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ERROR: type should be string, got "https://doi.org/10.1007/s40572-020-00292-3\nCurrent Environmental Health Reports (2020) 7:392–403 https://doi.org/10.1007/s40572-020-00292-3\nCurrent Environmental Health Reports (2020) 7:392–403 CLIMATE CHANGE AND HEALTH (C GOLDEN, SECTION EDITOR) Abstract Purpose of Review The purpose of this review is to describe the combined impacts of the nutrition transition and climate change\nin Nigeria and analyze the country’s national food-related policy options that could support human and planetary health\noutcomes. Recent Findings This paper uses a food systems framework to analyze how the nutrition transition and climate change interact in\nNigeria affecting both diets and the double burden of malnutrition, resulting in what has been termed the syndemic. Interactions\nbetween climate change and the nutrition transition in Nigeria are exacerbating diet-related inequities and will continue to do so if\nfood systems continue on their current trajectory and without significant transformation. Siloed policy actions that attempt to\nmitigate one aspect of food system risk can create a negative feedback loop in another aspect of the food system. Our analysis\nfinds that Nigeria has five national policies that include actionable steps to address food system insufficiencies; however, each of\nthese policies is constrained by the boundaries of singular nutrition, climate change, and agricultural objectives. The country\nshould consider a coherent policy environment that explicitly identifies and links underlying systemic and institutional drivers\nbetween climate change and malnutrition that simultaneously and comprehensively address both human and planetary health\noutcomes of food systems. Summary The systemic and institutional outcomes of this emerging syndemic—undernutrition, obesity, and climate change—\nare inexorably linked. Nigeria lacks a coherent policy environment taking on this challenging syndemic landscape. The analysis\nin this paper highlights the need for Nigeria to prioritize their national nutrition and agricultural and climate policies that uncouple\nfeedback loops within food systems to address climate change and malnutrition in all its forms. Keywords Nigeria . Food systems . Policy coherence . Nutrition transition . Climate change . Planetary health Nutrition Transition and Climate Risks in Nigeria: Moving Towards\nFood Systems Policy Coherence Alexandra E. Morgan1 & Jessica Fanzo2 Accepted: 16 September 2020\n# The Author(s) 2020\n/ Published online: 1 October 2020 Accepted: 16 September 2020\n# The Author(s) 2020\n/ Published online: 1 October 2020 2\nThe Nitze School of Advanced International Studies, Bloomberg\nSchool of Public Health, Berman Institute of Bioethics, Johns\nHopkins University, Washington, DC, USA 1\nThe Nitze School of Advanced International Studies, Johns Hopkins\nUniversity, Washington, DC, USA This article is part of the Topical Collection on Climate Change and\nHealth Introduction staple grains and salt, and sanitation and hygiene improve-\nments are partially responsible for reductions in the worldwide\nburden of undernourishment from 14.8 to 10.8% [3]. However, urbanization, income shifts, and work and lifestyle\npatterns have simultaneously produced an increase in over-\nweight and obesity across all regions [3]. The past two decades have produced a dynamic shift in world\ndiets for low and lower middle-income countries [1•, 2]. Increased income and some significant interventions such as\nthe promotion of exclusive breastfeeding, fortification of As populations become more affluent, dietary consumption\npatterns shift. While diets become more diverse, moving away\nfrom meals composed predominantly with staple grains and/\nor tubers, there is also higher intake of refined carbohydrates\nand highly processed foods (and drinks) with higher amounts\nof added sugars, unhealthy fats, and sodium, and animal\nsourced foods. This typical dietary shift is known as the nu-\ntrition transition [4, 5]. This pattern is associated with global-\nization and urbanization factors but also an increasingly sed-\nentary lifestyle [6], and the combination of these trends leads\nto shifts away from infectious diseases towards diet-related This article is part of the Topical Collection on Climate Change and\nHealth 1\nThe Nitze School of Advanced International Studies, Johns Hopkins\nUniversity, Washington, DC, USA 1\nThe Nitze School of Advanced International Studies, Johns Hopkins\nUniversity, Washington, DC, USA 1\nThe Nitze School of Advanced International Studies, Johns Hopkins\nUniversity, Washington, DC, USA Curr Envir Health Rpt (2020) 7:392–403 393 non-communicable diseases such as cardiovascular disease,\ndiabetes, and stroke [4, 5]. undernutrition, and unsustainable food systems are associated\nwith both burdens [8•, 15••, 18]. If no action is taken to ad-\ndress climate change and its impacts on food systems, the\nhistoric progress made to reduce undernutrition could be lost,\nand overweight and obesity trends will continue to increase\n[1•, 8•, 15••]. Human and planetary health outcomes cannot be\ndecoupled, and effective policies must target the feedback\nloops linking the health of both the planet and people [9••,\n15••]. What results from this transition is a population dealing\nwith both undernutrition and overweight and obesity—what\nhas been termed the double burden of malnutrition (also\ntermed the multiple burdens of malnutrition) [1•]. The inter-\naction between the nutrition transition and the epigenetic ef-\nfects of undernutrition has fueled this trend. Introduction Early nutritional\ndeficits put certain populations at risk for overweight and obe-\nsity later into adulthood [1, 7]. Both of these trends affect\nmorbidity and mortality, and poor diets remain a high-risk\nfactor for childhood death as well as adult non-\ncommunicable disease. Nigeria is the most populous country in Africa, and its\npopulation of 196 million people [19] is expected to double\nby 2050 [20]. Within the Economic Community of West\nAfrican States, Nigeria makes up more than two thirds of\nGDP [21]. Because of its economic growth and political status\nin the region, continent, and globally, guiding Nigeria towards\na trajectory towards sustainable development is critical\n[21–23]. Food systems connect and contribute to these dietary