Appendix 02

Factors and effects across systems in the framework

This table provides an operational guide for identifying action points across domains. It shows how climate, food systems and health systems affect nutrition through both supply-side mechanisms (what is produced, processed and delivered) and demand-side mechanisms (what people can access, afford and choose). Policymakers and practitioners can use this table to identify intervention points within their mandate and to recognise where coordination with other sectors is essential.

A2.1 Factors and effects across systems in the framework

Domain	Factors affecting nutrition	Supply-side effects on nutrition	Demand-side effects on nutrition
Environment and climate	● Temperature. ● Precipitation and rainfall patterns. ● Extreme climate events (floods, droughts, storms, heat wave). ● Soil, water and biodiversity degradation. ● Sea level rise and ocean acidification.	● Disrupts agricultural and fisheries production through lower yields, higher crop and livestock failure risk and changing fish stocks. ● Increases post-harvest losses and food safety risks due to heat and humidity. ● Reduces availability of wild foods. ● Reduces nutrient density (protein, iron, zinc) in some staple crops. ● Damages health; water, sanitation and hygiene; and market infrastructure. ● Disrupts supply chains for food and essential health and nutrition commodities.	● Reduces incomes and employment in climate-sensitive livelihoods, compressing food budgets. ● Increases seasonality and volatility in access to nutritious foods through price spikes. ● Raises climate-sensitive disease burdens (diarrhoeal diseases, vector-borne diseases, heat stress) and associated care costs. ● Drives displacement and raises time and financial costs for accessing care, interrupting continuity of nutrition and health services.
Food systems	● Food production systems and input use. ● Land use patterns and crop/livestock diversification. ● Storage, cold chain, processing and retail structures. ● Food environments, marketing exposure and labelling. ● Domestic and international food trade, public procurement and distribution systems.	● Determines composition and diversity of food output across major food groups (staples, pulses, fruits and vegetables, animal-source foods, oils and sugar). ● Influences volumes and types of processed foods in markets, including products high in fats, sugars and salt. ● High post-harvest losses and weak cold chains lower availability, stability and quality of perishable nutrient-dense foods. ● Procurement and distribution arrangements influence whether diverse, nutrient-dense foods reach different regions, seasons and population groups.	● Sets relative prices and affordability of nutritious foods compared with energy-dense, nutrient-poor options. ● Shapes local food environments through density and types of outlets, and placement,labelling and promotion of different foods. ● Affects consumer exposure, including that of children and adolescents, to promotion of products high in fats, sugars and salt. ● Uses school, workplace and safety net food provision to establish routine dietary patterns across population groups.
Health systems	● Coverage and quality of essential nutrition actions across the life-course (antenatal care, postnatal care, breastfeeding support, infant and young child feeding, child health, adolescent health, non-communicable disease care). ● Availability, distribution and competencies of health workers and community health workers. ● Facility readiness: nutrition commodities; supply chains; guidelines; water, sanitation and hygiene; and infection control. ● Financial protection and user fee policies for primary care and nutrition services. ● Community outreach, referral and links to social protection.	● Expands coverage of growth monitoring, nutrition counselling, breastfeeding promotion, infant and young child feeding support, micronutrient supplementation, wasting care and other key nutrition services. ● Shapes availability and quality of obesity- and diet-related non-communicable disease prevention, screening and treatment. ● Adequate or poor water, sanitation and hygiene and infection control in facilities influences infection-related undernutrition. ● Strengthens or weakens frontline capacity for regular, nutrition-focused counselling and follow-up.	● Care-seeking for maternal, child and non-communicable disease–related nutrition services is shaped by costs, distance, wait times and perceived quality. ● Health and nutrition literacy, trust in providers and social norms influence use of services and adherence to advice. ● Awareness and uptake of health-linked entitlements and social protection benefits buffer or fail to buffer nutrition shocks. ● Social and behaviour change communication influences dietary practices, infant feeding and healthcare-seeking patterns.

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