Diagnosis of Food Systems Worldwide Provides Guidance for Ensuring Healthy Diets and Environmental Sustainability

Food systems worldwide need better governance and accountability to ensure that they deliver healthy diets while safeguarding the environment and natural resources. But decision-makers often lack data about achieving these goals and even where such information does exist, tools are lacking to assess food systems’ performance. A paper published today in PLOS is the first of its kind, drawing on more than 600,000 data points, to develop a methodology for diagnosing food systems’ performance to help inform food systems governance and accountability around the globe.

“This paper presents a diagnostic methodology for 39 indicators representing food supply, food environments, nutrition outcomes, and environmental outcomes to assess performance of national food systems,” said co-author Jessica Fanzo, Bloomberg Distinguished Professor of Global Food Policy and Ethics at the Johns Hopkins Berman Institute of Bioethics. “This information can be used to generate actions and decisions on where and how to intervene in food systems to improve human and planetary health.”

Food systems include the people, places, and methods involved in producing, storing, processing and packaging, transporting, and consuming food. They can consist of either long or short supply chains and be global or local. Johns Hopkins University and The Global Alliance for Improved Nutrition (GAIN) launched a Food Systems Dashboard in 2020 to provide a single platform for food systems data relevant to diet and environmental outcomes, and to enable the use of these data by policymakers, non-governmental organizations, civil society leaders, educators, and researchers. The Dashboard draws upon more than 30 sources to provide data from over 200 indicators across 230 counties and territories, to support informed policy making and other uses.

The authors of the paper, “Diagnosing the performance of food systems to increase accountability toward healthy diets and environmental sustainability,” drew upon the Dashboard to establish parameters for likely challenges within national food systems.

“We hope this diagnosis will aid the interpretation of food systems data, so that decision-makers can see what is going relatively well as well as what is challenging in each setting and consider a range of possible actions to address challenges and maintain successes. It can be used to identify an array of possible actions to improve food security, diet, health, and environmental outcomes,” said Anna Herforth, of Harvard University, the first author of the paper who led the study.

The paper includes a global assessment and country case studies to illustrate how the diagnostics could spur decision options available to countries. For example, in Tanzania, the paper’s authors identify the challenge of child stunting and recommend policy and actions that may be appropriate to addressing it, such as investing in market infrastructure to enhance access to nutritious food and utilizing social protection platforms to enhance the purchasing power of women, especially around pregnancy.

“No single action can fix food systems, but governments, NGOs, civil society and businesses can each start to take action. We hope these diagnostics are a step towards better monitoring of food systems performance that can lead to stronger governance and accountability of food systems and their transformation,” said Stella Nordhagen, co-author of the paper, and Senior Technical Specialist at GAIN.

Jessica Fanzo named to Group Seeking Systemic Solutions for Climate Change’s Impact on Food Systems

Berman Institute faculty member Jessica Fanzo has been named to the recently launched Board for International Food and Agricultural Development (BIFAD) subcommittee on Systemic Solutions for Climate Change Adaptation and Mitigation in Agricultural, Nutrition, and Food Systems. The subcommittee will lead transdisciplinary evidence gathering to advise BIFAD with independent recommendations to improve U.S. Agency for International Development (USAID) programming and strategies.

“As a global community, we must act quickly to avoid the most severe consequence of climate changeon the world’s food supply and the health, food security, and safety of the world’s most vulnerable populations,” said Fanzo.

Dr. Fanzo is the Bloomberg Distinguished Professor of Global Food Policy and Ethics at the Berman Institute of Bioethics, the Bloomberg School of Public Health, and the Nitze School of Advanced International Studies at Johns Hopkins University. She also serves as the Director of Hopkins’ Global Food Policy and Ethics Program, and as Director of Food & Nutrition Security at the JHU Alliance for a Healthier World.

