Agriculture, Nutrition and Health Academy Week 2021: Learning Lab 21 June 2021

Anna Herforth, William Masters, Rachel Gilbert@AnnaWHerforth @wamasters @racheldgilbert

sites.tufts.edu/foodpricesfornutrition

Using Food Prices for Nutrition

Agenda

• Vision and aims

• Overview of cost and affordability indicators and methods

• Q&A

• National case studies and global results

• Activity: Calculating the Cost of a Healthy Diet

• Discussion: tool development and current use of the metrics

• Next steps in Food Prices for Nutrition

Engaging in this session

• Turn off video and mute when not speaking

• We are recording

• Polls and chat for questions

• Reactions welcome!

Name?

What country you are joining from?

What attracted you to this Learning Lab on using food prices for nutrition?

Getting to know one other – answer the Yes-No poll

• Are you working from home right now due to COVID-19?

• Did you attend our Learning Lab at ANH 2020?

Food security is when all people, at all times, have physical and economic access to sufficient, safe, nutritious food to meet dietary needs and food preferences for an

active and healthy life. – World Food Summit, 1996

Vision

Accountability to this vision rests on understanding availability and affordability of healthy diets

AvailabilityAffordability

Nutrient needsDignityCulture

Protection of health

Aims: what do we want to know?

• If you went to the market in any country, how much would it cost to obtain a healthy diet?

• How many people in the country cannot afford that cost?

Photos: W. A. Masters (Ethiopia, Tanzania, Ghana, Morocco) and S. Kaiyatsa (Malawi)

Even rural farm families rely on market purchases for healthy, diverse diets

Source of calories consumed by month, rural Ethiopia, 2010-11 Shares of food consumed, by food group, rural Ethiopia, 2010-11

Purchased

Own production

Purchased

Source: Adapted from Sibhatu and Qaim, 2017

We estimate three least-cost diets

• “Energy sufficient diet” - Cost of Calorie Adequacy (CoCA)

o Minimum cost to meet energy requirements using the least expensive, available starchy staple food in each country

• “Nutrient adequate diet” - Cost of Nutrient Adequacy (CoNA)

o Minimum cost to meet energy and nutrient requirements (23 macro and micro-nutrients, with upper as well as lower bounds)

• “Healthy diet” - Cost of Healthy (Recommended) Diet (CoRD)

o Minimum cost to meet food-based dietary guidelines, based on food group classifications; a behaviorally realistic way to meet nutrient needs and other needs, including proportionality, norms, culture, and protection of health against NCDs

Least-cost diets

• Most affordable (cheapest, lowest cost) combination of foods that meet the criteria of these diets

• No standard set of itemso Foods chosen depend on time and place

o Seasonal or locally-available foods selected

• Provide a conservative estimate (lower bound) on the cost per day o Preferences or convenience would add to the cost

Most common items in cost of healthy diet by state in India

Source: Raghunathan, Headey and Herforth, 2020

When healthy diets are unaffordable, food prices are an insurmountable barrier to improved diet quality.

Healthy diets(meet food group recommendations)

Nutrient adequacy (avoid deficiencies or excesses of essential nutrients)

Caloric adequacy(short-term subsistence)

When all diets are affordable, food prices are one of many influences on food choice.

Source: Food Prices for Nutrition, October 2020

Other goals (convenience, preferences)

Food prices create a ladder of affordability

Types of food price data

Price data

• Household expenditure survey data to calculate food unit costs for purchased itemso Caveat: Surveys done every 5-10 years in many countries

o Benefit: Can calculate expenditure shares on food, food groups, and food items

• Market information systems (MIS) typically track wholesale and/or retail prices of commodities for farmers and traderso Caveat: Usually does not include packaged or processed foods (like milk or cheese)

o Benefit: Can be useful to engage agriculture sector

• Vulnerability assessments track consumer prices to guide emergency interventionso Caveat: In most cases, a small number of items are included, methodologies may differ

• World Bank International Comparison Program (ICP) has unique global dataset of retail priceso Caveat: Items limited to comparable products sold in multiple countries; national annual average price per item

Food price data: national government CPI data

• Main data are food prices collected by national governmentso Used for measuring inflation with the Consumer Price Index (CPI)

• Generally, these prices are collected: o On a monthly or quarterly basis

o At representative market locations

• CPI is generally weighted by share of total expenditure, so culturally acceptable, commonly consumed food items are tracked.

