Sometimes whilst eating, I feel as though I am sitting in a broken chair with only three legs; the problem is not the chair however, but the food in front of me.

In recent years I have seen numerous food movements evolve and converge with others, working for better access to health, environmental justice, and gender, racial, and economic equity. Food is the entry point for the majority of problems in today’s society; it can help us work towards a healthier and more sustainable future. Food can address the multitude of social, environmental, economic, and health challenges we face, whilst simultaneously supporting community development. We need to understand the links between these issues and food, as shown by the 2016 Food Sustainability Index (FSI).* 

World Cancer Research Fund International developed the NOURISHING framework: a policy database and tool designed to help policymakers, researchers, and civil society organisations promote healthy diets through political action.

Nutrition label standards and regulations on the use of claims and implied claims on food

Offer healthy food and set standards in public institutions and other specific settings

Use economic tools to address food affordability & purchase incentives

Restrict food advertising and other forms of commercial promotion

Improve nutritional quality of the whole food supply

Set incentives and rules to create a healthy retail and food service environment

Harness food supply chain & actions across sectors to ensure coherence with health

Inform people about food & nutrition through public awareness

Nutrition advice and counselling in health care settings

Give nutrition education and skills

This framework will help to reduce obesity and other non-communicable diseases (NCDs) for different populations, and provide an extensive and innovative overview of implemented government policy actions from around the world.

These ten areas encompass food environments, food systems, and behaviour changes in communication; influencing the “who”, “what”, and “where” aspects of the food we eat.

This holistic view, the resulting strong evidence, and practical experiences contribute to the rethinking of our food and the systems that produce it.

In the NOURISHING framework we find references to improve nutritional standards in health care settings:

Germany - meal guidelines in hospitals, rehabilitation centres, and care homes for the elderly contain a seven-day meal plan. This plan consists of three meals and two additional snacks per day with suggested serving amounts

• Whole grains: minimum 14 servings per week
• Potato products: maximum two per day
• Salad, vegetables, or legumes: three times a day
• Fruit: two times each day
• Dairy products (ideally low-fat): minimum two times a day
• Fish: minimum twice per week
• Meat: maximum three times a week.

Latvia - food served in hospitals and long-term social care institutions may not exceed 1.25g of salt per 100g - with the exception of fish products that may contain up to 1.5g; these standards also apply to educational institutions.

United Kingdom and France, - guidelines for vending machines dispensing crisps, chocolate, and sugary drinks, amongst other products, have been established to meet the specified criteria of “healthier choices”, which set limits on the permissible content of fat, saturated fat, sugar, and salt/sodium. Additionally, the UK Government Buying Standard for Food and Catering Services (GBSF) by the Department of Environment, Food and Rural Affairs (DEFRA), sets out standards for the public sector (i.e. schools, hospitals, care homes, communities, and the armed forces), when buying food and catering services in order to set maximum levels for sugar in cereals, and generally for saturated fat and salt, as well as a minimum content of fibre in cereals and fruit in desserts. Meal deals also have to include vegetables, and fruit as dessert, and menus fish on a regular basis.

Additionally, a wide range of mechanisms for integrating nutrition advice into primary care, including counselling, self-help materials, and computer-tailored messages have demonstrated to have positive outcomes, particularly for people with elevated risk factors for non-communicable diseases. Examples of these mechanisms can be found in:

Finland - the heart symbol scheme is used in supermarkets and meals served outside home to inform consumers at a glance whether that product is a healthy choice according to the Finish nutrition recommendation. Also, nutrition guidance is provided free of charge by public health nurses on a mandatory basis as part of antenatal care, and during appointments at child health clinics post-partum.

Germany - the integration of diet and physical activity into training programmes for health professionals have not been implemented nationally, but through actions in some states and communities.

Governments should take some responsibility in giving patients, employees, and visitors information about a healthier diets, Nutritionists and dieticians, are key-players in most European countries, such as  Denmark, France, Italy, or United Kingdom, But in Spain, for example, they should be encouraged to become part of the healthcare system, thus ensuring patients’ nutritional needs are covered as a way to prevent malnutrition in primary care and further interventions in hospitals.

There are then many local and national policies that should be considered for encouraging the healthfulness of food. However, we need to go even further and consider the explicit alignment between health and environmental considerations for addressing sustainability in Europe and beyond.

As I wrote in a blog post last year, this link can be reflected in national dietary guidelines. Several European countries: France, Germany, Holland, Sweden, the United Kingdom - have started to incorporate elements of sustainability into their dietary guidelines, as it is being reflected in the new briefing written by Eating Better in collaboration with Medact. Nevertheless, despite the great emphasis that these recommendations made in terms on limiting animal-based products and shifting towards more plant-based products, I believe more powerful strategies are required and vital to have a real effect on food consumption (and why not, food production).

Sustainability is more than just a nice word; it should be included in our menus. Explaining how food is produced and the rationale of sourcing decisions should also be included. It is time to see sustainability as an opportunity and not as a threat to our plates - a chair can be repaired or replaced, but there is no turning back for our food system.

- Paola Hernández, Food Project Officer

*The 2016 Food Sustainability Index (FSI) highlights how diet and food systems are at the heart of many of our biggest global challenges, and establishes a comparable benchmark for countries to measure their progress. The index ranks 25 countries and clearly demonstrates the important links across three pillars: sustainable agriculture, nutrition, and food loss and waste. The opportunities and solutions, through the interwoven matrix of global food system sustainability, are also pointed out to raise awareness and enable people to make informed choices about food and nutrition.

Preview image: Paola Hernández