Nutrition Policy

Johanna T Dwyer, National Institutes of Health, Bethesda, MD, USA; School of Medicine and Friedman School of Nutrition Science
and Policy, Boston, MA, USA; and Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
Ó 2016 Elsevier Inc. All rights reserved.

What is Nutrition Policy? 2

Nutrition Policy 2
Goals of Nutrition Policy 2
Who Makes Nutrition Policy? 3
Legislative and Judicial Branch Officials 3
Executive Branch Officials 3
Civil Society 3
How Is Nutrition Policy Made? 3
What Influences Nutrition Policy? 3
Nutrition Policy Implementation 4
Nutritional Risk Assessment 4
1. What Is the Nutrition-Related Problem and How Severe Is It? 4
2. Who Is at Risk? 4
3. Where Is the Problem? 4
4. When Does the Problem Occur? 4
5. Why Does the Problem Occur? 4
Risk Management 5
6. What Can Be Done about the Problem? 5
7. What Should Be Done about the Nutrition Problem, and to What End? 5
8. Who Should Implement the Policy, and How Much Will It Cost? 5
Decide What the Policy Will Be 5
9. Who Makes the Final Decision? 5
Implement the Nutrition Policy 6
10. How Is It Best to Translate the Policy into Action Programs? 6
11. How Is It Best to Implement the Policy? 6
Monitor and Evaluate 6
12. How Does One Know that the Intervention Is Working? 6
13. What Needs to Be Retrofitted or Changed after the Program Has Been Implemented? 6
14. How Can Program Aspects That Need to Be Changed Be Revised? 6
Theory versus Reality 7
Actors Who Make Nutrition Policy a Reality 7
Legislators 7
Lawyers 7
Economists 7
Public Health, Medical, and Other Health Professionals 7
Food and Nutrition Scientists, Food Technologists, and Agricultural Scientists 7
Core Skill Sets 7
Awareness of Larger Issues 7
Examples of International Institutions Making Nutrition Policies 8
World Health Organization 8
Food and Agricultural Organization of the United Nations 8
United Nations Standing Committee on Nutrition 8
The Future 8
Conclusions 8
References 9
Further Readings 9
Relevant Websites 9

Reference Module in Food Sciences http://dx.doi.org/10.1016/B978-0-08-100596-5.03326-6 1

2 Nutrition Policy

Glossary
Food policy A policy, which does not necessarily explicitly Food safety Assurance that food will not cause harm to the
incorporate public health concerns. consumer when it is prepared and/or eaten according to its
Food and nutrition policy An umbrella term used to intended use.
incorporate public health concerns into food policy, in Food security The elements include:
order to lead to more concert intersect oral action.
l All people at all times have both physical and economic
Food and nutrition action plan A plan which shows how
access to enough food for an active, healthy life.
to develop and implement food and nutrition policy.
l The ways and means by which food is produced and
Food and nutrition council (or equivalent mechanism) A
distributed are respectful of the natural processes of the
national mechanism which oversees the development, earth and are thus sustainable.
implementation, and evaluation of national action plans l Both the consumption and production of food are
through an intersectoral approach.
grounded in and governed by social values that are just
Food control A mandatory regulatory activity of and equitable, as well as moral and ethical.
enforcement by national or local authorities to provide l The ability to acquire food is assured.
consumer protection and ensure that all foods during l The food itself is nutritionally adequate and personally
production, handling, storage, processing, and and culturally acceptable.
distribution are safe, wholesome, and fit for human l The food is obtained in a manner that upholds human
consumption; conform to quality and safety dignity.
requirements; and are honestly and accurately labeled as Source: Definitions Used by WHO European Region
prescribed by law. Relating to Nutrition Policy (WHO, 2001).

What is Nutrition Policy?

Nutrition Policy
Nutrition policy is a statement by an authoritative body (usually the government) of its intent to act in order to maintain or alter the
food supply, nutritional status, or some other indicator in society. It is distinct from ‘food policy’ since food policy does not explic-
itly incorporate public health concerns. Another term, ‘food and nutrition policy’ is an umbrella term that incorporates both public
health concerns and intersectoral action with food policy. Food and nutrition policy should be discussed together because the
effects of nutrition policy depend to such a great extent on food consumption. Nutrition politics are activities by individuals or
groups that involve the governance of a city, state, or country that involve nutrition. Nutrition policy and politics are inextricably
bound to each other in most settings, especially when governmental institutions are involved. Therefore politics and the roles that
governmental institutions play must also be considered.

