Sustainable Diets: Food for Healthy People and a Healthy Planet: Workshop Summary (2014)

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Options and Approaches to Enable Sustainable Food Choices

As the workshop progressed, the focus of discussion shifted from the synergies and trade-offs associated with healthy eating to options and approaches for managing those synergies and trade-offs in ways that simultaneously improve human health, the environment, and economic issues. The intention was to consider not just policy approaches but also economic, educational, and research approaches. This chapter summarizes the presentations and discussion, during which participants explored some of those options and approaches.

The first speaker, Tim Lang from the City University London, provided an overview of how the European Union (EU) and the efforts of several EU countries are approaching the issues. He described the various policy efforts under way by nongovernmental organizations (NGOs), the sciences and other professions, governments, and industry. In his opinion, different policy approaches are still “jostling” for position, with no “take-off” yet. Next, Katherine Clancy, a food systems consultant, discussed key lessons learned from the EU experience, including the need for a changed consciousness among U.S. policy makers and regulators and a willingness to act on that consciousness. She emphasized the importance of cross-silo collaboration when developing new sustainable diet policy and identified specific policy targets in the United States, a key one being the U.S. dietary guidelines. Finally, Jennifer Wilkins, from Cornell University, explored available evidence on linkages between dietary guidance, human health, and environmental protection. Although nutritionists have a long history of studying the connection between dietary guidance and human health, they

are only just beginning to explore the connection between dietary guidance and environmental protection.

Before the presenters spoke, moderator Gail Feenstra, from the University of California, Davis, encouraged workshop participants to keep three key challenges in mind as they considered the various options put forth. First, she encouraged workshop participants to adopt a systems thinking approach to examining the issues at hand. That is, rather than thinking about situations in terms of “either/or,” think in terms of “both/ and.” Feenstra observed that the field of nutrition has come a long way toward systems-level thinking in the past 25 years. When she first started practicing, in the 1970s and 1980s, most nutritionists and dieticians were confident in their roles promoting health through improved diets. Although this often remains their primary role today, more and more nutritionists approach their roles in promoting health from a larger perspective. In 1986, in an article titled “Dietary Guidelines for Sustainability,” in the Journal of Nutrition Education, Joan Gussow and Kate Clancy proposed building diets on environmental as well as nutritional criteria and coined the term “sustainable diet” (Gussow and Clancy, 1986). That article and the thinking behind it changed the face of the nutrition field, in Feenstra’s opinion. No longer was nutrition education just about human health it also included concern for the environment.

The second challenge Feenstra posed to workshop participants was to be mindful of how the workshop discussions included, or excluded, racial, ethnic, or income classes not represented and which have historically not had much voice in critiquing or designing sustainable diets. For her, sustainability encompasses not just the present and future health of our food economies and our environment, but also social justice for all populations engaged with the food system, especially given that disenfranchised populations are often hardest hit by environmental resource limits.

Finally, Feenstra challenged workshop participants to consider that many options exist for addressing the complexity of sustainable food choices. She encouraged participants to take note of what other countries and regions are doing to address the many food, environmental, and social justice challenges ahead.

LESSONS FROM ACROSS THE ATLANTIC: POLICY FAULTINESS AND POLICY POSSIBILITIES ON SUSTAINABLE DIETS¹

The European Union, with 27 countries, is not just a large region, but also has complex systems of food governance, Tim Lang suggested. His intention was to provide workshop participants with the flavor of sustainable diet policy activities across Europe, with an emphasis on policy activities aimed at resolving some of the tensions being discussed during this workshop. The “big picture,” in Lang’s view, is that the food system is in trouble. Although huge advances have been made during the past century, with more food being produced, more people being fed, and people living longer lives, those advances have come at a cost. The effort to resolve hunger by producing more food has led to what Lang described as a “weird world” in which more people are obese or overweight than are hungry and where under-, mal-, and over-consumption exist simultaneously and nega-

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¹ This section summarizes information presented by Tim Lang, Ph.D., Centre for Food Policy, City University London, United Kingdom.

tive impacts on the environment and health are pressing. Although Europe is not suffering hunger seen in various other regions across the world, it does exemplify many trends and problems that must be addressed in the 21st century, which is why efforts to embed notions of sustainability, not least in diet, are rising up in the policy agenda.

The notion of a “sustainable diet” is not a new idea, in Lang’s opinion. He agreed that the Gussow and Clancy (1986) paper was a seminal event, but he observed that the many themes in the notion of “sustainable diets” can be traced back to the Malthus debate about environmental limits and what makes for a good food system.

Although Lang’s talk was organized around the four major categories of “actors in the system,” specifically, civil society (e.g., NGOs), the sciences and other professions, government (both EU and national governments), and industry, in his opinion the bigger story is how complexity is being addressed and how progress is being redefined. He described what is happening in Europe with respect to sustainable diet policy as a rethinking of the food system, a process that started in the 1940s but with no “lift-off” yet. He described current activity as different policy approaches “jostling for position.”

Civil Society

The European Union is home to some very powerful NGOs that are well organized and cover sectoral interests familiar to the United States, including environmental, human health, consumer, and animal welfare lobbies. NGOs across these sectors are beginning to be aware of and address the unsustainability of the food system.

The United Kingdom (UK) hosts many NGOs whose rising influence has been partly a legacy of political efforts to reduce the role of the state from the era of Prime Minister Margaret Thatcher. For example, Sustain,² a UK alliance on food, health, and environment, which Lang used to chair, has more than 100 member organizations, from the very small to some of the largest NGOs in Europe. For 30 years, member NGOs have been learning from each other and cross-fertilizing each other’s issues. Together, they are significant sources of pressure to address food and sustainability.