“I am honored to serve on the BIFAD Subcommittee on Systemic Solutions to Climate Change Adaptation and Mitigation. Alongside twelve other global experts, we recently began our work supporting BIFAD and USAID toward our shared goal of a resilient, prosperous, and equitable world with net-zero greenhouse gas emissions. Together, we have the important task of exploring evidence-based climate change action in programs aimed at safeguarding agricultural productivity, inclusive food systems changes, and poverty- and malnutrition-reduction objectives.”

The subcommittee is envisioned to support USAID’s role in accelerating systems change and transformative climate change adaptation and mitigation approaches in agriculture, food systems and nutrition, and in targeting climate finance to benefit smallholder farmers.  Subcommittee members bring a breadth of expertise across disciplines, diversity of views, and organizational perspectives to tackle the greatest challenge to food security.

GLIDE Recognizes Nelson Sewankambo for Outstanding Work in Global Bioethics

Professor Nelson Sewankambo was presented with the inaugural biannual GLIDE Global Health Ethics Leadership Award in recognition of his outstanding contribution in the field of global bioethics.

In the early 1980s Professor Sewankambo was one of the first physicians in Uganda to recognise HIV/AIDS as a new disease. In addition to his leadership in HIV/AIDS research, Professor Sewankambo has devoted much of his professional attention to the advancement of medical and bioethics education, research, and service in Uganda and the African continent. He helped build the research capacity strengthening consortium (THRiVE) which involved seven African institutions and two universities in the UK, and provided leadership for the Initiative for Strengthening Research Capacity in Africa (ISHReCA).

In presenting the award at the Global Health and Bioethics International Conference on 28 June, Professor Joseph Ali, of the Berman Institute of Bioethics, said:

‘Professor Sewankambo is a visionary who has paved the way for bioethics to flourish in Uganda and across Africa through regional and global partnerships.  He has long-recognised that the work of bioethics requires not only individual passion, but also deep commitment and coordination within and across institutions. His efforts have inspired countless researchers, practitioners, and organisations to direct their attention to the goal of strengthening bioethics systems and answering critical bioethics questions for the benefit of society.’

Professor Sewankambo is a director of the NIH Fogarty-funded Makerere International Health Research Ethics Master’s Training Programme, the Makerere University International Bioethics Doctoral Research Training Programme, and the Fogarty African Bioethics Consortium-Postdoctoral Fellowship programme. He is also a key member of the International Expert Network for the Oxford-Johns Hopkins Global Infectious Disease Ethics (GLIDE) Collaborative.

3rd Annual SNFBA Summer Course to focus on Ethics and Research: Lessons from the Pandemic

The Stavros Niarchos Foundation Bioethics Academy (SNFBA) is proud to announce that it will be hosting the 3rd Annual Bioethics Summer Course at the Stavros Niarchos Foundation Cultural Center in Athens, Greece June 19-22, 2022.

The Bioethics Summer Course is an annual training activity of the SNFBA whose goal is to support and enhance knowledge and awareness for bioethics among biomedical researchers, policy professionals, and healthcare administrators in Greece.  The course is co-directed by Prof. Jeffrey Kahn, the Andreas C. Dracopoulos Director of the Johns Hopkins Berman Institute of Bioethics (JHU), and Prof. Effy Vayena, Head of the Health Ethics and Policy Lab at the Swiss Federal Institute of Technology in Zurich (ETH).

The 3rd Annual Bioethics Summer Course  will be a three-day intensive course focusing on Ethics and Research: Lessons from the Pandemic and, as in past years, will include lectures from distinguished bioethics experts from Johns Hopkins and ETH Zurich, and in-depth small group discussion of case studies and lecture topics.


The SNFBA is free to accepted participants, and fully supported through the generosity of the Stavros Niarchos Foundation (SNF). Airfare and lodging is provided to accepted participants from outside of Greece and lodging (and travel where required) is provided to accepted participants who reside outside of Athens.  The total number of participants is limited to 50 to preserve a high-quality experience.


