Using the public health topic identified during assessment 1, write a critical review of the

literature, including evidence drawn from at least one systematic review. The focus 3 of this

critical review should be to inform a key area of professional practice and so should represent

a thorough and critical synthesis of the most recent and best evidence available, concluding

with specific recommendations for practice.

CRITICAL REVIEWED ON “FOOD AND NUTRITION INSECURITY:

DISRUPTIONS OF THE FOOD SYSTEM BY THE COVID-19 PANDEMIC”.

INTRODUCTION

The public health topic of focus for this literature review is ‘Food and Nutrition Insecurity:

Disruption of the Food System by the Corona Virus Disease 19 (COVID-19) pandemic’.

“Food systems encompass the entire range of actors and their interlinked value-adding

activities involved in the production, aggregation, processing, distribution, consumption and

disposal of food products that originate from agriculture, forestry or fisheries, and food

industries, and the broader economic, societal and natural environments in which they are

embedded (Braun et al., 2021)”. These value-adding activities of the food system cannot
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progress without human activities. It is not surprising that a pandemic that restricts human

activities like COVID-19 has disrupted the global food system.

Disruptions in the food system is a potential threat to food and nutrition security. “Food and

nutrition security exist when all people at all times have physical, social and economic access

to food of sufficient quantity and quality in terms of variety, diversity, nutrient content and

safety to meet their dietary needs and food preferences for an active and healthy life, coupled

with a sanitary environment, adequate health, education and care” (Braun et al., 2021). 

Farmers, traders, retailers, food manufacturers, foodservice businesses, nutritionists, workers

in the food supply chain, and policymakers in the agriculture development sector are

examples of occupations involved in the sustenance of an effective food system. Key among

these occupations are the policymakers. They develop and implement policies on access to

safe and nutritious food, reducing food waste, effects of climate change on agricultural

activities, ensuring equitable livelihoods and building resilient food systems (Braun et al.,

2021). It is important for these professionals to understand how the pandemic affected

individuals and identify the right interventions to address similar future occurrences.

The linkage between food security and health is malnutrition. Optimal nutrition is one of the

main determinants of health. It is not surprising that Zero Hunger (End hunger, achieve food

security and improved nutrition and promote sustainable agriculture) is the second

sustainable development goal (United Nations, 2021). COVID-19 has had some devastating

effects on employment, freedom of movement, healthcare, food security, tourism and

transport, and the global economy just to mention a few (World Health Organisations, 2021).

In April 2020, the United States of America recorded its highest unemployment rate of 14.7%

since 1933 and 22.8% food insecurity, twice the value in 2018 (Litton and Beavers, 2021).

Even before the pandemic, about 75% of the world’s population were not consuming
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recommended consumption of fruits and vegetables (Msambichaka  et al., 2018). A poor-

quality diet characterises this season of COVID-19. Fruits and vegetables are key to obtaining

optimal nutrition. Policymakers should up their game in facilitating quality nutrition. This is

because optimal nutrition reduces the risk of chronic disease, boosts immunity, enhance

better prognostic outcomes of diseases and offers a higher recovery from COVID-19

(Coelho-Ravagnani et al., 2021).

This critical review aims to identify some disruptions in the food system caused by the

prevailing COVID-19 pandemic, suggest practical measures to mitigate these disruptions and

increase the preparedness of governments in future pandemics. This will provide high-quality

evidence to guide key professionals in developing and implementing policies that will

promote proper food and nutrition security. 

DISCUSSION

Validity of literature

Concerning the public health topic above, four studies will be critically reviewed: Murphy et

al (2021), Éliás and Jámbor (2021), Picchioni, Goulao and Roberfroid (2021) and Van Dijk

et al (2021). Apart from Murphy et al (2021) which was a cross-sectional study, all the others

were systematic reviews that summarized quantitative data from primary observational

studies. These studies had clearly defined research questions that addressed various aspects of

COVID-19 related food and nutrition insecurity. 

Murphy et al (2021) through social media, external market research agencies and researcher

networks reached 2360 global participants to participate in an online cross-sectional survey.

Considering COVID-19 restrictions at the period of study, this method was the most

appropriate. The researchers provided details of the methodology and data analysis making

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their study very easy to reproduce. Their findings give policymakers an understanding of diet

quality and consumers food practices during health crises.

Using the Preferred Reporting Items for Systematic reviews and Meta-analysis (PRISMA),

all the systematic reviews in this critical review selected the best available peer-reviewed

literature useful to their research question. COVID-19 restrictions limited majority of the

study designs cross-sectional surveys of descriptive design.

