Meghan O’Hearn is a doctoral student at the Friedman School of Nutrition Science and Policy at Tufts University under the mentorship of Dr. Dariush Mozaffarian. Her research interests include understanding the use of dietary quality metrics to monitor global diet-related disease burdens as well as how research can collaborate with the food industry to address the growing double burden of malnutrition globally.
First, Meghan, thank you for talking to me! I used to work for television, I used to be a journalist, that’s why I asked, but for interviews is fine. Meghan. I wanted to ask you some questions about the initiative that the School of Nutrition is doing in the realm of ESG (Environmental Social and Governance issue), which is now a topic these days and a lot of organizations and scholars are looking at it, as well as businesses. There is still not total clarity, but governments follow this movement and, in many countries, they are now enforcing ESG reporting. How did this initiative in the field of food start?
Meghan: Yeah, great question. So, the Friedman School freedmen recognized that suboptimal diet is the leading cause of morbidity mortality and health care spending around the world. Poor diet is estimated to cause 12 million deaths due to non-communicable diseases locally. In the US, specifically, we know that less than 10% of the of US adults are metabolically healthy and treatment for cardiovascular disease diabetes and cancer comes for about one in four healthcare spending dollars which is 18% higher than it was in 2009. So, we see this massive burden of cardiometabolic health burden that is very much driven by poor quality diet, and we also see as you kind of mentions growth in ESG investing.
I’m sure you’re familiar with all the numbers and figures, so I won’t go into that, but we saw ESG investing is really an untapped opportunity. Our work here at the Friedman School is a lot of working (?) on policies like uncanned government policy change, different community-based interventions, things like that, but we really haven’t ever worked with financial markets. Using financial markets has left leveraging financial markets in a way… it to drive a healthier food system (?). And recognizing how suboptimal nutrition is deriving chronic disease, we also see that this presents significant business risks for companies in the food sector. When I talk about the food sector, mostly what I’m talking about is consumer facing food and food-and-beverage businesses (so like food and beverage manufacturers, restaurants and retails). Recognizing that there’s an entire supply chain here as well and at agriculture distribution there’s many other aspects of the slide chain that are linked to consumer health and nutrition, but we decided we wanted to really focus first on the things that are most closely related to people’s diets and to health impact.
So, we saw that there are increasing business risks for food companies to not really address this growing burden of diet-related chronic disease; there’s regulatory risks. These include things like fronted package labeling requirements, warning labels, taxation policy for human policies, restrictions to the amount and the types of additives that can be in products marketing restrictions. So, if companies are not really reacting to this, that’s a risk for them, in terms of their long-term business performance. Similarly, there are reputational risks, so there’s societal pressure increasingly to hold these kind of actors, these sector actors accountable for their role in diet-related health; there’s increasing advocacy efforts to expose the tactics that food is using to harm public health. And so, again, not responding to that is a risk.
There’s also a growing consumer demand, particularly among young consumers, for healthier and more authentic foods, for greater transparency among companies. Also it is considered to be a business risk. As I was mentioning above, the health burden of poor diet is related to negative externalities in economic terms, in terms of lost worker productivity, increased healthcare spending as a result of this kind of burden. That impacts private sector enterprises as well as entire nations’ economies. Also, there’s a kind of this movement towards stakeholder centric businesses: considering employees and communities is important, but also you have to think about consumers as well.
We saw that today the work in ESG investing really tries to tackle the environmental and governance issues. There is some work in the social area particularly over the past couple of years, but the focus on consumers’ health and nutrition has really not gotten a lot of attention. So, we wanted to jump into that space, full on, learn and try to understand the landscape and then also use our knowledge of nutrition epidemiology and food policy to move the momentum forward in ESG.
So, concretely, what have you done so far?
Meghan: Yeah, so far what we’ve done (and what we’re currently doing) is working on a landscape analysis of what are the existing ESG metrics. A big part of it is what I mentioned, about reporting on an ESG performance and companies. We’re looking into what are the existing frameworks that are out there. So I’m sure your program like SASB or the GRI is kind of like big broad frameworks that really any company can use. Then, also looking into food sector specific frameworks that are out there, that are trying to quantify or to evaluate a company’s performance on ESG. So, we’re looking for metrics that specifically are looking at consumers’ health and nutrition and we’re evaluating the strength and the gaps of those, in terms of what is out there.
