Food sovereignty, food security and health equity: a meta-narrative mapping exercise

Abstract

There has been growing policy interest in social justice issues related to both health and food. We sought to understand the state of knowledge on relationships between health equity--i.e. health inequalities that are socially produced--and food systems, where the concepts of 'food security' and 'food sovereignty' are prominent. We undertook exploratory scoping and mapping stages of a 'meta-narrative synthesis' on pathways from global food systems to health equity outcomes. The review was oriented by a conceptual framework delineating eight pathways to health (in)equity through the food system: 1--Multi-Scalar Environmental, Social Context; 2--Occupational Exposures; 3--Environmental Change; 4--Traditional Livelihoods, Cultural Continuity; 5--Intake of Contaminants; 6--Nutrition; 7--Social Determinants of Health and 8--Political, Economic and Regulatory context. The terms 'food security' and 'food sovereignty' were, respectively, paired with a series of health equity-related terms. Combinations of health equity and food security (1414 citations) greatly outnumbered pairings with food sovereignty (18 citations). Prominent crosscutting themes that were observed included climate change, biotechnology, gender, racialization, indigeneity, poverty, citizenship and HIV as well as institutional barriers to reducing health inequities in the food system. The literature indicates that food sovereignty-based approaches to health in specific contexts, such as advancing healthy school food systems, promoting soil fertility, gender equity and nutrition, and addressing structural racism, can complement the longer-term socio-political restructuring processes that health equity requires. Our conceptual model offers a useful starting point for identifying interventions with strong potential to promote health equity. A research agenda to explore project-based interventions in the food system along these pathways can support the identification of ways to strengthen both food sovereignty and health equity.

Keywords: Food security; food sovereignty; health equity; meta-narrative; social determinants; social justice.

Figure 1

Pathways from food system processes to health equity. 1—Micro- and macro-level social and ecological factors (e.g. global environmental change, cultural change). 2—Vulnerability to occupational hazards (e.g. pesticide exposure, musculoskeletal injuries due to factors such as weak employment standards protections). 3—Effects of ecological change on health equity (e.g. impact of fisheries depletion on coastal communities). 4—Threats to and revival of traditional food producer livelihoods and cultural foodways (e.g. with implications for a range of health determinants). 5—Ingestion of chemical or biological contaminants (e.g. either directly through human consumption or indirectly through effects on livestock). 6—Household food access and nutritional interventions (e.g. among impoverished communities). 7—Interactions with income and other social determinants of health (e.g. uneven effects of agricultural production and retailing). 8—Macro-level processes (e.g. trade liberalization, state welfare policies, foreign aid that affect agricultural production and food access).