BACKGROUND

Diet-related factors are one of the primary reasons for the global burden of diseases. The sustainable development goals for nutrition are difficult to achieve, largely due to the high cost of healthy diets (FAO et al., 2020). In 2019, the EAT-Lancet commission recommended dietary guidelines ensuring a healthy food intake for 10 billion people by 2050 and sustainability for people and the planet (Willett et al., 2019). While recent attention has been focused on estimating the cost of healthy diets, national and global diet costs can mask subnational and temporal heterogeneities. Furthermore, little is known about how the cost of recommended diets compares to actual dietary intakes. In other words, we do not know if, and by how much, actual diets diverge from recommended ones.

Against this background, our study first estimates the EAT-Lancet diet cost at the district level in India using primary high-frequency data on food diversity and prices collected monthly from local food markets in our field locations between June 2018 and May 2019. Second, we compare the cost of current diets to the EAT-Lancet diet cost from the perspective of "ground truthing" the affordability of EAT-Lancet diets.

We use primary data collected through a market survey and a detailed, in-depth assessment of the diversity and prices of food items available in 12 local weekly village markets - known as haats - across the four TARINA² districts [Munger (Bihar), Maharajganj (Uttar Pradesh) and Kandhamal and Kalahandi (Odisha)]. The market data was collected monthly from June 2018 to May 2019.

Simultaneously with the market surveys, we surveyed 160 households to collect data on household food purchases (quantity) and other consumption indicators. We also used population-level secondary data from the Consumer Pyramids Household Survey (CPHS) carried out by the Centre for Monitoring of the Indian Economy (CMIE) for data on food expenditures from June 2018 to May 2019 for Uttar Pradesh, Bihar and Odisha. Readers are referred to Gupta et al. (2021) for details on how we estimated the cost of diets.

COST OF DIETS

The actual costs of diets across our sample are USD 0.62 (using minimum prices) and USD 1.00 (using average prices) per person per day averaged over August 2018 - May 2019. These costs are lower than the EAT-Lancet diet cost based on the minimum and average prices of USD 3.33 and USD 5.32 per person per day, respectively. They are also less than the population-level cost of diets across the country (USD 1.74) and each of the three states. We find, on average, it would have cost an individual at least USD 3.30 daily to meet the EAT-Lancet recommendations if they bought the cheapest food item(s) in each food group from the weekly village market in each district and USD 5.00 daily if they chose to purchase foods of average cost within each food group.

The cost of diet in all three of our programme states was lower than the national average. Rural households were spending at the very least half of the minimum cost of the EAT-Lancet diet (USD 3.00) and one-fourth of its average cost (USD 5.00). The population-level estimates indicate that individuals can meet (and even exceed) the recommended cost share for cereals in the minimum EAT-Lancet cost estimates. These estimates also indicate that expenditures on vegetables (including green leafy vegetables) are also greater than recommended guidelines in Odisha and just shy of the requirements in Bihar and Uttar Pradesh. However, people cannot meet the minimum cost shares of the recommended intake for fruits, dairy and meat, fish and poultry.

The current cost of the actual diet indicates that current food consumption patterns are unable to meet the average intake recommended by the EAT–Lancet diet. Households would have to spend USD 2.80 - 4.30 (fig. 1) more per person per day to meet EAT-Lancet recommendations. The bulk of this increase in spending is required in three nonstaple food groups: meat, fish, and poultry, fruits and dairy.

Figure 1
Monthly Differences in the Actual Diet vs EAT-Lancet Diet Cost, August 2018-May 2019


Note. The deficit in the diet cost is calculated as (the actual diet cost - the EAT-Lancet diet cost). The minimum deficit refers to the cost estimated considering the cheapest food items in each food group. The average deficit refers to the cost estimated considering the average price of all food items in each food group. Prices are adjusted for edible portions. The vertical line demarcates the annual average from monthly data.

Variations across seasons are observed in the EAT-Lancet diet (minimum), which increases from USD 2.90 per person per day in June to USD 3.50 in November and then to USD 3.70 in April. The EAT-Lancet diet's average cost peaks to nearly USD 6.00 per person per day in November and April. Monthly variations in food group prices explain these variations. Another factor contributing to the variation is the agricultural production cycle, where October-November and March-April corresponds to the time before the harvest season. Both supplies and household incomes are likely low at the end of the lean season, contributing to the price volatility and lower purchases, respectively

IMPLICATIONS

The results from our study highlight the urgency of ensuring the affordability of healthy diets by the rural poor in the country. Both agricultural and food policies need to converge towards the end goal of ensuring that the poorest households can access diverse, nutritious foods from local markets year-round, for which both supply- and demand-side factors need to be considered. The agricultural policy urgently needs to move away from its focus on staple cereals like rice and wheat to ensure the supply of affordable healthy foods. The diversification of cropping systems towards pulses and other non-staples like fruits and vegetables can be incentivised via improvements in crop yields, access to inputs like seeds and modern technologies and investments in the irrigation infrastructure. In support of the above, markets should reduce price risk and transaction costs for farmers, ensuring adequate price realisation. The market system needs strengthening with a market infrastructure like cold-storage facilities and efficient procurement by the government to ensure year-round supplies of nutritious and affordable food. Informal and traditional food markets need investments (in infrastructure and information) and regulations (e.g., related to food safety), as they act as major supply chain partners for reaching out to the rural people. Besides local markets, households also rely heavily on the country's various food safety nets. Programmes like the public distribution system, Integrated Child Development Services and the Mid-day Meal scheme can also be diversified for providing non-staples for consumption.

From a policy perspective, the demand for nutritious foods depends on both access and affordability. These can be ensured by enhanced household incomes and stability in market-level food prices. Furthermore, at the household level, seasonal food deficits can be mitigated by promoting kitchen gardens that produce perishable foods like fruits and vegetables throughout the year. The demand and consumption of nutritious food can also be increased with behaviour change campaigns, education and information dissemination.

Our study also highlights the need for better data systems required for tracking the role of markets for nutrition security. This can be achieved by collecting up-to-date data on the availability, diversity and prices of food items at local markets. This data should be collected seasonally to reflect seasonal variations in both the availability and price volatility of foods.

You can read the full paper here: Gupta, S., Vemireddy, V., Singh, D. K., & Pingali, P. (2021). Ground truthing the cost of achieving the EAT Lancet recommended diets: Evidence from rural India. Global Food Security, 28, 100498. https://doi.org/10.1016/j.gfs.2021.100498

¹ The study is co-authored with Dr Soumya Gupta, Dr Dhiraj K. Singh and Professor Prabhu Pingali.
² TARINA (Technical Assistance and Research for Indian Nutrition and Agriculture) is a research program led by the Tata-Cornell Institute for Agriculture and Nutrition at Cornell University.

REFERENCES

• Gupta, S., Vemireddy, V., Singh, D. K., & Pingali, P. (2021). Ground truthing the cost of achieving the EAT Lancet recommended diets: Evidence from rural India. Global Food Security, 28, 100498. https://doi.org/10.1016/j.gfs.2021.100498
• Willett, W., Rockstrom, J., Loken, B., Springmann, M., Lang, T., Vermeulen, S.,... & Declerck, F. (2019). Food in the Anthropocene: The EAT-Lancet Commission on healthy diets from sustainable food systems. Lancet, 393, 447-92. http://dx.doi.org/10.1016/ S0140-6736(18)31788-4
• FAO, I., UNICEF WFP & WHO. (2020). The state of food security and nutrition in the world 2020. Transforming food systems for affordable healthy diets. FAO.