intoxications are from food of
animal origin in the developed world. Antimicrobial resistance contributes signifi-
cantly to the burden of disease across the globe and constitutes a threat to public
health.

**Box 1: The impact of COVID19 on Food Systems**

Food

The new type of respiratory tract disorder COVID-19 is based on an
infection with the new type of coronavirus (SARS-CoV-2). The main target
organs of coronaviruses in humans are the respiratory tract organs. The
scientific data collected so far suggests that the virus is transmitted mainly
via small respiratory droplets through sneezing, coughing, or when people
interact with each other in close proximity, as may happen in slaughterhouses
and meat-processing plants, where environmental conditions seem more

(continued)
**Box 1** (continued)

favourable than in other places to the propagation of the virus. In fact, there have been COVID-19-related outbreaks at some slaughterhouses and meat-processing plants worldwide, which has led to risk management measures to contain the propagation of the virus from occupational exposure among workers and related communities. Up to now, there is no evidence that food, including meat, is a source or transmission route of SARS-CoV-2. Meat, like any other food, might theoretically be contaminated by SARS-CoV-2. This could happen with food in the same way that it could happen with any other animated or non-animated surface. For example, food might be exposed to the virus through contamination by an infected person during food manipulation and preparation. This does not mean however that the food ingested would cause infection for the consumer. As indicated above, there is so far no evidence of transmission of this virus through ingestion of any type of food. Several food safety agencies and organisations worldwide have concluded that there is no evidence of food-borne transmission of the virus.

Pandemics and value chains

COVID19 is an example of the importance of ONE HEALTH approach as it is a zoonosis (disease transmitted from animals to humans). It is well known that damaging ecological systems might lead to spillovers of zoonotic agents (mainly viruses such as Ebola, SARS, MERS) outside their original environment with dramatic economic and public health consequences and the potential to cause global pandemics. A consequence of the COVID-19 pandemic is the disruption of global, or concentrated value chain production in terms of affordability and food availability; inversely, many local value chains have seen increases in production and market shares.

Waste

In response to COVID-19, hospitals, healthcare facilities and individuals are producing more waste than usual, including masks, gloves, gowns, other protective equipment and single-use plastics that could be infected with the virus. Infected medical waste could lead to public health risks, as well as environmental risks add to land, riverine and marine pollution.

**Political Economy Trade-Offs** Broad awareness of the positive or negative consequences of food system changes from nutritional, health, environmental and livelihood perspectives among key policy-makers is key to policy changes that facilitate a transition to healthy diets from sustainable food systems. Increased biodiverse agricultural production can result in increased employment and income, leading to growing demand for (healthy) food, provided that there is strong consumer awareness regarding diets and their consequences, and provided that there are few competing demands on incomes, especially of the poor.
The political impediments to achieving healthy and sustainable diets are numerous. Maintaining the status quo benefits the current actors of the food system, hence the inertia for change (Béné et al. 2020; Fanzo et al. 2020; Herrero et al. 2020). Additionally, many public policies are not geared towards creating sustainable food systems, such as a lack of research and investment in nutritious foods at the expense of cereals or the creation of food environments that promote nutritious foods. The current system rewards economic efficiency rather than sustainability and the production of nutrition foods (Béné et al. 2020). Therefore, farmers have little incentive to change production practices. At the same time, large private companies exercise disproportionate control over the food agenda, and this is not necessarily aligned with a health and sustainability agenda needed to transform the food systems.

Technology will be important, but even with the best intentions, assurance that equitable and fair distribution of its availability and impacts are taken into account when designing transition pathways remains elusive (Herrero et al. 2021). Critical dialogues and transparency in designing these transition pathways must be developed with a broad range of stakeholders, and with mutual respect for values and motivations (Herrero et al. 2021).

# 6 Solutions and Actions

Solutions for enabling the shift towards more sustainable consumption need to be defined around cross-cutting levers connecting policy reform, coordinated investment, accessible financing, innovation, traditional knowledge, governance, data and evidence, and empowerment (Béné et al. 2020). It is important to identify and learn from the success stories of individuals and groups that have shifted to healthy diets from sustainable food systems and use these examples to clearly inform policymakers, practitioners and the public. Figure 1, from the Global Panel on Agriculture and Food Systems for Nutrition (2020), synthesises the range of critical actions necessary to effectively create transition towards healthy and sustainable diets. We develop this list further into a broader set of actions for implementation in different contexts, which are presented below, following the categories of actions in Béné et al. (2020).

**Economic and Structural Costs** Off-set the economic and structural costs associated with the transition to more healthy and sustainable diets.

* Develop policies and investments across food supply chains (food storage, road infrastructure, food preservation capacity, etc.) that are critical to cutting losses and enhancing efficiencies so as to reduce the cost of nutritious food (FAO et al. 2020).

* Provide support and transition options for potential losers impacted by the required changes to land use, food production practices, storage and processing technologies, food environment, distribution and food waste.
<figure><img src="image_18.png" /><figcaption>**Fig. 1** Priority policy actions to transition food systems towards sustainable, healthy diets. (Global Panel on Agriculture and Food Systems for Nutrition 2020)</figcaption></figure>

* Direct funding towards a healthy and sustainable food system, e.g., repurpose funding from monoculture crops, or foods that, when overproduced, are detrimental to health and the environment (e.g., sugar and its derivatives).

* Facilitate easier access to loans from financial institutions, or lands from municipalities, notably for young farmers, both men and women.

* Pilot and scale behaviour change interventions that are effective in reducing consumer food waste and increasing the adoption of healthy and sustainable diets.

* Invest in innovative food-related infrastructure and logistical systems that will improve the efficiency of food supply chains, particularly for urban consumers.

* In low and lower middle-income countries, facilitate increased consumption of nutrition foods by encouraging those with access to land to grow more such foods themselves or by exchange within the local communities.

* Encourage the creation of rural food markets in cities based on the production and sale of indigenous and sustainably produced foods grown by local farmers.

* Break existing policy silos so as to facilitate food system transformations, providing support for a major policy drive to enhance the cultivation of indigenous food systems. Many native foods have biological components that can contribute to nutritionally-rich and healthy diets. Priority actions should be taken to promote research into these native foods worldwide.
**Challenge the Current Political Economy**

* Encourage large food system actors to transition to the provision of healthy diets through incentives that are matched with penalisation or taxes for overproduction of unhealthy dietary items, or the use of degradative production practices.

* Develop trade policies and input subsidy programmes that can change incentives towards nutritious foods like fruits and vegetables. This also implies improvement of food safety to reduce non-tariff trade measures so as to increase the availability of healthy diets.

* Promote social and environmental aspects of corporate performance to be equal to financial performance.

* Develop regulatory measures such as taxes and front-of-pack information labels to limit the sale and production of unhealthy products.

* Change the global regulatory environment, including international trade and investment agreements, to favour healthy diets from sustainable food systems.

* Promote divestment to avoid harm. This includes the exclusion of certain companies from investment portfolios.

* Encourage a culture of corporate responsibility in the food industry to investigate the level of sustainability of products. Encourage social impact investing. This aims to generate a positive social impact from investment decisions, alongside financial return.

* Empower consumers to demand healthy, sustainable products and reject unhealthy products.

* Encourage consumers to demand increased accountability for large food system actors.

* Encourage institutions, for example, schools, health care facilities and government offices, to transition to healthier diets through improved nutrition standards, which flow on to improve the nutritional quality of meals served in those institutions (Gearan and Fox 2020).

* Gear public policies towards creating healthy diets from sustainable food systems.

**Influencing Consumer Demand** The Global Panel on Agriculture and Food Systems for Nutrition (2020) recommends the following four priority lines of action, while also acknowledging that far better evidence of what works in low- and middle-income countries is required:

* Define principles of engagement between the public and private sectors, leading to the leveraging of expertise and resources and influence of the businesses in the food sector. This recognises the considerable role of firms in driving consumer choices, too often employed in ways that are not conducive to healthy diets from sustainable food systems. A new relationship between public and private actors is needed, so that they can work together on a common agenda.

* Upgrade and improve food-based dietary guidelines and promote enhanced knowledge about the implications of dietary choices. For example, food-based dietary guidelines seldom take account of issues of food system sustainability.
Moreover, policy-makers in many governments need to take account of food-based dietary guidelines in developing policies, both in relation to the food system and in wider areas of government (e.g., relating to infrastructure development, safety nets, etc.).

* Improve regulation of advertising and marketing. This is mentioned in the AT2 paper and discussed further in the Foresight report, which addresses, in particular, the ineffectiveness of businesses self-regulating.

* Implement behavioural nudges via carefully designed taxes and subsidises.

**Education and Cultural Norms** The role of education will be pivotal in changing consumption patterns at many levels. It can facilitate a cultural shift in consumer perceptions and behaviour.

* Provide education and clarity for consumers about what constitutes a healthy and sustainable diet and educate consumers to make healthy choices, coupled with other incentives to improve success and effect.

* Invest in female, minority and youth leadership and technical and managerial skills, which are key to promoting the more equitable and sustainable participation of women in food supply chains, as producers, processors, business leaders and consumers, using women's self-help groups as an example.

* Alter food availability options to promote healthy diets.

* Invest in large-scale awareness campaigns that connect food consumption patterns with health, the environment and, specifically, climate change outcomes.

* Engage in school education programmes on healthy diets from sustainable food systems to ensure that the next generation has a novel conceptualisation of what the food system can offer.

* Include sustainability-of-consumption learning modules in medical school curricula worldwide.

**Equity and Social Justice** Manage equity and social justice to provide the greatest benefit to all:

* Identify the current consumption patterns of households.

* Encourage regions to transition to more healthy and sustainable diets in a culturally appropriate manner.

* Systematically use full supply chain traceability to promote internal transparency, as has been shown to work (Bush et al. 2015). This could potentially be a way to promote social justice in the industry and protect people employed in low- and middle-income countries.

* Deploy safety nets to protect the poor against dynamic food system transitions that might render them vulnerable and disenfranchised. This will require international coherence and action (Global Panel on Agriculture and Food Systems for Nutrition 2020).
Governance and Decision Support Tools

* Invest in additional knowledge, skills, data and tools needed to identify, prioritise and manage trade-offs and competing priorities.

* Establish standardisation and clear labelling.

* Develop tools for measuring consumer and retail food waste at the national level, so as to understand the scale of the problem, identify hotspots for targeted action, and track progress towards SDG 12.3.

* Increase adherence to principles of circular economy recycling and the repurposing of food waste until they become the norm.

* Rationalise food-related sustainability standards. Such initiatives, which set standards for sustainable production and often include certification programmes to verify compliance, can be used as tools to drive consumer choice on the one hand and to channel and enhance the nascent demand for more sustainable food systems into market-related investments on the other. However, some regulatory approaches and private sector-led schemes create barriers, primarily because of the costs of compliance and the potential exclusion of actors. Nevertheless, some excellent examples exist within the salmon industry (Global Salmon Institute 2020).

7 Conclusions

A shift towards sustainable consumption patterns is necessary to harmonise global societal and environmental goals and for humanity to prosper sustainably and equitably in the coming years. Transitioning towards healthy diets from sustainable food systems at the country level is essential to achieving this, together with strategies for managing waste reduction and increasing productivity.