Eight years ago, for example, in collaboration with a large UK food company, Sustain explored whether campaigning for food labels to include multiple sustainability features would be feasible and useful. They concluded that, while possible, food labels should use colors and shapes to include sustainability features (Sustain, 2013), but its real value lay more in encouraging companies to lower their carbon or other impacts. In Lang’s

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² See http://www.sustainweb.org.uk (accessed December 11, 2013).

view, there is currently not much pressure for a sustainability element to European food labeling, although that might emerge, given the European Commission’s predilection for common labels and information systems to aid the free flow of goods. Instead, the sharing of consumer information through social media networks is “really taking off,” Lang said, not just in the European Union, but also in the United States.

Across Europe, Lang noted that there is currently considerable NGO interest in developing sustainability indicators and in pushing for tougher impact reduction targets. An example is the Zero Carbon Britain project,³ which is using life-cycle analysis (LCA) to benchmark what a diet based on zero carbon emissions would look like. Lang also noted the “very interesting think tank work” from Which? (formerly the Consumers Association), the UK equivalent of the American Consumers Union, showing that the more consumers learn about the complexity of environment, health, and social justice issues, the more concerned they become (Which, 2013). EU consumer groups are increasingly aware of the gap between what consumers eat and what is desirable for both health and environment. As a result, coalitions and campaigns are emerging. In the United Kingdom, for example, about 30 organizations have formed the Eating Better⁴ coalition to promote sustainable diets to meet environmental, human health, social justice, and animal welfare concerns.

Lang summarized NGO policy activity evolving in the European Union around sustainable diets as a process of “bubbling democratic experimentalism,” a mixture of championing the integrated approach to sustainable food and diets and challenging policy makers, industry, and the public itself. A key tension emerging from all work is whether policy should be based on consumer choice (assuming consumers are in control of their food and the food system) or on choice editing (in which producers or retailers frame the choices by reducing impacts before the consumer can even choose). Lang noted that while in the United States the policy rhetoric is of consumer choice, most large EU companies are taking the choice editing route, saying “trust us, we’ll do it.” Privately, however, many companies and commercial researchers express concerns about how far they can pursue choice editing before consumers will have to be engaged more openly in a shift to sustainable diets.

The Professions/Sciences

Although the field of nutrition has not been engaged in the past in discussions of sustainable diets or sustainable foods, today its engagement

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³ See http://www.zerocarbonbritain.org (accessed December 11, 2013).

⁴ See http://www.eating-better.org (accessed December 11, 2013).

is growing rapidly. The UK Nutrition Society held a meeting in 2012 and the Belgian, French, and UK Nutrition Societies co-hosted a conference in 2013.⁵ Lang mentioned academic work emerging from, for example, a Barilla-funded academic center at Bocconi University, Milan, Italy, and at various universities, for example, in France via the French National Institute for Agricultural Research, in the Netherlands at Wageningen, and in the United Kingdom at Universities of Aberdeen, Cardiff, City, and Oxford.

Amid this development, agricultural science appears to be caught in what Lang described as a “clash between two policy narratives”: productivity (i.e., should the goal be to try to decarbonize productivity gains and rally around the notion of sustainable intensification?) versus social change (i.e., should the goal be to consider how to change society and the consumer differently?) (Lang and Barling, 2012).

Engineers are also becoming engaged in the sustainable diet/food dialogue, bringing a heavy focus on technological solutions, for example, to waste (Institution of Mechanical Engineers, 2013). Likewise, Lang noted, social science interest is rising as analysts realize that behavior change requires shifts in consciousness. Texco, the largest retailer in Great Britain and the third largest retailer in the world, awarded a £25 million grant a few years ago to social scientists at the University of Manchester, England, to found a Sustainable Consumption Institute.⁶ Lang noted that there is some tension between different schools of thought in social science about around how to change behavior: “nudge individualism” versus “shove control” (e.g., see Centre for Climate Change Economics and Policy recent seminar series⁷).

In sum, Lang observed that although the sciences are engaged in the sustainable diet/food dialogue, “they are pretty nervous about it.” They remain confined by their disciplinary silos. They follow their research funding, which comes mostly from the European Union, but also national governments, companies, and some foundations. So far, most thinking around sustainable foods is through the lens of “low-carbon and healthy.” There is no sustainable diet equivalent of the Eurodiet—a set of common guidelines about population health. Eurodiet was created through a 3-year effort to coalesce all member states’ dietary guidelines. In Lang’s opinion, a similar effort is needed to develop a sustainable diet equivalent. Although the Eurodiet is not yet formally supported by the Europan commission,

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⁵ See http://fensnutrition.eu/docs/news/ProgramSustainableDietLille.pdf (accessed December 11, 2013).

⁶ See http://www.sci.manchester.ac.uk (accessed December 11, 2013).

⁷ See http://www.cccep.ac.uk/Events/Past/2012/January/corporate-action-climate-change.aspx (accessed December 11, 2013).

Lang noted that discussion has been taking place in Brussels and beyond about its desirability.

Commerce

Although many food and drink companies currently focus on LCAs as the methodology of choice for measuring product impact, in fact companies and commercial research bodies are doing much more than that, according to Lang. In 2002, for example, a group of multinationals launched the Sustainable Agriculture Initiative,⁸ and in 2009 another group of top companies, called B20, launched its position on food security and food sustainability (B20, no date). To date, most EU companies are taking a product-specific approach to sustainability, that is, they are decarbonizing (or reducing carbon emissions of) specific products. Lang referred workshop participants to a 2012 FoodDrinkEurope report, Environmental Sustainability Vision Towards 2030 (FoodDrinkEurope, 2012). The report represents a convergence in thinking between the commercial sector and the European Union’s Knowledge-Based Bio-Economy research framework. The Barilla Center’s double pyramid also contributes to that shift in thinking (see Figure 2-2).

