This presentation was made possible by the American people through the U.S. Agency for International Development (USAID) under Cooperative Agreement No. AID-OAA-A-11-00031, the

Strengthening Partnerships, Results, and Innovations in Nutrition Globally (SPRING) project.

Measurement of food environments to improve the design and evaluation of agricultural interventions for nutrition

Anna Herforth Co-author Selena Ahmed

CGIAR ISPC/A4NH workshop - Sept 23, 2014

Increased Income and Production Goal of most agriculture projects in general Agriculture-nutrition projects too

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Source: Du, Feed the Future Landscape Analysis 2014

Does income always lead to improved diets?

Empirical link (from interventions) between ag income and nutritional status is weak and variable Ag income associated with faster reductions in both undernutrition and faster increases in obesity (Webb and Block 2012)

Suggests income increases are associated with improvements in adequacy of diets but declines in moderation

Brazil is a good example Ability to answer this question is limited by lack of standard indicators of diet quality

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Variable and Changing relationship between income and food consumption

Consistent positive relationship between income and increased dietary variety across settings

Elasticities varied from 0.39 to 1.37: the same increase in income is associated with smaller or larger increases in dietary variety (Hoddinott and Yohannes 2002)

Nutrition transition – as income rises, effects on diets have been somewhat predictable

However, they vary: South Korea vs. Mexico Income elasticities of demand for meat in China changed within a few years; curve flattened between 1989-1997 (Popkin and Du 2003)

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Income*Food Environment interaction

Income always interacts with food environments in how it affects diets It is critical to understand, and perhaps influence, the food environment if we want to understand how agriculture is affecting nutrition.

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Food environment

We define it as: Availability, Affordability, Convenience, and Desirability of various foods We consider policy and sociocultural aspects to affect the food environment, but limit scope of our definition to the above characteristics of actual foods. We are focusing here on the food market environment, but recognize there are other important parts of the food environment (farm and wild)

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INFORMAS model 7

Source: Swinburn et al. 2014

Social ecological model

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Source: 2010 Dietary Guidelines for Americans

Few ag-nutr research/pathways consider it 9

Source: Hawkes et al. 2012

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Agriculture-nutrition research would benefit from measuring food environments

Predict/understand the likely effect of additional income on diets Monitor/evaluate the effect of the program on the food environment Design better nutrition-sensitive programs to fill supply and demand gaps based on understanding of the existing food environment

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Food Env diets: Availability

Khoury et al. 2014 (CIAT) assessed trends over the past 50y in the richness, abundance, and composition of crop species in national food supplies worldwide

Since 1961, national per capita food supplies expanded in total quantities of food calories, protein, fat, and weight, with increased proportions of those quantities sourcing from energy-dense foods. national food supplies worldwide became more similar in composition, correlated particularly with an increased supply of a small number of cereal and oil crops Food supplies have changed most dramatically in Africa

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Source: Keats and Wiggins 2014; 2009 data from FAOSTAT

Food availability in sub-Saharan Africa 14

Source: Herforth 2014; 2009 data from FAOSTAT Dotted lines represent need

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Source: Keats and Wiggins 2014; 2009 data from FAOSTAT

Donor priorities: Food for 2050? 16

http://ccafs.cgiar.org/bigfacts2014/#theme=food-security

No other food groups mentioned…

Food for 2050 17

http://50.usaid.gov/infographic-the-global-state-of-agriculture/

Food for 2050 18

An alternative view for future food…

Top contributors to “Dietary risks” All developing countries, 2010

Source: Institute for Health Metrics and Evaluation

Top 10 causes of years of life lost All developing countries, 2010

Source: Institute for Health Metrics and Evaluation

Affordability: Cost of healthy diets A systematic review of cost-of-diet studies globally: healthy diets $10.50/week more expensive than less-healthy diets (similar across countries) (Rao et al. 2013)

UK: the healthiest diet was double the price of the least healthy diet (Morris et al. 2014) US: refined grains, added sugars, and fats are much more affordable than the diet recommended by dietary guidelines (Drewnowski and Darmon 2005)

Healthy diets were unaffordable for large portions of the population in all sites studied (Ethiopia, Myanmar, Tanzania, and Bangladesh), costing between $0.72-$1.27/day more. (Chastre et al. 2007) South Africa: a healthier diet costs 69% more than an unhealthy diet (Temple and Steyn 2011)

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Bangladesh model: rise in staple prices 22

Source: Bouis et al. 2011

Cross-price vs. own-price elasticities Cornelsen et al. (2014) “What happens to patterns of food consumption when food prices change? Evidence from a systematic review and meta-analysis of food price elasticities globally.”