Goals of Nutrition Policy

The goal of nutrition policy is to have a safe, wholesome, nutritious, culturally appropriate food supply that is economically acces-
sible and available in adequate amounts to promote health, prevent dietary deficiency, and reduce other diet-related diseases.
Nutrition policy always involves a focus on nutritional adequacy and food safety. (The impact of food and nutrition on the
public health is also a legitimate policy concern that must be considered.) The goals are increasingly being broadened to bring
in and address many other concepts, including goals that the food supply must be sustainable, enjoyable, inexpensive, organic,
locally produced, acceptable to different cultural groups, ‘unprocessed,’ ‘organic,’ and the like. Countries focus on these prior-
ities to varying degrees. They are often reflected in food-based dietary guidelines and other nutrition policies (Dwyer et al.,
2013).
Nutrition policy goals also vary from region to region. They largely depend on what the most pressing problems seem to be. For
example, the World Health Organization (WHO) European Regional Office’s food and nutrition policy goals were food safety,
nutrition, and food security, attained through a sustainable food supply. The rationale was that growing, buying, and eating appro-
priate diets could reduce the risk of disease and simultaneously promote a sustainable environment. The policy also stated that
a sustainable environment should ensure a renewable food supply with enough food of good quality for all, while helping to stim-
ulate rural economies and promote social cohesion within rural societies (WHO, 2001).
In contrast, to improve maternal and child health in the entire world, the Sixty-fifth World Health Assembly of the WHO
declared that six global nutrition targets to be achieved by 2025; increasing breastfeeding and decreasing stunting, wasting, anemia,
child overweight, low birthweight (WHO, 2014). Food and nutrition policies in different countries actually focus on these priority
areas to varying degrees since the WHO targets are recommendatory, and not mandatory.
 Nutrition Policy 3

Who Makes Nutrition Policy?

Nutrition policy involves many different institutions, actors, and goals. However, government is usually regarded as the chief initi-
ator and driver of explicit regulatory or administrative policies and related actions that are authorized by specific supporting legis-
lation to address a food and nutrition problem. Implementation of the policy relies on a set of concerted actions, usually based on
a governmental mandate, that are intended to ensure good health in the population by providing informed access to safe, healthy,
and adequate food (Bender, 2005).

Legislative and Judicial Branch Officials

The legislative branch of government makes the laws. At this level, the actors involved in nutrition-related legislation include poli-
ticians, their staffs, and pressures from the general public and special interests, represented by lobbyists. The courts and judicial offi-
cials determine if the laws are legal.

Executive Branch Officials

Once the laws are made and their legality is established, civil servants in the executive branch must put the laws into action by prom-
ulgating regulations, supervising programs, and disbursing funds. The executive agencies involved vary because nutrition’s dimen-
sions cut across so many levels of government, as a recent ‘roadmap’ of nutrition programs at the federal level in the US illustrates
(Interagency Committee on Nutrition Research, 2016). In the United States, cabinet level departments including the US Department
of Agriculture and the US Department of Health and Human Services usually take the lead in food and nutritional policy making.
The Departments of Defense, Education, Commerce, and others are also involved, depending on the problem.

Civil Society
Nutrition policy is also influenced by the constituencies who are particularly affected by the policies such as industry, nonprofit,
professional associations, and other private and voluntary groups. Second are those in the larger society that are affected less
directly, such as the general public.

How Is Nutrition Policy Made?