As summarized by Lang, although there is no sustainable diet commercial framework, serious engagement with aspects of sustainability is now advanced in EU food sectors. The European Commission provides some important guidance through its Sustainable Consumption and Production framework, which focuses on resource efficiency. Some uncertainties remain with regard to the business model. Commerce seems divided on whether the priority is cost cutting or a genuine ecological commitment.

Government: The European Union

We need to remember that “Europe is not Europe,” Lang said. “It is 27 member states with different arguments, different traditions, and very different players.” According to Lang, the contemporary EU approach toward sustainable diet and food can be traced back to agreements reached at the 1992 United Nations Conference on Environment and Development, Rio de Janeiro, Brazil, and then again in Johannesburg in 2002 and at the 2012 Rio+20 Conference, and with the resulting 10-year framework of programs, called the Marrakech Process.⁹

Lang identified two phases in the EU general approach to sustainable diets. Phase 1 (2008-2013) focused on sustainable consumption and pro-

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⁸ See http://www.saiplatform.org (accessed December 11, 2013).

⁹ See http://esa.un.org/marrakechprocess (accessed December 11, 2013).

duction (SCP), following the 1992 Rio and 2002 Johannesburg summits. Phase 1 developments included a study on eco-labeling that resulted in the eco-label extension to sustainability being dropped (Oakdene Hollins Research and Consulting, 2011). Lang’s opinion was that this study was a missed opportunity, having started with trying to see whether the organic food label could be expanded to include other sustainability criteria. He wouldn’t have started with that label, he said. Also during phase 1, the European Food Sustainable Consumption Production Roundtable¹⁰ was created, a much more important and powerfully backed policy framework.

Phase 2 of the EU general approach to sustainable food policy is more recent. Its focus is a specific effort to reduce carbon emissions and waste. He highlighted one document in particular Roadmap to a Resource Efficient Europe (European Commission, 2011). This report called for systems-level change thinking, not just product LCA and paved the ground for new pan-European thinking summarized in the 2013 Sustainable Food consultation (European Commission, 2013). This is a step toward what might become an EU formal directive (law/regulation). Another document of importance Lang noted that summarizes much scientific input to EU policy processes is the 2011 3rd Scientific Advisory Committee on Agricultural Research report (Freibauer et al., 2011).

Although the sustainability challenge is beginning to emerge in EU food policy, Lang noted that the “elephant in the policy room” remains the Common Agricultural Policy (CAP). In the past 10 years, CAP has shifted from paying farmers for commodity production to paying them for environmental and public goods. (CAP still dominates EU budgets, accounting for about 40 percent of total European Commission budgets.) Although the environment now plays a significant role in EU farm policy, Lang noted that health does not. There is an EU Platform for Action on Diet, Physical Activity, and Health,¹¹ but this is a voluntary platform and so far has not injected public health goals into CAP, although it may create some progress toward incorporating sustainability issues. More significant is the commitment to waste, for example, the Integrated Product Policy.¹² Overall, the pursuit of sustainable diet as integrating environment, health, and social goals remains distant, Lang judged.

He observed the importance of the shift from the SCP platform to a LCA approach. Policy makers and commerce appear comfortable with LCA because it provides metrics for measuring carbon and water, but an overreliance on LCA has dangers, Lang thinks. Cultural and social issues of

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¹⁰ See http://www.food-scp.eu (accessed December 11, 2013).

¹¹ See http://ec.europa.eu/health/nutrition_physical_activity/platform/index_en.htm (accessed December 11, 2013).

¹² See http://ec.europa.eu/environment/ipp/integratedpp.htm (accessed December 11, 2013).

sustainability are not measurable in LCA terms, which define sustainability precisely but too narrowly and materially.

Government: Member States

Among EU member states, Sweden was the initial leader in policy development on sustainable diets. Lang encouraged workshop participants to read the Swedish report The National Food Administration’s Environmentally Effective Food Choices (Livsmedelsverket, 2009), which he described as the “best attempt anywhere on the planet to produce sustainable dietary guidelines.” The report considered the best environmentally conscious ways to proceed, given key foods that Swedes eat, and recommended eating seasonally. It used an integrated knowledge framework covering public health nutrition, environment, and sociocultural mores. The report was sent to the European Food Safety Authority for approval at the EU level in 2009 but later withdrawn. Lang said some deemed it too threatening, others claimed that it infringed the European Union’s single-market commitments (by recommending local and seasonal foods). Whatever the reason, the report has been withdrawn, but it still represents the high point in formal evidence-based governmental advice among EU member states.

Many other, particularly northern, European countries have begun to develop positions on sustainable food, if not diet, per se. These various efforts deserve examination. Lang mentioned The Netherlands’ advisory report Guidelines for Health Eating: An Ecological Perspective as being especially interesting because it has not been withdrawn (Health Council of the Netherlands, 2011).

Debates in the United Kingdom around sustainable diets started with two 2008 documents. The first, Food: An Analysis of the Issues (Cabinet Office, 2008a), provided the first review of British food policies since World War II. The second, Food Matters: Towards a Strategy for the 21st Century (Cabinet Office, 2008b), argued for a new, low-carbon and healthy framework for British business. These reports were followed by a series of additional policy reports and the 2008 Climate Change Act, which aims at reducing greenhouse gas emissions by 80 percent by 2050 (UK Government, 2008). The 80 percent reduction in greenhouse gas emissions targeted by the Climate Change Act requires that the food system be addressed. Lang said, “You cannot deal with 80 percent carbon reduction in any country unless you are dealing with the food system.” The act served as a lever for action and led to a rapid explosion in activity within the government, including Setting the Table (Sustainable Development Commission, 2009) and culminating in Food 2030 (DEFRA, 2010). Lang considered Food 2030 to be the most ambitious national report linking health and environmental issues.

