Healthy public food procurement and service policies

The State of Food Security and Nutrition in the World 2022 report reveals the heavy global burden of hunger and malnutrition in all its forms. The lingering effects of the COVID-19 pandemic — along with disruption to the food supply caused by intensified conflict and extreme climate events — continue to impede progress towards achieving the Sustainable Development Goals (SDG) targets. Globally, more than 3 billion people cannot afford a healthy diet. Unhealthy diets cause millions of deaths per year through, for example, inadequate consumption of whole grains, legumes, vegetables and fruit, and high consumption of sodium/salt, sugars and harmful fats¹.

A key message of the report is that current government support to the food and agricultural sectors is often not aligned with the promotion of healthy diets. This report shows how re-aligning food and agriculture policies can increase access to nutritious foods and make food systems more healthy, equitable and sustainable. Existing public budgets need to be allocated in different ways, to stimulate production of more nutritious foods, increase their availability and reduce their costs so that healthy diets can be affordable. At the same time, other food system policies need to complement these efforts to increase their impact by creating incentives and supportive environments for healthy diets.

WHO supports countries' efforts to improve food systems with a package of priority action including taxing unhealthy foods and subsidising healthy options, protecting children from harmful marketing, ensuring clear nutrition labels, reducing the salt, sugars and harmful fats in processed foods, fortifying staple foods, improving meals in schools and hospitals, and strengthening national food control systems.

Healthy public food procurement and service policies, for example, have untapped potential. Healthy public food procurement and service policies involve governments setting criteria for food served or sold in public settings or food purchased with government funds. Public settings, such as government offices, schools, childcare facilities, nursing homes, hospitals and all other canteens of public institutions, can play a key role in ensuring people are provided with nutritious, safe and healthy food. Often, meals and snacks in these settings do not align with healthy diet recommendations.

The full potential of healthy public food procurement and service policies is not yet being realized — although 93 countries are implementing food procurement policies in schools, there is little action in other settings². To support countries in these efforts, WHO provides guidance in the Action framework for developing and implementing public food procurement and service policies for a healthy diet.

There are three main ways in which healthy public food procurement and service policies can complement the repurposing agenda:

• Stimulating the supply of nutritious food by creating large-scale predictable demand and making production more economically viable

  The scale of institutional buying and the structured nature of public sector purchasing processes, can create large-scale, predictable demand for nutritious foods, especially perishable foods. Millions of meals and snacks are served or sold in public settings every day, and public procurement is big business. A significant proportion of funds used for government buying — between 12 and 20% of countries' GDP³ — are spent on food and could be redirected towards delivery of healthy diets. This can in turn increase the economic viability of producing such foods, reducing the risk for smallholder farmers and creating an accessible, guaranteed market. Implemented broadly, healthy public procurement policies have the potential to stimulate the production of fruits, vegetables and other nutritious foods. Public food procurement policies can also encourage a shift towards more sustainable food production methods.

  In Brazil, the National School Feeding Programme requires, among other components, 30% of the budget to be used to purchase food from family farms. The predictable and guaranteed market created by the programme has prompted many farmers to shift from producing single crop — such as corn or soy — to more diverse production, including growing more fruits and vegetables⁴, and the availability of fruits and vegetables in school meals has increased⁵.

  In the cities Copenhagen and Vienna, implementation, over the last 20 years, of procurement policies requiring a given percentage of food to be organic has stimulated increased supply of organic fruits, vegetables and other nutritious foods^6,7. Moreover, by specifying sustainability criteria the Municipality of Copenhagen has reduced several negative environmental impacts.

• Shaping eating habits and shifting demand and consumption patterns towards healthier food

  Through their wide reach, healthy food procurement and service policies have enormous potential to shape eating habits and shift demand towards healthier diets.This in turn can stimulate increased production of nutritious foods at lower costs. The policies can be implemented at national, regional or municipal level depending on the division of responsibilities for public procurement.

  In the Philippines, in 2021, the "Quezon City Healthy Public Food Procurement Policy" introduced mandatory nutrition standards for all food and food supplies in city-run hospitals, offices, departments, and institutions. The policy also supports urban agriculture and locaIl sourcing of healthy food and ingredients. By ensuring that healthy meals and snacks are served in the places where people work, live or receive care, the policy can potentially shape eating habits in this city of 2.7 million people.

  In 2017 the government of Singapore introduced a "Whole- of-Government Healthier Catering" policy which requires all Government Procuring Entities to provide employees and members of the public with healthy food and drink choices at government-organised functions and events where catered food is provided. Hospitals are encouraged to join. By requiring, for example, water to be offered as the default beverage use of whole grains, lower-sodium ingredients and healthier oils, the policy can help foster healthy dietary preferences.

• Improving the access of at-risk groups to healthy diets and supporting vulnerable food system actors

  The changes as a result of repurposing of food and agricultural support policies can have unintended consequences. For example, they can lead to short-term livelihood insecurity and loss of income during the transition. Healthy public procurement policies can help mitigate these effects. This can be done by improving the access of at-risk groups to healthy diets, protecting vulnerable food system actors, supporting businesses that meet decent employment criteria and contributing to equity. An expansion of social protection programmes that involve public food procurement — such as school feeding programmes or food assistance — may be needed to protect vulnerable groups during the transition phase. It is important that the foods provided through these forms of social protection contribute to healthy diets.

  In Kenya, for example, repurposing is supported by a policy requiring 30% of public food procurement contracts to be reserved for women-led farms. In Ghana it is required for caterers with government contracts to use at least one-third of the budget to purchase food from smallholders⁸.

  In India, for example, 118 million schoolchildren are covered by a government scheme providing a daily hot cooked meal in schools⁹. In Lebanon, during 2021 one in three people needed assistance to put food on the table in a time of severe economic crisis, and over 300,000 of the most vulnerable received in-kind food assistance¹⁰.

Healthy public food procurement and service policies are part of the WHO promoted package of game changing food systems for health actions. These actions focus on improving the nutritional quality of food along the food supply chain and creating healthier food environments.

1 GBD 2019 Risk Factors Collaborators. Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet, 2020. 396: 1223-49.

4 Valencia V, Wittman H, Blesh J. Structuring markets for resilient farming systems. Agronomy for Sustainable Development. 2019;39(25): 1–14.