As climate shocks, malnutrition, and diet-related diseases converge across the Global South, repositioning health systems as active anchors within food systems offers a transformative pathway toward nutrition security, climate resilience, and equitable development
Health systems and food systems are deeply interconnected, yet they continue to function in relative isolation across much of the Global South. Food systems are increasingly recognised as one of the most powerful determinants of population health, environmental sustainability, and social equity. Far beyond the linear chain of food production and consumption, they encompass interconnected processes of cultivation, processing, distribution, consumption, and waste management, all embedded within wider ecological, economic, and political structures. Contemporary evidence suggests that food systems contribute nearly one-third of global greenhouse gas emissions, while unhealthy diets are linked to approximately 11 million preventable deaths annually. These burdens are disproportionately concentrated within countries of the Global South, where environmental vulnerability, structural inequality, and fragile governance systems intersect.
Despite the centrality of food systems to population health, health systems have historically remained focused on downstream biomedical care rather than the upstream structural conditions shaping nutrition and dietary outcomes.
Across these settings, multiple forms of malnutrition coexist simultaneously. Persistent undernutrition and micronutrient deficiencies increasingly overlap with rising rates of obesity, diabetes, cardiovascular diseases, and other diet-related non-communicable diseases. This evolving “triple burden of malnutrition” reflects broader transformations in food environments driven by urbanisation, industrial food systems, and globalised supply chains. At the same time, climate change, biodiversity loss, agrarian distress, and market instability continue to undermine the resilience of local food production systems, particularly those dependent on smallholder agriculture and informal food economies.
Despite the centrality of food systems to population health, health systems have historically remained focused on downstream biomedical care rather than the upstream structural conditions shaping nutrition and dietary outcomes. In many low- and middle-income countries, health systems evolved around vertical disease-control programmes and curative service delivery models, often influenced by donor-driven priorities. While these approaches improved specific health outcomes, they also reinforced fragmented institutional responses that insufficiently engage with food environments, agricultural systems, or market dynamics. Consequently, interventions addressing malnutrition frequently remain confined to supplementation, treatment, and behavioural counselling, with limited capacity to influence the broader systems that shape access to nutritious, affordable, and culturally appropriate foods.
This disconnect is especially consequential within contexts marked by poverty, informality, and social exclusion, where food access is mediated by complex interactions between livelihoods, local markets, ecological vulnerability, and governance structures. The absence of coherent institutional linkages between health systems and food systems limits policy effectiveness and constrains efforts to advance nutrition security and health equity. As climate change intensifies pressures on both agriculture and public health, the need for integrated, systems-oriented approaches has become increasingly urgent.
Agriculture, health, nutrition, climate, and social protection policies frequently operate in silos, limiting the capacity of governments and public institutions to respond effectively to overlapping burdens of food insecurity, malnutrition, and environmental degradation.
A growing body of literature now recognises food systems as interconnected socio-ecological systems in which agriculture, nutrition, health, environment, and economic structures continuously interact. Contemporary nutrition challenges are closely linked to broader food system transitions occurring across low- and middle-income countries. Rapid urbanisation, rising incomes, market integration, and industrial food production have accelerated dietary shifts toward energy-dense and highly processed foods. These changes have increased the burden of diet-related non-communicable diseases while failing to eliminate undernutrition and micronutrient deficiencies. Existing institutional responses, however, remain fragmented. Agriculture, health, nutrition, climate, and social protection policies frequently operate in silos, limiting the capacity of governments and public institutions to respond effectively to overlapping burdens of food insecurity, malnutrition, and environmental degradation.
Governance emerges as a central determinant of food system resilience and equity. The literature repeatedly highlights the importance of multi-sectoral coordination, policy coherence, and rights-based approaches that prioritise participation, food sovereignty, and local control over food systems. Yet implementation gaps remain substantial, particularly in contexts shaped by institutional fragmentation, weak regulatory systems, and competing economic priorities. Similarly, financing structures strongly shape food environments and nutritional outcomes. Subsidies, procurement systems, taxation policies, and market incentives continue to favour industrial food systems and ultra-processed foods in many settings. At the same time, evidence suggests that strategic public financing and procurement mechanisms can help redirect food systems toward healthier and more sustainable outcomes.