Lang observed that although much of this UK government-level activity ceased with the 2010 election, the commercial sector is still pushing the broad framework forward and recently pressured the government to initiate the Green Food Project (2011-2012).¹³ Many of the old arguments still exist, Lang said, but in different forms. Lang also noted interesting policy activities in Wales and Scotland, e.g., Toward Healthier and More Environmentally Sustainable Food and Drink in Scotland (Scottish Government, 2011).

Moving Forward

Although progress in refining what is meant by “sustainable diets” and “sustainable food” has occurred, Lang cautioned that there is opposition.

This is true not just in the European Union, but also in the United States. In Lang’s opinion, it is important to pay attention to those arguments. “We’ve got to address the critics,” he said.

The case for sustainable dietary guidelines deserves support, Lang opined. Most importantly, sustainable dietary guidelines bridge the gap between the noncommunicable diseases and CO² emission discourses. They also help reset moral drivers. For example, what is a “good” food system? Is it one that allows you to go into a grocery store and choose from 35,000 items? Or is it one that assures you that your great, great grandchildren will be able to eat, too? Above all, sustainable dietary guidelines would provide a new basis for public advice and supply chain goals with respect to what to eat, how to consume, and how food is produced.

There are a number of options for moving forward, including public policy (government-led), professions-led, commercially-led, and civil society-led routes. Possible government-led routes include a World Health Organization/Food and Agriculture Organization (FAO)/United Nations Environmental Programme joint high-level report and creation of an intergovernmental panel on sustainable diets, like the International Panel on Climate Change. Possible science-led routes include formation of an interdisciplinary working group or foundations-led work (e.g., the Gates Foundation). Possible commercial-led routes include, as Lang said, “leaving it to the Barillas of this world.” Finally, possible civil society-led routes include engaging the World Wildlife Fund and its One Planet Diet. It is unclear, Lang opined, which of these routes the sustainable dietary guideline movement will take.

If given 5 minutes with the President of the United States, this is what Lang would say: “Don’t be frightened of this. It’s evidence-led.… You

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¹³ See https://www.gov.uk/government/publications/green-food-project-conclusions (accessed December 11, 2013).

can organize changes better than enforce change.… Embryonic shifts are already under way. You’re not going to have to force companies to do it. They’re beginning to do it.” Lang emphasized what he called the “garbage can theory.” Even if today’s thinking about sustainability is not delivered today, a future president will be able to reach down into the garbage can and pull out previously developed ideas and policy proposals and apply or use them.

The scientific task at hand is to conduct more interdisciplinary research, which currently is poorly funded, and to move on from Malthus (i.e., notion that environment determines capacity). Lang referred to the 1943 Hot Springs, Arkansas conference, which he said set today’s global United Nations food policy framework. “We need a new Hot Springs,” Lang said, to set “the framework for the future.” Some of his own thinking is laid out in work for the UK Sustainable Development Commission (2011) and in various academic papers (see Lang and Rayner, 2012, and Lang and Barling, 2012, 2013).

POLICY IMPLICATIONS¹⁴

It is clear that sustainable diets, even if widely adopted, will not lead automatically to a sustainable agriculture. What is required for widespread adoption of the latter is a farm policy that rewards agricultural practices conserving of natural resources, and an overall policy (domestic and foreign) that promotes regional self-reliance in food both here and abroad. (Gussow and Clancy, 1986, p. 1986)

Kate Clancy observed that although some progress has been made since she and co-author Joan Dye Gussow concluded that sustainable diets require both a farm policy and an overall food policy as described in the above quote, both policy goals are still quite far away. She considered lessons that can be learned from the EU sustainable diet policy experience, new policy approaches under way in the United States, and specific U.S. policy targets.

What Can Be Learned from Europe?

The first key lesson from Europe, in Clancy’s opinion, is a great need in the United States for a changed consciousness among policy makers and regulators of the linkages between food choices and environmental integrity and a willingness to act on that consciousness and knowledge. This

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¹⁴ This section summarizes information presented by Kate Clancy, Ph.D., Food Systems Consultant, University Park, Maryland.

would include, at minimum, recognition of the food system as a complex system containing multiple feedback loops that cannot be addressed successfully by addressing only their constituent parts and acknowledgment that sustainable diets are an appropriate policy and public health goal in the United States. Clancy observed that a portion of the food industry and of many civil society organizations (e.g., people advocating for sustainable food systems) is far ahead of most policy makers working on this topic. Although there is still a great distance to go, these “pioneers” in industry and in the NGOs world make very good private-sector partners for governmental work.

A second key lesson learned from Europe is the need for good planning. Clancy observed that although the Department for Environment, Food, and Rural Affairs’ work in Great Britain has been suspended, as Lang noted during his presentation, a 2011-2012 evidence plan can still be found on the department’s website (DEFRA, 2011). Clancy described the evidence plan as extensive, incorporating myriad components and six themes. Another European example of good planning is the 2010 FAO Biodiversity in Sustainable Diets report (FAO, 2010), which was the result of a coordination of multiple efforts and institutions worldwide. Clancy contrasted these efforts with the U.S. situation, where she is aware of no attention by agencies developing federal dietary guidance to the environmental implications of food choices. Nor does the United States have a food policy framework that would provide a starting point for working across agricultural and food sectors rather than continuing down the same siloed pathways. Clancy noted that the lack of a food system policy framework was eloquently discussed many times in the early 1980s, with an important report issued by the Government Accountability Office (GAO) (1982).

A third key lesson pertains to the status of evidence-based research across Europe. There is already quite a lot of evidence on the environmental consequences of food production, especially of animal products, processing, and delivery. Clancy referred to the many workshop presentations covering some of that evidence base. But there are many gaps in the evidence base as well, “far too many gaps,” in Clancy’s opinion. Many recommendations put forth for sustainable dietary guidelines are qualitative, not quantitative, due to a lack of research attention and statistical uncertainties around greenhouse gas emissions and other phenomena (Health Council of the Netherlands, 2011).

