Systems Thinking and Complexity Science Methods and the Policy Process in Non-communicable Disease Prevention: A Systematic Scoping Review.

BACKGROUND: Given the complex determinants of non-communicable diseases (NCDs), and the dynamic policy landscape, researchers and policymakers are exploring the use of systems thinking and complexity science (STCS) in developing effective policies. The aim of this review is to systematically identify and analyse existing applications of STCS-informed methods in NCD prevention policy. METHODS: Systematic scoping review: We searched academic databases (Medline, Scopus, Web of Science, EMBASE) for all publications indexed by 13 October 2020, screening titles, abstracts and full texts and extracting data according to published guidelines. We summarised key data from each study, mapping applications of methods informed by STCS to policy process domains. We conducted a thematic analysis to identify advantages, limitations, barriers and facilitators to using STCS. RESULTS: 4681 papers were screened and 112 papers were included in this review. The most common policy areas were tobacco control, obesity prevention and physical activity promotion. Methods applied included system dynamics modelling, agent-based modelling and concept mapping. Advantages included supporting evidence-informed decision-making; modelling complex systems and addressing multi-sectoral problems. Limitations included the abstraction of reality by STCS methods, despite aims of encompassing greater complexity. Challenges included resource-intensiveness; lack of stakeholder trust in models; and results that were too complex to be comprehensible to stakeholders. Ensuring stakeholder ownership and presenting findings in a user-friendly way facilitated STCS use. CONCLUSION: This review maps the proliferating applications of STCS methods in NCD prevention policy. STCS methods have the potential to generate tailored and dynamic evidence, adding robustness to evidence-informed policymaking, but must be accessible to policy stakeholders and have strong stakeholder ownership to build consensus and change stakeholder perspectives. Evaluations of whether, and under what circumstances, STCS methods lead to more effective policies compared to conventional methods are lacking, and would enable more targeted and constructive use of these methods.

Promoting insect farming and household consumption through agricultural training and nutrition education in Africa: A study protocol for a multisite cluster-randomized controlled trial.

BACKGROUND: Edible insects are a sustainable source of high-quality animal protein. Insect farming is gaining interest globally, particularly in low-income countries, where it may provide substantial nutritional and economic benefits. To enhance insect farming practices in Africa, new farming systems are being developed. However, knowledge on how to best promote uptake of these systems is lacking. This study aims to fill this gap by investigating the effectiveness of educational interventions in promoting insect farming for household consumption in Africa. METHOD: The study is designed as a multi-site randomized controlled trial to evaluate the impacts of agricultural training alone or in combination with nutrition education on the adoption of insect farming in Ghana, Kenya and Uganda. In each of the three countries, ninety-nine villages are randomly assigned to one of three arms: two intervention arms and a control arm with no interventions. Focusing on production (P), the first intervention arm covers agricultural training on insect farming combined with provision of insect production starter kits. Focusing on both production and consumption (PC), the second intervention arm involves the same intervention components as treatment P plus additional nutrition education. The impacts of the interventions are measured by comparing baseline and endline data collected one year apart. Primary outcomes are adoption of insect farming and consumption of the farmed insects. DISCUSSION: Understanding the drivers and impacts of novel agricultural practices is crucial for transitioning to sustainable food systems. The current project is the first to investigate how educational interventions promote insect farming for household consumption in low-income countries. The results will contribute evidence-based knowledge to support sustainable development through insect farming in Africa. TRIAL REGISTRATION: The protocol is registered in the American Economic Association registry for randomized control trials with registration number AEARCTR-0009996. Initial registration date: 02 September 2022, last updated 17 May 2023.

Consensus-building around the conceptualisation and implementation of sustainable healthy diets: a foundation for policymakers.

BACKGROUND: Healthy and sustainable diets need to be adopted to reduce the negative impact of food consumption on human and planetary health. Food systems account for a third of greenhouse gas emissions. "Dietary Patterns for Health and Sustainability" is a World Health Organization (WHO) project that aims to build consensus among international food, health, and sustainability experts and policymakers on how to conceptualise healthy and sustainable diets and on the actions and policies that could be implemented in the WHO European Region to promote these diets. METHODS: A qualitative study among European food, health, and sustainability experts and policymakers to elicit their views on multiple dimensions of food sustainability and health was carried out using a three-phase process, including semi-structured interviews, a Nominal Group Technique, and focus groups during a participatory WHO workshop held in Copenhagen. Thematic analysis was used to analyse the three data sources. RESULTS: The workshop resulted in a shared understanding of the interconnected components of sustainable healthy eating habits. As a result of this understanding, a variety of potential solutions were identified, including actions across different policy domains, tools, strategic guidelines, needs, and pathways for sustainable healthy diets. The pathways included the need for a multi-stakeholder approach, as well as the simultaneous execution of an aligned and coherent mix of policies at the local and national levels. CONCLUSIONS: The prioritised actions should be aimed at helping government policymakers promote sustainable healthy diets and make decisions on improving dietary patterns for citizens' health and wellbeing in line with the United Nations Sustainable Development Goals in the European Region.

A systematic scoping review of the sustainability of vertical farming, plant-based alternatives, food delivery services and blockchain in food systems.

