key: cord-0724596-4jx0h0y5
authors: Murphy, Madhuvanti M.; Guariguatax, Leonor; Samuels, T. Alafia
title: A COVID-19 opportunity: Applying a systems approach to food security and noncommunicable diseases
date: 2020-08-14
journal: Rev Panam Salud Publica
DOI: 10.26633/rpsp.2020.84
sha: 7f628d66220bc5a4be65a2e8c01f1e5eba4722d2
doc_id: 724596
cord_uid: 4jx0h0y5

nan

Small Island Developing States (SIDS) are highly dependent on food imports from larger nations, with the Caribbean Community (CARICOM) and Pacific islands combined importing almost $5 billion in food in 2018, and more than half of SIDS countries importing more than 80% of their food, much of it nutritionally poor and highly processed (1) . This has been an important driver of high levels of obesity (>30% of adults), food insecurity, and noncommunicable diseases (NCDs) (between 10-30% of adults) in these countries (2) . The susceptibility of the SIDS food system to shocks in the supply chain of imported foods has been dramatically exposed in recent weeks through the growing COVID-19 pandemic with discussions focused on food security and vulnerability to climate change (3). The current crisis has accelerated the discourse on increasing food security, particularly in the CARICOM, as the region-which consists of 15 nations with a combined population of over 18 million-braces for a disruption in food imports from larger economies, and also due to border closures. Food security in the context on COVID-19 was high on the agenda at the Ninth Special Emergency Meeting of the Conference of Heads of Government of CARICOM on April 15, 2020, focusing on a regional approach instead of individual country approaches (4, 5) .

In October 2010, the CARICOM published the Regional Food and Nutrition Security Policy, which has goals of promoting increased production and access to safe and nutritious value-added food products in order to reduce the region's vulnerability to NCDs, natural disasters, and socioeconomic shocks (2) . Implementation of the policy, however, has been slow. Like the rest of the world, SIDS are already seeing the dire and challenging consequences of COVID-19 on supply chains. However, there is a window of opportunity to enhance food sovereignty in SIDS focused on increasing the availability and consumption of local and regionally produced healthy foods. It is not enough, though, to just increase agricultural production. The policies and plans developed and implemented during this critical time must align with goals set in health, development, and climate sustainability (6) . In January 2019, the Lancet Commission report on "The Global Syndemic of Obesity, Undernutrition, and Climate Change" made explicit the need to not only coordinate policies, but target them in such a way that they create lasting systemic change across goals for sustainable develop, health, and climate change (7).

One ongoing project in the CARICOM, the "Improving Household Nutrition Security and Public Health in the CAR-ICOM" has taken a systems approach to examine the drivers of unhealthy eating in the context of low agricultural production and food importation (8) . Stakeholders across the food, health, and development sectors involved in the project have highlighted the need to shift the ways in which the SIDS populations interact with local foods. Currently, local agricultural production is dependent on the fluctuating willingness of retailers to buy local, which is further dependent on availability and affordability of healthy local agricultural foods. There must be a prioritization and protection of those foods by the government and producers, and an accompanying infrastructure to ensure storage, safety, and processing capacity. Policies must be coordinated from the local to national and regional levels with buy-in across sectors. Key to success is increasing the demand by the private sector, such as manufacturers, as well as the public, which will need strong marketing components to compete with unhealthy, affordable products. Perhaps unrecognized in the current discussions is the need to limit the reach of the nutritionally poor, highly processed foods that make up the bulk of diets in many SIDS. In terms of health, the best hope for reducing the NCD burden and improving food sovereignty in CARICOM is to continue to enhance consumer demand, availability and competitive pricing of healthy local foods, while taxing unhealthy foods such as sugar sweetened beverages and ultra-processed foods and also banning transfats. Governments at the national and regional levels can ensure a better future with these systemic issues in mind. What cannot be lost as we try to implement quick solutions to address the potential food security issues in SIDS, as a response to COVID-19, is the ability to evaluate which diets and food production practices together will achieve the necessary goals for a healthier, more sustainable future.

FAO's work with Small Island Developing States Transforming food systems, sustaining small islands

Study on the State of Agriculture in the Caribbean

The COVID-19 pandemic and agriculture -Short and long run implications for international trade relations

CARICOM Agri Ministers meet to craft COVID-19 Food Security Position

Ninth Special Emergency Meeting of the Conference of Heads of Government of the Caribbean Community, via videoconference

The Helsinki Statement on Health in All Policies

The Global Syndemic of Obesity, Undernutrition, and Climate Change: The Lancet Commission report

Using Group Model Building to Describe the System Driving Unhealthy Eating and Identify Intervention Points: A Participatory, Stakeholder Engagement Approach in the Caribbean