Abstract
As part of a global policy response for addressing malnutrition, food system actions have been proposed. Within food system interventions, policies directed to supply chains have the potential to increase the availability and affordability of a healthy diet. This qualitative study aimed to identify opportunities to integrate nutrition as a priority into the food supply policy space in Mexico. Data were collected through analysis of 19 policy documents and 20 semi-structured stakeholder interviews. As an analytical framework, we used policy space analysis and embedded the Advocacy Coalition Framework (ACF) and the steps of the food chain of the conceptual framework of food systems for diets and nutrition. Policy issues relevant to nutrition were viewed differently in the economic and agricultural sectors versus the health sector. Overall, the main policy objective related to nutrition within the economic and agricultural sectors was to contribute to food security in terms of food quantity. Nutrition was an objective in itself only in the health sector, with a focus on food quality. Our policy space analysis reveals an opportunity to promote a new integrated vision with the recent creation of an intersectoral group working on the public agenda for a food system transformation. This newer integrative narrative on food systems presents an opportunity to shift the existing food security narrative from quantity towards considerations of diet quality. The political context and public agenda are favorable to pursue a food system transformation to deliver sustainable healthy diets. Mexico can provide a case study for other low- and middle-income countries (LMICs) for putting nutrition at the center of food policy, despite the ongoing constraints on achieving this.
Highlights
Malnutrition in all its forms, which includes overweight, obesity, undernutrition and micronutrient deficiencies, is a significant health and development policy challenge for lowand middle-income countries (LMICs).[1,2,3] In Mexico, there is persistent undernutrition coexisting with a rising prevalence in diet-related non-communicable diseases (NCDs)
It is necessary to reduce dietary risk factors for malnutrition; increased intake is required of nutrient-rich foods like vegetables and fruits, whole grains, nuts, legumes and seafood, and reduced intake is required of ultra-processed foods containing excess amounts of fat, sugar and salt.[8,9,10,11]
We used Policy Space Analysis[38] and embedded the ACF39, and the steps of the food chain of the food systems framework[14] to contribute a primary analysis of the contextual, political and policy factors that creates constraints and opportunities for the food supply chain policy process to integrate nutrition priorities. We applied these frameworks to Mexico as a case study using document analysis and key informant interviews. We make it possible to understand in a LMICs context what it would look like to think differently about food systems, in line with international recommendations on food system transformation to deliver healthy diets.[8,14,19]
Summary
Malnutrition in all its forms, which includes overweight, obesity, undernutrition and micronutrient deficiencies, is a significant health and development policy challenge for lowand middle-income countries (LMICs).[1,2,3] In Mexico, there is persistent undernutrition coexisting with a rising prevalence in diet-related non-communicable diseases (NCDs). An undernutrition burden persists with almost 1.5 million Mexican children younger than five years with low height for age; 14% of children have chronic undernutrition.[4] At the same time, overweight-obesity prevalence is 33% in schoolchildren and 73% in adults.[4] These trends of undernutrition and obesity reflect what is known as the double burden of malnutrition. The causes underlying malnutrition are complex, poor diet makes the biggest contribution.[5,6] In Mexico, only 42% of adults eat vegetables regularly, and 1%-4% reach the recommended intake of legumes, in contrast to 85% who drink sugar sweetened beverages regularly.[4,7] It is necessary to reduce dietary risk factors for malnutrition; increased intake is required of nutrient-rich foods like vegetables and fruits, whole grains, nuts, legumes and seafood, and reduced intake is required of ultra-processed foods containing excess amounts of fat, sugar and salt.[8,9,10,11]
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