shifts,\npoor health outcomes, and environmental degradation [8•,\n9••]. Unsustainable food production systems allocate calories\nand nutrients in inefficient ways, while also contributing to\nclimate change [8•, 9••] and natural resource degradation\n[9••, 10••, 11]. Because of this circularity, climate change will\ncontinue to compound the health effects of malnutrition in all\nits forms [8•, 12–14]. The food systems framework (Fig. 1)\nhighlights the interactions between environment, food, and\nhealth. Nigeria is already experiencing the earlier described\n“syndemic.” Average maximum temperatures and average\nnumber of hot days have increased, while precipitation has\ndecreased in the country [24]. Temperature change has led\nto increasing desertification in the north, erratic and changing\nrainfall across the country, and increased flood risk in coastal\nregions and along the major river systems [25–28]. These\nchanges make food production, distribution, and utilization\nmore vulnerable, which in turn affect dietary and nutrition\noutcomes [16••, 29]. At the same time, Nigeria is experiencing\nthe double burden of malnutrition [30–32] with malnutrition\nranked as the number one risk factor for death and disability,\nand sub-optimal diets have risen to become the 7th highest\nrisk in the past decade [33]. Both climate change and the\nnutrition transition interact with the demographic shifts Climate change, undernutrition, and obesity share underly-\ning societal causes, and feedback loops between them magni-\nfy negative health and nutrition outcomes. This “syndemic” is\na synergy of epidemics that occur at the same time and place,\ninteract, and share common drivers [15••]. These emerging\nsyndemic risks exist in most countries but are particularly\nacute for the rural poor in the global South [16••, 17]. Food Systems Framing Food systems are composed of the people and activities that\nplay a part in growing, transporting, supplying, and, ultimate-\nly, eating food. These processes also involve elements that\noften go unseen, such as food preferences and resource invest-\nments. Food systems influence diets by determining what\nkinds of foods are produced and available in markets. They\nalso influence what foods people want to eat and are able to\naccess. As shown in Fig. 1, the different parts of the food\nsystem include food supply chains, food environments, and\nconsumer behavior (not shown in this framework for simpli-\nfication purposes). Food supply chains consist of the activities\nand actors that take food from production, storage and distri-\nbution, process and packaging, retail, and waste [34, 35]. Food environments are the physical, economic, political and\nsocio-cultural surroundings, opportunities, and conditions that\ncreate everyday prompts, shaping people’s dietary preferences\nand choices as well as nutritional status [34, 36]. They can be\nmarkets, restaurants, or cafeterias. These different parts shape\nfood systems and can lead to both positive and negative out-\ncomes across a range of outcomes [34]. Both rural-urban and north-south divisions are character-\nized by different nutritional challenges in Nigeria. While the\npopulation is evenly split between rural and urban residents\n[49], currently, urban populations are more likely to experi-\nence obesity and overweight while rural populations are more\nlikely to experience undernutrition [45]. However, evidence\nsuggests that rural places are beginning to catch up with urban\nobesity trends [50]. At the same time, DHS data show that in\nthe last 20 years underweight and vitamin deficiencies have\nbeen higher in the northern arid zones of the country, while\noverweight and obesity have been higher in the southern\nzones. Although northern zones produce more food for the\ncountry, residents in the north are the most likely to be food\ninsecure [23]. Childhood stunting and undernutrition are par-\nticularly acute in northern Nigeria. Almost half of all children\nin the northeast and northwest are stunted [51]. Food systems are not static. They are in constant transition\nand are shaped and shifted by different internal and external\ndrivers that push or pull the system in different directions [37]. While Fig. Introduction An\nincreasing number of countries are experiencing a double bur-\nden of overweight and obesity alongside continued Food supply chains\nFood environments\nFood production \nsystems and \ninput supply\nStorage and distribution\nProcessing and \npackaging\nDiets\nNutrition and \nhealth \noutcomes\nOther impacts\nSocial\nEconomic\nEnvironmental\nClimate \nChange\nGlobalization \nand Trade\nIncome \nGrowth and \nDistribution\nFood availability\nFood affordability\nProduct properties\nVendor properties\nFood messaging\nUrbanization\nFig. 1 Food systems framework. Source: 35 Income \nGrowth and \nDistribution Urbanization Nutrition and \nhealth \noutcomes Processing and \npackaging Fig. 1 Food systems framework. Source: 35 Curr Envir Health Rpt (2020) 7:392–403 394 occurring in Nigeria, exacerbating dietary inequalities and af-\nfecting access to high quality, nutrient-dense, and safe food on\na reliable basis. environments. For the purposes of this paper, we are focusing\non the gray-shaded elements and relationships of Fig. 1. Climate change and natural resources shape food system\nfunctionality, efficiency, and resiliency [38]. In turn, food sys-\ntems are a cause of climate change and environmental degra-\ndation [39]. Food systems contribute to greenhouse gas emis-\nsions, depletion of freshwater resources, deforestation, and\nnutrient pollution on landscapes and waterways [12]. The di-\nversity, safety, and quality of diets very much depend on\nthriving food systems. However, evidence suggests that sub-\noptimal diets dominate across the world, contributing to both\nenvironmental and climate degradation and detrimental health\noutcomes [9••]. This paper uses an adapted food systems framework (Fig. 1) from the High-Level Panel of Experts Report on Nutrition\nand Food Systems [34] to analyze the combined effects of\nclimate change and the nutrition transition on Nigerian diets,\nexamining multiple ways climate change will affect food sup-\nply chains and environments and its dietary and nutritional\nimpacts on consumers. It also reviews the literature on two-\nway relationship of role climate change in accelerating the\nnutrition transition and