Q&A: ‘Transformation takes time,’ Richard Horton on the EAT-Lancet Commission diet

Richard Horton, editor-in-chief of The Lancet. Photo by: Rick Bajornas / U.N.

MANILA — The EAT-Lancet Commission report came out in 2019 with big ambitions: getting the world’s population to adopt a diet that is more sustainable and healthy for the planet. But its proponents knew there would be pushback. One of its biggest criticisms is its recommendations for populations to adopt a more plant-based diet.

But Richard Horton, The Lancet journal’s editor-in-chief known not to shy away from engaging in controversial topics, believes some of the criticism was uncalled for, and a product of wide misinterpretation. For instance, the report recommended a reduction — not eradication — of meat consumption, he said.

“We're talking about a transformation, and a transformation takes time. It's a transformation in our food systems. It's a transformation in our agriculture. It's a transformation in our policymaking. And what it needs is an agreement about the scientific evidence.”

— Richard Horton, editor-in-chief, The Lancet journal

“We weren't saying that everybody should go vegan in their diet … but seeing meat as something of a luxury food item, a privilege to have, not every day, not necessarily every week, but maybe a couple of times a month,” he said.

Some of the attacks were also “deeply personal” on the scientists who make up the commission and those who supported it.

“I welcome constructive criticism, but I deplore cheap personal attacks on individuals, which actually weakens any scientific or questions that we may have posed to the commission,” Horton said.

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Amid the criticisms, Horton said there also have been some successes. Even with the end of 2019 — which The Lancet designated as the year of nutrition — the commission’s fight and his activism for healthier diets continue.

This conversation has been lightly edited for length and clarity.

What was the motivation behind the launch of the EAT-Lancet Commission on nutrition?

We've worked with the EAT Foundation for a couple of years, and I've been very impressed by the ambition of the EAT Foundation to try and do what the rest of the world seems to have failed to do, which is to unite three very separate communities: the science community, the policy community, and the business community.

Scientists are very good at talking to themselves. We're very bad at connecting with policymakers, and we're even worse at connecting with the business community. And what the EAT Foundation really exists for is to try and promote a conversation, a constructive conversation, between those three groups. So the purpose of the commission was to provide the science to strengthen those connections and conversations.

The EAT-Lancet report was one of your most popular reports published in 2019. What would you say were its achievements?

It's kind of you to say it was one of the most popular. I think it was one of the most provocative. Not everybody welcomed the report. And I think that it stirred a very valuable, although still unresolved, debate about the ideal diet.

But that said, I think that its main achievements were in those three communities that I've mentioned to you — the scientific community, the policy community, and the business community. I think scientifically it was a very successful synthesis of the available evidence about what constitutes a referenced diet in today's environment whereby we have a threatening ecological catastrophe. So what it did so well was to link the very complex arena of earth system such as climate to something that we can actually change, in other words, our diet. And that I think was one of its greatest successes in making that linkage.

I think in the policy community we saw a very strong response, not only the debate that I've already mentioned, but also in different domains of policymaking. So city mayors endorsed it, the European Commission picked it up, to use as a basis for some of their planning. Individual countries embraced some of the guidelines on diet, such as Indonesia.

And then on the private sector side, I think the most important thing was it did promote a constructive conversation between some food companies and the science and policy community.

“The diet isn't supposed to be a one-size-fits-all diet that we're recommending for every community or population in the world.”

Did you expect some of the criticism?

Yes, we did. Very much so. When we launched a series on nutrition about a decade ago, we had a very strong pushback from the agricultural sector, particularly from farmers. And I can understand the tension. And I think we have to listen very carefully ... this is what the EAT-Lancet Commission did emphasize, we're not talking about tomorrow we need to end meat consumption.

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We're talking about a transformation, and a transformation takes time. It's a transformation in our food systems. It's a transformation in our agriculture. It's a transformation in our policymaking. And what it needs is an agreement about the scientific evidence.

And we weren't saying in this commission that we need to go — and this was a wide misinterpretation, deliberate misinterpretation, I think — we weren't saying that everybody should go vegan in their diet. What we were saying was that there needed to be a transition to a more plant-based diet, which did mean reducing the amount of meat in our diet. Not cutting meat out completely, but seeing meat as something of a luxury food item, a privilege to have, not every day, not necessarily every week, but maybe a couple of times a month.

So this was the transition, the transformation that we were recommending. And that means that yes, the agricultural industry does need to enter a dialogue with policymakers and scientists about how that transformation should evolve. So I think we were prepared for it. And I think we're in a better position this time to deal with it because the strength of the evidence, particularly the strength of the evidence as it pertains to environmental degradation and the impending ecosystem catastrophe that we face if we do nothing … is so much stronger than it was a decade ago.

You were talking about the agriculture sector. How did you engage them in the process?

We included in the authorship of the commission, a wide range of people who have many connections with the agricultural sector and the food sector. And so we engaged them through their networks.

The commission took two years to produce. So there were many meetings and many consultations. And of course, what you're doing during that process is you're trying to sift through the evidence. You're trying to work out what's valid and what isn't valid. And then try and link these issues around diets with these major changes in climate and land use and so on. And that does in the end require a judgment call. You can have a conversation, but at some point that conversation has to arrive at a conclusion. And that's what the commission did.

And I think that's one of the reasons we saw the pushback was that the commission was very clear and unambiguous about the transformation that was needed. So yes, we engaged elements of the agricultural sector, but at some point that engagement has to reach a finale. And that's what led to the provocative discussion that the commission caused. But it was a welcome discussion.

