Health(1) and well-being depends on access to foods such that diets can be adequate with respect to both the quantity and balance of essential nutrients and energy. Indeed American agriculture, the source of so much of the world's food, is ultimately in the business of human nutrition and health.
Despite the remarkable capacity of American agriculture to produce high quality food, incorrect nutrition presently contributes to at least five of the ten leading causes of death (heart disease, cancer, stroke, diabetes, atherosclerosis) of Americans (1). In addition, a fifth of American women and children is estimated to be anemic (much due to poorly bioavailable dietary iron) and low intakes of calcium contribute to high rates of metabolic bone disease particularly in post-menopausal women. Deficiencies of vitamins A and C are prevalent among Hispanic and African Americans particularly in lower socioeconomic groups. At the same time, rates of overweight and obesity are increasing. The irony is that a country with the world's most productive agriculture and sophisticated post-harvest food processing and marketing systems continues to have diet-related health problems varying from food insecurity to overnutrition. These problems erode quality of life and have substantial social costs, making them consumer as well as public health issues.
Food and nutrition-related problems are also national development issues. Malnutrition affects nearly half of the world's population, particularly the poor in the developing nations (2). Some 840 million people do not have access to enough food to meet their basic needs, and more than a third of the world's children are stunted due to inadequate diets. Some 2 billion people live at risk to diseases resulting from deficiencies of vitamin A, iodine and iron; most of them are women and children. By potentiating infectious disease, malnutrition is thought to account for half of all child deaths. Although impressive gains have been realized in global food production, high-yielding, "green revolution" varieties of staple grains have displaced traditional crops, decreasing the diversity of many cropping systems and actually contributing to micronutrient malnutrition. Clearly, better approaches are needed to meet the increasing demands of a world that expects to add 2.5 billion people over the next 25 years. Malnutrition is not only morally unacceptable; with an expanding global population and an internationalizing economy, its effects are inescapable. Thus, two facts are clear: that nutrition interventions, which have focused on correcting nutrient inadequacies, have not succeeded in solving either the domestic or global problems of poor nutrition; and that the full potential of food systems has not been exploited to these ends.
Table 1. Diet-Related Health Problems in the US
| problem | links to diet | people affected | impacts |
| anemia | insufficient bioavail-able Fe | 20-28% of women; 10-21% children | impaired work productivity, increased morbidity, poor growth |
| metabolic bone diseases | insufficient intakes of Ca (excess P); poor vitamin D status | 13 million frac-tures (200,000 of hip)/yr | increased fracture risk (hip, spine, radius); lost mobility; high mortality |
| low birth weight | poor prenatal care including nutrition | 7 million (50% infant deaths) | increased morbidity and mortality |
| growth retardation | poor general nutrition | 13-15% of children 0-5y in some sub-groups | impaired physical development |
| overweight | excess caloric intake, e.g., fat | 26% of people 20-74 yrs | increased risk to heart disease, diabetes, gall bladder disease, some cancers, osteoarthritis |
| heart disease and stroke | diet appears to modify risk, e.g, excess satur-ated fat, cholesterol, excess sodium | 7 million cases (350,000 deaths/yr) | increased morbidity and mortality |
| cancer | diet appears to modify risk, e.g., excess fat, low intakes of com-plex carbohydrates and fiber | 346,000 deaths/ yr (20% of all deaths) | increased morbidity and mortality |
| noninsulin-depen-dent diabetes | excess caloric intakes, e.g., excess fat | 7 million cases | increased morbidity and mortality |
We propose that the replacement of malnutrition by diet-related chronic diseases as major health problems associated with industrial development, and the persistence of malnutrition in resource-poor regions of the world both relate, at least in part, to a dysfunctional view of the relationship of agriculture and human health. Indeed, diet-related health problems in the US tend to be dealt with on economic (e.g., food security) and medical (e.g., therapeutic) bases, and mal-nutrition in the developing world has been viewed as resulting mainly from insufficient supplies of the macronutrients, energy and protein (3). The former view has underemphasized the role of food science and technology in promoting health and the latter view has underestimated deficiencies of critical micronutrients (vitamin A, iron and iodine), problems now being referred to as "hidden hunger" and recognized as major sources of morbidity and mortality and impaired cognitive development and learning(2).
