FFTC Agricultural Policy Platform (FFTC-AP)

ABSTRACT

Diets are shaped by food systems that determine population nutrition and are associated with population health outcomes. To improve food systems for healthier diets, effective policies and actions that address key determinants of the food systems are needed. This study aimed to determine and compare existing government policies and actions for food systems for healthy diets in Thailand with reference to internationally recommended policies and actions.

Documentary review was conducted to gather all information about policies and actions related to food systems that have been implemented by the Thai government. Data were assessed using Food Systems Dashboard Framework, which recommends ten policy domains with 42 policies and actions to get food systems working for healthier diets for all. Results showed that the Thai government implemented 31 policies and actions (out of 42 in total), especially in the following domains: agriculture, supply chain infrastructure, education and public awareness, national guidelines and public institution. The policies and actions that are not available in Thailand include trade policies to prioritize the supply of nutritious foods; mandatory large-scale food fortification programs; lower prices of nutritious foods; zoning laws to restrict fast food outlets and vendors; financial incentives and planning regulations to drive the establishment of new supermarkets, fresh food markets, shops and street vendors; and development of independent accountability mechanisms to monitor and publicly report on business progress. The findings of this study suggest that continued attention to promoting policies and actions related to sustainable agriculture as part of a healthy diet policy is needed. This should include gaining a balance in agriculture, the environment, and natural resources. Together, the government needs to build the strong governance capacity of the responsible organisations to carry out their responsibilities effectively in the long run. A robust monitoring and evaluation system for tracking progress on policy performance and targeted outcomes is essentially required.  

Keywords: food and agricultural policies, food systems, sustainability, healthy diets

INTRODUCTION

The double burden of malnutrition, characterised by the coexistence of overweight, obesity and diet-related non-communicable diseases (NCDs), along with undernutrition, is increasingly prevalent in Thailand. Overweight and obesity remained in the top five major risk factors for NCDs nationally (Burden of Disease Research Program Thailand, 2018). NCDs (particularly cardiovascular diseases, cancers, diabetes, and chronic respiratory diseases) were a major cause of mortality in Thailand, contributing to 14% of all premature deaths in 2014 (Burden of Disease Research Program Thailand, 2016). Undernutrition is also a prevalent issue, with stunting in children under five years of age accounting for 13.4% of the total population in this age group (Global Nutrition Report, 2021).

The Thailand Burden of Disease study showed that unhealthy diets, particularly the low intake of fruits and vegetables, are one of the leading causes of death and disability among the Thai population (Burden of Disease Research Program Thailand, 2018). The analysis of the burden of diseases attributable to risk factors from 2004 to 2014 demonstrates the increasing trend of the burden attributable to the low intake of fruits and vegetables. This dietary risk accounted for 341,000 disability-adjusted life years (DALYs) and 21,650 Thai deaths in 2014.

The double burden of disease and unhealthy diet are being driven by changes in food systems (the production, aggregation, processing, distribution, consumption and disposal of food products), embedded by sub-systems (farming system, waste management system, input supply system, energy system, trade system, health system, and more) (FAO, 2018). Food systems also interact with broader contexts (rapid population growth, urbanization, growing wealth, changing consumption patterns, and globalization, as well as climate change and the depletion of natural resources). The food systems thus encompass a range of actors (individuals or organizations) and are intrinsically related to health, environment, culture, politics and economy.

Thailand is facing dual challenges in food systems – both increasing food demand and resource competition (Food Systems Dashboard, 2020). While the Thai population increases each year, cereal yields slightly increased from 3.0% in 2016 to 3.2% in 2017, and vegetable yields increased from 7.8% in 2017 to 7.9% in 2018. Share of employment in agriculture remained unchanged, at 32% in 2017 and 2018. Agricultural infrastructure for supporting the food supply chain is still limited, with the agricultural infrastructure index score at 49 in 2019 (out of 100 for the best infrastructure support). Increased loss of fruits was observed, from 7.8% loss in 2000 to 10% loss in 2018. There was also a decline in supply, particularly of vegetables, fruit, pulses, fish and milk, per capita. Higher accessibility to and availability of processed food products such as ultra-processed foods was observed. The retail value of ultra-processed food sales per capita increased from US$155.8 in 2017 to USD168.3 in 2018. Modern grocery retailers and supermarkets grew from 1.8 stores per 100,000 inhabitants in 2017 to 1.9 stores per 100,000 inhabitants. Personal consumption expenditures rose from US$8,242 in 2017 to US$8,591 in 2018.