vice versa in Nigeria and assesses to\nwhat degree current national food-related policies in Nigeria\naddress the syndemic. Siloed actions that attempt to mitigate\nthe effects of one issue can create potential negative feedback\nloops and impacts in another area [15••]. In order to address\nclimate change and malnutrition, Nigeria must prioritize pol-\nicies that address the syndemic—by uncoupling feedback\nloops between climate, undernutrition, and obesity by\nstrengthening food system actions. Nutrition Transition of Nigeria Malnutrition in all its forms is the number one risk factor for\ndeath and disease in Nigeria [33]. The combined effects of\nrising obesity and stagnating stunting in children indicate that\nNigeria is going through a nutrition transition. Demographic\nand Health Survey (DHS) data have shown slight declines in\nstunting for children and adult female thinness as well as in-\ncreasing adult female overweight and obesity over the last\n20 years [40–44]. Independent studies have found that urban\nobesity increased by 20% in Nigeria between 2002 and 2010\n[45]. While some populations have access to sufficient calo-\nries, stunting and thinness have decreased slowly, and under-\nnourishment overall has risen since 2000, indicating that ad-\ndressing malnutrition will require multiple strategies that span\nhealth, food, care, and the environment [46–48]. Food Systems Framing 1 does not show all the myriad drivers that shape\nfood systems, climate change, urbanization, and globalization\nare significant drivers that instigate feedback loops of food\nsystem outcomes—diets, nutrition and health, environment,\nand livelihoods—on food supply chains and food Currently, Nigeria cannot meet food requirements through\ndomestic production [52]. The major food crops produced in\nthe country include cassava, cowpea, and sorghum [31, 53]. The Government of Nigeria (GON) reports that demand ex-\nceeds supply by more than 50% for rice, wheat, fish, milk, and\ntomatoes. Nigeria also underproduces maize, chicken, yams, Curr Envir Health Rpt (2020) 7:392–403 395 to 2010, and sugar-sweetened beverages have increased. There are increases, although small, in the consumption of\nmilk and fruits. This data source does not capture fish and\nseafood consumption, but these food sources are important\ncomponents of the Nigerian diet. Overall, the health of the\ndiet has not changed much over the last 15 years. Across the\nentire country, only 56% of women meet the minimum criteria\nfor dietary diversity, a marker for dietary quality, in the pre-\nvious day [40]. and oil palm to a lesser extent [52] and has significant losses of\nfruits and vegetables as these perishable foods move along the\nsupply chain [54]. Because it cannot meet its population’s\ndemand with its own production, Nigeria imports between\n$3 and $5 billion worth of food annually [55]. Food imports both reduce Nigeria’s foreign exchange re-\nserves and make consumers vulnerable to international prices. Over half of the population lives on less than $2 per day,\nincluding the majority of rural residents [4]. While some\nsmallholder farmers produce enough food for family con-\nsumption, the average rural family only produces a quarter\nof food they consume [18, 56]. Across the country, the aver-\nage household spends 65% of its income on food expenditure\n[57]. The unaffordability of nutritious food can be a signifi-\ncant barrier to consuming a healthy diet. The cost of a nutri-\ntionally adequate diet (CoNA) measures the minimum daily\ncost of meeting nutrient and energy requirements for a refer-\nence healthy adult woman, as a percent of daily per capita\nhousehold spending on food and non-alcoholic beverages. In\nNigeria, the CoNA is 92%, whereas in South Africa it is 42%\nand in the USA it is 32% [53]. Climate Vulnerability for Nigeria and Nigeria’s\nFood System In Nigeria, an increase in the number of days\nwith extreme temperature will reduce the output of cassava,\ncocoyam, sweet potatoes, cowpeas, and maize [63] By 2050,\nhotter temperatures are expected to reduce output of rice, sor-\nghum, millet, maize, yam, and cassava [68]. Increased rainfall\nwill also compromise sweet potato and rice production [64]. In the short term, warmer temperatures are associated with\nincreased production of millet, onions, tomatoes, and melon\nin northern Nigeria [63]; however, erratic rainfall patterns may\nreduce any positive effects of temperature. Pricing feedback loops highlight the economic effects of\nclimate change. Lowered or shifted yields will impact liveli-\nhoods for 60% of Nigeria’s labor force involved in agricultur-\nal production, 90% of which are smallholder farmers [27]. The\nprice effects of lowered yields will also affect non-farming\nand urban populations reducing their access to high quality\nand nutritious diets. Additional challenges affecting the food\nsystem include certain push factors such as increasing move-\nment from rural to urban areas, putting more stress on food\nsupply chains to urban areas and encroachment of urbaniza-\ntion into adjacent rural land (hinterlands) that are near major\nurban centers [26]. Figure 3 summarizes some effects of cli-\nmate change on food system elements (focusing on food sup-\nply chains and food environments), intermediary diet out-\ncomes, and nutrition and health outcomes in Nigeria using\nthe food systems framework in Fig. 1. Nutrient content will also shift in major food crops and\nconsumers’ access to nutrients will be negatively affected by\nchanges to food storage. Increased concentrations of atmo-\nspheric carbon dioxide will reduce zinc, iron, and protein in\nrice [69] and cassava will have increased concentrations of\ncyanide [60]. Heat will also make storage of vegetables more\ndifficult [29]. Consumers will also have elevated exposure to\nmycotoxins, such as aflatoxin, and mold increases because\nonly 10% of maize traders across the country fumigate and\ndry their wares [64]. Increased surface water temperature, sea level rise, and\nocean acidification will negatively affect aquaculture and fish-\neries [70, 71]. This will affect nutrient access for much of\nNigeria since fish make up about ½ of protein intake [70]. Human control may make aquaculture more resilient to cli-\nmate change [70]; however, farmed fish may hold less nutri-\ntional value than wild caught fish [72]. Nigeria is one of the\nseveral countries