Since food and nutrition policies so often involve government action, like other public policies, many conditions are required for
their effective implementation. The enabling legislation or other legal directives mandating the nutrition policy must have clear,
consistent objectives so that there are substantive criteria for resolving goal conflicts between involved parties. For this to happen,
the policy must incorporate a sound theory that identifies the principal factors and causal links affecting policy objectives. This
provides officials who must implement it with adequate jurisdiction or leverage over target groups to make achievement of the goals
possible. The policy must also structure implementation to maximize the likelihood that those who are supposed to implement the
measures involved will do so. It is also vital that the leaders who must implement the nutritional measures have managerial and
political skill and be committed to achieving the policy goals. There must also be an organized constituency that supports the
program, including key legislators or chief executives, and a neutral or supportive judicial system. Finally, the priority of the objec-
tives and the causal theory connecting the policy with the desired effects cannot be undermined by conflicting public policies,
changes in socioeconomic conditions, or weakening political support (Mazmanian and Sabatier, 1987).

What Influences Nutrition Policy?

Nutrition policy making is not a straightforward process. Policy goals are accomplished through politics; activities by individuals or
groups that involve the governance of a state or country. Politics is always involved in policy making, but it is perhaps most evident
at the legislative level. In the United States, Western Europe, and many other highly industrialized countries, nutrition politics
involves the interplay between the laws resulting from the deliberations of legislatures, the judgments of the legality of laws by
the judicial branch, the executive branch’s interpretation and implementation of laws in regulations and programs, and the efforts
of affected constituencies to influence these processes. Nutrition politics often involves lobbying actions of individuals representing
the interests of various groups (nonprofits, industry, etc.) who attempt to influence government decision-making. Lobbying is legal
and based on the right of citizens to petition their government. In many countries, lobbyists must register and declare themselves as
representing special interests so that their motivations are transparent. Lobbying techniques include providing information and
expertise to those making or implementing a policy or program. Lobbyists also build support by organizing coalitions or cooper-
ative efforts of mutual support for each other’s objectives. They are also skilled at developing grass roots support for an action
among constituents to exert pressure on legislators or civil servants involved in making policy. Also, they often represent clients
who provide cash or in-kind support to political campaigns.
Nutrition policy involves many different disciplines both in its formulation and execution. The views of many different stake-
holders must therefore be taken into account. A sufficient scientific evidence base and the political basis for a policy must be estab-
lished. The factors that influence decision-making and nutrition policy making include the interpretation of science including
scientific facts, risk assessment, and risk management options. However, they also include economics, cost–benefit analysis,
comparative effectiveness analyses of different options, the likely influences of the policy on the public, industry, environmental
4 Nutrition Policy

groups, on political bodies and laws, and other uncertainties. The decision must finally be transformed into action after taking all of
these factors into account (Matanoski, 2001).
Scientific evidence is only one of multiple factors to be considered in nutrition policy (Liberati et al., 2009). Scientists serve
a useful role as advisors to government decision-makers, but they rarely are the final arbiters of what happens. In part this is becau-
se they often have limitations in understanding that the roles of factors other than scientific considerations are necessary elements in
policy making.

Nutrition Policy Implementation

Once the laws are made, and their legality is established, civil servants must put the laws into action by promulgating regulations,
supervising programs, and disbursing funds. Ideally those who implement the nutrition policy directives should follow the rational
processes described below.

Nutritional Risk Assessment

Steps 1–5 below involve assessing the problem, a process sometimes called ‘risk assessment.’ Risk assessment describes the relation-
ship between the consumption (e.g., the dietary exposure to) of a nutrient, food, food constituent, food, or group of foods by the
population and its associations with risk factors (e.g., blood pressures, serum cholesterol) or some health outcome (dietary defi-
ciency disease, chronic disease, or death). For nutrition and food scientists, standards judging how strong these associations are
rely not only on ‘eminence-based’ opinions of experts but also increasingly on ‘evidence-based’ systems for risk assessment.
They examine the totality of the evidence, taking into account the strength of the cause and effect relationship (causal inference)
and bias. Tools used included evidence-based reviews, and, if appropriate, meta-analyses to summarize the data. Estimates of
the probability of the resulting effect are stated in statistical terms, with limits for making false-negative and false-positive conclu-
sions. Both observational and randomized trial evidence are used. The strength and totality of the evidence must be carefully
analyzed. These new advances in risk assessment have done much to improve the quality of risk assessment and the evidence avail-
able to policy makers (Liberati et al., 2009). However, they still involve myriad assumptions, and it is important that the evidence be
carefully weighed and interpreted.

