Working Together To Secure Nutritious Diets - UNICEF

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Food Systemsfor Children andAdolescentsWorking Togetherto SecureNutritious DietsUNICEFOffice of ResearchInnocentiFlorence, Italy5–7 November 2018INTERIMSUMMARY REPORTA G LOBAL CONSUL TA TI O N CO - HO STED BY:With the support of theMinistry of Foreign Affairs of theKingdom of the Netherlands1

WHY IS A FOOD SYSTEMSAPPROACH NEEDED TOADDRESS POOR DIETS OFCHILDREN AND ADOLESCENTS?Malnutrition, in all of its forms, isa problem of global proportion andrequires urgent action. In many partsof the world, most children andadolescents do not receive the dietsthey need – in quantity, frequencyand quality – to survive, grow, anddevelop to their full potential. Poordietary diversity, inadequate dietarypatterns, and frequent consumptionof poor quality foods contribute to thisreality. Poor quality diets cut acrossall age groups from infancy throughschool-age years and adolescence, aswell as across regions and countries,with consequences for undernutrition,overweight and non-communicablediseases.Food systems are essential to deliveringhealthy, affordable and sustainablediets, but the nutritional needs ofchildren and adolescents (both ofpresent and future generations) areoften not prioritized. Actors across thefood system, including food producersand suppliers, typically do not accountfor the nutritional needs of childrenand adolescents when determiningwhat foods to grow, produce,distribute, and sell. Processed, lessnutritious foods are skilfully marketedand widely available and affordable,2while nutritious foods are often moreexpensive and unaffordable to many.The food environment often does notlend itself to nutritious diets for childrenand adolescents, nor is it incentivizedto do so. Actors across local, nationaland global food systems need to beheld accountable for providing healthy,affordable and sustainable diets tochildren and adolescents today and inthe future.2. Validate a common approach toelucidate priority actions within thefood system to improve diets ofchildren and adolescents, andTo this end, the United NationsChildren’s Fund (UNICEF) and theGlobal Alliance for Improved Nutrition(GAIN), in partnership with the Ministryof Foreign Affairs of the Kingdom ofthe Netherlands, co-hosted a globalconsultation on children, adolescentsand food systems at the UNICEFOffice of Research-Innocenti on 5–7November 2018. The consultationbrought together 60 participants fromgovernment, development partners,business, and academia from low-,middle- and high-income settings.The consultation aimed to:Food systems approaches address thedirect and underlying system actors,drivers, and dynamics that affect food,people, and the planet. In preparationfor the consultation, a food systemsframework for children and adolescentswas developed (Figure 1).1 Foodsystems are made up of and connectedby people, and are influenced bytheir decisions. Actors across foodsupply chains and food environments,and children, adolescents and theircaregivers, play an important rolein assuring the diets of children andadolescents. As such, they are centralactors in a food systems approachand in the food system framework forchildren and adolescents.1. Develop a common narrativearound the need for food systems toproduce nutritious, safe, affordable,accessible, and sustainable diets forchildren and adolescents,3. Develop an action plan to improvechildren and adolescents’ diets usinga food systems approach.What is a food systems approachfor children and adolescents?

The Innocenti Frameworkon Food Systems forChildren and AdolescentsDRIVERS OFFOOD SYSTEMSINFLUENCERS Accessibility of food Affordability of food ConvenienceSOCIALAND CULTURALDRIVERSDEMOGRAPHICDRIVERSPOLITICALAND ECONOMICDRIVERSPERSONAL FOODENVIRONMENTS(Individuals andHouseholds)CAREGIVERSBEHAVIOURSOF CAREGIVERS,CHILDREN ANDADOLESCENTSFOODSUPPLYCHAINSINFLUENCERS Inputs Post-harvest, Processing and Distribution Natural Resources Management Agricultural research and developmentEXTERNAL FOODENVIRONMENTS(Retail and commercial markets,schools, informal food vendors)CHILDREN ANDADOLESCENTSDIET OFCHILD/ADOLESCENTINFLUENCERS Intra-household dynamics Food preparation Desirability and acceptability of food Socio-economic characteristics Eating patterns AppetiteNUTRITION FACTS30%INNOVATION ANDTECHNOLOGICALDRIVERSINFLUENCERS Availability of food Price of food Food quality and safety Marketing and regulationBIOPHYSICALAND ENVIRONMENTALDRIVERSFigure 1. The Innocenti Framework on Food Systems for Children and Adolescents. 23

The Innocenti Framework comprises of elementsincluding a set of drivers plus four determinants(food supply chains, external food environments,personal food environments, and behavioursof caregivers, children and adolescents), whichtogether shape children and adolescents’ diets.These are described in additional detail below. UNICEF/UN016877/NooraniElementsof theFramework4