We have some broad overall themes that we’ve found; generally, those metrics are focused on commitments, rather than actual actions or outputs of the company; oftentimes they’re too narrow in scope, they look at things like sales of fruits and vegetables, which are not the only healthy thing that you can eat – right, they’re important, but not the only healthy thing – or they look at targets for reduction of specific nutrient – like saturated fat (you know, saturated fat is bad in some respects, but there are other things that are bad, and targeting specific things is not a very holistic approach). Some metrics, instead, are too broad in scope; some of the metrics have impractical data requirements: it’s not possible or it’s very difficult for a company to actually report on that, or they don’t have that data, or whoever is reporting on it, it’s infeasible or impractical; or it requires very subjective decision making by the reporter, in terms of how they interpret what the metric is.
Finally, some of the issues is that they’re not necessarily validated for their relationship with health outcomes or financial materiality. This performance on that metric actually improves the health of consumers and this actually leads to returns for that company and investors. That’s part of what we’re doing.
In parallel, we’ve been working on developing metrics here at the principles, as well. One of the metrics that we’ve been really focused on is an objective measure of healthfulness, because to really evaluate a company’s impact on consumers’ health and nutrition, we need to be able to look at the helpfulness of the products they’re selling, or the services, or whatever, depending on what kind of company it is – if it’s a restaurant, or catering service, or food and beverage manufacturer and so on.
Over the past couple of years, we’ve been developing a novel nutrient profiling system called “Food Compass”: basically, it’s an objective measure of healthfulness of a product (of an individual food product, but you could also apply it to an entire company’s portfolio). It scores products on a scale of 1 to 100, in terms of how helpful it is, based on 54 different attributes of the food (things like ratios of different nutrients, like sodium potassium, total carbohydrates fiber ratio, we look at vitamins and minerals, level of processing, different additives that are in the food, fatal chemicals, specific food ingredients that we know are associated with these factors).
So, we have this Food Compass, we developed it and we validated it by scoring about 8000 foods and compared it to existing metrics that are out there, existing nutrient program systems, like Nutri-Score (which is used in the European Union), Health Star Rating (which is more common in Australia and New Zealand). We showed that it has very good discriminatory ability, it’s able to discriminate much better than some of those broad categorical metrics; we also are able to use it across any food, so the same algorithm is used across any food or beverage, instead of having different algorithms for different types of foods, which requires a decision about which algorithm to use.
So, there are a lot of benefits in using Food Compass, based on the latest science, in terms of what we know, in terms of what is associated with improved health outcomes. So, we’ve developed that Food Compass for multiple purposes. I think it has a lot of use in the world of ESD investing, but we also see its use potentially in front of package labeling, for consumer information, in informing industries reformulation and targeting, to inform policies, like different incentives schemes that could be created, for health insurance companies, or for retailers, or for things like social safety net programs like Supplemental Nutrition Assistance Program, or things like that.
Have you shared it with corporations, with some businesses to get their feedback or with some policymakers? What was the…?
Meghan: Yeah, so we’re continuing to work in Canada business developments; the algorithm is publicly available, so anybody could recreate it and could score products. It’s a little complicated. We’re having different talks with everything, from small startups to large tender food and beverage manufacturers, that are interested in either applying it to their products. We’ve gotten a lot of interesting feedback and that has helped us. We’re working on it. It’s an iterative process. We’ve published what Food Compass is, but we also recognize that the science is constantly changing and so we’re open and amenable to changes of it. Obviously, we don’t want to be influenced by, you know…
Of course, it shouldn’t turn into a lobby.
Meghan: Yeah, you know, we don’t want a cheese company to say “oh … we’re like… ahahha….” “cheese is super good!”) No, we have to maintain that kind of independence, but it is helpful to get user’s feedback.
And what are your next steps?
Meghan: The next steps for Food Compass, or for ESG work? ‘Cause they’re both kinda in parallel,so…
First, I would start with the Food Compass, because we were talking about it, and then the overall vision on the ESG initiative.
Meghan: Yeah, so for Food Compass, we are actively searching for funding. We don’t currently have funding to expand our work on it, so that’s one thing.
And What is the ask? What would you need to be able to make it really a killer app?
Meghan: We need funding to be able to do additional research. Some of it is continuing to validate Food Compass on larger datasets, we don’t necessarily have access to those datasets, or the human resources to actually work on applying them. It’s complicated. So, we need funding to do those kinds of things.
