Background paper for the FAO/WHO international workshop on fruits and vegetables 2020 The persistence of undernutrition and the increasing levels of overweight and obesity worldwide (with their associated societal costs) are calling for a transformation of food systems towards healthier diets. Fruits and vegetables are key components of a healthy diet; however, their consumption is considerably below the minimal levels recommended by the World Health Organization (WHO). This under consumption is particularly pronounced in low- and middle-income countries and among low-income socio-economic groups in all countries. This paper uses the value chain approach to analyze the factors that affect the availability and affordability of fruits and vegetables. It examines major challenges across the value chain and identifies opportunities for improvement as seen through a nutrition-sensitive lens. Factors that negatively affect the availability and affordability of fruits and vegetables discussed in this paper include low production and productivity, the loss of agrobiodiversity, inadequate technology, logistics and infrastructure, weak organizational, business and technical skills, and inefficient market linkages across the supply chain. The paper proposes a number of policy recommendations based on insights from documented cases of good practices and on lessons learnt in domestic and export-oriented value chains. The paper makes a case for reviving native, underutilized and neglected fruit and vegetable varieties to improve nutrition and increase agrobiodiversity. In addition, short value chains delivering to local markets are recommended as a resilience strategy for smallscale producers and low-income consumers in the face of climatic and economic shocks. The paper advocates the reshaping of value chains through policies that boost efficiency, promote the inclusion of poor and vulnerable actors − including consumers − in the chain, and ensure that production is environmentally sustainable

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This background paper summarizes the evidence on the effects of fruits and vegetables intakes on direct and indirect health outcomes. For direct health outcomes, we have primarily considered premature mortality and non-communicable disease occurrence. For indirect health outcomes, we have briefly considered planetary health and reducing inequities. Two existing low-risk-of-bias systematic reviews identified broad and significant benefits from fruits and vegetables intakes on premature mortality, coronary heart disease, and type 2 diabetes incidence. These direct health effects observed due to fruits and vegetables intakes are considerable, and may be due to their constituents, such as dietary fibre and micronutrients, and their low energy density and high satiety relative to other foods that may also contain added sugars, sodium, and saturated fats. Modelling and observational research studies have reported benefits to sustainability outcomes and a reduction of inequities in food systems with the production of fruits and vegetables grown within agroecological systems and distributed through short supply chains. Such systems require protection from largescale monocropping and industrial methods of food production and supply. Finally, we have considered fruit and vegetable processing and preparation methods given the considerable health consequences of changes to the food supply towards ultra-processed products. This background paper concludes with a summary of findings.

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