Drivers are underlying, structural factors that impact the functionality of foodsystems, and that need to be put in place for the food system to be able todeliver nutritious, safe, accessible, affordable and sustainable diets.They include: (1) demographic drivers (urbanisation, population growth,migration); (2) political and economic drivers (leadership, policies, trade); (3)innovation and technological drivers (technology, infrastructure, investment);(4) biophysical and environmental drivers (climate change, natural resourcemanagement); and (5) social and cultural drivers (norms, traditions, andunderlying social dynamics).Drivers of Food SystemsSOCIAL AND CULTURALDRIVERSDEMOGRAPHIC DRIVERS1. Urbanization2. Population growth3. Migration and forced displacement4. AgingINFLUENCERS Accessibility of food Affordability of food Convenience1. Norms, traditions, and beliefs2. Gender equality3. Social inclusion and dynamicsPOLITICAL ANDECONOMIC DRIVERSPERSONAL FOODENVIRONMENTS(Individuals andHouseholds)BEHAVIOURSOF CAREGIVERS,CHILDREN ANDADOLESCENTSFOODSUPPLYCHAINSINFLUENCERS Inputs Post-harvest, Processing and Distribution Natural Resources Management Agricultural research and developmentINNOVATION ANDTECHNOLOGICALDRIVERS1. Internet2. E-Commerce3. ICT4. Financing and Investments5. InfrastructureEXTERNAL FOODENVIRONMENTS(Retail and commercial markets,schools, informal food vendors)1. Political economy2. Trade and markets3. Land tenure policies and agricultural subsidiesCHILDREN ANDCAREGIVERS4. Foodmarketing and regulationsADOLESCENTS5. Conflict and humanitariansettingsDIETOFCHILD/6. EmploymentADOLESCENTINFLUENCERS Intra-household dynamics Food preparation Desirability and acceptability of food Socio-economic characteristics Eating patterns AppetiteBIOPHYSICALAND ENVIRONMENTALDRIVERSNUTRITION FACTS30%INFLUENCERS Availability of food Price of food Food quality and safety Marketing and regulation1. Natural Resources Management2. Climate Change3. Ecosystem Services4. Natural Disasters5

Determinants of food systemsThe four determinants represent the processes and conditions in the food system,from production to consumption, that are necessary to improve the diets ofchildren and adolescents. For each determinant, the framework identifies a list ofinfluencers. Influencers are the more immediate and individual-level factors thatdetermine the extent to which a determinant contributes or fails to contribute todelivering healthy, affordable and sustainable diets. They can be viewed as entrypoints to make the food systems more nutrition-focused.DEMOGRAPHICDRIVERSFood supply chains comprise actors and activities that play arole in taking food from production to consumption, and eventuallyto the disposal of its waste. Food chains can be long and representmore than what is produced on farms. This offers multipleopportunities along the different stages of the supply chain –production, storage, distribution, processing, packaging, retail andmarkets – to maximize nutrition ‘entering’ and minimize nutrition‘exiting’ the value chain.4 Costs to shift and maintain productionpractices can be high for producers, and support to align productionpractices with healthy, affordable and sustainable diets for childrenand adolescents cannot fall on producers alone.Food environments refer to the physical, economic, political andsocio-cultural context by which consumers interact with foodsystems to procure, prepare and ultimately consume food.5 Theexternal food environment includes the retail and commercialmarkets, schools, and informal vendors, among others, whereconsumers interface with food. It reflects aspects related toavailability, food price, marketing and advertisements, and vendorand product properties (e.g., vendor hours, food offered, etc.).Though individual consumers often have less control over theirexternal food environment, they can influence it through demandand advocacy.6INNOVATION ANDTECHNOLOGICALDRIVERS

SOCIALAND CULTURALDRIVERSPOLITICALAND ECONOMICDRIVERSPersonal food environments depict the individual andhousehold level factors that consumers bring to the foodenvironment, such as purchasing power, access, convenience anddesirability, and inform why people choose to procure the foodsthat they do. They complement dimensions of price, availability,and vendor properties in the external food environment.Behaviours of caregivers, children and adolescentsrefer to the food procurement, preparation, supervision, and eatingpractices of children, adolescents and their caregivers.Caregivers are often gatekeepers for the diets of infants and youngchildren, acting as a buffer between food environments and youngchildren’s diets. They are responsible for procuring and preparingfoods for, and supervising eating practices of young children. Olderchildren and adolescents, on the other hand, are more autonomous.They do not necessarily rely on caregivers as gatekeepers. Theyoften procure and prepare food for themselves (and, sometimes,others in their family), and interact directly with their foodenvironments.BEHAVIOURS OFCAREGIVERS,CHILDREN ANDADOLESCENTSCAREGIVERSCHILDREN ANDADOLESCENTSEating behaviours are the consumption practices of children andadolescents. They reflect what and how children eat, and areinfluenced by children and adolescents’ eating patterns, tastepreferences, appetite, level of physical activity, as well as psychosocial factors.BIOPHYSICALAND ENVIRONMENTALDRIVERS7

The interactionsCentral to the framework are the arrows that connect thedifferent determinants. The interactions show how thedifferent determinants link to one another, but also howthey reinforce one another, both positively and negatively,through feedback loops throughout the system. Forinstance, the food supply chain must provide nutritiousfoods so that those foods can be available in the foodenvironment from which food providers purchase foods;the demands, needs, and preferences of caregivers,children and adolescents also influence the external foodenvironment and the food supply chain.DIET OFCHILD/ADOLESCENTDIET OFCHILD/ADOLESCENT8The combination of these elements (all of the drivers,determinants, influencers and interactions of the framework)culminate into the diets of children and adolescents. The dietsof children and adolescents also feed back into the systemby influencing and reinforcing the behaviours of caregivers,children and adolescents.