Applications are encouraged from professionals working in institutions in Greece and the Balkans, with the following experience and expertise:

  • Professionals working in, or overseeing, Clinical Research
  • Medical Students and Pharmaceutical Students interested in developing capacity in Clinical Research
  • Members of committees performing Biomedical Research Ethics Review
  • Professionals working in health and science policy


Applications are now being accepted online until April 11, 2022 but may close earlier if 50-person capacity is reached.

Required Application Documentation

  • Curriculum Vitae
  • Short Personal Statement no more than 250 words including why the Course is of interest to you, your motivation for applying, and how the Course will be of use in your professional work and professional development

Apply for the 3rd annual SNFBA Bioethics Summer Course now.

For questions please contact Katerina Ligomenides (snfbagreece@gmail.com)

Work Begins on Project to Incorporate Human Rights-Based Frameworks into Food Systems Policy and Planning

The Consortium for People-Centered Food Systems, led by Bloomberg Distinguished Professor Jessica Fanzo at Johns Hopkins University, has initiated the first phase of its ten-year effort to foster human rights-based approaches to food systems policy and planning. This effort seeks to strengthen the capacity of governments, peasants, and other people living in rural areas to adopt and incorporate human rights frameworks such as the UN Declaration on the Rights of Peasants and Other People Working in Rural Areas (UNDROP) into food policy and food systems action.

Adopted in 2018, UNDROP proposes that countries work with rural food system actors to create policies that promote and protect the right to adequate food, food security and food sovereignty, sustainable and equitable food systems, and others, such as the right to land, water, and seeds.

This interdisciplinary project seeks to use advocacy, build capacity, and develop accountability tools to better integrate human rights frameworks into the food systems policy context. Led by Dr. Fanzo, the project consortium includes academics, development practitioners, ethicists, and lawyers from Johns Hopkins University, RikoltoInternational Institute of Rural Reconstruction, and CIAT on behalf of the Alliance of Bioversity International and CIAT. The project is jointly funded by member organizations and the Swiss Agency for Development and Cooperation.

“Small-scale farmers produce more than 80% of the world’s food, but this diverse population suffers disproportionately from hunger, poverty, discrimination, violent conflict, and climate change. Human rights instruments like UNDROP represent a major step forward in protecting their human rights, but more work is needed to integrate them into food systems policy effectively,” says Dr. Fanzo.

Dr. Fanzo is the Bloomberg Distinguished Professor of Global Food Policy and Ethics at the Berman Institute of Bioethics, the Bloomberg School of Public Health, and the Nitze School of Advanced International Studies at Johns Hopkins University. She also serves as the Director of Hopkins’ Global Food Policy and Ethics Program, and as Director of Food & Nutrition Security at the JHU Alliance for a Healthier World.  Faculty joining Dr. Fanzo in this work from JHU include Drs. Leonard RubensteinAnne Barnhill, Swetha Manohar, and Rebecca McLaren.

Initial project activities will take place in Cambodia, Ethiopia, Honduras, and Uganda, and are funded by the Swiss Agency for Development and Cooperation. In each of these countries, project team members are partnering with Rikolto, IIRR, CIAT, and local stakeholders to assess the food systems context and identify potential areas for improvement in awareness, capacity, accountability, and policy coherence. Later phases of the project will aim to scale the approach to other countries and produce global guidance on putting people’s rights at the center of food systems. In the next few months, countries will begin by sensitizing the project in the four countries with local stakeholders and governments and will produce a paper on what it means in practical terms to integrate rights into food systems action and policy.

For media inquiries, contact: Jamie Smith, Jamie.smith@jhu.edu

Provide Tax Breaks to Encourage Electric Vehicle Manufacturers to Produce Low-Cost Models for a Fair Net Zero Transition, New Study Recommends

Investors in solar panels and electric vehicle manufacturers should be granted tax breaks incentivizing them to produce lower-cost models of their products within the purchasing power of lower income households. That’s the recommendation of energy experts, including the Berman Institute of Bioethics’ Jess Fanzo, exploring the challenges of delivering a fair and just transition to a net zero society as detailed in a new research paper published January 31 in Nature Human Behaviour.