One of the other criticisms of the diet was that it wasn't as affordable for the global south as it would be for those who have the luxury of choosing between meat and no meat. Is that something that was discussed and that was expected?

I think that was a very important piece of work actually in that it casts new light on the sustainability, so to speak, of the planetary health diet as recommended. I think there may have been some misunderstandings in the diets. The diet isn't supposed to be a one-size-fits-all diet that we're recommending for every community or population in the world. The diet is supposed to be a reference diet that can be interpreted in the local contexts, that are relevant for the diet to be used.

But I fully recognize that there are challenges to these diets, and these challenges need to be engaged with by policymakers. Just as an example, there are enormous subsidies in parts of our economy paid to industries to support them. And we need to think about the distribution of those subsidies, and whether they're appropriate to support not only the transitions in the economy that we need to see to more renewable and sustainable features, but also to the kinds of diets that we eat. So yes, there are challenges, and those challenges ... need to be subject to scrutiny and different types of policy.

“The EAT-Lancet Commission showed very clearly that if you could implement the recommendations that it was promoting, then you could avert something like 11 million deaths. That is an astonishing number.”

Earlier you mentioned one of the successes of this report is bringing together scientists, the policy community, and the business community. Where do bilateral donors, philanthropic foundations and NGOs fit into the picture?

Well, part of the challenge is to get them interested in food. Many international NGOs or civil society organizations have very specific remits around, for example, health. But they may not see food as something directly related to health. Often people will acknowledge obviously that nutrition is important and as a determinant of health. But then getting into the details of Earth systems and food and transformations in agriculture that might seem a little bit outside the central remits of some funding organizations or NGOs.

And I think one of the, again, one of the successes of this commission, in fact, it wasn't just this commission. We had several pieces of work last year. There was another commission on what we call the Global Syndemic of Obesity, Undernutrition and Climate Change. And then at the very end of the year we did a series on the double burden of malnutrition with the World Health Organization.

Those three pieces of work, which were kind of the foundations for our work last year on nutrition, were also about trying to make the case to funders and ministries that you can't think about health without thinking about food and nutrition, and that includes agriculture.

So we're trying to bring together these different communities that often sit very separately. And I think to a very large degree, we were successful in that. I mean I found it very encouraging, just to take The EAT-Lancet Commission as one example, I found it very encouraging that that Commission was funded by the Wellcome Trust here in London. And the Wellcome Trust is a charity that invests in health. But in this particular case they invested in food as health, and that was a very visionary decision of them.

Are there any particular entities or organizations that you’re hoping to join into that conversation but that you're still trying to get on the table?

Well, the most important organization that in a sense orchestrates the global conversation around health and certainly would be absolutely critical to trigger or accelerate action in countries is the World Health Organization. And I think that with this commission, and the other two pieces of work that I've just mentioned, we definitely engaged WHO in taking food, nutrition, and health even more seriously than they did before.

But, but, and there's a big but here, one of the issues that we also saw was that the work that we commissioned and published led to opposition by certain countries. And the reason for that was that their food industries lobbied governments to oppose this work in WHO. The World Health Organization is an arena where the interests of the food industry are being fought out with the scientific and policy communities, and that fight, that battle for truth in nutrition is taking place right now.

It will take place at the executive board at the end of this month. It will take place at the World Health Assembly in May this year. And it's not yet fully clear who's going to win that fight. We saw governments intervening in WHO to try to oppose the work that we published last year, in the most incredible, anti-scientific ways. And certainly, a government that we are aware of that intervened to oppose did so purely because it had been intensely lobbied by its local food industry to stop the science that we were promoting from being given any oxygen at all. So this is an ongoing and important fight that we're engaged in right now.

I understand where you're going with because of how WHO is set up, but do you think there is some sort of room for how WHO can push the science forward against all of this pushback from its own member states?

Well, there's room, there's room, but don't underestimate the power of the food lobby. And this is what we've seen. The food lobby is very powerful, and the scientific community, although it may have truth on its side, doesn't have the dollars to be able to lobby governments as effectively as the food industry does. So we have to keep this fight up.

It's the lives of people that are at stake here. I mean, the EAT-Lancet Commission showed very clearly that if you could implement the recommendations that it was promoting, then you could avert something like 11 million deaths. That is an astonishing number. That simply changing the diet in the way that we were suggesting could have a huge impact on human health. And we need to be holding global food companies accountable for that opportunity.

How does The Lancet plan to take this discussion on nutrition and planetary health forward?

Well, what we're doing this year is we're taking the work of 2019 and slightly reframing it. We're looking particularly at child and adolescent health this year, and of course the nutritional challenges for children and young people are where some of the greatest nutritional challenges rest in the world today, whether we're talking about undernutrition in under 5, or whether we're talking about early child development or whether we're talking about childhood obesity.

These are some of the major threats to human health in the early years of life. So we're going to take the theme of nutrition, and we're going to link it with the theme of child adolescent health. And over the course of the next 12 months we're launching new work, new commissions, new series, to draw attention to this particularly horrifying dimension of the twin threats of under and over nutrition. And we start in February with the launch of a commission on child and adolescent health, where we will be focusing on some of the most damaging determinants of children's health today.

Amruta Byatnal contributed reporting to this article.

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About the author

  • Jenny Lei Ravelo

    Jenny Lei Ravelo is a Devex Senior Reporter based in Manila. She covers global health, with a particular focus on the World Health Organization, and other development and humanitarian aid trends in Asia Pacific. Prior to Devex, she wrote for ABS-CBN, one of the largest broadcasting networks in the Philippines, and was a copy editor for various international scientific journals. She received her journalism degree from the University of Santo Tomas.