On why the EAT-Lancet’s ‘Great Food Transformation’ will require a ‘Great Economic Transformation’—and more

Illustration by Hiroko Yoshimoto.

A new paper by scientists at the International Food Policy Research Institute (IFPRI) and Tufts University analyses the costs of adopting the ‘universal reference diet’ recommended for both human and planetary health by the EAT-Lancet Commission (Willett et al., Food in the Anthropocene: The EAT–Lancet Commission on healthy diets from sustainable food systems, 16 Jan 2019). Such a diet, report the paper’s authors, is beyond the means—indeed, it exceeds the total household per capita incomes—of more than one and a half billion people today.

Commenting on the paper, veterinary epidemiologist Delia Grace Randolph, of the International Livestock Research Institute (ILRI), says:

‘These findings make a strong case for significantly increasing the availability and accessibility of livestock products, which will require “sustainable intensification”, which means better access to livestock markets and inputs and better livestock feeds, genetics, health services and husbandry.

‘The good news is that unlike eating more vegetables or exercising more, increasing our consumption of meat, milk and eggs is hard-wired in each of us and needs no advertisement or persuasion: If the price of these nutritious foods goes down, their consumption will go up.’

From the ‘Summary’

‘The EAT–Lancet Commission drew on all available nutritional and environmental evidence to construct the first global benchmark diet capable of sustaining health and protecting the planet, but it did not assess dietary affordability.

We used food price and household income data to estimate affordability of EAT–Lancet benchmark diets, as a first step to guiding interventions to improve diets around the world.

‘We obtained retail prices from 2011 for 744 foods in 159 countries, collected under the International Comparison Program. We used these data to identify the most affordable foods to meet EAT–Lancet targets. We compared total diet cost per day to each country’s mean per capita household income, calculated the proportion of people for whom the most affordable EAT–Lancet diet exceeds total income, and also measured affordability relative to a least-cost diet that meets essential nutrient requirements.

‘The most affordable EAT–Lancet diets cost a global median of US$2·84 per day (IQR 2·41–3·16) in 2011, of which the largest share was the cost of fruits and vegetables (31·2%), followed by legumes and nuts (18·7%), meat, eggs, and fish (15·2%), and dairy (13·2%).

This diet costs a small fraction of average incomes in high-income countries but is not affordable for the world’s poor.

We estimated that the cost of an EAT–Lancet diet exceeded household per capita income for at least 1·58 billion people.

‘The EAT–Lancet diet is also more expensive than the minimum cost of nutrient adequacy, on average, by a mean factor of 1·60 (IQR 1·41–1·78).

‘Current diets differ greatly from EAT–Lancet targets.

Improving diets is affordable in many countries but for many people would require some combination of higher income, nutritional assistance, and lower prices.

Data and analysis for the cost of healthier foods are needed to inform both local interventions and systemic changes.

‘Bill & Melinda Gates Foundation.’

From the ‘Introduction’
‘More than 2·5 billion people worldwide suffer from at least one form of malnutrition, with approximately 800 million people undernourished, around 2 billion adults overweight or obese, and over 2 billion people with micronutrient deficiencies. . . . Current food production methods pose risks to the health of the planet as well. The agricultural sector now accounts for 16–27% of global greenhouse-gas emissions and is a major cause of freshwater pollution, soil degradation, and loss of biodiversity.

The global food system falls far short of achieving global goals for both health and the environment.

‘. . . To help guide change, the EAT–Lancet Commission was tasked with using the best available evidence to determine a universal reference diet that is healthy for both humans and the planet, minimising chronic disease risks and maximising human wellbeing. The EAT–Lancet reference diet is rich in fruits and vegetables, with protein and fats sourced mainly from plant-based foods and unsaturated oils from fish, and carbohydrates from whole grains. Combined with improved agricultural production practices and a reduction of food waste and loss, the Commission estimated that this diet would permit feeding the estimated 10 billion people in 2050 within planetary boundaries that restrict global warming, land-systems change, freshwater expansion, biodiversity loss, and nitrogen and phosphorus cycling.