The range of constraints preventing this transition include the lack of availability and access to healthy diets, the costs of eating healthily, poor food environments, lack of incentives and standards, food safety, pandemics and, in many cases, a lack of political will. These are not insurmountable. Many strategies exist for circumventing these problems, including awareness-raising, behaviour change interventions in food environments, food education, strengthened urban-rural linkages, improved product design, investments in food system innovations, public-private partnerships, public procurement, and novel strategies for food waste management.

The role of science and innovation will be essential in deploying these interventions at scale and at low costs, and for minimising the potential trade-offs that may arise. Transparent multi-stakeholder dialogues will be key at all stages of planning the appropriate transition pathways towards our desired global goals of healthy diets, healthy ecosystems and prosperity for all.

**Acknowledgements** Helpful comments on an earlier draft by five external peer reviewers, and by colleagues in the Scientific Group, are gratefully acknowledged.
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# Fruits and Vegetables for Healthy Diets: Priorities for Food System Research and Action

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Jody Harris, Bart de Steenhuijsen Piters, Stepha McMullin, Babar Bajwa, Ilse de Jager, and Inge D. Brouwer

## 1 Why Fruits and Vegetables? Why Now?

Fruits and vegetables are vital for healthy diets, and there is broad consensus that a diverse diet containing a range of plant foods (and their associated nutrients, phytonutrients and fibre) is needed for health and wellbeing (FAO 2020). Studies have suggested intake ranges of 300–600 g per day (200–600 g of vegetables and 100–300 g of fruits) to meet different combinations of health and environmental goals (Willett et al. 2019; Loken et al. 2020; Afshin et al. 2019). The World Health Organisation (WHO) recommends that adults eat at least 400 g of fruits and vegetables per day (World Health Organisation 2003), with national food-based dietary guidelines translating these into recommendations to eat multiple portions of a variety of fruits and vegetables each day for health (Herforth et al. 2019).

Despite this clear message, intake of fruits and vegetables remains low for a majority of the global population (Afshin et al. 2019; Kalmpourtzidou et al. 2020). Low fruit and vegetable consumption is among the five main risk factors for poor

J. Harris (✉)

World Vegetable Centre, Bangkok, Thailand

e-mail: Jody.harris@worldveg.org

B. de Steenhuijsen Piters

Wageningen Economic Research, Wageningen, the Netherlands

S. McMullin

World Agroforestry, a partnership of CIFOR-ICRAF, and CGIAR FTA, Nairobi, Kenya

B. Bajwa

CABI, Rawalpindi, Pakistan

I. de Jager

Wageningen University and Research, Wageningen, the Netherlands

I. D. Brouwer

Wageningen University and Research, and CGIAR-A4NH, Wageningen, the Netherlands
health, with over 2 million deaths and 65 million Disability-Adjusted Life Years (DALYs) attributable to low intake of fruits, and 1.5 million deaths and 34 million DALYs attributable to low intake of vegetables globally each year, particularly in low- and middle-income countries (Afshin et al. 2019). Low consumption is a global problem, affecting high- and low-income countries: only 7% of countries in Africa, 7% in the Americas, and 11% in Europe reach 240 g/day of vegetables on average (Kalmpourtzidou et al. 2020), and only 20% of individuals in low- and middle-income countries reach the recommendation of five servings of fruits and vegetables a day (Frank et al. 2019). The mean global intake of vegetables is estimated to be around 190 g/day, and of fruits, 81 g/day. Studies generally agree that parts of Africa and the Pacific Islands have the lowest fruit and vegetable consumption, and East Asia has the highest vegetable (but not fruit) consumption (Afshin et al. 2019; Kalmpourtzidou et al. 2020; Micha et al. 2015).

Changes in fruit and vegetable consumption are happening against a backdrop of the ‘nutrition transition’ from traditional foods to processed and ultra-processed foods that are high in energy, fat, sugar and salt, but poor in other essential nutrients (Popkin et al. 2020). This transition also brings opportunities to diversify into healthy diets containing more fresh fruits and vegetables, although, for some populations, there is less opportunity than for others (Global Panel on Agriculture and Food Systems for Nutrition 2016). The available literature does not suggest systematic differences in fruit and vegetable consumption between men and women in many contexts (Frank et al. 2019; Micha et al. 2015), but it does highlight differences in consumption between rural and urban areas (Hall et al. 2009; Ruel et al. 2004; Mayen et al. 2014), and among populations with different levels of education and national income (Frank et al. 2019). These differences illustrate that there is an equity issue across populations in accessing fruits and vegetables (Harris et al. 2021a).

We now have good conceptual models for how food systems work to provide diets (HLPE 2017). These help us to describe the structural and social constraints to fruit and vegetable consumption and research how these play out in different contexts and for different populations. Below, we summarise what we know (and what we need to know) about how to address the issues above through a set of push (production and supply), pull (demand and activism) and policy (legislation and governance) actions. We conclude that there is still a need to better understand the different ways that food systems can make fruits and vegetables available, accessible, affordable and desirable for all people, across places and over time, so as to meet global recommendations, but also that we know enough to accelerate action in support of healthy diets. The year 2021 is the UN International Year of Fruits and Vegetables, embedded in the middle of the Decade of Action on Nutrition. Now is the time to prioritise understanding and addressing these issues to enable fruit- and vegetable-rich food systems that can drive healthy diets for all.
## 2 Policy Factors: Political Power

The Green Revolution in the latter part of the twentieth century transformed agriculture's ability to produce sufficient calories to feed the world, but the focus on grain crops through funding, research, extension and technology development limited the supply of nutrient-dense fruits and vegetables, both through losses of wild sources with the promotion of monocultures and through policy and structural impediments that crowded out non-staple crops (Pingali 2012). Today, the combined international public research budget for maize, wheat, rice, and starchy tubers is 30 times greater than for vegetables, for instance (Herforth 2020), and these incentives skew many of the technology and infrastructure drivers of food systems. This has fed into national food policies, which are normally focused on the production or import of staple crops (as a source of cheap calories), rather than diet quality through diversity of fresh foods (as a source of other essential nutrients) (McDermott and De Brauw 2020). Following suit, food system data have focused largely on globally tradable commodities, leading to a dearth of trustworthy and disaggregated data with which to track the production, price, trade or consumption of the diversity of fruits and vegetables (Masters et al. 2018), and global data are biased towards economically-relevant crops, often missing traditional fruits and vegetables and those produced non-commercially (Thar et al. 2020). Research on food systems and diets often treats fruits and vegetables as a single food group, rather than looking at diversity within fruit and vegetable species, or the amounts or variety consumed within the food group (Harris et al. 2021b), further limiting our knowledge on the specifics of issues or actions.

At the same time, large structural changes outside of the food system, such as the globalisation of supply chains and societies, and changing demographics and urbanisation have shaped food regimes to prioritise foods that are non-perishable and globally tradable (Magnan 2012; Lang and Heasman 2015), the very opposite of most fruits and vegetables, whose perishability requires shorter food chains from farm to fork. Modern trade rules improve regulation on the safety of imported fruits and vegetables and may protect domestic production or improve supply of highly-traded commodities, but they also limit the ability of governments to protect the public health policy space and the institutional purchase of fresh foods (Thow et al. 2015) and tend to prioritise staple foods over fruits and vegetables, while out-sourcing the environmental impacts of production to poor countries (FAO 2020). In many contexts, the concentration of inputs, distribution and retail of foods – including fruits and vegetables – in the hands of a few large companies, has shifted food system choices away from the livelihood interests of producers, the health interests of consumers, and the environmental interests of all (Howard 2016).

These broad and sweeping changes have not been without interruption: the COVID-19 pandemic and previous economic shocks and natural disasters have disrupted many aspects of food systems and diets over time (Savary et al. 2020; Block et al. 2004; Darnton-Hill and Cogill 2010). Such disruptions particularly affect fruits and vegetables because of their specific labour, storage and transport
requirements (Harris 2020), with at least temporary impacts of different shocks having been documented on the livelihoods of fruit and vegetable producers and on fruit and vegetable prices and consumption (Block et al. 2004; Darnton-Hill and Cogill 2010; Harris et al. 2020; Hirvonen et al. 2020). These shocks have affected the diets and livelihoods of marginalised populations in ways different from those with economic or social power, further exacerbating inequity (Carducci et al. 2021; Kansiime et al. 2021; Goldin and Muggah 2020).

## 2.1 Opportunities for Research and Action

Each of these big-picture policy and political drivers has created food system 'lock-ins' (Leach et al. 2020), which have tended to steer away from pathways prioritising fruits and vegetables, and away from agronomic and food system paradigms – such as agroecology, a right to food, or food as a commons rather than a commodity (Rosset and Altieri 2017; Vivero-Pol et al. 2018; Patnaik and Oenema 2015) – that might promote a return to more diverse production systems. Policy decisions can start with evidence: we need to know more about how different production and distribution systems, based in different social and political traditions, drive the availability and accessibility of fruits and vegetables in food systems, and how they weather shocks to provide healthy diets sustainably and equitably. However, ultimately, while data and evidence can reveal nuance in the issues and their solutions, food policy decisions are political (and, ideally, ethical) in reality, depending on the priorities and tolerances of the actors involved in making those decisions (Harris 2019). Bringing together people with a stake in food systems to debate and decide policy, explicitly recognising disparities in power among them in contributing to outcome and decisions, is likely to lead to the most context-specific and equitable policy in practice when done well (Chaudhury et al. 2013; Barzola et al. 2019; Blay-Palmer et al. 2018).

A starting point for addressing the lack of fruits and vegetables in food system policy is 'reverse thinking', putting the dietary outcomes we want from food systems upfront in responsive food policy-making and legislation, and working towards incentivising systems that create these (McDermott and De Brauw 2020). A difficulty in achieving this vision is that different actor coalitions frame food system issues and priorities differently according to their interests and beliefs, so that there is no single narrative to work towards (Harris 2019; Béné et al. 2019), and coherent diet and food system policy will require policy sectors to work together in non-traditional ways (Thow et al. 2018). There is, therefore, a need to better understand how public and private decision-makers make food system choices and how other food system actors influence these, as well as the implications for fruits and vegetables across food systems.

Public investment in agriculture is shown to impact the growth of production through the private sector, but different types of investment produce different results for different foods in different contexts (Mogues et al. 2012), so we need to know
more about how specific investments, such as in breeding, production subsidies, and extension support, play out in food environments for different fruits and vegetables. Acknowledging the imbalance of power among food system actors, illustrated by disparities between budgets of processed food producers (Baker et al. 2020) and public investment in healthy foods such as fruits and vegetables (Herforth 2020), is necessary in order to make transparent and health-positive policy, regulation and investment. Public policy shaping food environments – such as mandating vegetables in institutional meals (schools, workplaces, hospitals), setting incentives for healthy retail, and regulating food system actors (Knai et al. 2006; Micha et al. 2018; Vandevijvere et al. 2019) – is seen to improve intakes in some contexts. Similarly, land rights are a key issue for sustainable food access and production (Sunderland and Vasquez 2020), and we need to know more about how these issues affect fruits and vegetables. For all of these analyses, better data and contextual knowledge on diverse fruits and vegetables in different systems is needed, particularly in low- and middle-income countries, to inform businesses, policy-makers, practitioners, workers and activists in making decisions within food systems.