While the UK Government’s newly published Net Zero Strategy proposes new requirements for car manufacturers to produce a greater proportion of clean vehicles every year, the paper’s authors at the University of Sussex, Johns Hopkins University and Indiana University want this to go further to ensure electric vehicles, and other low carbon technologies, are an affordable option for a much broader range of socio-economic groups.

The study also recommends the widespread introduction of pay-as-you-go schemes, leasing programs and community/cooperative models to lower the financial burden of adopting low-carbon technologies for low- and moderate-income households.

“We must come to craft policy and action that is more aware of tensions in equity across demographic, spatial, environmental, and temporal dimensions so they can be minimized or maybe even eliminated,” said Fanzo, the Bloomberg Distinguished Professor of Global Food & Agricultural Policy and Ethics at Johns Hopkins. “Whether a future low-carbon society liberates and empowers vulnerable groups or threatens to further trap them into cycles of poverty and precarity will depend on the actions we take collectively in the next few decades.”

The study also calls for wider use of climate and citizen assemblies to help ensure the active participation of a cross-section of society in shaping significant changes towards a net zero future. Specifically, targeted engagements with organizations working closely with women, the elderly or racially marginalized groups could help pre-empt unintended negative impacts of low-carbon technology, the academics recommended.

Benjamin K. Sovacool, Professor of Energy Policy in the Science Policy Research Unit at the University of Sussex Business School, said “Emerging innovations are often seen as solutions that will benefit society while transforming various energy, building, or food systems. But low-carbon innovations are not automatically just, equitable or even green and our research shows how such technologies and behaviours can introduce new inequalities and reaffirm existing ones. At the very least, they can reflect unequal access to technologies and to incentives to adopt them and disparities in affordability. At the very worst, such innovations can sometimes disproportionately affect some groups while benefitting others, and thus serve to exacerbate inequality and injustice.”

The study also recommends that just transition compensation and assistance strategies should be expanded far beyond those currently considered for communities and individuals directly impacted by the phasing out of fossil fuel industries. The authors argue a more refined and nuanced analysis needs to be informed by intersectional approaches taking a more complete view of the social groups most vulnerable to the impact of the net zero transition.

The research goes on to recommend steps to protect future generations from being unfairly burdened with the net zero transition and limit the temptation of politicians to pass more costly and political contentious policies onto their successors or businesses to delay longer-term reform and in favour of immediate profit.

The authors advocate wider use of institutional innovations using indirect representation to advocate on behalf of social groups set to be impacted by current policy decisions in the future highlighting the good practices of the parliaments and assemblies which have ombudspeople for future generations to safeguard their interests.

In the study, the academics examined how four innovations in low-carbon technology and behaviour create complications and force trade-offs on different equity dimensions:

Improved cookstoves and heating: Equity risks and trade-offs include improved cookstoves can cement uneven patterns of work and domestic life and leave many women responsible for maintenance; and some improved cookstoves may still rely on fossil fuels/carbon-intensive electricity and thus contribute to deforestation or climate change.

Battery electric vehicles: Risks include further embedding private motorized travel to detriment of walking, active/public transport alternatives; charging point availability biased in favour of urban users; EV tax incentives currently favour wealthy households; conventional cars replaced by EVs in developed markets end up in other markets where they continue to pollute.

Household solar panels: Risks include requirements of owning a building or access to space to mount panels, take-up is shaped along race, space, income, and class divisions, panels are made with toxic materials and generate hazardous waste flows.

Food-sharing: Risks include strong urban and city bias to food sharing adoption, demographics tilted towards wealthier homes, larger homes, and homes with children, with higher rates of digital literacy; food sharing can lead to missorted waste or wasted mishandled food.

