Encouraging Healthy Diets in East Africa: The Role of Food Prices and Consumer Preference
Access to and consumption of healthy diets, including fruits and vegetables, forms a key pillar of food security. Consumption of nutritious foods have been shown to reduce the risks of non-communicable diseases like diabetes and heart disease and to cut rates of early morbidity and mortality. Despite these benefits, however, the world’s population continues to overconsume unhealthy foods, such as those high in sugar, fats, and salt, and underconsume healthier foods. For consumers in low- and middle-income countries (LMICs), shifting dietary trends toward healthier foods requires addressing both economic and sociocultural factors. A recent article in Global Food Security examines average diets in four East African countries and analyzes the reasons for and potential solutions to these countries’ healthy food consumption gaps.
The study focuses on Ethiopia, Kenya, Tanzania, and Uganda, whose economies and food systems are growing and modernizing rapidly. Researchers used household expenditure and consumption surveys conducted between 2014 and 2017; these surveys were representative at the national level and included both rural and urban areas. The surveys asked households to recall their food consumption over the past seven days, including quantities of food consumed at home, expenditures on food bought outside the home, and estimated cost of own-produced foods and foods they may have received as gifts.
The results show that average diets in the four study countries differ markedly from recommended healthy diets (as specified in the 2019 EAT-Lancet study). While there were instances of households reporting underconsumption of calories, many adults actually consume more calories than needed. Further evidence of this common overconsumption of calories can be seen in the countries’ rates of overweight and obesity, which are particularly high for adult women (between 8 and 33 percent from 2014-2016).
In addition, the majority of calories consumed on average come from starchy staple foods, specifically refined grains. While diets vary across regions and between urban and rural areas, there is an overall lack of fruits, vegetables, pulses, meat and meat products, dairy, and fish. This lack of dietary diversity often means micronutrient deficiency, which can lead to negative health impacts like anemia.
The study’s authors examined three potential causes of these consumption gaps. The first is low household budgets. The results show that most of the surveyed households cannot afford the recommended healthy diet laid out in the EAT-Lancet report. This is particularly true for rural households, whose median food budgets cover only half of the total cost of the recommended diet.
Second, the authors looked at the cost of the individual food groups that comprise the recommended healthy diet. Starchy staple foods and processed foods with added fats and sugars are by far the least expensive food groups in all four countries, costing a few U.S. cents per 100 kilocalorie per day. Meats, fish, and eggs, on the other hand, cost between %0.50 and $1.09 per 100 kcal per day. Vegetables cost between $0.25 and $0.55 per kcal per day, while fruits and dairy both cost between $0.10 and $0.25 per kcal per day.
For many households facing poverty and food insecurity, diversifying their diets to incorporate more nutritious food groups may simply cost too much to be feasible.
Turning from economic factors, the authors looked third at overall consumer food preferences. The results show even when incomes rise, households still show strong preferences for starchy staple foods and for ultra-processed foods. Richer households also show stronger preference for animal products and fruits, but rising incomes have less effect on preferences for vegetables, pulses, nuts, and seeds. This latter result shows that underconsumption of some healthy foods is not due solely to economic constraints.
The combination of economic and behavioral drivers of the nutrition consumption gap in East Africa suggests the need for a multi-faceted approach, the authors conclude. On the supply side, investments in nutrition-sensitive agricultural production, modernized value chains, and infrastructure like cold storage can increase the accessibility and affordability of nutritious foods. On the demand side, designing effective interventions is more complex. While programs like school feeding, food/cash transfers, and taxation of unhealthy foods may be useful in encouraging consumption of more nutritious foods, consumer preferences are slow to shift. In addition, interventions aimed at behavioral change need to take into account local and regional contexts. More research is needed into the effectiveness of such interventions in LMICs specifically.