## 3 Push Factors: Production and Post-Harvest Power

By the data we have, global fruit and vegetable production is insufficient to meet the WHO dietary recommendations, and has been since global records began: in 1965, sufficient fruits and vegetables (≥400 g/day) were available for 17% of the global population, increasing to 55% in 2015 (Mason-D'Croz et al. 2019). Supply varies widely between contexts: in Africa, only 13% of countries have an adequate aggregate vegetable supply, while in Asia, 61% do (Kalmpourtzidou et al. 2020). This is despite the fact that fruits and vegetables are valuable: the annual farmgate value of global fruit and vegetable production is nearly $1 trillion and exceeds the farmgate value of all food grains combined (US$ 837 billion) (Schreinemachers et al. 2018). Most fruits and vegetables (about 92%) are not internationally traded, but the international trade in fruits and vegetables was still valued at US$ 138 billion in 2018.

Fruit and vegetable production needs to increase, particularly in regions with low consumption, together with accompanying measures to prevent losses, to provide enough for healthy diets (Mason-D'Croz et al. 2019). Scaling production is not straightforward, as fruits and vegetables have specific attributes – in terms of seasonal and agro-climatic differences, labour and input needs, knowledge and expertise, and storage and distribution – that mean there are particular trade-offs to consider. While we can, in theory, produce healthy diets within planetary boundaries (Willett et al. 2019), achieving national food-based dietary guidelines has been found to be incompatible with climate and environmental targets in a majority of the 85 countries studied (Springmann et al. 2020), and producing more fruits and vegetables may require more land, water and chemical inputs than producing staple foods in some contexts (Aleksandrowicz et al. 2016), with one-third of all
greenhouse gas emissions being produced by the food system (Crippa et al. 2021). Various studies show widespread misuse of agricultural chemicals, particularly on high-value vegetables, creating hazards for farm workers, consumers and the environment (Schreinemachers et al. 2020a). Foodborne diseases caused by biological contamination of food are also an important threat to public health, particularly in low- and middle-income countries, and fruits and vegetables are among the riskiest foods for biological hazards (Grace 2015).

Seed or planting stock is a key input in fruit and vegetable production, although it is a contested area: some see the introduction of (often proprietary) improved varieties of fruits and vegetables as necessary to transform the fruit and vegetable sector to one with increased volumes of regularly available quality products (Schreinemachers et al. 2018; Dawson et al. 2019; Schreinemachers et al. 2021; Lillesø et al. 2018). Others stress the importance of local or cultural seed-saving and exchange of planting material for conserving farmers’ independence, agricultural diversity and food sovereignty (Howard 2016; Phillips 2016), and debates about the primacy of breeders’ rights or farmers’ rights are ongoing (Gupta and Negi 2019; Salazar et al. 2007; Dias 2011). Beyond inputs, labour requirements in fruit and vegetable production are considerably higher than in cereal production, with labour costs making up more than 50% of production costs, depending on the food grown, related to more skilled and intensive field operations (Weinberger and Lumpkin 2007; Herrero et al. 2017). This is a positive for food system worker incomes, but extension services are often geared towards staple crops, with little support for fruit and vegetable producers, limiting formal training opportunities (Pingali 2015). Beyond the farm, post-farmgate midstream employment in developing regions constitutes roughly 20% of rural employment (Dolislager et al. 2020; Reardon et al. 2014). It is assumed that many smallholders also engage in midstream fruit and vegetable chain operations, such as trade and processing, but fruit and vegetable value chains have not been a focus of this work, so more knowledge is needed in this area.

Of food produced for human consumption, around one-third by volume or one-quarter by calories is either lost (before retail) or wasted (after purchase) (HLPE 2014). Highly perishable fruits and vegetables have the highest rates of loss and waste, usually within the range of 40–50% (Global Panel 2018; FAO 2019). Local production is therefore central, and in many contexts, ultra-local home-based fruit and vegetable production and wild plant gathering are important strategies (Schreinemachers et al. 2015; Bharucha and Pretty 2010), as are ‘under-utilised’ species and many traditional fruits and vegetables that are often left out of data, policy and extension (Raihana et al. 2015; Hunter et al. 2019). Fruits and vegetables are particularly seasonal, which can be an advantage in diverse systems where different foods become available at different times, or a challenge where there are gluts and shortages that lead to price changes over the course of the year (Gilbert et al. 2017; McMullin et al. 2019).
## 3.1 Opportunities for Research and Action

Clearly, greater availability of a variety of fruits and vegetables is needed for everyone to meet recommendations. This can be achieved through increased production, although there are trade-offs between environmental sustainability and providing for diets: sustainable intensification using a wide range of approaches according to the social, political and agro-ecological contexts to improve yields or protect against climate changes without environmental degradation has been suggested (Schreinemachers et al. 2018; Godfray and Garnett 2014), although further understanding of the implications of different approaches to fruit and vegetable production is needed. Organic agriculture meets goals for a range of environmental factors, including reduced chemical contamination of diets, but it has weaknesses in terms of lower productivity and reduced yield stability (Knapp and van der Heijden 2018), and the subsidisation of chemical inputs makes it appear less profitable. Supporting the availability of planting material through formal (breeding and seed companies) and informal (seed-saving and sharing networks) channels is important (Schreinemachers et al. 2018).

The economic value of fruits and vegetables is a strong incentive for their production, but much of this value is captured by large global firms rather than smallholders, despite over 80% of fruit and vegetables being grown on smallholder family farms (<20 ha) in LMICs (Herrero et al. 2017). The smallholder nature of many fruit and vegetable producers and traders provides challenges and opportunities for vegetable supply (Reardon and Timmer 2014), and the complexity of systems of traders and the heterogeneity of smallholders and their support needs (particularly peri-urban vegetable producers or women, who may not be engaged in formal extension systems (FAO 2021; Fischer et al. 2017)) means that agricultural policy very often does not adequately support the twin goals of healthy food production and livelihood development (Gassner et al. 2019). Aggregation or contract farming is commonly used to reduce transaction costs and risk, and to sell to modern channels such as supermarkets, where demand for fruits and vegetables is growing (Reardon et al. 2012; Holtland 2017), although the impacts of commercialisation on the diets of commercial farmers themselves are mixed (Carletto et al. 2017). Farmer extension needs to be strengthened (Schreinemachers et al. 2018), and we need more documented understanding of how informal sectors and formal small and medium enterprises involved in fruit and vegetable processing, distribution and retail can deliver more on desired food system outcomes. These need further research to understand how they play out in fruit and vegetable systems.

Better availability can also be achieved by addressing food loss and waste: in low-income countries, through addressing on-farm pests and diseases, pre-maturity harvesting due to climate shocks or seasonal gluts, and inappropriate post-harvest handling, transport and storage, and in middle-/high-income countries, by addressing quality grading standards set by retailers (Global Panel 2018). Packaging of perishable fruits and vegetables can limit losses (Wohner et al. 2019), but also contributes to environmental pollution and greenhouse gas emissions (Crippa et al. 2021;
Yates et al. 2021). More understanding is needed of the production, processing and distribution options and trade-offs, and of food loss and waste, specifically for fruits and vegetables in different contexts.

The physical availability of food varies, depending on functioning supply chains, whether short or long. Food deserts and swamps associated with poorer diets occur where there is a lack of available fresh foods for local purchase, and exist particularly in poorer urban areas (Ghosh-Dastidar et al. 2014). Physical access is a key driver of purchase (and, by extension, consumption), with a lack of fresh food outlets making consumption of fresh produce harder (Beaulac et al. 2009), and, conversely, living close to vegetable vendors making vegetable purchase more likely (Ambikapathi et al. 2021), suggesting that local access options are important in shaping diets.

# 4 Pull Factors: People Power

While availability of, and physical access to, sufficient fruits and vegetables is an important prerequisite, there are other factors at the socio-economic and personal levels that also impact their role in diets. Reviews of research suggest that, in low-income countries, similar determinants play a role in food choices as in high-income countries, at the individual level (income, employment, education level, food knowledge, lifestyle, time), in the social environment (family and peer influence, cultural factors), and in the physical environment (food expenditure, lifestyle) (Gissing et al. 2017).

Food prices interact with incomes to determine whether households can afford the components of a healthy diet, and fruits and vegetables, along with animal-source foods, are the most expensive element of a healthy diet, comprising, by many metrics (Maillot et al. 2007; Headey and Alderman 2019), around 40% of the cost of a healthy diet (Herforth et al. 2020), although these costs tend to vary with the season (Gilbert et al. 2017). Fruits and vegetables are unaffordable for many, with 3 billion people unable to afford diverse, healthy diets (Herforth et al. 2020). Fruits and vegetables appear more affordable when comparing prices per micronutrient, according to which they are likely to be a relatively low-cost source of varied vitamins, minerals, and phytonutrients (Drewnowski 2013), but this is not how most families choose their food.

Beyond a certain income level, affordability is not a driving factor for everyone everywhere: while an increase of fruit and vegetable consumption by income across geographical regions is confirmed in many studies, indicating that a low income is a barrier to fruit and vegetable consumption for some (Frank et al. 2019; Miller et al. 2016), there is only a weak association between incomes and fruit and vegetable consumption, showing that, on average (across 52 countries), 82% of the poorest quintile consume an insufficient amount of fruits and vegetables and 73% of the wealthiest quintile do the same (Hall et al. 2009). As incomes rise, the consumption of meat, dairy and ultra-processed foods rises much faster than that of vegetables; additionally, the purchase of vegetables in some contexts changes little across
income groups, and hence vegetable consumption is relatively inelastic to income past a certain level (Ruel et al. 2004), although a greater amount of fruit may be consumed at higher incomes. With little change in the consumption of vegetables across income groups in some contexts (Morris and Haddad 2020), affordability is not the largest driver of consumption for all.

Even if vegetables are available, accessible and affordable, most people still do not consume large enough quantities (Hall et al. 2009), particularly if they are not considered an acceptable or desirable food choice, for instance, due to food safety or contamination concerns, taste preferences, or cultural appropriateness (Aggarwal et al. 2016; Ha et al. 2020; Hammelman and Hayes-Conroy 2014). Low desirability of fruits and vegetables is a particular problem among children and adolescents, with data across 73 countries showing that between 10% and 30% of students do not eat any vegetables at all in one-quarter of these countries (FAO, IFAD, UNICEF, WFP, WHO 2019).

## 4.1 Opportunities for Research and Action

Addressing the affordability of fruits and vegetables is key to creating an environment where all can access a healthy diet, and affordability can come from a combination of lower retail prices (through productivity improvements, reduced post-harvest losses, or increased market efficiency for stable prices) and higher incomes (from inclusive economic growth and social safety nets) (Hirvonen et al. 2019). Cheap food is not necessarily good for healthy diets, fair livelihoods or biodiverse environments, so a focus on raising people up through fair wages is important (Benton et al. 2021). Price subsidies for fruits and vegetables is a policy option that is popular with the public in some contexts (Niebylski et al. 2015), and there is evidence that price incentives to make fruits and vegetables more directly affordable have worked to increase consumption (Swinburn et al. 2019; Olsho et al. 2016). These affordability interventions in contexts where a majority of fruits and vegetables are purchased can be combined with non-purchase interventions such as promoting home and community production or the facilitation of foraging where the context allows (Schreinemachers et al. 2016; Baliki et al. 2019; Powell et al. 2015).