Both Éliás and Jámbor (2021) and Picchioni, Goulao and Roberfroid (2021) could not

conduct a meta-analysis on the included studies due to their heterogeneous nature. There

were differences in the methodology, data type collected, participants characteristics, period

of study and the analysis tool. While Éliás and Jámbor (2021) failed to comment on the

quality of studies included in their systematic review, Picchioni, Goulao and Roberfroid

(2021) revealed that only one out of the 35 primary studies were of high quality. Per their

observation majority of the studies did not describe the sampling process as well as the

proportion of no respondents. These notwithstanding, both systematic literature reviews serve

as high-quality evidence exposing the food and nutrition insecurities resulting from COVID-

19.

van Dijk et al (2021) is “a meta-analysis of the projected global food demand and the

population at risk of hunger for the period 2010 – 2050”. This study did not focus on the

impact of COVID-19. However, it was included in this critical review to remind key

professionals of the food system that, food insecurity persists as a global challenge for over

decades. Without considering the impact of health crises like COVID-19 a 35% - 56%

increase in global food demand is envisioned in 2050. Findings from this study are expected

to motivate policymakers to consider food insecurity as a public health topic of high priority.

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As stated above, this meta-analysis followed the PRIMA checklist to select 57 relevant

studies from a wide range of search engines. van Dijk et al (2021) observed a high level of

uncertainties in projections by all 57 studies due to differences in methodology and analysis.

To homogenize projections and make studies comparable, the researchers mapped the

selected studies to the Shared Socio-economic Pathways (SSP) and Representative

Concentration Pathways (RCP). Few studies could not be mapped to one of the SSP models

and were excluded from subsequent analysis. This was a brilliant approach by researchers in

their meta-analysis.

In summary, all four studies included in this critical review are valid in terms of methodology

and results. Considering the period of study and the problem of heterogeneity, the researchers

described and adopted the most suitable methodology for their studies. With globally

representative samples, findings from these studies are globally applicable. Professionals

responsible for designing and implementing interventions on food and nutrition security

should consider findings from this literature as high literature evidence in their activities.

Evidence from the literature

Upon critical review of these studies, it is evident that COVID-19 disrupted global food

systems resulting in food and nutrition insecurity.

1. Low income:

A major disruption of the food system reported in Éliás, and Jámbor (2021) and Picchioni,

Goulao and Roberfroid (2021) was low income. Low income is a factor that has replying

effect on diverse aspects of the food chain. Talk of affordability, access to food, quality and

quantity of food, farm input, and transport. 85% and 71.8% of responders from India and

Bangladesh experienced low income during the COVID-19 pandemic (Picchioni, Goulao and

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Roberfroid, 2021) Throughout their study, Éliás, and Jámbor (2021) constantly reminded its

readers that the greatest disruption to global food insecurity during the COVID-19 pandemic

is low income; all other disruptions are resultant effects.

They observed a direct relationship between food insecurity and low income. 43% of food

insecurity was reported in Bangladesh, 38% - 43% in Uganda, 15% higher food insecurity

among women compared to their male counterparts, 62% increase in food insecurity

associated with low income in India (Éliás, and Jámbor, 2021). Though these are

observations from a high level of literature, this observation should be interpreted with care

as Éliás, and Jámbor (2021) is a review of low-quality literature. van Dijk et al (2021) gives

further support to this observation, reporting income growth as the second driver of global

food insecurity. 

2. Panic and/or bulk buying

According to Murphy et al (2021) and Éliás, and Jámbor (2021), bulk buying or panic buying

suddenly increased in the early stages of the pandemic. This probably contributed to the

temporal unavailability of ingredients and its resulting increase in the purchase of readymade

foods (Murphy et al., 2021; Picchioni, Goulao and Roberfroid, 2021). Participants from Great

Britain, the Island of Ireland, New Zealand, and the United States of America reported

significant difficulty in accessing ingredients (p < 0.001) (Murphy et al., 2021). This is

comparable to Picchioni and colleagues’ systematic review which reported a 61% increase in

the difficulty to access the same quantity and/or quality of food in the early parts of the

pandemic. 

3. High food prices

Panic buying, bulk buying, increased demand, reduced food transport due to restrictions all

contributed to the increased food prices reported (Éliás, and Jámbor, 2021; Picchioni, Goulao

and Roberfroid, 2021). 94% of participants in Bangladesh and 61% in Cote d’Ivoire reported
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an increase in food prices. The consumer price index (CPI) increased by 24% in the early

parts of the pandemic (Picchioni, Goulao and Roberfroid, 2021). van Dijk et al (2021)

reported food prices as the third indicator of food security. This higher hierarchy of evidence

affirms increase food prices as a disruption to the food system. Restraining food from export

by some countries (as a means of achieving national sufficiency) and storing crops for a later

time when prices increase created avoidable shortage (Éliás, and Jámbor, 2021). Increased

food prices cause an unhealthy balanced diet for people with low income since they could not

purchase the expensive nutrient-rich foods.

