10.5 What conclusions can we draw and what further research questions need answering?
  • SHEPs need to be taken seriously by policy makers and composite approaches to promoting them are needed.
  • Composite interventions should combine macroeconomic, fiscal, societal and cultural influences.
  • There is potential to shift consumption patterns exist, but so far there has been a lack of concrete interventions and therefore evidence of effectiveness is lacking.
  • Substitution effects and trade-offs are to be expected, and need to be better understood and thereby avoided when designing interventions.
  • Further research questions need to focus on integrated solutions, macro and local initiatives.
  • More focus and research is needed into possible pathways for SHEPs in developing countries.


SHEPs are important and composite approaches are needed


Composite approaches are needed: No one approach will do everything. A mix of regulatory, fiscal, voluntary and other approaches is required.

Consumption matters: Sustainable healthy eating patterns must be taken seriously. See Chapters 3 and 5 for the environmental impacts of food systems; see Chapter 7 for more on food and health.

Don’t leave it to the individual: There is a lack of evidence for individuals taking action, and attitude-action gaps are evident. Public understanding of the environmental impacts of food is low.

Don’t leave it to industry goodwill or enlightened self-interest: Some in the food industry are acting but their efforts alone are not enough.

Governments need to govern: Policy makers need to create a strong regulatory and fiscal framework, and international trade needs to reflect the importance of sustainable healthy diets.

Work in schools: School-based interventions show promising health results, and their actions now need to incorporate an environmental focus.

Lack of evidence is no excuse for inaction: action generates evidence.

Monitoring & evaluation essential: more focus is needed on mechanisms to track the impact of interventions and inform refinements.

A whole supply chain approach is needed : While there are health and environmental win-wins there can be trade-offs too as seen with the different health and environmental impacts of sugars and meats. There will also be food system trade-offs, and the different interests of different stakeholders need to be recognised.

What are the next steps for research?

  • Can we design interventions with both health and environment as objectives?
  • What are the substitution effects following consumption changes?
  • What are the links between production-consumption and health-environment relationships?
  • How do interventions aimed at fostering lower environmental impact and healthy diets, affect jobs, livelihoods and economic development?
  • How do we make decisions about trade-offs?
  • What are the positive macro-economic influences on consumption and levers for change?
  • What are the influences on consumption in low- and middle-income countries?

More integrated studies are needed: most of the studies reviewed came from the health literature or (to a lesser extent) from the sustainability literature. There were very few studies that sought to investigate the effects of interventions on both health and sustainability outcomes. More cross-disciplinary collaboration and research here is required.

Substitution effects need to be explored: how do different interventions (particularly but not only those that influence price) affect our consumption of non-targeted foods, and how do the effects of interventions vary by population group?

Understanding the production-consumption, health-environment relationship: studies need to look at the effect of consumption targeted interventions on producers and vice versa. They also need to consider the impacts on both health and the environment in the country where the intervention is undertaken, and any risks of ‘leakage’ of impacts in other regions.

Designing macro-economic policies for health and sustainability: Analysis of what a health- and sustainability-promoting agricultural, trading, investment and market development regime might look like has not yet been undertaken. This is clearly an area – albeit vast – that merits further research and could lend itself to model based exploration. Understanding the influences on consumption in middle- and low-income countries and the potential levers for change: As highlighted, most of the work on the sustainable healthy eating agenda, on the drivers of consumption and on the intervention options is undertaken in and for high-income countries.

Understanding of how and why people consume in low and middle income countries, how this is changing and why, and what the intervention levers are for change, is conspicuous by its absence. This needs to change.

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