1. What Is the Nutrition-Related Problem and How Severe Is It?

This describes the nutrition problem and its severity, who is afflicted or ‘at risk’ and their characteristics, where the problem exists
why and when it occurs. The problem may involve the diet and nutritional status of individuals in a special group or entire pop-
ulations. For example, in the United States during the early twentieth century, many poor pregnant teenagers suffered from severe
iron deficiency anemia.

2. Who Is at Risk?
The group at risk of nutrition problems may be based on biology, socioeconomic status, occupation, or some other characteristic.
Some groups such as young infants, children, teenagers, pregnant, and lactating women, and those who are ill and frail have high
nutritional requirements and may be especially vulnerable to malnutrition. In order to find these individuals, a representative
sample of the entire population is often used; this is called a ‘population-based’ survey. A second method is to focus on lists of
people within the population who are suspected to be at high risk of nutrition problems, such as patients suffering from HIV-
AIDS, and then to identify clinics or other sites where they are likely to be found in large numbers. This is called ‘list-based
sampling.’ For example, severe iron deficiency anemia was particularly prevalent in poor teenaged pregnant girls in the rural
south of the United States who lacked access to obstetric care, had diets poor in iron, and were infected with hookworm, which
causes blood loss.

3. Where Is the Problem?

Geographic distribution may be important. For example, in the early twentieth century in the United States, iodine deficiency
disease and endemic goiter were common in a region from the Great Lakes to the Rocky Mountains called the ‘goiter belt,’ but
it was rare elsewhere in the country.

4. When Does the Problem Occur?

Some nutrition problems occur only at certain times, such as during a famine, or when seasonal variations affect the food supply. It
may also be linked to events, such as the monthly timing of pension or food benefits, before which those with limited incomes may
lack money to buy food.

5. Why Does the Problem Occur?

Diet-related diseases may be due to too little food, lack of a single or several nutrients (such as iodine, vitamin D, iron or folic acid),
excessive intakes of nutrients (such as excess calories, sodium, saturated fat, sugars, or alcohol), toxicities (such as excessive alcohol
intake, contaminants, or intake of foodborne pathogens causing illness), and diet-related diseases (such as type 2 diabetes) or other
 Nutrition Policy 5

conditions that affect the individual’s abilities to utilize the food. In the United States, the reference standards used for evaluating
these risks include dietary reference intakes for nutrients, the Dietary Guidelines for Americans for constituents, foods, food groups,
and dietary patterns, and clinical reference values for other risk factors (Otten et al., 2006, US Department of Health and Human
Services and US Department of Agriculture, 2016). Each country uses different but generally similar standards for nutrients and clin-
ical values.

Risk Management
Steps 6–9 below involve managing the risks or problems that have been identified. Ideally risk assessment should be separated from
risk management since the skills required differ. Risk assessors describe and quantify risk. Risk managers decide what should be
done about the potential risk and what the policy options are for doing it. Separation of the two processes lessens the tendency
of either or both parties to over or underestimate risk, or to insist on a certain set of solutions without considering larger issues.
The risk managers consider the scientific evidence from the risk assessment and also economic and other considerations.

6. What Can Be Done about the Problem?

This involves assessment of capabilities and resources for managing the nutrition problem. For example, countries differ in their
approaches to dealing with low folate levels in women of childbearing age. It is possible to increase intakes of a vitamin such as
folate by nutrition education, fortifying a staple food in the food supply, by providing vitamin supplements, or a combination
of these measures. In highly industrialized countries where population-based surveys of dietary intake and health status of the pop-
ulation are available, computer modeling is often done to simulate the effects of various interventions on likely dietary intakes or
health outcomes. This was done, for example, in testing the effects of adding various levels of folic acid to the US food supply on the
prevalence of dietary deficiency in the vitamin. For more complex nutrition problems, such as poverty-related malnutrition, things
may not be so easy or obvious since nutrition may be only a small part of the solution. What science and technology are best
prepared to offer may not be what the target population needs the most.

7. What Should Be Done about the Nutrition Problem, and to What End?
What should be done depends on the problem. For example, although many peoples’ intakes fall below current recommendations
for magnesium, it is not clear at this time that increasing magnesium intake will have major beneficial health outcomes. In this
instance the best option may be inaction. It is often important to ask whose problem is being solved and for what purpose, and
there are always trade-offs. For example, a regulation requiring the stocking of organically grown, locally produced food in govern-
ment cafeterias provides benefits to producers of these products, but it decreases the market for other producers and may also
increase food costs to eaters.

