Group 2—Key control points for healthy, equitable and sustainable food and nutrition

Co-Chairs: Professor Jennie Brand-Miller and Professor Amanda Lee

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:

  1. wastage at all stages of the food chain represents an avoidable environmental burden
  2. any food or drink consumed above an individual’s optimal energy requirement represents an avoidable environmental burden
  3. reducing the consumption of discretionary foods reduces the use of environmental resources and health risks
  4. a diet comprising less animal- and more plant-derived foods delivers ecological and potential health benefits
  5. eating should be a source of pleasure. Dietary patterns that are not enjoyable and/or involve too much discipline or self-sacrifice are unlikely to be sustained.

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.

Questions to get you thinking

  1. Interpretation of the scientific evidence base on effective strategies to prevent diet-related ill health is underscored by two diverse philosophical views: one is that this requires improving food environments (so that consuming a healthy diet is easy irrespective of education, income, culture etc); the other is that healthy eating is a personal responsibility and if we teach people how to eat well, they’ll comply.  How can these different philosophical views be reconciled?
  2. With respect to economic drivers, are food taxes the way to go?  Should we increase the GST on all discretionary foods and drinks or just some (for example, a ‘sugary drink’ tax or a saturated fat tax), and/or ensure that nutritious foods in the five food groups remain GST free? Should we consider subsidies for agriculture and transport, and/or voucher systems targeted to high-risk groups?
  3. How do we compare/balance the three components of healthy, equitable and sustainable diets?  Are any aspects more important than the others?
  4. In the face of limited resources, should we focus attention on improving the diet of the majority of the population rather than vulnerable groups? Or should we focus just on high-risk groups such as pregnant women and/or Aboriginal and Torres Strait Islanders? Why/why not?
  5. What vested interests and potential conflicts of interest are most problematic in efforts to improve the Australian diet? How should these be managed to produce an effective, evidence-based food and nutrition policy/strategy/action plan in Australia?
  6. Is plant breeding the answer? Can we solve important nutrition problems by ensuring that staple crops contain sufficient macronutrients and micronutrients for optimum health?
  7. Can Planet Earth cope with providing the recommended 7 serves of fruit and vegetables every day for 7 billion people, and counting?
  8. Currently breakfast cereals are fortified under voluntary industry practice and contribute important micronutrients to the diet. Should we legislate vitamin and mineral fortification of all packaged foods (for example, in proportion to energy per serve)?
  9. Globally, regulatory and legislative reforms (such as fiscal measures, mandatory advertising restrictions on discretionary food and drinks, and mandatory interpretive front-of-pack food labelling systems) have been shown consistently to be among the most cost-effective interventions to improve diets. However there is little political appetite for such approaches. Is there a role for scientists in advocating for such evidence-based interventions, and if so, what would this look like?

Recommended reading

Lee A, Baker P, Stanton R, Friel S, O’Dea K, Weightman A. Scoping Study to Inform the Development of the new National Nutrition Policy, 2013, QUT, Australian Department of Health and Ageing (RFT 028/1213). Released under FOI, March 2016; Available here 

Sachs G et al 2017, Policies for tackling obesity and creating healthier food environments, Scorecard and priority recommendations for Australian governments, Available at:

Sturm R, Ruopeng A 2014, ‘Obesity and economic environments’, Cancer J Clin 64 (5): 337-350 doi: 10.3322/caac.21237

Center for Agriculture and Food Systems at Vermont Law School and Harvard Law School Food Law and Policy Clinic (2017) The Blueprint for a National Food Strategy (USA), available at:

National Health and Medical Research Council. Australian Dietary Guidelines: providing the scientific evidence for healthier Australian diets. Canberra: National Health and Medical Research Council, Canberra: NHMRC, 2013.  Available from:

Food and Agriculture Organization of the United Nations (FAO). Climate change and food systems: global assessments and implications for food security and trade. Rome: FAO; 2015.

Food and Agriculture Organization. Sustainable diets and biodiversity directions and solutions for policy, research and action. Rome: FAO; 2012.

World Health Organization. Global action plan for the prevention and control of non-communicable diseases 2013-2020. Geneva: WHO; 2013.

Lawrence M, Friel S, Wingrove K, James, SW, Candy, S 2015, ‘Formulating policy activities to promote healthy and sustainable diets’, Public Health Nutr. 18:2333-40 doi: 10.1017/S1368980015002529

Friel S, Barosh L, Lawrence M 2014, ‘Towards healthy and sustainable food consumption: an Australian case study’, Public Health Nutr. 17:1156-66 doi: 10.1017/S1368980013001523

Lee AJ, Kane S, Ramsey R, Good E, Dick M 2016, ‘Testing the price and affordability of healthy and current (unhealthy) diets and the potential impacts of policy change in Australia’, BMC Public Health 2016, 16:315 doi: 10.1186/s12889-016-2996-y

Monteiro C, Cannon, Moubarac, Martins AP, Martins CA, Garzillo J, Canella DS, Baraldi LG, Barciotte M, Louzada ML, Levy RB, Claro RM, Jaime PC 2015 ‘Dietary guidelines to nourish humanity and the planet in the twenty-first century. A blueprint from Brazil’, Public Health Nutr. 18:2311-22 doi: 10.1017/S1368980015002165

Mozaffarian D 2017, ‘Foods, nutrients, and health: when will our policies catch up with nutrition science?’, The Lancet Diabetes & Endocrinology 5(2):85-88. doi: 10.1016/S2213-8587(16)30265-0

Roberto, Swinburn B, Hawkes C, Huang T, Costa SA, Ashe M, Zwicker L, Cawley JH, Brownell KD 2015, ‘Patchy progress on obesity prevention: emerging examples, entrenched barriers, and new thinking’, Lancet. 385:2400-9 doi: 10.1016/S0140-6736(14)61744-X

Moodie R, Stuckler D, Monteiro C, Sheron N, Neal B, Thamarangsi T, Lincoln P, Casswell S; Lancet NCD Action Group. 2013, ‘Profits and pandemics: prevention of harmful effects of tobacco, alcohol, and ultra-processed food and drink industries’, Lancet. 381(9867):670-9 doi: 10.1016/S0140-6736(12)62089-3

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