identified by Golden et al. Climate Vulnerability for Nigeria and Nigeria’s\nFood System The Nigerian government predicts that the major impacts for\nagricultural production will include lower yields and poor\nlivestock performance in the Sahel and savanna agro-\necological zones, rapid farm wastage, decreased soil fertility,\nand leaching. Seawater incursion and desertification will re-\nduce arable land [29]. Flooding will also affect coastal and\nfreshwater fisheries production negatively through siltation\nand contamination [61]. Some climate models suggest that\nrainfed agriculture may decline up to 50% by 2080, while\noverall agricultural productivity could decline by 10–25%\n[65]. irrigation. Only 1% of agricultural land currently uses modern\nirrigation [26, 28, 73]. The north central region may have\nlower sensitivity to rainfall changes in the short run, if lake\nwater in the region is harnessed to provide irrigation [26]. However, irrigation is not a panacea given uncertain changes\nin rainfall. Extreme weather may also cause flooding and a\nwidespread lack of flood control will make erratic rain partic-\nularly damaging [29, 62]. The agricultural impact of severe flooding caused by heavy\nrains in 2012 provides an example of the multiple pathways in\nwhich climate change may affect household nutrition. In\n2012, heavy rainfall strained dam infrastructure and flooded\nsettlements along the Niger, Benue, and Gongola rivers, caus-\ning $16.9 billion dollars worth of damage [62]. The disaster\ndestroyed 30% of the year’s rice production. The majority of\nfamilies affected by floods that relied on agricultural produc-\ntion to meet their family’s nutritional needs were forced to turn\nto markets to buy the majority of their food [62]. Increased\ndemand created a subsequent negative feedback loop elevat-\ning the price index for food and making market consumption\nmore inaccessible. Scarcity coping strategies used by families\nincluded borrowing food, reducing or skipping meals, and\nrelying on less preferred foods [62]. Countrywide surveys\nshow that even absent crisis level shocks, many families resort\nto food coping strategies. In 2010 and 2011, countrywide\nsurveys showed that between 7 and 9% of those in the lowest\nincome quintile used severe coping strategies such as going to\nbed hungry or borrowing food from the community or local\nNGOs as food assistance in the past 7 days [56]. Increasing temperature [63], shifts in rainfall, [64, 66] and\natmospheric carbon dioxide concentration [60] will drive\nshifts in agricultural yield. Across West Africa, a hotter dry\nseason will cause rice yields to decline, even with increased\nirrigation [67]. Climate Vulnerability for Nigeria and Nigeria’s\nFood System Temperatures in Nigeria are estimated to rise between 1.1 and\n2.6 °C by 2060 [60] leading to losses of up to 30% of GDP\n[61]. Sea level rise is expected to reach 1 m by 2050 [27]\naffecting coastal regions and river systems. Temperature in-\ncreases will affect agriculture mainly through changes in rain-\nfall. Climate change is projected to make the northern zones\ndrier and the southern zones more wet [27, 28, 60] Increasing\ndesertification will harm the northern part of the country,\nwhile sea level rise, saltwater intrusion, and flooding will af-\nfect the southern part of the country [62–64]. While GON analysis focuses mainly on staple crops, low\nconsumption of fruits and vegetables are also associated with\nnegative health outcomes, and the combination of both do-\nmestically produced and imported fruits and vegetables in\nNigeria do not meet the dietary requirements for daily vege-\ntable consumption [58]. Climate change will impact Nigeria’s agro-ecological\nzones in different ways. Nigeria has two main types of\nvegetation—tropical rainforest in the south and savannah in\nthe north. Erratic rainfall and unpredictable severe weather\nevents may affect agricultural production across both areas. While specific climate risks will differ depending on the agro-\necological zone, most key challenges will be related to water Figure 2 shows how diets have changed in Nigeria com-\nparing data from 1990 to 2010 (the most recent available)\nfrom the Global Dietary Database. There are interesting\ntrends. Whole grains and legumes have decreased from 1990 27.8\n98.1\n1.8\n100.2\n37.9\n15.3\n5.8\n25.6\n25.4\n53.2\n113.9\n58.9\n28.1\n103.3\n2.8\n82.3\n41.3\n17.5\n5.7\n25.3\n26.2\n72.3\n117.6\n44.8\n0.0\n20.0\n40.0\n60.0\n80.0\n100.0\n120.0\n140.0\nfiber\nfruits\nfruit juices\nlegumes\nmilk\nnuts and seeds\nprocessed meats\nred meats\nseafood\nsugar-sweetened beverages\nvegetables\nwhole grains\ngrams/day\n2010\n1990\nFig. 2 Changes in the Nigerian diets, 1990–2010. Source: [59] 2010\n1990 Fig. 2 Changes in the Nigerian diets, 1990–2010. Source: [59] Curr Envir Health Rpt (2020) 7:392–403 396 resources. In the north, dryness and drought will affect both\nagricultural production and livestock, while in the south, soil\nporosity issues will heighten the effects of sudden increased\nrain and flooding [26]. Climate change will impact each zone\ndifferently but will also shift the boundaries between the zones\n[27], challenging traditional agricultural cultivation patterns. Climate Vulnerability for Nigeria and Nigeria’s\nFood System as most reliant on\nfish, which also has estimated marine catch reductions of over\n20% by 2050 [72]. Climate Change-Driven Food System Impacts Nutrition and Health Outcomes Intermediary Dietary Outcomes Intermediary Dietary Outcomes Climate Change-Driven Food System Impacts\nIntermediary Dietary Outcomes\nNutrition and Health Outcomes\nReduced caloric intake\nReduced dietary quality and diversity\nIncreased risk of foodborne illness\nIncreased consumption of less \nperishable staple grains and tubers\nWasting \nStunting \nMicronutrient Deficiencies \nOverweight and Obesity\nNCDs\nFood supply chains\nReduced fruit and vegetable production\nIncreased loss of perishable foods\nIncreased contamination of foods with aflatoxin and molds\nIncreased concentration of cyanide in cocoyams\nDisrupted transportation and distribution\nLowered livestock productivity\nReduced fisheries and aquaculture production\nLowered production of rice, cocoyam, sweet potatoes\nReduced micronutrient content in rice and cassava\nFood environments\nIncreased vulnerability to infrastructure of markets\nReduced ability to get to