Cost of Nutritious Diets: Changes in Affordability of Food and Nutrients in Africa and South Asia

1. The Cost of Nutritious Diets: New Price Indexes Reveal Changes in Affordability of Foods and Nutrients Results from Changing Access to Nutritious Diets in Africa and South Asia (CANDASA) funded by UKAid and the Bill & Melinda Gates Foundation http://sites.tufts.edu/candasa IFPRI Policy Seminar, 29 May 2019

2. Why measure the cost of nutritious diets? • Food environments are changing rapidly, in both urban and rural areas • from own-production to use of markets • from generic commodities to branded, packaged foods • shifts in cost of starchy staples, milk, eggs, meat, fruit & veg • shifts in earnings, towards more choice among affordable foods • Food prices are collected to measure inflation and poverty • economists have used prices for the cost of calories & food demand • aid programs have used prices to recommend a least-cost diet • we use prices to study food systems, for access & affordability • Analysis of diet costs can guide intervention • each CANDASA researcher will share findings from their work • discussion today is at project midpoint, from Jan. 2018 to June 2020 Photo by Anna Herforth at Nsawam market, Ghana

3. The CANDASA project (Jan. 2018 - June 2020) builds on past work at Tufts, IFPRI and elsewhere Our research team: Individual consultants: Anna Herforth (Co-Investigator) Fulgence Mishili (Sokoine U.-Tanzania) Kate Schneider (PhD student) Will Masters (PI) Yan Bai (PhD student) Stevier Kaiyatsa (Gvt of Malawi) At Tufts: Daniel Sarpong (U. of Ghana) Kalyani Raghunathan (IFPRI-India) Fantu Bachewe (IFPRI-Ethiopia) Derek Headey (Co-PI) At IFPRI:

4. Why are CANDASA price indexes needed? Motivation for this project: Individual consultants: Anna Herforth (Co-Investigator) Fulgence Mishili (Sokoine U.-Tanzania) Kate Schneider (PhD student) Will Masters (PI) Yan Bai (PhD student) Stevier Kaiyatsa (Gvt of Malawi) At Tufts:

5. Standard food price data say nothing about nutrition National food prices (weighted by share of total expenditure) World food prices (traded commodities only) Components: Cereals Vegetable oils Sugar Meat Dairy Vulnerability monitoring (most commonly consumed staples) Source: www.fao.org/worldfoodsituation, April 2019

6. For the cost of nutritious diets, need data on diverse foods Predecessor project (IANDA) helped Ghana MoFA expand price monitoring Source: John Nortey, Ghana Ministry of Food and Agriculture (2017) Photo: A. Herforth (Ghana), 2016

7. For the cost of nutritious diets, need data on diverse foods Predecessor project (IANDA) helped Ghana MoFA expand price monitoring Ghana MoFA institutionalized the updated food list nationwide Source: John Nortey, Ghana Ministry of Food and Agriculture (2017) Photo: A. Herforth (Ghana), 2016

8. New price indexes account for nutritional needs • Cost of Recommended Diets • Based on food-based dietary guidelines • Food groups & servings (g) per day • Choose foods that meet recommendations at lowest total cost Benin Food Guide India Food Guide • Cost of Nutrient Adequacy • Lowest cost of meeting calorie, macronutrient, and micronutrient needs • Specify quantity of each nutrient • Choose foods that meet needs at lowest total cost Compare to Cost of Caloric Adequacy U.S. Food Guide

9. What data are needed for the cost of nutrient adequacy? Nutrient requirements, nutrient composition and food prices Individual consultants: Fulgence Mishili (Sokoine U.-Tanzania) Kate Schneider (PhD student) Yan Bai (PhD student) Stevier Kaiyatsa (Gvt of Malawi)

10. For nutrient adequacy, diets must meet requirements U.S. and Canada dietary reference intakes specify minimum and maximum levels for up to 20 nutrients, totaling 34 constraints, for each demographic group Source: Dietary Reference Intakes (DRI) values for the US & Canada, last revised 2011. Available online at https://www.nal.usda.gov/fnic/dietary-reference-intakes

11. For nutrient adequacy, we consider all individuals’ needs Nutrient needs vary by age, sex & status We use average requirements, to meet needs of a median healthy person -- We also compare to recommended daily allowances (RDAs), to meet needs of almost all people (97.5%) Our base case is an adult woman -- We also compare across individuals, to meet needs of whole households Calculated from Institute of Medicine (2011), Dietary Reference Intakes. https://www.ncbi.nlm.nih.gov/books/NBK56068

12. Can we compute price indexes facing households? Using household data to infer individual adequacy and cost Individual consultants: Anna Herforth (Co-Investigator) Fulgence Mishili (Sokoine U.-Tanzania) Kate Schneider (PhD student) Will Masters (PI) Yan Bai (PhD student) Stevier Kaiyatsa (Gvt of Malawi) At Tufts: Daniel Sarpong (U. of Ghana) Kalyani Raghunathan (IFPRI-India) Fantu Bachewe (IFPRI-Ethiopia) Derek Headey (Co-PI) At IFPRI:

13. Cost per day depends on age, sex & maternity status • Women and children need fewer calories than men, but typically need more micronutrients per calorie. • Adolescent girls need more calcium and phosphorus; • Breastfeeding calls for more folate, protein, vit A, especially for older women (>31); • Older men need more vitamins B6, B12, C and E; • Children 1-3 years need the most lipids. • Different needs translate to different costs to meet all daily nutrient needs.

