Menzies Centre for Health Policy, School of Public Health, University of Sydney, Sydney, NSW, Australia.
Department of Biochemistry and Biotechnology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
Int J Health Policy Manag. 2021 Dec 1;10(12):909-922. doi: 10.34172/ijhpm.2020.203.
The global food system is not delivering affordable, healthy, diverse diets, which are needed to address malnutrition in all its forms for sustainable development. This will require policy change across the economic sectors that govern food systems, including agriculture, trade, finance, commerce and industry - a goal that has been beset by political challenges. These sectors have been strongly influenced by entrenched policy agendas and paradigms supported by influential global actors such as the World Bank and International Monetary Fund (IMF).
This study draws on the concept of path dependency to examine how historical economic policy agendas and paradigms have influenced current food and nutrition policy and politics in Ghana. Qualitative data were collected through interviews with 29 relevant policy actors, and documentary data were collected from current policies, academic and grey literature, historical budget statements and World Bank Group Archives (1950-present).
Despite increased political priority for nutrition in Ghana, its integration into food policy remains limited. Food policy agendas are strongly focused on production, employment and economic returns, and existing market-based incentives do not support a nutrition-sensitive food supply. This policy focus appears to be rooted in a liberal economic approach to food policy arising from structural adjustment in the 1980s and trade liberalization in the 1990s, combined with historical experience of 'failure' of food policy intervention and an entrenched narrowly economic conception of food security.
This study suggests that attention to policy paradigms, in addition to specific points of policy change, will be essential for improving the outcomes of food systems for nutrition. An historical perspective can provide food and health policy-makers with insights to foster the revisioning of food policy to address multiple national policy objectives, including nutrition.
全球粮食系统无法提供负担得起、健康、多样化的饮食，而这些饮食是解决各种形式营养不良以实现可持续发展所必需的。这将需要在管理粮食系统的各个经济部门（包括农业、贸易、金融、商业和工业）中进行政策变革，这一目标一直受到政治挑战的困扰。这些部门受到根深蒂固的政策议程和范式的强烈影响，这些议程和范式得到了世界银行和国际货币基金组织（IMF）等有影响力的全球行为体的支持。
本研究借鉴路径依赖的概念，考察了历史经济政策议程和范式如何影响加纳当前的粮食和营养政策及政治。通过对 29 名相关政策参与者进行访谈收集定性数据，并从现行政策、学术和灰色文献、历史预算报告和世界银行集团档案（1950 年至今）中收集文献资料。
尽管加纳对营养问题的政治重视有所增加，但将营养纳入粮食政策的程度仍然有限。粮食政策议程主要集中在生产、就业和经济回报上，现有的基于市场的激励措施并不支持对营养敏感的粮食供应。这种政策重点似乎源于 20 世纪 80 年代结构调整和 90 年代贸易自由化带来的自由经济方法对粮食政策的影响，加上历史上对粮食政策干预的“失败”经验以及对粮食安全的狭隘经济概念的根深蒂固。
本研究表明，除了具体的政策变革点外，关注政策范式对于改善粮食系统促进营养的成果至关重要。历史视角可以为粮食和卫生政策制定者提供见解，以促进重新构想粮食政策，以实现包括营养在内的多个国家政策目标。
