外文文獻(xiàn)食品安全和健康營(yíng)養(yǎng)

Contents lists available at ScienceDirect Global Food Security journal homepage Food security food safety Walls et al 2016a Food safety addresses food borne illness and covers the handling preparation and storage of food World Health Organization Regional Offi ce for Southeast Asia 2015 Food security has been de scribed by the United Nation s Food and Agriculture Organization FAO as a situation that exists when all people at all times have physical social and economic access to suffi cient safe and nutritious food to meet dietary needs and food preferences for an active and healthy life Food and Agriculture Organization of the United Nations 1996 It encompasses both food safety and healthy nutrition as well as a wider set of concerns related to food availability access utilization and stability the four pillars of food security identifi ed by the FAO Food and Agriculture Organization of the United Nations 1996 Yet tensions exist between food safety healthy nutrition and the distinct aspects of food security This article critically assesses the compatibility of these concepts as a framework for achieving coherent food policy and global health It does so by undertaking a brief literature review and using illustrative case studies of Malawi and the European Union and draws on political science theory to add conceptual clarity Most food system conceptualizations feature all three of food se curity food safety and healthy nutrition c f HLPE 2017 Kanter et al 2015 Turner et al 2018 Pinstrup Andersen and Watson 2011 Kearney 2010 Ingram 2011 and each of them fi t within the frame work of the High Level Panel of Experts on Food Security and Nutrition 2017 which defi nes food systems as covering all the elements en vironment people inputs processes infrastructures institutions etc and activities that relate to the production processing distribution preparation and consumption of food and the outputs of these activ ities including socio economic and environmental outcomes HLPE 2017 Thus food safety healthy nutrition and food security are all compatible in that they are each necessary dimensions of a healthy food system However in practice implementing these three objectives is a fun damentally political as well as technical challenge All three concern the distribution of resources and power both within and between states and involve decisions made by both international organisations and state governments Balarajan and Reich 2016 Baker et al 2018 Furthermore whilst they are sometimes considered as diff erent aspects of a single process or set of objectives refl ected in terms such as food and nutrition security food security food safety and healthy nutri tionhave diff erentcharacteristicswhichmeanthattheyare https doi org 10 1016 j gfs 2019 05 005 Received 1 November 2018 Received in revised form 15 April 2019 Accepted 15 May 2019 Corresponding author E mail address Helen Walls lshtm ac uk H Walls Global Food Security 21 2019 69 71 2211 9124 2019 Elsevier B V All rights reserved T conceptualized and prioritized diff erently by policymakers Shiff man and Smith 2007 Smith 2013 Addressing these issues eff ectively requires both political prior itization and the allocation of resources fi nancial technical and human commensurate with the severity of the issue in order to im plement policy responses Baker et al 2018 Shiff man and Smith 2007 However policy making is not a purely rational process It is complex and non linear with policy makers pulled between multiple concurrent policy challenges each with advocates able to cite evi dence on the scale of the issue and the need for governmental response making calls upon the fi nite resources available Smith 2013 Russell et al 2008 Hawkins and Parkhurst 2016 Agenda setting and poli tical prioritization is an area that has been widely studied and many diff erent frameworks exist to help understand these processes Many such frameworks highlight the importance of similar activities and dynamics One such framework to understand political prioritization within health policy the Shiff man and Smith framework Shiff man and Smith 2007 outlines four key areas that shape the priority an issue receives on a political agenda actor power the strength of the in dividuals and organisations concerned with the issue ideas the ways in which those involved with the issue understand and portray it po litical context the environments in which actors operate and decisions are taken and issue characteristics features of the problem such as whether credible evidence exists the severity of the problem and whether eff ective interventions are available to address it Shiff man and Smith 2007 When considering the domain of issue characteristics some issues are considered to be acute with immediate eff ect whilst others have eff ects that are felt over the longer term Peters 2017 Policymakers respond very diff erently to immediate issues such as food safety with its acute eff ects on food related health and wellbeing than longer term or chronic issues such as healthy nutrition Walls et al 2011 Characteristics of food security such as the emphasis on availability access and system stability are again diff erent to those of the other two issues and characteristics which have strong resonance with some decision makers given their implications for national se curity It has been observed that decision makers prioritize short term or acute issues over longer term issues that may go beyond electoral cycles Geneau et al 2010 Meadowcroft 2011 Thus food safety with its acute characteristic and the potential to disrupt markets for a country s export products often receives high prioritization in food policy and international standards and domestic regulation that are strongly en forced Walls et al 2011 An example of such standards is the World Trade Organization WTO Agreement on the Application of Sanitary and Phytosanitary Measures SPS Agreement The SPS Agreement addresses the application of food safety animal and plant regulations It requires countries to adopt international standards such as those de veloped by the Codex Alimentarius Commission for food safety Do mestic food safety regulations which are more stringent than those of the SPS Agreement often aim to ensure that agricultural produce is fi t for consumption in terms of acceptable levels of contaminants in cluding chemical residues and that imported food is produced pre pared and stored in such a way as to prevent foodborne illness and adverse impacts to a country s economy society or environment Unnevehr 2015 In contrast few equivalent regulatory measures have been im plemented to address unhealthy nutrition either at national or inter national levels despite high and increasing levels of overweight and obesity amongst adults and children in most high income countries over several decades Ng et al 2014 Dietary risk factors are con sidered to have recently overtaken tobacco as the leading risk factor for