impacts manifest themselves in raised risks of obesity and/or NCDs.
Poor diets are often characterized by overconsumption of specific foods or groups of foods with problematic health profiles (e.g., resulting in obesity and NCDs, including diabetes, heart disease, cancers), and tend to be shaped by unhealthy “food environments.” Food environments have been defined as the physical, economic, political, and sociocultural context in which consumers engage with the food system to make decisions about acquiring, preparing, and consuming food [9, 10]. There is ongoing articulation to focus on the interaction between people’s daily lives and activities that shape their diets [11]. Increased consumption of sugar-sweetened beverages has been singled out as a significant contributor to the obesity epidemic in recent years [12]. Overconsumption of animal products has been connected with heart disease, diabetes, and various cancers [13]. High sodium intakes are associated with higher blood pressure and hypertension [14]. Globally, 1.7 million annual deaths from cardiovascular causes have been attributed to excess sodium intake [15]. A number of recent studies suggest that high consumption of saturated fats is associated with increased risk of coronary heart disease and diabetes [16]. The negative health impacts of trans fatty acids – a type of unsaturated vegetable fat typically found in manufactured cooking oils – are now the subject of broad consensus, with legal limits and bans in Denmark, Austria, Switzerland, Iceland, Hungary, Norway, and Latvia [17]. In the USA, a nationwide ban on partially hydrogenated oils – the primary dietary source of artificial trans fats – came into effect in 2018 [18]. Overall, the increasing proportion of ultraprocessed foods in diets has been identified as a driver of excess energy intake [19].
Overweight and obesity have reached epidemic levels in many countries [20, 21] and continue to increase in all regions, particularly among school-age children. In 2018, an estimated 40 million children aged under 5 years were overweight [22]. In 2016, 131 million children aged 5–9 years, 207 million adolescents, and 2 billion adults were overweight. About a third of overweight adolescents and adults and 44% of overweight children aged 5–9 years were obese [1].
According to the WHO, over the period from 2011 to 2025, the cumulative economic losses due to NCDs under a “business as usual” scenario in low- and middle-income countries could reach USD 7 trillion, as compared to an annual expenditure of USD 11.2 billion to implement a set of high-impact interventions [15].
5. Food Insecurity
People get sick because they cannot access adequate, acceptable food at all times. Health impacts of food systems also occur through insufficient or precarious access to food that is culturally acceptable and nutritious.
The most recent updates on food security and nutrition indicate that more than 820 million people in the world are still hungry today and the absolute number of undernourished people slowly continues to increase. Around 2 billion people do not have regular access to safe, nutritious, and sufficient food, i.e., they experience moderate or severe food insecurity [1]. The lack of regular access to nutritious and sufficient food, alongside inadequate access to health, water, hygiene, sanitation, and care services, puts people at greater risk of malnutrition and poor health. It is estimated that 149 million children under the age of 5 years are still stunted and the pace of progress is too slow to meet the 2030 target of halving the number of stunted children. Hidden hunger also prevails in children and adults. Current estimates show that 264 million women of reproductive age are affected by iron deficiency anemia, partly due to the inadequacy of diets [23].
Why the Heath Impacts Are Systematically Reproduced
The health impacts of food systems have been comprehensively researched and documented. Given the breadth and severity of the impacts described above, an urgent case for reforming food and farming systems can be made on the grounds of protecting human health. Furthermore, many of these impacts are closely linked to industrial food and farming systems, i.e., systems based on deriving productivity gains from specialization, intensification, and concentration of production and distribution. The resulting practices – chemical-intensive agriculture, intensive livestock production, the mass production and mass marketing of ultra-processed foods, and the development of long and deregulated global commodity supply chains – drive negative health impacts across the spectrum.
Why, then, has concrete action not been systematically pursued to address the root causes of unhealthy food systems? Firstly, while the evidence is clear and compelling, food systems remain complex. For example, chronic exposure to EDCs is particularly hard to trace to specific sources or even to specific chemicals, while zoonotic pathogens and antimicrobial resistance can spread through multiple pathways within and around food systems. Furthermore, many of the health impacts described above are compounded by factors like climate change, poverty, and unsanitary conditions, which are reinforced by industrial food and farming practices. This complexity is real and challenging, but should not be an excuse for inaction.
Secondly, the low power and visibility of those whose health is most affected by food systems leaves major blind spots in the evidence base. Precarious working conditions on farms, fishing vessels, and food production lines means that those exposed to the greatest health risks are not seen or heard. In particular, the insecure status of hired and migrant laborers undermines the reporting of abuses and injuries. Risks to farmers and farmworkers in developing countries are particularly under-documented. The biggest health risks tend to accrue to vulnerable groups, particularly hired and migrant laborers, who are less likely to report injuries and illnesses for fear of termination, or lack of knowledge of their right to medical services. In turn, employers may have a financial incentive to under-report injuries and illnesses that occur on their premises in order to lower their workers’ compensation insurance payments.
These blind spots make it less likely for problems to be prioritized politically, allowing health risks to continue to afflict marginalized populations. This is compounded by a broader disconnection of the general public from the process of food production. Reconnecting people with the realities of the food they eat – and bringing the true cost of our food systems to light – is therefore essential to unlock the food-health nexus.
Thirdly, the root causes of health impacts are obscured by the disproportionate power of dominant actors to set the terms of debate. Powerful actors – multinational agribusinesses, governments, donors – have the power to establish the narratives that frame the problems and the solutions. These “solutions,” from biofortification to climate-smart agriculture, are premised on further industrialization of food systems, and ignore the role of current systems in driving health risks (e.g., by perpetuating poverty and climate change). This means reinventing the problem as the solution. Meanwhile, those most affected by the