Alongside the ability to afford fruits and vegetables, the challenge is to enhance consumer choice of and preference for these foods. There is clear evidence that focusing on education at all levels is a key component for modifying behavioural changes in general (Alderman and Headey 2017), and nutrition literacy, social norms for healthy eating, and self-efficacy are key components of health-related behavioural change (Eker et al. 2019), although we know less in regard to fruits and vegetables in particular. Nutrition literacy programmes generally target women, who are custodians of household nutrition in many contexts, but there may also be a need for community-targeted messages to change social norms (Van den Bold et al. 2013). Promoting traditional or under-utilised vegetables that are familiar was seen as a key policy option for healthy diets and environmental sustainability among the
members of an expert opinion Delphi panel (Pedersen et al. 2020), and the latest generation of food-based dietary guidelines have begun to move in this direction, but these efforts need to better consider cultural acceptability and may require promotional efforts to increase the willingness of consumers to shift their tastes to new or forgotten foods (Davis et al. 2021). Food composition data is lacking for many indigenous species, limiting the opportunity to develop appropriate nutritional messaging and promote wider use (Stadlmayr et al. 2013; Jansen et al. 2020).

Beyond appeals to public health, better understanding is required of consumers’ preferences and behaviours with respect to these foods and what kinds of incentives might promote more consumption in different contexts. Strategic placement of fruit and vegetables in retail outlets is found to have a moderately significant effect on increasing fruit or vegetable servings (Broers et al. 2017), and early exposure to fruits and vegetables through schools may shape future preferences for healthier diets (Schreinemachers et al. 2020b). Marketing is a key factor shaping desirability, but is consistently applied for ‘hedonic’ (processed) rather than ‘healthy’ (nutrient-dense) foods (Bublitz and Peracchio 2015). On marketing issues, much is known about high-income countries (Thomson and Ravia 2011), but less about low- and middle-income contexts where these approaches (understanding market segments and speaking to issues of desirability, aspiration, emotion and imagination) can be adapted for fruits and vegetables (Deo and Monterrosa 2020).

# 5 Fruit and Vegetable Food Systems: What Next?

The brief review above has laid out evidence on the key food system issues for fruits and vegetables in healthy diets, and, where available, included evidence on actions to address these. From this summary, it is clear that we know, on a broad scale, the structural limitations to fruits and vegetables: global and national challenges of increasing production and accessing quality growing material shared equitably, local issues of ensuring affordability, addressing perishability and enabling everyone everywhere to access fruits and vegetables, and social issues of valuing vegetables for their role in cuisines and for health. It is also clear that the precise issues and solutions to these vary by population and according to the food system context, and that there are multiple potential routes towards solutions that sometimes clash on ideals. Food system actions to make fruits and vegetables more available, affordable, accessible and desirable through policy, push and pull mechanisms comprise various options working at the macro (global and national), meso (institutional, city and community) and micro (household and individual) levels. Examples of actions from the review above are laid out in the table below.

It is unlikely that these are all of the options available for orienting food systems towards fruit- and vegetable-rich diets, but these are the options that appear in the academic literature, albeit with varying levels of evidence. In addition, there are two important over-arching considerations when considering action options: (1) Acknowledging that power shapes food systems, from the concentration of
economic and political power in a few global agri-food businesses to the marginalisation of certain groups in societies from accessing healthy diets, so this needs to be considered in terms of both facilitating inclusive processes for deciding policies and actions and assessing their equity impacts (Howard 2016; Harris and Nisbett 2018); and (2) there will be trade-offs among food system outcomes, so starting with a focus on healthy diets is important, but understanding how food system decisions then impact fair livelihoods and sustainable environments is key (Wiebe and Prager 2021). We do not yet know enough to formulate clear actions that will address these trade-offs, but they need to be acknowledged and openly debated by those making food system decisions.

<table><caption>Examples of Policy, Push and Pull Actions at Different Levels</caption><thead><tr><th></th><th>Macro (global and national)</th><th>Meso (institutional, city and community)</th><th>Micro (household and individual)</th></tr></thead><tbody><tr><td>Policy</td><td>R&D investment<br>Right to food legisla-<br>tion<br>Food safety regulation</td><td>Zoning and marketing regulation<br>Prioritising fruit and vegetables<br>(F&amp;V) in institutional food pro-<br>curement plans</td><td>Protected foraging<br>rights<br>Land rights</td></tr><tr><td>Push</td><td>Production subsidies<br>Efficiency through<br>breeding and technol-<br>ogy<br>Support for diverse<br>alternative production<br>paradigms<br>Infrastructure develop-<br>ment<br>Fair finance access</td><td>Quality F&amp;V planting material<br>(formal and informal systems)<br>Pre- and post-harvest practices and<br>packaging<br>Improving market access, shorten-<br>ing food supply chains<br>F&amp;V extension and training<br>Support for fresh food outlets</td><td>Home &amp; community<br>gardens</td></tr><tr><td>Pull</td><td>Price subsidies<br>Social safety nets<br>Food-based dietary<br>guidelines</td><td>F&amp;V-rich institutional meals<br>Basic processing for preservation<br>Social marketing campaigns<br>Promotion of traditional F&amp;V<br>F&amp;V product placement in shops<br>and canteens</td><td>Nutrition literacy cam-<br>paigns<br>School gardens and<br>learning for shaping<br>preferences</td></tr></tbody></table>

These actions are likely to be foundational to creating change within food systems towards enabling fruit- and vegetable-rich diets. None of these actions will change diets when implemented alone, but rather packages of actions need to be assembled to address particular limitations for fruit and vegetable consumption. These need to be considered in context, in light of an understanding of food system issues and bottlenecks limiting healthy diets in different places and for different people. It is likely that the best way to start is to bring together diverse groups of people interested in these issues at the different levels, to understand the issues and options from different perspectives and to prioritise together which actions should be undertaken first in their own context. This is not easy, given inherent power disparities among interested parties, but with care and inclusion, a strategy, policy
or plan can be crafted to move towards enabling fruit and vegetable-rich food systems.

To guide better action, we need more evidence and understanding. We know a lot about a small fraction of the fruit and vegetable species of which we are aware, and very little about the rest. We know that there are disparities in diets in different contexts, but not how to address the political, social and equity determinants of who gets to eat fruits and vegetables. We know much about the technical production and market aspects of fruits and vegetables, but less about bottlenecks in bringing these to low- and middle-income countries, and we do not know enough about how these things change with context or over time. Work drawing on different academic traditions, including valuing traditional and tacit knowledge, is needed to connect the dots. Food systems that enable fruits and vegetables in healthy diets are not only a technical issue, but bring up very real political, social and ethical questions that societies will have to address, alongside a reliance on evidence. Having these conversations through the lens of equity to address the needs of both winners and losers within changing food systems will be a vital part of the UNFSS process towards enabling fruit and vegetable-rich food systems for healthy diets for all.

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<figure><img src="image_21.png" /></figure>
<figure><img src="image_22.png" /></figure>

David Laborde and Maximo Torero

# 1 Introduction

The 2030 Agenda for Sustainable Development calls for transformational change that aims to achieve economically dynamic, socially inclusive and environmentally sustainable change. The 2030 Agenda has raised awareness of the key role that agrifood system transformation can play as an entry point for accelerating progress to achieve many of the SDGs, but also highlighted the complexity of promoting transformational change. SDG 2 alone draws attention to several related challenges: the need to eliminate hunger and all other forms of malnutrition by ensuring that sufficient quantities of safe, nutritious and affordable food are available to all while also recognizing the importance of raising the productivity and incomes of small producers, and calling for a variety of measures, including investment, trade and market development to promote the inclusive, sustainable development of agriculture and agrifood systems. Yet, the 2030 Agenda also emphasizes the interconnectness of the SDGs beyond SDG 2 and requires that Member States achieve this while creating the growth and employment opportunities needed to eradicate poverty, protect biodiversity and the natural resource environment, and address the growing pressures of climate change.

Addressing the multidimensionality of agrifood systems requires using a multisectoral, dynamic multi-country model to properly capture the various

<footnote>D. Laborde (✉)
International Food Policy Research Institute (IFPRI), Washington, DC, USA
e-mail: d.laborde@cgiar.org</footnote>

<footnote>M. Torero
Food and Agriculture Organization of the United Nations (FAO), Rome, Italy</footnote>
trade-offs.<fnref n="1" /> Specifically, this model will allow us to grasp the interactions among different food value chains (primary production, processing, distribution), as well as with the rest of the economy. This is important for economic interactions (demand for inputs and outputs, income generation flows) and for environmental aspects: the carbon footprint of food production and consumption depends on the energy system in which it operates. Agrifood systems cannot be studied independently from the wider economic structure, both because these structures condition a number of drivers shaping agrifood systems (income distribution, availability and costs of technologies, inputs) and because agrifood systems represent a major source of employment and income generation for a large number of low- and middle-income economies. Therefore, the transformation of agrifood systems will have macroeconomic implications (employment, income, cost of living, fiscal consequences) and economy-wide trade-offs.

Secondly, this model structure will allow us to consider the dynamic evolutions of agrifood systems and their environment, since policy reform does not occur in a frozen universe. A static analysis could describe current systems. But it is essential to develop a dynamic framework to capture the evolution of the world, particularly in terms of economic growth, inequalities, demographic pressure and climate change. We cannot jump from current systems to a different one in a framework where other conditions remain the same. Even if such an exercise could shape the debate and provide important insights, any practical implications and guidelines for triggering the required transformation—a set of voluntary actions—need to consider future evolutions of the world that agrifood systems could help to shape, but not define. This is important when presenting roadmaps for action and dynamic trade-offs.

Finally, it will allow us to capture the plurality of agrifood systems (with an “s”) at a global level and understand the interactions that occur through the flows of goods, services, capital, people and ideas. The magnitude and speed of globalization have skyrocketed in recent years, but agrifood systems have been largely shaped by international exchanges for more than 6000 years. Regions with a high concentration of population, or volatile weather, have relied on external food producers to guarantee their food security. New crops and technologies have been traded and new products consumed, taking advantage of the diversity of agro-ecological systems at a global level. However, even as production and consumption decisions in one country could affect producers and consumers 10,000 miles away in just a few

<footnote n="1">¹Externalities generate trade-offs when people's welfare is pitted against environmental objectives. Sometimes, trade-offs happen at a large scale, among food, land, water, energy and climate (Bleischwitz et al. 2018 and others). Other times, they emerge from biomass uses and the competition among food consumption, feed for animals and biofuels (Muscat et al. forthcoming). In addition, many different dimensions, such as time, geography, governance and technology, affect the links among the SDGs. Positive interactions, though not discussed here, can be used to build strategies across sectors. Negative interactions are the targets of regulations and policies or the topic of public investment in technologies and solutions. The ultimate goal is to support coherent strategies and policies that neutralize the negative impact of SDG interactions, while achieving food and nutrition security and socioeconomic and environmental sustainability.</footnote>
weeks, we do not have a homogenous and global, fully integrated food system. We
have a web of interconnected (at various degrees) and heterogenous agrifood
systems. Our modeling system should capture them. In particular, while prices in
different locations interact with one another, we should not imagine that they are
cleared in one global market. Beyond the market linkages, the global perspective is
essential for non-marketed outcomes. We have to take into account the fact that the
transformation of domestic agrifood systems will have external environmental
footprints, and that global production and consumption involve trade-offs that
require international cooperation.