4. A decline in the consumption of fruits and vegetables

One will naturally expect an increase in consumption of fruit and vegetables in a health crisis

to boost immunity. This was not entirely the case during the COVID-19 pandemic. In

Murphy et al (2021), consumption of fruits and vegetables increased in participants from

Great Britain while only fruit consumption increased in New Zealand and the Island of

Ireland (p < 0.001). It should be noted that their study is a single cross-sectional study with

participants from different regions. Hence, an increase in fruit and vegetable consumption in

three regions should not be considered as three different studies.

Four out of the five studies that reported on fruits and vegetable consumption in Éliás, and

Jámbor, (2021) reported a decline with only one study from Spain reporting a significant

increase. Two of these studies that reported the decline were African countries and the other

two were conducted in the United States of America. About 50% of households in India

reported a significant decline in the consumption of fruits (Picchioni, Goulao and Roberfroid,

2021). In all, five out of seven studies reported the decline. All five out of seven studies

reported this decline. More studies are required to investigate reasons that accounted for these

observations; be it the economic status of a country, sampling bias or otherwise. 

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With less supporting data, Picchioni, Goulao and Roberfroid (2021) reported that females and

children are more likely to reduce their intake of fruits, vegetables, and proteins. In Ethiopia,

about 16% and 30% of female farmers ate reduced food quantity and bought less expensive

food. van Dijk et al (2021) provides evidence for this observation in their study by listing

childhood undernutrition and increased population at risk of hunger (women, children, low

socio-economic population) as major indicators of food insecurity. 

5. Increased household cooking 

Another healthy effect of COVID-19 aside from consumption of fruits and vegetables is

increased household cooking and decreased food wastage (p < 0.001) (Murphy et al., 2021).

Unfortunately, only a fragment of participants in the cross-sectional survey (Britain and

Ireland) reported this behavioural change. Home cooking is often associated with the use of

healthy ingredients (Murphy et al., 2021). However, forced home cooking caused by

lockdowns amidst a temporary shortage of food items could have negative implications. With

more mouths to feed, no school feeding support, and boredom, home cooking can negatively

raise the demand for ingredients. Classifying household cooking as a positive behaviour

could be misleading since Murphy et al (2021) did not investigate the quality of food cooked

in households. Further investigations should be conducted to evaluate this finding with a

larger sample in higher-level literature.

6. Consumption of unhealthy and unbalanced diet

Consuming unhealthy and unbalanced diets were reported in Murphy et al (2021), Éliás, and

Jámbor (2021), Picchioni, Goulao and Roberfroid (2021). There was an increase in

consumption of processed foods and snacks observed in 9 studies reviewed by Éliás, and

Jámbor (2021). Other participants admitted to eating less quantity and quality of food who

due to fear of contracting the disease failed to shop for food (Éliás, and Jámbor, 2021). A

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significant increase in consumption of saturated fat (p < 0.001) was reported in the islands of

Ireland, Great Britain, and New Zealand (Murphy et al., 2021).

Seven out of the 35 studies reviewed in Picchioni, Goulao and Roberfroid (2021) also

reported unhealthy consumption of less expensive staple food over the expensive nutrient-

dense crops. While this observation subsided upon easing lockdown restrictions, an

unbalanced diet persists in Addis Ababa, Ethiopia (Picchioni, Goulao and Roberfroid (2021).

40% and 55% increase in consumption of unhealthy food were reported in Kenya and

Uganda respectively. van Dijk et al (2021) agrees to this observation that disruption in the

diet has a direct impact on global food security. They listed diet as the fifth driver of food

insecurity.

IMPLICATIONS

To promote healthy food practices among consumers in future pandemics Murphy et al

(2021) suggests that more health promotion programs aimed at encouraging consumption of

fruits and vegetables, discouraging takeaway foods, teaching healthy recipes with available

ingredients, and batch cooking be organized. This will promote healthy eating behaviour.

According to Éliás, and Jámbor (2021), most of the causes of food system disruptions

encountered during the COVID-19 pandemic are temporary except for low income. They

argue that panic-buying, negative dietary changes, reduced labour inputs, restricted

movement affecting food access, the sudden increase in food will gradually return to normal

as soon as COVID-19 lockdown restrictions are no more. This argument should not

discourage governments and policymakers from mitigating food disruptions during a crisis.

Countries that had functioning social protection programs and food distribution systems were

able to mitigate the food and nutrition insecurities arising from the current health crises

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(Picchioni, Goulao and Roberfroid, 2021). Policymakers should from now on design more

resilient food system interventions that can withstand future crises.

