Poor diet is now the major preventable risk factor contributing to burden of disease, globally and in Australia. According to the Australian Health Survey 2011–13, only 4% of Australians consume diets consistent with recommendations of the National Health and Medical Research Council’s Australian Dietary Guidelines. At least 35% of the energy intake of adults and at least 39% of the energy intake of children are now derived from ‘discretionary’ choices i.e. foods and drinks high in saturated fat, added sugar, salt and/or alcohol that are not required for health.
Further, dietary risks are not distributed equally. People who experience greater social disadvantage through relative lack of opportunities in education, employment, income and location have poorer diets, and suffer increased risk of malnutrition, obesity and diet-related chronic disease. Aboriginal and Torres Strait Islanders suffer particularly high rates of diet-related conditions compared to other Australians. Most of the social and economic determinants of healthy eating (including availability, affordability, accessibility and acceptability of healthy choices) lie outside the health system.
In Australia and other high-income countries, rising rates of obesity and chronic disease have coincided with a rise in general food abundance (including the cheapest food in history relative to income), sedentary lifestyles, and insufficient physical activity. In Australian women, rates of obesity and overweight are highest in the lowest socioeconomic group (63%) compared to the highest socioeconomic group (47%) but there is little difference among men (ranging from 68% to 71%). The lack of difference suggests that we need to understand the changes in the environment that affect all groups, not just differences between subgroups.
Environmental sustainability is also critical to human diet and health, as the foods consumed affect the environment, and the environment in turn affects aspects of food production and supply, hence the food available for consumption. There is increasing evidence that the types of foods that minimise environmental impacts, including greenhouse gas emissions, use of natural resources such as water, and pressure on biodiversity, tend to be those associated with health benefits. The synergy between dietary patterns for health and those that have minimal environmental impact is fortuitous. A healthy and sustainable diet can be based on guiding principles including:
What are the critical control points? Research has highlighted the important role of local food environments in influencing diets. These are the products of the broader food and nutrition system, and are influenced by political, economic, environmental, social and cultural drivers. This system is complex, but contains many potential leverage points for intervention. Action on the determinants of healthy, equitable and sustainable eating involves a diversity of sectors including agriculture (plant breeding, animal foods, fish stocks), trade, food manufacturing (including fortification and supplementation), wholesaling and retailing, employment, education, social protection, health, housing, transport, and planning.
Internationally and in Australia, many effective nutrition policy actions have been identified (such as fluoridation of water supplies, iodisation of salt, food labelling and healthy food supply strategies in school and other public sector settings). While there are vested interests throughout the food and nutrition system which can make intervention in the current system challenging, the growing and selling of healthy food must be profitable.
There is an urgent need for a global and national food and nutrition policies, strategies and action plans that address critical control points and help shift the current intake of the whole population towards healthy, equitable and sustainable diets.
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