8. Who Should Implement the Policy, and How Much Will It Cost?
Some person, agency, or group must be commissioned to carry out the policy and the program resulting from it. The human and
other resources needed and costs entailed must be calculated and paid for. These costs must be weighed against competing uses of
these same resources for other nutrition policies and programs.

Decide What the Policy Will Be

9. Who Makes the Final Decision?
Risk assessors and risk managers rarely make the final decisions on major nutrition issues. In fact, for the most complex controver-
sial and consequential problems, scientists and technologists are rarely, if ever, the key or only decision-makers because the impli-
cations are so widespread in society. Usually it is higher government officials or government appointees at the political level who
render the final judgments after reviewing the options, since the political process is needed to go forward. The issues that are taken
into include value judgments about goals, priorities, and the likelihood of success. Before putting policy into action to deal with
a nutrition problem, it is important to clarify why action is desirable, what should be done, and what evidence is available to justify
the action. Also needing consideration is how much the intervention will cost, who decides that the action is worthwhile, who bene-
fits, how it will be implemented, and how it will be monitored, assessed, and ultimately valued.
Finally nutritional issues often need to be placed into a larger context and weighed accordingly. In regulatory law, freedom of
commercial speech may trump health officials’ views abut whether a marketer’s health claim that a botanical dietary supplement
inhibits memory loss in older adults even though the scientific evidence is very weak that it does so.
The ultimate decision sometimes rests not purely on science but on other factors such as influential views of industry, consumer
advocates, the media, activists claiming to act in the interest of consumers, not-for-profit institutions, religious groups, and many
others. For example, an amendment to the US Constitution, later repealed, prohibited the sale of alcoholic beverages in the United
States early in the twentieth century. It was based only in part on evidence that alcohol was associated with adverse health effects
particularly in individuals who overindulged or who were unable to metabolize it efficiently. Rather it was consumer activists and
religious groups who had a far more decisive role in bringing prohibition about (Okrent, 2010). To take another example, even
when the scientific evidence is very strong, as it is for fluoridation of water to prevent dental caries, other political factors may
triumph to prevent implementation of such a policy. In some areas in the United States and in England, opposition to government
6 Nutrition Policy

requiring fluoridation of water has run afoul of groups who believe that fluoride is tantamount to rat poison and that it is morally
wrong to inhibit the freedom of the individual to choose the water he/she drinks. For example, the state of New Jersey in the United
States and several parts of England lack fluoridated water as a result of such views.

Implement the Nutrition Policy

Finally the time comes to implement the policy and translate it into program (steps 10 and 11).

10. How Is It Best to Translate the Policy into Action Programs?

Ideally the program is tested and piloted to overcome problems in interpretation and implementation and only then scaled up and
final regulations specified. For example, in the United States, new regulations for school meals programs may have benefited from
pilot studies to iron out difficulties before scaling up to a countrywide final rule for the program. Politically acceptable interventions
are only as good as the processes that define the problems and solutions. Open and inclusive (often referred to as ‘transparent’)
processes produce agendas that are more likely to be acceptable to the majority of stakeholders and citizens than closed-door
(or ‘nontransparent’) decision-making processes since the latter often put into the foreground the interests of the few and may
be regarded as unfair (Jasenoff, 2003).