markets Less foods available \nin markets\nIncrease waste of perishable foods\nIncreased cost of food\nFig. 3 Impacts of climate change on food systems for Nigeria. Sources: [26, 27, 29, 60, 61, 63, 64, 67] Food supply chains Increased risk of foodborne illness Wasting \nStunting \nMicronutrient Deficiencies \nOverweight and Obesity\nNCDs Reduced caloric intake\nReduced dietary quality and diversity Increased consumption of less \nperishable staple grains and tubers Fig. 3 Impacts of climate change on food systems for Nigeria. Sources: [26, 27, 29, 60, 61, 63, 64, 67] CCN), the National Policy on Food and Nutrition (NPFN), the\nAgriculture Sector Food Security and Nutrition Policy\n(ASFS), and the National Strategic Plan of Action on\nNutrition (NSPAN), to determine whether they used a food\nsystems framing to develop interventions targeting the\nsyndemic—malnutrition, nutrition-sensitive agriculture, and\nclimate change. Nigeria committed to the creation of a health\nand environment strategic alliance in the Libreville declara-\ntion, acknowledging the important link between environmen-\ntal risks and health outcomes [74]. Overall, Nigeria has devel-\noped strong policy guiding documents and national strategies\non climate change, nutrition, and agriculture. However, policy\nimplementation has been limited due to budgetary constraints\nand stakeholder fragmentation [23, 75] with state budgets and\npolicies not matching federal planning [23, 76]. affordability of diets or the choice architecture of these built\nplaces to facilitate healthier eating. More significantly, only 3\nof the policies contain a cost analysis of implementing the\ngoals and actions set out in those policies. All of the policies\ncontained a monitoring and evaluation (M&E) plan. Assessment of Relevant Nigerian Food-\nand Climate-Related Policies Using the food systems framework as a guide, we assessed\nfive national policies in Nigeria, the Agriculture Promotion\nPolicy (APP), the National Adaptation Strategy (NASPA- Rainfall change will have particularly negative effects on\nagriculture because of Nigeria’s dependence on rainfed Curr Envir Health Rpt (2020) 7:392–403 397 Climate Change-Driven Food System Impacts The most\ncomprehensive set of interventions along the supply chain\ncomes from the Agriculture Sector Food Security and\nNutrition Policy; however, this plan does not explicitly inte-\ngrate the effects of climate change on the supply chain. Table 1 below summarizes the results of the analysis. Challenges to Implementation While Nigeria’s policy documents highlight actionable items\nto create nutrition-sensitive and climate-smart interventions,\nsignificant challenges remain. The NASPA-CCN was devel-\noped in 2011, but fragmented implementation of the strategy\nhas made farm-level adaptation to climate change difficult to\nachieve [78]. The agricultural section of the National Climate\nPolicy focuses on the diversification of livestock, increased\naccess to drought resistant crops, better soil management prac-\ntices, national early warning systems, and increased use of\nirrigation and crop cover [61]. The government also suggests\nthe increased provision of crop insurance at subsidized rates\nfor smallholder farmers, provided by non-profits, or through\npublic-private partnerships. However, adaptation results have\nbeen limited. While the climate policy has ostensibly been in\neffect for 9 years, a 2019 study in two northern communities\nfound that while farmers were using adaptation strategies, they\nwere not utilizing the strategies best suited for their dryland The Nigerian government has made inroads to combine\nagriculture and nutrition policies using a systems perspective. However, the explicit integration of climate change adaptation\nand mitigation actions into nutrition policy has been limited. Three of 5 policies recognize the double burden of undernu-\ntrition and overweight/obesity, while two policies focus on\nundernutrition exclusively. The three nutrition polices have a\nweak focus on climate change, while the climate change pol-\nicy has little focus on nutrition. All five policies make target\ninterventions at various points along the supply chain, but\nagriculture production focused interventions are the most\nprevalent in the climate change and agriculture policies, while\ndemand focused interventions to improve diets are stronger in\nthe nutrition policies. Food environment interventions overall\nwere limited with very little focus on how to change the Curr Envir Health Rpt (2020) 7:392–403 Table 1\nNational policy environment in Nigeria\nNational strategy document\nYears active\nDoes the policy address\nmultiple burdens of\nmalnutrition? Does the policy address the ag-environment-nutrition\nnexus? Does the policy include\ninterventions along food systems? Challenges to Implementation Cost\nanalysis\nM&E plan\nNational Adaptation Strategy\nand Plan of Action\n(NASPA-CCN)\n2011–current No\nUndernutrition only\nNo\n•Focus on climate impacts on\nagricultural production\n•Focus on food access\n•No mention of nutritional\nquality of food\nNo\nFood supply chains\n•Improved agriculture systems for\ncrops and livestock\n•Increase irrigation\nFood environment/markets\n•Facilitate credit to smallholder\nfarmers\nNo\nYes*\n*Focused on building\nout framework, not\ninterventions\nAgriculture Promotion\nPolicy\n(APP)\n2016–2020\nYes\nRecognizes double burden of\nunderweight, overweight,\nand obesity\nNo\n•Focus on agribusiness supply chains\n•Integrating climate-smart agriculture*\n•Integrating nutrition-sensitive programming*\n*Mentioned as a goal to integrate throughout all\nobjectives, but many objectives lack integration of\nnutrition and climate\nYes\nFood supply chains\n•Fertilizer, increased soil nutrients\n•Irrigation\n•Pest and disease control services\n•National grain storage centers\nFood environment/markets\n•Infrastructure improvement\nDiets\n•Import substitution to reduce\neffects of exchange rate policy\non consumers\n•School feeding programs\n•Strategic reserves of food\nNo\nYes\nNational Policy on Food and\nNutrition\n(NPFN)\n2016–Current Yes\nRecognizes burden of\nmalnutrition in all its forms\nNo\n•Links agriculture and food security\n•Does not mention climate change\nYes\nFood supply chains\n•Promote priority value chain\ncrops\n•Improved on-farm storage\n•Myco-toxin prevention\n•Improve processing and\npreservation\nFood