Value Chains and Diet Quality: A Review of Impact Pathways and Intervention Strategies
Low and middle-income countries increasingly face a triple burden of malnutrition encompassing undernutrition, micronutrient deficiency, and excessive energy consumption contributing to overweight and obesity. Food systems are also becoming more complex, supported by investments in food processing and retailing. Traditional approaches addressing hunger, typically based on agricultural development, are deemed insufficient alone to address the problem and attention is now being directed to food value chains, although experience is currently limited. To assess the state of science and identify knowledge gaps, an integrative review of the broad topic of value chains and diet quality was undertaken, with particular focus on interventions and their related impact pathways. Interventions were classified according to their primary orientation: to increase the availability, accessibility, or desirability of nutritious food. We identified 24 separate interventions associated with 10 different impact pathways, demonstrating the numerous entry points and large potential for value chain interventions to influence diet quality. However, case study evidence regarding effectiveness remains scant. Most studies addressed individual nutrient-rich commodities that could address a nutritional deficiency in the community of interest. Rarely was overall diet quality assessed, and future studies could benefit from taking a wider perspective of dietary patterns and food substitutions. The value chain analytical approach was deemed valuable due to its consumer orientation that seeks to understand how food products are used and what motivates their choice. The systems perspective is also important as it considers the roles of actors involved in food production, distribution, marketing, and regulation. However, few studies directly engaged with the subject of the local food environment as the bridge connecting food production and food choice. The challenge is to combat the increasing prevalence of processed foods of low nutritional value through interventions that lead to nutritious food becoming more conveniently available, affordable, and desirable.