11. How Is It Best to Implement the Policy?

This is difficult because opinions vary on what is best, how strong the scientific evidence is for the intervention, and what other
factors to take into account. The same scientific evidence is often interpreted variously by different policy makers. For example,
consider the problem of preventing neural tube defects. Increasing folic acid intakes of those who are deficient can lessen them.
The United States and Canada implemented the policy of fortifying wheat flour with folic acid in the mid 1990s, and in the nearly
two decades since then the prevalence of neural tube defects has fallen dramatically (by more than 50%), folic acid deficiency
anemia has decreased and few adverse effects have been noted (Ahrens et al., 2011). At present North American authorities see
the benefits as outweighing the risks, but folic acid fortification is not regarded as positively in Europe, even though scientists
and policy makers in all of these countries have access to the same scientific evidence. There, in contrast to North America, a folic
acid fortification policy is very controversial and is still being hotly debated; there is more fear of possible harm, and the precau-
tionary principle of avoiding potential adverse effects is invoked. For example, concerns are raised about the possibility of overlook-
ing clinical vitamin B12 deficiency, especially when doses are very high (above 1 mg/day), and the need for more definitive research
on folic acid fortification’s effects on some cancers (colon, prostate, and breast), on the thyroid and diabetes, cognition, and hyper-
sensitivity. European countries have chosen a different policy, advocating the use of folic acid containing dietary supplements.
However, supplementation had been tried and failed in the United States before fortification was adopted, and recent evidence
suggests that it has not succeeded in Europe either (Khoshnood et al., 2015). It remains to be seen what the European Union
will do to remedy the deficiency problem in the future (Mills and Dimopoulos, 2015).

Monitor and Evaluate

Lastly comes monitoring and evaluation of the program in the field (steps 12–14).

12. How Does One Know that the Intervention Is Working?

Often it is simply assumed that the attack or approach to the problem will work ‘because it is the right thing to do’ and that the
program will be carried out as planned. In reality, little evidence exists that this is the way things usually work out. Monitoring
and evaluation must be put into place prior to implementation to assess what is actually occurring. It is difficult to determine
what has gone on after the fact if the original implementation plan lacks built-in monitoring. Implementation and evaluation
are now research fields in their own rights, and experts in these areas should be involved. An evaluation of monitoring results
will reveal if the policy and program need to be refined and reintroduced or abandoned.

13. What Needs to Be Retrofitted or Changed after the Program Has Been Implemented?
Modifications must be often made. For example, the United States reviews and develops food-based dietary guidelines for Amer-
icans every 5 years (USDHHS and USDA, 2016). A dietary guidelines scientific advisory committee reviews the science and updates
it as necessary. The US Department of Agriculture and the US Department of Health and Human Services then take their recommen-
dations under consideration and issue new guidelines to keep nutrition advice up to date.

14. How Can Program Aspects That Need to Be Changed Be Revised?

Most nutrition programs are not perfect as they are initially implemented. Successful programs make needed changes and go
forward. For example, in the first few years after regulations were implemented that revised the types of foods offered to children
in the National School Lunch and Breakfast programs in the United States, it became obvious that pretesting had not been adequate.
Preparation difficulties with the new foods for lunch and breakfast led to poor acceptability of the meals to students and increased
food waste because acceptability to students was poor. This was finally recognized, and in subsequent years, after training of the
school food service workers, and with modest changes in the program requirements, the program was better accepted.
 Nutrition Policy 7

Theory versus Reality

In actuality, nutrition policy making and implementation rarely follow the linear step-by-step ideal process described above in
either the legislative or executive branches of government. It is a far more messy process; in fact, some have described it as being
less like a shark lunging toward its prey and more like an amoeba oozing slowly forward toward implementation.

Actors Who Make Nutrition Policy a Reality

Legislators
Legislators bring their interpretations of popular opinion to the nutrition policy issue as they decide on whether an action will cause
the desired effect. Politicians use different metrics than scientists. While political give and take are inevitable, if nutrition is regarded
as a human right, then it is not an issue where partisan politics (that is, political relating solely to the agenda of one political party or
another) should not play a dominant role in food and nutrition policy. Once the policy issue becomes entangled in partisan poli-
tics, larger partisan principles or beliefs may be dominant, and not the particulars of the nutritional issue. When this happens, the
politicians’ final decisions on the nutrition policy issue depend less on the scientific evidence and more on larger political issues and
compromises.

Lawyers
Lawyers frequently serve as decision-makers on nutrition policy matters, particularly in legislatures and regulatory agencies. They
rely on rules of evidence that are different, and they also often differ from food and nutrition scientists in their standards for causal
inference. At the same time, lawyers must consider if the course of action is appropriate considering the philosophy and rules of the
governing legal system, and what compromises are needed to develop workable solutions. Some of these factors, such as free
speech, or cost, may compete with scientific evidence of cause and effect as being the only criterion for deciding on taking action.