‘A shift to healthier diets requires that the necessary foods be both available and affordable for low-income populations. This factor is recognised by the EAT–Lancet Commission, although the report did not consider cost or affordability of the healthy reference diet. To improve dietary intake, the EAT–Lancet Commission calls for a Great Food Transformation: “a substantial change in the structure and function of the global food system so that it operates with different core processes and feedback”. In this study, we aimed to provide evidence to guide those changes by calculating the most affordable way to meet EAT–Lancet targets using available foods in almost every country of the world, and comparing the resulting dietary cost to prevailing incomes in each country.’

From ‘Research in Context’

‘Added value of this study
‘This is the first study, to our knowledge, to calculate the cost of foods needed for a healthy and sustainable diet across the globe. Using standardised data for prices for 744 food items in 159 countries, the minimum daily cost of an EAT–Lancet reference diet in 2011 (in international dollars) ranged from a median of $2·42 in low-income countries to $2·66 in high-income countries. These reference diets are affordable for most of the world’s people, but not in low-income countries where the cheapest food options for meeting EAT–Lancet targets would cost nearly 90% of the mean per capita household income. For at least 1·58 billion people, mostly in sub-Saharan Africa and South Asia, the cost of this reference diet would exceed their total income. Reaching EAT–Lancet targets would cost an average of 60% more than the least-cost options for achieving adequate intake of essential nutrients.

The EAT–Lancet reference diet is often unaffordable for the poor because it requires larger quantities of higher-cost food groups such as dairy, eggs, meat, fish, fruits, and vegetables than the near-subsistence diets that are consumed by very poor people.

‘Implications of all the available evidence
‘Our findings indicate that a widespread global shift to the EAT–Lancet diets is feasible only through some combination of higher earnings, more favourable market prices, and nutrition assistance for low-income people, in addition to changes in local and global food systems that drive food choice among more affluent populations. Meeting EAT–Lancet targets in low-income areas will require higher farm productivity and lower food prices, plus greater non-farm earnings and social safety nets, allowing people to shift consumption away from starchy staples and increase their intake of more nutritious but currently unaffordable animal-sourced and vegetal foods.’

From the ‘Discussion’

‘. . . We estimated that at least 1·58 billion individuals, mostly located in sub-Saharan Africa and south Asia, face a daily cost of meeting EAT–Lancet targets in their country that exceeds their total per capita household income.

‘Although large, this estimate of 1·58 billion is a lower bound because many more people would be unable to afford EAT–Lancet reference diets after paying for non-food necessities such as housing, transportation, education, and health care. Furthermore, we found that EAT–Lancet reference diets were on average 60% more costly than the foods needed for nutrient adequacy, due, in part, to larger quantities of animal-source foods as well as fruits and vegetables.

The EAT–Lancet Commission recommends a diet containing less meat than diets currently consumed by richer people but includes more of these high-cost foods than the world’s poor now consume or could afford. . . .

‘Looking across food groups, our analysis confirms that fruits and vegetables and animal source foods are the most expensive components of the EAT–Lancet reference diet, and that retail markets in lower-income countries have some less expensive vegetal foods but more expensive animal source foods than are available in higher-income countries. . . .  Increasing access to animal source foods could be helpful for children in low-income countries; our analysis focuses on adult diets, showing that access to inexpensive vegetal foods allows adults to meet essential nutrient requirements with even less animal source foods than the quantities specified in the EAT–Lancet reference diet.’

Even if many poor consumers were to aspire to consume healthier and more environmentally sustainable foods, income and price constraints frequently render this diet unaffordable.

Measures to alleviate price and income constraints will be essential to bringing healthy and sustainable diets within reach of the world’s poor.

Read the full article: Affordability of the EAT–Lancet reference diet: a global analysis, by Kalle Hirvonen, Yan Bai, Derek Headey, William A Masters, in The Lancet Global Health, 7 Nov 2019.