In addition to the above features, we need to think about the type of model we
need. The traditional modeling toolbox has recently been expanded beyond the
econometric models and the equilibrium models. At the same time, other instruments
(machine learning, evolutionary behavioral models) have been proposed. However,
we can narrow down the choice of the instrument easily. Indeed, our goal is not to
provide a foresight tool or to forecast the future using econometric models or
machine learning models. Both of them heavily rely on reduced forms, and, as
such, the traditional Lucas' critique (1976)<fnref n="2" /> would be a notable weakness for them.
Transformative change requires structural and disaggregated models. We need a
modeling framework based on a strong economic theory, which would allow us to
compare various “equilibriums”—or the state of the world and agrifood systems
under different conditions and policies. For this reason, we need models for which
the equilibrium’s unicity and stability are theoretically grounded.

For these reasons, we have selected, in this paper, a global, computable general
equilibrium model (CGE): the MIRAGRODEP model has the core element of the
modeling framework. It is a dynamic, multisectoral, global model that generates
unique market equilibria across goods, services and factors of production, in which
economic agents (farms, firms, households, governments) are fully described with
structural equations, and have clear optimization programs and constraints. Such a
model has the virtue of being completely consistent: there is no leakage, “free
lunch,” or elements outside the system. Agrifood systems would be properly defined
within a multisectoral context, and the framework itself would allow for the inves-
tigation of different definitions when drawing borders across systems. In addition,
while providing a framework within which countries interact while facing individual
constraints—through their balance of payments and domestic endowments, includ-
ing labor and land—we can still operate with imperfectly integrated markets, leading
to various price dynamics in different countries.

The MIRAGRODEP model has been developed to capture various social and
environmental outcomes so as to track the various trade-offs at stake, going beyond
the traditional CGE model. It can also be paired with various models upstream, or
downstream, that could provide key inputs (e.g., crop technology, nutrient balance
for the soil or human consumption) or downscale or extend the results generated by
the CGE model. The MIRAGRODEP framework has been used to study social and

<footnote n="2">² Lucas (1976).</footnote>
environmental implications of various policies and economic changes. For instance, see Laborde and Martin (2018) for the link between economic growth and rural poverty; Laborde (2011) and Laborde and Valin (2012) for an assessment of biofuel policies; and Laborde et al. (2020a) for GHG accounting of farm policies. The MIRAGRODEP model has also contributed to policy and political processes in various countries.

The modeling initiative proposed in this chapter brings the modeling innovations of the last decade into an integrated framework and builds on existing partnerships to extend its scope. It builds and extends the existing development for the Ceres2030 project,<fnref n="3" /> looking at several aspects of SDG2 (hunger, environmental sustainability, poverty, and smallholders’ income). In particular, a strong comparative advantage of the MIRAGRODEP CGE is its integration with household data and the use of detailed household information. We will discuss this issue at greater length in the next section, but it is very important to be able to capture household heterogeneity, in terms beyond income-level structure, production opportunities, food consumption patterns and potential locations, in order to properly assess the socio-economic and health implications of agrifood system transformation.

The model is based on a set of macro and sectoral accounts updated for 2017 (GTAP database of social accounting matrix), and where national data can be modified easily. In addition, it has been made compatible with the last release of the latest FAO food balance sheets and the *State of Food Security and Nutrition in the World 2020s* prevalence of undernourishment and cost of healthy diets numbers. It also benefits from a large dataset on farm and trade policies, in particular, from the Ag-Incentives project.<fnref n="4" /> It is also compatible with various emissions (farm and non-farm databases) and satellite accounts. The household dataset is largely based on the POVANA database, not only comprising LSMS surveys, but also reconciled with other macroeconomic accounts and data sources. In terms of commodity and sector coverage, the GTAP database covers 67 sectors, of which 21 are food or agri-food products. The MIRAGRODEP dataset has been extended to cover additional products. In particular, some key staples like cassava and key inputs like fertilizers have been disaggregated.

This chapter is organized as follows: after the introduction, Sect. 2 presents the main objectives of the agrifood systems summit that will be targeted through the modeling and how the different objectives will be used to develop the scenarios to be modeled. Section 3 presents an overview of the model, its attributes and limitations, and describes the baseline scenario. Section 4 features the results of all the scenarios modeled and, finally, a section of conclusions is presented.

<footnote n="3">³Laborde et al. (2020b).</footnote>

<footnote n="4">⁴http://ag-incentives.org/</footnote>
## 2 Addressing the Objectives of the Agri-Food Systems

An agrifood systems approach is centered around people by aiming to achieve food and nutrition security, improve diets and reduce poverty for all. People-centered objectives are embedded in the broad performance of the system with regards to social, economic and environmental sustainability. Goals and targets in the 2030 Agenda that relate to the food system are owned by all stakeholders involved in its management and operations. They are owned by the global development community, which aims to promote sustainable development now and in the future.

The success of the food system approach depends on the actions and conduct of a large number of actors that are engaging with it. Among them, governments and the development community play a key role in coordinating the food system so that the objectives are achieved in a sustainable way.

The four core objectives are:

*   **Objective 1: End hunger and malnutrition.** The principal objective of sustainable agrifood systems is to provide food and nutrition for people. While the last few decades have seen progress on this front, it is no longer sufficient to focus only on increased production, calorie consumption and low food prices. Increasing production at any cost has damaged the Earth. Calorie consumption alone does not constitute a healthy diet. Lower food prices can hurt producers and discourage them from investing in technologies to protect the ecosystem.

*   **Objective 2: Achieve high-quality diets for all.** Failure to deliver high-quality diets for everyone is holding back SDG progress. Yet, there is no mention of it in any of the SDG targets or indicators. Just ensuring stable access to food is not sufficient. Rather, we must understand the interactions among diets, health and agrifood systems to make progress toward SDG Goals and targets in agriculture, inequality, poverty and sustainable production and consumption.

*   **Objective 3: Achieve 1 and 2 while enabling the sustainable use of biodiversity and ecosystems.** Safeguarding land, oceans, freshwater and climate is a precondition for social justice and robust economic development for current and future generations (Arrow et al. 2014). Agrifood systems' operations have to be compatible with ecosystem services. Restricting the use of natural resources and the effects of climate change can limit agricultural productivity. Sustainable agrifood systems need to find ways to address this trade-off. Agroecological farming practices are one way to move in this direction.

*   **Objective 4: Eliminate poverty to the level necessary to achieve 1, 2, and 3.** Poverty and hunger are interlinked, and reduction of extreme poverty has a direct impact on the elimination of hunger and all forms of malnutrition. In this sense, under this objective, we want to identify the level of extreme poverty reduction that is needed to achieve all three of the above objectives.

However, all four of these objectives should be seen as different pieces of an overarching objective: Achieve high-quality diets for all, while enabling the sustainable use of biodiversity and ecosystems.
It is quite useful to see that objectives 1–4, as previously defined, are composed of caloric consumption, healthy diets, environmental sustainability and inclusiveness. As shown in Fig. 1 and Table 1, these elements are bricks. They can theoretically be achieved independently. Combined together, and in an incremental way, they form our four objectives. Therefore, we use the model to illustrate each of these bricks and the impacts of achieving this goal on a number of indicators.

However, the implementation of the model requires defining scenarios to achieve these goals. Instruments and interventions are the actual means of achieving our set of objectives. They are policy actions by nature. We propose to use a set of definitions developed by Laborde et al. (2020b): (a) an *Intervention* is a public action aimed at altering the existing state of the world. The action is intended to solve a problem (such as a market failure). It targets a specific population. It is associated with a set of expenditures paid by one (or several) economic agent(s). It has a given

<figure><img src="image_23.png" /><figcaption>**Table 1** Breaking down the Objectives</figcaption></figure>

<table><thead><tr><th>A</th><th>Caloric consumption</th><th>B</th><th>Healthy diets</th><th>C</th><th>Environmental sustainability</th><th>D</th><th>Inclusiveness</th></tr></thead><tbody><tr><td colspan="2"><strong>Objective 1:</strong> Ending hunger</td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td colspan="2"><strong>Objective 2:</strong> Ending malnutrition</td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td colspan="2"><strong>Objective 3:</strong> Sustainable food system</td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td colspan="2"><strong>Objective 4:</strong> End poverty &amp; sustainable food system</td><td></td><td></td><td></td><td></td><td></td><td></td></tr></tbody></table>

Source: Authors' own elaboration
set of direct effects; (b) an *Instrument* is the projection (i.e., translation) of the intervention in the model space.

The combination of various policy instruments is necessary to achieve the various objectives, while balancing trade-offs. This could be seen as an illustration of the famous Tinbergen rule (1952).<fnref n="5" /> Scenarios are a combination of objectives (the end) and instruments (the means). This is an important issue, since a structural model could achieve the same goal through different pathways: We can eliminate hunger by implementing a major redistribution of income, massively subsidizing production, or investing massively in agricultural R&D. These different pathways will generate different trade-offs. The model allows us to tailor such a story in an *ad hoc* way (we define the mix of instruments to be used qualitatively and quantitatively). Or the model can be used to define an optimal mix of instruments, taking into account one or several constraints (fiscal optimization, social preferences<fnref n="6" />).

In the current context, and for the initial use of the model, we propose not crafting complex policy mixes, whether exogenous or endogenous, that will reshape incentives within agrifood systems. We will use a simple set of policy instruments to illustrate the core trade-offs. In particular, we will achieve: (a) brick A: ending hunger, with a producer subsidy on staple products. The value is endogenous, determined for each country to reduce its prevalence of undernourishment (PoU) below three percent; (b) brick B: sustainable diets, with a differentiated consumption subsidy by food groups to target a recommended diet pattern by country (relative contribution of various food groups in terms of calorie intake). The total value of subsidies per country will be constrained to zero, meaning that the final vector of subsidies will include positive and negative values (e.g., tax); and (c) brick C: when introducing environmental sustainability, we will implement a carbon tax instrument that could be extrapolated to other sustainability dimensions, like biodiversity and water use, to internalize externalities and target pre-defined constraints (e.g., first of all, a carbon budget for agriculture, based on the Paris NDC plans).

From A to C, the goal is to modify relative prices so as to shift production and consumption patterns. Brick D will introduce another set of instruments, including a progressive tax system (e.g., negative income tax), allowing for household redistribution. This will significantly change the required amount of distortions needed to achieve [A] and [B], since we will directly help poor consumers to expand their food consumption in both quality and quantity without having to alter the market prices. These choices of instruments are obviously quite conservative and far from optimal, but they do not require “new technologies” or strong behavioral shifts in preferences. They are quantifiable outcomes. In addition, we do not change trade policies; trade flows will adjust. In this regard, the different instruments that we propose in order to achieve bricks A and B are not neutral—since a consumption subsidy is “neutral” in

<footnote n="5">⁵See Tinbergen (1952): https://repub.eur.nl/pub/15884/. Also see Preston (1974) for generalization: https://www.jstor.org/stable/2296399?seq=1</footnote>

<footnote n="6">⁶See Laborde et al. (2020a) for discussion.</footnote>
terms of trade implications, but a production subsidy is not, except if we assume a global homogenous subsidy.

As an illustration, let us consider Country X. Country X has a prevalence of undernourishment above 25% of the population, which is high. It also enjoys a relatively diversified food consumption pattern, but has high levels of greenhouse gas emissions due to a large livestock sector. Country X can pursue a number of pathways to achieve SDGs 1, 2, 3 and 4 (as set out in Fig. 2). On a traditional pathway, Country X would likely have adopted a production-focused approach, aimed at reducing its PoU through increasing the supply of staple foods. This approach encourages a sectoral focus, with an emphasis on technical fixes to increase production. The interventions would be under the mandate of the agriculture ministry or sector-specific agency.