environments/markets\n•Effective food distribution\nsystems\n•Improved infrastructure\nDiets\n•Biofortification of staple foods,\nvitamin provision\n•Food quality standards\n•National buffer stock to reduce\nprice volatility\n•School feeding programs\nNo\nYes\n2016–2025\nYes\nNo\nYes\nYes\nYes\n8\nCurr Envir Health Rpt (2020) 7:392–403 398 p\ny\ng\nNational strategy document\nYears active\nDoes the policy address\nmultiple burdens of\nmalnutrition? Does the policy address the ag-environment-nutrition\nnexus? Does the policy include\ninterventions along food systems? Challenges to Implementation Cost\nanalysis\nM&E plan\nNational Adaptation Strategy\nand Plan of Action\n(NASPA-CCN)\n2011–current No\nUndernutrition only\nNo\n•Focus on climate impacts on\nagricultural production\n•Focus on food access\n•No mention of nutritional\nquality of food\nNo\nFood supply chains\n•Improved agriculture systems for\ncrops and livestock\n•Increase irrigation\nFood environment/markets\n•Facilitate credit to smallholder\nfarmers\nNo\nYes*\n*Focused on building\nout framework, not\ninterventions\nAgriculture Promotion\nPolicy\n(APP)\n2016–2020\nYes\nRecognizes double burden of\nunderweight, overweight,\nand obesity\nNo\n•Focus on agribusiness supply chains\n•Integrating climate-smart agriculture*\n•Integrating nutrition-sensitive programming*\n*Mentioned as a goal to integrate throughout all\nobjectives, but many objectives lack integration of\nnutrition and climate\nYes\nFood supply chains\n•Fertilizer, increased soil nutrients\n•Irrigation\n•Pest and disease control services\n•National grain storage centers\nFood environment/markets\n•Infrastructure improvement\nDiets\n•Import substitution to reduce\neffects of exchange rate policy\non consumers\n•School feeding programs\n•Strategic reserves of food\nNo\nYes\nNational Policy on Food and\nNutrition\n(NPFN)\n2016–Current Yes\nRecognizes burden of\nmalnutrition in all its forms\nNo\n•Links agriculture and food security\n•Does not mention climate change\nYes\nFood supply chains\n•Promote priority value chain\ncrops\n•Improved on-farm storage\n•Myco-toxin prevention\n•Improve processing and\npreservation\nFood environments/markets\n•Effective food distribution\nsystems\n•Improved infrastructure\nDiets\n•Biofortification of staple foods,\nvitamin provision\n•Food quality standards\n•National buffer stock to reduce\nprice volatility\n•School feeding programs\nNo\nYes\n2016–2025\nYes\nNo\nYes\nYes\nYes\n8\nCurr Envir Health Rpt (2020) 7:392–403 No No Curr Envir Health Rpt (2020) 7:392–403 399 (continued)\nl strategy document\nYears active\nDoes the policy address\nmultiple burdens of\nmalnutrition? Does the policy address the ag-environment-nutrition\nnexus? Does the policy include\ninterventions along food systems? Challenges to Implementation Cost\nanalysis\nM&E plan\nure Sector Food\nity and Nutrition\ny\nRecognizes burden of\nmalnutrition in all its forms\n•Strong focus on agriculture and nutrition\n•Climate change mentioned once\nFood supply chains\n•Expand production of\nbio-fortified foods\n•Scale up fruit and vegetable\nproduction\n•Reduce post-harvest loss through\nincreased cold storage and\nprocessing\n•National aflatoxin control\ninitiative\nFood environments/markets\n•Facilitate access to credit for\nsmallholder farmers\n•Improved nutrition labeling\nDiets\n•Develop improved food-based\ndietary guidelines\nSector Component of\nnal Food and\ntion Policy\nN)\n2014–2019\nNo\nFocus on undernutrition,\nspecifically for mothers and\nchildren\nDoes not address overweight\nand obesity\nNo\n•No mention of agriculture or climate change\nNo\nDiets\n•Vitamin supplementation\n•Feeding centers for severe acute\nmalnutrition\n•Breastfeeding promotion\nYes\nYes\n[30, 31, 52, 61, 77] National strategy document\nYears active\nDoes the policy address\nmultiple burdens of\nmalnutrition? Does the policy address the ag-environment-nutrition\nnexus? Does the policy include\ninterventions along food systems? Cost\nanalysis\nM&E plan\nAgriculture Sector Food\nSecurity and Nutrition\nPolicy\n(ASFS)\nRecognizes burden of\nmalnutrition in all its forms\n•Strong focus on agriculture and nutrition\n•Climate change mentioned once\nFood supply chains\n•Expand production of\nbio-fortified foods\n•Scale up fruit and vegetable\nproduction\n•Reduce post-harvest loss through\nincreased cold storage and\nprocessing\n•National aflatoxin control\ninitiative\nFood environments/markets\n•Facilitate access to credit for\nsmallholder farmers\n•Improved nutrition labeling\nDiets\n•Develop improved food-based\ndietary guidelines\nHealth Sector Component of\nNational Food and\nNutrition Policy\n(NSPAN)\n2014–2019\nNo\nFocus on undernutrition,\nspecifically for mothers and\nchildren\nDoes not address overweight\nand obesity\nNo\n•No mention of agriculture or climate change\nNo\nDiets\n•Vitamin supplementation\n•Feeding centers for severe acute\nmalnutrition\n•Breastfeeding promotion\nYes\nYes 400 Curr Envir Health Rpt (2020) 7:392–403 environment [79]. Irrigation policies are also critical for cli-\nmate adaptation, but efforts to scale up irrigation have been\nfragmented and duplicative [73, 80]. large strides to improve its policy environment and coherence. Its 2017 agricultural and nutrition policy highlights a systemic\nunderstanding of the drivers of malnutrition. Integrating cli-\nmate change into a more coherent food systems framework\nwould provide nuance to future assessments of malnutrition\nand will allow Nigeria to address and mitigate climate risks for\nnutrition. Doing so would require some major revisions to the\npolicy. Ecker et al. Challenges to Implementation (2020) also recommended that Nigeria’s\npolicymakers consider adopting a food systems framework to\nreformulate national food and nutrition policies in order to\nimprove household diets and reduce the multiple burdens of\nmalnutrition [89]. Numerous surveys of Nigerian farmers have highlighted\nthe continued challenges to increase the use of adaptation\nstrategies. Studies of farmers’ perceptions of climate change\nhave shown that farmers accurately perceive changes in tem-\nperature and rainfall [81], but climate adaptation strategies\ndepend on farmer income, perception of risk, and environment\n[82–84]. Other surveys have found that adaptation strategies\nfor farmers differ between older and younger farmers [82] and\nthat in some communities, challenges remain