The important role fruits and vegetables play in a healthy, diverse diet is well-documented: Eating enough of these food groups ensures adequate intake of most essential vitamins and minerals and fiber, and brings reduced risks of numerous diet-related noncommunicable diseases. Yet around the world, diets lack sufficient fruits and vegetables. Challenges abound in affordability, availability, accessibility, and desirability, and the combinations of these factors can vary significantly. To address these complex problems, we need a combination of “push” actions, to bring fruits and vegetables to the consumer, “pull” actions, to bring consumers to the fruits and vegetables, and policy solutions.

Push and pull: The challenges of availability, affordability and desirability

Globally, we aren’t growing enough fruits and vegetables to meet World Health Organization consumption recommendations. But the problem is more complex than raw quantities. Only an estimated 20% of people in low- and middle-income countries consume the recommended five servings per day, even though many have access—smallholder family farms grow 80% of fruits and vegetables in these countries. Worldwide, 3 billion people are unable to afford healthy, diverse diets, and significant disparities exist between rural and urban areas, and education and income levels, making the problem an equity issue as well.

Fruits and vegetables also present distinct production and distribution challenges: Their great variety means it is not straightforward to scale up production; labor costs are high; complex storage and transportation needs present food safety issues; and loss and waste occur at many points along food supply chains. Affordability is a particular problem: Fruits and vegetables, along with animal-sourced foods, are among the most expensive elements of a healthy diet. Desirability plays a role as well. While consumption of meat, dairy, and ultraprocessed foods increase with income, fruit and vegetable consumption does not, and persuading children and adolescents to eat sufficient servings is a perennial problem. To top it off, there is the tension between expanding farming of these very input- and land-intensive crops and the potential climate and environmental impacts.

Policy and action: Learning from history

The United Nations has declared 2021 the Year of Fruits and Vegetables. Combined with the spotlight shining on food systems and nutrition from the recent UN Food Systems Summit (UNFSS), is now the time when we can finally make progress overcoming the many barriers to fruit and vegetable consumption?

To succeed, it is helpful to understand where we have failed in the past, and how those missteps and circumstances build on one another.

• Insufficient funding leads to insufficient understanding: Research and development focusing on fruits and vegetables, from production to consumption, is chronically underfunded. The combined public research budget for maize, wheat, rice, and starchy tubers is 30 times that of vegetables. Even when they are studied, the scope is limited: Fruits and vegetables are often combined, which doesn’t enable research to examine the diversity of foods, meaning we know a great deal about only a very small number of these crops.
   
• Persistent attention to staples: For good reason, many countries have focused for decades on importing or producing staples to meet the caloric, rather than nutritional, needs of their populations. Policy and implementation structures change slowly, meaning the needed turn toward food environments that support healthy diets as a whole has been slow to emerge, even as awareness of this this vital focus has grown.
   
• A global focus on what’s tradeable: At the global food system level, the focus has long been on nonperishable and tradeable goods, able to be shipped long distances without risk of spoilage. This description is, of course, the very opposite of fruits and vegetables (at least without significant processing, which can remove nutrients). This global focus can also discount the critical role small- and medium-scale enterprises play in delivering perishable foods to consumers in otherwise hard-to-reach areas, at affordable costs.

Push, pull and policy: Options for action

The structural challenges and limitations to increased fruit and vegetable consumption are easy to identify, but will take time and effort to address. Solutions do exist, but we must be willing to prioritize the dietary outcomes we want and work toward a system that creates them. We must understand that there is no single solution; we will have to look at and work with actors in a wide range of contexts to find solutions tailored to specific situations. Some will require pushing actions to help bring fruits and vegetables to the consumers. Others require pulling the consumer toward the fruits and vegetables. Finally, to work, such approaches need an enabling policy environment and may also require some big structural changes.

In rural areas, for instance, encouraging the production of indigenous fruits and vegetables in home gardens is a good way to stimulate consumption among local households. For urban middle-income consumers, convenience is an important driver of food choices, so investments could focus on making chopped vegetables available to nearby workplaces.

In our recent paper for the UNFSS Scientific Group, we outline some solutions in each of these categories into a matrix of contexts to provide a starting point for discussion:

Identifying the right mix of actions at different levels, that can, together, accelerate impact, assessing the tradeoffs, and enacting appropriate policies will require understanding choices, incentives, and implications within contexts – so it will mean raising the voices of those who know their local food contexts well. It will require research into little-known aspects of the food system, tapping into traditional knowledge, paying attention to equity, and generating innovative ideas for addressing challenges ranging from farming through production, transport, marketing, and non-market acquisition of food.

We have the tools; now we must make the effort. The health of people everywhere, as well as that of our planet, depend upon our actions. The stakes are high, but so are the potential rewards: In focusing on fruits and vegetables through sustainable food systems, we can lay the foundation for a global food system that makes healthy diets for all a reality.

Inge D. Brouwer is an Associate Professor at the Division of Human Nutrition and Health at Wageningen University and Research in the Netherlands. Jody Harris is a Senior Scientist and Lead Specialist for Food Systems with the World Vegetable Center in Thailand.