disease globally Lim et al 2012 but whilst tobacco is addressed by the WHO Framework Convention on Tobacco Control FCTC there is no similarly powerful global mechanism for addressing unhealthy diets Vanderijvere 2014 At national level an increasing number of gov ernments are implementing fi scal measures in particular on sugar sweetened beverage taxes and front of pack nutrition labelling to ad dress consumption of some unhealthy foods However for the most part governments have favored those approaches with little chance of suc cess in isolation educational and awareness raising approaches and industry self regulation rather than enacting comprehensive struc tural measures addressing the production availability processing and marketing of foods Walls et al 2009 2016a Moodie et al 2013 Food security is the issue from food systems that most often features in debates regarding national and regional security with the European Union EU Common Agricultural Policy an example of this Winters 1990 Wallinga 2010 Walls et al 2016b This strategic importance to national security contributes to its high priority on na tional political agendas For example agriculture alongside coal and steel was selected as a core policy area on which to base the devel opment of trans European economic and political integration in the 1950s in part due to the fundamental role of both agriculture and heavy industry in war The idea was that countries with integrated food supplies would be less likely or able to go to war Kant 1903 In more recent times EU countries and high income countries such as the United States have strongly protected domestic agricultural producers from external competition something which led in the early 2000s to the stymying of the World Trade Organization s Doha Development rounds Cho 2010 That this protectionism continues today at the expense of higher food prices in the EU for consumers perhaps re stricting dietary choices and poorer nutritional content refl ects not just the vested interests extensive resources and political organization of the EU and US farming lobby but wider concerns amongst deci sion makers about national security and thus the need to address food security and protect domestic supplies This high prioritization of food security is arguably most appro priate in a context of on going food shortages and hunger and in particularly resource constrained settings In Malawi for example malnutrition levels are high and there are challenges with food safety Sassi 2012 Matumba et al 2014 Mensah et al 2012 Both issues are rightly on the political agenda however it is food security that is most highly prioritized Several poor growing seasons and hunger crises in years following economic liberalization of the 1980s and 1990s which included removal of subsidies on fertilizers seeds and credit supported by the World Bank and International Monetary Fund and adverse weather and other conditions including hardship caused by the civil war in Mozambique led to the Malawian government introducing agricultural input subsidy programs Chinsinga and Poulton 2014 Resnick et al 2012 Chibwana et al 2014 Prominent amongst these is the 2005 06 Farm Input Subsidy Program FISP a large scale na tional program the main objectives of which are to increase maize production promote household food security and enhance rural in comes Lunduka et al 2013 Arndt et al 2015 The donor community was initially opposed to the FISP Thus while many high income countries subsidize their farmers extensively Malawi was criticized for doing so However the FISP was soon hailed as a success with Malawi achieving its biggest ever maize harvest in 2006 and subsequently be coming an exporter of its maize surplus Dorward and Chirwa 2011 although FISP impact is not without debate Resnick et al 2012 Chirwa et al 2012 Over time the FISP has evolved to target legumes as well as maize with one of the aims of this change to address dietary diversity and healthy nutrition However food security is still the pri mary food related target of the policy Thus food security is often prioritized politically over food safety and food safety over healthy nutrition In a resource constrained country such as Malawi where much of the population is food insecure such a focus may seem most obvious However lack of dietary diversity and issues such as obesity and non communicable disease particularly related to healthy nutrition are now aff ecting substantial proportions of the country s population Ziraba et al 2009 Msyamboza et al 2013 Related to this Pelletier et al 1995 2012 for example has discussed the food fi rst bias in low income contexts whereby food H Walls et al Global Food Security 21 2019 69 71 70 security is prioritized above healthy nutrition Pelletier et al 1995 2012 In high income contexts for most of the population healthy nutrition is receiving increasing political attention given high levels of obesity and NCD Nevertheless large and perhaps increasing propor tions of populations in countries such as the United Kingdom and the United States are food insecure Loopstra et al 2015 Gundersen and Ziliak 2015 Indeed there is substantial overlap and synergy between these three food system issues and their health outcomes and in all three instances their causes are to a large extent political in nature For example the so called double burden of malnutrition whereby un derweight and associated micro nutrient defi ciencies and overweight obesity and NCD co exist in the same communities and even families Walls et al 2016a are often a result of varying combinations of food insecurity unhealthy nutrition as well as issues with food safety which can aff ect nutrient absorption Unnevehr 2015 Grace 2015 We have described how despite apparent tensions the three aspects of strong food systems are not only compatible in that they are all important objectives and outcomes of healthy food systems but are complementary in principle with important synergies existing between them in terms of their impact on population health outcomes In practice however they are much less compatible with political trade off s between them evident For example governments often prioritize achieving food security and food safety at the expense of healthy nu trition although the appropriateness of such trade off s as discussed above may diff er between country and regional contexts The challenge for food systems researchers and advocates is to fi nd ways to improve the compatibility of healthy nutrition with food security and food safety from a political perspective and increase the tractability of healthy nutrition on the political agenda This involves the development of food security and food safety measures which at the same time support the goal of healthy nutrition within healthy sustainable food systems Declarations of interest None Appendix A Supplementary data Supplementary data to this article can be found online at https doi org 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