Conclusion

The nutrition transition raises immensely important challenges for food policy. This chapter argues that these need to be accompanied by sensitivity to other challenges raised by contemporary globalization.

Table 4.5 Different Food and Health Policy Frameworks: fragmented or systemic solutions?

Fragmented approach Systemic approach

Food policy focus on productionism &  Food policy seeks sustainability & citizenship

consumerism

Marketing appeal to individual health Population approach to public health

Reliance on technical fixes  Diet-based approach to preventive health

(drugs, functional foods, etc.)

Marginalization of health from supply  Health central to economics

chain thinking

Separation of safety and nutrition Policy linkage between safety, nutrition and

sustainable food supply

Intensification Diversification

Health costs externalized Health costs internalized

Poor links between global, regional,  Multilevel governance

national and local governance

Competing frameworks within government  Integrated policy across government and food

and corporate sector supply chain

There is a strong case for action on food and health. Interventions much cited in the literature, such as the North Karelia experiment in Finland, are often rooted in an era of more interventionist government action. Finland produced a 55% decline in male mortality due to coronary heart disease in the period 1972–92. So even in the con-temporary policy climate, interventions can work. As has been illustrated by Thailand, which engineered a decline in childhood malnutrition from 50% in 1982 to 10% by 1996. The key, according to the Commission on the Nutrition Challenges of the 21^st Century (2000) reporting to the UN, is a combination of political will, health planning, and community focus.

The good news is that awareness of health as a central element of development is growing. Pressure to enable the new ecological public health approach is building up. Policy options and the implications of choices are becoming clear, but much more coordinated thinking, research, and health action is needed if enormous changes such as the nutrition transition are to be steered in positive rather than negative directions.

Table 4.5 summarizes some of the policy goals that need to be reviewed and analyzed more clearly and carefully. The case argued here is that unless such issues are included in the discourse about the nutrition transition, there is a danger the transition will be seen as immutable and inevitable. The context presented here reminds us that the nutrition transition is not an isolated phenomenon. Economic, political and cultural transitions accompany, facilitate and frame the nutrition transition. It is an indicator of a wider restructuring of society and lifestyle, part driven by strong forces, part pulled by aspirations, immensely complex.

Now that so much is known about the nutrition transition, the challenge is to widen debate to include what to do about it. There are strong forces who argue that the transition is unimportant, a policy deviation, a side-show in the onward march of social progress, a matter for consumer choice. They argue that it is beyond governance. One strand of modern thinking on governance agrees with this analysis, arguing that the state and public thinking are too diffuse or weak to act on mega-trends such as the nutrition transition. We know better. The history of public health suggests that there have always been such siren voices. Good people, armed with evidence, informed governments like Thailand’s or Finland’s and together with progressive forces in the food supply chain acted with imagination and persistence to improve public health. The nutrition transition is an awesome challenge. It requires new alliances, new political will and new thinking. And since when were public health challenges easy?