Economists
Economists are another group who are often active in decision-making involving nutrition policy. Economists examine the costs
and trade-offs involved in a policy using techniques such as cost-effectiveness and cost–benefit analysis. Their techniques also
provide clarity, but not certainty, to analyses because their estimates involve multiple assumptions.

Public Health, Medical, and Other Health Professionals

Since food and nutrition policy affect health so directly on both individual and societal level, these professionals are also intimately
involved in much nutrition policy making. However, medical and public health professionals are not experts on food composition,
consumption, and dietetics. Their views need to be informed and complemented by other health professionals who do possess that
expertise.

Food and Nutrition Scientists, Food Technologists, and Agricultural Scientists

Core Skill Sets
Nutrition scientists, food scientists, agricultural scientists, and other biological and social scientists need particular skills if they are
to be effective nutrition policy experts. It goes without saying that technical knowledge and sills are indispensable. To succeed, it is
necessary to take into account all of the various dimensions and implications of food and nutrition problems and their solutions.
Thus food scientists and technologists, with their intimate knowledge of food and its constituents, as well as of food production and
marketing, are also essential. The knowledge and skills that are necessary include a basic understanding of the sciences involved
(food science, nutrition science, social welfare) and the industries or other organizations (nongovernmental organizations, etc.)
in the society that are involved. An understanding of epidemiology and biostatistics is also critical for assessment of the health status
of populations, delivery of health services, and investigations that are relevant to disease etiology. It is also important to understand
the difference between health promotion and disease prevention, and disease treatment, and individual- versus population-based
interventions.

Awareness of Larger Issues

An awareness of the role of the legislative, executive, and judicial branches of government and how they come into play in the
nutrition issue or program is also essential. Finally the scientist must realize that the notion ‘more nutrition science inevitably
means more progress’ is a myth. Science and technology do not necessarily hold the sole or complete solutions to obesity,
food and water scarcity, AIDS, and malnutrition. In fact, “. just as more food does not necessarily solve the problem of global
hunger, so too more science cannot be expected to solve the basic problems of economic development” (Jasenoff, 2009). It
8 Nutrition Policy

follows that since they are not able to solve these complex problems single-handedly, scientists and technologists are not the key
or only decision-makers in nutrition policy. Very few scientists or other individuals embody all of the needed qualities. Therefore
many individuals with different types of expertise must all bring their skills to the task at hand. Nutrition policy makers must also
have the ability to recognize unintended consequences often occur – that solutions to one problem may cause others. For
example, while there is good evidence that fortification of wheat flour with folic acid in the United States decreased the prevalence
of neural tube defects, it also might have increased the masking of vitamin B12 deficiency, which may cause irreversible cognitive
problems, particularly in the elderly. Such a possibility must nevertheless be considered, and the population must be monitored
to determine if ill effects are indeed present. Nutrition policy makers must also recognize that the risks and benefits of interven-
tions are not equally shared across the population. And they must recognize that there are many different standards for judging
cause and effect (causal inference), and several usually are involved in making risk management and intervention choices. In
describing the cause–effect relationship, scientists understandably use their own standards for causal inference to describe the
strength of the associations between a food and one of its constituents and a health risk or outcome, but these standards may
not be accepted by other experts or by politicians as the sole basis for an intervention. They base their decisions on broader
or different criteria and priorities.

Examples of International Institutions Making Nutrition Policies

World Health Organization
The World Health Assembly is the WHO’s health policy–setting body. It often issues nutrition policy on global issues, including
global nutrition targets (WHO, 2014). In addition to problems focused largely on developing countries, such as the global nutrition
targets which were largely focused on maternal and child health, WHO has also published many monographs based on expert
consultations on various nutrition topics, such as a recent report on sugars intakes and others on specific nutrients and disease
risk (WHO, 2015). The nutrition division of WHO is located in Geneva, Switzerland.

