Next Generation Delegation 2016 Commentary Series
 
By Kara Bresnahan, MPH candidate, University of California, Berkeley, 2016 Next Generation Delegate
 
The rapid growth of cities and accompanying demand for food in low- and middle-income countries in Africa, Asia, and Latin America necessitates development and expansion of food supply chains. This increasing demand for food in urban areas creates both opportunities and challenges to promoting food security and health in a manner that is equitable across socioeconomic strata and geographic regions. While undernutrition and micronutrient deficiencies are classic health concerns related to food insecurity in developing countries, overnutrition also becomes concerning with market deregulation and increased availability of processed foods. In order to prevent malnutrition and promote optimal nutritional status across the board, public-private partnerships are paramount to ensuring that the health of vulnerable populations is considered as an important outcome of improved food systems.
 
The rural poor comprise the majority of smallholder farmers in low- and middle-income countries. Due to lack of infrastructure, agricultural knowledge, and access to technologies, rural poor populations tend to consume a high portion of their diet as nutrient-poor, starchy staple food; are more likely to experience food insecurity; and are disproportionately missed by nutrition programs. Seasonal poverty, which corresponds to the dry season, and distance from urban areas can further exacerbate food insecurity.  Chronic inadequate dietary intake produces undernutrition and micronutrient deficiencies among the rural poor.  These forms of malnutrition are linked to deficits in developmental outcomes and increased morbidity and mortality among children, which limit educational attainment, wage earning capacity, and productivity across the life course. 
 
Public-private partnership is important to ensure that smallholder farmers are included in the growth of food systems. The public sector must advocate on behalf of smallholder farmers as food supply chains evolve, such that they may be mobilized out of poverty through economic opportunity and increased food security. Additionally, public sector involvement is paramount to private sector investment in growing food systems through expansion of infrastructure and implementation of supportive policies. The transformation of supply chains can ensure food security across urban and rural regions through rural job creation, increased agricultural outputs, and enhanced processing and transport methods.              
      
As urban populations grow, new technologies are introduced, and policies are implemented to promote international trade, the amount of hyper-processed and fast food options can increase. According to the World Health Organization, market deregulation is associated with higher fast food consumption and greater prevalence of overweight and obesity.  This phenomenon, in which an urban population shifts from a traditional diet to a more Westernized one, is known as the nutrition transition. The urban poor are particularly vulnerable to the nutrition transition because they are more likely to experience hunger and are often reliant on inexpensive hyper-processed foods that contain high amounts of saturated fat, sugar, and salt.  Again, public-private partnership is necessary to ensure that food systems are developed in a manner that promotes health among urban populations.  In order to mitigate the risk of overnutrition and its associated burden of noncommunicable disease, these partnerships must promote availability of nutritious foods across socioeconomic strata and agree upon a level of market deregulation that strengthens growing food systems while limiting production of hyper-processed foods.
 
In conclusion, urbanization and the growth of food systems in low- and middle-income countries present opportunities to promote optimal health among both rural and urban populations. In order to promote optimal health, public-private partnership is necessary to ensure vulnerable populations, such as smallholder farmers and the urban poor, are included in the creation of an improved food supply and benefit from secure access to nutritious foods.