Although no country can be well prepared for pandemics, Éliás, and Jámbor (2021) propose

that policymakers implement structural policies to reduce poverty and low wages as this will

drastically reduce food disruptions. It will also reduce the number of people who would need

food aids during pandemics and save government purse for post-crisis recoveries.

Lastly, the world faces a threatening 35% to 56% increased food demand by van Dijk et al

(2021). We can only pray that the world is spared of global crises within the period.

However, this does not rule out the need to boost food production by about 70% to meet the

growing demand (van Dijk et al (2021). Every country should aim for self-sufficiency by

designing policies to support local food production.

CONCLUSION

This is a critical review on “Food and Nutrition Insecurity: Disruptions of the Food System

by the Covid-19 Pandemic”. Food and nutrition security is achieved when everyone always

has access to enough and nutritious food in a safe and healthy environment. The food system

encompasses all activities involved in the food chain. The issue of food and nutrition

insecurity should be a concern for every living being and not only people involved in the food

chain. Key among these professionals are those who develop and implement policies/

interventions. This review aimed to identify some of the disruptions in the food system

during the COVID-19 pandemic and discuss pragmatic measures to key professionals to

increase global preparedness for the next unforeseen crisis.

Studies considered in this review were a cross-sectional study, two systematic reviews and a

meta-analysis. These studies were selected based on their high level of validity and

applicability. Due to lockdown, the cross-sectional study as well as most studies discussed in
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the systematic review adopted an observational survey methodology. Considering the

challenges of researching COVID-19 restrictions, this methodology was the most applicable.

All studies had defined research questions, clearly described their methodology and present

conclusions relevant to their scope of the study. 

Upon critical review of these studies, it is evident that COVID-19 disrupted global food

systems resulting in food and nutrition insecurity. Some of the disruptions include low

income affecting food affordability, panic and/or bulk buying, declined access to food

partially due to lockdown restrictions, high food prices, reduced fruits and vegetable

consumption increased consumption of unhealthy and unbalanced diet and increased

household cooking.

Indeed, no country can be well prepared for unforeseen crises. Nonetheless, policymakers are

encouraged to design policies and implement interventions that will make the food system

resilient more resilient. Policymakers who are the key professionals of the food system need

to implement programs that will boost food production to meet the worlds growing demand.

Such policies will make countries self-sufficient and reduce reliance on food imports. Again,

there should be financial restructuring to reduce poverty and low income. By this, individuals

will have enough to meet their food and nutrition needs even during crises. There should be

regular health promotion programs to educate people on the need to practice healthy food

behaviours like consuming fruits and vegetables, cooking healthy recipes with limited

ingredients, and batch cooking.

REFERENCES

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 1. de Faria Coelho-Ravagnani, C. et al. (2021) ‘Dietary recommendations during the

COVID-19 pandemic’, Nutrition Reviews, 79(4), pp.382-393.

2. Éliás, B.A. and Jámbor, A. (2021) ‘Food Security and COVID-19: A Systematic

Review of the First-Year Experience’, Sustainability, 13(9), p.5294.

3. Litton, M. M. and Beavers, A.W. (2021) ‘The Relationship between Food Security

Status and Fruit and Vegetable Intake during the COVID-19

Pandemic’, Nutrients, 13(3), p.712.

4. Msambichaka, B. et al. (2018) ‘A cross-sectional examination of physical activity

levels and their socio-demographic determinants in Southern Tanzania’, International

journal of environmental research and public health, 15(6), p.1054.

5. Murphy, B et al. (2021) ‘Changes in consumers’ food practices during the COVID-19

lockdown, implications for diet quality and the food system: a cross-continental

comparison’, Nutrients, 13(1), p.20.

6. Picchioni, F., Goulao, L.F. and Roberfroid, D. (2021) ‘The impact of COVID-19 on

diet quality, food security and nutrition in Low and Middle Income Countries: A

systematic review of the evidence’, Clinical Nutrition.

7. United Nations in Ghana. (2021). Available

at: https://www.un.org/sustainabledevelopment/hunger/ (Accessed on 23rd September

2021)

8. van Dijk, M. et al. (2021) ‘A meta-analysis of projected global food demand and

population at risk of hunger for the period 2010–2050’, Nature Food, 2(7), pp.494-

501.

9. Von Braun et al. (2021) ‘Food Systems–Definition, Concept and Application for the

UN Food Systems Summit’, A paper from the Scientific Group of the UN Food

Sysetms Summit.
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 10. World Health Organisation. (2021) COVID-19. Available

at: https://covid19.who.int (Accessed: 4 September 2021)

Word count: 2961

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