Universal Nutrition Coverage: A Transformative Opportunity for Health and Food Advocates
An African farmer collects leaves from her vines for a tasty meal. Worldwide, the fresh produce of smallholder farmers remains important to food security and nutritional diversity.

On Universal Health Coverage Day – an appeal to food and health advocates to shape an agenda for ‘Universal Nutrition Coverage’ including joined-up solutions that promote sustainable agro-ecosystems producing healthier foods for people with co-benefits for the planet.

Every year on December 12, the health community marks Universal Health Coverage (UHC) Day. While the technical definition of UHC focuses on health services (‘UHC means that all individuals and communities receive the quality health services they need without suffering financial hardship’), the concept has come to represent more than this. UHC is about equity, the progressive realisation of ‘health for all’, and leaving no one behind.

Nutrition is one of the fundamental determinants of health. Yet globally, the impacts of poverty and other socio-economic determinants of health on the increased prevalence of malnutrition mean that we are off track to meet five out of six maternal, infant and young children nutrition targets and all diet-related non-communicable disease (NCD) targets. Unhealthy diets, combined with sedentary lifestyles, are the leading risk factor for disability and death from NCDs worldwide. It is estimated that about 3 million people worldwide cannot afford a healthy diet.

Industrialized food systems – failing to deliver health

Industrialized foods – failing to deliver health.

Many point to the industrialized food system as the cause. Mounting evidence shows that it is failing to deliver health; a situation inextricably linked to and exacerbated by the COVID-19 pandemic, in which food insecurity has risen and people living with obesity have been especially at risk. Food systems transformation is urgently needed to achieve universal health and good nutrition for all.

The food we eat and how it is produced, packaged, shipped, consumed, and wasted also has a deep impact on animal and ecological health. Food production contributes to more than a third of all greenhouse emissions and is one of the main drivers of catastrophic biodiversity loss today.

Similarly, last week a new study by the UN Food and Agriculture Organization confirmed that soils are one of the main receptors of agricultural plastics — containing larger quantities of microplastics than oceans. At COP26, food systems transformation, and the need for healthy and sustainable diets, was an important theme discussed in many side events, building on efforts begun at the UN Food Systems Summit.

Agriculture Plastic Residues Are Poisoning Soils, Food Systems & Threatening Human Health, Says FAO 

Also last week, the Tokyo Nutrition for Growth Summit (N4G), which concluded on 8 December, put the spotlight on global nutrition goals, aiming to renew and generate new actionable commitments for attaining nutrition-related Sustainable Development Goals and WHO targets, aligned with national priorities. Top of the agenda at N4G was the theme ‘Integrating nutrition into universal health coverage (UHC)’.

UHC  criticised for too much focus on curative health services – nowhere is this clearer than in the case of nutrition

Many consumers globally rely on traditional markets for affordable, accessible, and nutrient-dense foods- but these markets are often poorly positioned to compete with a new world of supermarkets and industrialized foods.

Alongside global health security, UHC is a dominant paradigm in global health. It has, however, been criticised for its focus on individual-based, curative health services, as opposed to population-based, preventative public health approaches.

Nowhere is this clearer than when looking at nutrition. We need stronger health systems to provide services to treat malnutrition in all its forms; but we also need deeper collaboration between food and health sectors so that together we can think more holistically about our shared roles in a whole-of-society approach to improve nutrition outcomes and address the root causes of poor nutrition in ways that co-benefit the planet too.

This UHC day is an opportunity to catalyze further action and progress made in 2021 and imagine what Universal nutrition coverage would look like. To us this means a world where all people receive the nutrition they need without suffering financial hardship, in ways that follows the “one health” approach, and that calls for ensuring equitable benefits to human, animal, and ecological health.

At COP26, we witnessed a huge and timely effort by the health sector to make sure health is at the heart of national climate policies: more than 460 health organisations, representing more than 46 million health workers, in over 100 countries have signed the ‘Healthy Climate Prescription’ letter which calls for stronger action on climate change to protect people’s health.

Interconnected food-health pathways: unhealthy diets & food insecurity; food safety, zoonotic pathogens and environmental contamination; and occupational hazards

Unhealthy, unregulated food is one risk factor for NCDs as well as food-borne illnesses.  Unsafe and poorly regulated food systems can also provide pathways for the emergence of new zoonotic pathogens as well as anti-microbial resistance.

A new narrative by WHO “Food Systems Delivering Better Health” also describes five interconnected and interrelated pathways between food and health: unhealthy diets and food insecurity; zoonotic pathogens and antimicrobial resistance; unsafe and adulterated foods; environmental contamination; and, degradation and occupational hazards.

Yet, there’s still much to do: the links between climate, health and food systems – for example as described in the 2019 Lancet Commission Report, The Global Syndemic of obesity, undernutrition and climate change – are still not being fully capitalised on at the UN Food Systems Summit, COP26, or at the recent N4G in Tokyo.

Governments and the private sector have critical roles to play in improving nutrition and creating the enabling environments for equitable access to healthy and sustainable diets, and health sector professionals are also critical agents of change and influence. Youth, such as medical students and future healthcare professionals, are already advocating for the inclusion of food systems in the public health field.

They are empowering themselves with the required knowledge, skills and competencies, and they are using innovative approaches such as online courses, workshops, small working groups, and simulations to widen the horizon on the interlinkages between food, nutrition, and health. They are engaging their communities through webinars and campaigning based on research and policy analysis.

As we look ahead to 2022, with the annual World Health Assembly in May and COP27 later in Egypt, we must all work together, reaching across geographies, economic sectors and professional silos.  We need to mobilize around the levers of change to which we have access to in order to ensure that healthy, sustainable diets are a reality for all – as we strive towards universal health and universal nutrition. \

We invite all those working in the health sector to consider universal nutrition coverage, and what they can do to ‘leave no one’s nutrition behind’. Youth leaders, in particular, have an opportunity to lead the way forward.

Malnutrition is not an unknown virus, it is a ‘known known’, which we can and must tackle through radical and hopeful food systems transformation.


Ruth Richardson is the Executive Director, Global Alliance for the Future of Food, a strategic alliance of philanthropic foundations working together to transform global food systems. In 2020, she was appointed Chair of the UN Food Systems Summit Champions Network.  @RuthOpenBlue / @futureoffoodorg

Mohamed Eissa is a 6th-year medical student from Alexandria, Egypt, and the Liaison Officer for Public Health Issues of the International Federation of Medical Students’ Associations.


Image Credits: The Future of Food , Ashley Green / Unsplash, Michael Casmir/Pierce Mill Media, Sven Petersen/Flickr.

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