A key theme across all of these lessons is that although there are differences between the EU and U.S. situations, many thoughtful and useful data analyses, logic models, and plans that were developed in Europe are available for use and could provide the United States with a head start on addressing some of the complicated issues at hand.

New Policy Approaches

Clancy identified two different but related new policy approaches, transformative and interconnected (i.e., interconnected across departments and administrations), emphasizing that even transformative policy work should be carried out by departments, agencies, and administrations that are willing to work together. What is surprising, even concerning, for Clancy is that although the idea of systems science, cross-disciplinary research, and related concepts has existed for decades in multiple academic disciplines and organizations across the United States, little of what has become second nature to many food policy analysts seems to have made its way into government projects.

That said, the National Research Council report Toward Sustainable Agricultural Systems in the 21st Century (NRC, 2010), provides what Clancy described as a “rich, detailed, articulate rationale for increasing the attention and resources” directed toward interdisciplinary and transdisciplinary systems research. She believes very strongly that the same argument put forth in that report can apply to policy work on sustainable diets. Specifically, she emphasized the need for appropriate price signals or incentives to farmers to adopt more resource-conserving production practices; the need for farm and food policies to be redrafted so that they are less likely to produce unintended consequences that result in less conservation of water, land, and other resources; and the need for more policy tools that are politically viable and effective at a landscape level. Except for some policy that relates to watersheds, most sustainable agriculture policy is still directed toward individual farms, which doesn’t elicit any systems thinking and is too incremental.

In addition, the groundbreaking 1982 GAO report stated that GAO’s emphasis, from then on, would be on cross-issue analyses and requested that agencies dealing with food-related issues consider the same. The 2011 Foresight report on global foods states strongly that interconnected policy making is critically important to solving those problems (Foresight, 2011).

Clancy also noted the many good policy ideas put forth by workshop speakers, all of which could be compiled into a policy research agenda for building sustainable diets that could be disseminated both inside and outside government.

Multiple agencies need to be looking across food supply chains to comprehensively delineate and share information on energy use, climate change, greenhouse gasses, water pollution, soil erosion, and other environmental consequences. Clancy pointed to some excellent internal work being conducted at the U.S. Department of Agriculture (USDA), with people from different agencies within the USDA collaborating on the Know Your Farmer, Know Your Food initiative (USDA, 2013). But that’s an internal model for

collaboration. There is also some cross-agency collaborative work on sustainable communities planning grants being conducted by the U.S. Department of Housing and Urban Development, the Environmental Protection Agency, the Department of Transportation, and USDA (USDHUD, 2013; USDOT, 2012). Clancy called for more models of successful collaborations not just across government agencies, but also between government and NGOs.

Specific Policy Targets

With respect to specific policy targets, Clancy identified first and foremost the U.S. dietary guidelines and described several components of what would be a much more complex process for the dietary guidelines committee to consider (USDA/HHS, 2010). First, would be to add committee members with knowledge of sustainable diets, that is, with expertise on how diet and food choices interact with agricultural and environmental resources. Second, would be to develop a working definition of a sustainable diet specifically for the purpose of dietary guidance. Clancy considers the FAO and Biodiversity International definition¹⁵ to be a wonderful long-term goal, but not necessarily the right starting point because it includes so many elements. Third, would be to review all available evidence related to diet/ environmental linkages. Fourth, would be to take a step-wise approach, that is, to start by examining and including one or more components and then adding others as more research is conducted.

Dietary guidance is an important policy target partly because of its multifunctional nature. Not only can it be used to educate the public about food choices, it can also be used to effect change in food choices. Although its effect on changing food choices has a mixed history, there have been some successes. If environmental concerns become incorporated into dietary guidance, dietary guidance can also be used to educate the public about the entire food system and, in Clancy’s words, “its utter dependence on ecological health.” In addition to being a tool, dietary guidance is also a signal that the government recognizes its role in providing the best food and dietary advice to the public in order to protect public health and understand the links between health, environment, and food security. In Clancy’s opinion, it is impossible to talk about food security without recognizing that the intersection of health and the environment is essential to national

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¹⁵ “Sustainable diets are those diets with low environmental impacts which contribute to food and nutrition security and to healthy life for present and future generations. Sustainable diets are protective and respectful of biodiversity and ecosystems, culturally acceptable, accessible, economically fair and affordable; nutritionally adequate, safe and healthy; while optimizing natural and human resources” (Burlingame and Dernini, 2012, p. 7). (See the summary of Barbara Burlingame’s presentation for background information on this definition.)

food security. Dietary guidance is also a signal that the public has a role in conserving natural resources through its food choices and that citizens are not bystanders. Although people have been saying this for “many decades,” Clancy said, incorporating environmental concerns into dietary guidance would signal its importance.

A second specific policy target is research. Clancy called for an acceleration of progress in research that will help to inform sustainable dietary guidance and for more government funding for research. Reports issued in the past few years from a range of sources, such as the American Enterprise Institute (Alston and Pardey, 2011) and the President’s Council of Advisors on Science and Technology (2012), have stated that the federal government needs to fund more agricultural research because of the low commercial value of many environmental improvements to agricultural production. Clancy also called for more research, both basic and applied, encompassing the multiple dimensions of sustainability and resiliency and conducted by multi- and transdisciplinary teams (ideally across agencies). Finally, she called for more research on systems properties (e.g., emergent properties of food systems).