Making food systems sustainable requires the provision of support for population diets and nutrition. Policy interventions with the potential to create an enabling environment for sustainable food systems are needed (HLPE, 2017). The policy interventions should address each part of the food system to ensure its impact. As the food systems are complex, affected by many different factors and made up of many processes and actors, policy packaging with potential priority actions is an important strategy to ensure the impact of the food system on healthier diets for all populations. Potential policy packages developed by Food System Dashboards, for example, recommended 42 policies and actions with the potential to get food systems working for healthier diets (Hawkes C, Walton S, Haddad L, & Fanzo J, 2020). These policies and actions cover multiple domains of food systems across production, supply chain, food environments and consumers.

Although the Thai government has committed to improving the performance of the public sector to gear the food systems towards greater sustainability and balance in all dimensions, as well as strengthening food security and ensuring equitable access to safe and healthy food for all (Ministry of Foreign Affairs, 2021), there is limited evidence on the governmental progress in creating sustainable food systems for healthy diets for all. This information will be helpful for the governments and other stakeholders in identifying ways to make government actions both effective and politically feasible to change and improve food systems. Therefore, this study aimed to determine and compare existing government policies and actions on food systems for healthy diets in Thailand with reference to internationally recommended policies and actions.

MATERIALS AND METHODS

Data collection

Documentary review was conducted to gather all information about policies and actions related to food systems implemented by the Thai government. Data for national-level implementation were gathered and assessed using the Food Systems Dashboard framework (FSD). The FSD recommends ten areas, with 42 policies and actions in total, to get food systems working for healthier diets for all (Table 1) (Hawkes C et al., 2020). The ten areas include agriculture (7 actions), international trade (1 action), research, processing and technology (7 actions), supply chain infrastructure (6 actions), finance (4 actions), public institution (2 actions), business (5 actions), regulations and laws (5 actions), education and public awareness (4 actions), and national guidelines (1 action).

Table 1. 42 Policies and actions by Food System Dashboard

Relevant policy documents were collected by searching websites and publications of governmental and non-governmental organisations and major Thai newspapers. Policy data that were used for analysis were the government policies being currently implemented from October to December 2021 (from the start date to the finish date of data collection).  

Data analysis

This study employed content analysis to describe the details of each policy action compared with the FSD recommendations of 42 policies and actions across ten domains and identify implementation gaps of each policy action. The analysis was performed by SP and ST, whereby the coded categories were derived directly from the framework. This is an iterative process of abstraction where sentences and paragraphs from the documents related to the 42 policies and actions across ten domains were identified and compared with the FSD.  

RESULTS

Figure 1 illustrates a proportion of policy actions in each policy area that were implemented in Thailand. The Thai government implemented 31 policies and actions (out of 42), especially in the following policy areas: supply chain infrastructure, public institution, education and public awareness, and national guidelines. Most recommended policy actions that were not in place were observed in the areas of international trade, finance and business incentives.

DISCUSSION

This study reviewed and analysed the presence and absence of government policies and actions for improving food systems for healthier diets for all populations in Thailand compared with the framework of FSD recommendations. Overall, the implementation of the Thai governments covered the majority (74%) of the recommended actions in each policy area. A major implementation gap was identified in particular in policy areas on international trade.