UNICEF/UN0151147/DejonghHow can a foodsystems approachimprove childrenand adolescents’diets?A food systems approach engagesactors at all levels of the system toreshape it and ensure that the foodsystem delivers healthy, affordable andsustainable diets to all children andadolescents by securing:6 An agricultural sector that deliversfood for healthy and affordable diets,sustainably, Food supply chains that deliverhealthy foods in ways that areeconomically viable and that supportdecent livelihoods, Food environments that makehealthy diets available, affordable,acceptable and appealing, Children and adolescents wantingand being able to eat healthy diets(and consequently, developingpreferences for those diets in thelong-term), and Children and adolescents eatinghealthy diets.10A food systems approach can identifypolicy and programme levers andpartnerships across the food system,and can illuminate how those actionsconnect and reinforce one anotherto improve the diets of children andadolescents.In addition to the common narrativeand conceptual framework developedat the meeting, in order to put a foodsystems approach into action forimproving children and adolescents’diets in a given country or setting, thereis a need to develop analytical tools thatcan guide the identification of specific(contextual) policy and programmeactions at the country level to improvethe diets of children and adolescents.Additionally, public and private sectoractors at global and regional levelsneed to: Develop clear and easy tounderstand guidance on healthydiets for children and adolescents, toaddress malnutrition in all its forms; Develop and enforce evidence-basedmandatory standards for nutrition thatare aligned with guidelines for healthydiets for children and adolescents; Develop and enforce principles ofengagement with private sectoractors that produce food andbeverages consumed by childrenand adolescents, that seek the bestinterest of children and adolescentsand that avoid conflict of interest; Identify the incentives anddisincentives that encourage actorsacross food supply chains and foodenvironments to protect, promote andsupport healthy diets for children andadolescents; Determine research priorities to filldata and information gaps relatedto what children and adolescentseat, how they make their foodchoices, in addition to documentingbetter practices and lessonslearned in improving children andadolescents’ diets.

The experiences and expertise of the multiple stakeholders,including those present at the meeting as well as thoseof in-country stakeholders and implementation partnerscan help to identify actionable levers for positive changefor children and adolescents in the food system. Foodsystems approaches have already been integrated intoexisting international commitments, and making childrenand adolescents central to the food system can buildon these commitments. By integrating a food systemsapproach for children and adolescents into global strategies,we can make food systems work better to secure healthy,affordable and sustainable diets that support optimal growthand development in children and adolescents.This interim summary report will be followed by a fullmeeting report and will be represented in UNICEF’s Stateof the World’s Children 2019 report (February/March2019). Additional dissemination of findings will also occurthrough a peer-reviewed journal supplement (anticipatedDecember 2019).All of the materials that were developed for the meetingcan be accessed at: .Endnotes1 The framework was developed byJessica Fanzo (FAO, Johns HopkinsUniversity), Ahmed Raza (FAO) andElizabeth Fox (Johns Hopkins University)in collaboration with Saul Morris (GAIN),Nita Dalmiya (UNICEF), Roland Kupka(UNICEF), Arnold Timmer (GAIN), andJoyce Greene (GAIN). The figure graphicwas developed by Nona Reuter (UNICEF).Feedback from two rounds of externalreview by experts on child and adolescentnutrition, as well as feedback during theInnocenti meeting, were incorporated inthis version of the framework.2 Feedback from the Innocenti meetingintegrated into this version of theframework.3 High Level Panel of Experts (HLPE). 2017.Nutrition and food systems. Committeeon World Food Security, Rome.4 Downs S & Fanzo J. 2016. ManagingValue Chains for Improved Nutrition.Good Nutrition: Perspectives for the environment research in low- andmiddle-income countries. Agriculture,nutrition and Health Academy FoodEnvironments Working Group (ANHFEWG), London, UK6 Based on Corinna Hawkes’ presentationat the Innocenti meeting: “Towards anAction Plan for a Food-Systems Approachto Improve the Diets of Young People:How do we identify effective foodsystems solutions?”5 Adapted from HLPE, 2017, and Turneret al. 2017. Concepts and methods forAcknowledgementsThe organizers thank the Ministry of Foreign Affairs of the Kingdom of the Netherlands for the support to thismeeting; the colleagues at UNICEF Office of Research – Innocenti for hosting the meeting in Florence; Nona Reuter(UNICEF), Tatiana Harmon (UNICEF), and Cristina Hayde Perez Gonzalez (UNICEF) for their technical assistance.Front cover photo: UNICEF/UN0241729/DEJONGH11

With the support of theMinistry of Foreign Affairs o f theKingdom of the Netherlands12

Food environments that make healthy diets available, affordable, acceptable and appealing, Children and adolescents wanting and being able to eat healthy diets (and consequently, developing preferences for those diets in the long-term), and Children and adolescents eating healthy diets. How can a food systems approach

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