OPTIONS AND APPROACHES TO ENABLE SUSTAINABLE FOOD CHOICES: RESEARCH PRIORITIES¹⁶

Has research been successful in connecting dietary guidance, human health, and environmental protection? If success is defined as having a dietary guidance tool to promote sustainability, then, according to Wilkins, the quick answer is “no.” But, for Wilkins, further examination of the question revealed three embedded connections: connections between dietary guidance and environmental protection, connections between environmental protection and human health, and connections between human health and dietary guidance. Wilkins examined the evidence base available for understanding each of these connections.

Dietary Guidance and Human Health

The field of nutrition has a long history of researchers accumulating evidence of the connection between diet and health. That evidence is reviewed every 5 years by an advisory committee who makes recommendations for improving the dietary guidelines (USDA/HHS, 2010). Food guides (e.g., MyPlate.gov) are also updated, but less frequently. Most of the evidence that informs the dietary guidelines and recommendations on

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¹⁶ This section summarizes information presented by Jennifer Wilkins, Ph.D., R.D., Cornell University, Ithaca, New York.

food intake comes from single-nutrient studies. Although single-nutrient studies have been very informative with regard to how nutrients and food components affect health and the risk of chronic disease, they have also led to the realization that it is important to look at whole foods and entire diets. There is a fair amount of evidence that non-nutrient components in food are very protective against chronic diseases. Wilkins mentioned the discontinued single-nutrient beta-carotene retinol efficacy trial (known as CARET) conducted back in the 1990s. The trial was designed to test the effect of daily doses of beta-carotene and retinyl palmitate supplement on incidence of lung and other cancers and death among more than 18,000 participants. It was discontinued when researchers found that participants receiving the supplement showed a 28 percent increase in incidence of lung cancer and a 17 percent increase in death (Omenn et al., 1996).

Wilkins categorized evidence on diet–health connections into three groups: (1) consistent evidence, that is, evidence that remains the same when research is replicated; (2) emerging evidence; and (3) contested evidence. Nutritional evidence about the healthfulness of fruits and vegetables and whole grains in the diet is based on consistent evidence. Recommendations regarding types of fat and quantity of fat in the diet are based on emerging evidence; it is still not clear what kind of fat or how much fat is healthy. That same is true for certain components in foods, like phytochemicals. Calcium requirements, including how much calcium is needed from dairy foods, are an example of nutritional advice based on contested evidence and are a “real hot button” right now in the nutrition community, according to Wilkins. The vitamin D requirement is similarly contentious, as well as benefits derived from iron from meat versus iron from other sources.

Human Health and Environmental Protection

The environmental movement as a whole stemmed, at least in part, from concern about exposures that can be harmful to public health. The assumption, in Wilkins’s opinion, is that protection of and resilience of natural resources (water, air, soil, biodiversity) is a necessary condition for people to be healthy. Researchers are beginning to explore that connection as it relates to food choices. Again, the evidence can be categorized as confirmatory, emerging, or contested.

Water is an essential nutrient and comprises 70 percent of our body weight. Although humans can survive without food for weeks, they cannot survive more than a few days without water. Years of research have shown how agriculture impacts water quality in ground water, streams, rivers, and aquifers. The impacts of nonrenewable fossil fuel-based inputs, such as fertilizers and pesticides, on ground water, streams, and rivers are especially

well documented. The U.S. Geological Survey reported nearly two-thirds of domestic and public drinking water wells sampled to be contaminated with at least one volatile organic compound, pesticide, or nitrate from human sources (Toccalino and Hopple, 2010). Impacts of intensive food animal production on water quality are also well documented, with many studies concluding that the amount of manure generated yearly is too much for the land to absorb, leading to nitrogen and phosphorous runoff into streams and shallow aquifers and turning what could be a rich resource into a pollutant (Hooda et al., 2000; Smith et al., 2013). In addition, animal waste often has other elements in it, including antibiotic-resistant bacteria and other pathogens, arsenic, dioxin and other persistent organic pollutants, and complex mixtures of volatile organic compounds. In Wilkins’s opinion, comparing different kinds of animal production systems should be a research priority. She also urged comparing animal production systems to systems built around plant-based sources of protein.

Research on air quality has detailed significant impacts from industrial food animal production as well; air is contaminated with ammonia, hydrogen sulfide, carbon dioxide particulates, and microorganisms (Heederik et al., 2007; Viegas et al., 2013). Research has also shown substantially elevated rates of respiratory conditions among workers and community members living near the facilities (Mirabelli et al., 2006; Schinasi et al., 2011). In Wilkins’s opinion, air quality issues raise social justice issues as well, as often the damage and negative health effects from the food system are experienced by people without much voice. Pesticides are another air quality issue.

The nutrition community is, in Wilkins’s words, “really waking up to” the link between soil quality and human health. She recalled earlier issues of various journals, such as the American Journal of Alternative Agriculture (now called Renewable Agriculture and Food Systems), calling for a broader consideration of soil quality beyond productivity. Researchers were urged to also consider environmental quality, human and animal health, and food safety and quality. Soil quality is an area Wilkins thinks deserves more attention. Food is the most obvious ecosystem service that soil provides, but soil also can improve water and air quality, help mitigate greenhouse gas emissions, and enhance biodiversity.

With respect to biodiversity, Wilkins referred workshop participants to Barbara Burlingame’s presentation (see Chapter 2) and reiterated that the global food supply depends on very few species. Only 12 plant species account for 75 percent of the global food supply, and only 15 mammal and bird species account for 90 percent of animal agriculture (FAO, 1998, 2007).

