International food trade contributes to dietary risks and mortality at global, regional and national levels

Food trade is generally perceived to increase the availability and diversity of foods available to consumers, but there is little empirical evidence on its implications for human health. Here we show that a substantial proportion of dietary risks and diet-related mortality worldwide is attributable to international food trade and that whether the contributions of food trade are positive or negative depends on the types of food traded. Using bilateral trade data for 2019 and food-specific risk-disease relationships, we estimate that imports of fruits, vegetables, legumes and nuts improved dietary risks in the importing countries and were associated with a reduction in mortality from non-communicable diseases of -1.4 million deaths globally. By contrast, imports of red meat aggravated dietary risks in the importing countries and were associated with an increase of -150,000 deaths. The magnitude of our findings suggests that considering impacts on dietary risks will become an important aspect of health-sensitive trade and agriculture policies, and of policy responses to disruptions in food chains. About a quarter of all food produced for human consumption is internationally traded. Trading food between countries is generally perceived to increase the supply, access and diversity of food available to consumers and, in principle, can contribute to greater food and nutrition security, and a more efficient use of environmental resources. However, concerns have been raised about the role food trade plays in outsourcing environmental pollution and the health risks associated with changing dietary patterns and increasing levels of overweight and obesity. Among the various approaches to studying the relationship between trade and health, there have been those focused on assessing the correlations between general markers of health (for example, life expectancy and body mass index) and either trade liberalization (often measured in terms of globalization and trade indices) or specific trade agreements (as captured by statistical or process-based economic models), as well as those focused on describing the contributions international trade has made to the distribution of calorie and nutrient availability in an attributional sense. However, there has been little research on how the trade in food contributes to those dietary risks that are related to food intake and the associated diet-related diseases. Here we quantify the proportion of dietary risks and diet-related mortality that is attributable to international food trade. Dietary risks include eating too few fruits, vegetables, legumes and nuts and too much red meat (including beef, lamb, goat and pork). They are a leading cause of non-communicable diseases, such as heart disease, stroke, cancer and diabetes, and collectively responsible for one in five deaths globally. Linking dietary risks to international food trade can help identify the role food imports play in the dietary health of

M. Springmann, H. Kennard, C. Dalin, F. Freund