The Thai Government’s policy performance was best for the policy areas ‘Agriculture,’ ‘Supply chain infrastructure,’ ‘Public institution,’ ‘Education and public awareness,’ and ‘National guidelines.’ All the recommended actions in these areas were being implemented in Thailand. This performance on supply chain infrastructure, in particular, can be explained partly by the impact of the implementation of the 20-year National Strategy (2018-2037), which places sustainability of national biodiversity, environmental quality, and natural resource among national development priorities (National Strategy Secretariat Office, 2018). The national strategy focused on developing high-quality infrastructures to connect Thailand with the world through creating seamless transport networks. Land, water, and transport and infrastructure networks should be more developed to accommodate transportation and logistics along the regional supply chain. The strategy also places the importance on developing skilled local manpower, especially the skills of local entrepreneurs and enterprise groups required by the labour market in each area, such as food value chain management and marketing.

Encouraging zero-waste targets and total and sustainable waste management was another priority action for the national strategy to create eco-friendly water, energy, and agricultural security in the country. With this comprehensive strategic plan for actions toward achieving the country’s development goal, as such, responsible government agencies are mandated to develop actions aligned with the national strategy and plan. Accelerating government actions toward sustainable, nutrition-friendly and consumer-focused food systems, gaining a balance among agrifood systems, environment and natural resources is needed. Strong governance capacity of the government organisations is also essentially required for carrying out their responsibilities effectively in the long run.

The Thai government performed well in the policy area on education and public awareness. This was not surprising as Thailand has apparently more downstream (individual-level behavioral approach) policy actions than upstream (affecting large populations) policies. Actions on nutrition education, food literacy and skills training, and mass media and communication campaigns were partly under the Department of Health’s mandate to public health and nutrition education and were also delivered through the existing formal education system as part of Health Education subject. Action on dietary counselling to women during antenatal care and pregnancy was part of actions under the Thai Universal Health Coverage policy (Prakongsai P, Limwattananon S, & Tangcharoensathien V, 2009). However, increasing the effectiveness of public awareness and learning activities to reach a level where people can change their behaviour is always challenging. This requires a long and arduous journey that hangs on mobilising around the provision of education, training and information that requires institutional support, especially in financial resources, and periodic evaluation, which is always at the heart of policy implementation challenges (OECD, 2020) to improve the government performance in informing and educating citizens.

Thailand reported no action on the trade policies to prioritize the supply of nutritious foods. The evidence suggests that trade policies such as modern trade agreement affects or create tensions that potentially constrain policy space for creating or enforcing policy for public health nutrition outcomes (Thow et al., 2018; Thow et al., 2015). Actors in trade policy prioritize the outcomes of economic growth for exporting nations and food security and food safety for importers over public health nutrition. This can pose a challenge to the Thai national government in advancing the trade policies toward supporting the supply of nutritious foods, similar to previous research in another context (Harris et al., 2022). In addition, the trade policies involve cross-border actions, which strongly require cooperation and harmonization of the cross-country policies and actions, especially at a regional level. This will help to avoid weakening national restrictions and will strengthen government efforts to address population nutrition in trade space.

This study has some limitations. Firstly, the study obtained data based on publicly available information using documentary review and thus may have missed some information that is not publicly available or accessible. This may, therefore, affect the analysis results of policies and actions. Secondly, the study may have missed other policies and actions that are beyond the FSD recommendations, such as local level policies and actions that play a critical role in improving local or community food systems and thus country food systems. Lastly, this study did not aim to provide an in-depth understanding of current level of implementation of the policies and their effectiveness, although that is of importance for policy improvement. However, this study provided a starting point to determine issues needed for further in-depth investigation.

CONCLUSIONS

An important step in orienting food systems toward healthy diets in Thailand is to understand the government’s performance and progress against policy areas and policy actions in order to identify rooms for improvement. This study found that the Thai Government’s implementation of policy policies and actions is in line with the majority of FSD recommendations. The study identified the good government performance in the upstream food systems, including agricultural production, food processing, transportation and distribution, and a lack of international trade policies. Continued attention to promoting policies and actions related to sustainable agriculture as part of a healthy diet policy is important. This should include gaining a balance in agriculture, environment, and natural resources. Together, the government needs to build the strong governance capacity of the responsible organisations to carry out their responsibilities effectively in the long run. A robust M&E system for tracking progress on policy performance and targeted outcomes is essentially required. The cooperation of the cross-country policies and actions, particularly at a regional level, is needed in putting the international trade policies for nutrition outcomes in place.

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