14. Do households have enough food to meet nutrient needs? • We use household survey data to compare consumption to needs. • To aggregate needs to the household level, we use two sharing scenarios and individual nutrient density needs. • Sharing food: everyone eats the same diet. • Nutrient density per nutrient, defined by the member with the highest nutrient-per-calorie need; • Eaten per person in proportion to energy needs. • Targeted diets: each person eats a separate diet tailored to individual needs. • Households are a sum of individual needs. Households are consuming a diet that, at best, meets 70-80% of total nutrient needs.

15. How do prices vary across types of rural markets? Testing for differences between more vs. less remote markets Individual consultants: Anna Herforth (Co-Investigator) Fulgence Mishili (Sokoine U.-Tanzania) Kate Schneider (PhD student) Will Masters (PI) Yan Bai (PhD student) Stevier Kaiyatsa (Gvt of Malawi) At Tufts: Daniel Sarpong (U. of Ghana) Kalyani Raghunathan (IFPRI-India) Fantu Bachewe (IFPRI-Ethiopia) Derek Headey (Co-PI) At IFPRI:

16. Do prices vary by type of market, as well as location? Are prices lower in district capitals, or in more remote markets? Market in a district capital Market in a more remote town Thyolo (Thyolo district capital) Mitundu market (44 km from district capital )

17. In Malawi, diet costs are lower in more remote markets Contrary to our expectations, costs per day are lower in more remote towns than in district capitals Cost per day,2007-17 (US$ at PPP prices) Prices in more remote markets are lower for vegetables, fruits and starchy staples Source: CANDASA results, from Kaiyatsa et al. (2019)

18. How do prices vary over time, in different regions? In Tanzania, a major factor in diet cost is seasonality Individual consultants: Anna Herforth (Co-Investigator) Fulgence Mishili (Sokoine U.-Tanzania) Kate Schneider (PhD student) Will Masters (PI) Yan Bai (PhD student) Stevier Kaiyatsa (Gvt of Malawi) At Tufts: Daniel Sarpong (U. of Ghana) Kalyani Raghunathan (IFPRI-India) Fantu Bachewe (IFPRI-Ethiopia) Derek Headey (Co-PI) At IFPRI:

19. Seasonal price rises are largest for fruits & vegetables, and in southern regions Width shows estimated period of higher prices Dark dots show statistically significant peaks Colors show magnitude of seasonal rise We have price data for 64 items from 21 regions, 2011-15 Seasonality in diet costs varies among foods in the timing, duration and magnitude of seasonal peaks Starchy staples Seasonal rises in the cost of nutrient adequacy are greatest in the southern regions Pulses Animal foods Animal foods (and processed foods) have the least seasonality Fruits and Vegetables Fruits and vegetables have the most seasonality, and also variation in peak timing Oils and Fat Source: CANDASA results, from Bai et al. (2019)

20. Seasonality is greater for nutrients than for energy Seasonal variation is significantly greater for nutrients than for daily energy Seasonality is driven by fruits and vegetables, even though a large fraction of diet costs would be animal foods, beans and grains Cost of Nutrient Adequacy Cost of Caloric Adequacy Source: CANDASA results, from Bai et al. (2019)

21. How do prices relate to earnings, for affordability? In Ethiopia, the big change is higher wages Individual consultants: Anna Herforth (Co-Investigator) Fulgence Mishili (Sokoine U.-Tanzania) Kate Schneider (PhD student) Will Masters (PI) Yan Bai (PhD student) Stevier Kaiyatsa (Gvt of Malawi) At Tufts: Daniel Sarpong (U. of Ghana) Kalyani Raghunathan (IFPRI-India) Fantu Bachewe (IFPRI-Ethiopia) Derek Headey (Co-PI) At IFPRI:

22. Food system transformation & nutritious diets in Ethiopia: 2001-2017 Trends in the costs of nutrient adequacy, caloric adequacy and real wages in Ethiopia, 2001-2017 (2011 PPP $/day) • Ethiopia invested heavily in cereals and jobs growth • Cost of starchy staples and daily energy has fallen since 2008 • Cost of nutrient-rich foods (vegetables, meat, eggs) has been stable or rising • Real wages have grown sharply • Not all Ethiopians earn wages • But unskilled wages are a proxy for incomes of the poor: • Correlated with HH spending • A “reservation” or fallback wage Daily wages ($/day) Real wages for unskilled workers (right scale) Diet costs ($/day) Cost of nutrient adequacy Cost of caloric adequacy Source: CANDASA results, from Bachewe et al. (2019)