Agri-food Systems Transformation: New, Ambitious Framework Proposed to Monitor Progress

Sustainable, resilient, just, and equitable food systems that support access to healthy diets for all are possible. Realizing this potential is of utmost, urgent importance if the world is to achieve the Sustainable Development Goals by 2030, the Paris Agreement, and other global goals. The UN Food Systems Summit in 2021 highlighted both the challenge and the opportunity for food systems transformation. However, at present there is no rigorous, coordinated effort to monitor all aspects of food systems and their interactions to set priorities and track progress. In a new paper, “Viewpoint: Rigorous monitoring is necessary to guide food system transformation in the countdown to the 2030 global goals,” Dr. Jessica Fanzo of the Johns Hopkins Berman Institute of Bioethics and colleagues call attention to this need for global food systems monitoring in order to inform decisions and support accountability for and good governance of the transformation process.

Under the leadership of Dr. Fanzo, Dr. Lawrence Haddad of GAIN, and Dr. Jose Rosero Moncayo of the United Nations Food and Agriculture Organization, over 50 collaborators have come together to propose a rigorous monitoring framework for food systems populated with a clear set of relevant, high quality, interpretable, and useful indicators to support evidence-based policymaking and those who hold decision-makers to account. In this initial paper, the authors have developed an overarching framework that establishes five core thematic areas in need of monitoring: (1) diets, nutrition, and health; (2) environment and climate; and (3) livelihoods, poverty, and equity; (4) governance; and (5) resilience and sustainability. Under these areas, they have established indicator domains and will go through a rigorous process over the next year to select the indicators to be monitored within each and produce a baseline assessment of global food systems.

Learn more about Professor Fanzo’s work in Food Systems Monitoring.

Perilous Medicine: The Quest to Restore Protections for Health Workers

Pervasive violence against hospitals, patients, doctors, and other health workers has become a horrifically common feature of modern war. These relentless attacks destroy lives and the capacity of health systems to tend to those in need. Inaction to stop this violence undermines long-standing values and laws designed to ensure that sick and wounded people receive care.

In his new book Leonard Rubenstein—a human rights lawyer who has investigated atrocities against health workers around the world and core faculty member at the Berman Institute of Bieoethics —offers a gripping and powerful account of the dangers health workers face during conflict and the legal, political, and moral struggle to protect them. In a dozen case studies, he shares the stories of people who have been attacked while seeking to serve patients under dire circumstances including health workers hiding from soldiers in the forests of eastern Myanmar as they seek to serve oppressed ethnic communities, surgeons in Syria operating as their hospitals are bombed, and Afghan hospital staff attacked by the Taliban as well as government and foreign forces. Rubenstein reveals how political and military leaders evade their legal obligations to protect health care in war, punish doctors and nurses for adhering to their responsibilities to provide care to all in need, and fail to hold perpetrators to account.

Bringing together extensive research, firsthand experience, and compelling personal stories, Perilous Medicine also offers a path forward, detailing the lessons the international community needs to learn to protect people already suffering in war and those on the front lines of health care in conflict-ridden places around the world.

In an interview with Global Health Now, Rubenstein explained why he wrote the book:

“I wrote it, first and foremost, for those who take enormous risks to provide care in the midst of war, so that their commitment to health can be matched by a commitment to rights to their protection. At the same time, I wanted to enhance understanding of the pervasiveness of the violence, the logics animating it, and its devastating impacts for millions of people already suffering in war. Another goal was to seek to engage the public health, nursing, and foreign policy communities—and the wider public—in stopping it.”

Read the full Q&A.
Listen to Rubenstein’s appearance on the “Public Health On Call” podcast.
Attend (via Zoom) his Oct. 11 Berman Institute Seminar Series talk, “The Paradoxical Fragility of the Norms of Protection of Health Care in War.”