Your own data

• Retail prices collected within research studies or projects

o Data should several different items from each food group, of standard quality (not discount, not premium)

o Food items selected should be commonly consumed items in lower income households

o Rule of thumb: If you want to calculate the Cost of a Healthy Diet, need at least ~20-30 foods

o Rule of thumb: If you want to calculate CoNA, need at least ~60 foods. Smaller numbers tend to omit important nutrient-rich low-cost items that are available in the market.

• Activity in this session to demonstrate how to calculate the Cost of a Healthy Diet from your own data, or CPI data

1. Do you currently have your own research or project data that you would like to use for calculating these metrics?

2. Are you thinking of either collecting your data, or using existing household survey or CPI data, to calculate these metrics?

Diet cost and affordability methods

Calculating the Cost of Nutrient Adequacy

Food price dataCombine with

food composition data

Linear programming to calculate

cheapest diet that meets nutrient and

energy requirements

Energy and nutrient requirements

• Energy requirements based on age, sex, and level of physical activity

• Acceptable ranges for macronutrients - protein, fats, carbohydrates

• Lower and upper bounds for 23 micronutrients + upper bound for sodium

Schneider, Kate, and Anna Herforth. “Software Tools for Practical Application of Human Nutrient Requirements in Food-Based Social Science Research.” Gates Open Research 4 (December 10, 2020): 179. https://doi.org/10.12688/gatesopenres.13207.1.

Calculating the cost of a healthy diet

• Healthy diet is operationalized as a recommended diet, based on quantitative food-based dietary guidelines (FBDG)

• ~100 countries have FBDG; FAO maintains FBDG repository

o Only some are quantitative

As far as you know, does the country where you live have its own food-based dietary guidelines?

Benin’s quantitative food-based dietary guidelines

• Food groups

• Number of portions per day

• Grams per portion

Benin

India

U.S.A.

Malta

Vietnam

Oman Netherlands

ArgentinaJamaica

China

EAT-Lancet

Affordability of diets

Affordability is the comparison of cost to a defined income standard

• Poverty lines

o National

o International (US $1.90)

• Food expenditures

• Income

• Wages

o Compared to unskilled wages in India, Ethiopia

Photo (CC): skuarua

As far as you know, does the country where you live have a national poverty line?

Thinking about the meaning of affordability

• Do you spend more than US $1.90 per person on food for a single day?

• Think about your own expenses: food, housing (rent), transportation, education, other necessities, and entertainment/discretionary spending. About what percentage of your total expenses do you spend on food?

National applications and global results

Variation across space with monthly price data: Pakistan

• National Bureau of Statistics data for 40 cities, 2017

• Cost of healthy diet - Prs 87 / USD 1.43 (2011 PPP)

o 58% of individuals spend less on food than this cost

• Cost of dairy and vegetables higher than other food groups

• Vegetables, dairy, and fruit are most variable across regions

o Perishability and transport?

• Availability: prices for dark green leafy vegetables seasonally missing in Pakistan

Figure source: Dizon and Herforth, 2018

Source: Dizon, Herforth and Wang, 2019

Affordability of a healthy diet relative to wages in India

• Price data: monthly data for 101 food items in 24 states, 2001-2011

• Affordability as the cost of a healthy diet relative to unskilled laborers’ wages

o For men and women separately

• In most states, healthy diets became more affordable for men over time

• ~60–75% of the rural poor could not afford a healthy diet in 2011

% change in cost of a healthy diet : wages, 2001-2011

Source: Raghunathan, Headey and Herforth, 2021

Household survey expenditure data for healthy diets: Bangladesh

• 2016 Household Income and Expenditure Survey: prices derived from food consumption questions for householdo Total spent/quantity purchased

• Cost of a healthy diet (CoRD) was 58 BDT ($1.70 2011 PPP)

• Can compare least-cost diet with actual food group expenditures

• Food preferences can be incorporated (CoRD-FP); this was demonstrated in Myanmar

Source: Dizon, Herforth and Wang, 2019

3 billion people globally lack sufficient income to purchase least-cost healthy diets

• Calorie affordability is still a problem in some countries

Source: FAO, 2020; Herforth et al. 2020

% of population who cannot afford energy sufficient diet

3 billion people globally lack sufficient income to purchase least-cost healthy diets

• Calorie affordability is still a problem in some countries

• Most people in sub-Saharan Africa cannot afford nutrient adequate diets

Source: FAO, 2020; Herforth et al. 2020

% of population who cannot afford nutrient adequate diet

3 billion people globally lack sufficient income to purchase least-cost healthy diets

• Calorie affordability is still a problem in some countries

• Most people in sub-Saharan Africa cannot afford nutrient adequate diets

• Most people in sub-Saharan Africa and South Asia cannot afford healthy diets

Source: FAO, 2020; Herforth et al. 2020

% of population who cannot afford healthy diet

Healthy diets by any definition are far more expensive than the entire international poverty line

$1.90 (Food and non-food IPL)

$1.20 (Approx. food only IPL)

>$3.50Median cost of 10 guidelines

Source: Herforth et al. 2020

Discussion: Application of indicators in countries and programs

• What did you find the most useful about the global analysis?