Using a systems-thinking approach, however, Country X would aim to achieve several goals simultaneously by developing a policy package that uses multiple systems to reduce the PoU and greenhouse gas emissions at the same time. This would necessitate the engagement of a number of ministries, including energy, environment and agriculture, and a coordinated policy response, as illustrated in Fig. 2.

In the Appendix, we provide an analytical and formal representation of our method for integrating the various Objectives in our modeling framework.

<figure><img src="image_24.png" /><figcaption>**Fig. 2** Illustrating trade-offs: a simple PoU case. (Source: Authors' own elaboration)</figcaption></figure>
# 3 The Model

## 3.1 Model Overview

The model used in this paper is the MIRAGRODEP model. This model is an extension of the widely used MIRAGE model of the global economy.<fnref n="7" /> The model was developed and improved with the support of the African Growth and Development Policy Modeling Consortium (AGRODEP). It is a multi-region, multi-sector, dynamically recursive CGE model. The model allows for a detailed and consistent representation of the economic and trade relations between countries.<fnref n="8" />

The model assumes perfect competition in each market. In each country, a representative consumer maximizes a CES-LES (Constant Elasticity of Substitution-Linear Expenditure System) utility function subject to an endogenous budget constraint to generate the allocation of expenditures across goods. This functional form replaces the Cobb-Douglas structure of the Stone-Geary function (that is, LES) with a CES structure that retains the ability of the LES system to incorporate different income elasticities of demand, with those for food typically being lower than those for manufactured goods and services. The demand system is calibrated around the income and price elasticities estimated by Muhammad et al. (2017).

Once total consumption of each good has been determined, the origin of the goods consumed is determined by another CES nested structure, following the Armington assumption of imperfect substitutability between imported and domestic products. On the production side, demands for intermediate goods are determined through a Leontief production function that specifies intermediate input demands in fixed proportions to output. Total value added is determined through a CES function of unskilled labor and a composite factor of skilled labor and capital. This specification assumes a lower degree of substitutability between the last two production factors.

In agriculture and mining, production also depends on land and natural resources. Labor markets are differentiated by gender, assuming an imperfect substitution between male and female labor for each category of skills. Unskilled labor is imperfectly mobile between agricultural and non-agricultural sectors, according to a constant elasticity of transformation function. Land is also imperfectly mobile among agricultural sectors. Capital in a given region, whatever its origin (domestic or foreign), is assumed to be obtained by assembling intermediate inputs according to a specific combination. The capital good is the same regardless of the sector. In this version, we assume that all sectors operate under perfect competition, there are no fixed costs, and price equals marginal cost.

The model dynamic is recursive in nature: capital in year t + 1 is based on the capital of year t, increased by the previous year's investment, and corrected for

<footnote n="7">⁷Decreux and Valin (2007).</footnote>

<footnote n="8">⁸Laborde et al. (2013).</footnote>
<figure><img src="image_25.png" /><figcaption>**Fig. 3** An integrated modeling framework: the MIRAGRODEP CGE. (Source: Authors' own elaborations)</figcaption></figure>

depreciation. Total factor productivity at the sectoral level and labor supply follow the exogenous trend. The macroeconomic assumptions used for the analysis were designed to be relatively “neutral” to avoid situations in which macroeconomic adjustments such as real exchange rate changes outweigh the impacts of interest, and to allow us to focus on the impacts of agricultural support policies on emissions. These assumptions were: (a) the investment dynamics (savings driven) and the real exchange rates evolve to keep the current account constant relative to national GDP; (b) global savings balance is achieved through a proportional change in the demand of foreign capital by net capital importers; (c) aggregate real public expenditures are kept constant, and a consumption tax is adjusted to keep the government budget balance fixed as a share of GDP and (d) total employment in the economy is constant.

A comprehensive modeling is depicted in stylized ways in Fig. 3. The figure summarizes the scope of the model, showing the added value of having these different layers in an integrated framework.

## 3.2 How Do We Couple This Model with Other Models?

The core contribution of the MIRAGRODEP CGE model is to provide an integrated framework in which economic and biophysical constraints can be implemented and markets will clear in a consistent way. As a matter of fact, markets are the nexus where final decisions on production and consumption are determined. In addition, explicitly representing market equilibria for goods and factors of production is essential in order to capture both the real income impacts and their social implications.

However, the MIRAGRODEP CGE does not aim to answer all relevant questions about agrifood systems. Nor is it meant to be used on its own. It is designed to be integrated with other modeling platforms, either as an element of a knowledge value
chain (using inputs from other models or providing inputs to other models) or in a
coupled way (the integrated approach). As result, model integration or connectivity
should be done with parsimony and under strict scientific principles regarding the
compatibility of the approaches, including theoretical underpinnings, the definition
of model solutions and data consistency.

We have identified IIASA with the GLOBIOM modeling team as our main research partner. They have global modeling capacity and a global model with a detailed land use component. As such, they provide a strong complementarity to the MIRAGRODEP CGE framework and could downscale MIRAGRODEP results and develop a targeted biodiversity indicator. They could also provide a more detailed description of technology and technology changes, with their GHG implications, in the farm sector. They also have deep experience in addressing climate change issues. It is critical when combining modeling frameworks into a unified analytical platform to guarantee data consistency at the initial stage.

We are exploring other downstream linkages in the fields of health, nutrition, gender and inequalities. While our modeling framework “stops” at the household level, some socio-economic drivers such as food availability parameters at that level could break down the analysis and investigate intra-household challenges.

Regarding upstream linkages, most of the ongoing investigations are focused on biophysical models that could inform the transformation of the production function and the input/output relations, including for non-priced inputs. Similarly, some ecosystem valuation approaches could expand our set of indicators and the illustration of trade-offs. But the investigations are at a very early stage.

## 3.3 Importance of Including Household-Level Modeling

As discussed, a significant amount of the changes in agrifood systems will have very heterogeneous impacts across households, in terms of income opportunities and consumption space. Therefore, having a proper representation of the household heterogeneity is essential.

The MIRAGRODEP CGE framework proposes two approaches to including household-level analysis (for details, see Laborde et al. 2021b). The choice of the precise method depends on the scale of the exercise (global assessment, or regional- or country-level requirements), data availability and the need to integrate feedback effects. Both approaches rely on our harmonized treatment of existing household surveys, which describe both the expenditures and the revenue account of each household, including the farm production module, when available (POVANA database). The household data is also used to reproduce non-economic indicators, such as the PoU by reconciling household expenditure pattern, food consumption and its caloric equivalence, as well as household energy requirements.

The first approach, which could be implemented in most low- and middle-income countries, is a top-down approach. It is where country-specific macroeconomic
variables from the MIRAGRODEP CGE are implemented in our set of harmonized household surveys, which include prices of goods and services, factors of production, remittances and tax instruments, among other things. This approach allows for a systematic assessment of how a systemic change impacts households in terms of poverty (real income) or food consumption. The household-level modeling could include first order impacts alone or second order impacts as well, with production and demand function calibrated for each household, but consistent with the aggregated CGE response in the initial condition. Choosing this approach allows for the use of the GIS tagging available in some surveys to illustrate within-country heterogeneity.

The second approach incorporates a large set of households directly into the CGE model in a fully bottom-up way. Usually, using 75-150 household categories captures most of the relevant heterogeneity in terms of consumption pattern and income generation. This approach is more intensive in terms of computational power and requires additional data reconciliation between macroeconomic accounts and household-level data. But this approach may be needed when distributional issues have strong feedback effects and alter the sectoral or macroeconomic equilibrium. Indeed, even with the calibration used in the first approach, if prices and income changes are significant, the aggregated response of the CGE and sum of individual responses in the household surveys start to diverge, mainly because the economic weights of the various household groups change compared with the initial conditions.

Depending on the use of the modeling framework for the Agrifood Systems Summit (global or regional assessment, or country-level profiles), we propose using the two approaches alternatively. The existing coverage of countries for which we have detailed household data is available online<fnref n="9" /> and is frequently updated. For countries that are not covered, we generate representative household distribution at the continental level based on available countries' data and reshape the distribution weights to target demographic and income macroeconomic indicators (e.g., Poverty and GINI for each country). The existing dataset and country coverage could be expanded easily, since the POVANA database is based on systematic templates and protocols that could be used to add new countries or update data for those already covered.

## 3.4 What Are We Missing?

While the modeling framework already covers a number of topics, there are still some limits and missing elements that should be acknowledged.

<footnote n="9">⁹https://public.tableau.com/profile/laborde6680#!/vizhome/POVANA_Surveys/POVANA</footnote>
(a) Competition: The first element is directly related to how we represent markets. While the choice of imperfectly integrated markets for goods and factors of production is satisfactory, the way we capture imperfect competition remains a major challenge. By default, our model operates in perfect competition. Therefore, the consumer at the end, leading to some optimistic view in terms of inequalities, captures all changes in production costs. The questions of imperfect competition and market power within agrifood systems are critical and could have significant implications for agrifood system transformation's social impacts. While there are modeling options to address this issue, the lack of data, especially on a global basis, remains a key challenge. In addition, considering how various consumers/producers at the household level may face differentiated mark-ups is not a trivial issue. For these reasons, we propose to flag this issue as one to be discussed as a major research question. In the meantime, existing results should be interpreted with caution. Most importantly, since our competition assumption changes the way that markets operate, this issue should not be fixed “outside” the model, with a complementary analysis upstream or downstream; rather, it should be tackled within the model.

(b) *Biophysical Balances and Soil Health:* While the issue of soil health constitutes a key topic for the sustainability of agrifood systems, systematic datasets and actual causal linkages between production systems and evolution of soil health remain scarce. In particular, we should aim to track soil health and nutrient balance, and be able to capture feedback effects through productivity channels within the model, since they will change relative to productivity and prices. However, the complex mechanisms at stake may not need to be implemented in the MIRAGRODEP CGE and could be developed externally. The CGE model will just adjust the input-output coefficient matrix describing farm technologies. It could include dynamic equations about the soil quality productivity as a new form of capital in the farm sectors. At this stage, a potential limitation is the reliance on only one aggregated item for mineral fertilizers. To be sure, the price and supply dynamics of various fertilizers are more complex. For future development, it may be required to break down this sector into sub-products. Similarly, the substitution between manure and mineral fertilizer is not currently integrated, while manure on cultivated soil is still monitored for emissions purposes. This could be addressed, assuming the availability of technical expertise.

(c) *Household Data in Developed Countries:* Due to the history of the modeling framework and the acuteness of food insecurity in developing economies, our household database does not include developed countries. Since the social and health implications in the developed economies should not be neglected, we should aim at addressing this data gap with the right set of partners.

**3.5 Key Indicators Generated**

The MIRAGRODEP CGE framework, with its satellite account, could generate a huge number of indicators to illustrate the evolution of agrifood systems and some of their trade-offs. Figure 4 provides an overview of such indicators. Some are based on
<figure><img src="image_26.png" /><figcaption>Fig. 4 Quantifying agrifood systems. (Source: Authors’ own elaboration)</figcaption></figure>

the detailed household impacts (e.g., poverty, hunger, overweight), others on macroeconomic accounts (e.g., public finance). Still others are linked to sectoral productions (e.g., water use, land, energy).