Rubenstein has spent his career, spanning four decades, devoted to health and human rights. A graduate of Harvard Law School he is now Professor of the Practice at the Johns Hopkins Bloomberg School of Public Health, and Director of the Program in Human Rights, Health and Conflict at its Center for Public Health and Human Rights. At Johns Hopkins, he is also a core faculty member of the Berman Institute of Bioethics and the Center for Humanitarian Health.

Exploring the Global Systems that Shape Diets and Nutrition for Nations Around the Globe

From the impacts of quinoa’s global popularity on small-scale Andean farmers, to challenges gaining public acceptance of genetically modified rice in the Philippines, to threats to human health from deforestation and cattle production in the Amazon, ensuring optimal diets and nutrition for the global population is a grand challenge fraught with many contentious issues. Food security for all depends on functional, equitable, and sustainable food systems, highly complex networks of individuals and institutions that rely on governance and policy leadership.

In Global Food Systems, Diets, and Nutrition: Linking Science, Economics, and Policy, a new textbook published this month by Palgrave Macmillan, authors Jessica Fanzo and Claire Davis of Johns Hopkins University explain how interconnected food systems and policies affect diets and nutrition in high-, middle-, and low-income countries. In tandem with food policy, food systems determine the availability, affordability, and nutritional quality of the food supply, which influences the diets that people are willing and able to consume.

“Global food systems touch on every aspect of society in both positive and negative ways. The challenges facing food systems are critical ones that demand urgent attention. As Covid-19 and climate change are showing, our food systems are fragile and inequitable. The book tackles why that is, and what can be done about it,” said Fanzo, the Bloomberg Distinguished Professor of Global Food Policy and Ethics at Johns Hopkins. “This book is a comprehensive evaluation of how food systems and policy intersect around the world to affect diets and nutrition. By taking a global perspective on food systems and policy, it fills a gap among existing academic textbooks”

Readers will become familiar with both domestic and international food policy processes and actors and be able to critically analyze and debate how policy and science affect diet and nutrition outcomes.

Part I provides an introduction to the key concepts of food systems and food policy. Part II explores the causes and consequences of global malnutrition, assesses the current state of global dietary patterns, and analyzes how various drivers affect food systems, diets, and nutrition. Part III covers the global policy landscape and its influence on diets and nutrition, including policies affecting the food supply chain, food environments, and consumer behavior. Part IV focuses on new challenges to achieve healthy diets for nutrition, addressing the accessibility of diets, sustainable diets amidst the threat of climate change, and new technologies shaping diets and nutrition.

“Our hope is that this book will help educate the next generation of policymakers, researchers, and public health practitioners and improve their understanding of global food policy processes and actors,” said Davis, a science writer for the Global Food Ethics and Policy Program at the Berman Institute of Bioethics.

Case studies examine experiences from Brazil, South Sudan, Malawi, Ethiopia, Mexico, Chile, India, Denmark, Pacific Island countries, United States, and many other countries from around the world. Additional features include chapter introductions and illustrative figures.

“While students enrolled in public health nutrition and policy courses are our intended audience, many chapters may also interest lay readers who want a deeper dive into food systems and policy,” said Davis.

Jessica Fanzo is the Bloomberg Distinguished Professor of Global Food Policy and Ethics at the Berman Institute of Bioethics, the Bloomberg School of Public Health, and the Nitze School of Advanced International Studies at Johns Hopkins University. She also serves as the Director of Hopkins’ Global Food Policy and Ethics Program, and as Director of Food & Nutrition Security at the JHU Alliance for a Healthier World. From 2017 to 2019, Jessica served as the Co-Chair of the Global Nutrition Report and the UN High Level Panel of Experts on Food Systems and Nutrition. Claire Davis is a Science Writer for the Global Food Ethics and Policy Program. Her work focuses on the relationship between food and diets, human health, and environmental sustainability.