Environmental Protection and Dietary Guidance

The connection between environmental protection and dietary guidance has not been a central issue for most nutritionists, Wilkins opined. It is not a central topic for her department at Cornell University, nor has it been a central message from the major nutrition professional organizations, such as the Academy of Nutrition and Dietetics and the Society for Nutrition Education and Behavior. However, within both of those organizations and others, like the American Public Health Association, small but growing communities of nutrition professionals are addressing the issues. One of Wilkins’s roles at Cornell is to serve as community coordinator for her department’s dietetic internship program. She remarked that it has been interesting to observe the changing interests among applicants in the past few years. A growing number want environment protection–dietary guidance connection issues to be part of their dietetic training. Wilkins also sits on a national committee that is advising the Academy of Nutrition and Dietetics on developing standards of practice and professional performance in the area of sustainable and resilient food and water systems. “The fact that they formed this committee and want this information I think is very encouraging,” Wilkins said.

Wilkins highlighted several key research needs to help understand the connection between environmental protection and dietary guidance. First are questions related to diet composition, especially the different roles of plant versus animal protein in a sustainable food system. How much meat should we eat? What other ecosystem services do we want agricultural animals to provide? How would those services be translated into ounces of meat or kinds of meat consumed daily or weekly? How do intensive animal production systems compare with pasture-based multi-species systems in terms of their impact on the natural environment and their ability to feed and meet consumer demand?

Understanding seasonal variation is another key research need. For example, does varying diet by seasonal availability alter the nutritional content of one’s diet? What are the nutrition, food-planning, and meal-cooking implications of varying the form of food being used (e.g., fresh fruits and vegetables in season compared to stored fruits and vegetables in the off season)? What are the environmental impacts of canning, freezing, and other off-season storage processes?

Variety is yet another research issue to consider. In Wilkins’s opinion, a varied diet is the cornerstone of nutrition advice. Yet, the U.S. national diet is not a varied diet, with half of vegetable intake comprised of potatoes and tomatoes. Wilkins suggested that much could be done to vary the vegetables, as well as fruits, being consumed. She mentioned local and regional food systems and efforts by Ian Merwin, a pomologist at Cornell University,

who grows about 30 different varieties of apples on his farm, some ripening in July, others in November. His work is based on the premise that greater variety satisfies the market for fresh apples for a longer period of time.

Finally, Wilkins identified processing as the “elephant in the room.” She encouraged workshop participants to read Carlos Monteiro’s invited commentary “Nutrition and Health: The Issue Is Not Food, Nor Nutrients, So Much as Processing,” in Public Health Nutrition (Monteiro, 2009). The commentary categorizes foods into three processing groups: (1) minimally processed foods are foods that are recognizable after they have had something done to them (i.e., after they have been washed or trimmed); (2) substances extracted from whole foods include oils, flours, and other food substances often used to enhance foods in the first category; and (3) ultra-processed foods are shelf-stable, subsidized ingredients that are generally profitable (for the food industry) but not healthful. Processing itself is not the problem, Wilkins remarked. Rather, the problem is the quality and type of processing and whether any inherent nutrients remain in the product after it has been processed. In addition to being “nutrient-sucking,” as Wilkins said, a lot of processing is energy- and resource-intensive.

How Can Food Systems Research Support Sustainable Diets?

Wilkins identified several gaps in food systems research. First, is the lack of information about food systems embedded in food products. She mentioned how eye-opening it is for her students to evaluate food products in terms of the food systems represented by those products. Second, is a need for more evaluations of the types of healthy-food-access intervention activities that are under way and how they are working. Third, is a need for more work on the relationship between food skills and waste. Fourth, is a need for comparisons between highly concentrated food systems and local and regional food systems. Fifth, is an evaluation of the social costs of food systems (i.e., the social costs of what is grown, how it is grown, and where it is grown).

Dietary Guidelines: The Need for a New Framework

The dietary guidelines are intended to promote health and reduce chronic disease (USDA/HHS, 2010). They also provide nutrition standards for food assistance programs (e.g., school meal programs; the Special Supplemental Nutrition Program for Women, Infants, and Children; the Child and Adult Care Food Program; Supplemental Nutrition Assistance Program Education). Finally, they may affect sustainability of the food system, but in untapped ways. The process for developing dietary guidelines needs to be reinvigorated, in Wilkins’s opinion, such that the guidelines not only

promote health and reduce chronic disease but also increase sustainability and resiliency.

Wilkins also urged broadening the food guide definition. The current definition (from Welsh et al., 1992, p. 12) reads: “A food guide translates recommendations on nutrient intake into recommendations for food intake. It provides a conceptual framework for selecting the kinds and amounts of foods of various types which together provide a nutritionally satisfactory diet.” In the end, the goal is to encourage food choices that do two things: promote not just optimal health and disease but also sustainable regional food systems. A new framework, or conceptual model, for developing new dietary guidelines and food guides should be based not only on what is known about the relationship between diet and health, but also on lessons from communication and behavior change research and theory and on seasonality and other regional food system sustainability criteria. Although the food choices people make can be steered by dietary guidelines and food guides, they are also moderated by all sorts of individual factors (e.g., individual preferences, food histories) and environmental factors (e.g., availability at the local store).

The Northeast Regional Food Guide, which was developed in the mid-1990s and was based on the 1992 food guide pyramid, illustrates how geographic context can be embedded into a food guide (see Figure 5-1).

FIGURE 5-1 Northeast Regional Food Guide developed in the mid-1990s and based on the 1992 U.S. Food Guide Pyramid.
SOURCE: Cornell Cooperative Extension, 1996.

Instead of oranges and bananas in the fruits section, regional fruits are represented. Also, instead of symbols for fats and sugars in the fats, oils, and sweets section, actual regional agricultural products are represented (e.g., syrup, butter, canola oil, jams and jellies). Wilkins suggested that a guide like this one might foster more regionally based sustainable food systems.