A 10% increase of the price of fruits/vegetables/legumes (FVL) 7.2% reduction in consumption in low income-countries A 10% increase in the price of meat and dairy 7.8% reduction (8.0% for fish) A 10% increase in cereal prices small but significant (0.7%) increase in FVL consumption in low-income countries; insignificant association with ASF

Some of the studies had negative, and some had positive cross-price elasticities between cereals and non-cereals; all were small and close to zero.

Main conclusion: own-price elasticities have a much bigger impact on consumption of specific food groups than cross-price elasticities.

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Elasticities map 24

Staple prices down

Limited direct effect on FVL consumption

(small but significant cross-price elasticity of demand; -0.065 in Cornelsen et al. 2014)

Staple consumption up

(significant own-price elasticity of demand; 0.61 in Green et al. 2013)

Real income up (especially where food expenditure is a high proportion of income)

Staple consumption depends on income level ------------------(insignificant cross-price elasticity)

FVL consumption up slightly (income elasticity of demand)

ASF and junk food up strongly (status foods) (income elasticity of demand)

FVL prices down

FVL consumption up strongly (strong effect of own-price elasticity; 0.72 in Cornelsen et al. 2014)

Food Envdiets: Affordability

Main takeaway: The main effect of staple prices on diet, especially for the poor, is primarily through an effect on real income.

As seen above, income has variable effects on diet quality, modified by the food environment.

To encourage consumption of nutritious foods, the strongest way is to lower their own prices.

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Food Envdiets: Convenience This is a new addition to the “food environment” definitions that have been used before When time is a scarce resource, convenience may be even more important that the dollar cost of food. US literature: taste, cost, and convenience are major factors affecting food choices (Drewnowski 2003, Glanz et al. 1998) International literature: very little emphasis per se Distance to markets can be prohibitive Perishable foods and refrigeration? Women’s time

Highly constrained Reducing women’s time burdens often discussed as a principle of improving nutrition through agriculture

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Food Envdiets: Desirability

Purpose of marketing is to affect desirability Not only direct approaches, also “nudging” “Quality” has been a term used in other food environment definitions

sad-looking produce not very desirable American consumer perceptions of broccoli: “Overcooked, soggy.” “Hiding under cheese.” “Told not to leave the table until I eat it.” (NYT)

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http://www.nytimes.com/2013/11/03/magazine/broccolis-extreme-makeover.html

Nutrition-focused marketing in Kenya

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Photo: Anna Herforth

Habits and norms change over time

Washington Post 11/9/2013

Existing measures of the food environment Reviewed existing measures, and reviews of them

Vision to marry thinking in US community nutrition with international nutrition

Hundreds of indicators/methods The majority focus on geographical aspects of the food environment, such as counts of the number of food stores or restaurants within a specific area; the nearest distance to food stores or restaurants

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What is needed

The primary need is a measure of availability and affordability of the components of a diverse, nutritious diet. This could be an objective or a subjective measure.

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Does it exist Healthy Eating Index – food supply

Limited resonance with agriculture Save the Children “Cost of Diet” tool

Complex; need to know which components of the diet are relatively expensive

Optifood Intended to identify opportunities for BCC, not to show costs of various food groups

INFORMAS (Lee et al.) conclude that a new framework needs to be developed for monitoring food prices (and they propose one)

Based on “healthy” and “less healthy” foods, not specific food groups that could be affected by local agriculture

WFP VAM and monitoring of staple prices Could adapt methods to many foods Capacity of ag extension on regular market surveys to get useful data?

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Need to develop

Objective measure of prices of various food groups

Methods for aggregating data and coming to a price representing the whole food group need to be developed/standardized/mainstreamed take cues from the minimum food basket methodology

Subjective measure? Have a food list and simply ask people if they are able to buy it regularly (if they wanted it)

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Convenience and desirability measures?

Time/Distance to markets Kinds of markets easiest to access Preparation time of foods Attitude measures about foods (to capture desirability) INFORMAS: Food retail and food promotion

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Key questions

How to develop reliable, feasible, objective and/or subjective measures of availability and affordability of diverse, nutritious diets Under which circumstances should they be part of ag-nutr M&E How to measure all aspects (convenience and desirability?) and parts of the food environment (market, farm, and natural environments). Several measures or one?

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Summary Income has no direct effect on consumption; it is always modified by the food environment. (and also by who controls the income.) The food environment can be defined as availability, affordability, convenience, and desirability of various foods. There are many ways the food environment has been measured. Few are relevant to apply internationally in rural areas.

The primary need is a measure of affordability of the components of a diverse diet. (Objective or a subjective measure.) Other non-market parts of the food environment (farm, wild) also need to be understood.

These measures could benefit agriculture-nutrition program design and evaluation.

Track impact on food environments Understand likely effect of income on diets Inform design of agriculture-nutrition programs

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