Now more than ever, it's important to challenge the world's food and beverage manufacturers to address nutrition issues like obesity and undernutrition. Today, we're going to discuss the 2024 Global Access to Nutrition Index, a very important ranking system that evaluates companies on their nutrition related policies, product portfolios, marketing practices, and engagement with stakeholders. The index is an accountability strategy produced by ATNI, the Access to Nutrition Initiative, a global nonprofit foundation seeking to drive market change for nutrition. Our guest today is Greg Garrett, Executive Director of ATNI.

Interview Summary

You know, I very much admire the work you and your colleagues have done on this index. It fills such an important need in the field and I'm eager to dive in and talk a little bit more about it. So, let's start with this. You know, we've all heard of the concept of social determinants of health and more recently, people have begun talking about corporate determinants of health. And your organization really is focused on corporate determinants of nutrition. Let's start with a question that kind of frames all this. What's the role of industry in nutrition, according to the way you're looking at things? And how does the Global Index shine a light on this topic?

Thanks for the question. We're working primarily quite downstream with large manufacturers and retailers. But we hope to affect change across the value chain by working with that group. Of course, when we talk about private sector in food, that's a very, very broad terminology that we're using. It could include farmers on the one hand, looking all the way upstream, all the way through to SMEs, aggregators, processors, manufacturers.

SMEs are what?

Small and medium enterprises, small and medium enterprises, local ones. All the way through to the multinational food and beverage manufacturers. But also catering organizations and restaurants. When we talk about business what we're trying to do is ensure that business cares about portability, and access to safe and nutritious food. And I think we can say pretty safely, based on the data which we'll talk about, that the health aspects of food are still not as, they're not at the forefront like they should be. Yet.

We'll dive in and talk a little bit more about what the index is and what it shows in a minute. But let's start with a kind of broader question. What is the role of diet and consumption of processed foods in influencing health?

Yes, so they say now one in five deaths are related to poor diet. It's arguably now the biggest risk factor related to global morbidity and mortality. We've seen in the last 20 years a slight slowing down of our efforts to combat malnutrition and undernutrition. Whereas we've seen over nutrition, obesity, really taking off. And that's not just in high income countries, but also low- and middle-income countries. So, you know, it might be too little good food and that can lead to at the extreme end of things wasting. It might be too little micronutrients, which can lead to all kinds of micronutrient deficiencies or hidden hunger that leads to many adverse outcomes. Including, for example, cognitive decline or reduced immune system. And then, in terms of diabetes and obesity, we're seeing that really skyrocket. Not only in countries where we have excessive food intake, but also in low- and middle-income countries where they have too much food with a lot of, say, empty calories. Not enough nutrients that are needed. In fact, the recent numbers that we've been working with, it looks like in the last 20 years, obesity rates have gone from about 7.9 percent to 15.9 percent. And by 2030, it might be that 20 percent of global population is considered obese if we don't mitigate that.

Right, and of course that number is many, many times higher in the developed countries. So, you've got a tough job. You talked about the complexity of the food industry going all the way to the farmers, to the big companies, and caterers even, and things. And a lot of different health outcomes are involved. How in the world do you construct an index from all that? Why don't you tell us what the Global Index is, and then some of what you found in the most recent report.

Yes, so the Global Index, we've been running it for 11 years since ATNI was founded. And it has gone through multiple iterations. This latest one was the biggest we've done and we tried to capture about a quarter of the world's market. So, what we did is we took the 30 largest food and beverage manufacturers by revenue. We looked at 52,000 of their products, and that's where we know the market share was about 23 percent global market share. We profiled the foods. We tried to understand their governance structures and how much nutrition features in the way they run their business. We tried to understand, for example, how they market the foods. Are they marketing them responsibly, according to the World Health Organization guidelines? Really dive deep. It's dozens and dozens of indicators where we ask lots of questions of the companies over a 10-month period. And, by doing that, we hope to understand how financially material is nutrition to these companies. We want to give something of use, not only for the companies, but to policymakers. Because we know there's a big role for policymakers to both incentivize the production and the marketing of healthy foods, but also disincentivize unhealthy foods. We want this to be useful for investors. So, we spend a lot of time, through collaborative engagements, working with the shareholders of these companies as well so that they can invest more responsibly in the food company. And then the other group that we hope to eventually work with are the consumer associations. The groups that would represent consumers so that they can put appropriate pressure on the demand side, you know. They can demand healthier food. It's not that we believe by running an index somehow companies are going to start doing everything right. No. We want to provide data and analysis to the sector so that all the stakeholders can use it to help influence change.

That makes perfect sense to have some data driven enterprise to figure out what's actually going on. Otherwise, you're just having to go on intuition. So, what did the most recent index find?

Right, so out of those 30 companies, what did we find? There's some good news. Let's start with the good news before we get into the bad news. There's maybe more bad news than good news. In aggregate, we're actually now seeing that 34 percent of the revenue derived from the products that we profiled, those 52,000 products, is based on healthier sales. Meaning 34 percent could be considered healthier foods. That doesn't sound great, maybe, but consider just 4 years ago when we ran this index, it was at 27%. So, there's some marginal increase and maybe if we can accelerate things, and that's what we're trying to do, it's our big strategic objective. We hope that by 2030, we could say that at least half of business' revenue is coming from healthier food options. There's a lot of changes that need to take place to get to that point, but some companies are doing it.

Also, we noticed a lot more companies are now starting to use a government endorsed nutrient profile model to define the healthiness of the food products, to measure and monitor the healthiness of their food portfolios, and then to disclose that. That's really good. It's the beginning. First step is measure, disclose. The second step would be put targets on that and actually start to get substantive change towards 2030.

But there was a lot of unfortunate news too. We had some backsliding from some of the major companies. For example, low- and middle-income countries actually had the lowest health score. What we think is happening, based on the data we looked at, is that if you're a low-income country, you're getting the lowest healthiness score of these products in your country. So, brand X would be slightly healthier in Europe, but less healthy in the low-income country. So there's a need for regulation there.

Can I stop and ask you a question about that? I've got a million questions just flying out of my head that I'm dying to ask. But what you reminded me of is the history of the tobacco industry. When the policies came into play, like very high taxes and banning smoking in public places in the developed countries, US specifically, the smoking rates went way down. But the companies made more money than ever because they just went outside the US. Especially the developing countries and were selling their products. So, it sounds like the food companies might be engaged in a similar enterprise. But why in these countries would they be pushing their least healthy foods so aggressively?

I'll start with the facts, because there's some speculation here. But the fact is, if you look at your own monitored data, the highest growth of the modern food retailers is in Africa. So, you've got, for example, 80 to 300 percent growth over the last 5 years in Africa of these modern food retail shops. And in Asia, that's, that's already happened. Still happening in some countries. So, you have enormous opportunity for packaged foods, right? Because that's usually what they're selling, these retailers. I think you have some aspiration going on there, too. I think there's consumers who aspire to have convenient foods. They're more affordable now as incomes increase in those settings. Now, regulation is definitely, in general, in those countries, not as mature as it might b...