Food system technologies (FSTs) are being developed to accelerate the transformation towards sustainable food systems. Here we conducted a systematic scoping review that accounts for multiple dimensions of sustainability to describe the extent, range and nature of peer-reviewed literature that assesses the sustainability performance of four FSTs: plant-based alternatives, vertical farming, food deliveries and blockchain technology. Included literature had a dominant focus on environmental sustainability and less on public health and socio-economic sustainability. Gaps in the literature include empirical assessments on the sustainability of blockchain technology, plant-based seafood alternatives, public health consequences of food deliveries and socio-economic consequences of vertical farming. The development of a holistic sustainability assessment framework that demonstrates the impact of deploying FSTs is needed to guide investments in and the development of sustainable food innovation.

Sustainable food profiling models to inform the development of food labels that account for nutrition and the environment: a systematic review.

Sustainable food profiling models (SFPMs) are the scientific basis for the labelling of food products according to their environmental and nutritional impact, allowing consumers to make informed choices. We identified ten SFPMs that score individual foods according to at least two environmental indicators, with the most common being greenhouse gas emissions (n=10) and water use (n=8). Six models additionally assessed the nutritional quality of foods and presented different methods to combine nutritional and environmental indicators. Key advantages of identified models include a wide range in system boundaries, reference units, approaches for defining cutoff values, design proposals for food labelling schemes, and the comprehensive geographical scope of the lifecycle inventory databases used in the development phase of the model. Key disadvantages of identified models include inconsistent methods for food classification and poor replicability due to unclear methods, unavailable code for environmental and nutritional impact calculation, and unclear cutoff values. We found that few SFPMs to date account for at least two environmental impact factors, and even fewer include nutritional values or other dimensions of sustainability. This systematic review highlights the need to use consistent components and to develop national and international reference values for the classification of sustainable food to enable standardised food labelling.

Intake and adequacy of the vegan diet. A systematic review of the evidence.

BACKGROUND: Vegan diets, where animal- and all their by-products are excluded from the diet, have gained popularity, especially in the last decade. However, the evaluation of this type of diet has not been well addressed in the scientific literature. This study aimed to investigate the adequacy of vegan diets in European populations and of their macro- and micronutrient intakes compared to World Health Organization recommendations. METHODS: A systematic search in PubMed, Web of Science, IBSS, Cochrane library and Google Scholar was conducted and 48 studies (12 cohorts and 36 cross-sectional) were included. RESULTS: Regarding macronutrients, vegan diets are lower in protein intake compared with all other diet types. Veganism is also associated with low intake of vitamins B2, Niacin (B3), B12, D, iodine, zinc, calcium, potassium, selenium. Vitamin B12 intake among vegans is significantly lower (0.24-0.49 µg, recommendations are 2.4 µg) and calcium intake in the majority of vegans was below recommendations (750 mg/d). No significant differences in fat intake were observed. Vegan diets are not related to deficiencies in vitamins A, B1, Β6, C, E, iron, phosphorus, magnesium, copper and folate and have a low glycemic load. CONCLUSIONS: Following a vegan diet may result in deficiencies in micronutrients (vitamin B12, zinc, calcium and selenium) which should not be disregarded. However, low micro- and macronutrient intakes are not always associated with health impairments. Individuals who consume a vegan diet should be aware of the risk of potential dietary deficiencies.

Disrupted food systems in the WHO European region - a threat or opportunity for healthy and sustainable food and nutrition?

Dietary health and sustainability are inextricably linked. Food systems that are not sustainable often fail to provide the amount or types of food needed to ensure population health. The ongoing pandemic threatens to exacerbate malnutrition, and noncommunicable diseases (NCDs). This paper discusses threats and opportunities for food environments and health status across the WHO European Region in the current context . These opportunities and threats are focused around four key areas: NCDs and health systems; dietary behaviour; food insecurity and vulnerable groups; and food supply mechanisms. Food systems were already under great stress. Now with the pandemic, the challenges to food systems in the WHO European Region have been exacerbated, demanding from all levels of government swift adaptations to manage healthiness, availability, accessibility and affordability of food. Cities and governments in the Region should capitalize on this unique opportunity to 'build back better' and make bold and lasting changes to the food system and consequently to the health and wellbeing of people and sustainability of the planet.

Life cycle assessment of edible insects for food protein: a review.

Compared to their vertebrate counterparts in traditional husbandry, insects are extremely efficient at converting organic matter into animal protein and dietary energy. For this reason, insects for food and feed show great potential as an environmentally friendly choice in future food systems. However, to obtain a true assessment of this, more information is needed about the production systems. Currently, only six studies applying the life cycle assessment (LCA) method to insect production systems have been published. The studies are heterogenous and thus difficult to compare. The aim of this paper was to establish a versatile reference framework that would allow for the selection of standardized settings for LCA applications in insect production systems, taking both the peculiarity of each system and the latest developments in food LCA into account. It is recommended that future LCAs of insect production systems take the following into account: (1) clear definition of the insect species and life stages included in the LCA, (2) use of at least two of the following types of functional units: nutritional, mass, or economic-based, (3) collection of empirical data in situ (e.g., on farms/production sites), (4) comparative analysis where production systems produce products that are realistic alternatives to the insect species under investigation, (5) inclusion of additional or previously unconsidered unit processes, such as processing and storage and waste management, and (6) use of a wide range of impact categories, especially climate change, resource consumption, nutrient enrichment potential, acidification potential, and impacts on land and water consumption in order to allow for comparison between studies.