Table 2. Diet-Related Health Problems in the Developing World
| problem | links to diet | people affected | impacts |
| insufficient food | calories, protein and all other nutrients | at least 840 million | lost work productivity, im-paired physical and cognitive development; excess morbid-ity and mortality; social unrest |
| low birth weight | insufficient bio-available Zn, Fe | 35% of children 0-5 yrs. | impaired physical develop-ment; excess morbidity and mortality |
| vitamin A deficiency | insufficient pro-vitamin A-rich foods | 250 million (14 mil-lion with xerophthalmia) | impaired cognitive develop-ment; excess morbidity and mortality |
| anemia | insufficient bio-available Fe | 2.1 billion (including 42% of all women) | lost work productivity; im-paired cognitive development; excess morbidity |
| iodine defi-ciency diseases | insufficient I and/or Se | 200 million (6 million cretins born/yr) | lost work productivity; im-paired cognitive development |
We propose that a more useful and accurate view would see agriculture (including post-harvest food processing, technology, marketing, etc.) as inextricably related to human health with nutrition being at the nexus of these major activities. That view is facilitated by using systems approaches to conceptualizing and responding to these complex health problems.
We propose that the development of sustainable solutions to diet-related health problems can be best addressed using systems approaches, which consider all relevant causal variables and conceive of objectives in multi-disciplinary terms. These contrast to the traditional approaches to agricultural, food and nutritional sciences, which have generally been sectoral ones that tend to address problems with relatively narrow focus and to define objectives in limited ways; sectoral approaches have limited abilities to deal with truly complex issues. Systems approaches address real-world situations by assuming that when one variable is changed, all other variables may be affected by that variable and all ensuing interactions.(3)
Systems approaches consider effects across sets of variables and call for dynamic modeling with the expectation that changes will be non-linear and discontinuous.
Because systems approaches take comprehensive views of both ends and means, they have particular value in addressing diet-related health problems. While, historically, the agricultural sector has measured its success in terms of production, systems approaches expand that view to include measure of impacts on human nutritional status. They do this by setting among the explicit objectives of an agricultural system that of producing healthy people and, to that end, that of producing foods of sufficient quality and quantify to support human health and well being. Whereas health-based sectoral approaches have traditionally focused on the proximate and evident causes of poor nutrition in treating symptoms, systems approaches seek to identify the root causes of poor nutrition and look broadly to food systems in the development of sustainable solutions.
Because systems approaches are holistic, in that they encompass all relevant factors in their analyses, they are useful in gaining insights that permit imaginative and illuminating synthe-ses, as this is a "both-and" rather than an "either-or" world. This requires synthesis in devel-oping understanding and strict disciplinary thinking can impede this process, as disciplines are based more on analysis than synthesis. Systems approaches to improving human health, there-fore, call for trans-disciplinary cooperation and coordination; this can be achieved by focusing on the common objective is cost-effective and sustainable improvement in human nutrition.
We, therefore, propose a view of agriculture, nutrition, health and sustainable social development as being highly interrelated instrumental to each other. People are both the means and the ends in the systems perspective; their well-being is ultimately the most important motivating and evaluative criterion.
The food system concept emerges from the application of systems approaches to food and health issues and is fundamental to the development of food-based strategies for improving health. Food systems encompass all activities relating to the production, acquisition and utilization of food that affect human nutrition and health. They are varied, complex, integrated, multi-component systems with multiple inputs (e.g., labor, capital, knowledge, seed stock, etc.) and multiple outcomes, including the health and well-being of people within such systems. Food systems consist of sub-systems which can be described somewhat vectorially, proceeding from the physical points of the growing of food plants and animals to the physiologic utilization by individuals of the nutrients provided by those foods.
Last autumn, we convened a group of 95 food, nutrition and health experts from the private, public and academic sectors of 31 countries to consider the opportunities offered by food systems for the development of sustainable solutions to micronutrient malnutrition in the developing world (4). That group developed a conceptual model of a food system (Fig. 1) It consists of three sub-systems. Food production subsumes activities associated with land use and tenure, soil manage-ment, crop breeding and selection, crop management, livestock breeding and management, and harvesting. Food acquisition subsumes an array of post-harvest activities (e.g., including the processing, transportation, storage, packaging and marketing of food) as well as activities relating to household purchasing power, traditions of food use (including child feeding practices, food gifts and celebratory food use) and public food distribution. Food utilization subsumes activities involved in the preparation, processing and cooking of food at both home and community levels, as well as household food decision-making and food distribution practices, cultural and individual food choices/preferences and access to health care, sanitation, energy and knowledge. The components of these sub-systems have substantial overlap and interlinkage. For example, food production includes several activities collectively referred to as cropping systems (e.g., soil management, crop/livestock management, harvesting, post-harvest processing) that are directly affected by several components of the food acquisition sub-system (e.g., processing, marketing, consumer demand, transportation/ distribution). Similarly, household food decision-making relates to knowledge/ education, to intra-household food distribution and feeding practices, as well as to consumer demand and marketing practices.