regarding\nfarmers’ perception of the causes of climate change. Farmers\nwith larger farms, higher incomes, and more schooling are\nmore likely to practice adaptation strategies [82] while those\nthat link climate change to religious beliefs are less likely to\nproactively use adaptive strategies [81]. A significant infor-\nmation gap exists between farmers [83]. Without increasing\nexpenditure on agriculture and other related industries such as\naquaculture and agroforestry, smallholder farmers are likely to\nbe left out of mitigation and adaptation strategies. One revision would be to fulfill the Comprehensive Africa\nAgriculture Development Program (CAADP) pledge to invest\nin agriculture, and, within agriculture, nutrition-climate-\nsensitive agriculture. Nigeria is a signatory to CAADP, which\nhas set a goal of 10% of government budget going towards\nagriculture. However, Nigeria has consistently\nunderperformed on this metric. Average yearly agricultural\nspending between 2008 and 2012 only totaled 4.6% of the\nnational budget. [90]. The most recent CAADP performance\nassessment gave Nigeria 0% progress on its three goals related\nto modernized agriculture, well-nourished citizens, and envi-\nronmentally sustainable and climate resilient economies [91]\nNigeria must increase domestic funding for climate, agricul-\nture, and nutrition in order to address malnutrition. Nutrition policies also lack budget allocations. The Scaling\nup Nutrition (SUN) Movement reports that Nigeria has met\n70% of the criteria for an enabling policy environment for\nnutrition as of 2019 [85]. However, budget allocations have\nnot matched the goals outlined in the costed strategies. Surveys of government and NGO stakeholders in 2015 and\n2016 found concerns about appropriate resource allocation at\nthe federal and state level [86]. In 2019, Nigeria only spent\n0.2% of its budget on nutrition specific interventions [85]. Budget delays lead to limited implementation. Challenges to Implementation A review of\nfederal stakeholders with responsibility for the NSPAN\n(2014–2019) found that only 1/3 had begun implementation\nof the plan by 2018 [87]. Limited domestic resource mobili-\nzation means that nutrition programs rely heavily on interna-\ntional donors for funding [85] and those resources can vary\nwidely depending on donor motivations. A second revision would be to consider double- or triple-\nduty actions. Double- and triple-duty actions simultaneously\nact on two or three of the epidemics (undernutrition, over-\nweight, and/or climate). One example could be reducing red\nmeat consumption to prevent cancer/obesity (obesity/NCDs),\nincrease land efficiency to grow food for human consumption\n(undernutrition), and lower greenhouse gas emissions (climate\nchange). These actions are carefully calibrated so that a focus\non undernutrition does not lead to an increase in overweight\nand obesity for certain populations [92••]. Swinburn and col-\nleagues articulated areas in which double- or even triple-duty\nactions could mitigate the sydemic, many with direct actions\nwith food environments, the place where consumers engage\nwith food systems [15••]. However, if Nigeria’s national pol-\nicies that touch on food systems do not address the impacts of\nclimate change, today’s investments may have little impact in\nthe next three decades. An integrated, holistic food systems\nframing linking climate-smart and nutrition-sensitive agricul-\nture on both land and water could identify priority areas for\ntriple-duty actions to make a more significant impact on the\nsyndemic in Nigeria [9••]. Some examples include scaling up\nnutrition-sensitive agriculture programs with climate adapted\nseeds and irrigation technologies, adapting food-based dietary\nguidelines to promote nutrient-dense and climate-conscious\ndiets, taxing highly processed foods and devoting revenue\nstreams to climate-smart agricultural policies, and developing\nmore urban agriculture. While some of these elements are Strong policy guidance with a lack of implementation\nfunding has been a continued problem for the agriculture,\nclimate, and nutrition sectors in Nigeria. Increased govern-\nment spending on agriculture has been linked to economic\ngrowth [88]. However, Nigerian budgets are heavily depen-\ndent on world oil prices [23, 26], and current price slumps\njeopardize programming for agriculture and nutrition\n(Table 1). • Of importance • Of importance •• Of major importance 1.• Popkin BM, Corvalan C, Grummer-Strawn LM. Dynamics of the\ndouble burden of malnutrition and the changing nutrition reality. Lancet. 2020;395(10217):65–74 This study describes the chang-\ning nutrition dynamics across the world as malnutrition stag-\nnates and overweight/obesity rises. They argue the double bur-\nden of malnutrition is rising in low- and middle-income\ncountries. 16.•• Fanzo J, Mclaren R, Davis C, Choufani J. Climate change and\nvariability: What are the risks for nutrition, diets and food systems? IFPRI Discussion Paper 01645. 2017. This report provides a\nthorough analysis of the multiple ways climate change will im-\npact nutrition along the supply chain. The report stresses the\nneed to create solutions for vulnerable populations that will be\nparticularly affected by climate-related food insecurity. 2. Dietz WH. Double-duty solutions for the double burden of malnu-\ntrition. Lancet. 2017;390(10113):2607–8. 2. Dietz WH. Double-duty solutions for the double burden of malnu-\ntrition. Lancet. 2017;390(10113):2607–8. 17. IPCC. Global Warming of 1.5°C. An IPCC Special Report on the\nimpacts of global warming of 1.5°C above pre-industrial levels and\nrelated global greenhouse gas emission pathways, in the context of\nstrengthening the global response to the threat of climate change,\nsustainable development, and efforts to eradicate poverty [Masson-\nDelmotte V, Zhai P, Pörtner HO, Roberts D, Skea J, Shukla JR\net al]. In Press. 2018. 3. FAO, IFAD, UNICEF, WFP and WHO. The State of Food Security\nand Nutrition in the World 2019. In: Safeguarding against econom-\nic slowdowns and downturns. Rome: FAO; 2019. 3. FAO, IFAD, UNICEF, WFP and WHO. The State of Food Security\nand Nutrition in the World 2019. In: Safeguarding against econom-\nic slowdowns and downturns. Rome: FAO; 2019. 4. Drewnowski A, Popkin BM. The nutrition transition: new trends in\nthe global diet. Nutr Rev. 1997;55(2):31–43. 