PANEL DISCUSSION WITH THE AUDIENCE

Following Wilkins’s presentation, panelists welcomed questions and comments from the audience. Topics included dietary guideline revisions; how panelists’ past experiences in other places or sectors shaped their thinking about sustainable diets; and what panelists would choose to request if given a chance to influence an important policy maker with respect to the issues being discussed at the workshop.

Dietary Guideline Revisions

An audience member noted that the revision process for the next edition of the dietary guidelines (2015) is just getting started. The revision committee was announced in May 2013 (after the workshop), and a public comments database is available at www.dietaryguidelines.gov. The audience member encouraged workshop participants to submit comments.

Another audience member remarked that the U.S. dietary guidelines do not actually seem to be doing what they are intended to do, that is, prevent chronic disease. She noted the rapid rise in obesity and diabetes after the dietary guidelines were created in the late 1970s. She said, “Either they’re not working because people aren’t following them, or they aren’t working because people are following them. But either way, they aren’t working.” She suggested examining the decade before the U.S. dietary guidelines were created, when Americans were actually eating less food and farmers were making more money. Immediately after the guidelines were created, when people were told to start eating foods that required more processing (e.g., breads, cereals, pasta, grains) and less food requiring less processing (e.g., whole milk, meat, eggs), caloric intake increased and farm profits declined. The commenter opined that eggs are a great example of a cheap renewable source of protein, but the dietary guidelines recommend eating no more than one per day. That recommendation, she said, is based on outdated science on dietary and serum cholesterol and on egg intake and heart disease. She asked the panelists to address the reality that some dietary recommendations “get in the way of sustainability.”

Wilkins agreed that the dietary guidelines need improvement, especially if sustainability it going to be principled into them. She suggested that more work be directed toward how to communicate good choices within

the guidelines. The guidelines do not receive as much attention as other voices encouraging certain kinds of consumption. Efforts to market foods of minimal nutritional value far outweigh the promotion of wholesome food consumption.

Lang agreed with the commenter that dietary guidelines do not change diets. However, they do provide a benchmark for policy makers and companies to measure progress, and for NGOs and academics to conduct public interest reviews. Lang reiterated the significant role of the 1943 Hot Springs conference in creating not just FAO, but a way to think about food and agricultural policy as something that could transform human health and begin harnessing science, technology, and capital to increase production, support farming, and deliver more affordable foods. The creation of FAO was, in a sense, recognition that the legacy of the previous 100 years of industrialization and uneven supply could be tackled. The food system could be managed in a different way to address unmet need and prevent 1930s-type agricultural booms and slumps. The modern “productionist” food policy paradigm became dominant in the 1940s. Policy makers finally accepted the scientific and practical farming evidence that had been accumulating in the 1920 and 1930s. Today, once again, the dominant paradigm is in trouble. Lang said, “We’re in exactly the same situation, where we’ve got masses of evidence without an adequate policy response.” But we also have split proposals, some wanting a further round of intensification, others calling for realignment on ecological principles. Food companies are beginning to listen. Much depends on public reaction. But, in Lang’s opinion, it is the politicians who are not listening. Lang encouraged workshop participants to make the U.S. 2015 dietary guideline revision an opportunity to inject environmental thinking. He mentioned the “bitter fight” to do this in the recent Australian dietary guidelines, finalized in 2013 (Australian Government, 2013). Although mention of the environment in those guidelines appears only in the appendix, at least it appears.

Panelist’s Lessons from Past Experience in Other Places and Sectors

An audience member commented on the “primacy of synergy” in transdisciplinary thinking and innovation and asked Wilkins whether any of the innovative approaches from the University of Gastronomic Sciences, Italy, might be applied in the United States. Wilkins described the “stages,” or tours, of the University of Gastronomic Sciences curriculum. Each stage is focused on a particular food (e.g., pasta, cheese, salami, honey, other typical Italian foods). Students travel to different places, even different countries, to learn about the product and the food systems behind that product. For example, they might first visit Barilla and then visit a small artisanal manufacturer to learn about different scales of pasta production. The stage

concept is something that Wilkins opined could be embedded in food and nutrition programs in the United States.

The same commenter asked Lang how his farming experience has informed his work. Lang replied, “It changed everything.” He learned about the challenge of climate and temperature and soil, how difficult animals are, how messy nature is. One thing to which he is acutely sensitive after his farming experience is how farmers receive almost no money. The money is made “off the land,” i.e., after food leaves the farm and begins to route to processing, retailing, and catering or home. This is true even for very big farmers, in Lang’s opinion. He noted that there had been little discussion at the workshop about the implications of a transition to sustainable diets for food actors “off the land,” which he thought was a mistake. Very interesting alliances can emerge when and if the pursuit of sustainability is shared by interests beyond “just agriculture.”

If You Could Wave a Magic Wand and Ask a Policy Maker to Make One Change…

Erik Olson, from the Natural Resources Defense Council, asked the panelists what he called a “magic wand question.” If they had a magic wand and could influence an important policy maker, what would they request?

Clancy would ask for a consciousness and commitment to the idea that dietary guidance and sustainable food systems are a legitimate political and policy issue. There are myriad changes that need to be made, she said. So, rather than asking for any single change, she would ask for that conscious commitment, regardless of whether the issue is commodity subsidies or the Environmental Protection Agency budget or something else. Without that commitment and an integration of that thinking, she said “we can’t get anywhere.”

Lang would request at least two environmental scientists on the dietary guidelines revision committee; that the terms of reference for the revision committee include the need to address environmental considerations; and that the Institute of Medicine, professional societies, and others set up “watchdog” dietary guidelines monitoring committees representing a diversity of disciplines.

Finally, Wilkins identified a systems-level change in economics and where profits are made as the single most important change that she would like to see. Specifically, she would like to see margins in grocery stores being highest for healthful foods and lowest for ultra-processed foods (see the summary of Wilkins’s presentation for a description of “ultra-processed” foods).

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