Some indicators are generated by default with MIRAGRODEP, using a set of fixed coefficients per unit of outputs or inputs (e.g., water requirement per ton of wheat per country), but are aimed at being fine-tuned by linking the MIRAGRODEP outputs (directly or indirectly) to other models. In particular, the biodiversity indicator and spatially explicit land use changes will be generated by IIASA through the GLOBIOM modeling framework. Similarly, we investigate some additional health- and nutrition-related indicators by linking food consumption and income distribution outcomes to specific models, like the LIST models suit.

An important issue not directly linked to the objectives and the core trade-offs is assessment of the risk of the system, in particular, the “systemic” risk when considering the complex interactions and the various profiles of variance/covariance at stake. As a starting point, we propose to use historical events, such as a historical catalog of productivity (weather-related or zoonotic disease), prices (world prices, exchange rate), consumer choices (the “mad cow disease” type of consumer reactions) and other disruptors to see how the system in its initial or modified situation reacts, and how to assess the vulnerability of various populations or components of the system. The Appendix provides an illustrative example.

## 4 Modeling Results

With this previously detailed modeling framework, six individual interventions are modeled in terms of their impact on agrifood systems, prevalence of undernutrition and ecological effects in terms of GHG emissions, land and energy use, and the use
of chemical inputs. Due to synergies and complementarities among these scenarios, the authors also assess them as a package. The sensitivity to the results is also assessed under different governance principles, such as land use policies.<fnref n="10" /> The scenarios are listed in Table 2 and organized around three main pillars, as shown in Fig. 5: achievement of a more efficient and more inclusive system, allowing consumers and producers to make better choices. The results of the different scenarios are based on the baseline consistent with the State of Food Security and Nutrition in the World 2020, which, by 2019, reported 690 million undernourished people and the fact that healthy diets were unaffordable for almost three billion people in the world.

A first key result is the confirmation that ending chronic hunger at a 5% level is reachable by 2030 with the right balance of interventions. While no intervention alone, at a realistic scale, could solve the problem, we see in Fig. 6 that key structural interventions to increase the efficiency of agrifood systems, through increased farm productivity and a reduction of food loss and waste, will reduce the number of people in chronic hunger by 314 million in 2030. Beyond hunger, 568 million people will be able to afford healthy diets, as shown in Fig. 7. To target the remaining population, safety nets and well-targeted programs, such as school feeding interventions, will be required. When adding such safety nets into the model by designing them endogenously so as to leave no one behind, it is possible to cover the 2.4 billion remaining people without economic access to healthy diets.

Achieving the end of widespread hunger requires mobilization of significant resources, but the cost is manageable, and represents 8% of the size of food markets.<fnref n="11" /> Figure 8 provides the decomposition of this total cost by action (Panel a) and the distribution by group of countries (Panel b). In regard to the actions referred to as “better choices” in Table 2, i.e., consumer incentives and the repurposing of farm subsidies, they do not contribute to the total costs because they have been designed to be income neutral for the government, as well as for the producers (farm subsidies) or consumers (food tax/subsidies) in each country. The cost structure is dominated (45%) by the combined large structural investment in physical, human and knowledge capital of the innovation package that impacts through value chains, national economies and social safety nets (36% of total cost). Of course, these two main items are different in nature, since the latter involves recurrent spending every year and will have to be managed, and financed, by the governments alone.

A critical finding of the analysis is the role of other interventions in minimizing the cost of the safety nets. Indeed, to cover the income gap of the three billion people who without action will not be able to afford healthy diets in 2030, countries will have to redistribute 1.4 trillion dollars (constant 2017) annually. By investing in the

<footnote n="10">¹⁰Other aspects of the global agrifood systems, such as trade policies, are also analyzed to see how they interact with the main interventions considered.</footnote>

<footnote n="11">¹¹2030 spending and food market values, as estimated by the model for guaranteeing full consistency.</footnote>
<table><caption>**Table 2** Scenario definitions</caption><thead><tr><td>Action domain</td><td>Scenario label</td><td>Description</td></tr></thead><tbody><tr><td>More justice</td><td>#1 Social Safety Net: Healthy Diets for Everyone</td><td>Provide food stamps (income transfer that should be spent on food products) to eliminate the "poverty gap" between the per capita income of each household and the affordability of healthy diets cost line. The cost is initial calibrated on SOFI 2019 and updated based on model dynamics</td></tr><tr><td>More justice</td><td>#2 School Feeding Program</td><td>All children between 6 and 11 years old have access to school feeding programs 200 days a year. Daily per capita ration includes 320 g of fruits, 102 g of grains, 51 g of animal proteins (meat, fish, eggs), 480 g of milk, and 100 g of vegetables</td></tr><tr><td>Better choices</td><td>#3 Farm Subsidy Repurposing</td><td>All farm subsidies (outputs, inputs, others) are redistributed in the form a subsidy to farmer revenue. The rate of support is computed endogenous by the model to maintain farm subsidy budget constant, but a sectoral bias is introduced. Nutritious and low-emissions products are subsidized at twice the average rate, while products with low nutrition value and high emissions are subsidized at half the average rate</td></tr><tr><td>Better choices</td><td>#4 Consumers' Incentive Reform</td><td>Taxation of red meat products in high- and middle-income countries. The level of tax is computed by the model to obtain a reduction of consumption of 15% in high- and upper middle income countries (HIC and UMIC in Europe), and 7.5% in UMIC (exc. Africa). The group of countries have been constructed by computing an index of "excess" consumption by comparing average daily intake with a sustainable and healthy diet reference (i.e. Flexitarian diet in this case, but alternative diets give the same ranking of countries)</td></tr><tr><td>More efficiency</td><td>#5 Innovation, Technology and Knowledge for Farmers</td><td>This package of interventions is aimed at increasing farm level productivity, while reducing environmental footprints. It has three components<br>Increased/or Improved Irrigation systems. [X]% of each country cropland benefits from new investments by 2030. For regions with high rate of irrigated land (all Asian regions), we consider only an upgrade of existing materials, leading to no change in yield but a reduction in water inefficiency. For other regions, we consider an increase of water use (for irrigation, but with an improved average efficiency) but also a yield increase of [Z]%<br>With X = 10% in HIC, 20% in UMIC, 30% in LMIC and 40% in LIC; Z = 100% for all regions except Africa where Z = 200%. Initial cost of $1000 per ha</td></tr></tbody></table>

(continued)
<table><caption>**Table 2** (continued)</caption><thead><tr><th>Action domain</th><th>Scenario label</th><th>Description</th></tr></thead><tbody><tr><td></td><td></td><td><p>Increased <strong>livestock</strong> genetics and better practices for higher productivity [Z%] and lower emissions per unit of output. [X]% of the herd of each country is improved by 2030</p><p>With X = 10% in HIC, 20% in UMIC, 30% in LMIC and 40% in LIC; Z = 10% for HIC, 25% for MIC and 50% for LIC</p><p>Initial average cost of $400 per standard Livestock Unit</p><p>Extension services and farmer <strong>training</strong> to increase all farm productivity (total factor productivity, TFP). [X]% of farmers in each country are covered. TFP is increased by [Z]%. In addition, carbon sequestration in soil is increased</p><p>X = 10% in HIC, 20% in UMIC, 30% in LMIC and 40% in LIC; Z = 10% for HIC, 25% for MIC and 50% for LIC</p><p>1 extension agent per 100 farmers in average. Cost is indexed on labor cost across countries and calibrated at $10,000 for UMIC</p></td></tr><tr><td>More efficiency</td><td>#6 Reducing Food Waste and Loss</td><td>Reduction of 25% in all countries of food waste and food losses, including for left-on-the field. Recurrent cost per unit of food restored</td></tr><tr><td>Combined actions</td><td>All except Safety Nets</td><td>Include actions 2–6. Since the Safety Net is computed to provide enough income to everyone to be able to afford healthy diets, it is important to consolidate all the other actions before this one</td></tr><tr><td>Combined actions</td><td>All including Safety Nets</td><td>All actions, 1–6. While this package will take care of all vulnerable people, showing the consolidated impact on environmental and economic indicators is important (trade-off lens)</td></tr><tr><td>Combined actions</td><td>Everything with Land Use Regulation</td><td>In this consolidated scenario, we do not allow for land use change (fixed amount of agricultural land) by considering a stronger land governance</td></tr></tbody></table>

Source: Authors' own elaboration

various programs, the value of the required safety nets drops by about two thirds (428 billion dollars globally) in 2030. Using safety nets to make sure that everyone can afford healthy diets is required, but, if used alone, they will be far too expensive.

The second panel in Fig. 9 shows the distribution of the spending by region, i.e., where the money needs to be spent and/or invested. Since the needs are unevenly distributed globally, a significant effort in terms of global coordination, and even solidarity, will be required, especially to support the transformation of the agrifood systems of low-income countries.
<figure><img src="image_27.png" /><figcaption>**Fig. 5** Policy Action Scenarios. (Source: Authors’ own elaboration)</figcaption></figure>

<figure><img src="image_28.png" /><figcaption>**Fig. 6** Number of people (mio) removed from a chronic undernourishment situation in 2030. (Source: Authors’ own elaboration)</figcaption></figure>

As previously shown, no single intervention could achieve the end of malnourishment, and synergies are needed to tackle the various source causes of the problem, but also to minimize the total cost of the package. However, their complementarity goes beyond their impacts on household food security and their cost-effectiveness, and therefore we also need to combine them to address heterogeneous environmental trade-offs.
<figure><img src="image_29.png" /><figcaption>**Fig. 7** Number of previously deprived people (mio) who will gain access to healthy diets by 2030. (Source: Authors' own elaboration)</figcaption></figure>

<figure><img src="image_30.png" /><figcaption>**Fig. 8** The cost of actions: magnitude and distribution. (Source: Authors' own elaboration)</figcaption></figure>

Finally, it is important to mention that the actions modeled will generate trade-offs in regard to GHG emissions (emissions from agricultural production, and net emissions from AFOLU), agricultural land, an increase in the use of chemical inputs (index of chemical inputs per hectare), biodiversity (i.e., reduction of forest habitat
<figure><img src="image_31.png" /><figcaption>**Fig. 9** Impacts of actions on environmental indicators. (Source: Authors' own elaboration)</figcaption></figure>

and agricultural land) and energy consumption, as shown in Fig. 9. As shown, the levels of trade-offs across all interventions are relatively small, the highest being for the innovation and full package, but the effects are negative (i.e., an improvement) for the case of food loss and waste across all trade-offs. However, when looking at net agricultural emissions and AFOLU, the effect is negative, as in the case of forest land. This highlights the need for policies that stimulate investments in innovations for carbon farming (growing carbon in soil and trees as a tradable commodity) and related payment schemes for ecosystem services.

# 5 Conclusions

While identifying the conceptual linkages at play within the agrifood systems and the different trade-offs involved is essential, providing a quantification of these mechanisms is required to illustrate concepts, support informed decisions and trigger proper actions. Considering these interactions is a necessity during the whole process: at the diagnostic stage (i.e., quantifying trade-offs), on the way to achieving core SDG targets (i.e., the roadmap to 2030) and, finally, when designing policy responses that may also lead to various indirect effects.

This chapter tries to develop a proper quantification approach based on a modeling platform that combines state-of-the-art and up-to-date databases covering all the metrics of interest (hunger, poverty, nutrition, and environmental indicators) and dynamic simulation models that explore future pathways and optimal policy responses.
Various modeling approaches could be considered, however, the task to be addressed leads to very specific requirements. Tackling trade-offs within the agrifood system requires a holistic strategy, considering not only the supply side and the primary production sectors, but also the full set of value chains operating and interacting within the food system. It also needs to capture how the food system interacts within the broader economy within, and across, countries. Indeed, various market failures leading to inefficient and unsustainable agrifood systems take place in the initial stages of production.