Community-based and primary healthcare platforms are increasingly recognised as important interfaces linking food systems with population health. Nutrition-sensitive agriculture, local food initiatives, community nutrition programmes, and preventive healthcare models demonstrate significant potential, although integration remains fragmented and uneven. Accountability also emerges as a critical dimension of equitable food system transformation. Weak enforcement mechanisms, fragmented monitoring systems, and limited institutional responsiveness continue to undermine food and nutrition policy implementation across many Global South contexts.
In response to these challenges, the Health Systems as Food System Anchors (HSFSA) framework is proposed as a conceptual model for repositioning health systems as active institutional actors within sustainable and equitable food systems. The framework is grounded in the understanding that health systems are not merely providers of clinical services, but complex institutional arrangements embedded within broader social, economic, political, and ecological systems. Health systems possess regulatory authority, financing capacities, institutional legitimacy, and extensive community reach – attributes that enable them to influence food environments, dietary practices, and population-level nutrition outcomes.
In response to these challenges, the Health Systems as Food System Anchors (HSFSA) framework is proposed as a conceptual model for repositioning health systems as active institutional actors within sustainable and equitable food systems.
The HSFSA framework conceptualises health system engagement with food systems through four interconnected domains: governance, financing, service delivery, and accountability. Within governance, health systems can function as convening and coordinating institutions capable of aligning food, agriculture, nutrition, social protection, and environmental objectives. Through multi-sectoral governance platforms, health systems can strengthen policy coherence, harmonise regulatory standards, and integrate nutrition and sustainability priorities within broader food system strategies. Within financing, health systems can shape food systems through strategic procurement and resource allocation mechanisms. Public institutions, including hospitals, schools, and community health programmes, can prioritise nutritious and sustainably produced foods, thereby influencing local food economies and market incentives. Nutrition-sensitive financing can also strengthen preventive approaches to addressing malnutrition and diet-related diseases.
The framework further expands service delivery beyond conventional biomedical care to include interventions addressing food access, dietary practices, and local food environments. Community-based nutrition initiatives, nutrition-sensitive agriculture, local food programmes, and culturally relevant dietary counselling can function as integrated components of preventive healthcare. Community health workers, in particular, can bridge formal healthcare systems with local food economies and culturally specific dietary practices.
Finally, accountability mechanisms are essential to ensuring equitable and sustainable food system transformation. Integrated monitoring systems, participatory governance mechanisms, citizen engagement, and regulatory oversight related to food quality, marketing, and equity can strengthen institutional responsiveness and transparency. The concept of “anchoring” is particularly relevant within the Global South, where food systems are frequently characterised by volatility, informality, climate vulnerability, and structural inequities. By leveraging their institutional legitimacy, financing capacities, and community-level reach, health systems can provide continuity, coordination, and direction within these systems. Importantly, the HSFSA framework addresses three major systemic gaps identified across the evidence base: the weak integration of food systems within health system structures; the marginalisation of agro-ecological and community-based food practices within mainstream policy systems; and the insufficient operationalisation of equity and climate justice within food and nutrition governance.
The HSFSA framework addresses three major systemic gaps identified across the evidence base: the weak integration of food systems within health system structures; the marginalisation of agro-ecological and community-based food practices within mainstream policy systems; and the insufficient operationalisation of equity and climate justice within food and nutrition governance.
The converging crises of malnutrition, climate change, ecological degradation, and widening social inequities require a fundamental rethinking of how health systems are conceptualised and governed. Sustainable and equitable food systems cannot be achieved through isolated sectoral interventions alone. By extending the remit of health systems beyond downstream clinical care toward broader engagement with food environments and structural determinants of health, the HSFSA framework offers a systems-oriented approach for advancing nutrition security, climate resilience, and social justice. Rather than functioning solely as reactive institutions responding to disease, health systems can become proactive institutional actors shaping healthier, more resilient, equitable, and environmentally sustainable futures.
Subhasree Ray is Section Head - Wellness at TVS Motor Company's Sustainability Department.
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Dr. Ray, an Executive MBA and PhD with 11+ years of expertise in employee wellbeing, is the Section Head - Wellness at TVS Motor Company's ...
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