Food and Agricultural Organization of the United Nations

The Food and Agricultural Organization of the United Nations (FAO) has a long history of work on food and nutrition as well as
agriculture-related problems (FAO, 2015). It collaborates with WHO in holding conferences and producing reports, such as the
recent FAO/WHO second International Conference on Nutrition (FAO, 2015), and the landmark publication of food-based die-
tary guidelines (WHO/FAO, 1996). FAO is currently devoting much of its resources to eradication of hunger and actions to
combat climate change. Its publications also involve many other nutrition issues, including food composition, dietary assess-
ment, sustainability and ecosystems, food waste, nutrition in emergencies, and food systems. It is located in Rome, Italy (see
Relevant Websites).

United Nations Standing Committee on Nutrition

The United Nations Standing Committee on Nutrition (UNSCN) is the harmonizing forum for all of the United Nations efforts
relating to nutrition. It publishes a newsletter summarizing various topics such as nutrition and chronic disease, nutrition and
climate change, and steps to accelerate the reduction of anemia. Its secretariat is now located in Rome, Italy (see Relevant Websites).

The Future

Some possible directions for nutrition policy were summarized in a recent poll of experts in the field. With respect to the science
base issues will include molecular and physiological science underlying nutrition and brain health; the human microbiome: under-
standing the immune system and preventing disease; identifying and mitigating errors in nutritional science; procuring relevant
measures and big data analysis; and exploring the science behind food-related behavior in humans. The food and nutrition policy
implications thought by the expert panel to be most likely were sustainable developmental goals for food and nutrition; authen-
ticity of foods (by geographic origin, type of agricultural production, species and kinds of raw materials, certain processing qualities
such as sustainability or ecological footprints); and the safety of foods. Although the exact issues that will arise cannot be predicted
with certainty, it is obvious from the list that nutrition policy continues to be inextricably intertwined with food policy (Allison
et al., 2015).

Conclusions

The nutrition policy-making process has become more science based over the past century. Progress continues toward integrating
nutrition and food policy, keeping partisan politics to a minimum and being mindful of the undergirding ethical and moral imper-
atives involving human health and happiness. With such a focus, it is to be hoped that ill thought out, illogical, irrational, and scien-
tifically indefensible nutrition policies that are unlikely to be successful will shrink in number over time.
 Nutrition Policy 9

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Further Readings

Fisher, R., Ury, W., Patton, B., 1991. Getting to Yes: Negotiating Agreement without Giving in. Penguin Press, New York.
Friis, R.H., Sellers, T.A., 2015. Epidemiology for Public Health Practice, third ed. Jones and Bartlett, Sudbury, MA.
Jasenoff, L.S., 1990. The Fifth Branch: Science Advisers as Policymakers. Harvard University Press, Cambridge, MA.
Jasenoff, L.S., 2005. Designs on Nature: Science and Democracy in Europe and the United States. Princeton University Press, Princeton, NJ paperback 2007.
Klemm, R., West, K. Food and Nutrition Policy Open Course at: http//www. ocw.jhsph.edu.
Mackerras, D., 2012. Food standards, dietary modeling and public health nutrition policy. Nutr. Diet. 69, 208–212. http://dx.doi.org/10.1111/j.1747-0080.2012.01622.x.
Paarlberg, R., 2013. Food Politics: What Everyone Needs to Know, second ed.r. Oxford University Press, New York.
Panel on Enhancing the Data Infrastruture in Support of Food and Nutrition Programs, Research and Decision Making, 2005. Improving Data to Analyze Food and Nutrition Policies
National Research Council. National Academies Press, Washington, 0-309-63319-3.
Schneider, M.J., 2006. Introduction to Public Health, second ed. Jones and Bartlett, Sudbury MA. ISBN:9780117082847 PDF, 2.39MB, 384 pages.
Shi, L.H., Singh, D.A., 2015. Essentials of the US Health Care System, fourth ed. Jones and Bartlett, Burlington, MA.
Timmer, C.P., Falcon, W.P., Pearson, S.R., 1983. Food Policy Analysis. Johns Hopkins University Press, Baltimore.
Wilde, P., 2013. Food Policy in the US: An Introduction. Routledge, New York. ISBN:13-978-1849714297.

Relevant Websites

http//www.fao.org/nutrition – Food and Agriculture Organization of the United Nations (last accessed 12.10.16.).
http//www.unscn.org – United Nations Standing Committee on Nutrition (last accessed 12.10.16.).