Beyond these macro and meso requirements, the most important challenge is to capture the essence of the SDGs and the livelihood of people, in particular, the most vulnerable parts of the population. In this context, the modeling platform used includes explicit representation of household heterogeneity. Households differ in terms of income sources, production and consumption patterns. The conditions they face regarding food, labor and input markets are various, even within a country, and determine their choices regarding the food that they produce, buy and eat. Representing their features explicitly is a necessity for providing a realistic picture of the situation and a policy package that will be inclusive for all.

The quantitative framework used builds on an economic state-of-the-art dynamic global Computable General Equilibrium (CGE) model, MIRAGRODEP. The model includes many household groups and is combined with land use, farm and livestock components to approximate essential biophysical trade-offs. The model is able to capture both macroeconomic linkages (within and between countries), multisectoral interactions (agrifood systems are not limited to agriculture activities), and interaction for different households, including the poor and most vulnerable. Indeed, it will be presumptuous to properly assess specific SDG targets without addressing heterogeneity among households and inequalities.

Six interventions are modeled to study their impact on agrifood systems, undernutrition, and the environment. We also assessed the interventions as a group to consider the impact of synergies and complementarities. The first finding confirmed that ending chronic hunger at a 5% level by 2030 is possible, with key structural interventions to ramp up agrifood systems' efficiency. Through increased farm productivity and a reduction of food loss and waste, the number of chronically hungry people could be cut by 314 million. In addition, 568 million people would be able to afford healthy diets by 2030. Under these interventions, the cost of ending hunger represents 8% of the size of global food markets, a sum that can be mobilized and invested to generate impact through food value chains, national economies, and social safety nets. Furthermore, the use of well-targeted social safety nets could provide an additional 2.4 billion people with access to healthy diets.

The second critical finding was that various interventions could create synergies that not only address different causes of hunger, but also minimize the total cost of interventions. In addition, the levels of trade-offs across all interventions are relatively small, the highest being for the innovation and full package of technological innovation, but the effects are negative (i.e., an improvement) for the case of food loss and waste across all trade-offs. This highlights the need for policies that stimulate investments in innovations for carbon farming (growing carbon in soil
and trees as a tradable commodity) and related payment schemes for ecosystem services.

Countries would have to redistribute $1.4 trillion annually to fill the income gap of the 3 billion people who cannot afford healthy diets. However, by investing in various interventions, countries can drive down the cost of the safety nets by about two thirds, or $428 billion, globally in 2030. Combined interventions can also address environmental trade-offs that are bound to occur.

# Appendix

## A Formal Representation of Our Objectives

The defined objective could be interpreted as an objective function in an optimization program. This section provides an illustration of this approach, with a rewriting of the problem in such terms. It also shows where the actual objectives will need to be more properly formulated, especially if we want to illustrate trade-offs correctly. In a second part, we provide graphical illustrations.

Mathematically, an optimization program can be seen as looking for the maximum (maximization) or minimum (minimization) of an objective function, X, subject to a number of constraints, Y, X, etc. Constraints could be written as $y \le \bar{y}$, meaning that the variable y should not exceed a given upper limit $\bar{y}$, or $z \ge \bar{z}$, meaning that z remains above a given level. When these inequalities are replaced by equalities, we say that these constraints are binding.

In our setting, we can see X as a function defining the PoU. So, the function objective could be the minimization of X, the level of caloric hunger. But asking how to minimize hunger without a number of constraints is a useless question; there are many ways to achieve it: letting the hungry people die, spending trillions of dollars on inefficient measures, and so forth. Therefore, defining the right set of constraints is critical. We will not specify the obvious ones (e.g., a given level of population, the various technological constraints, etc.), but will instead focus on the most relevant one.

An important additional feature of such optimization is that maximizing X subject to $y \le \bar{y}$ leads to the same results as maximizing/minimizing Y subject to $x \ge \bar{x}$. This is the duality principle, a key instrument in microeconomics analysis. The standard example is the consumer optimal choice: *Maximizing the utility U* provided by the consumption of a bundle of goods given, or subject to an available budget (or income, noted as y), such as $\le \bar{y}$, generates the same optimal allocation of money across goods as minimizing the budget *Y* needed to achieve the least level of satisfaction, or utility, $u \ge \bar{u}$. We are going to use such properties in our example.

If we consider Objective 1, eradication of hunger, we can formulate it as the desire to minimize hunger, measured as the PoU, subject to some constraints. Indeed, we know that the PoU is bounded by 0, and, as pointed out above, a large
number of pathways could lead to the same outcome. We can actually see two simple
programs related to hunger:

*Minimizing PoU subject to existing public budget* $\bar{B}$ i.e., $B \le \bar{B}$. This program will identify how to allocate existing budget $\bar{B}$ across various policy instruments in order to achieve the lowest possible level of undernourishment. In this case, the starting point is to define the budget constraint $\bar{B}$. This can be seen as a **repurposing of public expenditures** to achieve better objectives. The symmetric program is to *Minimize public expenditure* *B* subject to a *PoU* target—for instance, 5%, i.e., *PoU* $\le$ 5%. This is the approach actually used in the Ending Hunger project and detailed in Laborde et al. (2017).

In this framework, we can express **the trade-offs**. Assuming that we focus only on GHG emissions, and we do not care about fiscal constraints, **Objective 1** could be represented as **Minimizing GHG emissions subject to PoU $\le 5\%$**. This is the simplest representation of minimizing trade-offs. It is qualitatively equivalent to **Minimize PoU subject to GHG $\le \bar{GHG}$**, where GHG is an acceptable carbon footprint for agrifood systems (for instance, compatible with the 1.5C scenario).

The situation becomes more challenging to represent when we have several
elements in our objective. Let's consider **Objective 2** now, and translate it with
two indicators, the **PoU** (element A) and the **prevalence of overweight** (PoO, proxy
for element B), while we also take GHG emissions into consideration (GHG, a proxy
for element C). Conceptually, we want to achieve the lowest level of these three
variables. However, this is mathematical nonsense. We can optimize only one
variable. So, two approaches are possible:

(a) We define a multi-criteria objective function. This will be a social objective function. We can call it D, as it represents a Damage Function. It is a combination of PoU and PoO, for instance: (PoU, PoO) = PoU<sup>a</sup>PoO<sup>b</sup>. Two important things should be noticed: This is the logic beyond many **composite indices** showing how good, or bad, a multi-dimensional system is, and *a* and *b* are actual weights on the various dimensions. There are different ways to obtain these weights, knowing that none are perfect; the key challenge is to properly capture the social preferences regarding these different dimensions. These preferences are not universal, and should be specific to a specific community at a specific period. So, in this approach, we can represent our previous optimization problem as *Minimizing D(PoU, PoO) subject to existing public budget* $\bar{B}$, i.e., $B \le \bar{B}$, or, if we think about environmental trade-off, we can represent it as **Minimize D(PoU, PoO) subject to GHG $\le \bar{GHG}$** or **Minimize GHG subject to D(PoU, PoO) $\le \bar{D}$**.

(b) We maintain one objective, but combine different constraints, such as: **Minimize GHG subject to U $\le 5\%$ PoO $\le 10\%$**, if we assume a 5% for PoU and 10% threshold for overweight.

**Objective 3** will be achieving all of the elements at once, i.e., having three con-
straints binding. **GHG** $\le \bar{GHG}$, **PoU** $\le 5\%$ and **PoO** $\le 10\%$. There are no other
dimensions for optimization, except the cost of achieving this goal. In this case, we
will be in a similar framework as the one used in Ceres2030, which is actually
**Minimizing B:public expenditures subject to SDG2.1: PoU ≤ 5%, SDG2.3: Income2030 ≥ 2 * Income2015 with Income: the small-scale food producer income, and SDG2.4: GHG ≤ GHG.** In the agrifood systems framework, the small-scale food producer constraint is replaced by the malnutrition target. So, it can be *Minimizing B:public expenditures subject to GHG ≤ GHG*, *PoU ≤ 5%* and *PoO ≤ 10%*. Of course, we will also have many more indicators, and therefore constraints (water, etc.).

We will discuss below the exact interpretation of **Objective 4**. But it can be seen as finding the minimal level of poverty compatible with Objective 3. Therefore, it is **Maximizing Poverty subject to GHG ≤ GHG, PoU ≤ 5% and PoO ≤ 10%**.

We will now propose some basic illustrations of the issues at stake. We will limit all illustrations to two-dimensional choices for the sake of easiness of visual representation.

First, let's start with a representation of the **frontier of production possibilities** (FPP) between two goods: Maize and Pulses, as displayed in Fig. A.1. It shows, for a given set of technologies and institutions, as well as endowments (factors of production: land, labor, capital), how much you can produce of each good. For the sake of simplicity, we will consider that this analysis is done globally (so there is no need to represent trade, although that is doable), and that we do not have other economic activities to consider, meaning that, for example, labor in agriculture is constant.

Panel (a) shows the basic story: If you want to produce more of one good, you need to sacrifice a number of units of the second good. This “marginal rate of transformation” (MRS) varies, and is indicated by the slope of the green curve. Producers make choices by equalizing this MRS to the relative prices between the two goods, maize and pulses. This is a first result of an optimization problem and an actual trade-off (“if I produce more of X, I need to produce less of Y”). Policies could change incentives between the two goods by changing relative prices through taxes

<figure><img src="image_32.png" /><figcaption>**Fig. A.1** Frontier of production possibilities</figcaption></figure>
or subsidies. They could move the *free-market* choice of J to I, for instance, by subsidizing maize.

While, in the next paragraph, we are going to show how we move from this frontier of production to our objective and trade-off space, it is quite relevant to see how the FPP illustration could be used to show the impact of non-sustainable practices that can lead to a collapse of the space of potential production over time (Panel b), or how major technological innovation could modify this frontier, including in a biased way. Panel c illustrates a green revolution scenario in which a technological innovation has benefited one crop, maize, although it was not “against” pulses, but the new market equilibrium (from J to K) still results in more maize, and in this case, fewer pulses. So, some public policies could have **unintended consequences**.

Since the entire weight of production is consumed, and for a given distribution of income, we can associate the production of maize and pulses in terms of supply of calories, and therefore PoU outcome. Similarly, the production of maize and corn represented by the FPP is associated with a volume of GHG. So, each point of the FPP, within the space of quantity produced, could be projected in the space of objectives, with our two elements PoU (for Objective 1) and GHG emissions (for trade-off or Objective 3). This is displayed in Fig. A.2, Panel a. While we can end up having more hunger, and more emissions, for any combination of pulse and maize production by wasting resources and making sub-optimal choices, we are mainly interested in the **frontier of optimal trade-off** between undernourishment and GHG emissions. Visually, this frontier is inverted compared to the FPP, mainly because we are displaying “damages,” and not positive outcomes.

The various analyses we will conduct will help us to move along this frontier, and potentially displace it, with new technologies or institutions.

Panel b shows the outcome of fixing a maximum level of acceptable PoU, represented by the red line (e.g., 5%). In this case, minimizing the environmental

<figure><img src="image_33.png" /><figcaption>**Fig. A.2** Trade-off space</figcaption></figure>