• Int’l report notes agri. policies & consumer subsidies favouring cheaper staple crops over expensive but nutrient dense fruits/veggies/meats 
• Points towards need to repurpose agri. policies via addl. investment in transport/infrastructure/logistics 

In many South Asian countries including in Sri Lanka, nutrient dense foods, especially fruits, vegetables, and animal meat-based foods, being relatively expensive compared with calorie dense foods is partly because of agricultural policies and consumer subsidies having long favoured the production of staple crops. 

To deal with the situation, countries should take a number of measures, including increasing the availability and reducing the prices of nutritious foods by repurposing agricultural policies towards nutritious foods and by increasing investment in transport, infrastructure, and logistics.

These challenges were discussed in a recently released report titled ‘Global Food Policy Report 2024: Food Systems for Healthy Diets and Nutrition’ which was issued by the International Food Policy Research Institute (IFPRI). The report looked into how policies, regulations, cultural practices, economic models, and agriculture and food related decisions have positively and negatively affected food habits and resultant concerns such as those relating to health.

Food habits & health concerns

The report analysed the prevalence of malnutrition and non-communicable diseases (NCD) in the six most populous countries of South Asia, i.e. Afghanistan, Bangladesh, India, Nepal, Pakistan, and Sri Lanka. 

The prevalence of undernourishment in Sri Lanka in 2021 (as a percentage of the population) was recorded as 5.3%, and it was the lowest among the six countries. The prevalence of stunting in children under five years was 14.6% in Sri Lanka in 2012, the lowest among the six countries, and a comparison of the countries’ situations recorded in 2011, 2012, and 2013 showed that the other five countries’ prevalence was over 38.7%.

The prevalence of raised blood pressure in adults was the lowest in Sri Lanka, with recorded percentages of 21.9% and 22.3% in 2011 and 2015, respectively. Meanwhile, the prevalence of diabetes in adults in Sri Lanka was also recorded as the lowest in the region, and it was 6.9% in 2011 and 7.4% in 2014.

In addition, the data showed that Sri Lanka was at the second highest place among the six countries when it came to the prevalence of adults being overweight, as recorded in both 2006 and 2016. 

When it came to the share of the population consuming all five recommended food groups, salty or fried snacks, and no vegetables or fruits (in the 2021-2022 period), Sri Lanka had recorded the highest consumption of all five recommended food groups in the region with a percentage of close to 60% of the population. Regarding the consumption of salty or fried snacks, the country’s status was average among the above-mentioned countries. Under the ‘no vegetables or fruits’ category, Sri Lanka had recorded a share of around 5%, when the remaining countries had recorded over 10%.

Drivers of poor diet quality

“The factors underlying poor diets are well known. They include, affordability constraints, behavioural and cultural preferences, agriculture and food policies, and food environments that favour rice, wheat, sugar, and calorie dense foods,” the report pointed out.

With regard to poor affordability, the report explained: “South Asia is among the world’s poorest regions. More than 10% of the population (nearly 200 million people) live in extreme poverty (at or below United States Dollars [US $] 2.15/capita/day), and 44% (814 million) live below the poverty line in lower-middle-income countries (US$ 3.65/day). Nearly half of the more than two billion people worldwide who cannot afford a healthy diet reside in South Asia, with the cost of the EAT-Lancet reference diet exceeding the daily incomes of more than 600 million people in the region (38.4% of the total population), and being too expensive for 75% of the population. Even the least-cost nutrient adequate diets are unaffordable for a third of all households in South Asia.”

Relative prices were another concern, regarding which it was noted that micronutrient rich foods are expensive in South Asia, while cereals, fats and oils, sugar, and sugary and salty snacks are relatively cheap. In the region, dark green leafy vegetables and vitamin A rich fruits and vegetables cost eight to 22 times more per calorie than starchy staples and twice as much per calorie as sugary and salty snacks, while calories from fats and oils and sugar cost even less than those from staples in India and other South Asian countries. 

As in many other parts of the developing world, agriculture and food policies across South Asia continue to focus on keeping starchy staples affordable, rather than on the diverse diets needed for lifelong health,” the report said about cereal centric agriculture and food policies in the region. Adding that the need for balanced diets rich in micronutrients is widely recognised but largely ignored in the allocation of resources, the report pointed out several examples. While rice, wheat, and sugarcane growers are entitled to price guarantees in India, similarly, rice farmers in Sri Lanka have preferential access to subsidised fertilisers. This bias, the report explained, also extends to public investments in agricultural research and development, which have prioritised enhancing the productivity of rice and wheat, while neglecting coarse grains and pulses. 