In addition, food systems were seen as existing within several environ-ments: a bio-physical environment, including such factors as geographic location, climatic conditions, soil types, indigenous plants and animals, etc.; a social environment, including such factors as traditions with respect to women's roles, etc.; an economic environment, including such factors as costs of food and shelter, value of labor, etc.; a public health environment, including such factors as access to health care, disease exposure burden, water quality, etc.; and a policy environment, including such factors as government subsidies, incentives and disincentives.
The health and well-being of individuals were seen as outcomes of this
complex, nested system interacting to varying degrees within these several
environments. Because interactions were seen as operating non-uniformly
on populations, health outcomes were also seen as non-uniform within populations.
Accordingly, it is imperative that interventions target individuals at greatest
risk to micronutrient malnutrition in specific local situations.
The conceptual model is useful in considering food-based approaches to micronutrient malnutrition, as those approaches and subject to the dynamic and complex interactions within food systems. The model can be expanded to address the impact of food-based approaches on health, and sections can be amplified to show important interactions. Considerations of food systems can reveal unexpect-ed consequences of interventions and novel ways of improving nutrient outputs.
We propose that food systems thinking can overcome the limitations inherent in traditional, disciplinary and sectoral approaches to diet-related human health problems. Thinking in terms of food systems enhances considerations of agricultural sustainability by explicating the interrelationships of production and environmental and health impacts. Thinking in terms of food systems facilitates building trans-disciplinary teams to address more effectively complex issues related to agriculture practice and policy. Thinking in term of food systems encourages specialists also to operate from generalist perspectives. Therefore, the imperative to the academy is to find effective ways for our students (and ourselves) to learn to use food systems thinking.
In 1994, Cornell developed a new program in the College of Agriculture and Life Sciences (CALS) to implement the CALS mission by find ways to focus food systems on human health and well-being. The Food Systems for Improved Health (FSIH) Program is a cross-departmental effort to foster the trans-disciplinary, systems-based teaching, research and outreach efforts for the development of sustainable solutions to diet-related health problems in both domestic (New York State and the U.S.) and international contexts. The FSIH approach is to consider food systems holistically with human nutrition and health identified as explicit outcomes of those systems. In doing this, it has undertaken to cross traditional disciplinary, institutional, sectoral and geo-political boundaries to form productive, trans-disciplinary linkages. Ultimately, FSIH seeks to transform itself from a program activity into a way of doing the core businesses (instruction, research and outreach) of CALS.
FSIH program activities have been very successful. These include an international workshop focused on malnutrition in the developing world "Food-Based Approaches to Preventing Micronutrient Malnutrition" (Salt Lake City, 1995); a national symposium focused on domestic agriculture-health linkages "Creating Healthful Food Systems: Linking Agriculture to Human Needs" (Seattle, 1997); trans-disciplinary, collaborative research projects "Implementing a Food Systems Approach to Improving Micronutrient Nutrition in Egypt" and "Breeding Micronutrient-Efficient Cultivars of Staple Grains" (5); and launching a collaborative learning-modeled undergraduate course "Linking Food Systems with Human Nutrition Needs". The FSIH program is presently developing a global network of institutions interested in sharing expertise in this area.
1. U.S. Dept.Health and Human Services. 1990. Health People 2000: National Health Promotion and Disease Prevention Objectives. DHHS publ. No. (PHS) 91-50212, U.S. Gov. Printing Off., Washington, DC, 691 pp.
2. Administrative Committee on Coordination-Subcommittee on Nutrition. 1992. Second Report on the World Nutrition Situation, Volume I. Global and Regional Results. Micronutrient Deficiency - the Global Situation. United Nations, New York, 80 pp.
3. Pelletier, D.L., K. Deneke, Y. Kidane, B. Haile and F. Negussie. 1995. The food-first bias and nutrition policy: Lessons from Ethiopia. Food Policy 20:279.
4. Combs, G.F., Jr., R.M. Welch, J.M. Duxbury, N.T. Uphoff and M.C. Nesheim (eds.). 1996. Food-Based Approaches to Preventing Micronutrient Malnutrition: an International Research Agenda, Cornell International Institute for Food, Agriculture and Development, Ithaca, New York, 68 pp.
5. Graham, R.D. and R.M. Welch. 1996. Breeding for staple food crops with high micro-nutrient density. Working Paper on Agricultural Strategies for Micronutrients, No. 3. Internat. Food Policy Res. Inst., Washington, D.C. 12 pp
1. Health is used to connote a state of physical, mental and emotional well-being . . . not merely freedom from disease or the absence of any ailment.
2. Malnutrition can, therefore, be viewed as both an outcome and a cause of under-development.
3. This approach contrasts with the sectoral analysis which, focusing on limited sets of independent variables to achieve desired outcomes, make the simplifying assumption (at the expense of realism) that effects depend on changes in a single variable with all other variables remaining the same.