4. Drewnowski A, Popkin BM. The nutrition transition: new trends in\nthe global diet. Nutr Rev. 1997;55(2):31–43. 5. Popkin BM. Relationship between shifts in food system dynamics\nand acceleration of the global nutrition transition. Nutr Rev. 2017;75(2):73–82. 18. FAO. Small family farms country factsheet: Nigeria. Food and\nAgriculture Organization. 2018. http://www.fao.org/3/i9930en/\nI9930EN.pdf. Accessed 15 Mar 2020. 6. Steyn NP, Mchiza ZJ. Obesity and the nutrition transition in sub-\nSaharan Africa. Ann N Y Acad Sci. 2014;1311(1):88–101. 19. World Bank Group. Population total- Nigeria. https://data. worldbank.org/indicator/SP.POP.TOTL?locations=NG. Accessed\n15 Mar 2020. 7. Conclusion and Recommendations While budgetary dependence on oil revenues and the frag-\nmentation of the federal system will challenge Nigeria’s abil-\nity to implement policies that focus on the common systemic\ndrivers of malnutrition and climate change, Nigeria has made Curr Envir Health Rpt (2020) 7:392–403 401 environment, and reduce climate change for a growing\npopulation. already present in Nigeria’s national policies, budgetary\nguidelines do not explicitly promote double- or triple-duty\nactions. Given Nigeria’s budget constraints and oil revenue\nvolatility, double- or triple-duty actions should become prior-\nity strategies. p p\n10.•• IPCC. Climate Change and Land: an IPCC special report on climate\nchange, desertification, land degradation, sustainable land manage-\nment, food security, and greenhouse gas fluxes in terrestrial ecosys-\ntems [Shukla PR, Skea J, Calvo E, Buendia V, Masson-Delmotte\nHO, Pörtner DC et al (eds.)]. In Press. 2019. This report provides\na detailed analysis of climate change interactions with agricul-\nture and food security and weighs the evidence of high to low\nconfidence for adaptation and mitigation across food systems. Open Access This article is licensed under a Creative Commons\nAttribution 4.0 International License, which permits use, sharing, adap-\ntation, distribution and reproduction in any medium or format, as long as\nyou give appropriate credit to the original author(s) and the source, pro-\nvide a link to the Creative Commons licence, and indicate if changes were\nmade. The images or other third party material in this article are included\nin the article's Creative Commons licence, unless indicated otherwise in a\ncredit line to the material. If material is not included in the article's\nCreative Commons licence and your intended use is not permitted by\nstatutory regulation or exceeds the permitted use, you will need to obtain\npermission directly from the copyright holder. To view a copy of this\nlicence, visit http://creativecommons.org/licenses/by/4.0/. 11. Ripple WJ, Wolf C, Newsome TM, Barnard P, Moomaw WR. ‘World scientists’ warning of a climate emergency. BioScience. 2019. https://doi.org/10.1093/biosci/biz088. 12. Searchinger T, Waite R, Hanson C, Ranganathan J, Dumas P,\nMatthews E. Creating a sustainable food future. World Resources\nReport. World Resources Institute. 2019. https://wrr-food.wri.org/\nsites/default/files/2019-07/WRR_Food_Full_Report_0.pdf. Accessed 20 Mar 2020. 13. Springmann M, Clark M, Mason-D’Croz D, Wiebe K, Bodirsky\nBL, Lassaletta L, et al. Options for keeping the food system within\nenvironmental limits. Nature. 2018;562:519–25. https://doi.org/10. 1038/s41586-018-0594-0. 14. Springmann M, Mason-D’Croz D, Robinson S, Garnett T, Godfray\nHCJ, Douglas G, et al. Global and regional health. Lancet. 2016;387:1937–46. References 15.•• Swinburn BA, Atkins VJ, Baker PI, Bogard JR, Brinsden H,\nCalvillo A. The global syndemic of obesity, undernutrition and\nclimate change: The Lancet Commission report. Lancet. 2019;393:791–846 This report highlights the feedback loops\nconnecting climate change, undernutrition, and overweight/\nobesity. It develops a new framework to understand these re-\nlationships as a syndemic as well as the drivers and underlying\ncauses that cause these outcomes. Papers of particular interest, published recently, have been\nhighlighted as: • Of importance Nigeria’s first national commu-\nnication under the United Nations Framework Convention on\nClimate Change. Federal Republic of Nigeria. 2003. 47. Baye K, Laillou A, Chitweke S. Socio-economic inequalities in\nchild stunting reduction in sub-Saharan Africa. Nutrients. 2020;12(1):253. 28. Haider H. Climate change in Nigeria: impacts and responses. K4D\nHelpdesk Report 675. Institute of Development Studies: Brighton;\n2019. 48. Ndukwu CI, Egbuonu I, Ulasi, TO, Ebenebe JC. 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Global Alliance for Improved\nNutrition (GAIN) and Johns Hopkins University. 2020. Geneva,\nSwitzerland. https://www.foodsystemsdashboard.org. 36. Swinburn B, Kraak V, Rutter H, Vandevijvere S, Lobstein T, Sacks\nG, et al. Strengthening of accountability systems to create healthy\nfood environments and reduce global obesity. Lancet. 2015;385:\n2534–45. 55. USAID. Global food security strategy Nigeria country plan. U.S. Agency for International Development. • Of importance Wells JC, Sawaya AL, Wibaek R, Mwangome M, Poullas MS,\nYajnik CS, et al. The double burden of malnutrition: aetiological\npathways and consequences for health. Lancet. 2019;395:75–88. 20. United Nations department of Economic and Social Affairs,\nPopulation Division. World Population Prospects 2019:\nHighlights. 2019. (ST/ESA/SER.A/423). Accessed 10 Mar 2020. 8.• Whitmee S, Haines A, Beyrer C, Boltz F, Capon AG, Ferreira de\nSouza Dias B, et al. Safeguarding human health in the\nAnthropocence epoch: report of the Rockefeller Foundation-\nLancet Commission on planetary health. Lancet. 2015;386:1973–\n2028 This report comprehensively describes the interactions\nbetween climate and human health. 21. African Development Bank Group. West Africa economic outlook\n2019. 2019 https://www.afdb.org/en/documents/document/\nregional-economic-outlook-2019-west-africa-108624. Accessed\n10 Mar 2020. 22. African Development Bank Group. West Africa economic outlook\n2018. 2018. https://www.afdb.org/fileadmin/uploads/afdb/\nDocuments/Publications/2018AEO/African_Economic_Outlook_\n2018_West-Africa.pdf. Accessed 10 Mar 2020. 9.•• Willet W, Rockström J, Loken B, Vermeulen S, Garnett T, Timan\nD, et al. Food in the anthropocene: the EAT-Lancet Commission on\nhealthy diets from sustainable food systems. 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