Читать книгу Hidden Hunger and the Transformation of Food Systems - Группа авторов - Страница 41

The food environment is a complex adaptive system, influenced by the wider food system, whereby various industries and actors operate interdependently and adaptively, and their interaction is often shaped through space and time. Food environments are especially dynamic and opportunistic in LMICs as a significant proportion of purchased and consumed food is acquired through traditional domestic channels, such as informal and unregistered vendors, wet markets, and street stalls [6]. Food environment dimensions include food accessibility, food availability, food promotion, food policy, food pricing, and food safety.

Personal and external food environment interventions target the built and natural physical environments, legal and political environments, socioeconomic, and cultural environments. Food systems offer many entry points to improve children’s nutrition, and these environments are the points with which children and their families directly interact, including in the home, school, workplace, and consumer and retail spheres.

Consumer and retail food environments inadvertently shape food access, availability, affordability, and media promotion. Through laws and policy, governments should ensure multilateral and bilateral trade and investment agreements are aligned with encouraging healthy, micronutrient-rich, and safe food environments. At the same time, evidence-based subsidies and food taxation have become strategies to minimize food deserts and swamps. Additionally, improving public health nutrition literacy through national and local social and behavior change communication and food-based dietary guidelines all serve to increase awareness and influence consumer behavior [6].

At the household level, decision making and purchasing power relating to food, sociocultural beliefs, as well as intra-household food allocation, are key factors in addressing hidden hunger. Adolescents, but especially children, may not have full autonomy and choice over what is made available to them and what they consume. This includes what is available in their homes, what their parents or providers purchase, and what the household can afford. In a LMIC context, girls are at a greater risk for micronutrient deficiencies due to cultural and social norms that prevent equitable food distribution [5]. In parallel, globally, school-aged girls more often than school-aged boys do not enroll for or consistently attend school [24]. Therefore, interventions and social safety-net programs delivered through the school system, such as school feeding programs or increased availability in school cafeterias of micronutrient-rich foods like fresh fruits and vegetables, which offer an opportunity to improve the micronutrient status, are not advantageous to out-of-school children.

In addition, with nutrition transition on the rise globally, school food environments have become frequent sites for unhealthy, micronutrient-poor food access, availability, and promotion. In a review and meta-analysis of unhealthy food and beverage marketing interventions to children, there was a statistically significant increase in dietary intake (mean difference 30.4 kcal, 95% confidence interval 2.9–57.9) during or shortly after exposure to advertisements [25]. This finding led to the development of 12 recommendations adopted by the World Health Organization and endorsed by the World Health Assembly aimed at reducing the impact of marketing foods high in saturated fats, transfatty acids, free sugars, or salt to children. Examples of environmental interventions specific to school-aged children and adolescents include policies that incentivize school vendors (tuck shops, canteens) to offer healthier food options, and the removal of advertisements and media which promote unhealthy eating.