Exploring the intersection of climate/environmental change, food systems, nutrition, and health: global challenge, opportunity, or both?

Changes in our climate and physical environments are having profound effects on all aspects of human existence. With efforts such as the Intergovernmental Panel on Climate Change [1] and the annual UN conference on climate change (known as the UN Conference of the Parties, COP27) [2], the world is slowly coming to recognize the significance of these impacts. An area that has received increasing attention is the intersection of climate/environmental change (CEC) and food systems. Our ability to develop sustainable and resilient food systems is critical not just to the environment but to all aspects of human health. To date, much attention has understandably focused on food supply. However, that focus left an equally important aspect of this intersection relatively unnoticed: the impact of CEC on the intimate and inextricable role of nutrition in all aspects of human health and wellbeing. The biology of nutrition is the glue that connects the food supply and diet to health. Whether it is the ability to withstand the impact of increasing vector-borne diseases and food-borne illnesses or resilience in the face of acute and chronic climate-related stress, our appreciation of the role of nutrition in the complexities of these phenomena demands a more integrated approach. This complexity is exemplified by the intersection of iron biology and malaria, a prominent vector-borne disease impacted by climate. Climate is causing an increase in malaria prevalence [3], as well as complicating an already complex set of issues regarding iron biology, assessment, and intervention choices [[4], [5], [6]]. A new approach must acknowledge the reciprocal nature of the relationships between nutrition and health outcomes, i.e., nutrition both affects and is affected by each of these phenomena. Nutritional status is both an input that affects the susceptibility to disease and the response to treatment and an outcome of disease and treatment. Consequently, a need exists to move beyond a limited view of “malnutrition” as simply a matter of too much or too little food.

Our ability to achieve global nutrition targets, such as those outlined in the WHO 2025 Global Nutrition Targets [7], is an additional challenge that requires the application of an ecological approach because most priority health outcomes are multidimensional [e.g., stunting [8] or anemia [9]]. This ecological approach requires the integration of CEC efforts to improve the precision of clinical diagnosis and disease surveillance, as well as support context-specific interventions. Examples of situations where there is evidence of potential associations between CEC and priority global nutrition targets are presented in the text box.

Impact of climate/environmental change on global nutrition targets.

• •Childhood wasting or stunting [[10], [11], [12]]
• •Reduction of anemia and related conditions [[13], [14], [15]]
• •Adverse pregnancy outcomes or low birth weight [[16], [17], [18], [19], [20]]
• •Reduction in noncommunicable diseases (NCD) [21, 22]
• •Addressing the “hidden hunger” of micronutrient deficiency [[23], [24], [25], [26]]

We suggest a more comprehensive appreciation of “nutrition ecology,” which views humans as complex biological systems interacting with both their internal and external environments. Our ability to improve precision, both clinically and through surveillance, demands an application of this ecological approach and its components [8]; the challenge is how to get there.

Fortunately, we are currently in a milieu that is highly conducive to understanding these complex relationships. In response to the challenges imposed by CEC, numerous US government initiatives have been formed to engage stakeholder communities in the development of evidence-based programs, interventions, and recommendations. These include the Interagency Crosscutting Group on Climate Change and Human Health [27], which has a dedicated work stream focused on food systems and nutrition security that specifically attempts to identify indicators of food safety and nutrition security. Moreover, the US government’s Global Nutrition Coordination Plan 2.0 [28] includes a new technical subgroup entitled “Climate, Health, Agriculture, and Nutrition in Global Ecology .” The goal of these efforts is to coordinate federal work, both domestically and globally, to address the impact of CEC on programs and identify and respond to the role of nutrition in health promotion and disease prevention. These efforts will include not only deliberations and dissemination of information within the US government community but also will engage the domestic and global research enterprise.

To foster new research, several agencies led by the US Department of Agriculture/National Institute of Food and Agriculture [29] have been actively supporting extramural research to address the connections between food systems and CEC. In addition, the NIH Climate Change and Health (CCH) Initiative [30] includes representation from all institutes and centers reflecting the full breadth of interests and activities across the NIH community. Informed by an executive board consisting of directors from multiple NIH institutes, the CCH Initiative provides guidance and direction and sets priorities to address the challenges facing the biomedical research community. The initial efforts of this group have focused on the development of a framework to address many critical components of the external ecology, e.g., structural issues such as health systems and environmental health equity.

The rapidly changing physical environment that confronts our food production system will also shape food choices and the interventions that are possible. A newly launched initiative called “Agriculture and Diet: Value Added for Nutrition, Translation, and Adaptation in Global Ecology: ADVANTAGE,” led by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, is an effort to better understand the intersection of food systems, diet, nutrition, and health in a changing environment by addressing the following core questions:

• •How are the current realities of CEC affecting dietary choices or patterns and relevant aspects of the food system, and what are the implications for specific public health outcomes of interest?
• •How can we apply an ecological approach to assess the nature and impact of these relationships?
• •How can we best translate the evidence generated to support dietary guidance and intervention choices to promote health and prevent disease?

The goal of ADVANTAGE is to determine what we know and what we do not know about these critical issues and, in doing so, develop an implementable research agenda to address these compelling needs.

Only a few federal agencies and initiatives are addressing the important links between health, nutrition, food systems, climate, and the environment. Behind these activities are dedicated program staff who stand ready to support the efforts of investigators to successfully navigate the granting process and meet the opportunities presented by this critical global health challenge.

Funding

Financial support for this study was provided by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) at the United States National Institutes of Health (NIH). The funders of the study also provided financial support for the editing, proofing, and submitting the manuscript but did not have any role in data collection, analysis, and interpretation of the results, drafting of the present manuscript, or decision to publish. The contents of this article represent the authors’ views and do not constitute an official position of the National Institutes of Health, the United States Government, the Editor, or the Editorial Board of The American Journal of Clinical Nutrition.

Author Contribution

We thank Blair Jarvis, Kevin Jarvis, and Andrea Tucker, staff of BioCentric Inc., for their help in editing and formatting the manuscript according to the journal style, as well as assisting with the manuscript submission process.

DJR and AAB: participated in all aspects of manuscript writing, review, and revision. Both authors read and approved the final manuscript.

Conflicts of Interest

The authors report no conflicts of interest.