We also have an expert advisory group that has provided a lot of interesting ideas to us, in terms of strategic next directions. They have research ideas of how we could apply these in different countries. So, part of the work that I’ve done is validating Food Compass as a predictor of health outcomes. So what we have done is we have shown… We actually scored the diets of US adults and said to individuals who have a higher Food Compass score for their diet, do they actually have better health outcomes? Do they have lower blood pressure, lower BMI, better cholesterol levels, lower blood glucose? Is there a reduced risk of metabolic syndrome, diabetes and things like that, as well as mortality? Do they reduce risk of mortality?
So, we’ve done that in a large US population (about 50,000 people) but doing that in other populations is also important to show that it has that external validity across different populations and for different health outcomes. We were looking mostly at cardiometabolic health outcomes but being able to look at undernutrition issues and in the use of Food Compass for undernutrition is also important and, as I said, in different populations.
I think it also has a lot of potential use: we see a lot of different interesting research areas or areas of interest in looking at how… well, you could either do some modeling research or you could actually do an intervention, where you put Food Compass on products, in decision making, in retail environment. You could do something like that. You could partner with a health insurance company and see if they create instead similar like these physical activity, fitness, kind of incentive schemes, where like you get a pedometer, if you can walk a certain number of steps, you get a reduction in there, you get some reward. Similarly, you can do something with nutrition and diet, by having a quantitative measure of health, maybe when you go to the grocery store, products are cheaper, certain healthier products based on Food Compass score are cheaper. So, we could evaluate some health insurance scheme that use that and then look at potential scaling as well.
And instead, the wider ESG framework of the School of Nutrition? What are its next steps?
Meghan: Yeah, right now part of it is looking at expanding the metric, so not just this measure of healthfulness, but also thinking about what all does a company do that affects consumers’ health and nutrition. So, we’ve developed this framework, where we say: “OK, these are the four different major areas through which consumer facing food and beverage company influences consumer health nutrition and that’s through their products, it’s through how those products are distributed, in the equity through which they’re distributed, the affordability and accessibility of those foods and then the marketing – How are those products marketed? Are the healthier products marketed more? What is the proportion of spending on healthy versus unhealthy products, in terms of marketing? Are they adhering to specific guidelines for marketing children? Breast milk substitutes things like that? The 4th and final area is: Have companies nutrition-related governance? What are their targets and commitments around consumers’ health and nutrition? Is the focus of innovation at the company towards improving health outcomes or is that not part of the conversation at all? And then, companies like CSR initiatives in the community, are they engaging the community in ways that help improve the health and nutrition of the community?
So, we have developed this framework and we have these ideas for metrics and part of what we’re now trying to do is to understand if there’s appetite among investors for these metrics – are they interested in them? Is it feasible for them to actually implement them and use them in investing decisions? So, that’s part of it. Also, validating those metrics is important, it’s something that we plan to do.
So, there’s kind of these different things: we have the Food Compass work that’s happening and is definitely related to ESG, and then there’s the ESG, which is kind of the broader, the investor’s interest in addressing consumer health and nutrition and how we can get these metrics into investment decisions. So, part of that, again, would be piloting the metrics with investment firms.
Obviously, we need data to be able to actually evaluate these things and so actually piloting it and testing it, seeing what works, what doesn’t work. I think these all are important next steps.
Finally, I think… I lost my train of thought
I mentioned at the beginning that there are all these different metrics that exist in these big major frameworks. There are also nonprofit organizations (if you’ve heard of “Access to Nutrition Index” or the “World Benchmarking Alliance”) that are specifically focused on the food and beverage sector. So, there’s all these existing metrics and it’s confusing and complicated for companies to know what to do. There are also some certain frameworks that have like 200 metrics, and it puts such reporting fatigue, it’s impractical to be put on all those things. So, coming to a short list – like “THESE are the most important metrics” – we think that it would help to move the needle, in terms of improving consumer health and nutrition. “This is our short list, opposed to the other huge, longer ones.”
And again, I think that trying to standardize is a goal, something that we can try to move towards, having standardized metrics to be used across the food and beverage sector. I think that there obviously have to be some tweaks and differences across say like retail versus restaurant – obviously they don’t have the exact same questions – but they’re going to get at the same things, like affordability and accessibility, as we said, the healthfulness is a product, the marketing governance, but potentially posed in different ways depending on the type of company that it is.