• What did you find least useful about the global analysis?

• What did you find most useful about the sub-national analyses?

• What did you find the least useful about sub-national analyses?

Activity: Calculating the Cost of a Healthy Diet

Steps to calculate the cost of a healthy diet

1. Ensure food price data is in standard units (price per kg or L)

2. Categorize each food in food price list according to the food groups in the selected dietary guideline

3. Calculate price per day for each item

• Price per kilogram x Quantity required per day in kilograms (accounting for edible portion)

4. Select the 1-3 least cost items (price/recommended Q to purchase/day) in each food group, ensuring that each item is unique (i.e. not two kinds of rice)

5. Sum the cost of all selected food items

Introducing new tools to facilitate calculation

• Database of food item quantities required for computing the cost of a healthy diet (version 1) is a “living document”

• Contains 11 different quantified FBDG, the Healthy Diet Basket (average of 10 FBDG), and the EAT-Lancet diets• For a given food item, provides:

o Recommended quantity per day to consume to satisfy the entire food group recommendation (for various FBDG)o Recommended quantity per day to purchase to satisfy the entire food group recommendation (for various FBDG)o Food group classification (for various FBDG) o Number of foods to select per food group

• Recommended quantity to purchase combines information on:o Serving size, total servings or kcal or grams recommended, expressed in consistent units (kg/day)o Edible portion of food

Healthy Diet Basket: Streamlined method for cross-country comparisons

• For the SOFI 2020, we calculated 10 FBDG and took the average cost across all 10

o Was merely an average cost; not associated with any identifiable set of food or gram amounts

Initial method: Found the median cost across all costed FBDG

>$3.50Median cost of 10 guidelines

Source: Herforth et al. 2020

Benin

India

U.S.A.

Malta

Vietnam

Oman Netherlands

ArgentinaJamaica

China

EAT-Lancet

Healthy Diet Basket: Streamlined method for cross-country comparisons

• For the SOFI 2020, we calculated 10 FBDG and took the average cost across all 10

o Was merely an average cost; not associated with any identifiable set of food or gram amounts

• The Healthy Diet Basket takes the average gram amounts of each food group across 10 guidelines, to find their cost

• Requires 11 unique items

Activity Instructions

1. Download the Excel file from the chat.

2. Read the “Instructions” sheet for detailed instructions.

3. Go to the “Activity” sheet.

4. Work in groups of 4 (breakout rooms) on the activity.

Questions on the Database or activity?

• What questions came up in your groups?

• What was the most difficult part of the activity?

• How can the Database be improved?

Discussion: tools and support for calculating the Cost of a Healthy Diet

• What questions do you have about the indicator after calculating it yourself?

• What would be most useful in tool development to enable calculation of this indicator?

• What would be most useful for programs or governments to use food price data for nutrition?

Next steps in Food Prices for Nutrition

• Promote use of food prices to measure diet costs and affordability

• Scale up monitoring and analysis

Provide tools, methods,

and data to calculate and

use the metrics

Support use of the metrics

within existing country

systems

Model impacts of policies

and programs that could

affect food prices

Food Prices for Nutrition eLearning course

• Will be hosted on the World Bank’s Opening Learning Campus (OLC) platform

• 3-hour self-paced course for government officials, program planners, researchers, and others

• Two modules

o Construction of diet cost indices

o Use and potential applications of diet cost indices in relation to policymaking

Forthcoming tools and events

• Publish the complete Database and User Guide online for data holders to compute Cost of a Healthy Diet themselves

• Updated estimates for SOFI 2021

• Introductory webinars in Food Prices for Nutrition countries throughout the summer and early fall o See website for details: https://sites.tufts.edu/foodpricesfornutrition/presentations/

• World Bank eLearning course coming next year, August 2022

Stay in touch with us!

• Give us feedback & stay in touch with this Google Form: https://forms.gle/TPJdVtHs1mtkxMBD7

• Visit our website: https://sites.tufts.edu/foodpricesfornutrition/ or Google “Food Prices for Nutrition”

• Reach out with questions or interest – Rachel.gilbert@tufts.edu

Thank you to our donors

This project is funded as INV-016158 by the Bill & Melinda Gates Foundation and UKAid, through the Foreign, Commonwealth & Development Office of the United Kingdom.