23. Improved affordability shifts attention to food choice Cost per day of nutrients and calories as a share of unskilled wages in Ethiopia, 2001-2017 • What’s the net result? • Since 2011, the cost of nutritious diets has fallen from >30% to <20% of wages • But the cost of calories has fallen more, from over 10% to only 5% of wages • Attention is shifting from calories to nutrients, and the relative cost of healthier diets • Counterfactual: • If nutrient costs had stayed constant as wages rose, nutritious diets would now cost just 11% of wages Source: CANDASA results, from Bachewe et al. (2019)

24. How do prices differ by food group, for the cost of a recommended diet? In India, the big concern is diet quality Individual consultants: Anna Herforth (Co-Investigator) Fulgence Mishili (Sokoine U.-Tanzania) Kate Schneider (PhD student) Will Masters (PI) Yan Bai (PhD student) Stevier Kaiyatsa (Gvt of Malawi) At Tufts: Daniel Sarpong (U. of Ghana) Kalyani Raghunathan (IFPRI-India) Fantu Bachewe (IFPRI-Ethiopia) Derek Headey (Co-PI) At IFPRI:

25. What does India’s officially recommended diet cost? National recommendations specify food groups and servings that allow for a lacto-vegetarian diet • Least-cost diet was $0.50 per day (2011 $) • Largest cost was dairy, then staples + Source: CANDASA results, from Raghunathan et al. (2019)

26. How costly is the recommended diet relative to wages? Trends in the cost of the recommend diet as a percent of wages for rural unskilled labor • Diet costs are a larger fraction of wages for women • 70-80% of women’s wage • 50-60% of men’s wage • Highly unaffordable: • Costs for non-food expenses and other family members? • Volatile! • But some improvement: • wages ↑ & diet cost ↓ since 2007, but more so for men Women Men No data Source: CANDASA results, from Raghunathan et al. (2019)

27. Data by region and food group reveal specific challenges LOTS of variation in seasonality by food group, especially fruits and vegetables LOTS of variation in trends for the cost of a recommended diet relative to wages Source: CANDASA results, from Raghunathan et al. (2019)

28. How can price indexes be used to inform policy? Ghana now has the most interest among government officials Individual consultants: Anna Herforth (Co-Investigator) Fulgence Mishili (Sokoine U.-Tanzania) Kate Schneider (PhD student) Will Masters (PI) Yan Bai (PhD student) Stevier Kaiyatsa (Gvt of Malawi) At Tufts: Daniel Sarpong (U. of Ghana) Kalyani Raghunathan (IFPRI-India) Fantu Bachewe (IFPRI-Ethiopia) Derek Headey (Co-PI) At IFPRI:

29. Policy dialogue for use of new price indexes in Ghana • Since 2016 IANDA/CANDASA has worked with Ghanaian authorities (GSS, MoFA) to help officials use the new price indexes within their routine food price monitoring • There is government interest, but support is needed • To help introduce new metrics, an informal “Nutritious Food Prices Analysis Support Group” to be hosted at the University of Ghana’s Institute for Statistical, Social & Economic Research (ISSER) • This is to allow government statistical officers to meet regularly with local economists and other stakeholders, before and after release of new data, to discuss the significance and interpretation of each indicator • Meetings will begin mid-2019

30. Conclusions and implications of CANDASA research Individual consultants: At Tufts: Derek Headey (Co-PI) At IFPRI:

31. The cost of nutritious diets: what have we learnt so far? • What do price indexes for nutritious diets reveal? • Total cost per day depends on the combination of all needed foods and nutrients • Total cost exceeds earnings for the poorest, who need aid to afford a healthy diet • Relative cost among affordable foods varies widely, influencing food choice • Food system changes could make healthier diets more affordable for all • Reduce seasonality in cost of perishable foods • Reduce spatial variation by region and type of market • Price monitoring could help guide policies and programs • Data collection: product range, frequency, representativeness, quality • Results dissemination: raise the profile of nutritional affordability metrics • Policy & program decision-making: use of data to guide intervention

32. The cost of nutritious diets: what can we do in the future? • There is so much more for CANDASA & others to do… • Use additional dietary guidelines, for more countries & population groups • Refine cost of nutrient adequacy, with more on food composition & needs • Improve price information, for more diverse foods, locations and time periods • Expand analysis to cost of unhealthy foods and dietary patterns • Expand use of wage & income data (as in India & Ethiopia) • Compare least-cost to actual diets, to understand divergence • Analyze impact of local production, storage & trade on diet costs • Analyze impact of diet costs on nutrition and health outcomes

33. The cost of nutritious diets: what can we do in the future? • Encourage uptake of nutritious-food price indices • Every national statistical agency collects food price data • Many agricultural and food agencies collect food price data • Yet almost none of them monitor the cost of nutrition! • How do we catalyze that change? • Capacity strengthening projects • Institutional collaboration: nutrition/health ministries and stats agencies/agricultural ministries (e.g. get prices in SUN movement, multisectoral nutrition strategies) • Make price data publicly available!