Regarding the role of social safety net programmes, it was noted that although South Asian countries implement some of the world’s largest food-based social safety net programmes to support poor households, pregnant women, new mothers, and young children, many of these programmes subsidise rice and/or wheat for target households. While these public distribution systems (PDSs) may reduce hunger, the report stressed, they have not improved access to balanced diets for the targeted households.

“One study found that access to the PDS has no effect on the consumption of micronutrient rich food; rather, the PDS skews household consumption toward cereals, thus reducing the consumption of items like fruits and milk. In addition, households with access to the PDS have reported replacing nutritionally rich coarse cereals with subsidised rice and wheat. However, other studies suggest that subsidised rice and wheat act as income transfers, and have a positive impact on the consumption of all food groups,” the report said, adding that switching from in kind transfers to direct cash transfers for food subsidies could reduce the cost of this support for Governments and eliminate the distortions affecting household choices.

Also pointing out behavioural and cultural preferences, the report said: “In addition to prices, incomes, and Government policies, non-economic cultural factors, including vegetarianism and the unusually late introduction of solid foods to infants, also have a strong influence on diets in South Asia. Moreover, even the wealthiest households (in the top decile of the monthly per capita consumption expenditure) consume less than the recommended quantity of vegetables and spend a large share of their food budgets on processed and ultra processed foods.”

The report explained: “In Sri Lanka for example, national food based dietary guidelines (FBDGs) have led to the development of a ‘model food plate’. This educational tool, representative of a balanced diet, was tailored to align with the cultural palate, locally sourced foods, and nutritional requirements of the Sri Lankan populace. The tool has been integrated into the school curricula and used by public health midwives for community based education.”

The way forward

The report pointed out a number of measures that should be taken to address the above-mentioned concerns.

With regard to diet related affordability, it was suggested to improve the national and sub-national monitoring of healthy diet affordability, including food prices, expenditures, and wages, in order to strengthen knowledge and provide a strong platform for nutrition interventions; accelerate pro-poor economic growth in low- and middle-income countries (LMICs) through reforms to catalyse more equitable and inclusive growth; and to increase the availability and reduce prices of nutritious foods by repurposing agricultural policies toward nutritious foods and increasing investments in transport, infrastructure, and logistics. In addition, scaling up nutrition sensitive social protection in LMICs, including the appropriate targeting of vulnerable groups, delivering transfers that come closer to bridging the healthy diet affordability gap, and linking social protection with nutrition education interventions that increase the demand for healthy foods and decrease the demand for unhealthy foods, were also recommended.

Concerning food environments, the report paid attention to several policy related matters. As per the report, although restrictions on the marketing of unhealthy products, especially to children and adolescents, hold promise for reducing the consumption of ultra processed foods, they require further evaluation. To address new threats created by the digital food environment, valid metrics for monitoring and research are urgently needed to assess the impact on dietary habits and to inform the effective, enforceable regulation of marketing. 

“Policies and actions designed to promote access to healthy foods, including fresh produce and animal meat based foods, require further research in LMICs. Studies examining subsidies for healthy foods and retail level interventions such as product placement have been limited to high-income countries, and those for retail level interventions are still inconclusive.”

Regarding plant source food, the report recommended to promote policies and accessible technologies that produce and supply more nutritious crops and foods, along with behavioural strategies that shift demand and consumer actions toward a sustainable, healthy diet. Prioritising investments in crop diversity that can lead to increased accessibility, affordability, and the appeal of safe and healthy diets was another recommendation.

As far as animal meat-based food is concerned, the report suggested to promote a shift toward more plant based diets in high-income countries and other populations with an excess intake of animal meat based food, through, for example, public awareness campaigns and adjusting prices to include environmental costs. 

“Support increased animal meat based food consumption among populations with deficient diets in LMICs, for instance by making animal meat based food more affordable through increased farm productivity, improved market efficiency, and by raising the household income,” the report said, also urging more investments in sustainable animal meat based food production systems.

Regarding improved governance, the report recommended to complement the economic analyses of policies for diets and nutrition with governance related assessments, to identify and address Governmental constraints or demoralisation in bureaucracy that limit capacity and influence, build Governmental accountability to citizens, and to provide an enabling governance based environment that fosters the growth of successful grassroots movements that can support better diets and nutrition.